1. Hair transplant concept
2. Indications
3. Types of hair transplant
4. Surgical technique
5. Hair transplant results
6. Recovery after a hair transplant
7. Frequently asked questions about hair transplant

HAIR TRANSPLANT

In some forms of alopecia it is necessary to resort to surgical treatment to achieve an optimal result. The technique currently used is hair transplantation using follicular micrografts. The technique of hair transplantation has improved substantially in recent years, to such an extent that we can say that at the present time it has reached its maturity, allowing totally natural results to be obtained.

The technique of hair transplantation by micrografts ("hair to hair") is a minimally invasive surgery performed under local anaesthesia that does not require admission, and the patient starts his/her normal socio-work life again within a few days. The final cosmetic result of the intervention is observed at twelve months, so the makeover obtained is gradual. It is an intervention that produces a very high degree of satisfaction in patients with alopecia, both men and women.

HAIR TRANSPLANT CONCEPT

The hair transplant technique is based on the principle of repositioning the hair from an area of the scalp that does not undergo the baldness process (donor area), to the area where it is being lost (recipient area). Once the procedure is performed, the transplanted hair will maintain the same characteristics as its original location, that is, it does not follow the process of baldness and is not lost.

Hair transplantation is based on the fact that hair follicles in the nape of the neck are genetically resistant to baldness (so alopecia does not usually affect that area). The transplant is therefore performed with the follicles of the same patient, removing them from the area where they grow sufficiently and putting them in the area where they are missing. In the old days, hair transplantation was performed by "grafts", that is, groups of multiple hair follicles that were transplanted into the bald area. It was a faster technique, but as the size of the grafts was very large, the final appearance of the patient was not ideal, taking on the look known as "doll hair".

The technique has been advancing and today it has been proven that the ideal procedure is the follicular micro-transplant, performing "micrografts". Through this technique, individual follicles are implanted, one by one, being a very laborious intervention, but that allows the patient to obtain a totally natural result.

Indications

The main indication of hair transplantation is androgenic alopecia in both males and females, when hair density has been lost and it is sought to recover it in a noticeable way.

There are other forms of alopecia candidates to improve with a hair transplant, such as some primary scarring alopecias (frontal fibrosing alopecia, lichen planopilaris, etc.) and secondary (surgical scars, burns, radiation therapy alopecia, etc).

TYPES OF HAIR TRANSPLANT

The technique used is hair transplantation with follicular micrografts. There are two types of micrograft hair transplantation:

a) FUSS or FUT TECHNIQUE (STRIP TECHNIQUE):

It consists of the surgical removal of a strip from the region of the nape, approximately 1 cm wide and about 15-20 cm long. This donor area is sutured by a technique that provides a virtually undetectable scar – the trichophytic closure – allowing the patient to hide it with their own hair (see FUSS technique scar video ). The follicles of that strip of skin are separated one by one by microscopes. Subsequently these individual follicles are implanted in the recipient area of baldness, usually in the upper area and above the temples. This technique achieves a high number of follicles for transplantation, and is commonly used in males with extensive alopecia and in women. For the strip technique, it is not necessary to shave the hair.

b) FUE TECHNIQUE (FOLLICULAR UNIT EXTRACTION):

This differs from the previous one in the form of extraction of the follicles, which is performed individually by a circular scalpel instead of making a strip. For this intervention it is necessary to shave the patient's hair on the back and side area of the head. The way hair is implanted is identical to the strip technique ("hair to hair", to obtain an all-natural result). This technique is mainly used in males who wear very short or shaved hair.

It is important to note that both techniques have the same result of naturalness and density, since the way to implant the hair is the same in both techniques. There is no better technique than another, but each will better adapt to the characteristics of each patient.

SURGICAL TECHNIQUE

Hair transplantation is a laborious procedure involving about seven to nine professionals (one or two doctors, three to five technicians, a nurse and an auxiliary). To separate all follicles individually, coordinated teamwork is required for several hours (usually surgery lasts about 5-6 hours). However, at the medical level, hair transplantation is a completely safe intervention, which is performed to an outpatient (it does not require admission), and by local anaesthesia.

In our Trichology and Hair Transplant Unit of the Pedro Jaén Group clinic, we perform the intervention in the operating room with the patient controlled at all times by an anesthesiologist for greater safety. This ensures that surgery is even safer and that the patient receives sedative medication which greatly improves intraoperative comfort. The patient is numb, but conscious at all times, as the intervention does not require general anaesthesia. For all of the above, the risk of medical complications during surgery is minimal.

Regarding the steps of hair transplant intervention, we differentiate three mainly:

1. Removing follicles from the donor area: the necessary hair is removed from the area of the nape, either by means of a strip (FUSS technique) or by the FUE technique.
2. Separation one by one and preparation of hair follicles: in the FUSS technique, the follicles are carefully separated by microscopes, while in the FUE technique the follicles are already separated and only have to be prepared for their implant.
3. Implant of the follicles in the bald area: the hairs extracted from the nape of the neck are implanted one by one in the bald area, using small micro-holes less than 1 mm made with a certain design to give a totally natural appearance.

