metic procedure, though may be restorative to
correct damage resulting from injuries or BIRTH
DEFECTS.
Surgical Procedure
Hair replacement procedures may involve tissue
grafts, flaps, expansion, or combinations of these
methods. The surgeon will plan the appropriate
approach for each individual’s situation and hair
loss circumstances. The OPERATIONis an AMBULA-
TORY SURGERY, performed with local ANESTHESIAand
a sedative for comfort. Most people require several
operations to establish satisfactory results. Mild to
moderate PAINis common for several days follow-
ing a hair replacement procedure.
Tissue grafts SKINgrafts were the original hair
transplantation method. The surgeon removes a
plug or slice of skin from the back or side of the
head and transplants it to a hair loss site. The graft
may contain from one or two to several hundred
hair follicles, depending on the technique and
size. With the first replacement procedure the sur-
geon places the grafts fairly widely apart (about
one eighth inch) to allow generous BLOODcircula-
tion. Subsequent grafts fill in the spaces. Gener-
ally, a pressure bandage holds the grafts in place
for 24 to 48 hours following surgery to help the
transplanted skin attach to the new site, and fine
sutures (stitches) close the donor sites.
HAIR REPLACEMENT GRAFT TECHNIQUES
Type of Graft Follicles Contained Grafts per Session
punch graft 10 to 15 50
micrograft 1 to 2 500 to 700
minigraft 2 to 4 500 to 700
slit graft 4 to 10 500 to 700
strip graft 20 to 40 500 to 700
Tissue flaps A tissue flap relocates a substantial
amount of hair-bearing skin to a single recipient
site. The surgeon loosens a flap of skin near the
area of hair loss, and removes a similarly sized and
shaped segment of skin from the hairless scalp.
The surgeon leaves one end of the flap attached
and pulls the remainder of the flap over the recipi-
ent site, suturing it in place. The surgeon also
sutures the edges of the donor location, which
heals beneath the hair with no visible SCAR. A
common variation of tissue flap hair replacement
is scalp reduction, in which the surgeon removes
more hairless scalp than the replacement flap cov-
ers, drawing the edges tight to pull additional hair
from the sides of the head higher onto the crown
of the head. Tissue flaps generally heal with less
chance of rejection than grafts because they
remain anchored to their original blood supply.
Tissue expansion Plastic surgeons developed
TISSUE EXPANSIONtechniques to reconstruct major
skin damage following trauma such as BURNSor
major surgery, then discovered tissue expansion
allows natural expansion of hair-bearing scalp for
hair replacement. The surgeon loosens a segment
of hair-bearing skin adjacent to an area of hairless
skin to create a pouch, and inserts a special sili-
cone balloon called a tissue expander.
Over a period of months the surgeon injects
saline (sterile saltwater) into the expander, gradu-
ally increasing its size. As the expander stretches,
the skin grows to accommodate it. When the area
produces the desired amount of growth, the sur-
geon removes the expander, surgically removes a
similarly sized and shaped segment of hairless
scalp, and pulls the new skin over the area. Tissue
expansion can relocate the greatest surface area of
hair-bearing skin in a single procedure and pro-
duces the most natural-appearing frontal hairline.Risks and Complications
Risks and complications are slight for hair replace-
ment methods, and include excessive bleeding,
INFECTION, and reaction to the anesthetic. The
recipient site on the scalp also may reject the
replacement tissue. Because relocation trauma-
tizes hair follicles, they immediately enter a rest-
ing phase and shed their hair about five to six
weeks following relocation. Though this is normal,
many people find it alarming and worry that it
signals rejection of the new hair. However, with
rejection the entire segment of relocated skin fails
to grow and eventually sloughs off. The surgeon
can generally replace the rejected replacement tis-
sue during the next session of surgery. When they
reestablish themselves in their new sites, the folli-
cles return to a growth phase and produce about
an inch of new hair within six to eight weeks after
the old hair falls out.hair replacement 163