What Is The Best Hair Transplant Procedure?

What Is The Best Hair Transplant Procedure?
April 17, 2015 9:41 AM

We don’t appreciate certain things till we don’t have them; this includes hair too. We don’t take much care of them while we have them. When they are no more, we feel bad. What you can do in such a situation is that you can go with hair transplants. In this article we feature an overview of currently available hair transplant procedures to help you chose the best one for you. You will also learn about how hair transplantation is performed and how to get ready for it.

Hair transplantation procedure

In 1950, the hair transplantation procedure was first introduced. The whole hair transplantation procedure is rather simple. In this procedure, from the back of the head, a small hair bearing scalp is taken off. With little or no hair, it is replaced. The whole hair transplantation procedure takes no more than a day. You don’t have to get admitted in a hospital. Hair transplantation will be done on the spot, so that you can go home.

Preparation for the procedure

Before the whole procedure, the doctor might take some photos for determining the extent of hair loss. Some thin areas will also be treated. After that, the doctor will explain the whole procedure to you and tell you what to expect after the treatment. The doctor will use the surgical pen to show the hairline shape and location. After this is completed, the removal of the donor hair from the donor area is the next step. During the removal of hair from the donor area, the hair surrounding the donor area will be covered with rubber bands. After this, from the donor area, the hair are cut.

Now the next step is to numb the area of the donor hair. For this purpose, an assistant will administer the local anesthesia so that the donor area is completely numbed. Before removing the hair, the doctor will make sure that you are completely comfortable and ready to get the donor hair removed. After sometime, the anesthetic administered by the assistant will start having its effect. When this happens, the tissues from the donor area are removed.

The doctor will remove all the hair from donor area. The hair from the donor area are actually consistent hair follicles. The hair transplantation is done through the donor hair. After removal of the hair from donor area, it is properly stitched. The donor area is covered by rubber bands.

Techniques for removing donor hair

The above mentioned method of the extraction of donor hair is just for your understanding. Specifically, there are two popular methods these days for removing the donor hair. Follicular unit extraction and strip harvesting are these two methods. Below will be given a description of these methods.

1. Strip harvesting

This is the most commonly used method these days (1). In this method, the doctor will take the hair from the place where the hair growth is good. Now the doctor removes the hair from the donor area with the help of a scalpel. During this process, the doctor make sure that the hair are completely removed from the donor site. The assistants close the wounds when the hair from donor area are removed. With the help of binocular stereo microscope, the excess tissues are removed. The assistant has to make sure that the follicular cells aren’t damaged in this procedure.

2. Follicular unit extraction

Follicular unit extraction is the second harvesting technique. In this technique, by giving local anesthesia, individual hair follicular units are removed. This is done by using micro blades and fine needles. This method is usually time consuming. Therefore, it can take one or multiple visits to the doctor. The main factor on which the time depends is the experience of the dentist and the amount of needed hair transplantation. The process can take only two hours or two days. The results are more natural in this method (2). However, it is higher in cost.

Preparing follicular units

At this point, the hair from the donor area is obtained and the donor area stitched and covered. Follicular units are made after placing the hair. During this time, you are free. You can read, sleep for some time or watch television. It isn’t a compulsion that you need to lie down all this time. You are free to walk about and talk with the clinicians. The doctors mold the donor hair and make follicular units. There can be as many as four hair follicles in each unit.

Placing the hair follicles

After you have got sufficient time to relax and the follicles have been prepared, anther anesthesia will be given to you. This time the anesthesia is given to the recipient area. Now the doctor will make small holes on the recipient area to fill them with follicular units. During this process, the concentration of the doctor is required and he has to make sure that every detail is looked upon. This makes the results close to natural. The depth of each unit should be taken care of by the doctor.

After the procedure

Once the hair follicles have been put in their place, the doctor will ensure their proper fitting. Now the assistant will give you certain instructions. The assistant will tell you how to take care of the transplant site. You will also be provided with medications. The assistant will instruct you how and when to take it. The assistant will also tell you how to deal with any kind of discomfort.

After getting hair transplant surgery, you need to keep in mind certain things. After the operation, wash your hair properly. After this, you need to have the hair examined by a health care professional. You should take good care of the hair if you don’t want to see a doctor. You might experience some itchiness or soreness in your hair. Don’t worry too much about it. Just take a leave from the office and rest for at least one day. Also, in a few days’ time, you will observe that the recipient area is cut and red. Sometimes, your head might also swell. But don’t worry about it as it will go away in a day or two. After a week has passed since you had surgery, the soreness and swelling will end.

