Understanding Hair Transplant in Depth
Hair transplant refers to the procedure in which a dermatological surgeon (a surgeon who performs surgeries to treat conditions related to the skin, and hair) moves hair from an area (called ‘donor site’, which is usually the back of the head) with high hair density to a thinning or a bald area to treat hair loss in men and women of all ages.
Hair plays a major role in our appearance, and it influences our self-perception as an individual. It is known that loss of hair leads to a detrimental psychosocial impact on people suffering from alopecia (hair loss) such as:
● Low self-esteem
● Loss of self-confidence
● Heightened self-consciousness
The prevalence of progressive hair loss is exceedingly common, corresponding to 85% of men and 40% of women around the world. Therefore, perhaps we could remark that hair transplant procedures emerged as a means to help people reconstruct their self-image in a very positive way, by restoring the volume of their thinning hair.
At Dr Serkan Aygın Clinic, with our experience of more than 25 years in this field, we understand how it might be somewhat puzzling for the patients to see a whole picture of all the new hair transplant techniques and find their way through all the questions on their mind amidst the myths and false information. Therefore, we’ve prepared this article to help you gain a profound insight on everything you need such as:
● Hair transplant techniques (such as FUE & DHI)
● Stages of the hair transplant procedure
Understanding Hair Transplant Thoroughly: What is Hair Transplant and How Does it Work?
What is Hair Transplant?
In the simplest sense, hair transplant refers to the procedure where hair is removed from one part of the body and transplanted (ie. taken and transferred) to a balding area (ie. an area without adequate hair). It is quite easy to understand when simplified like this, right?
Then, you will come across with many other terms and comparisons, “hair restoration vs hair transplant”, “hair plugs vs transplant”, “hair implant vs transplant” or other expressions like, “difference between hair grafting and transplantation”, while most of these expressions refer to the same thing, that is the hair transplant surgery itself.
We see that there are several misconceptions that stem from not grasping the hair anatomy, and the relevant glossary used to describe the hair transplant procedure. Therefore, the aim of this section is to equip you with thorough knowledge of hair transplant surgery and hence allow you to choose the best hair transplant and the best clinic.
Let’s begin to discuss them now.
There are many new methods of hair transplants, most of which build on the biggest advancement in hair transplant technology, the Follicular Unit Extraction (FUE) method. Gone are the days of having scars in the rear of the head (resulting from the strip surgery of the early 2000s) as well as the unnatural-looking hair plugs (from the 1980s and ’90s). Now, with the FUE method (and its many variants), as well as the DHI method of transplantation, results look natural and are long-lasting.
An Outlook on the Glossary
Oftentimes patients experience confusion of terms, such as ‘hair implant vs hair transplant’ or ‘hair restoration. This constitutes an impediment for the patients to fully grasp the treatment they are going through and leads them to have different or misguided expectations. At Dr Serkan Aygın Clinic, we believe in the importance of thoroughly informing the patients to help them have realistic expectations.
● Hair Restoration:
Any of the treatments that aim to do away with hair loss is a hair restoration treatment (such as medications, laser treatments and hair transplant surgery).
● Hair Implant vs Hair Transplant:
Yet, if we compare hair implants with hair transplants, we should perhaps remark that ‘hair transplant’ indicates that a hairy tissue (ie. a graft with hair follicles) is removed from a donor place. These grafted hair tissues are implanted into another, which is why it is called ‘transplantation’ just like any other organ transplantation.
Though these terms are often used interchangeably, because the most of times hair transplants and hair implants refer to the same thing; also note that in hair implants, hair inserted into the patient’s scalp could also be synthetic, which is often referred to as bio fibre hair.
Essentials of the Hair Transplant Surgery: A Summary of the Hair Anatomy
First, let’s start with understanding the structure of the hair. Individual hair follicles consist of two different structures:
- the visible part of the hair
- non-living, keratinized structure
- hair bulb at the bottom of hair follicle grows it
- tunnel-shaped living organ
- located in the epidermis (outermost layer of the skin) and dermis (a layer of skin beneath the epidermis)
- responsible for hair growth
- anchors the hair shaft to the skinThe gist of this section:
When moving hair from one place to another (ie. transplanting), the whole structure (hair follicles, hair shaft and the surrounding tissue) is to be moved.
The Basics of Hair Transplant Surgery: Grafts in Hair Transplant
The concept of grafting constitutes the backbone of hair transplantation to ensure the survival of the hair transplant follicles.
The medical definition of graft is a piece of living tissue surgically removed from a place on a body, called ‘hair transplant donor area” to be transplanted to another, usually to a damaged part called ‘recipient area’. And how is it related to the hair transplant now?
