Hair Transplant

1-  How does hair transplantation work?

Hair transplantation is really about relocating (transplanting) the bald resistant hair follicles from the back of the head to the balding areas on the top of the head. This process works for a lifetime because the hair follicles taken from the back of the head are genetically resistant to baldness, regardless of where they are relocated to.


2-  Will my hair transplant results look completely natural?

Hair transplantation, when done right, can be so natural that even your hair stylist will not know that you've had it done. But the skill and techniques of hair transplant surgeons does vary widely, as do their results. It's important to choose the right procedure and clinic to assure that you will get completely natural results. The state of art hair transplantation procedure that we recommend is called "Follicular Unit Hair Transplantation".


3-  How long does a hair transplant procedure take?

A typical session of between 1,500 to 3,000 grafts normally involves a full day of surgery on an outpatient basis. Most patients will arrive in the morning and will have their procedure completed by late afternoon.


4-  Does the hair transplant procedure hurt?

Patients are given local anesthesia in the donor and recipient areas. Most patients find that once the anesthesia is given that they feel no pain or discomfort during the surgery. Following surgery patients will typically feel some amount of soreness and numbness, with some mild discomfort. Most patients are pleasantly surprised by how minimal the discomfort from the surgical procedure is.


5-  How many grafts/hairs will I need?

The amount of grafts you will need ultimately depends on your degree of hair loss, now and in the future, and on how full you desire your hair to be.


6-  What is the recovery/healing time?

With today's very refined micro hair transplantation procedure the incisions are very small and less invasive than past procedures. This results in more rapid healing. Most patients feel fine within a day or two following surgery, although some numbness and mild soreness can be expected for several days following surgery.


7-  Will people know I had a hair transplant?

Immediately following surgery a patient's recipient area is typically pink with scabs forming around the micro incisions. These hundreds of tiny incisions will heal rapidly within a week to ten days. During the first few days after the surgery a person's hair transplants will be noticeable if there is no previous hair to mask these temporary scabs. However, most patients feel comfortable being in public without wearing a hat within 5 to 7 days following surgery. Once the transplanted hair grows out the results should look entirely natural, even under close examination.


8-  When will my newly transplanted hair start to grow?

Normally it takes between four to six months following surgery before the transplanted hair follicles begin to grow new hair. The transplanted hair grows in very thin initially and gradually grows thicker and fuller over time. After one year a patient's transplanted hair will be fully mature and will continue to grow for a life time.


9-  Are the results permanent?

Since the hair follicles that are transplanted to the balding areas are genetically resistant to going bald, they will continue to grow for a life time – just as if they had been left in the bald resistant donor area.


10-  How do I find an excellent hair restoration surgeon?

The most important decision in restoring your hair is the physician you choose. The skill, talent, and experience of hair restoration physicians vary widely, as do the end results. Who you choose will determine how natural and full your new hair will be for the rest of your life.


11-  Are you too young?

In general, people in their early twenties are too young to have hair transplants done. Most doctors would advise patients against getting a hair transplant until they are at least in their mid or late twenties when their hair loss has somewhat stabilized. Male pattern baldness tend to progress very rapidly when someone is in his twenties. It would be unwise to waste precious donor hair until you can reasonably predict the future progression of your hair loss. If you had hair transplant done at a very young age, you might find yourself in a very awkward situation should your hair loss continues to progress further after the hair transplant surgery.


12-  Norwood Scale

Try to familiarize yourself with the Norwood scale. Members and doctors in our clinic frequently refer to the Norwood scale when answering questions. This is a commonly used classification for male pattern baldness.


For women, the Ludwig scale is normally used to classify the extent of one's hair loss

Type I Type II Type III

13- Post Op - Scabs

You will be left with numerous scabs all over your recipient site immediately after the surgery. This is normal. In most cases, they will fall out automatically in about 2-3 weeks. Try not to rub them or touch the recipient site excessively. If your fingers are not clean, they can easily infect the recipient site.


