Author: Dr Xavier Tenorio
Definitions, objectives and principles
Hair loss is particularly distressing in both men and women.
The advent of micrografts has transformed this surgery. It helps to reduce the impact of intervention and residual scarring.
However, in the field of hair loss, there isn’t a single technique that can be applied to all cases.
The principle of these treatments is always the same: taking hair from the crown region, where hair is never lost, and transposing it into the frontal and tonsure regions.
Currently, four types of techniques can be used:
- STRIP HARVESTING
- TONSURE REDUCTION
- SCALP LIFTING
All these procedures can be combined on the same patient. Each case needs to be properly analyzed and several parameters need to be considered: the extent of hair loss, the softness of the scalp, hair quality and the patient’s expectations. Depending on the patient’s age and the extent of the baldness, the best strategy can be taken for each case. Your surgeon must have experience in all of these techniques in order to provide the best advice for your case.
Before the intervention
A routine pre-operatory checkup is conducted according to standards. If a general anesthesia is required, the anesthesiologist will be seen 48 hours before the intervention at the latest.
No medication containing aspirin can be taken within 10 days preceding the intervention.
Type of anesthesia
Most interventions can be done under a local anesthetic associated with a superficial sedation
The intervention can be done on an out-patient basis, i.e. leaving the hospital on the same day after a few hours of surveillance.
All surgeons use their own technique which is adapted to each case to get the best results.
The most common techniques are:
· MICROGRAFTS: practitioners will take a strip of scalp 8 to 10 cm long and 1 to 2 cm wide from the back part of the head that will be “chopped” into small fragments containing one to three hairs each (in micrografts) or four to eight hairs (minigrafts). Perforations are made in the balding area where the grafts will be implanted. A small scab forms on each implant that will fall off after about two weeks, taking the implanted hair with it, which will then regrow after about three months. Several sessions are needed on the same receiving area to get proper density. The intervention has a very low-impact and can be done under local anesthetic.
- STRIP HARVESTING: this procedure consists of removing a strip 15 to 18 cm long and about 3 cm wide whose pedicle, which is necessary for vascularization, is not removed so it pivots on this pedicle to be placed in the frontal region. This is the only procedure that provides high hair density with one operation in the frontal region. However, the strip harvesting technique involves risks with some people that should be explained by your surgeon. The intervention can be done under local anesthetic, but several days are required before resuming work.
- TONSURE REDUCTION: practitioners remove a part of the balding area and close it up immediately using the scalp’s elasticity. Usually, an area 10 to 12 cm long and 3 to 4 cm wide can be removed. This technique is suitable for the tonsure region and for patients who have good scalp elasticity. The intervention can be done under local anesthetic and work can be resumed shortly. It can be repeated two or three times after an interval of a few months.
- SCALP LIFTING: this technique is more invasive, combining a very wide tonsure reduction and one or two strips to cover the frontal region in the same operation. Such a procedure can cover large areas of baldness with only two operations. It is usually done under general anesthetic and usually required time off work from 8 to 10 days.
Recovery and follow-up
4 to 8 days should be taken off work.
For micrografts, a small scab forms over each graft that falls off after 8 to 10 days. The grafted hair falls out with the scab and then regrows within two or three months. It grows about 1 cm per month. With reductions, strips and scalp lifts, the hair doesn’t fall out and stitches can be removed after about eight days.
Shampooing is generally allowed 48 hours after the operation. Sports can be resumed gradually after the 4th week following the operation. Pain such as headaches may persist for a few days, but can be treated by antalgic medication.
Aftermath basically consists of the appearance of an edema (swelling) and ecchymosis (bruising) whose extent and duration can vary widely from one individual to another.
About 3 to 6 months is needed in order to assess the results of micrografts, and in any case, at least two interventions are necessary in order to get sufficient hair density. For other techniques, the result is immediate.
Even if it’s done for basically aesthetic purposes, treating baldness is still a real surgical intervention, involving risks inherent to any medical act, no matter how small it may be.
You should differentiate between complications linked with aesthetic and those linked with surgery.
· The anesthesiologist will personally inform the patient of the risks of anesthetics. You should know that anesthesia causes sometimes unexpected reactions in the body, but are usually easy to control: by having a perfectly competent anesthesiologist exercising in a truly surgical context make it so that the risks involved are nearly statistically negligible. Indeed, you should know that the techniques, the anesthesiologist themselves and the monitoring methods have made immense progress in the past twenty years, providing optimum safety, especially if the intervention takes place outside an emergency context and with a person in good health.
· With regard to the surgery: by choosing a qualified and competent plastic surgeon that has been trained in this type of intervention, you will be limiting these risks as much as possible, yet they cannot be avoided completely.
Fortunately, real complications are rare after an intervention performed standardly. In practice, the great majority of interventions occur without any problem and patients are fully satisfied with their results.
Still, and despite their rarity, you should still be aware of possible complications:
· Hair loss 2 to 3 weeks after the intervention in the area surrounding the grafted area is very frequent. It is usually temporary.
· Hematomas: usually are not serious, and can be removed if too extensive.
· Infection: exceptional after a scalp operation, except for rare micro-abscesses that develop on a suture stitch and can be easily treated with minor local treatment.
· Scarring anomalies: very rare in the graft donor area.
· Epidermic cysts: They may appear on the grafted hair and usually disappear on their own. If not, they are easy to remove and do not compromise the quality of the final result.
· Temporary alopecia: may occur on a strip. It appears at about the 3rd week and can be relatively extensive. When the hair grows back, it will have a normal appearance and density.
· Cutaneous necrosis: is sometimes observed in the strip harvesting technique, usually limited and localized. Extensive necrosis is actually exceptional. Preventing this necrosis relies on a properly observed indication and on doing a careful, appropriate technique.
In the end, risks should not be overestimated, but you should simply be aware that surgical intervention, even apparently simple ones, always involves a small risk. Seeing a qualified plastic surgeon will ensure you the safety of surgery, they have the training and competence required to know how to avoid these complications, or to treat them effectively if required.
Hair loss surgery has made decisive progress that now usually offers an appropriate therapeutic strategy and technique, and whether simply with micrografts or with other techniques, can solve the main aesthetic issues caused by hair loss in both men and women.