Surgical Treatments for hair loss

Hair Loss Information Center

Library of Congress Cataloging in Publication Data:
Sheen, Mary 1966-
Fighting Hair Loss /by Mary Sheen, MD p. cm. 97-090157
Copyrights © 1993-2006 USA Library Publishing, Inc.

Part Five

Surgical Treatments for Baldness

If you do not respond to medical treatments and If you have time, money, and a stoic attitude toward pain, Surgical hair restoration is the only truly permanent solution to baldness. It involves a series of operations that extract plugs of scalp from the sides an back of your head, where hair grows densely, and implant them on top and in front, where you're going bald.

The procedure, which usually isn't covered by medical insurance, can cost as much as $15,000 and takes a year or two to complete. Despite the time and expense, an estimated 250,000 American men each year elect to have the surgery.

Restoration is possible because the hair follicles on the sides and back of the scalp are insensitive to the hormones that cause androgenic alopecia, so the hairs are immune to fallout. During surgical hair transplantation, hair follicles are redistributed in balding areas, where they grow hairs that continue to grow for the rest of the individual's life.

Hair transplants are better than they used to be, for doctor can use a variety of techniques to make it look like natural hair. Here is a rundown of the major surgical treatment for baldness.

Hair Transplantation

The common method of implanting grafts is illustrated in figure 3. There are two type of donor grafts taken from the hair-bearing posterior scalp: cylindrical, elliptical (also macrografts) and micrografts or minigrafts.

The most common type of Macrografts is cylindrical plug. Using a device like a hole puncher, the surgeon removes 1/8-inch-round graft containing about 12 to 20 hairs and placed into a smaller cylindrical hole in the anterior balding region of the scalp.

Depending on the degree of baldness, 1 to 4 sessions of transplantation are required, with placement of 50 to 60 plugs at each session. Successive transplantation sessions are scheduled with at least a 3-month interval between procedures. Average cost: $12,000 per 50 grafts ( one session). The number of grafts depends on the hair coverage desired.

Elliptical grafts are used for large posterior areas of baldness. Nowadays macrografts are no longer used by most surgeons, since these techniques tend produce artificial appearance.

Micrografts (1 to 2 hairs) or Minigrafts (3 to 4 hairs) are implanted along the anterior hairline to mask the "doll's hair" look of the cylindrical plugs and give a natural appearance to the hairline.

A narrow two-inch section of scalp is removed from the back of the head. It is then divided into 1 to 2 millimeter grafts and implanted in tiny incisions made in the bald area. Average cost: $1,200 per 50 grafts (one session). When used with other procedures, at least two sessions may be required.

After transplantation, the recipient area is covered with a scab for several days, the donor hairs fall in 2 to 4 weeks, and new definitive hairs grow within 3 months. one study (19) showed that if topical minoxidil is applied twice daily beginning within 48 hours after hair transplantation, the hair in the grafts will stay and regrowth of hair begins immediately.

Typically, men with hair loss limited to the frontal area of the scalp are the best candidates for hair transplantation. However, the patient's age and the potential for more extensive baldness must be considered carefully. These factors may dictate that other procedures should be performed in addition to hair transplantation.

Certain hair characteristics make it easier for surgeons to re-create truly outstanding hairlines. Individuals with blond, gray or light brown hair usually require the transplantation of fewer grafts because there is less contrast between hair color and skin tone. Generally, if a patient has darker hair, more single-haired grafts are blended into the frontal hairline area.

Men who have at least some natural wave in their hair have an advantage over individuals with straight hair because the natural curl provides extra volume. Sometimes patients with straight hair opt for a permanent wave once their newly transplanted hairs grow to a sufficient length.

Scalp Reduction

Scalp reduction, also referred to as galeoplasty, male pattern reduction or bald area reduction is performed on patients with well-defined bald spots in the crown area of the scalp. It is sometimes done in conjunction with hair transplantation to reduce the size of the bald scalp, especially in patients who do not have enough donor hair to cover the bald areas. A section of bald scalp (up to 2 by 7 inches) is removed, and the sides of scalp are lifted and sutured together. Small hair grafts fill in the remaining bald areas. For patients with large area of baldness, successive scalp reductions are performed to reduced progressively the bald area. Average cost: 1,600 per procedure.

Scalp reduction is recommended for men with bald spots smaller than 3 inches in diameter. This technique is not suitable for patients with little or sparse donor fringe.

Flaps

A large horseshoe-shape piece of scalp is partially detached from the donor fringe area. The free end is positioned over the bald spot where a corresponding patch of hairless scalp has been removed. Additional small grafts are needed to create a natural look. Average cost: $2,7000 to 8,000 per flap, depending on the size.

There are some disadvantages associated with this procedure. First, the resulting straight frontal hairline does not appear natural, and a scar along the hairline can sometimes be detected. Second, the hairs of the flap grow in a direction different from the natural hairs, giving an artificial look. Discuss with your surgeon about your concern.

Tissue Expansion

As illustrated in the figure 6, silicone bags are inserted beneath an area of hairy scalp and gradually inflated with a saline water over a six-week period. This causes the hair-bearing skin to stretch, thus increasing the amount of hair-bearing scalp. After removing the bags, expanded hair-bearing skin is lifted and moved to an adjacent bald area where a similar-sized patch of scalp has been excised.

The major disadvantage is that patients have to tolerate the strange appearance of balloons in their heads for several weeks. Though men can camouflage this, most find it embarrassing. The procedure is even less suitable for smokers, whose blood supply to the scalp may not be sufficient to allow normal healing, and for diabetics, who are more susceptible to infection. Average cost: $4,000.

Before Making Any Decision

In US any licensed physician can perform hair the surgery, it is easy to end up with Unsatisfactory results--scarring, patches of thin transplanted hair over scalp sections that continue to grow bald, a "doll's hair" look, or loss of hair that leaves the scars from transplantation visible--are no longer as likely as they once were, but they are still a risk.

If you decide to go this route, choose your surgeon with care, and beware of seductive advertising brochures showing "after" photos of men with thick, way hair. Ask to see some real people whom the doctor has treated. The best way, actually, to find a surgeon is through a referral from a satisfied customer, but even then you should be sure the doctor's credentials check out. Check with the department of plastic surgery or dermatology at your nearest university medical school. You can also call or write to the American Hair Loss Council or the American Academy of Facial Plastic and Reconstructive Surgery (1110 Vermont Avenue NW, Suite 220, Washington, DC 20005; telephone 800-332-3223).