- Important Note: The number of grafts does not equate to the number of hairs you get after a hair transplant. While the number of hairs in a graft varies from 1-4, usually one graft contains 2 hair follicles.
The Gist of This Section: How Does Hair Transplant Work?
Hair transplants yield the best and most successful and permanent natural-looking results because transplanted hair follicles continue to grow in the recipient area just as the same way they did in their original place.
When the hair tissues are inserted into the small slits (ie. small cuts like holes in the recipient site), they begin to reconnect to the blood supply of the body, which happens approximately 3 days after the operation. When the transplanted hair-bearing tissues replace the damaged hair follicles and survive in their new environment, they grow healthily and cover the bald spots.
· Important Note: Hair grafts cannot be transplanted from another person. The immune system of the patient’s body will automatically reject the ‘foreign’ tissue and develop an immune response, such as an infection.
Understanding Thoroughly: Types of Hair Transplant
The technological advances in dermatology have contributed immensely to the field of hair transplantation, making it more accessible to almost everyone who aspires to improve their looks.
The Best Method to Harvest Hair: Percutaneous Hair Transplant
Percutaneous hair transplant is a breakthrough in hair transplant technologies that allowed hair transplant surgeons to perform minimally invasive hair transplant procedures without much impact on the integrity of the skin.
- inner tissues are accessed via the skin without large incisions to expose the inner organs
- needle-punctures and micro blades are used for minimal impact
In a hair transplant, the percutaneous hair transplant method refers to how hair follicles are harvested from the skin without much impact on the integrity of the skin. As it is the best hair harvesting method, at Dr Serkan Aygın Clinic, all the hair transplant procedures we perform are percutaneous to yield the most aesthetically pleasing results.
FUT Follicular Unit Transplant
FUT hair transplant involves making extensive incisions to remove hair by removing a strip of skin from the donor site which is usually the occiput (the back of the head) while the patient is under local anesthesia. Therefore, FUT hair transplant is also called “strip method hair transplant”.
Follicular Unit Transplant (FUT) also referred to as Follicular Unit Strip Surgery (FUSS) is the traditional hair transplant method.
A shorter operation time for a large number of grafts
A long, linear scar from one ear to another
No need to shave the donor area to grade zero
Longer recovery period (10-14 days)
Higher risks of swelling and pain
The FUT Procedure:
- The hair transplant surgeon draws a hair transplant hairline to cover the balding areas.
- The patient receives local anesthesia to numb the occipital donor area and the recipient area before the incisions.
- The hair at the area of extraction is trimmed to approximately two millimetres.
- A strip of skin that bears hair follicles is cut from the donor area.
- The hair transplant surgeon sutures (ie. stitches up) the open wound.
- Hair grafts are removed from the surgically removed strip of skin to make them ready for transplanting.
- The surgeon makes small cuts, known as hair transplant holes in the recipient site insert the collected grafts.
At Dr Serkan Aygın Clinic, we consider the FUT procedure to be an outdated method, as it leaves an unpleasant scar on the patient’s scalp, though it may allow the surgeon to extract a great number of hair follicles all at once. Therefore, we do not perform it at our clinic. However, there are still clinics around the world that operates on the patients with FUT method for a couple of reasons:
- Cost: Strip method hair transplant cost is rather lower compared to other procedures, as it can be performed in a shorter period of time with less staff.
- Easy: FUT does not require precision, expertise or special instruments when extracting hair follicles. Therefore, some clinics that do not bother themselves with keeping up with new technological advances may still perform it.
FUE Follicular Unit Extraction
Follicular Unit Extraction (FUE) is a more advanced and modern technique developed in the early 2000s as an alternative to the FUT. It is a painless outpatient operation that does not interrupt the patient’s daily routine.
Hair from other parts of the body as alternative donor sites
Longer operation time
Shorter healing time (5-7 days)
Less pain after the surgery
The FUE Procedure:
- The hair transplant surgeon draws a natural-looking hairline to cover bald spots.
- The patient receives local anaesthesia to numb the donor and recipient area or soft sedation to eliminate any possibility of discomfort while the patient is fully conscious.
- The hair at the area of extraction is trimmed to approximately two millimetres.
- Grafts are individually harvested from the donor area with the help of micro-motor and micro-punches varying in diameter from 0,7 (1 root) – 0,8 (2 roots) – 1,0 mm (3+ roots).
- As a part of the slit technique where micro-channels are created to implant the extracted grafts, the surgeon creates holes in the same angle and direction with the patient’s hair to place the fair follicle tissues inside.
- Grafts are implanted at 40-45 degrees into the patient’s scalp.
The FUE hair transplant is regarded as the gold standard of hair transplant, as it is the most minimally invasive (causing the least impact to the tissues by adjusting micro-blade sizes exactly to the diameter of the hairy tissue) procedure for transplanting hair grafts.