14-  Post Op - Shedding Of The Transplanted Grafts

It is very common for the transplanted grafts to fallout out together with the scabs. Don't panic. This is normal. After the transplanted grafts fall out from the recipient site, the follicles will go through a resting period of anywhere from 3-9 months before they regrow. For FUE patients, it is not uncommon for the transplanted grafts to continue to grow immediately after the surgery. But for strip procedure, the grafts are more likely to shed before they regrow. Q: My hair is fine. Is that a problem for a hair transplant? A: Fine hair will give a thinner look than thicker hair, but will look completely natural. Thin hair doesn't prevent one from having surgical hair restoration, providing your donor density and scalp laxity are adequate. Q: This is my second hair transplant surgery and it seems like it is growing more slowly than my first. Is this normal? A: It is common for a second hair transplant to take a bit longer to grow than the first, so this should be expected. It is also possible that there is some shedding from the procedure, or a continuation of your genetic hair loss. Propecia may be helpful in this regard. It is important to wait at least a year for the hair transplant to grow in fully and to give a chance for any hair that was shed to regrow. Q: I had a hair transplant two weeks ago and I just started noticing that some grafts were in my baseball cap at the end of the day. Am I losing the transplant and what can I do to keep this from happening? A: The follicles are firmly fixed in the scalp 10 days following the hair restoration surgery. Hair is shed from the follicle beginning the second week after the procedure. This is perfectly normal and does not represent any loss of grafts. What you are seeing is the root sheath that is shed along with the hair shaft. This looks like a little bulb, but is not the growth part of the follicle and should not be a cause for concern. Two weeks following the hair transplant surgery you may shower and shampoo your scalp as you normally did before the procedure without any risk of losing grafts. Q: How are recipient sites made during a hair transplant? A: At Dr, Piroozhashemi Clinic, we use tiny needles of varying sizes. At the start of the hair replacement procedure, the different size follicular units are fitted to specific site sizes to determine exactly the best size instrument to use for each graft. By custom fitting the sites to the grafts, healing is incredibly fast and patients are able to gently shampoo their scalp the day following hair loss surgery. All recipient sites are made using lateral slits, as these give the most full, natural coverage. Q: After a strip procedure, will the scalp's laxity return to normal and how long after the hair transplant does it take? A: Following hair transplantation, the scalp regains most of its laxity in the first eight months, but it will continue to loosen slightly after that. It is interesting that if the scalp is tight prior to hair loss surgery, the scalp is less likely to have its full laxity return than in patients who had loose scalps to begin with. With average or loose scalps, there is usually no difference. However, over time, the patient rarely, if ever, notices any permanent tightness, unless aggressive procedures have been performed or procedures such as scalp reductions and lifts. Q: Can you get your original density back with a hair transplant? A: Although the cosmetic benefit can be dramatic, a hair transplant only "moves" rather than creates new hair. In hair restoration surgery, a limited amount of hair from the donor area is transplanted to a much larger area in the front and top of the scalp, so that we can never reach the original density. Achieving a cosmetically appropriate density in the front part of the scalp (which is around 1/3 to 1/2 of the original density) generally takes two sessions and is the goal of most hair replacement surgery. Q: Can you perform a hair transplant into scar tissue? A: Yes, hair grows in scar tissue, but not quite as well as in normal tissue. The scar is not as elastic as normal tissue so the grafts are at slightly higher risk of being dislodged; therefore, more care must be taken to protect the grafted area after the hair transplant surgery. In addition, the blood supply in scar tissue is less than in normal tissue, so that area should not be transplanted as densely and the hair replacement should be performed over multiple hair transplant sessions. Finally, grafts do not grow well in thickened scars. If a scar can be thinned using injections of cortisone, it may improve the chance that the transplanted hair will grow. Q: What is Follicular Unit Transplantation and how is it different from Follicular Unit Extraction? A: Follicular Unit Hair Transplantation, called FUT for short, is a procedure where hair is transplanted in the naturally occurring groups of 1-4 hair follicles. During this type of hair transplant, a donor strip is removed from the back and sides of the scalp and then sutured or stapled closed, generally leaving a thin, fine-line scar. Individual units, or groups of hair, are then dissected from this donor strip using stereo-microscopes. In Follicular Unit Extraction (FUE), the individual units are removed directly from the back or sides of the scalp, through a small round instrument called a punch, so that there is no linear scar. There is, however, scaring from the removal of each follicle. Although the scars of FUE are tiny and round, the total amount of scarring is actually more than in FUT. Q: Is it possible to have a hair transplant that is totally undetectable immediately following surgery? A: Not unless a person has a fair amount of existing hair that can cover the transplanted area. Although surgical hair replacement techniques have improved dramatically over the past ten years, and wounds are so small that patients may shower the morning following the procedure, a hair transplant will be detectable for the first week. During this period, there may be some swelling that settles down on the forehead and some crusting and some residual redness.


15-  What causes hair loss?

