Commonly, hair transplantation is the dermal transplantation of follicles from the posterior scalp -which hair follicles are genetically resistant to balding- to the anterior scalp where hair is expected to grow.
As the plastic surgeons, we have been performing hair restoration surgery and hair transplant procedures with an increasing experience gained in more than thirty years.
First of all, hair transplantation should definitely be performed by Aesthetics and Plastic Surgery specialists and Dermatologists.
Nowadays, It’s heard that in some clinics, nurses or some allied health personnel are performing tasks similar to those of nurses undertake the job of a surgeon and perform the operations. Those titles like “hair transplantation specialist”, “fast tissue harvesting technician” or “fast tissue harvesting nurse” are just fabricated titles for this purpose.
A direct intervention on the patient by a nurse or allied health personnel is both inconvenient to health and illegal. Hair transplantation nurse, healthcare technician or cosmetician are not allowed to perform hair transplantation. It should be noted that the damage caused by such inadequate is irreparable.
In the simplest sense, the main function of hair follicles is to produce hair. This is the most prior benefit we are interested in. A hairy head is a highly significant cosmetic unit for our appearance in public.
The first treatment step we resort to upon hair loss is trying to trigger the hair follicles to produce hair again through medical treatments, or having hair transplantation. And what we need for this procedure is the professional recommendation of a specialist surgeon.
Why should hair transplantation be performed by a plastic surgeon?
The answers of this question can be listed under various headings like:
– Medical training
– Microsurgery training
– Specialization on hair transplantation
– Combining science and aesthetics in hair transplantation
The oldest belief is that the only function of hair is preventing heat loss. However, especially according to the improvements in molecular biology procedures, our increasing knowledge revealed that hair follicles have significant roles in a great deal of dermal mechanisms. Hair follicles act as an important source of stem cells which enable wound healing in addition to the hair growth. The hair follicles are under the control of androgenic hormones, thyroid gland, and your nutritional status. Any disorder in these systems can cause hair loss.
A physician has the training to maintain a holistic approach to growing and shedding of hair, and hair transplant. Before a hair transplant procedure, the physician takes a holistic approach towards their patient and finds out if the patient has an underlying health problem. The exact cause of hair loss must be uncovered before hair transplant.
The surgeon who is going to perform hair restoration should be a physician who can take a holistic approach towards a patient. For to have successful results, a plastic surgeon who is particularly specialized in hair and has the technical skills required for the hair transplantation operation is needed.
The specialist surgeon to perform the hair transplantation operation should have detailed knowledge of the anatomy and physiology of hairy skin and hair follicles because a hairy skin is not limited to the zone on which hair grows, and has a physiologically active and complex anatomy.
The specialist physician to perform the hair transplantation operation should also have detailed knowledge on hairy skin flushing, vascular structure, lymph drainage, hairy skin biomechanics and wound healing.
Scientific knowledge and impeccable surgical technique comprise the two bases of the triad of hair transplantation. The third base is the essential aesthetic approach. Medical knowledge, surgical experience, and aesthetic decision-making skills turn the whole hair transplantation process into art. Plastic surgeons can achieve a medically and aesthetically satisfying hair transplantation results by combining scientific knowledge, excellent surgical technique, and a competent sight.
The answer is definitely yes. After the transplantation, the body not perceives the transplanted hair as a foreign object and wouldn’t reject it as a result because the hair harvested from the donor site and transplanted to the recipient site belongs to the patient.
Transplanted hair also maintains its own characteristics and survives on the transplantation. Besides, the transplanted hair grows by maintaining such characteristics related to its color, pace of growth and curliness.
The results of hair transplant are permanent. The hair follicles transplanted in the operation are genetically resistant to the impact of testosterone that triggers hair loss. Because of that, the transplanted hair survives on the site for a lifetime. If the transplanted hair would later be lost, it would not be useful to have a hair transplant.
In applying of hair transplant, hair follicles (follicular unit) are transplanted. Hair follicles are anatomic structures and each unit can contain single, double, triple or more hairs. As these structures show anatomical integrity, using hair follicles in hair transplant contributes to a natural, aesthetical and efficient result.
In hair transplantation method, hair follicles (follicular unit) are harvested from the posterior scalp between the ears where hair is especially dense and resistant to shedding. Therefore the transplanted hair does not shed and a permanent result is attained with hair transplant.
