Usually, hair fall does not require specific medical therapy. If significant loss is present though, the underlying cause should be investigated and, after arriving at an accurate diagnosis, should be treated adequately. Hair replacement therapy can be opted for by patients for cosmetic reasons to boost their self-esteem and confidence levels. However, it should be done after taking into consideration all the pros and cons of the procedure as it is not medically necessary and purely an elective cosmetic procedure that can be expensive.

(Read more: Food habits to stop hair loss)

Hair transplantation is a surgical technique that involves removing hair follicles from one part of the body (the donor site) and implanting them in another (recipient) site, typically the scalp. Hair transplant is commonly used to cosmetically treat and correct male pattern baldness and receding hairlines but can also be used for eyebrows, arms, legs and even genital areas. Hair transplantation procedures can be opted for after consultation with a specialist surgeon and assessment of any contraindicating factors. Hair fall transplant is of two types – follicular unit transplantation (FUT) or follicular unit extraction (FUE). Both methods use different techniques to harvest the follicles of hair and transplant them to new sites. Precautions should be adhered to strictly and after-care medication should be taken diligently. Certain complications can arise due to the surgery or the drugs prescribed after it. Other options for hair loss management can be discussed and considered beforehand. 

(Read more: Hair loss prevention and natural remedies)

  1. Procedure and types of hair transplants
  2. Contraindications for hair transplant
  3. Aftercare measures to take following a hair transplant
  4. Precautions to take following a hair transplant
  5. Complications of hair transplants
  6. Other hair replacement options

In a hair transplant, hair is harvested from an area in the patient’s body, where the hair is not desirable, and planted into an area where the hair is desired. When a patient wishes to opt for this procedure, they meet with a specialist surgeon for a consultation. The surgeon will begin by taking a detailed medical history, including that of medications used and of family history of hair loss. Some investigations might be required in order to proceed with the surgery. For example, viral marker tests for diseases transmitted through blood, like HIV and Hepatitis B virus, are necessary before operating. Contraindications for the hair transplantation surgery will be explained to the patient, as will the realistic expected outcome. If all criteria are met, surgery is planned.

The first step in the hair transplantation process is harvesting. The surgeon begins by sterilising and numbing the area from which the hair follicles will be harvested, also called the donor site. Patients may request to be sedated during the procedure if it makes them more comfortable. Two types of hair transplantation surgeries can be performed after harvesting the hair follicles:

  • Follicular Unit Transplantation (FUT) or Follicular Unit Strip Surgery (FUSS): In a follicular unit transplantation (FUT) or follicular unit strip surgery (FUSS), after proper sterilisation, anesthesia and all aseptic precautions, surgeons begin by cutting out a strip of scalp tissue from the back of the patient’s head. This strip is usually up to 10 inches long and can extend from ear to ear. The area from where the strip was removed is sutured close. The scalp tissue strip is then cut up into thousands of little pieces, called grafts, containing hair follicles. Following this, holes are made with a needle or blade in the area of the scalp (or where the hair is being transplanted) and the grafts are implanted there. The surgical site is covered with bandage and gauze. The number of grafts to be harvested and implanted depends on the colour, type, thickness and quality of hair and the size of the area to be transplanted with hair.
  • Follicular Unit Extraction (FUE): The other method of hair transplantation used clinically is the follicular unit extraction (FUE) method. Instead of cutting out a strip of scalp tissue, the surgeon shaves off a portion of the hair at the back of the head and then manually extracts hair follicles. Marks can be noted over the site where the hair follicles were removed or harvested from. Following this, the surgical team will make puncture holes with a needle or blade in the area of the scalp (or elsewhere) where the hair follicles will then be implanted. After implanting the hair follicles in the new recipient site, the area will be bandaged close. Follicular unit extraction (FUE) is a popular method of hair transplantation and although most commonly done on the scalp, it can be done on any site of the body where the hair is thin, including arms, legs and genital regions.

(Read more: Hair loss prevention and natural remedies)

Absolute contraindications: In the presence of certain factors, hair transplantation should be completely avoided. These include, but may not be limited to:

  • Unreasonable expectations or a failure to understand the short-term goals of hair transplantation
  • Unreasonable expectations or a failure to understand the long-term goals of hair transplantation
  • Unstable emotional status (Read more: Mental health)
  • Absence of a medical diagnosis of the underlying cause of hair fall
  • Hair and scalp conditions like:
    • Known diagnosis of alopecia areata (an autoimmune disease that causes the autoantibodies formed in the body to attack and destroy hair follicles)
    • Presence of active scarring associated with alopecia
    • Presence of infection on the scalp
    • Telogen effluvium (disorder in which hair is shed in the telogen stage of hair growth) induced hair fall
    • Rapidly progressive variants of androgenetic alopecia (advanced and progressive male pattern baldness and receding hairline)
    • Diffused hair loss
  • Psychological conditions like trichotillomania where one compulsively pulls out hair from the scalp, eyebrows, eyelashes, etc. (Read more: Mental illness)

Relative contraindications: The presence of certain factors in a patient can warrant additional investigations, a dermatologist consultation, or even a punch biopsy in the area to be transplanted for further deliberation before proceeding with hair transplantation. Hair transplantation may be considered unadvisable in some of these cases. Some of these factors include, but are not limited to:

