Hair Transplant Surgery - What's new?

The technique of hair transplantation has undergone a tremendous advance in recent years after the introduction of the microscope to this surgery however, to learn more about what is new, it is better to understand a few things first. Unlike what many imagine, hair does not grow from the scalp one by one but rather in groups of 1, 2, 3, and rarely 4 hairs. These groups are called follicular units.

* Image of the scalp seen under a microscope (magnified by 50X)

The technological advance referred to above is the separation of these groups under a high-powered microscope and then transplantation in the bald regions exactly as they had been in the donor area with all the connected parts, glands, erector pili muscle etc. This technique is called “All Microscopic Follicular Unit Transplantation.”

The separation of the follicular units (FUs) consists of three phases:

Phase 1 – The slivering technique: This refers to the division of the scalp tissue removed from the donor area by slicing transversally into fragments that are the width of only one follicular unit. This step is very important, since a perfect sliver not only facilitates the second step but also makes certain that no hairs are destroyed or wasted by transection of the roots.

* Preparing Slivers under the microscope

Phase 2 – Separating the follicular units from the slivers.

* Separation of the follicular units of 1, 2 and 3 hairs under the microscope

Phase 3 – Trimming the Follicular Units: The purpose of this phase is to make them smaller and more refined.

As you can see, the process is delicate and requires the skills of an artisan, however the results are well worth it as they are absolutely natural and impossible to detect under any circumstances because the grafts are transplanted exactly as they grow from the scalp.

Other advantages to the microscopic technique are:

- Much smaller graft sizes, consequently a much greater number of grafts may be transplanted per square centimeter (cm?) providing greater density and volume to the results.

- Shorter recovery period and less visibility allowing for a much briefer post-operative period than conventional techniques, without the need to use bandages, as well as return to normal activity the following day.

- No loss to the Donor Area, in other words total benefit/use of the hair follicles. Whereas in conventional techniques, which separate the grafts under magnifying glasses or the naked eye, besides unaesthetic results, there is a 15-20% loss of the total area removed, which is unacceptable nowadays, as the donor area is a finite resource.

Megasession

A megasession refers to the maximum number of follicular units that may be transplanted in a single session without damage to the patient’s donor area. 2,000-3,000 follicular units may be transplanted in a megasession, which corresponds to 4,500-6,000 hairs. This total number will depend directly on the density and the elasticity of the scalp in the donor area and the percentage of 1, 2 and 3-hair follicular units.

However, in order to perform a megasession, which lasts on average six hours, you must have a large, well-trained staff. In our practice eight professionals make up our surgical team. While the surgeon and his assistant remove the donor area and (later) transplant the grafts, six highly-trained surgical assistants prepare and trim the grafts, as well as handle their proper storage while outside the body. In this dynamic procedure we reduce the surgical time and the patient’s discomfort, as well as increase the integration rate of the hair follicles, nowadays at 100%.

Results

The objective of every doctor who performs hair transplant surgery is to provide increasingly natural and more perfect results. In order to do so there must be some attention to detail, the most important of which is the hairline, the first rows of hair in the front, those most noticed at first glance. How does one offer an absolutely natural hairline, which may not be detected by anyone under any circumstances? Our response is simple: Trying to imitate nature to the maximum degree possible, that is, creating a hairline exactly like a person who is not bald.

To do so, many precautions must be taken, such as:

- Creating an irregular, non-straight hairline with progressive density that does not appear to begin growing abruptly.

- Using only single hair follicular units in the first lines.

- Appropriate design for each case.

However all of this is still not enough since in order to achieve an absolutely natural hairline we must imitate the “baby fine hairs” that naturally precede the first hairs in the front line. To do so, we need very fine hairs.

Using high powered microscopes we are able to isolate the follicular units with very fine single hairs from the other single hair follicular units. We call these Ultrafine Single Hairs. They are transplanted in front of the other hairs in an irregular pattern, providing sophistication and perfection to the results.

* note the difference between a normal single hair and an ultrafine
(both from the same patient)

The Surgery

The surgery is performed in a hospital. The patient is given a local anesthetic and light intravenous sedation and the procedure lasts, on average, six hours. The patient is discharged approximately thirty minutes after the end of surgery. No bandages are necessary and the patient will return to the clinic the following day to have his hair washed for the first time. From this point on the patient is free to carry on his (or her) normal day to day activities. There are only a few important precautions to take in the first few days in order to not damage the grafts.

The Post-Operative Period

Approximately 80% of the transplants fall out after one to two weeks post surgery. The hair follicles fall out but the roots remain in the scalp and new hair will grow. The new hairs will reach the surface of the scalp after three months and from this point they will grow about 1cm per month continuously. As the transplanted hairs do not have the genetic code for baldness, they will never fall out. Therefore the result of your hair transplant is life-long.

End of surgery                         7 days after surgery

But remember, your hair that was not transplanted and that has the genetic code for hair loss will continue to fall out. Therefore the need for a second procedure is directly proportional to the rate at which those hairs fall out.

For further information: info@rustonclinic.com