HAIR TRANSPLANT SURGERY 

Main uses: male pattern balding and female pattern hair loss, traction alopecia and scarring alopecias (when quiet)

Other names: Hair restoration surgery, HT surgery, FUE surgery, FUSS surgery, FUT surgery 

 

Introduction

I’m interested to learn more about hair transplantation. What does a hair transplant involve?

  • A hair transplant is a cosmetic procedure which involves removing hair from the back of the scalp (either by the "strip method" (FUSS) or by the "follicular unit extraction" (FUE) method) and transplanting  groups of 1-4 hairs called ‘follicular units’ into balding, thinning or scarred areas.  
  • It is an outpatient procedure (day procedure) which is done under local anesthesia – patients are not “put to sleep.”

I’ve heard that hair transplantation has changed a lot over the past few years. Is that true?

  • Yes, surgical techniques nowadays known as ‘follicular unit transplantation’.  Most hair transplants nowadays will not look ‘pluggy’ (as transplants did years ago) because only individual follicular units will be used in your transplant.  Each follicular unit is transplanted at a very precise angle and direction to mimic the way hairs normally and naturally grow. Because of this, the transplanted hairs will look natural.

How long will the procedure take?

  • A hair transplant takes 3-16 hours depending on the number of hairs to transplant and the technique used. The strip technique (FUSS) is generally shorter in duration than follicular unit extraction (FUE).

What side effects are possible with a hair transplant?

  • It’s important for patients to be aware of side effects that are possible with any hair transplant surgery. Speak to your hair transplant surgeon about potential side effects. A few general side effects are listed here:
  1.  Swelling and bruising.  Most patients do not experience much swelling and bruising after the procedure, but a small proportion of patients can get more significant amounts of swelling and bruising of the forehead area and around the eyes.   Unfortunately, if swelling and bruising occur, it takes about 3 days to up to1 week to resolve.  Most patients are asked to refrain from strenuous physical activity for 7-10 days and some patients require 2-4 weeks.
  2.  Numbness of areas on the back of the scalp.  Numbness is more common with the strip technique (FUSS) than follicular unit extraction (FUE). As part of the strip (FUSS) transplant procedure several small sensory nerves in the scalp may be cut in order to “harvest” your strip of hair from the back.  These nerves grow back with time.  Most patients have no loss of sensation to the scalp, but it’s important to know that if large nerves are cut, it’s possible to have some numbness or extra sensitivity in a small area. This improves with time in most cases and treatments can be given to help speed this up in the unlikely event this happens.  Very rarely, a small area can permanently remain with altered sensation.
  3. Temporary loss of hair in the first few months after transplantation.  20 % of men and up to 50 % of women can experience some temporary loss of hair on the front scalp in the first 1-3 months after hair transplantation.  It’s very important for patients to be aware of this and be prepared for this possibility.  It’s not possible to predict who will have this temporary hair loss and who will not. Anyone who has a hair transplant needs to be emotionally prepared for this possibility and understand that it is usually temporary.
  4. Scar on the back of the scalp.  A linear scar in the back of the scalp occurs with strip surgery (FUSS). Small tiny 'circular' scars occur with follicular unit extraction (FUE). The two types of scars are different and it’s important to understand the differences between FUSS and FUE.
  5. Infection.  Infection is very rare and occurs in less than 1 out of every 2000 patients (0.05 %).  A patient with infection develops pain, draining and increased redness. If infection develops, oral antibiotics will be prescribed for 14 days. You can help reduce your chances of infection by carefully following your post-operative instructions that your surgeon gives you.
  6. Bleeding.  In a healthy patient, bleeding after surgery is rare.  In the event some bleeding does occur, it generally responds to application of pressure with the hand.   It’s extremely rare for bleeding to continue after a good amount of pressure is applied.  However, if bleeding continues, you’ll need to contact your surgeon.
  7. Folliculitis. Very rarely small bumps can develop at the recipient site where new hairs were transplanted. These are related to ingrown hairs. These bumps may often resolve on their own, but may require treatment with oral antibiotics.

 

After your hair transplant

What care will be needed for my scalp after my transplant?

  • After your transplant, you will review  your ‘post-operative’ care instructions with your surgical team.
  • You will be given information on how to care for your donor area at the back (donor area), your recipient area, how to bathe, what to do if you have pain, and what to do if you experience any swelling or bleeding.

How long does it take for my new hair to start growing out?

  • Your hair will begin ‘growing out’ at around 3 months after your transplant but you won’t notice more significant changes until 6 months.  It generally takes about 9-12 months before the most significant changes are present and hair can even continue to grow for up to 15-18 months.

How many hair transplant sessions are needed?

  • The number of hair transplant sessions needed for a patient to achieve their goals differs for each patient and the amount of hair loss they have to begin with.  Patients with mild hair loss may feel that one transplant session gives them an amount of hair fullness and density that they are happy with.
  • Patients with more extensive hair loss typically require 2-3 sessions to fully transplant the front scalp, mid-scalp and vertex (crown) of the scalp.   
  • If needed, a second transplant can be performed  9-12 months following the first session.

Will I need to take pills (like Propecia for men) or use Minoxidil topically after my transplant ?

  • Your doctor will review with your need for medical therapy. 
  • It is important to remember that even though your transplanted hairs will grow well in their new location, the original hairs you have on top can continue to get thinner over time.  
  • In some cases, using medical therapy after your transplant can help you to maximize the long term results.  It may be helpful to start these medications before your transplant.

 

Minoxidil (Rogaine)

If I use Minoxidil (Rogaine), should I stop this before my surgery?

  • Speak to your surgeon and team if you need to stop this medication. Most physicians will recommend that you stop Rogaine before your transplant. You will be advised when you can restart it after your transplant.

 

BOOKING TIME OFF WORK

Should I book time off work or social activities after my hair transplant?

  • It’s generally advisable to take time off work after your transplant.
  • Be sure to speak to your surgeon about what is right for you

 

MEDICATIONS

Are there any medications I should avoid before my surgery?

  • You are requested to AVOID certains types of medications or substances before your transplant.  This is very important as your risk for bleeding complications increase substantially if you take certain medications.
  • Speak to your surgeon about what medications you should stop

SMOKING AND ALCOHOL  

Should I avoid smoking and alcohol before my surgery?

  • Speak to your surgeon about stopping alcohol and smoking and what he or she advises. You should avoid alcohol before your surgery (and one week after).
  • Alcohol thins the blood and increases your risk of bleeding. 
  • Smoking should  also be avoided  before your surgery. Speak to your surgeon regarding how long you need to stop


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