If you’ve tried shampoos, medicines, and the latest style wig and still don’t feel comfortable with your lack of or thinning hair, consider these surgical procedures designed to give you a fuller head of follicles. Some have serious side effects or unruly results, so consult a physician and find the one that’s right for you before going under the knife.
Hair transplants consist of removing hair plugs of varying sizes from areas where the hair is continuing to grow (the donor area) and placing them in areas where hair has been lost (the recipient area). Donor areas are usually found in the back of the scalp, which rarely goes bald. The plugs are spaced slightly apart to enable the surrounding tissue to assist in feeding the transplanted sections. It offers a tufted appearance, but follow-up micrografts or minigrafts can fill them in with one, two, or three hairs to help create a more natural appearance. The donor hair in back and on the lower sides is rarely if ever lost, and the follicles, which produce that hair, will do so throughout your lifetime. When those follicles are moved in transplantation to an area of thinning hair or baldness, they will keep the characteristics of their original location and continue to produce hair. This concept is called donor dominance.
Hair transplanting is one of the most natural-looking hair regrowth procedures on the market.
It’s important to remember that since the recipient area can’t grow hair, the hairs surrounding the transplanted hair will continue to thin, leaving patches of transplanted hair. So save some recipient areas for touch-up surgeries later on. Also remember that this procedure can cause minor scarring in the donor areas and carries a modest risk for skin infection. The procedure usually requires multiple transplantation sessions and may be expensive.
The good news: “Hair follicles that aren’t sensitive to dihydrotestosterone can be moved to another area, and they will maintain the color, characteristics, and genetic longevity of healthy hair,” says Dr. Friedman. “You live to your 80s and it will still be growing.” According to Friedman, hair transplants can be taken from an identical twin but not from a general family member, because it is essential to obtain the right tissue type. “When donating organs, even with the right tissue type, the recipient would still have to be on antirejection antibodies to prevent her own body from rejecting the donor organ. These drugs open up the possibility of infection, something that just wouldn’t be done for a cosmetic procedure. Maybe someday there will be drugs that are tissue specific and can be targeted to only the hair follicles.”
In the old days, there were hair plugs that were so far from subtle they could be spotted a mile away. Strips of hair were cut out from the back of the head, which had to be stitched back up, leaving an ugly scar. Follicular units were removed and then replanted into the barer areas at random. Today, according to Steven Victor, a cosmetologist in private practice in New York City, grafting is one of the most natural-looking hair re-growth procedures on the market. “This procedure involves the grafting of one or two follicular units in an effort to get natural-looking hair that re-creates what nature gave us. Those are called micrografts. In a minigraft, three to five follicular units in the same piece of skin are transplanted. We do micrografts closer to the front and minigrafts behind. The problem is if there aren’t enough hairs growing out of each pore it won’t look natural because hairs will be too spread out. Most doctors tend to use micrographs about 80 percent of the time and a combination of micrografts and minigrafts in about 20 percent of their cases.”
Most surgeons do not recommend the procedure called a hair flap; the results don’t look natural, and the procedure itself is painful.
“Grafting is a great option for women who have diffused hair loss and want a particular area thickened up,” says Victor. “But for every hundred guys who undergo a surgical hair procedure, there is probably one woman who does so as well. Hair loss tends to be obvious in men because of distribution on top and in the front. Women have estrogen protecting them, but in general hair loss tends to be diffused all over the scalp of a woman. Instead of bald patches, hair gets thinner all over and there is no sizable donor area.”
Again, most surgeons do not recommend having a soft tissue expansion done. Unsightly scars can result.
In this procedure, a sizable strip of scalp is taken from its original home base and transposed to an area that is balding to produce normal density hair in that area. It is a serious procedure that involves anesthesia. Only a small percentage of patients (about 15 to 20 percent, some female) are good candidates because their hair loss is restricted to a small frontal area. Hair styling and treatment tricks can be used to minimize the appearance of hair that grows backward, or the flap can be designed so that there’s more forward-growing hair. Flaps are done over a week in different stages, to allow time for the “lump” or “dog-ear” in the area where the flap has been turned to grow into the scalp. The final stage is the surgical correction of the dog-ear to return the flap in the hairline to its normal appearance.
The flap depends on the artery that it is feeding off is for survival. Over two to four weeks after it is sewn into its new home, it develops blood supply from this new location and is divided from its original base by cutting off the artery.
