Losing your hair is difficult to accept. Hair is seen as a trait of beauty and of authority. We are lucky to live in an age where something permanent can be done for hair loss. Recently, much has been learned as to why hair loss occurs. While much of it is unknown, we have found that hormonal changes that affect genetically programmed hair is probably the cause. The hormone, DHT, is known to be involved. This hormone acts on the genetically programmed hairs of the hairline and top of head and causes them to fall out and the follicles to atrophy. Fortunately, the hairs on the back of the head do not have the same genetic predisposition, and they are not affected by DHT.

What this means is that hairs from the back of the head can be transplanted to balding areas to provide natural, hair bearing scalp. In the past, hair transplantation was performed using larger grafts consisting of 8 to 10 hairs. Using grafts that are this large created a pluggy look that was evident to anyone with the conversation distance. With the advancement of hair transplantation surgery, we have realized the importance of creating a natural appearing hairline. This can only be done by using small grafts. These grafts are called mini-graphs and micro-graphs. The mini-graphs consist of 3 to 5 hairs and the micro-graphs consist of just 1 or 2 hairs. When these are used the re-created hairline is very natural appearing.

The transplanted hair grows and acts just like normal hair because it is. It is your own natural hair except it thinks it is still growing on the back of your head. Because it is genetically programmed to not be affected by DHT it will grow for the rest of your life just like it would have done, had it never been transplanted.

There are medications available such as Rogaine and Propecia that help. They help because they block some of the actions of DHT. The reality is, however, that they are not likely to provide a significant amount of regrowth but they are effective in preventing further balding in most people.

The hair transplants procedure normally takes about 3 or 4 hours to perform and is done under local anesthesia in the plastic surgeon's office. During the procedure you will most likely watch a movie. In fact, you are encouraged to bring in your own. You can drive yourself to and from the procedure.

Normally, 2 procedures spaced 4 months apart are necessary to obtain the desired results. After hair transplantation, it will take at least 3 months for the transplanted hairs to begin growing. The amount of hair transplanted will be determined by the area to be covered as well as by the type of hair that you have. A typical session will involve transplantation of anywhere from 500 grafts to 1000 grafts. During placement of the grafts it is important to make sure that the hair is placed such that it grows in a natural fashion.

Another type of hair replacement surgery, that allows for much quicker results, involves expanding the hair bearing scalp that you have by placing a tissue expander underneath it. Then, over the course of 6 weeks, the hair bearing scalp is expanded by filling the expander with water 2 or 3 times a week. When the hair bearing scalp has been expanded enough, a procedure is performed where the balding area is removed and the expanded hair bearing scalp replaces it. This is a good option for people who have lost almost all their hair. It, however, requires a 4-week period where your hair bearing scalp is being expanded. During this period of time you look strange. There's no other way to describe it.

Benefits

The benefits of hair transplantation are numerous.

• It makes you feel better about yourself.
• It makes you feel like you have control over the situation instead of feeling like there's nothing that you can do.
• Almost any male that is losing his hair can be benefited from hair transplantation.
• It is best to begin early in the balding process so that people do not even know you are balding in the first place.
• Men that are almost completely bald must understand that it is unrealistic to expect a full head of hair. However, it is possible to create a dense natural appearing hairline that can be styled.
• It will make you look younger and more attractive.

With women, the situation is a little different. While quite often they are candidate for hair transplantation, sometimes they are not. It depends on the type of hair loss that you have. If you are losing hair from all over, even from the back of the head then hair transplantation may not be as effective. It is necessary to consult with your doctor to see what the options are.

Are you a good candidate?

As mentioned above, almost all men that are losing their hair are candidates for hair transplantation. It is best to begin early in the balding process so that hair transplantation can be done over time so that it does not appear as if you are significantly balding.

If you have lost all your hair it is not reasonable to transplanted your entire head. In this case you have the option of developing a hairline so that you can have hair to management style. Another option is tissue expansion of the hair that you do have to replace the balding area. As mentioned above, however, this is more involved and you should discuss this with your plastic surgeon.

Women who have lost isolated areas of hair are the best candidates for hair transplantation as the results are quite good. If, however, you are losing hair from your entire head, hair transplantation becomes more difficult.

Possible complications

The most common complication is inadequate hair density. This can usually be corrected by performing another session of hair transplantation. It is important to understand that the balding process will continue and that even though you're having hairs transplanted hair density may not increase because of progress of balding. This just means that more hair transplantation may be necessary. Other complications include bruising and swelling, infection and wound healing problems, and possible graft loss.

Do's and Don'ts prior to surgery

While there are not many things that are do’s and don’ts for hair transplantation there are a few important things to understand.

• Medications. Certain medications thin your blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should not be used within 3 weeks of surgery. Your doctor will go over this more thoroughly prior to the procedure.

• Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask your doctor for something to help to sleep.

• Eating. Do not eat within 2 hours of  a hair transplantation. Please discuss all medications with your doctor.

• Washing. It is a good idea to wash your hair the morning of hair transplantation and comb it straight back. Do not apply hair spray or any gels to your hair.

• State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you must not be overly concerned. Excessive worrying can actually be detrimental and you should discuss this with your plastic surgeon prior to surgery so that something can be prescribed to make sure you remain calm.

Anesthesia

The anesthesiologist will discuss with you what type of anesthesia is best for you. He/she will take into consideration your medical history, the procedure, and your personal wishes.

Hair transplantation is done under local anesthesia. If you would like something to relax, discuss this with your doctor prior to the procedure.

After the procedure

The procedure itself will take about 3 to 4 hours.    

Immediately. Right after the procedure you will get up and walk around. The local anesthesia will still be effective so you will be able to drive home comfortably without pain medication. You will be given as much pain medication as necessary to last for the next 4 to 5 days. Of course, there will be swelling and bruising but there is surprisingly little pain. You will have a head dressing on as well as ice packs to help keep the swelling down. You must sit up for the first week so that your head and face do not swell.

That evening. It is recommended that you take it easy. You can walk around, eat, but not too much more. You must sit and lay with your head up on at least 3 pillows. You should take as much pain medication as necessary and try to go to sleep early. Apply ice packs every 2 hours for the first 24 hours. You will be given medication to help keep the swelling down as well as to prevent infection.

First 48 hours.  It is important to leave the head dressing on until the 3rd day or 2 days after the procedure. This is when you will see your doctor. He/she will take down the dressing and make sure everything is going OK. He/she will reapply another light dressing. You should then go home and take a bath. At the end of the bath submerge your entire head under water and gently let the water soak the transplanted area. Dry and repeat this the next day. Comb your hair gently.

First week. Four days after the procedure you can begin to let shower water gently trickle over the transplanted area. It is not necessary to apply anything to the area. From here on out it becomes easier as you can begin to style your hair gently.

Beyond. At about 10 days after the procedure the scabs will fall off. Resist the urge to help them come off. I know it can feel “itchy. ”  Some of the transplanted hairs will be visible but most will not. Many of the transplanted hair will fall out over the next 4-5 weeks but will regrow in about 3 months. It will take 6 months for the results to begin to show. It will take 1 year for all the hairs to be growing normally.

Recovery time

Most people return to work in 3 days. At this time there will be some scabs and swelling but this is not usually a problem.