I’m all for transplants. Done correctly, they can be very effective. Yet having them done correctly is not as easy as it sounds. In the transplant world there are also charlatans, and a good rule of thumb is to ignore those that splash large advertisements over the papers. Always choose a medical doctor, preferably a dermatologist or a cosmetic surgeon with transplant experience. Best of all, go to one that has been recommended by another respected professional and ask to see the results of other patients.
It may be difficult to grasp that transplants were first introduced in the 1930s and made acceptable in the late 1950s by Dr Norman Orentreich, a New York dermatologist. At that time the results weren’t as cosmetically acceptable as now. Improvements have been gradual over the last forty years, more so in the past fifteen years, definitively so in the past five to ten years. At first, the results were often brush-like and looked similar to a Barbie doll’s hair. A circular razor-like instrument was used to take out pellets of hair bearing scalp containing six to ten hairs.
However, to start at the beginning, the theory behind transplanted hairs and their follicles is that the recipient site, where the hairs are put after removal from the donor site, retains the characteristics of the donor area. We know that the sides and lower part of the head don’t go bald even in the most advanced male pattern baldness (the genetic and androgen response in these follicles is much reduced or even non-existent). So by removing follicles from these areas and putting them elsewhere, they will still grow as they would have if they had remained where they were–even if they were transplanted to the tip of the nose! In effect, the transplanted hairs will continue to grow in the way they used to grow wherever they were put.
This is the basic principle and it all sounds easy. It’s not. It needs an expert to do it and is extremely painstaking, needing immense care, patience and attention.
Hair grows at an angle from the scalp. The angle of growth is predominantly pointing away from the front and towards the back, which is the angle of the hair follicles. The expertise is to remove the donor grafts at this angle so that the papilla (growth point) at the base of the follicle is also removed. If it’s not, the hair won’t grow where it’s put. Then, perhaps requiring even greater technique, the grafts are transplanted into the receiving area at the same angle. If, for example, they were transplanted at an opposite angle at the front, the hair would grow forward, away from the forehead, towards the eyes and be uncontrollable in styling. I have watched the procedure many times, and the two best exponents I have seen are Dr Walter Unger, based in Toronto and New York, and Dr Patricia Cahusac, based in Paris and London. There are others, of course, but I have seen countless numbers of results from these two in particular.
Whereas the first transplants were done in small clumps, similarly to plugs, nowadays the donor area is removed in a strip, and single or double follicles are cut off and inserted in small slits to where they are required. It gives an exceptionally natural look and the hair line that used to be a problem is hardly different to normal growth patterns. Another advantage is that the strip can give more access to more follicles, and there is a choice in the number of hairs that each follicle contains. Some follicles contain a single hair, some two, others may contain three and sometimes four. Also, the success rate is greater because very few hairs are wasted, unlike in the old method when perhaps 10–30 per cent of the transplanted hairs may have been lost.
Apart from treating the initial transplants with great care so that they are not pulled out with vigorous rubbing whilst shampooing, when they do start to grow properly, in ten to twelve weeks, they can be handled normally.
When there is a large denuded area, a reduction of the bald area is often recommended prior to the transplant procedure. A strip of scalp is surgically removed, the size depending on the area that is to receive the transplants, sutured and allowed to heal–resulting in a smaller bald area and needing less hairs for transplantation. It sounds messy but it’s not really. Again, expertise and experience is necessary.
The expert surgeon needs to bear in mind the probable progression of thinning in five to ten years’ time. Although the transplanted hairs don’t fall out, the thinning may have progressed and more transplants are needed. Therefore a good quantity of hairs have to be left for future use if necessary. Another fact to remember is that in a way you are robbing Peter to pay Paul, and Peter can’t be left broke–meaning you can’t take too many hairs, otherwise the back and sides of your head will be too thin to cover up. However, it is surprising how far you can go.
The new techniques are now also suitable for women who have thinned, and single or double transplants can fill in a thinned area or the temple region.
One final point, which to my knowledge only I have documented, is this: dandruff is usually worse at the edges of the scalp, including the back area. As the donor area retains all the characteristics when put elsewhere, it retains the greater tendency to flake off, too. I have seen, as no doubt many of those with this problem have, small areas of dandruff flakes on the skin that contains the transplanted hairs where there was none previously. It’s just a point–nothing to worry about–easy to clear, but I thought you should know.
The effect these can have on your hair’s volume and thickness is considerable. They are an instant gratification for miserable looking hair, and an enormous styling and morale booster. Many women think extensions are God’s gift to hair. At least they do at first. But it’s not long before they begin to notice the drawbacks.
The old-fashioned hair extensions were put in by weaving threads which had hairs attached to them between the natural hair. They were weaved next to the scalp and tightly knotted at each end to secure them. Because of their proximity to the scalp, the thread, which had the hairs knotted onto it, rubbed on the scalp, caused irritation, consequently making it sore and sometimes breaking the skin. All very uncomfortable if left in for a while, which they often were. As the hair grew out, the attached weaved hairs would also become further away from the scalp, resulting in them having to be taken out and reweaved probably every four to six weeks.
This method is still used to some extent. But more often the hair swatches are glue-heated onto the natural hairs. They can still be uncomfortable and cause similar problems. However, the biggest potential problem is traction hair loss and breakage because of the pulling involved. Examples of this are seen in the tennis duo the Williams sisters, who have blonde or coloured hair extensions attached to the front hair, and the broken and receding hair is fairly obvious. Another drawback is shampooing: it is more difficult to do so and there is an extra risk of tangling the weaved hair into the natural hair, leading to poor scalp and hair hygiene, and flaky, itchy scalps.
Freshly done, it can look wonderful and completely change your appearance, particularly for special occasions. But it’s not a good idea to leave them in for too long for all the reasons I have given.
Unfortunately, many women get carried away: they get used to longer, thicker hair and want to keep it, particularly those with fine, thin, limp or short hair. And they so often end up with progressively thinner hair due to traction and breakage, thus need more hair weaved to make up for it, making the natural hair eventually worse. And so it goes on. By the time they panic and finish up in my office, the hair can be in a really difficult state, requiring extensive help to improve it. By all means wear extensions, just bear these facts in mind.
There’s not a lot to say about these really, but they need to be included in ‘Options’. A good wig can be almost undetected. It’s the bad ones that give wearing a wig a poor reputation. The psychological effect of a wig can be enormous–even the bad ones give huge satisfaction to the wearers. The biggest drawback to wigs is the neglect of the scalp and hair underneath. Because a wig is worn, there is no reason not to take proper care with daily shampooing. The warmth under the wig gives a better medium for bacteria to flourish, making the incidence of flaky and itchy scalps more common.
There is an obvious and understandable reluctance to own up to wearing a wig, so much so that I knew a man who had a series of wigs with different lengths of hair which he changed every few days. Every few weeks he used to announce that he was going to have a haircut. He went off, removed the wig with the longest hair and replaced it with the one with the shortest hair to show his hair had been cut! Extreme? Not really. It is another example of the deep psychological significance of hair.