Hair Transplant Surgery has seen a
long way from hair bearing flaps through hair strips and mini grafts to now follicular unit hair transplants.
Hair Transplantation specially Follicular unit hair transplant and micro-follicular hair transplant appeared as major
breakthrough in baldness treatment. Now the next breakthrough i.e. Hair cloning is long awaited . Baldness :
Hair Loss can be post burn, post trauma, post chemotherapy or post surgery, but the most common variety is male pattern
baldness, which occurs under influence of male sex hormone (testosterone, mainly its metabolite- dihydrotestosterone) DHT.
Normal Hair Cycle:-
Involves Catagen :- in which hairs are shed, Hair roots
remain dormant for around six months, Telogen :- a phase of temporary growth arrest, lasts 59 days Anagen :- phase of hair growth, lasts 5-6 years Note : At a time
some of hairs are in telogen phase, some in catagen phase and rest in anagen phase. So loss of up to 100
hairs in any normal person is normal variation of hair cycle and is not a problem. These hairs grow again after
a period of dormancy. Common forms of baldness are in both male and female (Men & Women) :-
Male pattern baldness, Generalized hair loss and thinning,
Telogen effluvium Traction alopecia.
Male Pattern Baldness :-
Some short of baldness is seen in every male, in form of temporal recession
of hairline but it is normal male hair pattern, in females anterior hair line is smooth straight line.
In males baldness appears as further recession of hair line posterior or as loss of hairs on crown which
progresses peripherally. Its mostly under influence of male sex hormone and has strong genetic tendency of
inheritance, usually people have history of hair loss on either paternal or maternal side. Some times a person can
be the be the beginner in family without obvious family history.
Different classifications have been advised but they are of little clinical significance. Generalized hair loss and thinning :-
presentation of hormone related ( a variant of male pattern baldness) in females. Telogen Effluvium:-
a phase of temporary growth
arrest, which usually occurs after some medical or surgical stress, like prolonged illness, some chronic
disease or after some surgery. Bye definition it’s a phase of temporary growth arrest, after which hairs again start
growing. In acute phase some hairs may be lost and some may show thinning, but ultimately they all grow. More
commonly seen in females. Bifid hairs (at tip) are mild variant of same problem. Traction Alopecia:-
because of tight hair bands in childhood among girls. In males, because of tight turbans
( Commonly seen in Sikh Population in our country). Hair loss in females or Baldness in females (women):-
most common reason is again
male pattern baldness, but presentation may be localized hair loss or reduced density in anterior scalp or
generalized hair loss and thinning. Both telogen and traction alopecia are more common in females (women) than in
males. Hair Loss in women are always more complicated than in males and are more often associated with hormonal imbalance .
Hair Transplant, Hair Transplantation
or Hair Restoration Surgeries :- Hair Restoration Surgery includes all surgeries done
for regaining hair at lost places e.g. hair bearing flaps, advancement flaps, tissue expansion, punch hair
transplant, follicular unit hair transplant, follicular hair transplant, micro follicular hair transplant. Different Hair Restoration Surgeries are- Hair Bearing Flaps Scalp Expansion – with tissue expanders or elastic bands. Punch Hair Grafting or Transplant. Mini Hair Grafting or Transplant. Micro follicular Hair Grafting or Transplant.
or Follicular Unit Hair Transplant Hair bearing flaps ( best avoided unless bald area
is very small) and tissue expansion are best suited for
post traumatic, post burn or post surgical resection alopecia. Punch Hair Grafting and Mini Hair Grafting or
Transplant:- both involve pieces of scalp tissue
bearing hairs and grafted in desired areas. Punch may
contain 12-15 hairs, minigrafts- 3-8 hairs per graft).