  • Daily hair shedding at rates considered significantly higher than normal for age and sex
  • Visibly and noticeably less hair on the scalp than six months earlier
  • Visibly and noticeably less hair on the entire body than six months earlier
  • Visible and noticeable hair loss from sideburns
  • Central pattern hair loss in those individuals with naturally afro-textured curly hair
  • Scalp itching (more than an occasional itch)
  • Burning sensation in the scalp (at least more than once per month)
  • Scalp redness
  • Scalp soreness
  • Scalp tenderness
  • Scalp bruising

The hair transplantation surgery may take up to several hours or even several days depending on the area to be covered and the work to be done by the surgical team. Following the completion of the hair transplant, the surgeon may inject triamcinolone (a corticosteroid) into the recipient area to stop inflammation and keep the swelling down. The doctor may prescribe the patient some medicines to aid the recovery process, alleviate pain, prevent infections and promote hair growth in the transplanted hair follicles. Medicines prescribed should be adhered to. Examples are:

  • Pain medicines or analgesics: NSAIDs like ibuprofen may be given.
  • Antibiotics: A short course of oral antibiotics are given to prevent infection in the healing surgical sites.
  • Anti-inflammatory medicines: An oral corticosteroid may be prescribed to keep swelling, redness and tenderness to a minimum.
  • Medications such as finasteride (Propecia) or minoxidil (Rogaine) to help stimulate hair growth.

(Read more: How to make hair grow faster and longer)

Following are a few steps you can take to reduce any complication of a hair transplant:

  • Normal activity and work can be resumed in around three days time.
  • Exercise should be avoided in the first week following the procedure.
  • Hair should not be washed for at least a few days after surgery or as per the doctor’s recommendations.
  • Only mild shampoos should be used to wash hair for the first few weeks.
  • Hair should not be pressed, brushed or combed hard for at least three weeks.
  • Avoid headgear, caps and clothing that may be tight to put on through the head and can compress the hair until further medical advice.

(Read more: Home remedies for thicker hair)

The most common complication after a hair transplant surgery, as with any other surgery, is scarring. Other complications related to hair transplant surgery can be:

  • Infections
  • Crust or pus drainage around the surgical sites
  • Scalp pain
  • Scalp itching
  • Scalp swelling
  • Inflammation of hair follicles (folliculitis)
  • Bleeding
  • Loss of sensation around the surgical sites
  • Visible areas of hair that do not match the surrounding hair or are noticeably thinner
  • Continuing to lose hair

Complications associated with drugs Minoxidil (rogaine) and Propecia used in the aftercare of hair transplant surgery can include:

Hair transplant isn’t the only solution for hair loss. Following are some other medications and procedures you can explore:

  • Medication: Medicines are generally the first step of treating hair loss. Hair growth stimulating medicines are available in easy-to-use formulations such as topical gels, creams and serums that are meant to be applied directly on to the area of hair loss.
    • Rogaine or minoxidil: This is the most common drug constituent present in over-the-counter hair growth promoting products. A doctor's prescription may not be needed to procure rogaine but it is wise to consult with one before using. Complications with rogaine can include scalp irritation and excessive hair growth in undesirable surrounding areas like forehead and face.
    • Finasteride or propecia: This is an oral medicine that is used to treat prostate enlargement (benign prostate hypertrophy). It is also used to slow male pattern baldness and can promote hair growth to some extent. It is a prescription drug. It acts by reducing active testosterone levels that can cause hair fall.
    • Corticosteroids: Corticosteroids are drugs that diminish inflammation in autoimmune diseases, including alopecia areata, leading to reduced scalp scarring and hair fall.
  • Procedures: While hair transplantation is the most common medical procedure done to cosmetically address hair loss, some other procedures can also be discussed with the doctor.
    • Scalp reduction: A flap is created surgically in the portion of the scalp that has sufficient hair to help cover a bald spot. A portion of the scalp that does not have hair on it can be surgically removed and closed by the surgeon as well.
    • Tissue expansion: Tissue expansion procedures also cover bald spots and are done in two-step surgeries. First, the surgeon places a tissue expander underneath the portion of the scalp covered with hair that is adjacent to a bald spot. After several weeks the tissue expander stretches out the hair covered portion of the scalp and with a second surgery, the newly formed flap is made to cover the bald spot.

(Read more: Hair growth treatment and tips)

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References

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  2. Lam SM. Hair Loss and Hair Restoration in Women. Facial Plast Surg Clin North Am. 2020 May;28(2):205-223. PMID: 32312508.
  3. Lam SM. Hair transplant and local anesthetics. Clin Plast Surg. 2013 Oct; 40(4):615-25. PMID: 24093656.
  4. Tai T., Chow M.S., Nadimi S., Kochhar A. Indications and Contraindications for Hair Transplant. Hair Transplant Surgery and Platelet Rich Plasma. 2020; 35-43.
  5. Nadimi S. Complications with Hair Transplantation.. Facial Plast Surg Clin North Am. 2020 May;28(2):225-235. PMID: 32312509.
  6. Dua Aman, Dua Kapil. Follicular Unit Extraction Hair Transplant. J Cutan Aesthet Surg. 2010 May-Aug; 3(2): 76–81. PMID: 21031064.
  7. Avram Marc R., Rogers Nicole, Watkins Shannon. Side-effects from follicular unit extraction in hair transplantation. J Cutan Aesthet Surg. 2014 Jul-Sep; 7(3): 177–179. PMID: 25538444.
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