Hair transplantation (synonym: hair transplantation) is a therapeutic procedure for the treatment of alopecia (hair loss). Hormonal changes or metabolic disorders can cause hair loss, which is partly genetically determined and often represents a great burden for the affected person. However, with the help of the surgical replacement of hair by the own hair transplantation only a reestablishment of hair follicles can be realized. Thus, the transplantation does not cause neogenesis (new formation) of hair follicles. The use of hair transplantation to prevent the development of baldness or in the case of existing baldness allows each hair to be placed in a new position and direction, so that the results of the therapeutic procedure can be judged as very natural looking.
Indications (areas of application)
- Alopecia androgenetica (synonym: androgenetic alopecia; the cause of hair loss, often described as genetic, is androgens – dihydrotestosterone, (DHT)) – hair transplantation represents the gold standard in the treatment of male pattern baldness. Women also often have hormonal hair loss, which can be treated with the help of hair transplantation. As a rule, hormonal hair loss in women is characterized by hair loss in the crown area or by the formation of so-called “receding hairline”. In contrast, the development of baldness in men often begins with the formation of the “receding hairline”, which can extend over the high forehead area to full baldness. However, a complete recovery in a full baldness is not possible in normal cases.
- Scarred alopecia – hair loss caused by scarring can also be treated to a certain extent with a free hair transplant.
Contraindications
- Full baldness – in the presence of full baldness, hair transplantation is an unsuitable procedure because there is no suitable donor area for transplantation.
Before surgery
- Clarification – Before surgery, an intensive medical history discussion should be conducted that includes the patient’s medical history and motivation for the procedure. The procedure, any side effects, and the consequences of the surgery should be discussed in detail. Note: The requirements of the explanation are stricter than usual, because courts in the field of cosmetic surgery require a “relentless” explanation.
- Diagnostics – Of critical importance is the assessment of whether hair transplantation is indicated as a therapeutic procedure in the present form of alopecia. Hair transplantation is not useful in all forms of hair loss.
- Discontinuation of anticoagulants (anticoagulants) – in consultation with the attending physician, medications such as Marcumar or acetylsalicylic acid (ASA) must usually be temporarily discontinued to minimize the risk of bleeding during surgery. The re-taking of the drugs may only take place under medical instruction.
- Reduce nicotine use – Smoking is associated with worsened wound healing, so smoking should be discontinued or reduced before surgery.
- The donor site is shaved and the scalp is locally anesthetized.
The surgical procedures
Before transplanting hair, it is first necessary to find a suitable site for hair harvesting. The occipital hair area (“occipital area”) often serves as the optimal donor area, as the quality of the donor hair there almost matches the hair quality in the recipient area.
- Punch graft transplantation – this procedure, also known as the punch method, is based on transplanting grafts with a diameter of four millimeters. There are more than 12 to 20 hairs in one punch graft. However, the use of punch grafts is considered problematic as a result of the diameter and the number of hairs. After the transplantation of punch grafts, a punch-like appearance with disturbing scars, protruding or sunken grafts can occur. Furthermore, an abrupt onset of the hairline in the frontal line can often be seen, which disturbs the aesthetics of the graft.
- Transplantation of mini grafts – in the mini grafts are five to nine hairs per graft with a diameter of about two millimeters.
- Transplantation of micro grafts – micro grafts have a diameter of about one millimeter and are equipped with a maximum of three hairs per graft. This procedure is currently used as a standard procedure in hair transplantation. The micro grafts can also be created as hair follicle grafts. The use of these hair follicle grafts improves the appearance of the graft and also represents the natural growth units of the hair follicles. However, the use of micrografts is highly costly, as up to 3,000 individual grafts must be used in one operation.
- Transplantation of single hairs (FUE technique, Follicular Unit Extraction; single hair method) – This involves the individual removal of the units for hair transplantation from the hair ring (= donor area). Duration of treatment: several hoursAdvantage of the method is that no visible scar strips remain on the back of the head.
- Transplantation by the strip method (FUT technique, follicular unit transplantation) – for this purpose, one to one and a half centimeter wide strips of skin are removed and the wound is sutured. In the laboratory, the skin strips are prepared under the microscope, i.e. they are divided into small hair root clusters with one to four hairs each. In this way, approximately 55 to 90 units can be obtained from 1 cm² of skin. For a satisfactory result, the hair requirement is about ten units per square centimeter. Duration of treatment: 6-8 hoursDisadvantage of the method is a remaining line-shaped scar, which can be combed over.
After surgery
- Wound care – the use of a wound dressing is not mandatory, because the grafts stick to the correct location due to fibrinogen (important factor for blood clotting), nevertheless, a dressing is usually applied for one day.
- Aftercare
- Approximately 6- 8 months it takes for the new hair to become visible from the inserted hair roots.
Possible complications
- Infections – in very rare cases, inflammatory processes may develop after surgery. Intraoperative or preoperative antibiotic therapy is not indicated due to the low risk.
- Bleeding – due to a mechanical load, slight bleeding may occur postoperatively, because the surgical area is well supplied with blood.
Varia
- Note: quality criteria in hair transplantation.
