What are the reasons for male pattern baldness?
The tendency toward male-pattern balding is genetic and can be inherited from either the mother or father, i.e., it is not gender linked. Balding starts when dihydro testosterone molecules bond with special receptor sights on hair follicle cells. This causes the hair follicle to miniaturize and eventually to die.
How does hair transplantation work?
The transplanted hair is removed from an area of the body (donor site) and transferred to another (recipient site). The transferred tissue is not “rejected” as it is not foreign tissue. The transplanted hair maintains its own characteristics: color, texture, growth rate, and curl, after transplantation and regrowth. The vitality of the grafted follicle is maintained by the rich blood supply to the scalp. Large circular grafts containing 15-20 hairs are transplanted, which can result in noticeable and unnatural results. Over years, instruments and techniques have been developed that allow us to achieve truly natural results by transplanting grafts very close together. Through the use of microscopes to dissect the donor tissue, higher graft counts are attainable. Hair grows in the scalp in groups of one, two, three, and sometimes four hair follicles. We transfer these groups of follicles after eliminating the excess surrounding fatty tissue. This allows the grafts to be placed closer together resulting in a denser and more natural result.
If you're already bald, what part of the body is the donor site?
Even in the baldest man a permanent ring of hair exists at the sides and back of the head. For reasons unknown this hair is unaffected by the balding process. In follicular hair transplantation a strip of skin containing this permanent hair is removed from the back of the head. Care is taken that this strip is not too wide so that the flexibility allows the edges to be neatly sutured together after the strip is removed. The hair follicles are then carefully dissected out from the piece of skin and placed in very small surgical sites made in the thinning or balding areas of the scalp. Once transplanted this hair behaves as it was programmed to behave and should grow naturally for the rest of your life.
What is the difference between density and fullness?
The word fullness rather than density describes the visual phenomenon in what we perceive as thick versus thin hair. The concept of fullness is broader and more inclusive. Density, i.e., the number of hairs per square cm is only one of several contributing factors that are required for the visual impression of hair that appears thick. Other factors include hair shaft diameter, colour, texture, and curl.
What can I expect at my consultation?
Plan on a 30- to 60-minute consultation consisting of an analysis and scalp evaluation with a trained hair-loss specialist. In addition, you will receive a customized treatment plan based solely on your individual hair loss needs and personal expectations. If a hair transplant seems like a viable option, we will arrange a consultation with our associates.
How should I prepare myself for the operation?
Very little preparation is necessary. The patient should shampoo the hair the night before, get a good night's rest, avoid over-indulging in food or drink, and have a normal breakfast. If the patient is taking aspirin, then this should be stopped one week before the operation. Do not get a haircut before the operation, because the longer the hair is in the donor area site, the less conspicuous the site of the operation.
What medical conditions should the physician know about?
Anything that would cause you concern or that you feel comfortable disclosing. The patient should tell the physician of any unusual physical conditions and in particular any history of abnormal bleeding, haemophilia, heart attacks, epilepsy, allergic reaction to drugs, or any drugs being taken to thin the blood.
How long will I be off work?
There are many variables involved when returning to work. Whether you have strip or FUE surgery, we recommend that you take at least two full days off, post op, to devote solely to aftercare. After those two days it is a matter of personal choice. One thing to keep in mind is post op swelling, which can develop 12 to 48 hours after surgery. Depending on the amount of hair in the transplant area, there will very probably be visible scabbing. A loose-fitting hat may be worn during this period. If a hat is not an option for your particular occupation, we recommend taking off a week to 10 days while the scabbing heals.
How much does the procedure cost?
Most of our sessions usually run from $3,000—$10,000. This cost is dependant on the number of grafts required. The majority of patients will need from 1—3 sessions.
Is this a painful procedure?
No. The procedure is performed under local anaesthetic and mild sedation. This means that both the donor and recipient sites are totally desensitized. You may experience a slight discomfort when the anaesthetic has infiltrated. Surprisingly, patients feel very little discomfort in the recipient area but occasionally complain of discomfort for some days or weeks in the donor area. This is because small sensory nerves are inevitably divided and this can lead to a tingling sensation for some weeks. Discomfort in both sites is usually controlled by acetaminophen.
How long does the surgery take?
Most operations take between 4—8 hours. We normally transplant between 500 and 3,000 grafts. This is exacting work and, therefore, requires considerable time, even though we have a team of 4—6 assistants.
What happens when the patient leaves the office?
No bandages are worn, full postoperative instructions are given, and many patients who live in the Louisville area come back to the practice for routine washing and aftercare.
Do large grafts produce a better denser result than smaller grafts?
High-quality hair transplants require fine instruments and delicate small grafts. These grafts can only be prepared using magnifying loupes or the dissecting microscope, and are ideally inserted as follicular units. The follicular units of the adult human scalp occur naturally in bundles of one to four, occasionally five, terminal hair follicles with associated sweat glands, erector muscles, a nervous and vascular plexus, and fine fibre sheath that surrounds and defines the units. These grafts can be distributed in a way that provides the most natural result. Nowadays the patient should seek out clinics that are able to insert sufficient numbers of small follicular units to produce the desired result.
What can be expected immediately after surgery?
The postoperative course will depend on adherence to the instructions given after surgery. Small scabs will form on the scalp at the graft sites. Generally speaking, these scabs disappear in 7—10 days. Shampooing can be resumed in 48 hours after surgery. The suture (stitch) used in the donor area is undetectable as it is completely covered by your existing hair in most cases. An appointment will be made for the suture to be removed 12—14 days after surgery. It is advisable to take at least two days off work after surgery. A baseball-type hat may be worn any time after surgery. Patients should avoid strenuous physical activity for at least five days after surgery. Typically, the grafted hair will shed in 6—8 weeks. New growth will begin in 4—6 months and length will increase approximately 3—4 cm per month with full density taking 12—18 months.
How physically noticable will it be after the transplant?
There are two issues here: redness and natural crusting. The first is the natural serum crusting that occurs at the base of the grafts after the transplantation. With frequent spraying of the scalp and gentle shampooing this can be kept to a minimum.
The second issue is redness. Some patients get no redness while others can have a little redness for 2—3 weeks. While spraying helps, redness appears to be a little bit of an individual characteristic.
Normally, transplants are hard to detect after seven days, but a person with some hair to cover the grafts may have no problems at all. It may be desirable for a person to take 7—10 days off after the first transplant, particularly if he or she has advanced baldness.
How soon will the hair start growing?
Initially the majority of the hair in the grafts will fall out at 2—4 weeks. Most transplanted hair will start growing at four months but recent evidence indicates that a few grafts may take seven months or longer to start growing.
What will happen to the donor area from which the hair is taken?
We use a strip of donor hair about 1 cm wide. The width allows the edges of the skin to come together easily and they are sutured with an absorbable monocryl stitch without tension. There may be some minor discomfort for a few weeks, however, as the excision is neither deep nor wide. The end result in virtually all patients is a fine, hardly discernible linear scar easily hidden by the surrounding hair. At any subsequent surgery the excision is made incorporating the existing scar, ensuring that the strip is not too wide and the closure is again carried out under minimum tension.
How long will the transplants last?
Assuming that the donor site was picked properly, they should last your lifetime. Grafted hair will retain all the characteristics from where it was taken. They are removed from areas that should never go bald. As people get very elderly and their overall hair thins, the grafts will also thin a little.