How is a hair transplant done?
Hair transplantation is based on moving the hair from the occipital area, where the follicular units are genetically more resistant to the action of androgens (donor area), to the area affected by alopecia (recipient area). But not everyone is suitable for this type of intervention. First of all, not all alopecia can be transplanted. The main indication for hair transplantation is androgenetic alopecia. The limit in this case is always set by the donor area. In patients with very scarce donor areas in relation to the degree of alopecia they present, surgery should be discouraged. The strongest, thickest, and most dense hair is the one that behaves best and, of course, the extraction will be better and the sensation of coverage when covering the receiving area will be greater. During the preoperative period, the patient must follow the guidelines that we give them prior to surgery, which include instructions such as reducing sports, tobacco, alcohol, and caffeine consumption. However, we ask that you do not shave your hair before surgery. The donor area is generally shaved in the clinic depending on the recipient area and the type of surgery you need..
A hair transplant is a procedure that generally lasts between 6 and 8 hours. It is a procedure that does not require admission, and the medical recovery is fast. We recommend patients postpone their socio-labor activities for approximately 14 days after the operation.
In our cases, we use local anesthesia. The patient may present numbness or decreased sensitivity in the grafted area and eventually in the donor area, up to 3–4 months after the surgery is performed, which will gradually recover. Speaking of whether it hurts or not, it can be said that you don’t feel anything. The only time that patients report discomfort is during the anesthesia process, which lasts approximately 10 minutes and for which we previously apply “pre anesthesia” to further reduce the discomfort that it may cause. During the postoperative period, it is common to develop a little frontal edema—that is, the inflammation goes down to the eye area during the first 3–4 days. But as of the second week, you can return to work activities (depending on the job you perform, of course).
In androgenetic alopecia, it is estimated that the degree of survival of micrografts is greater than 90%. However, the outcome of the intervention procedure is dependent not only on the clinic, the surgeon, and the team, but also on the patient himself, and whether he respects and correctly follows the pre- and post-operative guidelines.
In our case, the idea is that we do not have to do more than one session to achieve the goal. We can assume to carry out interventions of a large number of follicular units in a reasonable period of time, so we will always do the largest possible extraction in a single session to avoid further disrupting the patient’s life with what it entails facing the entire process twice.
FUT technique consists of extracting a strip of skin from the occipital region, from which the follicular units are isolated and later implanted individually. It is the fastest and cheapest technique, and it is not necessary to shave the patient’s hair, although it does leave a visible scar if the hair is very short. FUE technique consists of extracting the follicular units one by one from the occipital region using a micromotor with small 0.7-0.9 mm punches. This technique requires shaving the patient, although it has the advantage that it does not leave any type of visible scar. Likewise, it allows us to obtain a greater number of follicular units. DHI, on the other hand, is not an extraction technique; it is an implantation method. The implantation can be done through incisions previously made with sapphire, which will require the hair to be implanted one by one using tweezers, or through implanters, which are hollow-point devices that make both the incision and the implantation.
There is no defined age limit for performing this surgery, but it is recommended to wait at least until 22–25 years old, the age at which alopecia will have already appeared. The essential thing is to keep in mind that the micrograft is not a curative treatment; that is, the rest of the patient’s native hair must be cared for with medical treatment to prevent it from falling out and stop the alopecia process.
Once we have passed the most immediate postoperative period, the recipient area enters a stationary phase of about 4 months in which it presents a very similar appearance to the one it had before surgery. From then on, the growth will be progressive and exponential for a year. It is from 5–6 months when the new follicles begin to grow and the patient sees how their density increases progressively, and the final result will be seen 1 year after the surgery.