Methods of hair transplantation

Now let us look at some common methods of hair transplantation. Some of the common hair transplantation methods have been mentioned below:

1. Punch grafting technique

As the name suggests, in this technique, a 4 mm punch is used. In this technique, with the help of the punch, the hair follicles from the donor area are removed. There will be about 12 to 30 hairs in the punch grafting area, when the hair from the donor area have been removed. These hair are placed in a smaller punched cylinder and placed on the recipient area. The doctor gets rid of the bald skin of the recipient area. One thing which is quite interesting in this technique is that the holes in the donor area aren’t stitched, but they are left as they are, to heal for themselves. This hair transplantation method is rare these days. It was in common use about 25 years from now.

Through this method, the main task, which is to fill the bald areas of the head with hair is completed. However, this method gives a kind of “pluggy” look. However, after two or three visits to the doctor, this look will go away. But the hair line will still look unexpected. The hair line doesn’t get any better even after repeated visits to the doctor. The hair line is more prominent when hairs are thick. Also, in the donor hair, cuts are formed. Although punch grafting gained quite popularity, it was discarded by most doctor because better methods of hair transplant were developed.

Video 1: Punch grafting technique for hair transplant

Now let us look at some problems of this technique. One of the most prominent side effect of this method was that natural look wasn’t obtained through this method. Also, the replaced hair were the size of pencil eraser and no more than 35. Another defect of this technique was that many hair were lost due to punching. This was due to the fact that the exact angle was unknown to the doctors, because the doctor were unaware of the pattern of the skin below the surface, when they made cuts. Sometime after the introduction of this technique, to solve the problem of pluggy look, the doctors started to use smaller punches instead of large punches. Instead of making this right, it worsened the conditions.

Another major defect of the punch grafting technique is that not enough hair grow in the plugs. The reason is that when the hair are removed from donor area, the roots are cut off. When the hair are few in number, they look less pluggy. Also another side effect is that due to lack of oxygen, the hair follicles in the center of large plug don’t grow much. Due to this, the hair scatter away from each other and the baldness is still prominent.

Another side effect of this technique is that due to this technique, the donor hair aren’t recovered and they are lost. In some cases, the whole process isn’t completed because no more hair can be put in the recipient area. This is because the donor area is ended. 

Another problem with this technique is that big cuts on the head are formed due to punching. Due to this reason, this procedure is performed in multiple visits. In a sitting, usually 20 to 40 grafts are completed. Because multiple visits are required in this procedure, there is a concentration problem, due to which mistakes can occur.

In recent times, there have been many attempts to remove the defects of this technique. Most of these attempts have been without effect. This technique is rarely used these days because newer and better techniques are available.

2. Minigrafting/micrografting technique

After removing one or more than one parts of skin from donor area, the mini grafts are made. When the hair are removed from the donor area, the donor area is either stitched or closed by some other method, so that the wound heals quickly. Now the hair is cut into micro or mini grafts, so that it keeps its appropriate place in the recipient area. About 3 to 8 hairs are present in mini grafts. In micro grafts, only two to four hairs are present. Either they are made when the mini grafts are cut to their size or made on purpose. You might be surprised that in the preparation of these grafts, microscopes aren’t used. These grafts are made with naked eye or magnifying glass. 

The preparation procedure of micrografts can take anywhere from 2 to 8 hours. The main factor on which the time depends is the number of grafts. However, sometimes the hair graft can take multiple visits to the doctor. To make sure that these grafts look natural, the doctor will mix the large grafts with smaller grafts.

Video 2: Micrografting technique for hair transplant

Now let us look at some of the advantages of this method of hair transplantation. The main advantage which this method has over punch grafting method is that the hair don’t look ‘pluggy’. Also the donor area doesn’t receive much damage as it did in the punch grafting method. Due to these benefits, mini grafts and micrografts are in common use these days. Less time is required in this method as compared to the follicular unit hair transplantation. According to most people, follicular unit transplantation method looks more natural than micrografts technique. However, the results shown by this method are also good.

3. Multi strip method

Many scalpel blades are used for the multi strip method. These scalpel blades are passed through the donor area. This method is different from the punch grafting method in that it can open the cuts and bruises which are made by punch grafting method. Initially, the multi strip method was introduced to facilitate the punch grafting technique. It reduced the cuts produced by the punch grafting technique.

The problems produced by multi strip method are similar to those of the punch grafting technique. The main thing is that the doctor can’t see the angle with which to cut the hair. And they also have to avoid the cutting of follicles. But this is dangerous because lack of visibility might make the doctor to cut the follicles. Another problem with this method is that angle of the blades are fixed and can’t be changed. Due to this, no adjustment can be made to change the direction of hair present on the head.

