Hair follicles are not inhibited by DHT (dihydrotestosterone) because they lack the genetic instructions to be inhibited by DHT. They remain healthy permanently. Hair grafts from these DHT-resistant hairs are re-implanted into the balding and thinning areas of the scalp. This provides permanent hair since the donor grafts have healthy hair follicles which are genetically programmed not to shed. The follicles and hair are removed from one part of the head with either a tubelike instrument called a punch graft or with a scalpel. Stitches are used to close the opening made from removing the hair. The hair strands are then transplanted into tiny holes or slits in bald areas of the scalp. By virtue of this technique, a natural look on the forehead, abd a natural dense look on the top of the head can be achieved.
The Technique
Most micro-hair transplant procedures (individual hair micrograft restorations) use local anesthesia and are performed on an outpatient basis.. After approximately six weeks, the transplanted hair will fall out and be replaced about three months later when the new hair grows in. To achieve sufficient density, several sessions may be required. Transplantation is a progressive process requiring hundreds of micro-grafts, each of which will generally contain from one to three hairs mini-grafted from a donor site on the side or back of the head. They are randomly implanted in the bald (or thinning) area so that they will grow in a natural pattern and produce an undetectable result.
The Excision
The donor site is excised as an elongated fusiform ellipse of full-thickness scalp using a scalpel blade size 10 or 15.The resultant defect is closed using suture or skin staples, and the scar is minimal. Then, donor tissue is dissected carefully into the desired number of grafts, which can vary in size.
Micrografts and Macrografts
After anesthetizing the hair donation scalp site, a strip of scalp about ½" to 1" wide and 4 to 5" long is removed. Since the scalp is very elastic, the resultant gap is easily pulled together and sutured shut. The hair on the back of the head conceals the small thin suture line.
The surgery team then divides the donor hair strip, which contains thousands of hairs, into individual "grafts”. Micro-grafts each contain 1 or 2 shafts of hair. Mini-grafts contain 3 to 8 shafts of hair per graft. With these techniques, the surgeon transplants as few as 1 or 2 hairs at a time, which creates a more natural look rather than the "toothbrush" or "plug" effect. These hair grafts are then implanted into recipient sites in the balding area. Micro-grafts are inserted into tiny punctures in the skin and mini-grafts are inserted into extremely small (0.5mm to 2mm) openings. This achieves a more natural appearance and is an improvement over previous techniques, where transplants were inserted into slits in the scalp.This often resulted in an abnormal, compressed hair. Recipient sites are made in several ways. Some physicians use punch holes, some use linear slits, and others use a "slot" method that creates a narrow, elongated oval incision. The goal of all these procedures is to obtain a more dense, natural appearance for the patient, while allowing the hair to grow in its natural manner.
Creating and Dissecting Grafts
The obtained grafts can be transplanted directly or cut into smaller grafts using a size 15 blade or razor blade. These round grafts can be cut into halves or quarters, or they can be dissected down to single hair grafts. Grafts harvested by strip harvesting can be cut to single grafts, minigrafts, or micrografts by using a size 15 blade or razor blade. Grafts obtained using an ellipse must be dissected using a size 15 blade. Most surgeons use magnifying loupes to aid the dissection of grafts. More recently, dissecting microscope has been used by some surgeons to aid graft dissection. It is chiefly acknowleded that follicular grafts, ie, those that are essentially a single follicular unit, offer better results.
Scalp Surgery
"Scalp reductions” or “lifts” consist of cutting out bald skin from the top of the head and stretching the hairy “sidewall” up over the crown. Some doctors are even doing complex surgery to take strips of hair from the sides of the head, swinging them into the front, and stitching them in place.
This procedure allows bald scalp areas to be reduced and is probably the most common hair restoration procedure other than transplantation. The scalp is usually somewhat loose and the balding area may be reduced. This can be very effective for persons with midline or posterior ("monk spot"). Most people have a limited amount of hair for transplantation and reducing the bald area reduces the amount of hair needed for transplants. Rather than increasing the hairs available, scalp reductions reduce the amount of scalp you have to cover with transplants.After the scalp reduction has healed, hair transplants are implanted to cover any scarring and to achieve the desired results of the patient.
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