Dr.Tarek Ahmed Said , Plastic Surgeon, Cairo, Egypt (plasticsurgeryegypt.net)

Hair Transplantation

Hair follicle transplantation is the most up-to-date method to manage androgenic baldness in males as well as deficient hair density in females. It is the backbone of hair restoration surgery and it is now the primary treatment in all cases of Male Pattern Baldness.

Hair transplantation is based on the concept of "donor dominance" in Male Pattern Baldness (MPB). If a graft is taken from an area destined to be permanently hair bearing and is transplanted into an area of MPB or future MPB, it will after an initial short period of effluvium, continue to grow hair in its new site. Thus all planning of redistribution of permanent hair is predicated on an accurate assessment of the ultimate extent of alopecia and its counterpart, the permanent donor rim

In the 1990s the concept of follicular unit has revolutionized hair transplantation. Human hair emerges from the scalp in groupings known as follicular units.

Follicular unit transplantation is a method of hair restoration surgery where hair is transplanted in its naturally occurring individual follicular unit. This led to the use of smaller micrografts and finally single hair transplants. Using different-sized smaller grafts helps avoiding the corn rowing "the doll's head appearance" and dramatically improves results

There are three types of hair micrografts

Single hair follicular unit & Single follicular unit (for hairline resotration) Offer more natural look, However yield lesser number of grafts
-- Single Hair Follicular Units: Used primarily for the hairline area to create a softer more natural appearance.
-- Single Follicular Units consisting of 2-3 hairs:Used right behind the hairline to create a more dense appearance

Modified follicular unit consisting of about 3-4 hairs Used primarily for adding density to the recipient area. They provide a thicker, fuller appearance, and are more suited to the non-hairline regions of the scalp.

Megasessions of thousands of these three types of Follicular unit in a single sitting and dense packing of the bald area is the best solution to accomplish the maximum result in the least number of sessions, The number of sessions needed vary according to the extent of baldness and the size of the area to be covered

Planning is essential in hair transplantation, poor planning can easily lead to unsatisfactory results which may be impossible to correct. This may be because of unanticipated progression of hair loss, exhaustion of grafts or missized, misplaced or misdirected grafts or scars.

6 Factors decide patient selection and planning
1- Classification (Exent of baldness)
2- Scalp & hair color
3- Curliness
4- Texture (Caliber)
5- Density
6- Amount of donor hair

The procedure consists of the use of a small 8-mm wide strip of the back of the scalp removed surgically and closed primarily leaving a fine scar inbetween hairs which is completely hidden with no areas of alopecia. This strip in dissected under magnification into hair folliclular units which are then implantated into the desired ares thourgh small slits in order to leave no scars.

The procedure in performed under local anesthesia in 2 stages, the first is about 25-30 minutes long in which the scalp strip is harvested after which the patient is transferred back to his room. Follicule dissection takes around 3 hours after which the patient in invited back to the operating roon, where local aneshesia to recipient area is administered and follicles are implanted.

The area is covered by bandage for 2 days after which bandage is removed and the area is washed gently and left exposed. The scabs covering transplanted grafts should be left undisturbed till they fall spontaneously.

Postoperative Course
Small crusts will form over the grafts and usually fall over the first 2 weeks. The grafts will shed their hairs in 2-6 weeks. New hair growth usually begins 10-20 weeks after surgery and patient should be informed that it would take at least 6 month postoperatively for hair to grow and to give a good idea about the final appearance. The use of 2-3 % Minoxidil solution twice daily for 5-6 weeks postoperatively will often accelerate hair growth.

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