The amount to be transplanted in hair transplant represents the number of hair follicles.
The number of hair shafts can exeed twice the number of follicles. In this sense, it can be confusing that to offer the patient a number for hair shafts before the hair transplant. Considering that each hair follicle (follicular unit) contains more than one hair shaft, transplantation of 3000 hair follicles means that 8000 to 10,000 hair shafts are being transplanted.
Hair follicles to be used for hair transplant are obtained from the posterior scalp between the ears. These follicles are genetically resistant to shedding. They survive on the transplantation site for a life time and they grow hair.
FUE hair transplant technique is the most commonly used method. It is also popularly known as the “new technique”. Hair follicles are individually removed in their anatomic integrity from behind the posterior scalp by microsurgical technique and they are individually reinserted to the recipient site. On the other hand, with the FUT hair transplant method, the follicles are removed from the hairy skin between the two ears as a narrow strip. This leaves a narrow scar concealed on the hairy scalp. FUT hair transplant is popularly known as the “old technique”.
FUE hair transplant has some advantages; it does not leave a permanent scar, the donor site is used more efficiently and post-operation period is more comfortable for the patient.
FUE has been globally approved and it is being performed since 2003.
Ozge Ergun, MD have been performing FUE hair transplantation technique since 2004. By FUE technique, up to 4000-4500 hair follicles can be inserted during a single session in a single day.
Every single healthy individual with an adequate number and quality of hair on the site of the posterior scalp called the donor site can undergo a hair transplant operation as long as they have appropriate expectations from the procedure.
Those people who do not have an adequate number and quality of hair on the donor site should not undergo a hair transplant operation. Particularly those individuals who are experiencing the beginning stages of hair loss and whose hair does not show an apparent thinning should not have hair transplant. In such cases, medical treatment should be tried first.
Hair transplant causes no labor loss; the patient can return to work in 1-2 days after the operation. On the recipient site, punctate red scars and thin scabs form at the bottom of the transplanted follicles that last 7 to 10 days. In 10 days, the intensity of these thin scabs rapidly decreases to one tenth compared to the first day. The redness fades from the third day on after the procedure. When FUE method is used, the hair on the donor site grows long enough to cover the site of extraction by tenth day after the operation.
An exactly normal appearance is achieved after the 10th day. Hair transplant operation does not require any long-term post-operation care.
You can start to swim in the pool or sea and use the sauna from the 10th day on after hair transplant.
Immediately after hair transplantation, you can start to go for a short walk or do physical exercises that do not make you sweat. You can start to do heavy sports after 10 days. But you should take care to avoid severe strokes on the donor site for 2 months while doing heavy sports. For instance, you should not make a headshot while playing football.
Hair transplant causes no labor loss; the patient can immediately return to their work and social life. There will just be mild redness and thin scabs at the bottom of the hair shafts on the recipient site, which will be visible for 7-10 days.
Yes; the hair follicles should be visible just on the surface of the skin in order to be able to extract them individually without any problems. This requires a grade 1 haircut. However, if hair thinning is observed in a limited area and if a small number of hair follicles are required, you may not need to have your whole hair cut. The hair on the donor site is cut as narrow strips, and as this site is covered by the long hair shafts immediately above, the area which is cut is not visible.
Nowadays, it is more and more heard that in some clinics, nurses or those allied health personnel who perform tasks similar to those of nurses undertake the job of a physician and perform the operations. The titles such as hair transplantation specialist, fast tissue harvesting technician, fast tissue harvesting nurse are nothing more than fabricated titles for this purpose.
No hair transplant nurse, healthcare technician or cosmetician is allowed to perform hair transplant. A direct intervention on the patient by a nurse or allied health personnel is both unfavorable to health and illegal. It should be noted that the damage caused by such malpractices is irreparable.
The duration of the operation depends on the patient’s specific needs and the number of the hair follicles to be transplanted. While the transplantation of 1000 follicles may be completed in 2 to 3 hours, the operation may take 6 to 7 hours for 4000-4500 follicles.
If the patient has an adequate donor site and if the plastic surgeon to perform the operation has experience in the field, up to 3500-4500 hair follicles can be extracted during a single session. While technically possible, it is not recommended to extract more than this number. When these numbers are exceeded, the efficiency of the donor site decreases.
