Depending on a whole of critically prominent factors, hair transplant surgical operation can either be one of the best decisions you will ever make or among the worst. Today we're going to discuss the pros and cons of surgical hair restoration, euphemistically called hair plugs or transplantation. In fact, the more spoton description is "autologous hair bearing skin transplantation". This is because the actual course involves harvesting sections of skin from a hairy part of one's scalp (donor) and engaging it to a bald area (recipient) of the same person. Skin transplantation between anything other than genetically-identical twins does not work.
The technique of engaging hair bearing skin tissue grafts from one part of the scalp to another dates back at least 50 years. In the 1950's a pioneering surgeon by the name of Dr. Norman Orentreich began to experiment with the idea on willing patients. Orentreich's groundbreaking work demonstrated a concept that became known as donor dependance, or donor identity, that is to say that hair bearing skin grafts harvested from the zone of the scalp surface the pattern of loss continued to produce viable hair even though the grafts had been relocated into areas that had previously gone bald.
Swiss Twins
During the next two decades hair transplantation gently evolved from a curiosity into a popular cosmetic procedure, primarily among balding men of late middle years. In the 1960's and 1970's practitioners together with Dr. Emanuel Marritt in Colorado, Dr. Otar Norwood, Dr. Walter Unger showed that hair recovery could be feasible and cost effective. A suitable of care was industrialized that, in experienced hands, allowed for reasonably consistent results.
At the time the most coarse technique complicated the use of relatively large grafts (4mm -- 5mm in diameter) that were removed individually from the donor site by round punches. This tended to leave the occipital scalp resembling a field of Swiss cheese and significantly minute the yield that was ready for movement to the bald zones on top and in front of the patient's scalp.
Over the course of multiple surgical sessions, grafts were settled into defects that had been created in the recipient zone (bald area) using slightly smaller punch tools. After healing the sick person returned for follow up sessions where grafts were settled in and surrounded by the old transplants. Because of the relative crudity of this technique, results were often quite apparent and the sick person was left to walk around with a dolls hair like appearance, particularly noticeable at the frontal hair line, and especially on windy days. Such patients were commonly quite minute in the manner they could style their hair and, because of the wasteful donor dismissal method, many persons ran out of donor hair long before the process could be completed.
In the 1980's hair recovery surgical operation gently began to evolve from the use of larger punch grafts to smaller and smaller mini and micrografts. Minigrafts were used behind the hair line, while one and two hair micrografts were used to approximate a natural transition from forehead to hair. Donor site supervision also evolved from round punch dismissal to strip harvesting --- a far more productive technique. Pioneers in this area were skilled surgical practitioners such as Dr. Dan Didocha, Dr. Martin Tessler, Dr. Robert Bernstein and others. The concept of creating a more natural appearance evolved still additional in the 1990's with the advent of follicular unit dismissal (Fue), first proposed by the very gifted Dr. Robert Bernstein, and described in the 1995 Bernstein and Rassman publication "Follicular Transplantation."
The 1990's also brought new tools into the mix, such as the introduction of binocular or 'stereoscopic' microdissection. Stereoscopic microdissection allowed the surgeon to clearly see where one hair follicle begins and another ends. As the 1990's progressed, many transplant surgeons shifted away from the use of larger grafts in favor of one, two and three hair follicular units.
While very useful in the hairline region, such 'micrografts' were not always optimal in recreating density behind the hairline. So even after multiple sessions, the final outcome of micrograft-only transplanted scalps tended to look thin and rather wispy. Maybe of even greater concern, the dissection of a donor strip entirely into micrografts risked a significantly reduced conversion yield. Here's why.
Let's assume we are beginning with two donor strips of hair bearing tissue from two similar patients. Two surgeons are each dissecting a singular donor strip, but the first surgeon aims to dissect down into one and two hair micrografts alone, while the second surgeon dissects only sufficient micrografts to place in the hairline, leaving larger three, four, five and six hair grafts ready for placement behind the hairline. At the beginning each donor strip contains 1,000 hairs. Both surgeons should theoretically end up with 1,000 viable hairs ready for transplantation regardless of how the tissue was dissected. Unfortunately, the reality doesn't quite work out that way.
Every time the donor tissue is cut the risk of transecting a follicle occurs. Transected hair follicles are known colloquially in the industry as Christmas trees --- because they are hairs that lack viable roots. Basically, from a previously robust concluding structure, they either produce thin fine hair or none at all.
This is a problem for some reasons, but first and foremost, it is a problem because the act of hair transplantation does not 'create' new hair. The process simply relocates viable hair from the back of the scalp to the front.
