Almost one-third of all men in this country are affected by baldness and thinning of scalp hair, though fewer in number, some women have been affected as well. There are many causes for hair loss including thyroid disease, high fever as a result of severe infection, inadequate protein in the diet, certain medications, cancer treatments, childbirth and birth control pills. Many of these are reversible; however, other types of baldness may be permanent, including those which are a result of operations, accidents, and inflammatory or infectious diseases of the scalp. One of the most common types of permanent hair loss is male pattern baldness. This condition, inherited from either side of the family, starts when a person is in his or her teens, twenties or thirties. While women with this inherited tendency do not become bald, they can develop considerable thinning of the hair. Although many people are unconcerned about hair loss, others are distressed and look for ways to remedy the condition.
Hairpieces are a good solution for some, while others find them unnatural looking or difficult to maintain. New products on the market that claim to restore hair growth have had limited success. Today, however, several surgical procedures can provide a permanent solution for those who are bald or have thinning hair. Hair transplants or grafting, is a procedure which produces very favorable, permanent results for many people. Hair flap surgery is another technique that has had good results, as well as scalp reduction procedure.
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Hair Transplant Surgical Procedure
Hair transplant or hair grafting is a surgical procedure in which strips of hair-bearing skin are taken from the back of the scalp, dissected into smaller sections and transferred to the bald area on the head. The cosmetic surgeon carefully examines both the area from which the grafts are to be taken (donor site) and the area to receive the grafts (recipient site) to see if they are compatible. The patient’s type and pattern of hair loss are evaluated. The cosmetic surgeon and patient discuss how the hair should look in order to produce a satisfactory, natural appearance. Photographs are often taken to help the cosmetic surgeon plan the appropriate procedure to use. Blood tests may be taken to determine whether there are medical conditions such as bleeding or clotting defects that might make surgery inadvisable. Pre-operative instructions may include the elimination of drugs containing aspirin or aspirin-like product in order to minimize the possibility of excess bleeding.
Immediately before hair restoration surgery, the donor hair may be cut very short and cleansed with a special solution. A local anesthetic is applied to the donor site and a strip of skin containing hair and hair follicles is removed. This procedure could be done under IV conscious sedation while the patient is sleep.
This strip is then cut into minigrafts, (4-6 hairs) micrografts (2-3 hairs) or single hair grafts which are used to refine the hairline. The recipient site is similarly treated and the donor grafts are carefully placed in a pattern that matches the direction of the original hair. The hair grafts are placed in such a way as to allow each graft to receive an adequate blood supply during the healing process. Rarely sutures and/or bandages are used which are removed within a few days.
Following the procedure, the patient is required to wear a protective bandage overnight. Patients may experience a moderate amount of discomfort which is controlled with oral medication. Risks and complications are rare because only the outer layer of the skin is involved. Some swelling and bruising around the eyes may occur two to three days after surgery. Using eye compresses and sleeping in a semi-reclining position can minimize these problems. Numbness around the donor and recipient sites is common and will diminish within two to three months. Scabs may be present on the hair grafts for seven to ten days. Small scars remain but are hidden within the hairline.
About six weeks after hair restoration surgery, the hair begins to fall out. Approximately three months later, new hair appears and grows at about the same rate as it did in its original location, about one-quarter to one-half inch a month. One to three months later, the spaces between the new hair implants are filled in with new grafts. Several treatment sessions may be necessary and patients who want to achieve greater density or refinement of the hairline often return for additional hair transplants. The end result is a hairline similar to the patient’s original one. In some cases more than one hair transplant session may be required to obtain a good density of hair.
Another surgical procedure designed to reduce the amount of bald skin on the head is scalp reduction, often done in conjunction with hair transplants. Scalp reduction is a procedure which involves the removal of bald skin from the top of the head and is particularly well-suited for those with extensive hair loss. This procedure may reduce significantly the number of donor grafts needed to cover the area.
As with hair transplants, a local anesthetic is given and an incision is made, usually on the top center of the head, from the front to the back. Skin is loosened from the underlying tissue and excess skin is removed. The remaining skin on both sides is stretched gently over the midline area and the edges are sutured together. These sutures are removed in seven to ten days. Any discomfort or headache due to the incision is controlled with oral medication. A mild tightness of the scalp may be felt for one or two weeks following surgery.
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