Results

The goal of hair transplantation with the micrograft technique is to produce an all-natural result. To do this, the experience of the hair surgeon and his team, as well as the proper design of the transplant, will be essential.

Results of hair transplant in male patients

Results of hair transplant in female patients

Videos of the naturalness after hair transplantation

RECOVERY AFTER A HAIR TRANSPLANT

The hair transplant is a surgery that is performed in the operating room, lasting approximately five to six hours. It does not require admission, but the patient must be withdrawn from the socio-labor activities approximately seven to eight days so that it is not noticed that the intervention has been performed.

Post-operative care:
After a hair transplant, the patient should rest for 24 hours and should take antibiotic and anti-inflammatory medication for four days. Physical recovery is very rapid and not painful, a series of post-operative care must be taken for the survival of the transplanted follicles to be optimal:

• Avoid washing your hair for the first 48 hours, and then wash it in a special way during the first week.
  
• Avoid rubbing the receiving area for the first few days.
  
• Avoid continuous direct sun exposure the first few days (this care does not prevent hair transplantation from being performed in summer).
  
• Avoid wearing caps or hats for the first four to five days.
  
• It is common that between the second and fifth day edema/swelling of the forehead appears due to the low local anaesthesia due to gravity. Although this edema has no medical importance, it is the reason why we recommend that the patient avoids working the first week.
  
• Avoid exercising and cutting or dyeing your hair for up to 15 days after surgery.

Approximately from the first week of hair transplantation, the transplanted follicles break off progressively (what persists under the skin is the follicular root) so that at two to three weeks the appearance of the receiving area is very similar to that which there was before the surgery. In the first two to three months a discreet worsening of the hair density can be observed (especially in women), which is not usually very noticeable and it can be easily camouflaged with keratin microfibers. The follicular root will again produce follicles from five to six months, appearing progressively until one year. Therefore, the result of the hair transplant begins to be observed from six months, being at a maximum at twelve or even eighteen months after the intervention.

FREQUENTLY ASKED QUESTIONS ABOUT HAIR TRANSPLANTATION.

1. ¿ What is the approximate cost of a hair transplant?

This question will vary greatly depending on the technique, extent of the alopecia, the country and even the city in which the surgery is performed, the experience of the surgeon and his team, means for performing the surgery (operating room, presence or not of anaesthesiologist, high quality materials), follow-up included after intervention (reviews, therapies required) and much more. For approximate information on the cost of a hair transplant visit this LINK.

2. Can both men and women have surgery?

Hair transplantation can be performed on both men and women. More than gender, the important thing is to see if the patient is a good candidate for surgery (good quality donor area, type and extent of alopecia, etc.). Your dermatologist will advise you based on your individual characteristics. You can read more information about hair transplantation on women in this LINK.

3. Is there a better time of year than another to operate?

Medically this surgery can be performed at any time of the year, even in summer. Usually the date is decided based on when the patient can devote about a week to post-intervention care. 

4. Can I have surgery right before I go on vacation?

Of course. It's actually a strategy that many patients employ. They undergo hair transplantation, spend a couple of days in Madrid for post-operative review, and then go on vacation. During the first days of the holiday, the patient will have to be careful with the receiving area, and avoid diving into the sea or pool, but otherwise he will be able to live a fairly normal life.

5. How many days should I spend in Madrid if I have the operation and live in another city or country?

It will vary depending on how far the patient lives. In cases where the patient lives outside Spain or in a distant city, it is advisable to travel the day before the intervention and spend one or two nights more in Madrid, that is, a stay of two or three nights altogether.

6. When can the patient return to work after surgery?

The patient will be physically fine from the second or third day of surgery. However, from a cosmetic point of view we recommend delaying the restarting of work until seven to eight days after surgery - usually swelling somewhere on the forehead and a few scabs appear in the areas of the micrografts for a few days.

7. When do you see the final result of the transplant?

Until six months you don't usually start to notice the improvement. From six months, the patient is progressively improving until twelve months, at which point the final result is usually seen. In women, it may even take eighteen months to see the final result.

8. If a patient has a hair transplant, is it necessary to continue with medical treatment (antiandrogens/minoxidil)?

Of course the transplanted hair will no longer be lost, but the rest of the hair has to be maintained with the proper medical treatment that your dermatologist will recommend. 

9. How many hair transplants can be performed on the same patient?

It will depend on the extent and quality of your donor area, but on average we could say that a patient can undergo two large hair transplants throughout their life.

10. How can I request an appointment to assess if I am a good candidate for a hair transplant?

You can call 0034 - 914 317 861 and make an appointment with Dr. Vañó to rate the option of a hair transplant. You can also send an email to this email, stating that it is to request a hair transplant appointment.