American Medical Association Family Medical Guide - American Medical Association [786]
Hair transplantation
To transplant hair, doctors surgically transfer grafts of skin from a hair-growing part of the scalp to a bald area. The process involves multiple grafting sessions. Grafts of hair are inserted into tiny openings in the scalp (left). During subsequent sessions the surgeon fills in gaps between the original grafts with new grafts (center). After several grafting sessions over a period of up to 2 years, hair has filled in to form a natural hairline (right).
The Procedure
Before surgery, the surgeon will treat the areas from which hair will be taken (donor areas) and the areas to which hair will be grafted (recipient areas) with an anesthetic similar to the kind used by dentists. To perform a punch graft, the surgeon will use a tube-shaped instrument to punch out round skin grafts from the donor area. For the other techniques, surgeons use a scalpel to carefully remove small sections of scalp, which are then separated into tinier segments and transplanted to the recipient sites. The grafts are placed about 1/8 inch apart. Later grafts will fill in the spaces in between.
The surgeon will usually close the scalp incisions with a single stitch but may use more if needed. The entire scalp will then be gently cleansed and covered with gauze bandages.
After Surgery
After each grafting session, you may experience aching, throbbing, and tightness in your scalp, which can be controlled with pain medication. You may also have some swelling, bruising, and fluid drainage. Your bandages will be taken off the day after surgery, and you will be allowed to carefully wash your hair the day after that. A week to 10 days after surgery, the surgeon will remove the stitches. During the first month after surgery, you will have several follow-up appointments so he or she can monitor your progress.
Avoid strenuous exercise for 3 weeks and abstain from sexual intercourse for about 10 days after the surgery because these activities can increase blood flow to the scalp and cause bleeding. The newly transplanted hair falls out about 6 weeks after surgery, which is normal. However, 5 or 6 weeks later, the hair will begin to grow back at a rate of about ½ inch per month. Many people who have had hair transplants need additional touch-up grafts to make the results look more natural.
Scalp Surgery
Scalp surgery can replace balding areas of the head with skin that grows hair using a number of specially developed techniques. The three most commonly used methods are tissue expansion, flap surgery, and scalp reduction surgery. Tissue expansion stretches the hair-bearing skin of the scalp so it can be used to cover bald areas. In flap surgery, the surgeon uses a flap of hair-growing skin from the side of the head to replace a section of scalp that was removed from the front hairline. Scalp reduction surgery is used to reduce bald areas at the top and back of the head by pulling areas of hair-bearing skin closer together. Sometimes surgeons combine two of these hair replacement procedures to produce better results.
The Procedure
In general, all three types of scalp surgery are done on an outpatient basis. Before scalp surgery, you will be given a sedative to make you feel relaxed. The surgeon will then inject a local anesthetic into your scalp.
Tissue expansion
In tissue expansion scalp surgery, the surgeon inserts a silicone balloon under a hair-bearing part of the scalp next to a bald area. He or she gradually inflates the balloon with a saline (saltwater) solution at intervals of 1 to 2 weeks to stretch the scalp. When the skin of the scalp is stretched sufficiently—usually after about 2 months—the surgeon removes the balloon and performs a second procedure to cover the adjacent bald area with the expanded hair-growing skin.
Flap surgery
Flap surgery is usually performed while the person is under general anesthesia, in