The surgery is outpatient and does not require admission. They can sleep at home without any problem. However, in our case, as the patient usually travels from other provinces, they have a hotel night available that is included in the cost of the surgery. During the first few days, they should sleep at an angle of approximately 45º and with a cervical cushion that we provide them at the time of discharge. It’s true that many patients feel safer sleeping sitting up on the couch, but it really isn’t necessary. Sleeping in a semi-recumbent position would be enough. It is not recommended to do any type of sport, it should be avoided until one month after the intervention. After 15 days, light to moderate physical activity that does not involve sweating can be resumed. Keep in mind that sweating can increase the risk of infection, increase erythema and itching, and slow down the healing process. And the last sports that we can do will be those that involve aquatic environments, such as swimming, since chlorine can be harmful. As for sunbathing, the patient should be careful in the sun for at least the next 6 months after the intervention. We must remember that it is a scar, and as such the area with erythema could become permanently hyperpigmented in addition to compromising the viability of the transplanted follicular units.
After 10 days, a loose cap can be used occasionally without it touching the grafted area in any case. After a month, it can be covered with normal caps to avoid direct sun exposure, but it is preferable to avoid doing it for long periods.
We always warn that it is important to avoid alcohol and caffeine, as well as to stop smoking or reduce the consumption of cigarettes as much as possible from the previous 7 days. These substances increase bleeding, which makes it difficult to perform the technique properly during the micrograft. Likewise, they can interfere with the success of the surgery, delaying the healing process or favoring infections.
The basis of treatment for androgenic alopecia is 5-alpha-reductase inhibitors, both in mesotherapy and orally, and minoxidil. Minoxidil has been used topically for years, but one of the great novelties in the treatment of androgenic alopecia has been its introduction orally, since it has been shown that its efficacy and therapeutic adherence are greater by this route. Currently, there are also other drugs that are being studied and have been starting to be used for a few years, such as bicalutamide, prostaglandins… On the other hand, we can find other treatments that we could call second-line, which do not directly treat the alopecia, but serve to strengthen the hair and stimulate its growth, such as biostimulation with platelet-rich plasma.
Can grafting be done on the eyebrows?
We are at a time when beard and eyebrow grafting have been becoming more and more popular and are highly requested, especially by women (eyebrow grafting). It is quite common to lose the hair on the eyebrows due to excessive hair removal, the development of alopecia or simply over the years, and it affects the expressiveness of the look. In the case of beards, they allow us, through a minimally invasive procedure, to correct bald spots in areas with a lack of density. Once the postoperative period has elapsed, the patient can lead a normal life. He will be able to outline his beard, shave it or let it grow as if it had always been there.
Do women also apply for hair transplant?
In women, the proportion affected by androgenic alopecia (which is the optimal candidate for hair transplantation) is lower than in the case of men, but hair transplantation can be done in both women and men. The important thing is that it is suitable for the intervention. Before considering an intervention, it is essential to carry out the correct diagnosis and treatment of alopecia. However, most of the women who come to the consultation do so due to efluvium problems (intense hair loss that occurs in a timely manner), and in this case, an intervention is not necessary, but we do resort to various medical treatments to help the recuperation. The procedure is the same for both men and women. However, most women tend to prefer the no-shave implantation technique using DHI. But, is it the transgender group that demands transplants more frequently? The truth is that we find transsexual women who suffer from a process of androgenetic alopecia that is not very advanced and wish to be treated to prevent its progression as well as to surgically redo the first line and close the receding hairline. On the other hand, it is more and more frequent in the case of transsexual men who, due to hormonal treatments, resort to micrografting to treat the problem of alopecia that it generates.
Which clinic to choose for a hair transplant?
The objective of hair implant surgery is, mainly, to obtain successful aesthetic results. To achieve this, it depends on the skill of the medical team, hygienic facilities dedicated exclusively to hair grafting, and the use of the most innovative and effective techniques of the moment. It is also important to have everything necessary for patients to be comfortable, safe, and entertained during their surgery, since interventions last from 8 to 10 hours. At Estexper Clinic, we have high-resolution televisions with streaming platforms and a private rest room for patients, among others. And finally, a capillary graft does not end when the surgery is over, but rather the patient must comply with the postoperative period until medical discharge one year after the intervention, so the clinic must offer medical check-ups, clinic cures, post-operative products and pre-surgery, diagnoses and prescriptions, and the facility to contact the hair advisor at any time.
