Linda Briggs Cosmetic Surgery


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Index   |  Hair restoration

Cosmetic or Plastic Surgery

Hair Transplantation


Hair Transplantation
has come a long way since it began in the early 1950s.  In 1939, a Japanese dermatologist, Dr Okuda, published details in a Japanese medical journal of a revolutionary method of using small grafts that was similar to the way Hair Transplantation is performed today.  In the late 1950s, one physician in particular b egan to experiment with the idea of transplanting hair from the back and sides of the head to the balding areas.  'Donor Dominance' establi shed that hair could be transplanted from the bald-resistant donor areas to the balding areas, and that it would continue to grow throughout the recipient's lifetime.  This laid the foundation for modern Hair Transplantation.

During the 60s and 70s Hair Transplants grew in popularity - however this involved the use of larger grafts that were removed by round punches and often contained many hairs.  The problem with this method was that there had to be a minimum of 4 procedures for the final results to be noticeable, and therefore patients who underwent this type of Hair Transplantation usually gave up by the second procedure, for obvious reasons!

In the 1980s, Hair Restoration surgery evolved dramatically as the large punch grafts were gradually replaced with a more refined combination of Mini and Micrografts. This 'combination' Mini-micrografting Hair Transplantation procedure no longer used a punch to extract the bald-resistant grafts.  Instead a strip of bald-resis tant hair was surgically removed from the back of the head and then trimmed into mini and micrografts.  Typically the minigrafts (4-8) hairs were used to create fullness and density, whilst the one, two and three hair micrografts normally used more grafts - several hundred grafts per session, rather than the approx 50-200 large grafts of the original punch graft procedure.

The 1990s saw a gradual use of the creation of a refined and feathered hairline in the front.  This combination procedure also introduced a very refined surgical procedure now known as 'Follicular Unit Hair Transplantation' or 'FUT', by Drs Limmer, Bernstein and Rassman.  This exacting and labour intensive procedure transplants hairs in their naturally occurring 1,2,3 and 4 hair 'Follicular unit groupings' in which they grow naturally.

'Follicular Unit Extraction' or 'FUE', by Dr True, is a Hair Transplantation technique in which a small round punch is used to extract follicular units from a patient's bald-resistant donor areas.
These 1,2,3 and 4 hair follicular unit grafts are then transplanted into the patient's balding areas.
Given the time consuming and tedious nature of this procedure a surgeon is often limited to transplanting 1000 follicular units grafts in one day,  The donated hair follicles, surrounding tissue and skin, are called 'Follicular Units'.  Each Follicular Unit contains one or more hair follicles with accompanying hair, tissue and skin  The art of Hair Transplanta tion is as important as the mechanics of this medical technique - and it is very important to remember that no two heads are alike, and each procedure should be looked at on an individual basis.  Hair density is the number of hair follicles per square centimetre of scalp.  Scalp laxity constitutes the flexibility or looseness of the scalp and the more flexible the scalp the easier it is to harvest donor follicles.  Convers ely, the tighter the scalp the more difficult it is not only to harvest donor hair, but also to close the donor area after excision.  More hair can be transplanted if the scalp is loose and the density is high.

'Follicular Unit Transplantation' (FUT)
is a technique in which hair is transplanted from the permanent zone in the back of the scalp into areas affected by genetic balding, using only the naturally occurring, individual follicular units.  In order to re move follicular units from the back of the scalp without damaging them, the donor tissue is removed in one piece.  This technique, called 'Single Strip Harvesting' is an essential component of Follicular Unit Transplantation, as it not only preserves the follicular units, but it prevents damage (transection) to the individual hair follicles.  It differs dramatically from the 'Mini-Micrografting' technique of using a multi-bladed knife that breaks up follicular units and causes unacceptable levels of transection of hair follicles.

The other harvesting technique, 'Follicular Unit Extraction'  (FUE), allows the surgeon to remove indivi dual follicular units without a linear donor incision.  The most essential component of Follicular Unit Transplantation is 'Stereo-Microscopic Dissection'.  In this technique all of the follicular units are removed from the d onor tissue under microscopic control to avoid damaged.  Comp lete steroe-microscopic dissection has been shown to produce an increased yield of both the absolute number of follicular units, as well as the total amount of hair (upwards of 25%).  This procedure differs from Mini-Micrografting in which the grafts are cut with no microscipical magnification.  A major advantage of Follicular Unit Transplantation (besides preser ving follicular units and maximising growth) is the ability to use small recipient sites.  Grafts comprised of the individual follicular units are small because follicular units are themselves small, but also become surrounding non hairbearing tissue is removed under the microscope and does not need to be transplanted.
Follicular unit grafts can be inserted into tiny needle-sized sites in the recipient area, which heal in just a few days without leaving any marks.

