About Hair Loss

Advantages and disadvantages of hair transplant surgery

During general hair transplant surgery, a surgeon harvests a strip of skin with follicles from a donor area, i.e. an area of the scalp with good hair growth. This strip is usually about 1.5cm wide and up to 30cm long and can leave a scar in the donor area. The FUE (follicular unit extraction) method minimises scarring as it uses very small micro blades or fine needles extract hair grafts and then to puncture the area of the scalp that is to receive the hair grafts. Minigrafts, micrografts, or implants of single hair follicles can be used to fill in between larger implant sites and can provide a more natural-looking hairline. The implants will also be arranged so that thick and thin hairs are interspersed and the hair will grow in the same direction.

If the procedure goes well, the patient will have naturally growing hair in an area that was previously bald. However, since this is a serious surgical procedure, all the side effects typically associated with surgery can occur. In addition, implanted hair follicles can grow in the wrong direction and inflammation during the healing process can kill both the existing and the newly transplanted hair follicles. Individuals are usually awake during the procedure with only a local anaesthetic drug applied to numb the relevant areas of the scalp. Some people may be given a drug to help them relax or even general anaesthetic. Although the procedure itself is therefore pain-free, the recovery period can sometimes be painful. Alongside potential ongoing stinging/tingling pain, there is an itchiness that many people find difficult to cope with. There is often some swelling, bruising, headache, and discomfort around the graft areas and even around the eyes. These symptoms can usually be controlled with a mild pain reliever such as aspirin. Scabs may form at the graft sites and should not be scraped off. There may be some pain/numbness at the transplant sites, but it usually diminishes within two to three months. It is crucial that patients do not disturb bandages or scratch their scalp. Often, inflammation after surgery leaves the new hair vulnerable to falling out if disturbed or touched. Standard advice is that all strenuous activities should be avoided in the first few days after the surgery. On rare occasions, the implants can be ejected from the scalp during vigorous exercise.

Another type of hair replacement surgery is scalp reduction. This involves removing some of the skin from the hairless area and stretching some of the nearby hair-covered scalp over the bare area.

Health insurance will not cover hair transplants that are performed for cosmetic reasons. Insurance plans may potentially pay for hair replacement surgery to correct hair loss due to accidents, burns, or disease. However, in the case of regular pattern baldness this is unlikely as the procedure is not seen as ‘essential’.

It is always important to be realistic about what the final result of a hair transplant will look like. Although the translated hair will be alive and growing, this procedure does not create new hair. Rather, it redistributes the hair that an individual still has. In some experimental cases, even chest hair has been transplanted onto the scalp (however, since 2003, this procedure has not been widely used).

Unfortunately, hair transplantation is only a realistic option for small balding areas, as it isn’t possible to restore a full head of hair on a bald scalp. It is also important to note that the hairline only stops receding around the age of 50 – 60. Anybody who has a transplant before that age is likely to find their hairline receding further behind the transplanted area. Hair transplant surgery could be a worthwhile solution for smaller areas of thinning hair or baldness.

Current listed side effects of surgery

  • If hair follicles are implanted in the wrong direction or move during the healing process, the hair will look unnatural.
  • So-called hair shock is a condition in which inflammation kills both the implanted and the surrounding follicles, which can lead to more hair loss.
  • Scarring in the donor area can severely limit hairstyle options. Some of the psychological side effects include people becoming embarrassed and highly sensitive about their scarring, which is obviously counterproductive.
  • The process of ongoing hair loss is very likely to lead to more balding areas appearing behind the newly implanted hair over time. As there is a limited amount of transplantable hair, it can become impossible to keep up with a continuously receding hairline. In addition, a certain amount of follicles will die during the process of transplantation. Although there are rare cases of infection or scarring, the major cosmetic risk is that the grafted area may not look the way the patient expected it to look.

Cost

  • The transplantation of small patches can cost between £4,000 and £8,000. Most procedures that achieve visibly fuller hair tend to average around £10,000 – £20,000.

Success rate

  • Low to medium. Hair transplantation can be a good solution as it creates growing hair in formerly bald areas, but it only redistributes existing hair. This means that long term success can only be achieved in specific cases where enough growing hair still exists and the hair loss is no longer advancing. .
  • One commonly reported issue is the lack of thickness in the transplanted hairs. A fine ‘fluff’ of hair is often the result, although it does lead to less exposed skin on the scalp. Over time, some transplant patients report a gradual and steady loss of hair, leaving a thin front hair line with a large bald area behind it.