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Because
of significant surgical advances with improved results, interest in hair
replacement surgery has increased significantly during the past decade.
Hair loss affects two out of every three men, and one in five women. Some
people begin to lose hair in their twenties. Frequent shampooing, poor
circulation, wearing hats or any other personal habits are not factors
that cause hair loss. For men, heredity is the major factor in hair loss.
For women, hormonal changes, including those that occur in menopause,
are mainly responsible for female "pattern changes," which include thinning
and loss. Accidents, burns, and disease can also trigger hair loss. The
key factor in hair replacement is the presence of donor hair on the side
or the back scalp, which is then used to replace hair where loss has occurred.
Total baldness makes replacement surgery impossible. Hair quality is another
factor. Light-colored hair, as well as coarse-textured hair, produce a
look of greater density than fine or dark hair.
If you've wondered
how hair replacement surgery could improve your appearance and your self-confidence,
you need to know how this surgery is performed and what you, as an individual,
can expect from this procedure. This pamphlet can address many of your
concerns and provide you the information to begin considering hair replacement
surgery.

As
with all facial plastic surgery, good health and realistic expectations
are prerequisites. Understanding the limitations of the surgery is crucial.
No ideal in hair replacement surgery exists. The goal is to improve your
appearance as much as possible. Before deciding on hair replacement surgery,
ask your facial plastic surgeon to explain the options available for your
particular type of hair loss.
Male pattern baldness
often begins with a receding hairline or thinning at the crown, and is
the easiest condition to correct. It is progressive over a lifetime and
is a major consideration for your surgeon. Hair replacement surgery frequently
requires multiple grafts of hair being implanted during multiple sessions,
generally spacing each session at least four months apart to allow for
adequate healing.
The surgeon will
explain which type of anesthesia is indicated. Facial plastic surgeons
usually decide on a local or twilight anesthesia for grafting, but many
surgeons choose general anesthesia for the more involved surgical procedures
for replacing hair. The surgical facility to be used will also be determined
by the extent of the procedure.

It is not essential to be bald or nearly bald before undertaking hair
transplantation. Age also is no contraindication for hair transplantation.
The younger the person, though, the more conservative the approach must
be for transplantation, because the permanent donor site may not yet be
established. Ideally, the patient should have dense growing hair in the
donor sites to sufficiently fill any present or future areas of baldness.
The color of the
hair in contrast to the skin color will be discussed with you by your
surgeon. The texture of your hair, coarse or fine, will also determine
the final result in hair transplantation.
However, the patients
most satisfied with hair transplantation are those who will accept the
estimate of improvement as given by the surgeon.
If you opt for surgery,
your surgeon will describe the technique indicated, the type of anesthesia
to be used, the surgical facility, any additional surgery, and risks and
costs.

The
most commonly known hair replacement surgery requires taking a strip of
hair-bearing scalp from the back of the head. The strip is then divided
into several hundred smaller grafts. These grafts are then inserted into
tiny slits in the scalp, and must be placed in such a way that hair all
grows in the same, natural direction. While some of the grafts may contain
up to five or six hairs, it is sometimes necessary to use a number of
grafts containing only one or two hairs to create a natural appearance.
This is known as mini- and micrografting.
Skin flap surgery
is another efficient technique used to cover balding areas. After a piece
of bald scalp is removed, a section of hair-covered scalp is moved and
sutured into place. Scars are generally covered by new hair growth. Bald
spots at the crown of the head can be covered by removing the hairless
area of skin and then stretching the hair-covered scalp adjacent to the
bald spot over the opening. This is known as scalp reduction surgery.
A newer technique
involves the use of tissue expanders. This allows stretching of the skin
which aids in the reduction of the size of the bald scalp.

After surgery, your surgeon may choose to apply a dressing for a day or
two. If stitches are used, they are usually removed within 10 days. The
second or third day after surgery, you will probably be allowed to shampoo.
Your head and scalp may feel tight with some aching, but this can be controlled
by medication. It is crucial that you follow the instructions for post-operative
visits and care. Swelling or bruising in the area treated is likely. Cold
compresses may be recommended by the surgeon.
The newly transplanted
hair often falls out in the six weeks following the procedure. This, however,
is absolutely normal. New hair growth will take about six to 12 weeks
to develop. To attain a look of natural hair growth, it is often necessary
to fill in patchy areas, adjust the hairline, or remove excess tissue
from areas that have been treated with flap surgery. These touch-up procedures
are to be expected and are an essential part of the whole picture of hair
replacement surgery.
Your facial plastic
surgeon is the best source of information on what may be required for
you as an individual and for your specific surgery. Facial plastic surgery
makes it possible to correct many facial flaws and signs of premature
aging. By changing how you look, cosmetic surgery can help change how
you feel about yourself.
Insurance does not
generally cover surgery that is done purely for cosmetic reasons. Surgery
to correct hair loss from accidents, burns, disease, or trauma may be
reimbursable in whole or in part. It is the patient's responsibility to
check with the insurance carrier for information on the degree of coverage.
This section ©
Copyright 2000 American Academy of Facial and Reconstructive Plastic
Surgery
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