When performed by a skilled surgical team, Follicular Unit Transplantation can provide totally natural looking Hair Transplants that make the full use of the patient's donor supply to give the best possible cosmetic results in the fewest possible sessions!

This is one of the most commonly asked questions, and it is a very important one for those deciding which Hair Restoration procedure to choose.  In contrast to Follicular Unit Transplantation, where the follicular unit sizes are determined by nature, in Mini-Micrografting the graft sizes are arbitrarily determined by the assistants who cut the donor tissue into the sizes of pieces they require.
Another name for this technique is 'Mini Micrografts cut to size'.

In Mini-Micrografting, neither preserving follicular units nor even keeping hair follicles intact are considered to be of great importance.  Inst ead, the speed and economics of the procedure are the deciding factors.  Mini-micrograf ters use a multi-bladed knife or a single-bladed knife to quickly generate thin strips or a strip of tissue, and then use direct visualisation or back lighting (rather than microscopic control) to cut the tissue.  The resulting grafts are generally larger than follicular units and since the excess skin is not trimmed away the donor sites (wounds) are also larger - or the follicular units are trimmed under backlighting but the hair shafts or the hair bulb of the follicular unit are trans-sected due to poor visualisation - and therefore the final results are poor.
 It should be readily apparent from the above comparison that Follicur Unit Transplantation is far superior in producing a natural, undetectable result, in maximising healing, and preserving precious donor hair.

On arrival at the Hair Transplant clinic in Budapest, prior to your surgery the transplant staff will begin by going through and explaining everything that is going to happen throughout the procedure.
The Hair Transplant surgeon will review the goals that have been established and will answer any last minute questions that the patient might have.  The surgeon will take the time to ensure there are no outstanding issues, areas of confusion or concerns.  The surgical consent form is signed, followe d by the taking of pre-treatment photos.  Mild medication is given to relax the patient and to make him/her feel more comfortable. Routine antibiotics are also given before and after the procedure.

The Folllicular Unit Transplant may require many hours of work by a team of very experienced professionals.  Some of the longest proced ures (between 2000-2500+ follicular units) may take hours of surgery and during that time many highly trained members of the transplant team will participate in the process.  The work must be organised efficientl y so that the total length of the procedure for the patient will be minimised.  On average, a procedure of 1000 follicular units would take approximately 6 hours.

The procedure may be long, but from the patient's point of view the time does pass quickly!  Light sedation is administered so that the patient can, if h e or she wishes, sleep through it.  Most though choose to watch TV an d/or films for at least part of the time.  Everything is done to make your experience a pleasant one, so that the actual time the surgery takes is transparent.  However, some patients may prefer to be fully a wake throughout the entire procedure.

Usually the patient will sleep for a few hours, watch a film or two, and also chat to the Hair Transplant surgeon and nurses.  A relaxed and informal atmosphere is encourage d so that the day stands out as one of the better and more pleasurable experiences ever encountered!  The patient takes a series of breaks - for lunch - or just to stretch and move around..  Often patients report that being the centre focus of the day's activities is really very enjoyable - and further report that watching all the members of the surgery team working on them was like watching an orchestra playing beautiful music whilst having their every need catered for!

After preparatory medication is given orally, the actual anaesthesia is administered.  A combination of Lidocaine (Xylocaine), which you have probably been given by your dentist, and a longer acting local anaesthetic called Marcaine is used.  Injections around the perimeter of the scalp (called a ring block) will make the entire scalp numb.  With this technique, there is no need to use anaesthesia directly in the area that is being transplanted.  Once anaesthetisation is complete, there is generally no pain or discomfort during the remainder of the procedure.  If further anaesthetic is required, it will be given before the first wears off.

The procedures can be long, and during the initial period when the donor hair is removed, the surgical team must work without stopping.  The team must prepare the grafts according to the surgeon's exacting specifications.  The preparation of 2,000 or more follicular units and placing them into the recipient area may take a team hours of intensive, concentrated work.  Care must be taken to keep the surgical team free of stress.  Just as the patient needs a break, so do team members.  It is important to focus on the needs of the transplant team, as well as those of the patient to ensure that the best-trained staff in the world is always operating at peak performance.

