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Hair Transplantation

If there ever is a disorder which is depressing and disheartening, it is hair loss. And this is even worse when it occurs to men in their prime. Estimates indicate that more than 80% of men will lose their hair at some point in their lives and balding will be an accepted part of daily life. Unfortunately, for the majority of men this is not a good option and the remedy to grow hair goes back to the time of Hippocrates. Hair loss has affected millions throughout the centuries and still today, we have no cure or treatment. Everything under the sun has at one time been postulated to grow hair and the majority of it borders on junk science. There are no real drugs for hair loss, no potions, no herbs, no nutrients, no spices, not even praying helps. The only good solution to hair loss is hair transplantation. While not the first treatment of choice, it today remains the only choice –good or bad. Hair transplantation essentially involves transferring (transplanting) hair follicles from the back of the head or behind the ears (donor areas) to the front thinning area. These newly transplanted hair follicles will grow hair for a lifetime because they are genetically resistant to going bald. In the past 2 decade, hair transplantation has become an art and is technically refined. Unlike the past, when large skin plugs of hair were transplanted to the front, today, mini grafts containing 1-4 individual hairs are transplanted. The results are much better and better looking aesthetically. The modern hair transplantation can achieve an aesthetic appearance by mimicking natural hair. Given the improved results and durability of hair transplantation surgery, males with baldness are increasingly seeking this method of treatment as the choice


The modern beginnings of hair transplants evolved in Japan and only in the last 3 decade has this technique become of vogue in North America. In the old days, full thickness graft from the back were excised and transplanted in large patches on the front of the scalp. Over the past 3 decades, these maneuvers have been improved and today, single hair follicles are the gold standard for transplantation. Today follicular hair transplant using microscopic techniques is routinely practiced all over North America. Each graft containing 1-4 hairs is individually primed and retransplanted into the recipient site. The follicular unit hair transplant procedure has continued to evolve, becoming more refined using minimally invasive incisions. These smaller and less invasive incisions have allowed surgeons to insert a larger number of follicular unit grafts into a small area, thus increasing the density of hair growth. With current techniques, anywhere from 50-70 grafts can be placed per square centimeter. Surgeons are also devoting more time to the aesthetics of hair transplant, taking great care to place the transplanted hairs in a proper angle and orientation. Hair transplants can provide a new, natural-looking head of hair. While a hair transplant does not in reality add any hair to the head, they can impart the outward show of more hair.

The procedure

Hair replacement surgery can do everything to a man- makes one look young, self confident, handsome and more appealing. But hair transplant is not for everyone. Before the procedure can be done, one must go and see a hair transplant surgeon. The goal of surgery is to find the most efficient uses for existing hair. One must have hair somewhere on the head to allow it to be transplanted elsewhere- if there is no hair then there is no transplantation. On the first visit, the surgeon will assess the scalp and how many grafts you may need and how many sessions will be required. No transplant surgeon will make it less than 2-3 sessions and the numbers of grafts are always more than what you would think (doctors are like car mechanics- they love money just as much). Before the procedure, you will be asked to stop smoking and refrain from drinking for at least a week. For those taking aspirin and any blood thinning medications, these should be discussed with the surgeon as each has its own rules.

Hair transplantation candidates

There are numerous techniques of transplanting hair. The techniques vary from the punch grafts, mini grafts, micro grafts, slit grafts, and strip grafts. Other patients may undergo flaps, tissue expansion and scalp reduction. But despite all these fancy procedures and elegant names, hair transplant is not a panacea for the bald males - it does have limits. In general, the best individuals for hair transplants should be: - older than 25 and mature - comprehend what the procedure is all about - be in good physical health - be in good psychological health - have a realistic goal - want to improve their appearance - preferably non smoker - have hair on the sides and back of the head


