What is hair transplantation?
It is a surgical procedure in which the hair follicles of a donor area (denser and full of hair) are transferred to a receiving area (less dense than the donor area).
Most surgeries are done to improve the appearance of traditional baldness caused by androgenetic alopecia. The main donor area is at the back of the head, where the wires are less sensitive to the hormones that cause this form of alopecia. Transplanted follicles remain resistant after surgery, even if wires native to the recipient area are lost with the advancement of baldness.
Transplantation can also be done to catch faults in other areas such as the beard or eyebrows, and it is possible to use wires from different parts of the body (transplantation of wires from the back to the scalp, for example).
Is there a difference between transplant and hair implant?
In medicine, the word implant usually refers to artificial parts that are inserted into the body. As follicles are natural parts of our body, it is safe to say that they are transplanted (like a heart or a kidney, for example).
But in practice, it does not matter if one clinic discloses the surgery under the name of transplant and another with the name of hair implant: if both deal with natural hair follicles, the names mean the same thing.
(Curiosity: There are artificial hair implant techniques, but they are considered inferior to transplants in terms of results, the chance of rejection, etc., and so they are not very popular.)
Is it possible to transplant hair from one person to another?
Not currently. In theory, the procedure is possible, but it would have the same difficulties as transplantation of any other organ, such as the risk of incompatibility between donor and recipient (unless you have an identical twin who is willing to donate his hair for you :)).
Those who receive a transplanted organ need to take immunosuppressive drugs throughout their lives so that the body does not attack the new part. Remedies can cause considerable side effects and leave the body more vulnerable to external threats.
They are serious disadvantages, which can be overcome when we are talking about a vital organ, but not aesthetic surgery. Therefore a hair transplant from another donor is considered unfeasible today.
In which cases is the transplant recommended? How do I know if I can do it or not?
Only your doctor will be able to make an accurate assessment, but in general, the best candidates to do the transplant are:
- People with androgenic alopecia scale Norwood 3 or greater, or who have started to show their hair loss for at least five years ;
- People with already stabilized bald spots, who have had hair loss over many years;
- Who is resorting to surgery after having already tried other treatments for androgenetic alopecia (such as finasteride and minoxidil );
- People with permanent hair loss not related to hormonal causes (accidents, surgeries, burns, traumas, etc.);
- People who have the previous line of hair implantation (an area where the hair starts to appear on the forehead) very high, either from birth (without associated hair loss) or due to surgical procedures (such as facial or brow lifting);
- Some cases of cicatricial alopecia, provided they have been inactive and stable for at least one year;
- Some cases of trichotillomania, provided they have been inactive and stable for at least one year.
Other important requirements for safety and satisfaction with the procedure are:
- Have good yarn density in the donor area ;
- Have good health status (meeting pre-surgical evaluation criteria );
- Have realistic expectations about the outcome of the procedure;
- Choose a professional well qualified to perform the surgery;
- Follow the recommended care for the post-surgical period.
Is there a minimum age for surgery?
Technically not, but several experts prefer to wait until the candidate is at least 25 years old. Many people think that transplantation is best for young people because the results are better in milder cases of baldness, but this is not true. It is important to evaluate how your baldness will progress throughout life and whether the transplanted wires will look natural in the future.
Imagine a 20-year-old boy who starts having hair loss in the front and decides to do a hair transplant. The transplanted wires are sturdy and remain there for the rest of their lives, but the hairs native to that area continue to fall. After a few years, he can have the firm, strong transplanted wires in the front and a bald area immediately behind them. Terrible, right?
This lack of planning makes many people need corrective hair transplants in the future. To avoid the risk, the ideal is that baldness has already stabilized while doing the surgery, or at least a projection of how the picture should evolve in the future, to make a transplant that maintains satisfactory results in the next years.
A good exercise is to look at the people in your family and imagine that your baldness will progress in the same way as the baldest person of all : so you “plan for the worst” and have a margin of safety. If you are already at a level close to that person, you can do the surgery knowing that your frame should not advance much more than that. Or, if you’re still a long way away, you can try other treatments before you think about a transplant, or plan to have a surgery already planned with your doctor for more natural and long-lasting results.
Remember that the amount of yarn in the donor area is limited: you do not want to waste them doing surgery that you may regret in the future.
Is the female capillary transplant different from the male?
The procedure is the same, but surgery is not always an interesting option for women.
Female baldness is usually more diffuse and distributed throughout the scalp, and sometimes reaches the back of the head as well. In these cases, it is not possible to expect from the donor area the same stability and resistance that is observed in male pattern baldness, and the transplanted wires may end up being lost with time.