Different clinics around the world utilize a variety of instruments to extract and implant hair follicles with the FUE method. Therefore, according to the instrument used when implanting hair, FUE may be called under different names as such:
- Classic FUE (via micromotors)
- ARTAS Robotic FUE
- Sapphire FUE
|Classic FUE||Robotic FUE||Sapphire FUE|
|Manual extraction of grafts (expertise required)||Automated extraction of grafts by a machine||Manual extraction of grafts (expertise required)|
|Micro-punches (circular incisions) vary in sizes according to the number of hair follicles and thickness of hair to decrease scabbing and crusting after a hair transplant||Larger micro-punch sizes could increase the risks of trauma and tissue damage||Micro-punches vary in sizes according to the number of hair follicles and thickness of hair to decrease scabbing and crusting after a hair transplant|
|Hair can be harvested from other donor areas in the patient’s body (chest, beard, or back of the head)||A very limited donor hair site. Hair can only be harvested from the flattest part of the back of the head||Hair can be harvested from other donor areas in the patient’s body (chest, beard, or back of the head)|
|Metal lateral slits are used to open channels||Metal lateral slits are used to open channels only on the scalp.||Sharp sapphire lateral slits are used to open channels on any part of the body. The use of sapphire tips enables denser hair implantation and minimizes the scab formation|
|Fast recovery after hair transplant process and tissue healing||Faster and smoother post-operative tissue healing|
DHI Direct Hair Transplantation
Direct Hair Transplantation (DHI) is often referred to as a modified version of FUE hair transplant where hair grafts obtained from a donor area are directly transplanted (ie. taken and immediately implanted) to the recipient area with a device called Choi Implanter Pen.
|Hair transplant without shaving headQuick graft transplantation for higher tissue survival|
Takes less time
Hair from other parts of the body as alternative donor sites
|Higher cost than FUE or FUT|
What is Choi Implanter Pen?
The Choi Implanter Pen is a surgical tool resembling a pen with a 0.5 mm – 1.5 mm hollow cylindrical needle (at the tip of the implanter) connected with a tube and plunger.
The Choi Pen was developed at Kyungpook National University in South Korea to combine graft extraction, channel creation and graft implantation processes, and optimize the duration of the hair transplant procedure.
How Does the DHI Pen / the Choi Pen Work?
During a DHI Hair transplant, the hair transplant doctor loads the hair follicles harvested from the donor site inside the hollow needle of the implanter with the assistance of tweezers. Then, loaded follicles are implanted into the recipient region without making incisions at an angle of 40-45 degrees by pressing down the plunger.
The DHI technique saves from the time spent with making slits (ie. lateral cuts) on the recipient area. Therefore, the time interval between the extraction of grafts (when the blood supply of the hair follicles is ceased) and implementation of the hair follicles (when the grafted tissues can begin to re-establish their connection to the blood supply for their survival) is shortened. This contributes to the increase in the survival rates of transplanted follicles.
The use of a Choi pen allows for a hair transplant without shaving the recipient area, thus being the ideal choice for hair transplant long hair. As it is rather easier to conceal the donor area, DHI is recommended as an ideal hair transplant for women, and celebrities (as you may notice from the before-after photographs of female celebrities or actors that had a hair transplant for thinning edges or to lower hairline).
The DHI Procedure:
- The hair transplant doctor will redraw the hairline. Or it could be any other areas of the scalp to be covered with a hair transplant (temples, forehead, or whole head etc.)
- The patient is administered local anaesthesia to numb the donor and recipient area or soft sedation to eliminate any possibility of discomfort while the patient is fully conscious. (Take this option into consideration if you have any questions like “Is hair transplant painful?”)
- The hair at the area of extraction alone is trimmed to approximately two millimetres.
- Grafts are individually harvested from the donor area with the help of micro-motor and micro-punches varying in diameter from 0,6– 0,7 – 0,8 mm.
- During a DHI hair transplant procedure, these grafts are gently inserted into a hollow needle at the tip of a Choi pen. In a DHI surgery, 2-6 Choi pens and 15-16 needles (for different types of hair follicles varying in thickness and diameter) are utilized.
- Grafts are implanted at 40-45 degrees into the patient’s scalp with a good density.
When Should You Get a Hair Transplant?
Answer: You should have a consultation when you are concerned about the appearance of your hair. Accordingly, you should consider starting a hair restoration treatment from Norwood 3 (the earliest stage of male pattern hair loss) onwards.
We see that both men and women who consider a surgical hair restoration to their alopecia (hair loss) often try to find answers for the questions below for the best before-after results of hair transplant surgery:
What is the best age to get a hair transplant?
