Hair transplant surgery

About hair transplant surgery

Hair transplant surgery is a procedure used to treat hair loss. Various techniques are available, but all hair transplants involve taking hair-bearing skin from one part of the scalp and grafting these pieces of skin onto bald or thinning areas of the scalp or areas of trauma.

Hair loss may be due to common male pattern baldness (also known as androgenetic alopecia), scalp inflammation or injury to the scalp. Injuries from burns, scalds, surgery or car accidents may leave permanent areas of hair loss that can be concealed by hair transplantation.

Certain inflammatory diseases such as lichen planus, lupus or morphea can also lead to permanent areas of hair loss that are suitable for transplantation.

In Australia, most hair transplants are performed to treat male pattern baldness.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, there are alternatives. These include prescription medication, over-the-counter minoxidil lotion or accepting yourself the way you are.

Hair transplantation is not a cure for male pattern baldness. The transplants will cover bald scalp, but they will not protect you from further hair loss. As male pattern baldness is a progressive condition for most men, it might be worth considering combining surgery with medical treatments to slow down the balding process. Discuss this with your doctor.

Things to consider before having hair transplant surgery

Before you opt for hair transplant surgery, some important issues to keep in mind include:

• It is important to have realistic expectations. If you start off without much hair, a transplant will not give you a full head of hair. The thicker and denser your remaining hair, the better the results will be.
• Generally, thick hair that is light coloured or grey gives better results than hair that is thin and dark coloured.
• Following hair transplantation, it can take up to nine months before the hair takes root and begins to fill in.
• Think about the cost. Cosmetic surgery does not usually qualify for rebates from Medicare or private health insurance companies. If the hair loss was caused by burns or trauma, however, hair replacement surgery is considered a reconstructive treatment and may be covered by health insurance. Ask your medical practitioner about any out-of-pocket costs you can expect.
• Smokers are at increased risk of complications from surgery. If you are serious about undergoing surgery, you should try to quit smoking.
• There may be a need for continuing medical treatment after hair transplant surgery.

Finding a hair transplant medical practitioner

You may want to ask your doctor for advice on a suitable and reputable doctor or hospital where hair transplants are performed.

At your first consultation, you should ask the medical practitioner about their training and experience. It is preferable to have these procedures done by a reputable professional who is specially trained to perform hair transplant surgery and has a lot of experience in carrying out this type of operation.

Medical issues with hair transplant surgery

Before the operation, discuss the following range of medical issues with your medical practitioner:

• physical health – an examination will help your medical practitioner decide if the treatment is appropriate
• medical history – some pre-existing conditions and surgery you have had in the past may influence decisions about this operation, including the type of anaesthetic that is used
• hair evaluation – includes your hair growth pattern, the extent of your hair loss, the hair loss history in your family and any prior surgical or medical treatments for hair loss you may have had
• risks and possible complications – it is important that you understand the risks and complications so that you can weigh up whether a hair transplant is right for you
• medication – tell your medical practitioner about any medication that you take on a regular basis or have recently taken, including over-the-counter preparations such as fish oils and vitamin supplements
• past reactions to medication – tell your medical practitioner if you have ever had a bad reaction or a side effect from any medication, including anaesthesia
• preparation for surgery – your medical practitioner will give you detailed instructions about what you should do at home to prepare for surgery. For example, you may be advised to take a particular medication or alter the dose of an existing one. Follow all instructions carefully.

Hair transplant operation

Various methods of transplant surgery are available. Your medical practitioner will choose the surgery most appropriate for you, based on your own circumstances.

Hair transplant graft

Hair transplant grafts are usually performed under local anaesthetic. Each session of treatment can last from two to eight hours, depending on the number of hairs that are transplanted.

It is common to transplant between 1,000 and 2,000 hair follicles in one session, but larger areas of hair loss may require up to 4,000 follicles in each session. A session can take several hours and many people choose to have two or three separate sessions.