The most common cause of hair loss is inheritance. Men and women inherit the gene for hair loss from either or both parents. Men are most commonly affected by the inherited gene as the hormone, testosterone, activates the genetic program causing loss of hair follicles. Currently there is no known method of stopping this type of hair loss. The age of onset, extent, and rate of hair loss vary from person to person. Severe illness, malnutrition, or vitamin deficiency can accelerate this process. When applied incorrectly, permanent hair color and chemical relaxers damage the hair and follicle to the extent that hair loss can be permanent. Causes of hair loss do not include wearing a hat, excessive shampooing, lack of blood flow, or clogged pores.


16-  Does it really work?

Yes. The transplanted hair is removed from one area of the body (donor site) and transferred to another (recipient site). The transferred tissue is not "rejected" as it is not foreign tissue. The transplanted hair maintains it's own characteristics; color, texture, growth rate, and curl, after transplantation and regrowth. The vitality of the grafted follicle is maintained by the rich blood supply to the scalp. Originally, large circular grafts containing 15-20 hairs were transplanted resulting in noticeable and unnatural results. Over years, instruments and techniques have been developed that allow us to achieve truly natural results by transplanting small grafts very close together. We have found that hair grows from the scalp in groups of one, two, and three hair follicles. We transfer these groups of follicles after eliminating the excess surrounding fatty tissue. This allows the grafts to be placed closer together resulting in a denser and more natural result.


17-  What can be expected immediately after surgery?

The post-operative course will depend on adherence to the instructions given after surgery. Small scabs will form on the scalp at the graft sites. Generally speaking, these scabs disappear in 4-7days. Shampooing can be resumed 24 hours after surgery. The suture (stitch) used in the donor area is undetectable as it is completely covered by your existing hair. An appointment will be made for the suture to be removed one week after surgery. It is advisable to take at least two days off work after surgery. A baseball type cap can be worn at anytime after surgery. Patients should avoid strenuous physical activity for at least five days after surgery. Typically the grafted hair will shed in 2-4 weeks. New growth will begin in 3-4 months and length will increase approximately 1/2 inch per month.


18-  Is Hair Transplantation painful?

Most people are surprised at how little pain there is during the procedure. Some discomfort is to be expected as the anesthetic is injected into the scalp. Once the skin is anesthetized, there is no pain. If the numbing medicine wears off during the course of the procedure, more is injected to re-anesthetize the area.


19-  What will it look like after the procedure?

The grafts form small scabs in the days after the procedure. If one has enough surrounding hair, these scabs can be camouflaged with creative styling. If not, the small scabs may be visible but do not attract much attention. By keeping the scalp moist, the scabs usually come off in about a week or so.


20-  When can I go back to work?

Depending on the type of procedure you have done and the type of work you do, it is often possible to go back to work the next day. Your surgeon will discuss this with you during the consultation.


21-  Speake a little about gentic hair loss in men?

Androgenetic alopecia is the scientific name for the genetic predisposition in both men and women for pattern baldness. Pattern hair loss in men is often referred to as male pattern baldness(MPB). Androgenetic alopecia is the cause of over 95% of all pattern hair loss, including baldness in men and thinning hair in women. Pattern hair loss occurs in somewhat predictable stages, and is relentlessly progressive. Usually the earlier in life pattern hair loss begins the more advanced the hair loss pattern will ultimately become. Studies have shown that pattern loss is increasingly evident and advanced as people age. In MPB the hairs on the top of the scalp have a genetic sensitivity to the male hormone testosterone (DHT). DHT is believed to contribute to: 1)Shortening of the growing phase of the hairs, 2)Progressive miniaturization of hair follicles,and 3)A decrease in the number of visible hairs The hairs on the sides and back of the scalp do not possess this genetic trait and therefore are not affected. For this reason hairs removed from the sides and the back(donor hair)will maintain their genetic predisposition when transplanted and continue to grow when moved to the top of the scalp where hair loss has occurred. Another interesting aspect of male hair loss is the inheritance of the gene for baldness. Note that many years ago we were taught that genetic hair loss was sex-linked and thereby transmitted from mother's side only. We have since learned that this was only the tip of the iceberg. Like a political investigation, as the research goes deeper, more and more players(in our case, chromosomes)are implicated. Although male pattern baldness is definitely transmitted on the X chromosome(XY is a male, XX is a female), there are numerous other chromosomes(humans have forty-six)that help determine the age of occurrence, rate and degree of hair loss. So just because your maternal grandfather is bald doesn't mean you will be also.


22- Why start now?

If you have been determined to be a candidate for restoration by a NHI physician, and if you are uncomfortable with your hair loss, why not start now? With your restoration completed, you can get on with life without this distraction.


