Hair Transplantation
In this section:
What is a hair transplant?
A hair transplant is an operation in which hair follicles that are not susceptible to pattern hair loss (usually from the permanent fringe of hair at the back and sides of the head) are relocated to areas of the scalp that are bald, or destined to become bald. Hair can also be transplanted to other areas including the eyebrows, eyelashes, moustache, beard and body.
The field of cosmetic hair transplantation was born in the late 1950’s and has evolved dramatically over the last 50 years. With modern techniques of mini, micro and follicular unit grafting, pluggy, unnatural "doll’s hair" results are a thing of the past.
Using modern techniques and instrumentation, Dr. Korman and his team are able to create a natural appearance with the hairline, density and coverage that are appropriate for each individual patient.
The side-effects of hair transplantation surgery are relatively minor and serious complications are extremely rare. Modern hair transplantation surgery in our setting is comfortable, predictable, and produces pleasing results.
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How are hair transplants done?
Hair transplantation is performed under local freezing with mild sedation in a comfortable office setting.
An area of hair is removed from the back or sides of the scalp and microscopic surgical dissection is used to divide the donor tissue into its individual follicular units. Follicular units are naturally occurring groupings of one, two, three and sometimes four or five hairs. Depending on your goals and individual characteristics, under some circumstances slightly larger grafts known as multi-follicular unit grafts (MUG’s) can be created to help achieve additional density behind the hairline.
The donor area on the back or sides of the scalp is then meticulously sutured using a cosmetic surgical technique known as "trichophytic closure" which usually renders the scar completely undetectable.
Precise instruments are then used to create tiny recipient sites in areas of the scalp that are bald (or destined to become bald). The creation of the recipient sites requires surgical skill and artistry in order to achieve a long-term result that will continue to look totally natural even as the patient ages.
Once the recipient sites have been created, the grafts are individually inserted into place. The transplanted hair is your own and will continue to grow for the rest of your life, just as it did in its original location. It can be washed, brushed, cut and styled just like any naturally occurring hair.
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Does it hurt to have a hair transplant?
Part of our philosophy is that hair transplantation should be a comfortable and virtually pain-free experience. With the use of light sedation, local anaesthetic and gentle and meticulous techniques, the vast majority of patients report that they experience little or no pain. Many actually enjoy the experience, asking questions, chatting with Dr. Korman and the staff, listening to music, or watching a movie as the procedure progresses.
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What if I don’t want to look like I’ve had a hair transplant?
Many potential patients state that the only thing that they would find worse than baldness would be a bad hair transplant. The sight of unacceptable, obvious, pluggy, and frankly embarrassing results produced by older, outdated techniques would give anyone second thoughts.
The field of transplantation has come a long way from the days of "corn-rows" of hair plugs. Grafts have gradually gotten smaller, hairline design more sophisticated, and technology more advanced. The advent of follicular unit transplantation with stereo-microscopic single-hair graft preparation is now generally regarded as the end refinement in surgical technique, able to yield results that are predictable and undetectable. Often, patients’ hair stylists are not able to tell that a transplant has been performed.
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What is the difference between "follicular unit strip surgery (FUSS)" and "follicular unit extraction (FUE)"?
Follicular unit strip surgery (FUSS) and follicular unit extraction (FUE) refer to different techniques of harvesting the hairs that are to be used for transplantation.
FUSS involves removing one or multiple strips of donor tissue from the back or sides of the head. This strip is then dissected into smaller grafts, usually individual follicular units, using stereo-microscopes or other high magnification. The resulting wound in the donor area is then meticulously sutured, usually using a cosmetic surgical technique known as "trichophytic closure" which allows adjacent hair to actually grow through the fine linear scar thus rendering it almost completely invisible.
FUE is a different technique whereby individual follicular units are individually extracted from the donor area using a very small cutting tool called a punch. The resulting holes in the donor area are so small that they simply heal over on their own with no need for sutures. The purported advantage to this technique is that unlike in FUSS, there is not a single, long donor scar.
FUE is sometimes marketed as a "no-scalpel" technique. This can be misleading for some patients because while strictly speaking, no scalpel is used, FUE is still a surgical procedure requiring similar preparation and having the same (albeit low) potential for complications such as scar formation. It is just that instead of one long incision, hundreds, or even thousands of smaller ones are required.
While many centres do offer FUE and achieve excellent results with it, Dr. Korman believes that FUSS with microscopic graft preparation remains the gold standard technique. FUE is far more time consuming so in most centres, FUE sessions involve less hair transplanted in a longer time at a higher cost to the patient. Perhaps more importantly, Dr. Korman also believes that even in the most experienced hands, FUE is associated with a higher rate of donor follicle damage and transection (i.e. more precious donor hair wasted). In his opinion, while FUE does have applications in certain specific circumstances, it is not yet ready to supplant FUSS as the core technique of graft preparation.
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What are the differences between "plugs", "follicular unit" and "multi-unit" grafts?
There is a tremendous amount of confusion that exists, even among hair transplant specialists themselves, regarding the terminology used to describe different types of hair grafts. There are also many competing and confusing claims, particularly on the internet about the relative advantages and disadvantages of various techniques.
