Hair Replacement Surgery Options

The yearning for a thicker patch of hair to run your fingers through may lead you to consider hair replacement surgery. When a qualified physician performs a hair transplant on an ideal patient, it may be one of the most effective and long-lasting options for hair loss treatment.

“If it’s a genetic hair loss and you have enough donor hair to make a reasonable transplant, you can go ahead,” says hair restoration surgeon William Woessner, MD, director of the Woessner Medical Clinic in New Orleans. Donor hair comes from an area of the scalp where hair is growing more thickly, typically on the back or side of the head.

You and your surgeon may want to spend some time making sure you have a good diagnosis for your hair loss. A hair transplant may not be necessary if your hair loss is caused by a medical condition that can be managed some other way, for example.

You may want to schedule a consultation with several hair restoration surgeons before choosing the clinic or physician you want to work with. Consultations are usually free. It is a good idea to ask for before-and-after photos of patients with similar hair loss to evaluate the surgeon’s work.

You may also want to contact your health insurance plan. Most hair restoration surgery is not covered by health insurance. However, there are some circumstances, such as when hair loss is related to a disease, in which insurance may help pay for the procedure.

Hair Replacement

Most simple hair transplants (or hair grafts) are performed under local anesthetic with an oral sedative. This means you will be relaxed but awake, and either lying down or sitting up during the procedure.

A strip of donor hair will be taken from the back of the head. It may be grafted as is or cut into smaller segments of mini-grafts of one to five hair follicles. Mini-grafts are the most popular hair transplant procedures.

The replacement hair will be implanted into openings made by a tube-like instrument according to a pattern that you and the surgeon have agreed upon, in the places where you have hair loss. Once these grafts “take root” in the blood supply of the scalp, they can grow. “The scalp has a rich blood supply,” says Dr. Woessner.

Many small grafts are used to make a natural-looking hairline, while larger grafts and strips can fill in the scalp behind the hairline. According to Woessner, most people can expect between 300 and 8,000 grafts. These are sometimes referred to as FUGs (follicular unit grafts).

It can take a year to a year and a half for your hair transplant to completely grow in. In some people it may take longer. Within a week of the procedure, you will be able to style and even dye the transplanted hair as you would any other hair.

However, not everyone is a good candidate for hair transplant surgery. “You want to be able to tell a patient that they will have a good result,” explains Woessner, who has to turn many away. Those who are not good candidates for hair restoration surgery include:

• People with hair loss all over their head, instead of just on the top or center. This means there will probably not be a good donor hair site that can be used.
• People with inflammatory diseases, such as lupus or psoriasis, or other health conditions that could cause the transplant to fail.

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And finally, if you smoke you may want to quit before you seek surgical hair restoration. “Smoking is really bad for transplants. Smoking affects circulation and affects the entire cellular makeup of the scalp,” says Woessner. “Smokers often will have thin hair to begin with and a poor result.”

After the hair transplant, you may be told to use minoxidil topical (Rogaine) shampoo, which appears to help stimulate the growth of transplanted hair and can prevent additional hair loss.

Pros and Cons of Hair Replacement Surgery

Drawbacks of Hair Transplants

• They’re expensive. Total costs vary between providers. You may be able to negotiate a total bill that works with your budget. In general, says Woessner, surgeons charge $3 to $5 per graft. For most people, this adds up to thousands of dollars.
• May need more than one session. Some people may need to schedule several surgical procedures over a long period (with six months in between each) to get the result they desire.
• Risks of surgery. As with all surgery, hair transplant carries the risks of swelling, tenderness, bleeding, and infection, in addition to the possibility that the transplants will fail.
• Failed expectations. Hair replacement surgery will only improve coverage, not give you back a full head of hair. It does not create new hair. It’s a good idea to be realistic in your expectations.

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Scalp Reduction Surgery

Some people may be eligible for a procedure in which the surgeon removes part or all of the skin where hair loss has occurred. Adjacent scalp in which hair grows is then pulled over that spot. Because of the preparation involved, Woessner says this approach is “not something you would do for cosmetic reasons, usually.” Instead, this approach is more likely to be used with patients who have hair loss because of a traumatic accident.

Benefits of Scalp Reduction

Once healed, the hair will grow in the same way that it does elsewhere on the scalp, although there is the risk of more visible scarring from the scalp reduction procedure.

Drawbacks of Scalp Reduction

Before the reduction, your surgeon may recommend placing scalp expanders under the skin of your scalp for several months to raise up and stretch the skin. This will make it possible to pull the stretched area of hairy scalp over to fill in for the bald scalp that was cut away by the resection, but Woessner warns, this can be a very uncomfortable time for patients.

After the surgery, you may have wider-than-expected scars called “stretch-back” scars caused by the pressure of the scalp pulling back toward its normal site.

If you are considering hair replacement surgery, you have probably already catalogued the emotional costs of hair loss. It is a good idea to familiarize yourself with the procedures and other hair loss treatment options before you make a final decision.

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