The redness and the thin scabs which appear immediately after hair transplant disappear within the first 7-10 days and the person regains their normal appearance. The transplanted hair starts to fall out approximately during the sixth week following the operation. It should be noted that this is a normal and temporary situation. You may have concerns during the first three months when you recently start to see the results. But with a little patience, you will see that your hair will begin to grow rapidly and your concerns will disappear. The transplanted hair begins to appear within the first three months, and gradually increasing with every passing month, hair continues to appear for up to 1 year. The final result is obtained at the end of 1 year after which much change should be expected.
Hair surgery techniques are safe techniques in general, especially if performed by an experienced plastic surgeon. As a matter of course, patients differ to a great extent in terms of their physical conditions and their capacity of recovery; therefore, the result cannot be exactly predicted.
Hair transplant gives permanent results. Nevertheless, a second hair transplant operation may be needed in some cases. It may be needed in order to:
- achieve the desired result in cases of continuing rapid hair loss due to androgenic alopecia,
- achieve a natural appearance by a corrective operation for those patients who have had a prior hair transplant with the old techniques,
- achieve a density of hair nearly as abundant as the original hair for those patients who desire such a result,
- correct or shift the hairline for the aim of moving it forward or backward in accordance with the patient’s age,
- provide a hairy scalp on those sites where no prior transplantation has been done.
Another version of this question may be: “We both had the same number of hair follicles transplanted, why does he get a denser result?”
Even of the same age and gender, comparing the hair transplant results of two persons would be like comparing apples and oranges. The most prominent features are the shape of head, and the pattern and extent of hair thinning. But numerous factors have an impact on the results obtained, such as the thickness of hair shaft, the number of hair follicles contained in every hair follicle, the characteristics of hair –whether it is straight, wavy or curly-, color of hair and the contrast between the hair color and the hairy scalp.
Having an equal number of hair follicles transplanted does not guarantee the same results for everyone. Assuming that an equal number of hair follicles are transplanted on an equal extent of site on both of the persons, the person with thicker hair shafts and with a higher number of hair shafts in the follicles will obtain a more satisfying result with a denser hair appearance.
While 4000 follicles with predominantly three thick hair shafts correspond to an average of 10,000 thick hair shafts; 4000 follicles with predominantly a single thin hair shaft correspond to a total of 4000 hair shafts.
Similarly, curly hair shafts give a better impact of camouflage. And as the contrast with the scalp decreases, a denser appearance is obtained; which means, the result of hair transplant with a combination of gray hair and fair skin gives a denser hair appearance compared to a combination of black hair and fair skin.
The plastic surgeon considers these variables before the hair transplant operation and makes the best treatment plan to obtain the desired result. Use of a personalized plan and personalized hair transplant techniques ensure maximum satisfaction regarding the patient’s expectations.
In cases of a convenient hair density on the donor site and a convenient hair shaft thickness, 80-100 hair shafts per cm2 can cover the scalp. The number of hair follicles to give this density of hair depends on the characteristics of the patient. While 30 hair follicles per cm2 are enough for hair transplant performed with those follicles containing predominantly three and four shafts, this number is as high as 40-60 per cm2 with a person whose follicles predominantly contain single or double shafts.
There will be punctate red scars and thin scabs at the bottom of the transplanted hair shafts on the recipient site, which will be visible for 7-10 days. In 10 days, the intensity of these thin scabs rapidly decreases to one tenth compared to the first day. The redness fades from the third day on after the procedure. When FUE method is used, the hair on the donor site grows long enough to cover the site of extraction by the tenth day after the operation.
You will wholly regain your normal appearance within 7-10 days.
The transplanted hair starts to fall out approximately during the sixth week following the operation. It should be noted that this is a normal and temporary situation. Hair starts to grow again from the 5th-6th week on after shedding. You should be patient to get the exact result of hair transplant. In some cases, it may require one year to get the exact results of transplantation.
There will be mild redness and thin scabs at the bottom of the transplanted hair shafts on the recipient site, which will be visible for 7-10 days. After this period of time, others will not notice that you have had a hair transplant operation. If you do not want to keep the hair transplant operation secret, you can resume your ordinary life immediately by the day following the operation.
Hair transplant does not require any long-term care.
Natural appearance is the definition of a successful hair transplant operation. The follicles used for transplantation, a proper insertion of hair follicles, size of the hair follicles and the hair transplant technique chosen are among the determinant factors of a hair transplant operation which achieves a natural appearance.
One of the most significant criteria for a natural appearance is a successful hairline.
