Hair loss can be due to many different reasons: Aging, hormone changes, family history, burns or trauma.  There are many different options for this situation, here we give a quick review about hair transplants, which is not indicated in every case, so you should decide with you plastic surgeon which is the best option for you.  The best results are seen with combined techniques and multiple sessions.

This procedure can not give you the exact hair coverage that you had before your hair loss, but it can bring you a good camouflage to the thin areas and more fullness to your hair look.  The technique will use your existing hair to cover the problem areas, you will need to have agood coverage in the back and sides of the head to serve as donor areas for grafts and flaps (surgical techniques common in plastic surgery). 

To be able to produce a dramatic change in your hair look you may need flaps, tissue expansion or scalp reduction; for smaller changes punch, mini, micro, slit or strip grafts are available.

Posible Complications

The risk of this procedure include physical reactions and healing problems, making the results not completely predictable.  It is a surgical procedure and as any surgery it involves general and specific risks related to the procedure and anesthesia.  Infection, excessive bleeding, wide scars, reject of the grafts and even an unnatural "patchy" look especially in the transition areas where not transplanted hair continue to thin out.  In some of this cases, additional surgery may be required.

Before Hair Transplants

None of the available techniques are "perfect" or can apply to all the cases, usually more than one techniques may be needed for each patient.  Before surgery your plastic surgeon will evaluate your hair growth and loss, family history of hair loss and personal health and surgical history.

Is specially important to stop any medication that can affect your surgery, you should tell your surgeon about any drugs that you could be taken and if you smoke you should stop at least one or 2 weeks before the procedure.

The Surgery

Hair replacement is performed in an operating room in an outpatient basis, usually under local anesthesia with sedation, but general anesthesia can be used according to your needs.  During the procedure your surgeon will remove small pieces of hair bearing scalp from the donor site and then will place it to the bald or thinning areas, requiring knowledge and experience in the techniques.  The most common techniques include:

• Round shaped (punch) grafts: Usually contain from 10 to 15 hairs.
• Mini graft: 2 to 4 hairs.
• Micro graft: 1 to 2 hairs.
• Slit grafts:  Inserted into slits in the scalp contain 4 to 10 hairs.
• Strip grafts: Longer and thin than the other ones, usually contain from 30 to 40 hairs. 

You may need several sessions to achieve your goals, it is recommended to wait couple of months between each of them, and it could takes 2 years t get the finl results with full transplant series.  Coarse, gray or light colored hair affort better coverage than dark colored hair.  For large grafts you could have an avarage of 50 grafts per session, with mini or micro grafts it can be 700 or more. 

Special instruments are available for each technique, the hair in the donor area will be cut more short to make the scalp more accesible.  The incisions are multiple but the stitches and resulting scars can be easily cover by the surrounding hair.  The grafts from the same session will be placed about 1/8 of an inch apart.  You may need a pressure bandage for couple of days after the procedure.

With tissue expansion a balloon like device (tissue expander) is placed beneath hair bearing scalp next to a bald area, the device will be gradually inflated with sald water during weeks, making the skin to expand and grow new skin cells, usually in 2 months, the expansion is ready and this new skin can be used to cover the adjacent bald area.

Flap surgery can do the work of 350 or more punch grafts, with this technique, a section of bald scalp is removed and adjacent hair bearing skin is lefted off the surface preserving the other border, remaining the original blood supply.  The hair will then grows in the edge of the incision camouflagin the remaining scar.

In Scalp Reduction, sections of hair bearing scalp are advanced to fill in a bald crown, it is beneficial for the top and back of the head, not recommended for the frontal hairline. 

The Results 

You may feel some discomfort after the surgery that should be control with the medication prescribed by your surgeon.  You may gently wash your hair after 2 days according to your doctor's instructions.  Stitches will be removed in about 7 to 10 days.  You can return to normal activities withing few days, but should avoid sexual activity for 10 days and arduous activity for at least 3 weeks.   

It is normal that the transplanted hair falls down about 6 weeks after surgery, then another 5 to 6 weeks will be need to start new hair grouth, with about 0.5 inch per month.