Hair loss is one of the most common hair issues. Sometimes, it seems like the hair lost outweighs the hair grown in its place. This is especially true in cases of alopecia, where patches of hair fall out, causing significant bald spots. It can also cause hair growth to be stunted, so no hair grows back. One of the medical treatments for these bald patches is a hair transplant.
In this article, we break down hair transplant surgeries and explain the risks and challenges that come with it.
Read on to know more!
Table Of Contents
How Does A Hair Transplant Work?
Hair transplantation, also called hair replacement, was first tried with single hair strands back in 1939. It wasn’t until 1950 that large amounts of hair could be transplanted. It started out with grafted hair attached to plugs. But these plugs were large and were soon replaced with smaller graft and micrografts (1). Now, they use follicular units, known as the follicular unit transplantation.
Types Of Hair Transplant
In recent years, follicular grafts are used more as they are microscopic grafts and look more natural. There are two parts to the transplant surgery – FUT and FUE.
- Follicular Unit Extraction (FUE) – This is the process of extracting the follicular units from the donor. An area of healthy hair growth is opened, and some follicular units are taken from there. The area is then closed up.
- Follicular Unit Transplantation (FUT) – This is the process of placing the extracted follicular units into the recipient’s scalp. This requires precision as the punches for the follicular units need to be placed exactly right. The punches shouldn’t be larger than the units.
Both surgeries are equally taxing for the physicians as it takes an hour to remove less than 100 follicular units (1).
Challenges Of Hair Transplantation
1. Donor Surgery
Hair transplantation calls for excellent hand-eye coordination, physical stamina, and a full understanding of hair anatomy. Poor surgery decisions could lead to scars. These scars can be disfigured and apparent due to thinning or short hair (1). Scars typically remain when too much of the tissue is taken out, causing difficulty when closing the cut. The scars can remain due to the cut not healing properly.
Although surgeons and physicians have made the surgery better by accessing scalp laxity and incision limit, it still leaves a slight scar. They also have started using follicular units that are placed on the scalp using a scalp punch. But the scalp punch leaves a hole in the scalp, and when the follicular graft is taken out, the hole becomes a bit bigger and might hypo/hyper pigment (2), (3).
Surgeons have also started using robotic arms to do the procedure. The robotic arms follow a double barrel principle, with one needle handling the graft and the other making the small holes for the graft. The arm controls the angle and penetration amount of the needle. But there might be an issue with curly hair, as the needle might not be able to navigate due to the curves.
To further aid the healing process, physicians have used a few procedures to aid hair growth and wound healing (1):
- Platelet Rich Plasma (PRP) – It is a layer of concentrated platelets placed on the cut area after repairing it. The platelets are taken from a small amount of the donor’s blood.
- Extracellular Matrix Material (ECM) – It is a bio-scaffolding material that is packed with proteins, proteoglycans, and cellular factors. It helps in cell regeneration.
- Piloscopy – This procedure involves sending a camera to select particular follicular units. The camera has an attachment that can pull out the follicular units. This treatment doesn’t involve cutting into the scalp and hence doesn’t leave a scar.
- Scalp Micropigmentation – This is a non-invasive procedure in which the bald spots are covered with small black dots to give the appearance of short hair.
2. Graft Preservation
Grafts are usually preserved in chilled saline or Ringer’s lactate. They are the two most commonly used storage substances for the grafts. Research shows that the donor hair survives in these solutions for at least 8 hours before showing signs of demise (1). However, more cases are piling in more hair transplantations, which require more grafts and the need for longer preservation.
The aim is to make sure that every hair from the donor is viable beyond 8 hours. A new solution most doctors are using is Hypothermosol. Research shows that using hypothermosol donor hairs were viable for 5 days and showed hair growth after 18 months (1). This is because hypothermosol reduces stress and prevents free radical scavenging.
3. Optimizing Growth
Since they use follicular units, one of the biggest challenges is hair growth in the graft itself. The graft has to be replaced quite often, which doesn’t allow for the hair to grow too long.
4. Donor Preservation
The hair bulbs taken from the donor, like organs, remain ‘alive’ only for some time. It is difficult to find a donor in time for surgery. Often, the recipient has to wait until they can find a donor.
5. Hair Regeneration
The aim of hair transplants is to resolve hair loss and stimulate natural hair growth. Studies show that the graft shows hair growth, but in most cases, the areas around the graft have some form of hair damage (1). One of the biggest challenges is stimulating hair growth without any damage to surrounding areas.
6. Enhanced Grafts
Hair transplantation has come a long way, but it can be improved. The grafts take around a year to show substantial growth. This needs to be made faster. Another aspect is the need for more donor cells, but there are few donors. This has opened the door for stem cell regeneration using a small part of donor hair.
7. Preventing Hair Loss
The ideal endgame of hair loss is to stop hair loss before it happens. But when it comes to genetic conditions like androgenic alopecia, it may be difficult (1). A solution for this is genetic mapping and a clear understanding of hair growth and loss.
How Much Do Hair Transplants Cost?
Hair transplants generally cost around $4000-15000.
As with any other medical procedure, hair transplants come with their share of risks and side effects.
Risks And Side Effects Of Hair Transplants
- Bleeding & Swelling Of The Scalp – Sometimes, after the graft has been placed, the scalp reacts to it and causes bleeding and swelling (3). This means that the scalp is taking time to adjust to the graft.
- Itching – The graft can cause itching in the scalp as it is from a donor. But with the right medication, the itchiness can be stopped.
- Infection – Infections in the scalp are rarely likely after hair transplant surgeries (3). An infection can occur due to the donor’s follicular unit as it moves from one scalp to another. However, prescribed antibiotics can help stop the infection.
- Shock Loss – It might take time for the scalp to get adjusted to the new follicular units. Almost all the grafted hair may fall out. This will naturally stop after some time, and new hair will grow back in its place.
- Scalp Laxity – The amount of elasticity caused by tension that can be carried by the tissues underneath the scalp is called scalp laxity. During extraction, physicians might under or overestimate scalp laxity, which can cause disfigured scars that don’t heal.
- Graft Failure – Sometimes, the grafts or the area they are placed in don’t take to each other, or one rejects the other. This can only be resolved by replacing the graft. More recent grafts might fail to grow on the recipient’s scalp.
- Hair Curl – When it comes to curly hair, there are types, ranging from 2C to 4C. Sometimes, the donor unit might not curl the same way as the recipient’s natural hair. This can only be seen in a few months of the graft being placed.
Individuals undergoing hair transplants are asked to adhere to a few rules to ensure optimum results.
- Patients are asked to wear button-down shirts, as pulling a top or t-shirt over the hair may strain the follicles or pull them out.
- Patients are asked to be extra careful while sleeping. Sleeping more upright with sufficient pillows is suggested.
Any kind of medical procedure has associated risks. If you are thinking about getting a hair transplant, ensure that you have done thorough research so that you are prepared for what may be in store for you. Hope this article has helped shed light on the side effects of hair transplantation surgeries.
- Rose, Paul T. “Hair restoration surgery: challenges and solutions.” Clinical, cosmetic and investigational dermatology vol. 8 361-70.
- Avram, Marc R et al. “Side-effects from follicular unit extraction in hair transplantation.” Journal of cutaneous and aesthetic surgery vol. 7,3 (2014): 177-9.
- Loganathan, Eswari et al. “Complications of hair restoration surgery: a retrospective analysis.” International journal of trichology vol. 6,4 (2014): 168-72.
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