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Hair Replacement Surgery

What causes hair loss?

Hair loss is believed to be caused by a combination of the following:

  • Aging

  • Change in hormones

  • Illness

  • Family history of baldness

  • Burns

  • Trauma

What is hair replacement surgery?

The interest in hair replacement has significantly increased over the past 10 years.  By the age of 50, about 17 in 20 men have significant thinning of hair. Women may also suffer from hair loss. For men, the main cause of a diminishing hairline is heredity. Hormonal changes, such as menopause, can cause both thinning and hair loss in women.

There are a number of hair replacement methods available, although hair replacement surgery can't help those who are totally bald. Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are 4 different types of hair replacement methods:

  • Hair transplant. During a hair transplant, the surgeon removes small pieces of hair-bearing scalp grafts from the back or sides of the head. These grafts are then moved to a bald or thinning area.

  • Tissue expansion. In this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then needed to place the newly expanded skin over the adjacent bald spot.

  • Flap surgery. Flap surgery is ideal for covering large balding areas. During this procedure, a portion of the bald area is removed, and a flap of the hair-bearing skin is placed onto the bald area while still attached at one end to its original blood supply.

  • Scalp reduction. Scalp reduction is done to cover the bald areas at the top and back of the head. This method involves the removal of the bald scalp with sections of the hair-bearing scalp pulled together filling in the bald area.

Possible complications linked to hair transplant procedures

Possible complications associated with hair transplant procedures may include:

  • Patchy hair growth. Sometimes, the growth of newly placed hair has a patchy look, especially if it's placed next to a thinning area. This can often be corrected by additional surgery. A staged approach may be planned.

  • Bleeding or wide scars. Tension on the scalp from some of the scalp reduction methods can result in wide scars or bleeding.

  • Grafts not taking. Occasionally, the graft may not "take," and the hair-bearing skin dies. In this case, surgery must be repeated.

  • Infection. As with any surgical procedure, there is the risk of infection.

About the procedure

Although each procedure varies, generally, hair replacement surgeries follow this process:

Where the procedure may be done

  • Surgeon's office-based surgical facility

  • Outpatient surgery center

  • Hospital outpatient

  • Hospital inpatient

Anesthesia choices may include:

  • General anesthesia. You will sleep throughout the procedure.

  • Local anesthesia, combined with a sedative. This allows you to remain awake but relaxed.

How long will it take?

Several surgical sessions are usually needed to achieve satisfactory fullness, with a healing interval of several months recommended between each session. It may take up to 2 years before seeing the final result with a full transplant series.

How long is my recovery?

Plugged or grafted hair falls out within a 1 to 2 months after surgery, which is normal and almost always temporary. After hair falls out, it generally takes another month or more before hair growth resumes. A surgical touch-up procedure may be needed to create more natural-looking results after the initial incisions have healed. This may involve blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts, or slit grafts.

Online Medical Reviewer: David Lickstein MD
Online Medical Reviewer: Rita Sather RN
Online Medical Reviewer: Tara Novick BSN MSN
Date Last Reviewed: 1/1/2023
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