It should be noted that it is the plastic surgery specialist to consider all these criteria, do the planning and perform the transplantation. Therefore, the secret of a natural appearance lies with the choices made by a specialist physician who has expertise in hair transplant.
The points among hair shafts for inserting the follicles are incised by microsurgical technique with the help of magnifier equipment. There is no risk regarding this procedure for those patients with an apparent thinning, who have non-hairy scalp large enough among the follicles.
Considering the risk of doing harm to existing hair, hair transplant is not recommended for those individuals who are experiencing the beginning stages of hair loss and whose hair does not show an apparent thinning. In such cases, medical treatments are tried first.
Today, among the hair transplant techniques, FUE technique is the most commonly used one with a proven success. Thanks to the FUE technique, it is possible to achieve natural and aesthetically satisfying results with no scars left. FUE technique also ensures a more comfortable post-operation recovery period.
Regarding the FUE hair transplant, the most important concern of patients is the answer to the question: “Will I suffer any pain during hair transplantation?” Hair transplant operations are among those interventions which provide a high level of patient comfort. Just a mild level of pain is felt during local anesthesia injection at the beginning of the operation, and the rest of the hair transplantation operation after this stage is entirely painless.
In general, post-operation period with hair transplant is painless. Only a mild pain may be felt during the night following the operation, which is easily relieved by pain killers.
The ideal starting point for hair transplant is the early stage when thinning becomes visible but the patient and those people around the patient are not used to that appearance yet. The person should not particularly wait for a total hair loss so that neither the person nor their social environment get used to that appearance. It is possible to have a smooth transition before the person gets to be perceived as having no hair.
The most significant criterion for a successful hair transplant operation is choosing an experienced physician who is capable of performing the operation.
As the donor site has a limited number of hair follicles, it is important not to harm the follicles during extraction. The hair follicles get no harm when carefully and cautiously extracted under microscope, by a plastic surgeon with microsurgery training.
In order to achieve successful results, it is not enough to extract the hair follicles without harming them only; storing the extracted follicles in convenient conditions, making a personalized plan regarding the insertion pattern of the follicles, organizing the canal density and orientation, inserting the hair follicles without harming them, having the hair transplant operation performed by a plastic surgeon experienced in the field, and use of advanced technology are among the criteria required for a successful hair transplant which gives a natural appearance.
One of the most significant criteria for a successful hair transplant performed with an individual experiencing hair thinning is the appropriate patient expectation. A realistic and feasible common ground should be found between what we, as physicians, can provide the patient with and what the patient imagines. Full patient satisfaction is achieved with the hair transplant operations performed by a Plastic Surgeon specialized in the field with those individuals who have appropriate expectations.
FUE hair transplant operation can be divided into three stages.
The first stage consists of the extraction of hair follicles by a plastic surgeon. This stage takes an average of 1-2 hours.
The second stage consists of planning and incising the hair canals. This procedure -also performed by a plastic surgeon- takes 30-45 minutes.
During the third stage, hair follicles are inserted inside the canals opened. And the hair transplantation operation is completed with a proper dressing. This takes 2-3 hours.
Hair is washed on the first day following hair transplant and the patient is taught how to wash their hair gently. This procedure, usually done the next morning, takes 15 minutes. You can travel immediately after that.
No. There is no certain age for hair transplantation. Anybody with an apparent hair thinning can undergo hair transplant. It would be ideal to perform the operation at an early stage before other people further realize the extent of thinning.
We cannot talk about a specific convenient season for hair transplant. It can be performed with the same level of success in every season. But there will be limitations regarding swimming in the sea or pool, and being exposed to sun rays. This may render the operation socially difficult during summer months.
If necessary, hair transplant can be repeated 3-4 times depending on the density and the number of the hair follicles on the donor site.
A second hair transplant can be planned in cases of continuing rapid hair loss, with patients who desire a high density of hair, for the purpose of providing a hairy scalp on those sites where no prior transplantation has been done, and for the purpose of correcting the outcome with those patients who have had an unsuccessful hair transplantation in some other clinic.
The extraction operation is performed completely by microsurgery, with the help of magnifier equipment. Extraction is performed at the level of the hair follicles which falls within the limits of the hairy scalp. Since the operation does not extend beyond the level of the hairy scalp, the tissues located deeper in the head are not harmed.
No permanent scars are left after the FUE hair transplant operation.