Surgical hair restoration is the process of redistributing your own live, productive hair follicles—the roots from which your hair grows—from where they still exist to where they don’t. Bald areas can be covered, and new hairlines can be artfully constructed. Even mustaches, beards, sideburns, eyebrows, and eyelashes can be restored.
Typical restorative surgeries include hair transplants, scalp reductions, scalp flaps, tissue expansions, and scalp extensions. If your doctor recommends a scalp reduction, scalp flap, tissue expansion or scalp extension, he or she will usually do it in combination with a hair transplant.
Hair transplantation is the most common surgical hair restoration procedure. When people talk of “hair restoration,” they usually mean transplantation. It has been performed since the late 50’s, but today’s patients get results vastly superior to the “doll’s head” look of the early days. Techniques and instrumentation have improved immensely over the past decade, and skilled surgeons with the necessary artistic skills are now capable of creating natural looking heads of hair.
The procedure relies on donor sites—areas of your scalp that have an abundance of productive hair follicles. In typical male pattern baldness, those sites are above your ears and along the back of your scalp.
Most transplants require a number of individual sessions of surgery. Each session usually takes about 3-4 hours and is done in an outpatient facility, with a local anesthetic. The surgeon uses a punch to remove small strips of skin, usually about ˝ inch wide and 4 inches long, from the donor site. Each strip contains a number of follicles, sometimes thousands of them. The strips are then cleaned, trimmed to the proper length and divided into individual units of mini-grafts, which have 2–4 hairs apiece, and micro-grafts, with 1–2 hairs each.
Next, the surgeon creates receptor sites into which the grafts will be placed. These are small slits, cut in a random pattern in the bald area. Each graft is then skillfully inserted into the prepared sites in the proper area, position and angle.
Since scalps are very elastic, the tiny incisions where the hair was removed can be pulled together and sutured shut quickly and cleanly. Once the transplants are in and the sutures done, the transplant session is over. Some doctors place a bandage over both the donor and receptor sites that can be removed in a day or so. Others glue the grafts into place to avoid bandaging. After a short time, the body itself forms a tissue glue that holds the grafts in place.
Only a limited amount of restoration can be accomplished in a single session. Patients usually undergo a series of two or more sessions, spaced at 3 month intervals.
The best transplant surgeons have both excellent surgical skills and a highly developed sense of artistry. Where the grafts are positioned and in what size combinations determine how good a result you will achieve. The different sized grafts must be carefully positioned and angled to create a thinner, natural-looking hairline that transitions to denser, thicker coverage towards the back of the head.
Transplanted hair begins to show new growth in about 3-4 months, but does not fully mature for 9–12 months. When it first comes in, the hair is very fine and often light colored. By the time it is fully mature, it has regained its original color, texture, growth rate, and curl. When done by an accomplished surgeon, transplantation is the next best thing to getting your old head of hair back!
Scalp reduction is exactly what it sounds like—reducing the area of bald scalp on your head. It’s possible because of the flexible, elastic nature of scalps. In this procedure, surgeons remove a bald area of the scalp and then literally stretch the rest of the scalp to cover it. Scalp reduction is frequently used in combination with hair transplantation. Since it reduces the bald area, the number of grafts required to cover the remaining bald areas are reduced as well.
The elasticity of scalps also makes scalp flaps possible. In this procedure, entire segments of hair-bearing skin are folded over areas of bald skin. It is often used to reconstruct a hairline or crown hair (hair on the top of your head) in combination with hair transplantation.
Tissue expansion requires the use of expanders, devices implanted under hairy areas of the scalp adjacent to bald areas. The expanders are inserted in an initial surgical session and then gradually filled with a saline solution over a period of several weeks. As the expanders fill, they expand much as balloons do when filled with air. During a second surgical session, the expanders and the adjacent bald areas of the scalp are removed. The surgeon then pulls the stretched hairy areas of the scalp to cover the previously bald areas.
Scalp extension requires two surgical sessions. In the first, extenders (elastic straps with hooks at both ends) are placed underneath the scalp. The hooks are positioned to grip edges of hairy scalp areas adjacent to bald areas. Over several weeks, they gradually pull and stretch the hairy areas. The extenders and bald areas are removed in the second surgery, and the surgeon pulls the stretched hairy scalp to cover the previously bald areas.
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