What is the best season for hair transplant?
When is it too late for a hair transplant?
The answers to these questions are rather generalised statements that are derived from a variety of factors that affect the success of a hair transplant. Therefore, individual differences (cause of hair loss, pattern of hair loss, donor density, lifestyle) are oftentimes overlooked.
The Best Time to Have a Hair Transplant
Accordingly, we can say that there is no ‘best age for hair transplant’ or ‘right age for hair transplant’ because the most important criteria are whether the hair loss pattern is evident, and the patient has enough donor density for a hair transplant.
Even further, the statements such as “the best age to get a hair transplant is the 40s for men” or “hair transplant should be avoided before the 30s” could be misleading for a patient with advanced balding. It should be noted that it could be too late for a hair transplant when the patient experiences complete baldness, even in the donor area too (such patients are not a candidate for hair transplant).
Who is Not Eligible for Hair Transplant?
Though most patients are eligible to have a hair transplant, there are cases where a patient may not have a hair transplant. These can be summed up as:
· Congenital alopecia (baldness since birth)
· Bloodborne Diseases
· Haemophilia (a condition in which blood clotting does not occur)
· Too low donor density or complete baldness
Among these impediments, donor density emerges as the most frequently encountered situation that prevents hair transplant candidates from undergoing a hair transplant surgery.
What is Hair Density?
Hair density and hair thickness are two terms that are commonly confused. Hair follicle density refers to the number of hair shafts (hair strands) that grow out of each square centimetre. Hair thickness, on the other hand, refers to the width of each hair shaft.
Hair density varies according to ethnicity, sex, age, and where hair follicles are located. According to the comparative studies conducted on scalp hair:
· While hair thickness (ie. hair diameter) remains the same, hair density decreases with increasing age.
· Hair follicle density is highest in Caucasian descents, while Hispanic descents are recorded to have a higher hair density compared to the Asian descents who are found to have low hair density.
· Hair follicle density is found to be significantly higher in women compared to men.
In hair transplant surgery, we take the occipital hair follicle density as a reference for assessing the eligibility of a hair transplant candidate. Accordingly, a patient from donor area of whom approximately 40 follicular units per cm2 can be extracted with a 1.00 mm – 1.4 mm distance is an ideal candidate for a hair transplant. Surely, if the patient has high hair density, this allows us to extract a higher number of grafts. Yet, if this number is lower than 40 FUs, we consider this as low hair density.
The good news is that technological breakthroughs not only allowed the hair transplant surgeons to transplant hair to other areas of the body experiencing a hair loss but also harvest hair from other donor sites as well.
Therefore, low hair density in the back of the head as a limitation for hair transplant has been addressed with new techniques that enable body hair transplant to head for men. Thus, hair follicles harvested from other parts of the body with high hair follicle density, such as beard (where hair density ranges from 20-80 FUs cm2) or chest hair can be transplanted to the patient’s scalp in case of too low hair density for hair transplant.
Beard to Hair Transplant
Hair transplant using beard grafts is generally performed in cases where the patient has inadequate scalp donor supply and when the bald patches are too wide to be covered. Beard grafts that remain in the growth (anagen) phase for long periods are an excellent alternative donor source for hair transplantation.
Beard grafts are known to be thicker than the grafts at the back of the head. For this reason, to provide better volume in the transplanted area, hair grafts extracted from the beard are transplanted in the top and crown area, but it may not be the best option for frontal hair restoration, such as hair transplant to lower the hairline.
Body Hair Transplantation
For men planning to undergo a hair transplant, body hair is considered a third source for graft harvest. If grafts extracted from the back of the head, and the beard area are still not sufficient to cover the bald patches, chest hair can be considered as a good alternative source of hair follicles in hair transplantation. There are two underlying reasons why body hair is considered as the 3rd additional donor source in hair transplantation, these are:
· Body hair grafts, particularly chest hair, have a similar structure as beard grafts; they are thick and contain one or two hairs.
· The anagen phase of body hair is much shorter, hence body hair grows shorter.
This being said, similar to beard hair grafts, hair follicles obtained from the chest cannot be used in frontal hair restoration.
Why is Hair Transplant the Best Hair Loss Treatment?
Hair transplants are regarded as the best hair restoration treatment because transplanted hairs look, feel, and function just like the patient’s own hair because they actually are the patient’s own hair (unlike a wig that will possibly fall off your head).
- Minimally invasive
- Permanent results
Another advantage of FUE and DHI is that they allow dermatologists to address hair loss in other parts of the body such as eyebrows, eyelashes, and face (loss of facial hair) with treatments as below.
• Eyebrow Hair Transplant
• Facial Hair/Beard Transplant
• Eyelash Transplant