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What is Hair Transplant; Methods & Procedure

Hair transplant is a surgical technique to solve the problem of baldness permanently by moving hair follicles from a part of the body to bald part of the body. It is primarily used to treat male pattern baldness. It is a minimally invasive procedure without any risk or side effects. Grafts containing hair follicles that are genetically resistant to balding, like the back of the head, are transplanted to the bald scalp.
Hair Transplantation can also be used to restore eyelashes, eyebrows, beard hair, chest hair, pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplant. Through modern hair transplantation techniques, and efficacy in our Indian surgeons in the field of hair restoration now India becomes the hub for the hair transplant surgery. The natural beautiful or handsome look can be re-achieved with well grown and dense hair on head.

Procedure and techniques
Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia, which typically last about six hours. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested.
There are several different techniques available for the harvesting of hair follicles, each with their own advantages and disadvantages. There are two main ways in which donor grafts are extracted today: Strip Ecision Harvesting, and Follicular Unit Extraction. Nowadays the follicular strip excision via FUT becomes more relevant technique of hair transplant in order to perform more aesthetic transplant surgery. In India these facilities are available at an affordable cost with the expert surgeon.

Strip harvesting (FUT)
Strip harvesting (FUT Hair Transplant) is the most common technique for removing hair and follicles from a donor site. The surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. A single-, double-, or triple-bladed scalpel is used to remove strips of hair-bearing tissue from the donor site. Each incision is planned so that intact hair follicles are removed. The excised strip is about 1–1.5 x 15–30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts, which are small, naturally formed groupings of hair follicles, from the strip. Working with Binocular Stereo-microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting. The latest method of closure is called ‘Trichophytic Closure’ which results in much finer scars at the donor area.

The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place.

Strip harvesting will leave a “pencil thin” linear scar in the donor area, which is typically covered by a patient’s hair even at relatively short lengths. The recovery period is around 2 weeks and will require the stitches/staples to be removed by medical personnel or sub-cuticular suturing can be done. The Indian surgeons now become able to perform the procedure with minimal damage and great outcomes in terms of the greater number of viable hair roots with the aid of 20x magnification of the microscope as a result of revolution in technologies and expertise in the field of hair transplant.

Follicular unit extraction (FUE)

With Follicular Unit Extraction or FUE harvesting, individual follicular units containing 1 to 4 hairs are removed under local anesthesia; this micro removal typically uses tiny punches of between 0.6mm and 1.0mm in diameter. The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place.
FUE takes place in a single long session or multiple small sessions. The FUE procedure is more time consuming than strip surgery. An FUE surgery time varies according to the surgeons experience, speed in harvesting and patient characteristics. The procedure can take anywhere from a couple hours to extract 200 grafts for a scar correction to a surgery over two consecutive days for a mega-session of 2,500 to 3,000 grafts.
With the FUE Hair Transplant procedure there are restrictions on patient candidacy. Clients are selected for FUE based on a fox test, though, there is some debate about the usefulness of this in screening clients for FUE.
FUE can give very natural results. The advantage over strip harvesting is that FUE harvesting negates the need for large areas of scalp tissue to be harvested, so, there is no linear incision on the back of the head and it doesn’t leave a linear scar. Because individual follicles are removed, only small, punctuate scars remain which are virtually not visible and any post-surgical pain and discomfort is minimized. As no suture removal is required; recovery from Micro Grafting FUE is less than 7 days.
Disadvantages include increased surgical times and higher cost to the patient. Some surgeons note that FUE can lead to a lower ratio of successfully transplanted follicles as compared to strip harvesting. Others also suggest that in case a patient would need more than one transplant, it would be difficult to find a good strip after an FUE.
Robotic Hair Restoration is another innovative device in the field of hair restoration. The robot allows detection of the follicular units and its topography with several cameras. The images from the cameras can detect the location, distribution, and the angulations of the follicular grafts. The robotic arm has been able to increase the speed of graft extraction and minimize the exhaustion of the surgeon during an FUE transplant. Despite the advantages of robotic hair restoration systems, there are still some disadvantages such as the size of the punches being relatively large in comparison to what is used in other methods of FUE and the high price of the device.
FUT and FUE Comparison
The hair transplant involves two essential techniques – FUT and FUE. The major difference between two methods exists in the way of extraction of follicle units.
FUT includes extraction of follicles through strip method, under this a strip in scalp with hairs is taken from the backside by which the hair follicles are taken. On the other hand, FUE includes extraction of individual follicular units straightforwardly from scalp.
The prevailing advantage of both methods is the extraction of little group of natural hair which are called follicular units. These anatomical groups comprise of one to four hairs. The extraction technique is very crucial and significant factor in any kind of hair transplant. The emphasis is not on ripping several grafts off, instead only the healthy hair roots as they have a significant role in describing the root of graft.
In FUE, the punch needle size is very important to limit the risk of damage to the donor area. Before implementation FUE needs more intense and time consuming practice than FUT.
Both FUE and FUT also differ in the extent of scarring space left in the donor place. FUT leaves a fine linear scar on the backside of head, on the other side; FUE leaves only tiny scars which look like dots.
Grafts received through FUE are extremely sensitive to dehydration even more than those received through FUT.
Based on the size of area where transplantation needs to be done, 1000 to 5000 follicular units are needed often. FUE and FUT both offer the great results in the ideal conditions.
Transplantation performed under the local anesthesia while using FUT causes a stress in scalp. It is although, very nominal and fades away in a couple of days. On the other hand, FUE treatment doesn’t cause any pain and offers faster healing. FUT causes a deadening feeling which is however of short term and it may last for a few months. In FUE, nothing happens like this.

Post-operative care
Advances in wound care allow for semi-permeable dressing, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have the patient shampoo the day after surgery. Shampooing is important to prevent scabs from forming around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.
During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out. This is referred to as “shock loss”. After two to three months new hair will begin to grow from the moved follicles. The patient’s hair grows normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.

Side effects
Hair thinning, known as “shock loss”, is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day. Post-operative hiccups have also been seen in around 5% of transplant patients.
Other side effects include swelling of areas such as the scalp and forehead. If this becomes uncomfortable, medication may ease the swelling. Additionally, the patient must be careful if their scalp starts itching, as scratching will make it worse and cause scabs to form. A moisturizer or massage shampoo may be used in order to relieve the itching. It is a quite worthy decision to take the procedure in India with expert surgeons that fulfils your desire and expectations of having a head full of hair as a natural and an aesthetic outcome of hair transplant.


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