Hair transplant is an outpatient procedure. Some doctors do give a little mild sedation and others do apply a topical anesthetic. This lasts a few hours. The donor and recipient sites are shampooed before the harvesting of hair is done. Over the years, hair transplantation has undergone a revolution in its technique. From the thick grafts of the old days, we now transplant single follicles. Using a small needle, hair follicles are plucked out and re implanted into the recipient site. This eliminates the need to excise the skin. The procedure allows for faster healing, less trauma and no scars. However, the major disadvantage of this procedure is the cost and time. It may take an entire day to perform this procedure and the cost can be enormous. In general, from the donor site a small strip/plug of skin containing hair is removed and this is then trimmed of all the fat and excess fibrous tissue, leaving the hair follicles intact. Most of these plugs measure about 1x2 cm. When all these plugs of hairs are collected, they are implanted into a prearranged recipient site. An individual generally requires at least 50-70 grafts per sq cm to get an aesthetic look. Most individual require about 2-3000 grafts. Most surgeons perform about 1-3000 grafts in one session. Another procedure widely used to create the illusion of excess hair is tissue expansion. In this technique, a balloon like device is placed underneath the hair growing skin underneath the scalp. The procedure requires surgery to insert the balloon. Following this the balloon device is injected with some water/saline for a period of weeks and this causes expansion of the skin with the hair. After stretching the skin for about 2-3 months, another surgery is done. This hair covering skin is then pulled over the bald area. This technique is more applicable for individuals who do not have enough of their own hair to allow for a successful hair transplant. Another version of hair transplant is an advancement flap. This was one of the first procedures used to treat baldness and the success of it’s depends on the size of the scalp available and where the flap needs to be placed. In general, the balding scalp skin is cut out and a section of hair bearing skin is then moved forward thus covering the area. This flap is still attached to its blood supply at the original end. Following the healing period the incision is camouflaged. Scalp reduction is for coverage of bald areas at the top and back of the head. It is not great for covering the frontal hairline. The procedure does require anesthesia. The balding scalp is cut and then closed using various incisions which will narrow the balding patch. Basically all this does is decrease the size of scalp. Only recommended for the very desperate individual who can’t afford a hat and has no hair, anywhere.

Body hair

Plastic surgeons are not dumb and recently they have devised hair transplants by obtaining hair from other parts of the body. Some surgeons have taken hair from the armpits, others from the pubis and some even from the chest. The hair in these parts of the body is not characteristics of scalp hair but men being men just want hair to hide the bald spot. This body hair transplant is still in its infancy and long terms results are still pending. Men really do not care about tomorrow, it is today what matters. However, plucking hair from the pubis and armpits is no thrilling adventure, unless one is into S & M. Anecdotal reports do indicate that the body hairs are more fragile and do not last as long. The final cost and a bald axilla or pubis may not be worth all the hassle in the end. In all cases where hair is transplanted, several surgical sessions may be needed to achieve a head full of hair. Each session is done over a period of 3-6 months. In most cases, it takes up to two years before you see the final result with a full transplant series. The extent of coverage one needs is dependent on the color and texture of the hair. Coarse, gray or light-colored hair affords better coverage than fine, dark-colored hair. After the grafting session is complete, the scalp will be cleansed, all the blood wiped away and the head is covered with gauze/bandage. Other doctors may use semi permeable dressings which do not stand out like a turban. One is not allowed to drive home. The average time spent is about 3-6 hours.

Post-operative care

Unlike the past days when individuals were allowed to go home with large bandages, this is no longer so. Today, numerous semi permeable dressings are available which prevent fluid build up in the area of surgery and only need once a day changing. If bandages are used, they will usually be removed in several days at the doctor’s office. The hair should not be washed until one visits the doctor and follow his instructions. In general, hair is not washed for about a week and one is supposed to keep away from the sun. If any stitches were used, they are usually removed within 7-10 days. During the first few days, the pain may vary from mild to moderate and can easily be controlled with over the counter pain medications. After the first 7-10 days, one will notice that the majority of the transplanted hairs are falling out (this is normal and is usually due to the trauma of surgery). In a few months, new hair follicles will erupt from the site and the hair will grow normally. The hair will continue to thicken and in about 6-9 months will appear like natural hair. Some individuals may also combine the hair transplant by applying Rogaine or take minoxidil to prevent hair loss. Over the first few weeks, one should avoid rigorous scrubbing of the scalp. Exercise and other normal activities can be resumed in about 10 days.

Side Effects

Hair transplantation like all surgery procedures is also associated with some side effects. The most common are - Infection: occasionally some graft sites may appear red and tender and a short course of antibiotics will do the trick. - Hair loss: in all individuals the hair loss is transient in the initial period. The hair usually grow back after 3-4 months. - Mild swelling and bruising of the face which will resolve in 1-2 week. - Pain is moderate after the procedure but some men may have loss of sensation which will recover is a few months.

Complications of surgery

The complications of hair transplant are few but they do occur. The most common complications include: - Scarring may occur from where the graft was obtained. The scars are generally small and usually covered by growing hair. - Infection can occur in the grafted areas. The infection is usually mild and a short course of antibiotics will be adequate - In some cases, the hair transplant will not take These complications are hard to avoid and difficult to predict. The best one can do is follow the physician’s advice and trust his skills and judgment. For the hair manic, do not be fooled by any surgeon who claims that he has never had a complication. Reports of death have been reported in Europe

Follow-Up Procedures

Sometimes, the hair transplant may have left open incisions or patchy hair loss and so a “touch up” is required to make you look natural. These touch up procedures vary from camouflage, to more mini grafts to scalp reduction (Just like a second hand car, the doctor will always find something more imperfect especially if you are loaded). Before jumping into another procedure, please do discuss this with your doctor and get the price and what it will involve- there are horror stories out there when one starts mucking around too much with the body)