In addition, the transplant serves exactly to remove wires from a denser area and use them to fill the “sparse” parts. If the hair loss is distributed throughout the head, and the density is similar in all areas, surgery loses its purpose. So the ideal is to make an assessment for the doctor to analyze your case and tell you whether the procedure will benefit you or not.
The female capillary implant remains a great option in cases of:
- Traction alopecia (excessive eyebrow clipping or use of very tight hairstyles, such as braids close to the scalp or balding cokes, for example), burns or other traumas ;
- Plastic or other surgeries that caused wire loss in the area near the scars ;
- Baldness in a pattern similar to masculine (in more localized areas and with preservation of the wires in the back of the head, where the donor area is);
- Reduction of forehead area (in whom the hairline is naturally very high);
- Some stable pictures of cicatricial alopecia and trichotillomania.
What procedures and care before surgery?
The first step is the evaluation that the doctor will make your case. It should analyze the cause and extent of hair loss, the quality of the donor area, and determine if the transplant is the right solution for you. He will also talk about your expectations, discuss what you can do, what are the results you can expect, etc.
Before the transplant, the doctor should ask for some traditional pre-surgical exams ( chest x-ray, echocardiogram, blood count, coagulation tests, among others), ask if you take any medicine if you have any chronic diseases, etc.
After these two steps, surgery can be scheduled. The most common recommendations for transplant preparation are:
- Leave hair as long as possible for the day of surgery (the doctor will trim the required area, and the rest of the hair will help cover the scars in the donor area);
- Protect the scalp so as not to have any sunburn on the day of the procedure;
- Do not take aspirin, ibuprofen or other anti-inflammatories, vitamin supplements (especially type B and E ) and avoid smoking and alcoholic beverages one week before a transplant, as they may stimulate bleeding during transplantation and impair healing medicine, contact your doctor);
- Wash your head well with shampoo the day of surgery and do not use products such as gel, spray, mousse, creams, perfumes, and makeup (if you use a hair prosthesis, it must also be removed);
- Wear wider clothing that does not have to be pulled by the head to remove, to avoid rubbing with the dressings after the surgery (a button shirt is ideal);
- If you eat well before surgery, as your doctor advises (some patients may feel nauseous if they transplant on an empty stomach), but avoid caffeine (may encourage bleeding);
- Do not bring valuables to the clinic on the day of the transplant (the place may have no way of packing and ensuring the safety of your belongings);
- Sedation may cause drowsiness after the procedure, so driving after surgery is not recommended (ask an escort to take you home or take a taxi);
- Talk with your doctor about the products that you may have to use after surgery (pain medication or infection prevention, ice pack to reduce swelling, etc.) in case you want to buy them in advance to have it all in when you return from the transplant.
What type of anesthesia is used?
Most procedures are done with local anesthesia and mild sedation (which is optional but highly recommended due to the long duration of transplant sessions).
What are the types (or techniques) of hair transplantation?
The trade names may vary widely, but there are basically two methods on the market: the most common is Follicular Unit Transplantation, or FUT (Follicular Unit Transplantation). This technique removes a scalp strip from the donor area, from which the follicular units (natural clusters of up to 5 capillary follicles) are selected that will be implanted in small holes made in the receiving area.
The second method, which has gained enough popularity in recent years, is the Follicular Unit Extraction, or FUE (Follicular Unit Extraction, in English). The difference is that this technique removes the follicular units one by one, directly from the scalp of the patient, with the aid of a small cylindrical tool (like a straw). The insertion of the units in the receiving area is done in the same way in both methods. There is a variation of this technique in which the extraction of the UFs is performed by a robot, which helps increase the accuracy and quality of the procedure.
Some clinics report the realization of laser hair implants, but this technique is considered inferior: the laser is only used to open the holes where the wires will be inserted, and as it ends up burning the tissues, the chance of causing loss of follicles is greater.
The laser was most commonly used when the transplanted parts were larger and needed holes considered big by today’s standards (implanted tufts gave a super artificial effect of “doll hair” ). The follicular units of the current procedures are tiny, and the small incisions that are made in the receiving area cause as little damage to the scalp as possible.
How long does the surgery take?
It varies according to:
- The technique (the FUT method is usually faster than the FUE);
- The number of follicular units (UFs) transplanted;
- The team that will do the procedure (larger and more experienced teams usually take less time).
A small session (less than 800 UFs) with the FUT technique can take about 3 or 4 hours, while a larger surgery (more than 2,500 UFs) can take from 6 to 8 hours (in the FUE technique, larger procedures can be divided into two sessions, held on consecutive days).
How long does it take for hair to grow again?
Around the second or third month after the surgery the new threads begin to appear, and gain body until about the eighth or ninth month. Some changes in hair texture may appear, but between the first and second year after transplantation they are usually normalized. After this period, the final result of the procedure appears well and can be evaluated more completely.