After a strip of donor scalp is removed, it is temporarily placed into a container with chilled Lactated Ringer's, a solution that closely mimics the body's own natural fluids.  The area from where the donor strip is removed is sutured and closed.  This usually leaves a very fine scar that heals within 1-2 weeks and the sutures are removed during this time.


a donor scalp with some hair transplant techniques

Ideally, the scar may heal so well that it is almost undetectable even when the hair is combed back by a barber or hairdresser.  After the tissue has been harvested, the individual follicular units (each containing from 1 to 4 hairs) are meticulously dissected out in their naturally occurring groups under strict stereo-microscopic control.  The follicular units are trimmed of extraneous fatty tissue, and the bald intervening skin between the groups is discarded.  The isolation of individual naturally occurring follicular units, that were obtained from the donor area as a single strip and then carefully dissected under microscopic control, is an essential part of Follicular Unit Hair Transplantation.  If this step is not carried out correctly the follicles can be injured and growth impaired.  It is important that these steps be carried out only by a highly experienced surgical team.

A number of hours may elapse between the time the donor follicular units are removed from the back of the scalp to the time they are placed into the recipient area.  Great care must be taken to preserve the viability of the follicular units during this process.  The procedure starts with the removal of a strip of scalp from the donor area.  Once the strip is removed, it is immediately immersed into a cold bath of Lactated Ringer's saline to lower its temperature.  Once the individual follicular units are prepared, they are cooled to 3.8-4.0C and kept at this temperature while awaiting placement.

Many people are under the impression that Hair Transplantation is a 'bloody' procedure.  However, in the hands of an experie nced specialist Hair Transplant surgeon and his expert team, this is most definitely not the case!  Surgical techniques have been developed and put into practice at the Hair Transplant clinic in Budapest that greatly minimise the amount bleeding throughout all stages of the procedure.

The surgical team wears masks, surgical gloves, and gowns and uses instruments that are sterile.
The procedure is performed while the patient sits in a comfortable, adjustable reclining chair.  For added comfort the hair Transplant suites are equipped with music, TV, and an assortment of films.
After the local anaesthesia is administered, the patient should feel nothing other than pressure sensations.  Many patients have long and chatty conversations with the Hair Transplant specialist and assistants during the time it takes to complete the transplant.  
The atmosphere in the treatment area will make the patient feel very secure and relaxed.  Concern and compassion on the part of the doctor and medical staff make a tremendous difference and they always make a great effort to ensure that the patientís experience is a pleasant one.

The creating of the recipient sites determines much of the aesthetic look of the transplant - it determines the angle at which the new hair grows and also determines the distribution and density of the follicular units.  This is a very important part of the procedure and requires considerable artistic knowledge and surgical skill.  It may be the one part of the procedure where your Hair Transplant specialist is completely silent as he concentrates on creating these sites.  Don't be concerned if he isn't chatty during this time!  Your Hair Transplant doctor is well used to working in, and around, existing hair so there is no need to cut your hair short for the procedure.  Your existing hair may help to cover any traces of the transplant.

The placing of the new grafts is the longest part of the procedure.  The placement process is exacting and during this time the patient will be asked to keep his or her head relatively still.
Watching TV or a film, or even sleeping will make the time pass quickly.  Breaks can be taken as needed to eat or drink something, or just to stretch the legs.  When placing is complete, post-op instructions are given both verbally and in writing.  A baseball cap is placed on the head and is worn to leave the clinic.

On the night of surgery, and for the next few afterwards, patients are encouraged to sleep with their heads elevated on pillows.  Medication will be given, if needed, to aid sleep.  Patients return to the clinic the following day for hair washing and instructions how to shower and gently clean the transplanted area.  The follicular unit grafts are made to fit snugly in the recipient site and will not be dislodged in the shower provided the instructions provided are followed.  If the post-operative instructions are followed carefully, the transplant is, in most patients, barely detectable after a few days and practically undetectable after the first week

Patients are given medication for swelling, but in spite of this some do, over the following few days, experience swelling of the forehead that settles around the bridge of the nose.  If this does occur, it almost always disappears on the 5th day after the surgery and should not be a cause for concern.

Frequently, the newly transplanted follicular units can be made less noticeable by minor changes in hair style to cover the area.  Makeup consultants can help in choosing the appropriate shade and type of makeup.  Any problem of visibility can also be minimized by altering the appearance of the face.  If shaving is left for a while, most people will focus on a new beard, and not on the head!  For those having a moustache or beard, consider removing it for the first few weeks and then letting it grow back.


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Cosmetic Surgery Abroad   |   Page last updated 16 October 2018