The operation generally includes:

• The hair on the 'donor' area of scalp is trimmed short to make it easier to handle.
• The medical practitioner anaesthetises this area of the head where the hair grows thickly.
• The medical practitioner takes small sections of hair-bearing scalp and transplants them to the desired area (usually the front of the scalp above the forehead).
• Various instruments may be used to harvest the donor skin. For example, a round tube (punch) or a scalpel may be used. A single punch graft, depending on the size of the tube, may harvest 2 to 15 hairs. A slit graft may contain 4 to 10 hairs, and the much longer strip graft has up to 40 hairs.

Flap surgery

Flap surgery is used if the hair transplant is extensive (for example, requires large tissue flaps instead of small grafts). You may need to stay in hospital for this type of hair loss surgery and general anaesthesia will be required.

Flap surgery involves:

• The medical practitioner implants balloon-like devices (called tissue expanders) under the skin of a hair-bearing section of scalp. The tissue expanders are inflated with more and more saline over a period of weeks. This encourages the area to grow more skin cells.
• After about two months, the scalp has grown enough extra skin for the transplant surgery.
• The bald section of scalp is cut and removed. The newly grown area of hair-bearing skin is partly cut away, moved to its new location and stitched into place. Since the flap is never fully severed from the scalp, it should retain a good blood supply.

Scalp reduction surgery

Scalp reduction surgery is suitable to treat bald areas on the back and top of the scalp, not towards the front of the scalp. The surgery includes:

• Local anaesthesia is administered to the scalp.
• The medical practitioner cuts out a strip of bald skin in a U or Y shape.
• The scalp is loosened and the incisions are brought together and stitched.

Immediately after hair transplant surgery

How you feel afterwards depends on the extent of surgery. After the operation, you can expect:

• bruising and swelling
• possible numbness
• pain, throbbing and discomfort
• a tight feeling in the scalp
• to wear dressings or bandages (a pressure bandage may be worn for one or two days)
• formation of small scabs across the treated areas of scalp.

Complications of hair transplant surgery

All surgery carries some degree of risk. Some of the possible complications of hair transplant surgery include:

• risks of general anaesthesia, including allergic reaction, which may (rarely) be fatal
• surgical risks such as bleeding or infection
• scars that may be severe, raised, reddened and itchy
• nerve damage, including permanent loss of sensation
• death of the skin grafts
• tissue death along the wound
• further surgery to treat complications.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. Speak to your medical practitioner for more information.

Self-care after hair transplant surgery

Be guided by your medical practitioner. General self-care suggestions include:

• Follow all instructions on looking after your wounds.
• Avoid exercise or any strenuous activity that could increase blood pressure, as this can make your wounds bleed. Your medical practitioner may advise you to avoid sex for about 10 days.
• Report any bleeding, severe pain or unusual symptoms to your medical practitioner.

Long-term outlook after hair transplant surgery

Most hair transplants are successful, although it can take up to nine months before the hair takes root and begins to fill in. It is not uncommon for the transplanted hair to fall out after several months and then regrow.

Once the hair starts to regrow, it should look natural because the hair is transplanted in the direction in which the hair would normally grow in that location.
Most scars should be covered with hair and will be hard to see. Any visible scarring will be permanent, but should fade with time. Be patient – improvements to scars may take a year or so.

You will almost certainly need 'touch up' surgery to improve the look of your hair transplant.

Alternatives to hair transplant surgery

Non-surgical alternatives to hair transplant surgery include:

• prescription medications such as creams
• wigs, hair pieces or hair extensions
• accepting that hair loss is a natural part of ageing – talking to a counsellor or psychologist may help you overcome your concerns about your appearance and you may decide that you like yourself the way you are.

Where to get help

• Your GP (doctor)
• Dermatologist
• A medical practitioner specially trained and experienced in performing cosmetic surgery
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Australian Society of Plastic Surgeons Tel. (02) 9437 9200
• Australasian Foundation for Plastic Surgery
• Royal Australasian College of Surgeons Tel. (03) 9249 1290
• Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 419 495
• Australasian College of Dermatologists Tel. (02) 8765 0242