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Is Surgical Hair Restoration Permanent?

According to statistics, roughly 11% of the world population is seeking professional treatment for hair loss. Modern-day treatment options are versatile, ranging from topical and oral pharmaceuticals to surgical hair restoration techniques.

What is surgical hair restoration?

Generally speaking, surgical hair restoration involves relocation of hair-bearing sections of scalp from a donor area, where hair is resistant to balding, to a thinning or balding area. It is used for the treatment of both male and female pattern baldness (androgenetic alopecia), characterized by permanent loss of hair follicles.

The beginnings of hair transplant surgery date back to the early 1950s and the introduction of the “punch grafting” method, based on the then newly-established theory of donor dominance. This theory, according to which transplanted hair shows similar characteristics and resistance as the donor follicles, greatly advanced the science of hair restoration.

Popular hair restoration techniques

Today, patients have a variety of hair restoration techniques at their disposal, including alopecia reduction, scalp flaps and the latest techniques of follicular unit hair transplantation (FUT). FUT can be done via the traditional approach of strip excision (strip harvesting) or follicular unit extraction (FUE), a highly advanced version of the punch grafting method.

Scalp reduction doesn’t get many points for appearance, since unsightly scarring is common. During the procedure, the bald area at the top of the head is excised and the hair-bearing scalp on both sides is pulled towards the middle and sewn together.

Scalp flap surgery is mainly used for hairline restoration. It involves relocation of pieces (flaps) of scalp from a hair-bearing section to a balding area. If flaps are relocated together with their blood supply, they are referred to as pedicle flaps.

A more sophisticated version are the micro-surgical “free” flaps, where pieces of hair are relocated without the blood supply. This eliminates the risk of hair pattern distortion and inconsistency, but requires extreme skillfulness and expertise in microsurgery.

With the introduction of newer, safer, and more natural-looking techniques, Advanced Hair Restoration does not perform scalp reduction or scalp flap surgeries.

Strip excision involves removal of narrow strips of hair-bearing tissue from the donor area. Strips are then segmented into individual follicular unit grafts and inserted into previously incised recipient sites. The advantage of FUT via strip excision is the high graft yield, i.e. the number of follicles that can be harvested in a day. The drawback is the linear donor scar, making the method unsuitable for people preferring to wear their hair short in the back.

In the FUE approach, individual follicular units are harvested by direct extraction from the donor area, one unit at a time, using circular punches. The transplantation part is identical to FUT. The advantage of FUE is the possibility to harvest hair follicles without leaving a linear scar, however, it requires more expertise and equipment.

Can surgical hair restoration permanently solve your hair loss problems?

Hair surgery is the only permanent treatment for hair loss. However, there are several things to consider when contemplating hair transplant surgery.

The main prerequisite for a successful and permanent outcome of modern-day hair transplant surgery is the surgical skill and expertise, including in-depth knowledge, experience and excellent eye-hand coordination.

Competent surgeons know how to avoid unnecessary damage to hair follicles and premature depletion of viable donor hair supply. They are also able to anticipate any possible cosmetic issues or unexpected problems, and take preventive steps.

The visual appearance of the hair transplants is as important as the durability aspect. The transplanted hair looks and feels natural because it is the patient’s own hair, just relocated. This is where surgical skills and experience are crucial. Follicles must be transplanted in a pattern and placement that ensures natural look and proper growth, making the transplant virtually indistinguishable from native hair.

In hair transplant surgery, the outcome greatly depends on the characteristics of the donor area. Dihydrotestosterone (DHT), the active form of the male sex hormone testosterone, plays a major role in the pathogenesis of androgenetic alopecia in both genders. In susceptible individuals, dihydrotestosterone affects the ability of the hair follicles to absorb nutrients, leading to progressive shrinking of the follicles, hair thinning and ultimately hair loss.

Follicular units used for transplantation are harvested from the so-called permanent zone at the back of the head, where hair is naturally resistant to the effects of dihydrotestosterone. Hence, in accordance with the donor dominance theory, transplanted hair is not expected to thin or fall out.

In the first one or two weeks after surgery, the newly transplanted hair will shed due to the relocation trauma. This is expected and referred to as “shock loss”. In the following months, hair will start to regrow and get progressively thicker as time goes by.

In cases of extensive hair loss, surgery can be supplemented by topical Rogaine foam or Propecia pills to help maintain hair growth in DHT sensitive areas and prevent future loss.

Are there any risks and complications?

When done by experienced professionals in a reputable clinic, this is an extremely low-risk outpatient procedure. Nonetheless, complications are possible, as with any other surgical procedure. You may experience minor pain which can be relieved by a mild analgesic, as well as some swelling of your scalp and face, light bleeding and transient numbness. Postoperative infections are very rare and easily treated by a course of antibiotics.

Costs of treatment

Surgical hair restoration cost typically starts at a minimum of $4,000 and varies greatly depending on the amount of hair needed, the type of procedure you choose, the skill of your physician, and even location. It is nearly impossible to get an accurate estimate without assessing a person's individual hair loss, needs, and restoration desires.

In any case, make sure you do your research and choose a clinic with a proven success record and staff excellence.


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Published on May 26, 2015

By Advanced Hair Restoration