Follicular Unit Transplants (FUT)
When examined under a microscope, hair can be seen to grow in natural groupings that contain between one and four, and rarely as many as five or six hairs. These natural groupings are called follicular units (FU’s). When donor hair is divided into grafts for transplantation, preservation of the integrity of these FU’s allows the hair to be transplanted in a way that maintains a very natural appearance. This is in stark contrast to the unacceptable appearance of historical hair transplants that paid no attention to FU groupings and simply inserted coarse plugs which could contain as many as 20-30 random hairs.
The advantage of performing hair transplants using exclusively individual FU’s is that by mimicking nature, unparalleled naturalness can generally be achieved and even a small session can produce a stand-alone result that will continue to look natural, albeit thin, over the patient’s lifetime.
The disadvantage of surgery that employs FUT exclusively is that a vast number of grafts are needed in order to achieve what most people consider to be adequate density. This can require multiple sessions or huge mega-sessions that are extremely long and can be stressful for patients and staff. There is also a concern that transplanting many thousands of grafts in a single session can compromise graft growth by damaging the blood supply to the scalp. This could lead to a "two-steps forward, one-step back" situation where precious donor hairs fail to grow and are thus wasted.
Multi-Unit Grafts (MUG’s) or Multi-Follicular-Unit Grafts (MFUG’s)
While still preserving the FU integrity, multi-unit grafts (MUG’s or MFUG’s) keep two or more adjacent follicular units attached to each other to be implanted into a recipient site as one graft. MUG’s allow more hair to be moved with a smaller number of individual grafts thereby providing higher density at a lower cost. MUG’s are not used in the hairline where they would be noticeable. They are sometimes interspersed with individual FU grafts behind a transplanted hairline to achieve more density in the midscalp and frontal core areas.
Dr. Korman’s Approach
Dr. Korman's ultimate goal is to achieve a satisfying result for his patients. He believes in a combined approach where the patient’s wishes, as well as technical factors such as hair and skin color, donor supply, hair caliber and curl are taken into account. Dr. Korman will help you decide what specific techniques will yield the most appropriate balance of coverage, density and naturalness for your hair transplant.
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How many procedures will I require?
The number of procedures that you will require depends on several factors including your treatment goals, the degree of your hair loss, and the availability of donor reserves. Some people are satisfied after only a single procedure, while others will desire further treatment in order to add density, refine the hairline, temples or crown, or to keep up with progressive hair loss over the years.
As noted above, the main advantages of an exclusively "follicular unit" technique are that it achieves a degree of naturalness that would otherwise be unattainable and will maintain its natural appearance even if all of the surrounding original (non-transplanted) hair is eventually lost. The downside of follicular unit transplanting however, is that while the hair looks completely natural, it can still have a thin or see-through appearance unless very large numbers of grafts are used to achieve density. This is one of the reasons that more than one session is sometimes necessary, or that larger grafts are sometimes used in the centre of the scalp in order to achieve density without compromising naturalness.
Regardless of the number of transplant sessions that are ultimately carried out, Dr. Korman designs each one as a "stand-alone procedure." This means that each transplant will be specifically designed to look natural throughout your entire lifetime regardless of the extent of future hair loss or future surgery.
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What can I expect after my hair transplant?
You will be able to go home on the same day as your hair transplant but you may still feel drowsy from the sedation so you will need someone to drive you home. If necessary, Dr. Korman’s staff will make arrangements for a limousine service for you. In general, no bandages or dressings are required. A hat may be worn home if desired. You will receive detailed written instructions which will be reviewed with you before you leave. You will be provided with a phone number to reach Dr. Korman in case you have any concerns however Dr. Korman routinely calls all of his patients at their home or hotel on the night of surgery to make sure they are OK.
Most patients have only mild discomfort that can be controlled with over the counter medications such as Tylenol (acetaminophen). You will be provided with a prescription for stronger pain medication in case it is necessary. Sometimes antibiotic medication and anti-swelling medication are also prescribed and some patients choose to use topical sprays on the scalp to keep it moist and promote healing. You may gently wash your hair on the first day following surgery. Your hair transplant will be relatively maintenance free but Dr. Korman and his staff will make sure you understand all of the post-operative instructions.
Most people choose to take a few days off work but some people resume their normal schedule within 1-2 days. Dr. Korman discourages heavy lifting or vigorous exercise for one week following surgery.
Dr. Korman will remove the sutures from your donor site 7-10 days after surgery. If it is more convenient for you, or if you are from out of town, your sutures may be removed by your family doctor or a nurse closer to home.
It is normal for small scabs or crusts to form over the graft sites. These typically fall away after 4-7 days. It is also not uncommon to experience some minor temporary swelling in the forehead area. This will settle in a few days. In most patients, the newly transplanted hairs will fall out within 2-4 weeks. This is expected and new growth will commence within about 3 months. The transplanted hair will then grow at the normal rate of about 1cm per month and continue to thicken over time.
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Where can I learn more?
» Read more about hair loss and hair restoration at Dr. Korman's practice.
» Read about other surgical hair restoration options at Dr. Korman's practice.
» Click here for links to more information about hair restoration surgery.
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