Hair transplant is not a cheap undertaking. It is a booming industry and yet the prices are steep-it costs as much to have hair transplant as it does to have a nice 4 door sedan. You may have hair but you will be walking for a long while. The procedure is generally done by plastic surgeons but today cosmetic surgeons, dermatologists, head and neck surgeons and even some general surgeons are into it. So talk to people who have had the procedure and do not rush into the procedure. If in doubt, seek a second opinion. Typically each graft costs about $5-7 and one may need about 2-5000 grafts. Most individuals need a number of sessions of about 1-2000 grafts per session. The economics is pretty simple- it can cost anywhere from $5-20,000 for the entire procedure.

Alternative to hair transplant

There are a variety of alternatives to hair transplants, including scalp reduction surgery, flap surgery, hairpieces and drug treatments. Pills to grow hair have been around for decades. Each year, numerous medications, herbs, spices and nutritional supplement are being cited as the panacea for hair loss. Annually, North America men spend more than 2-4 billion dollars in the quest for the magic drug to look younger, sexier and grow more hair. So here is the latest on the horizon of medications to grow more hair. Today there are two FDA approved medications for hair growth: minoxidil which is sold over the counter as Rogaine, for both men and women, and Finasteride, a prescription pill sold as Propecia, for men only. Two other drugs have been recently approved for hair growth and include a high-estrogen oral contraceptive and Aldactone (spironolactone). However, these two medications are only for women due to their feminizing side effects.

The future

For the completely bald scalp there is no chance of getting a hair transplant and thus the future is bleak. But the following advances may help the bald men. Cloning: There are laboratories trying to clone hair follicles and use them for transplants. This is still a theoretical concept. Cloning is not an easy task and one has to ensure that the cloned hair will have the proper color, texture and correct direction of growth. For the bald men of today, this is still light years away and the cost would be prohibitive for most, except for the rich. Gene therapy: Gene therapy like cloning is a theoretical concept. Physicians always like to talk about gene therapy (talk is cheap) but we still do not even understand how hair loss occurs and what genes are involved. Gene therapy may come to fruition only in the laboratory. Scientists are currently mucking around in the laboratory to alter the life cycle of hair growth and hoping to end hair loss. Hair transplant form another donor: Some researchers’ claim that perhaps hair can be transplanted from one individual to another. If there are no live donors, use dead donors. Why waste all the dead people and their scalp- use them to transplant the hair- we use their kidneys, heart and lungs and so why not hair- Yep why not? But don't start looking for an ideal donor yet. Any new techniques in this area would probably not be available for at least another decade.

Wigs and hairpieces

For those who can’t bear to be bald, the cheapest and best alternative is wigs and hair pieces .These wigs are available all over the place and can cover the baldness. Naturally looking hair pieces are available and can be quite costly. One then leads a hidden closet life and becomes an indoor introvert. These real-life like hair pieces are now available for $5-1000 and have to be replaced every 3-6 months. One can’t do all those fun things like exercise or swim with them, and most of the wig wearers instead turn to the internet still surfing for a cure for baldness-the agony never ends.

Coping with hair loss

Losing hair is a miserable experience and one filled with anxiety, depression and loss of confidence. Hair loss typically occurs to males in their prime and is a very frustrating disorder to deal with. No matter what others say, hair loss is the Achilles heel of most men and coping is difficult. Many suggestions have been made to cope with hair loss and this includes joining a support group, discuss with family and friends and learn more about the disorder. Only time heals the pain of hair loss.


For those intent on having hair, the time to start drug therapy is when there is still some hair left on the head. For completely bald people, the options are limited to wigs and wearing a hat or accept a hairless scalp. Few insurance plans cover drug therapy and one needs to take the drugs forever to get the benefits and maintain them. The drugs are not cheap and there is no guarantee of hair growth. For a years supply, Rogaine may cost 2-300$ and Propecia can cost 7-1000$. Neither of these medications is covered by any medical insurance. Today, baldness has been glamorized and been made to look cool by personalities like Yul Bryner, Michael Jordan and Telly Salavas. Hell, these guys made millions of dollars flaunting their looks only after they became famous. I bet these same guys would still be surfing the net like the rest of us if they had not made it. For even one hundredth of the money these guys made, I would have flaunted my naked body- forget the bald head. While current research efforts are making some headway, a cure for baldness is light years away. Various drugs are available but less than 5% of individuals have any significant hair growth. The treatment can become expensive in the long run with no guarantee on the results. While accepting baldness may not be appealing solution to all men, it may save one the aggravation of searching for an illusive cure. The best advice is save one’s money and know that big, blonde or bald - it is not the hair that makes a men but the soul.