Both are obsolete now, as both leave unacceptable scar in
donor area and cosmetically unacceptable result in
Follicular Hair Transplant or
Follicular Unit Hair Transplant ( FUT or FUHT) :- Follicular unit hair
transplant is being widely practiced today. in this technique of hair transplant, individual follicular units
are harvested either for scalp strip or through individual follicular unit extraction. each follicular unit may
contain one , two or three hair follicles. so in, follicular unit hair transplant, a graft unit or
transplant unit can be mono-follicular, bi-follicular or tri-follicular. Micro-follicular Hair Grafts or Transplant :- are the
most advanced technique of hair grafting now. Involves either harvesting of a strip of hair bearing scalp tissue
from posterior scalp or harvesting of individual hairs with micro punch , where hair loss is not seen in most
cases in future , individual follicles are separated and transplanted in new area. In Micro-follicular hair
transplants one graft is equal to one hair.
Follicular Unit Hair transplant like any other
hair transplant technique involves procuring of hair graft from the donor area
and plantation of hair graft in recipient area. procuring hair grafts can be done in two ways : Strip Harvest : In this hair transplant
method, a strip of hair bearing skin is harvested from posterior scalp.
depending upon laxity of tissue and closure technique expertise of surgeon 1-2 cms broad strip can be harvested. individual hair follicles are harvested from this strip. Advantages : (i) Involves only a small segment of donor area, rest of area remains scarless despite of multiple sessions. (ii)
relatively fast technique (iii) harvests hair only from the area which gives you
best donor hair i.e. the area between two ears only. worldwide this is the most practiced hair transplant technique. Disadvantage : a permanent scar on posterior scalp is there quality of which depends upon expertise of operating surgeon. In
our hands, scar is almost invisible even if hairs small and with our Trichophytic closure technique you get the best result.
Trichophytic Closure :-
technique of closure of donor area determines how the scar will look in strip method. In inexperienced
hands this scar line may widen over time and looks bald. Another problem with donor management is reduction in
width of hair bearing scalp. With our technique despite of harvesting hairs there is no reduction in width of
hair bearing scalp on back side. Donor scar is only a fine line and hairs grow through that line so there is
practically no visible scar. hairs are harvested from donor area in a way that they dont leave bald area or
Hair Transplant picture 1 : Hair transplant donor Area : on operation table , long hairs easily can hide it
even just after hair transplant surgery.
hair transplant picture 2 : same donor area after healing
Hair Transplant Picture 3
: Before After
Picture hair Transplant Donor area showing re-growth of hairs in donor area with trichophytic closure. Color match takes a few months.
Follicular Unit Extraction (FUE) :- In this
technique, Rather than harvesting a strip and slicing them into individual follicles, we harvest individual follicles
separately and then they are transplanted. you may call it Follicular Unit Extraction or Separate
Follicular Unit Extraction. this technique is actually modification of older punch technique, the
punches now are very fine and they don't leave scar behind at donor area. A broad area develops diffuse scar but invisible.
Hair transplant Before After picture 4 : FUE donor area on day of surgery and after healing.
Advantage : No linear Scar on scalp, Disadvantage: slow process and diffuse scar in a broad area. Hair roots are deep to dermis and once
you cross dermis scar is bound to be there. Hair Graft Placement : Hair Graft is applied in most non-traumatic way.
Field is usually bloodless. see video.
Hair Transplant Video Follicular Unit Extraction (FUE) Using Titanium Gold Knife Micro-punch by Dr. Prabhash.
Non Scalp Hair Transplant:- Hair Transplantation can also be done at places other than scalp , like
Moustache, Beard, Groin , Eyebrow and axilla ( armpit) areas. Eyebrow Hair Transplant :- again mono follicular hair transplant from
specialized areas of scalp where hair matches with eyebrow hairs is used for eyebrow hair transplant. Eyelid Hair Transplant:- Should be best avoided as direction of growing hair doesnot match with
eyelashes and misdirected hairs can damage your cornea leading to blindness. Moustache & Beard Hair Transplant : uses
same technique as scalp hair transplant, only difference is very high density
and use of only micro-follicular hair transplant. Non Scalp Donor Area or Body Hair Transplant :- Usual donor area is your
occipital scalp ( posterior hairs), when they are also absent dense body hairs
are used as donor but these are not preferred as source of hairs unless you dont
have hairs on scalp. You may yourself judge how dense they are and how much they
grow. Principle of Hair Transplant :- Hair loss is mainly androgenic means because of your male sex hormone and
its variant Dihydro-testosterone . Distribution of DHT receptor determines extent of hair loss. Some hair loss
is universal in all males ( you may see temporal recession (sides). Scalp on back usually dont have this
receptor and so are immune to loss. You may see even in most severe hair loss hairs are there on posterior
scalp. Only these hairs are transferred to desired area and they persist there as long as hairs are there on
donor scalp means almost life long. Course of Hair transplant :- Consultation. Know the process in detail including expected result.
