Hair Transplantation
Should I have get a hair transplant? Which technique should I choose (FUT or FUE)? Will the result look natural? How many grafts can be transplanted per square centimeter? What is micro motor? Will I have swelling in my face? Is laser therapy used in hair transplantation?
Most people who have an interest in hair transplantation are confused with similar questions after doing some research on the subject. Along with the answers to these questions I will try to present my professional experiences about hair transplantation in an easy to understand manner and also summarize this very broad subject.
First of all you should know that you can not regain your original hair density with hair transplantation. There are two reasons for that:
* Why do people have hair transplantation?
When the correct technique is chosen, hair transplantation is hardly noticeable by untrained people. Reaching 50% of your original hair density is enough to change your appearance entirely.
* Would I be satisfied if I have hair transplantation?
First of all you should ask yourself this question “What are my real expectations from having a hair transplantation procedure?”
If you are expecting to have a hair density as when you were 18, or to cover a very wide area completely, you should not have hair transplantation.
On the other hand, if your expectation is to look natural without any signs of transplantaion surgery, you can easily achieve this via newly established techniques. The unnatural looking results, seen in the early days of hair transplantation, nowadays are not observed as much with the choice of an appropriate method.
It is your PHYSICIAN, who will evaluate your expectations and the status of your hair to check if it meets these expectations. Specifically, the tests and hair analyses, you donor area status and density, the contrast between your hair and skin color, your hair thickness and texture (wavy/straight), your blood circulation status, your donor area elasticity , the estimation of future hair loss pattern, will help your doctor to determine if hair transplantation meets your expectations.
The trickiest part of hair transplantation is to evaluate the planning and the donor area while taking into account possible hair loss profile scenarios that can happen with in the next ten years. With repeated sessions it might be possible to increase the existing density, or to compensate the potential hair loss in the future.
* Which techniques are used in hair transplantation?
In all the centers working on hair transplantation there are two main techniques being widely used today.
Most of the well-known hair surgeons and centers use both techniques, but both techniques have their advantages and disadvantages.
* FUT
FUT (Follicular Unit Transplantation) took its name from a journal paper published by a group of hair surgeons in 1998, even though it started with microscopic dissection methods by Dr. Bobby Limmer that took place in 1988. It is still accepted as the “golden standard” of the hair surgery techniques in the hair surgery congresses.
With the help of the elasticity of the occipital back region called donor area after surgically removing a strip of tissue with a width of 10 – 15 mm and a length of 10 – 20 cm the wound is closed with stitches. The elasticity of the skin, hair density, and the required number of follicles determine the length and the width of the removed tissue. According to the structure of the skin, a 3-5 mm wide surgical scar remains in the stitched area. The scar is not visible unless the hair is very short.
The excised tissue is separated into hair follicles called ‘’grafts’’ with microscopic dissection and then these grafts are transferred in to the desired areas under local anesthesia [1].
* What is “Trichophytic Closure”?
It is a special surgical technique that leaves a thinner scar on the scalp. With this technique, hair follicles can also grow in the scar tissue and so the stitches are masked [2].
* FUE
It is first defined in Masumi Inaba and Rassman’s studies in the mid 90’s.
In FUE technique, the hair follicles in the donor area are extracted one by one with the help of extremely thin punches. According to the hair follicle thickness, the diameter of the punches can be chosen as 0.7 mm, 0.8mm or 0.9 mm.
Since the extracted grafts are rather thin, it is possible to make a denser transplantation compared to FUT technique (70 – 80 FUs/cm2). But since the dermal structures, which support the follicle, are thinner compared to the FUT technique; the success rate (growth rate) in some individuals is 10 – 15% lower.
According to my professional experience I think the optimal density to be applied should be 50 grafts/ cm2. I believe when this density is exceeded the blood circulation would not be sufficient for all grafts and so the success rate would go down.
Since very thin punches are used, FUE technique leaves dot like marks in the donor area that can only be noticed when looked very closely. Therefore a person who had hair transplantation with FUE technique can shave his hair in subsequent years with almost not worrying about scars being noticed [3].
* What is “Dense Packing”?
It is the name given to the situation; when follicular units are transplanted in a higher density than 35 per square centimeter (35 FUs/cm2). The majority of hair surgeons do not want to exceed 25 follicular units per square centimeter (25 FUs/cm2) due to technical difficulties and risk of low success rate.
* What is a micromotor?
It is an electrical device with high rotational speed, which is also used by dentists.
Recently, micromotor usage has become popular in FUE technique, since they are capable of faster extraction of the hair grafts.
Hair follicles after entering the skin change their direction with a slight angle. It is possible to sense this angle using a light punch. But it is harder to sense this angle since the micromotor is heavy. Furthermore, I observed that micromotors due to their fast rotation, damage the near by follicles and causes wider scars and acne formation. Therefore; even though it takes less time to finish the work with a micromotor, personally I prefer to use the manual punch method.
* How many grafts could be extracted and transplanted via FUE technique in one day?
It is technically possible to extract and transplant 2000 grafts in a day without using a micromotor. But for extracted hair follicle not to stay out of the body in a graft solution for more than 4 hours.
I am limiting the number of grafts to 1200-1400. But if desired, a 2500-graft FUE operation can be performed in 2 sessions leaving a rest day between sessions.
* What kind of solution do you keep the grafts in?
Although the studies show no significant difference within the first 6 hours, between special solutions and saline solution for keeping the grafts; I think Ringer Lactate solution at +4 oC gives better results.
* Which technique should I choose? FUT or FUE?
This is one of the most frequently asked questions. The answer depends on the size of the hairless area, elasticity and the hair density of the donor area, and the estimation of the future frontline regression.
Both methods could be used in turn, in order to force the capacity of the donor area and to extract more grafts. Briefly, if you are not afraid to have a surgical operation and you are not planning to shave your hair in the future, FUT is the optimal choice for you, since it takes less time and it is more economical. But if you are reluctant to have surgery, or there is a possibility of further hair loss and your donor area might be reaching its limits, FUE technique can be a better choice. My personal advice on this matter is that you should make your decision after consulting your physician.
* Can both technique cause swelling?
Swelling can develop due to sensitivity of the skin, and the fluid injected beneath the scalp. It may develop in both techniques. It is mostly noticeable 48 hours after the hair transplantation operation, and after being noticed it goes away in 3 days. Swelling is observed in every 3-4 patients out of 10 who have undergone hair transplantation. This is a painless period and a natural process not to be concerned about.
* What is Low Level Laser Therapy?
It is a support-therapy that speeds up the healing of the wound after hair transplantation. Stabilizing the blood circulation it helps to reduce the inflammation time.