The benefits of flaps are that they create a beautiful anterior hairline with excellent hair density. The downside is that not everyone is a candidate since they may not have the right distribution of hair loss. It is essential to do the procedure on patients whose primary area of baldness is near the front. In addition, since it takes a number of stages, you can’t just get it over with. Expect and plan for recovery time!
Years ago, if an area was too large to be transplanted, the hair-bearing area of the scalp was stretched to expand the area that will be covered by hair. This was done with the insertion of a silicone balloon into a pocket between the scalp and the skull (unsightly scars are likely to result). Over a period of weeks, the balloon is blown up. In response to enlarging the balloon, the hair-bearing tissue of the scalp (not the number of hair-bearing follicles) expands, increasing the area of donation by mini- and micrografting or flap transfer. This is a great benefit to flap surgery. Once hair is transposed, closure is easier because there is more scalp tissue to work with.
Implanting artificial fibers into the scalp is another option for creating new “hair.” How it works: Synthetic fibers are implanted in small bundles directly into your scalp. The procedure can cause the scalp’s natural oils to build up at the base, resulting in inflammation and infection, which can destroy the scalp. In addition, the fibers are brittle and can frizz or break easily. Styling and blow-drying can also permanently damage them. The bottom line, as most experts will agree, is that it doesn’t look or feel like real hair. Another important issue: It can get inflamed or infected.
Hair weaving, hairpieces, or change of hairstyle may disguise the hair loss and improve the cosmetic appearance. This is often the least expensive and safest method of treating female pattern baldness. Hair weaving involves weaving together a fine net with hair attached and your natural hair. Hair is woven as close to the scalp as possible. Scalp friction can cause irritation and infection, and the procedure needs to be repeated about every other month since the net is raised farther away from the scalp as the hair grows. Also, weaves often pull on your hair underneath the hairpiece, causing traction alopecia, or localized hair loss. Hair weaving should be done carefully by an expert to ensure that tension placed on hair is minimal or it can cause severe hair loss.
MYTH: Standing on one’s head or getting a head massage will increase circulation and stimulate hair growth.
FACT: Increasing circulation in the scalp certainly can’t hurt, but it will not stimulate hair growth.
Hair integration is another option. Human hair is integrated with your own hair through a network of small, gold cylinders that attach the new hair to your hair. Using the cylinders allows more breathing room for your hair and looks natural but can be costly to maintain.
If the bald area is too large to cover with the limited amount of hair available on the donor site, the surface area of the bald section must be reduced. Now fairly common, a two-inch patch of scalp is removed, bringing the two hair-bearing pieces of scalp at the sides closer together. Once the skin is healed, hair can be transplanted onto the remaining area. Some resulting problems can include a hideous scar where the edges of the sections meet, accelerated hair loss, scalp thinning, an unnatural direction of hair growth, infection, hemorrhaging, pain and swelling from sutures, and loosened skin when the stitches relax.
Scalp reduction is now a fairly common procedure, but its side effects may give pause to most of us.
Tissue expansion can help here as well. One of the problems with scalp reduction is that when the scars get wide, they’re thick and unattractive. If the hair-bearing tissue is expanded before scalp reduction, the reduction is easier and scars are less likely to widen or become cosmetically unacceptable. In addition, a new type of expander that looks like a stretchy rubber sheet is placed under the scalp, stretched from side to side, and attached on both ends. It pulls the side up toward the top of the scalp and contracts the inside of the scalp, minimizing ugly scars that can result from scalp reduction.
Simply stated, suturing involves stitching fake hair to the scalp. Suturing of hairpieces to the scalp is not recommended, as it can result in scars, infections, and abscess of the scalp or brain. A thin layer of scar tissue replaces the skin, and these scars may cause blockage of the blood supply to the central portion of the scalp. Since the sutures aren’t ever removed and don’t dissolve, they tend to cut through the skin and have to be replaced. Combing your hair may also pull at the sutures and loosen them. Eventually, there’s a good chance your scalp may reject the sutured hair. Finally, the area of natural hair around the sutured hair can be permanently destroyed.
Suturing is another iffy procedure and can cause infection, scarring, and worse.
All of these procedures require considered thought before undertaking them. They are all serious operations and, given some of the dangerous side effects of some of these surgical treatments, it’s absolutely essential to choose a qualified specialist.