Another problem with this method is that the direction of hair is changed due to the blades. As the blades are fixed together, only when blade can follow a hair, but the other blades create cuts on the head. The follicles are damaged badly because ten or more blades are present in a multiple blade knife. This causes severe damage to the follicles. Also, when the hair are being cut from the blades, some blades might be blunt whereas others might cut too deep. Due to this, a wound is created and the follicles are damaged more.

Due to all the above mentioned problems of this method, it has been abandoned by most of the doctors. They think that it does more harm than good.

4. Follicular unit extraction

Now we come to the most widely used method of hair transplantation, the follicular Unit Extraction method. In this method, hairs are obtained for the Follicular Unit Transplantation. In this method, from the donor area, follicular units are obtained. What is interesting is that no cut is made in the donor area. With the help of a small punch of 0.8mm to 1mm, small holes are made on follicular unit, and then they are obtained from the head.

An important thing to mention here is that contrary to the popular belief, Follicular Unit Extraction and Follicular Unit Transplantation are more or less, the same thing. For your understanding, you can consider FUE (follicular unit extraction) as a kind of FUT (Follicular Unit Transplantation). In FUE, the follicular units aren’t obtained from a strip. Instead, they are obtained from the head directly. The two ways in which the hairs from the donor area are extracted from the FUT are single strip harvesting and FUE. It is, therefore, useless to make a comparison between FUT and FUE. The only difference between FUT and FUE can be the way in which the hairs from the donor area are extracted. Other than this, both of them are the same.

Video 3: Follicular unit extraction for hair transplant

Now let us view the procedure of this method of hair transplantation. Before the procedure, the hairs from the whole donor area are removed. The next step is obtaining grafts from the donor area. These are obtained with the help 0.8mm to 1mm punches. The follicular are then extracted with the help of the sharp side of the punch. Then the follicular unit is loosened with the dull side of punch. Counter traction is then used by the doctor so that the punch goes into the skin easily. Now with the help of tongs, the graft is pulled out by the doctor. Ringer’s lactate solution is then used for preserving the grafts. The maximum number of hairs in the grafts is up to 6. This is a difficult procedure. The grafts are then inserted in the recipient area.

Now let us look at the graft extraction procedure. A two-step procedure is usually used for the extraction of the graft. In the first step, the direction of hair is kept under consideration. On the Follicular unit, a punch is placed. The depth of the punch is also kept into view and the punch isn’t made deep. Then, gentle traction is applied on the Follicular Unit. This is done until the dermal deeper connections are loose. The above mentioned is the most basic method of this technique. A doctor can also use a different technique from this technique.

The plus point of this technique is that it doesn’t create any kind of cut on the head. Due to this reason, it is beneficial for a large group patients, including:

  • People who lose their hair and want short hair. This technique also gives a natural look to the hair, so person who doesn’t know that the hair have been transplanted won’t notice it. The main reason due to which other people notice that the hair have been transplanted, is due to the cut present on the donor area. For patients who keep long hair, the cuts aren’t a problem. But for patients who like short hair, the cuts can create a problem. The small holes which are made in FUE aren’t prominent at all.
  • Young people who suffer from hair loss. In such people, it isn’t known that how much more hair will be lost.
  • People who have gone through strip harvesting before. If these people suffer from further hair loss, strip harvesting can’t be done again. These people can turn to a more reliable method, which is follicular unit extraction.
  • People who have gone through other hair transplant surgeries before. In these people, the cuts are quite prominent. They can go through FUE which will make the cuts less prominent.

Now let us look at the advantages and disadvantages of this method of hair transplantation. The major advantage is that it doesn’t create any cut on the donor area. This is beneficial for people who like short hair. The punches which are made in the donor area in this transplantation, are quite small. Due to this, the small marks heal quickly. A person also feels less pain in the donor area, after the procedure is completed. This type of hair transplantation is beneficial for people who need small quantity of hair replaced.

A major disadvantage of this method is that the hair which are present outside the recipient area are sometimes lost. Another disadvantage of this method is that it is more time consuming and more expensive than other methods of hair transplantation.

The bottom line

When it comes to selection of the best hair transplantation method one should always talk to his or her doctor at first and ask for detailed explanation of advantages and drawbacks of proposed methods. This article should help you understand the differences between various hair transplantation methods and empower you with some additional information you may need in your decision making process. The most widely used hair transplant method these days is the FUE method (3). 

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Written by: Michal Vilímovský (EN)
Education: Medical student, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
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Published: April 17, 2015 9:41 AM
Last updated: April 20, 2015 9:20 AM
Next scheduled update: April 20, 2017 9:20 AM
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