What Is Hair Loss Surgery?


Hair loss surgery, Transplant, Replacement or Restoration is a cosmetic surgery procedure that transplants healthy hair follicles into balding areas to restore hair growth. Hair loss can have a devastating psychological effect. There are a number of factors that can cause hair loss including genetics, stress, ageing and chronic illness as well as medication and nutritional deficiencies. Surgical treatments for hair loss are the most effective way to treat baldness or thinning hair. While in the past many people were put off of surgery because it was incredibly invasive, more advanced contemporary techniques have made hair loss surgery far less traumatic and with much better results.

If you have a receding hairline, baldness, thinning hair, hair loss from an accident or injury or conditions such as alopecia then you could be a candidate for hair loss surgery.

There are very few medical reasons that would make you an unsuitable candidate for a surgical hair loss treatment.

The best candidates will have realistic expectations about what the treatment can achieve and be otherwise generally fit and healthy.

If your donor hair is not suitable, then you may not be able to proceed with surgery.

People who are prone to keloid scarring or those who have problems healing may also not be suitable candidates.

As with any surgery there is always some level of risk associated with going under the knife however advanced techniques in hair restoration surgeries mean that they are generally very safe and carry no major risks of complications. Hair transplant surgery in particular has a high safety record, in the right hands, and is now a relatively minor procedure.

With all types of hair loss surgery, you may experience some swelling and discomfort post procedure however this should only last for a couple of days. After scalp reduction surgery it is also possible that you may have some loss of feeling or numbness in the area.

With any surgery there is always the risk of infection. You can minimize the chances of this happening by following your cosmetic surgeon’s post treatment advice carefully.

While the older ‘strip surgery’ techniques could leave very noticeable scars, techniques employed by hair loss surgeons nowadays have lessened the chance of being left with unsightly scarring after your procedure. Scarring with hair transplant procedures should be minimal and easily hidden underneath the new hair. Scalp reduction surgery does leave scars but these should be able to be camouflaged by hair styling or having hair grafts.

Scalp reduction surgery can also sometimes result in a ‘dent’ in the scalp known as a ‘slot deformity’.

The side effects of scalp flap surgery can be a little more severe and include bleeding, pain, swelling and scarring. Another rare complication is a condition known as ‘necrosis’ which occurs when blood supply to the new tissue is affected and the tissue ‘dies’.

One of the biggest risks you take when undergoing any form of hair loss surgery is that the treatment will not be as effective as you want and may take a long time to achieve. With hair transplantation, for example, some people start to notice immediate results whereas others have grafts that fail to grow or do not start to grow for a few months. Having realistic expectations about your surgery is therefore vital.

Before undergoing any surgical procedure, it is vital that you have a thorough consultation with a qualified plastic surgeon. The consultation is your opportunity to discuss your reasons for wanting hair restoration surgery with your specialist and ask any questions you may have. The cosmetic surgeon will explain the hair loss surgery procedure to you in detail and make sure you are a suitable candidate by taking a medical history. You will also be asked to sign a consent form to make sure you fully understand the pros and cons of treatment. Make sure you read this and any associated material your surgeon gives you very carefully.

How your surgery is done will depend on the type of hair loss surgery you are having.

Hair transplant

There are a variety of techniques used for hair transplant surgery but they all involve taking hairs from one part of your head where they are still growing and transplanting them into areas where the scalp is bald of the hair is thinning. Hair loss treatments are usually performed under local anesthetic so you will be awake during the procedure. In some cases, your surgeon may offer you a mild sedative to further minimize your discomfort.

A donor strip will be harvested. This involves the surgeon making an incision in the scalp in order to remove a strip of donor hair. Before making the incision the surgeon will inject a solution under the skin in order to raise it and make it more easily removable. Surgical staples or sutures will then be used to close the wound. The grafts will then be prepared so that they can be transplanted back onto your head. There are many different grafting techniques, which dictate how many hairs will be grafted and how they are grafted. This ranges from micro-grafting where between one and two hairs are grafted into needle holes to standard round or square grafting where between 10 and 20 hairs can be grafted. The follicular unit graft is the most advanced technique. This uses multiple numbers of small grafts that contain between one and four hairs to enable the surgeon to place a large number of follicular units into a given area and devote more attention to the angle and orientation of the transplanted grafts. This means that the transplanted hair will lie better on the scalp and provide better coverage to bald areas.