Please mind hair transplant is redistribution of some of your existing hair from small area to new desired area. There is no
method available for hair multiplication or cloning so No. of hairs will be same as harvested.
Book a date.
Some blood tests for fitness.
Stop ay hair care treatment including minoxidil, use of any blood thinning medicine
and medicines which affect blood coagulation. Those who
are diabetic or Hypertensive should continue their
medicines as prescribed by their physician . Both should
be in control. You dont need to shave whole scalp for strip method, for FUE hair trimming to smallest level needed.
On the day of Surgery -
harvesting of hairs under local scalp block anaesthesia.
preparation of grafts and plantation in desired area.
Total procedure may takes around or more than six hours.
half an hour after surgery you are free to go home.
Scalp may look little dirty for around 7-10 days , dotted appearance. Will retrun to
pre surgical status in 10-12 days, Transplanted hairs will be lost over few days , some normal hair loss may
also happen in that area ( Telogen- these come back first).
Suture (If any) removal on day seven.
Hairs start growing after a period of rest ( Telogen - average 59 days ) , first
appearance is after two and half months. hairs which
were in shedding phase ( Catagen ) at the time of
plantation will grow after six months. so overall they
continue growing till one year. New hairs are initially
thin and little curly they continue gaining strength
till two years.
Hair Transplant Picture Showing Course of hair Transplantation.
Hair Tranplant Picture Showing Result After Five Months.
Before After Hair Transplant Picture
Hair Transplant Picture Showing hair Density Before & After hair Transplantation
Before After Picture Hair Transplant in Female (Women)
Commonly asked questions :- i) will there be any permanent mark after hair transplant?
Ans:- there will be one straight line in posterior scalp ,
which is not visible as graft is harvested in a manner to
allow hair growth in scar.
There will not be any scar anteriorly, where hairs are
grafted. ii) will transplanted hairs be my own original hairs?
Ans:- yes, they are your own hairs. iii) will transplanted hairs grow like normal hairs?
Ans:- yes they will grow with rest of your hairs and like
rest of hairs , you will need to get them dressed time to time. iv) will transplanted hairs grow after hair cut or Shaving ?
Ans:- yes, these are your normal hairs shifted from one place to other. v) will transplanted hairs stay on my scalp for whole life?
Ans:- yes, most probably. They will stay there as long
your posterior hairs ( donor area ) are there. Can be lost
only if you have strong tendency of complete baldness. vi ) can I apply oil and can I dye my transplanted hairs?
Ans:- you can use any oil which is commonly used for
hairs, dyeing with chemicals usually not advised. Even
the products claiming to herbal, may contain harmful
substances, because of poor quality control. vii) What about hair loss and hair transplant in females (women)?
Ans:- hair loss in females are more or less similar
to that in males. It can be because of nutritional
deficiency, illness or some stress. Male pattern baldness
( due to excess male sex hormone) can present both as
development of male like hair patter (recession in side)
or as diffuse hair loss. Hair grafting is useful both in
males and females. viii) Does hair loss in females (women ) specify some systemic problem?
Ans:- yes , it can be . hair loss may be
associated with some generalized problem in both male and females.
In females , when associated with development of facial (
like beard and moustaches) and body hairs , disturbances
of menstruation and change in breast and sex organs,
indicates some male sex hormone secreting tumor or some
enzyme deficiency , which increases level of male sex
hormones. For such problems always better to consult your
doctor to get improvement and better control of hairs. IX) Any rest required ?
No, bed rest is not required, You may leave hospital half an hour after
surgery, Relax sleep overnight, its better to take leave from work for 2-3
days, avoid exertion and heavy work for a week at