Hair Transplantation Procedure: A Comprehensive Guide
Hair transplantation is a surgical procedure that involves harvesting hair follicles from a donor area and implanting them into areas of hair loss, with follicular unit transplantation (FUT) and follicular unit extraction (FUE) being the two gold standard methods currently used.
Types of Hair Transplant Procedures
Follicular Unit Transplantation (FUT)
- Involves excision of a strip of tissue from the occipital donor area
- Requires suturing, resulting in a linear scar
- Allows harvesting of large number of grafts in one session
Follicular Unit Extraction (FUE)
- Involves harvesting individual follicular units directly from the scalp
- No linear scar (only tiny punch marks that heal)
- Requires greater skill but can yield excellent results in experienced hands 1
- Currently considered state-of-the-art alongside FUT 2
Pre-Procedure Considerations
Patient Selection
- Primarily indicated for pattern hair loss in males and females
- Can also be used for selected cases of scarring alopecia and eyebrow/eyelash restoration 3
- Caution should be exercised in:
- Very young patients with evolving alopecia
- Patients with advanced hair loss (Norwood grade VI or VII) with poor donor density
- Patients with unrealistic expectations
- Patients with significant systemic health problems 3
Pre-Procedure Testing
- Complete blood count including platelet count
- Bleeding and clotting time (or PT/aPTT)
- Blood chemistry profile including glucose 3
- In female patients: additional tests to rule out underlying causes like anemia or thyroid dysfunction
The Procedure
Anesthesia
- Typically uses 2% lidocaine with epinephrine in a tumescent technique 3
- For larger or more complex procedures, infiltrative anesthesia may be combined with tumescent local anesthesia 4
- Maximum safe dose for adults: 4.5 mg/kg of lidocaine or 7.0 mg/kg of lidocaine with epinephrine 4
Donor Area Harvesting
FUT Method:
- Strip dissection by single blade is recommended 3
- Careful closure to minimize scarring
FUE Method:
- Individual follicular units extracted using specialized punches
- Requires greater precision and time
Graft Preparation
- Stereomicroscopic dissection is recommended for follicular unit transplantation 3
- Careful handling and preservation of grafts in appropriate holding solutions to ensure survival
Recipient Site Creation
- Careful planning of hairline design is essential
- Creation of recipient sites at appropriate angles and density
- Minimum density of 35-45 units per square cm is recommended 3
- Implantation of grafts into recipient sites
Post-Procedure Care
Immediate Post-Op Care
- Mild analgesics for pain management
- Antibiotics may be prescribed to prevent infection
- Specific instructions for washing and handling the transplanted area
Recovery Timeline
- Initial healing: 7-10 days
- Shedding phase: 2-4 weeks post-procedure (temporary)
- New hair growth begins: 3-4 months
- Proper hair growth can be expected after about 9 months post-transplantation 3
Potential Complications
Hair transplantation is relatively safe but possible complications include:
- Bleeding and infection
- Scarring
- Poor graft survival
- Unnatural appearance
- Shock loss (temporary loss of existing hair)
- Most complications are avoidable with proper surgical technique and wound care 5
Adjunctive Treatments
Medical Therapy
- Most patients will need concurrent medical treatment since pattern hair loss is progressive 3
- First-line treatments include:
Platelet-Rich Plasma (PRP)
- Can be used as an adjunct to hair transplantation
- Recommended protocol: 3-5 sessions at monthly intervals
- Dose: 5-7 mL PRP (0.05-0.1 mL/cm²) per session 4
Follow-Up and Evaluation
- Baseline photos should be taken before starting treatment
- Evaluation at 3 months for initial response
- Critical evaluation at 6 months
- Comprehensive assessment at 12 months to determine if additional procedures are needed 6
Important Considerations
- Hair transplantation is a team effort requiring well-trained assistants, particularly for large sessions 3
- Results depend on donor characteristics, technique used, and individual skills of the surgeon 3
- Patients should have realistic expectations about outcomes and timeline for results
- The procedure should be performed by a qualified physician with specific training in hair transplantation 3
Hair transplantation has experienced increased popularity due to advances in techniques and devices, leading to natural-looking results and high patient satisfaction when performed correctly 2.