When the grafts are ready to be transplanted the surgeon will anesthetize your scalp and place them into tiny incisions in the skin. This involves a lot of skill on the surgeon’s part and can be a timely process.

The surgery usually takes between two and six hours.

Scalp Reduction Surgery

Before the surgery starts your surgeon will administer a local anesthetic. They may also give you a mild tranquilizer or sedative to help you relax. This procedure is usually done over a number of sessions as too much scalp cannot be removed at one time. Small sections of scalp are removed and then reattached to areas where the hair has been lost. The scalp is then stitched back up.

Sometimes a technique known as scalp expansion is used to loosen and stretch the skin. A tissue expander is implanted under the skin and filled over a number of weeks to achieve this. This makes the procedure easier for the surgeon as the skin has already been stretched.

Another technique known as scalp extension is also sometimes used. A surgical device made of hooks and elastic bands is placed under the scalp. As the device is tightened the tension helps loosen and stretch the skin and again makes the surgery easier.

Scalp Flap Surgery

Scalp flap surgery can be done under local or general anesthetic. The procedure involves a strip of scalp being removed and reattached at the donor site. This technique is often combined with scalp expansion. The surgeon will first make an incision where the upper part of the flap is going to be. An expansion balloon is then placed underneath the scalp tissue and the incision site is stitched up. Over three or four weeks the balloon is gradually filled with a saline solution to stretch the scalp. After this has been achieved you will go back to the surgeon who often then performs what is known as a ‘delay procedure’. Further incisions are made in the scalp to create the upper two thirds of the flaps. These are then sutured back in place to induce collateral circulation. The same procedure is then performed to create the lower part of the flap. Finally, the strip of hair bearing scalp can be re-positioned to the bald area on the head

After your hair loss surgery, you should be able to return home straight away. Your head may be bandaged but you will usually only have to keep these on for a day or two. It is advisable to take at least a day off work although you may want to take more time off especially if the transplant was significant.

After your surgery you may have some swelling and discomfort. Painkillers can help with this. If you have any severe pain or notice any signs of infection, then you should contact your practitioner immediately. You may also develop small scabs around the treated area but these should go within one to two weeks.

You may be given some antibiotic ointment to minimize the risk of infection. Make sure you use this as directed by your surgeon. Your surgeon may also advise using compresses or sprays and sleeping in a semi-upright position for two to three days after surgery. You may have to go back to see your surgeon after a week to 12 days to have your stitches/staples removed, depending on the type used.

Types of Hair Loss Surgery

There are three main types of cosmetic surgery procedures, which can be used to treat hair loss: hair transplant and scalp reduction surgery and scalp flap surgery. Of these hair transplant is the most effective and minimally invasive way of addressing baldness or thinning hair.

Hair Transplant

Hair transplantation is the best permanent solution to hair loss and is far less invasive than it used to be as techniques have developed significantly from the days of ‘strip surgery’ and using large ‘plugs’ and grafts. The most advanced technique is the follicular unit hair transplant procedure, which uses multiple numbers of small grafts that contain between one and four hairs. This enables the hair transplant surgeon to place a large number of follicular units into a given area and devote more attention to the angle and orientation of the transplanted grafts. This means that the transplanted hair will lie better on the scalp and provide better coverage to bald areas. This can be a timely process and repeat procedures are usually needed. However, this does yield the best results.

Scalp Reduction Surgery

Scalp reduction surgery involves removing the parts of the scalp where the hair has been lost and ‘stretching’ the parts of the scalp where there is still hair over the head. The scalp is then moved to a higher position on the head. Your surgeon may also recommend you undergo a hair graft so that not as much of the balding scalp needs to be removed. This procedure is ideal of those who have thick hair on the back and sides of their head but have gone bald on top.

Scalp Flap Surgery

Scalp flap surgery aims to recreate the hairline, so it is ideal for people who are only bald at the front of their heads. It is not necessarily a solution for those who have severe hair loss. The technique involves removing parts of the scalp where hair is growing and effectively reattaching it to areas where hair has been lost. It can create an instantly thicker hairline but is a fairly invasive and drastic surgery.