Hair Transplant

"Hair loss is caused by a combination of ageing, hormonal changes and a genetic history of baldness. The earlier hair loss begins, the more severe the baldness. It can also be caused by trauma, or burns, whereas this surgery is considered reconstructive.
Procedure Types

Hair Transplantation - The procedure consists of resurfacing bald areas of scalp with hair. Plugs of bald scalp are removed and then filled with plugs of scalp containing several hair roots taken from hair-bearing areas. Those grafts root themselves into their new locations and hair follicles start to grow eventually.
Depending on the degree of baldness, the number of grafts needed and the length of treatment sessions vary. Several operations may be necessary. The technique may leave many small scars on the site used (donor sites) but are usually not noticeable.

"Follicular Unit Extraction (FUE) Hair Transplant.
Follicular unit extraction or FUE is a hair transplant technique in which a small round punch is used to extract follicular units from a patient's bald resistant donor areas. These 1, 2, 3 and 4 hair follicular unit grafts are then transplanted into a patient's balding areas.
Given the time consuming and tedious nature of this procedure a physician is often limited to transplanting 500 to 600 follicular unit grafts in one day. The cost per graft of FUE is also typically twice the cost of the standard follicular unit hair transplant procedure in which a strip of donor tissue is removed from the back of the head and trimmed under magnification into individual follicular unit grafts.
How a FUE Hair Transplant is performed.
During the Follicular Unit Extraction or FUE procedure individual follicular unit grafts are excised one at a time using a tiny one millimeter or less sized punch. Typically the patient's hair in the donor area where these grafts are being removed is cut short so that the physician is able to see the patient's scalp.
The follicular units are extracted using a multiple step process. First a small sharp punch scores the skin around a follicular unit. Then a small dull punch is used to go deeper into the soft tissue surrounding the follicular unit.
Since the direction and angle of the follicular unit beneath the skin can't be seen and can often differ from the direction of the hair on the surface, a sharp punch if used below the surface of the skin might transect or severe the underlying follicular unit. However, the dull punch tends to envelope the follicular unit, while separating it from the surrounding soft tissues. This process is typically referred to as "blunt dissection".

Once the underlying follicular unit is separated from the surrounding tissues it can then be extracted, often by a forceps gripping the hair above the surface.
The small hole left behind after the follicle is extracted then heals over the next few days. This tiny wound contracts as it heals making the resulting round scar smaller and less noticeable. The FUE patient typically ends up with hundreds of small round white scars, which are normally not detectable to the naked eye once the patient's hair grows out.
Comparing Follicular Unit Extraction (FUE) to the Standard Strip Procedure.
While the FUE procedure has grown in popularity, largely due to the minimally invasive way in which follicular unit grafts are removed, the standard strip excision method is still the most popular hair transplant procedure.
The standard strip excision method involves surgically removing a strip of scalp from the bald resistant donor area of the patient. The donor area is then sutured together.

These sutures (either stitches or staples) are then removed about ten days after surgery. Some physicians use dissolvable sutures so that no removal is needed.
When the linear incision is fully healed the patient is left with a thin scar in the back of the head. This scar is typically hard to see once the surrounding hair grows out and conceals."

Scalp Flap Transfer – This is done when the sides of the scalp (above the ears) and the back of the scalp is hair-bearing. A long thin "flap" of scalp that is hair-bearing is removed and placed across a bald section to create a band of normal hair growth. As part of the treatment, parts of the bald scalp may be removed. The donor site is closed by stretching the opposite side of the scalp.
This procedure replaces hair across a large area of bald scalp. The hair growth looks normal, and the narrow scars are hidden between the hair follicles.
Scalp Reduction (Serial Excision) – This is the removal of as much of the bald section as possible and done in the first operation. The adjacent hair bearing areas of scalp are pulled in close to the bald section, with the understanding that some bald areas will remain. This technique is repeated one or more times at a later date to eventually reconstruct the bald area.
Tissue Expansion – A device called a tissue expander is placed under a hair growth area situated adjacent to a bald area. After several weeks, the tissue expander causes skin to grow new skin cells. Then another operation is necessary to place the newly expanded skin over the ajoining bald area.
Ideal candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will be the donor sites where the flaps and grafts will be surgically removed.
The procedure location options may include the surgeon`s office-based surgical facility, outpatient surgery center, hospital outpatient, or hospital in patient.
The anesthetic options are either general, or local (combined with a sedative)which allows the patient to remain awake but relaxed.
To achieve desired fullness, several surgical sessions are needed. There is a healing period of several months recommended between each session. The final result with a full transplant series may take up to 2 years.
A month or 2 after surgery, the grafted hair falls out (which is normal and temporary). It takes another month or more before hair growth starts. To create more natural-looking results, a surgical touch-up procedure may be necessary. This may consist of using a combination of mini grafts or slit grafts to fill and blend in the hairline."