And since there is a fixed furnish of permanent donor hair which may not be sufficient to fill the area of demand, it is intrinsically counterproductive to cut this minute furnish via a technique know to engender relatively poor yield. The problem is solved by the truthful use of Fue/micrografts in the recreated hairline and somewhat larger grafts behind the hairline. Refinement is thus achieved at the hairline with suitable density behind the hairline zone. If either of these factors are missing from the equation the follow is a dysaesthetic hair restoration. either the outcome looks thin and fuzzy (micrografts only) or it looks doll-hair like (large grafts only). So now we can now begin to see why the size and strategic placement of each graft becomes a critically prominent consideration in hair transplant surgery.
Several other potential caveats to hair transplant surgical operation are graft compression, misdirection, misangulation, mishandled grafts and donor site damage. Graft compression occurs by trying to insert too large of a donor graft into too small of a recipient hole. If the donor graft is not determined fitted to the recipient hole then the tissue and hair can indeed get 'squeezed together'.
To see how this works, enlarge the fingers from your left hand open and wrap the fingers from your right hand around the middle part of your left hand. Just as your fingers get squeezed closer together, the hairs in a compressed graft end up closer together then they were intended by nature. This tufting lends an odd or unnatural appearance to the hair.
Misdirected grafts produce hair that ends up growing in a direction contrary to that which was intended. Again, this problem causes a weird, unnatural --- and difficult to style -- head of hair. Misangulation, somewhat similar to misdirection describes a misplaced graft that produces hair at an angle which does not correspond to the way scalp hair is supposed to grow. Again, the follow is hair that just doesn't look right no matter how it is combed.
Mishandling of grafts commonly involves either transsecting a follicle (cutting off the root) or dessicating (allowing to dry out) the tissue. Graft mishandling typically occurs primarily in less than experienced surgical hands.
Donor site damage is metaphorically tantamount to decimating the whole Amazon rain forest in order to harvest a few dozen plants to use for decorating a neighborhood street. There are few things more aesthetically demoralizing then walking around with a partially-completed hair transplant --- knowing that there isn't sufficient donor hair ready to desist the job because your donor site is exhausted.
Your donor hair is a costly resource. Treat it like solid gold. It's all you've got and everything you've got to perfect a process of surgical hair restoration. Don't waste a singular follicle.
So from all of this we can begin to appreciate some of the key pitfalls and risks of transplant surgery. As we see, the risks are principally aesthetic --- meaning that the potential for damage is commonly cosmetic, not medical. The scalp of most wholesome people is very well vascularized and, in the setting of transplant surgery, scalp infection and/or other medically-relevant scalp complication is quite rare.
For those individuals considering transplant surgical operation it is crucial to equip oneself with good solid information. The internet is a good place to start. Visit trusted online resources. An excellent start would be a visit to the International community of Hair recovery Surgeons. another reasonably objective resource is the hair transplant network. David Tse runs a very educational website called Hairsite. There is always Medline which acts as a clearinghouse for all healing research, together with surgical hair restoration. Those who publish on pubmed.com are often the top caliber in their field.
Once you've gathered information from online resources you can move next to contacting the surgeon's office itself. Take your time. Don't let anything talk you into surgical operation until you're ready. Keep your money in your wallet and your donor hair behind your ears until you're indeed prepared to commit both to the task at hand.
Talk to actual patients. If possible, visit with a restored sick person or two in person. Many finished patients will not mind visiting with you if they're happy with their outcome. Plan to have at least one personal consultation with each surgeon you're considering. Don't be afraid to travel. You needn't go surface the United States for hair restoration. But if you live on the West Coast or East Coast you shouldn't be minute to hair surgeons in your immediate vicinity. It's your hair for goodness sake! Don't let geography be a factor in the decision.
Ask each candidate surgeon pointed questions, such as: Can you show me pictures from patients who started with my degree of hair loss? How close to a full head of hair can I come? What will be the total cost for me to get there? Not just price per graft, or price per procedure, but the cost to get me from where I am now to where I want to be. How many surgeries are we talking about, and spread over what period of time? What is your course for touch up work? What part of your convention do you devote to corrective surgeries? Can I see photos of patients that you've corrected? These last two questions are very useful because hair surgeons who are adept at correcting other people's mistakes are commonly less likely to blunder themselves.
There is a crucial take-home chapter from all of this. The singular most prominent criterion in predicting a good outcome for hair transplant surgical operation is not the patient, but the surgeon. In surgical hair restoration, art is at least as prominent as science. You've way to genuine excellence in the hands of experts like Dr. Dan Didocha, Dr. Robert Bernstein, Dr. Bradley Wolf, Dr. Martin Tessler, Dr. Leonard Aronovitz and others. So for those seriously mental about undergoing transplant surgery, the key is to arm yourself with knowledge first. Take your time. Be 'patient' before becoming anyone's "patient". follow this advice and the odds are you will end up happier after your hair recovery then you are today.
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