23-  How much hair do I need?

When you have your consultation with a our physician, he will suggest how many grafts may be available for your first procedure (and subsequent procedures if they will be needed). This number will be based on your present balding pattern, what it may become in the future, and how much donor hair is available. When an individual has high donor density, the follicular units usually contain multiple hairs, and when an individual has low donor density the follicular units often contain only one hair. If an individual has a very loose scalp, a larger donor strip can be removed, while an individual with a tight scalp will have a smaller donor strip. When an individual has a relatively small amount of hair that can be moved, our physicians take great pains to distribute the available hair in ways that produce the best coverage


24-  What is the difference between density and fullness?

The word fullness rather than density, more accurately describes the visual phenomenon in what we perceive as thick hair vs. thin hair. The concept of fullness is broader and more inclusive. Density, the number of hairs/cm2, is only one of several contributing factors that are responsible for the visual impression of hair that appears "thick". Other factors include hair shaft diameter, color, texture, and curl, which may be of equal of even greater importance than density, in contributing to the visual appearance of a "full" head of hair. In the early stages of balding the "thin look" is caused by a process called "miniaturization" where hair is reduced in size, but not actually lost. Therefore, the density (the counted number of hairs/cm2) remains the same, although the persons look of fullness can be dramatically reduced.


25-  Is it true that all Hair Transplantation Surgery`s Patients are men?؟

No. Of course, most hair transplant patients are men between the ages of 30 and 50, but you may be surprised to learn that women also suffer from hair loss and lots of our clients are ladies. Over 200,000 people had hair transplants in 1994 (more than four times the 1990 rate), and of those, about 13,000 were women. Women with localized thinning on the top of their heads or thinning around the temples often make good candidates for hair transplantation. Prior to evaluation for hair transplantation, it is important for women to discuss your thinning hair with a dermatologist and/or endocrinologist to make sure there is no other treatable reason for the hair loss.


26- How do I know if I'm a good candidate for hair transplants?

Even in the most extreme balding patterns, a permanent 'wreath' of hair exists on the sides and back of the head. This hair is unaffected by the balding process. In Follicular Unit Hair Transplantation, a thin strip of skin containing this permanent hair is removed from the back of the head (because the skin of the scalp is flexible, the scalp can be sutured together again after the strip is removed leaving little trace that anything was done). The hair follicles are then carefully removed from that piece of skin and placed in very small surgical sites made in the thinning or balding areas of the scalp. Once transplanted, this hair behaves as it was programmed to behave in the original area it came from and will grow naturally for the rest of your life. Most men in good general health are candidates for hair transplantation. In order to determine your candidacy, you should arrange to have a free, private consultation with a NHI physician. During your consultation, the physician will measure your donor density and scalp laxity. He will also determine your balding pattern and take your individual hair characteristics such as color and wave into consideration to develop a plan for your hair restoration.


27-  Is it possible for me to repeat this procedure?

In many cases, a patient may wish to return for additional transplants several months after the first surgery. When large quantities of hair need to be implanted, repeat sessions can be scheduled every 6-12 months. Some patients who are persistent with their process sometimes have as many as ten sessions, but this is most often unnecessary with the large number of grafts transplanted using modern methods. More commonly, men are very satisfied with at most, 2,000 to 3,000 grafts for an area of baldness that extends over much of the top of the scalp. If you have more hair to begin with, you will probably need fewer grafts.


28-  I have heared about `Shock fall out`. Clarify this matter to me?

The medical term for the very onerous sounding "shock fall out" is "effluvium" which literally means shedding. It is usually the miniaturized hair i.e. the hair that is at the end of its lifespan due to genetic balding that is most likely to be shed. Less likely, some healthy hair will be shed, but this should regrow. Rarely, but sometimes, we notice some shedding of hair from a prior transplant when transplants are spaced less than one year apart. However, this hair grows back completely. For most patients, effluvium is not a major issue and should not be a cause for concern. In the typical case, a patient looks a little thinner during the several month period following the transplant, when the transplanted hair is in its latent phase. It ends when the transplanted hair begins to grow. The thinning is often more noticeable to the patient himself, than to others. Shedding is generally noted as a thinning, rather than of "masses of hair falling out", as the term "shock fall out" erroneously suggests. In general, the more miniaturization one has and the more rapid the hair loss, the more likely will be shedding from surgery. Young, actively balding patients would be at the greatest risk. Older patients with stable hair loss would have the least risk.


end faq


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