Hair transplant surgery is an option some people choose to overcome hair loss. Various techniques are available, but all hair transplants involve taking skin with vigorous hair growth from one part of the scalp and grafting these pieces of skin to bald or thinning areas of the head.

Hair loss is primarily caused by a combination of ageing, changes in hormones and a family history of baldness. As a rule, the earlier hair loss begins, the more extensive the baldness will become.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, there are alternatives. These include non-surgical treatments, lifestyle options or accepting yourself the way you are.

Hair transplantation is not a cure for baldness.  The transplants will cover bald scalp, but they will not protect you from further hair loss.  As baldness is a progressive condition for most men, you should also consider treatments to slow down the balding process.  You should discuss this with your doctor.

Things to consider

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

  • 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.
  • Most hair transplants are successful, although it can take up to nine months before the hair takes root and begins to fill in.
  • Think about the financial burden. 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 surgeon 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.
  • The possible need for continuing medical treatment after hair transplant surgery.

Finding a surgeon

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 surgeon 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.

Dr Mario Marzola is a highly esteemed hair transplant surgeon and in 2018 was awarded the Manfred Lucas Lifetime Achievement Award by the International Society of Hair Restoration Surgery (ISHRS). It is the ISHRS’s highest honour and not given every year. The recipients of this award are rare talents indeed.

Dr Marzola consults at our East Melbourne centre two days a month and offers the following types of hair restoration strategies:

  • Micrografting/Follicular Unit Transplant
  • Follicular Unit Extraction
  • Body hair transplant
  • Micrografting to scars
  • Camouflage techniques after surgery

Medical issues

Before surgery, you need to discuss a range of medical issues with your doctor or surgeon including:

  • Physical health – an examination will help your doctor or surgeon to 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 – including 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.
  • Medications – tell your surgeon about any drugs that you take on a regular basis or have recently taken, including over-the-counter preparations like fish oils and vitamin supplements.
  • Past reactions to drugs – tell your surgeon if you have ever had a bad reaction or a side effect from any drugs, including anaesthesia.
  • Preparation for surgery – your surgeon will give you detailed instructions on what you should do at home to prepare for surgery. For example, you may be advised to take a particular drug or alter the dose of an existing medication. Follow all instructions carefully.

The hair transplant operation

Various methods of transplant surgery are available. The surgeon will choose the most appropriate surgery for you, based on your individual circumstances.

Hair transplant graft

Hair transplant grafts are usually performed under local anaesthetic. Each session of treatment can last from 2–8 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 different sessions.

The operation generally includes:

  • The hair on the ‘donor’ area of scalp is trimmed short to make it easier to handle.
  • The surgeon anaesthetises this area of the head where the hair grows thickly.
  • The surgeon takes small sections of hairy 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. A single punch graft, depending on the size of the tube, may harvest 2–15 hairs. A slit graft may contain 4–10 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 surgeon implants balloon-like devices (called tissue expanders) under the skin of a hairy 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 hairy scalp 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

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 surgeon 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 a hair transplant

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

  • Bruising and swelling
  • Possible numbness
  • Pain, throbbing and discomfort
  • A tight feeling in the scalp
  • To wear dressings or bandages
  • A pressure bandage to 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 or skin loss
  • 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. You need to speak to your surgeon for more information.

Taking care of yourself at home

Be guided by your surgeon, but 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 surgeon may advise you to avoid sex for about 10 days.
  • Report any bleeding, severe pain or unusual symptoms to your surgeon.

Long-term outlook

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 transplanted hair is placed in the direction in which the hair would normally be growing 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 in time. Be patient – improvements to scars may take around a year or so. You will almost certainly need ‘touch up’ surgery to improve the look of your hair transplant.

Other options

Non-surgical alternatives include:

  • Prescription medications like 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.

Things to remember

  • While various techniques are available, all transplant surgeries involve taking skin from hairy parts of the scalp and grafting it to the thinning or bald areas.
  • Generally, thick hair that is light-coloured or grey gives better results than hair that is thin and dark-coloured.
  • Most hair transplants are successful, although it can take up to nine months before the hair takes root and begins to fill in.
  • Talk with your surgeon about the risks and benefits of hair transplant surgery and what results you can expect.

To book a consultation please call us on 9654 2426 or email appointments@sinclairdermatology.com.au

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