Considering A Hair Transplant? - Certain Things To Know!

Everyone has heard of or even seen hair transplant horror stories, maybe in a magazine, online or even worse seen the obvious 'plugs' in an elderly friend or relative. However hair transplant surgery has jumped leaps and bound in recent years to make it a viable, safe and not too risky option for those suffering from male pattern baldness, many celebrities such as Nicholas Cage, Brendan Fraser Mather MOcanhey, Dwayne Johnson ('the Rock', WWE) Salman Khan (Bollywood) and even Italian Prime Minister Silvio Berlusconi are believed to have had hair transplantation surgery, although such is the stigma attached that none of them has admitted to it publicly, it only becomes obvious when studying before and after pictures.

History of Hair Transplant

The origins of hair transplant surgery stem from Japanese dermatologist, Dr Okuda, who in 1939 published a revolutionary method in a Japanese medical journal of using small grafts that were similar to the way hair transplantation is performed today. This method involved using hair transplant grafts to correct lost hair from various body areas, including the scalp, eyebrow, and moustache areas.

In the late 50's one physician, in particular, Dr Norman Orentreich began to experiment with the idea of relocating or transplanting the hair on the back and sides of the head to the balding areas. Dr Orentreich's experiments showed that when bald resistant hairs from the back and sides of the head were relocated, they maintained their bald resistant genetic characteristic regardless of where they were transplanted.

This principle is known as "Donor Dominance", which highlights that hair could be transplanted from the bald resistant donor areas to the balding areas and continue to grow for a life time. This laid the foundation for modern hair transplantation. During the '60s and '70s hair transplants grew in popularity. However, the standard of care involved the use of larger grafts that were removed by round punches and often contained many hairs.

In the '80s hair restoration surgery evolved dramatically, as the large punch grafts were gradually replaced with a more refined combination of mini and micro-grafts. This "combination mini micro-grafting" hair transplantation procedure no longer used the punch to extract the bald resistant grafts. Rather a strip of bald resistant hair was surgically removed from the back of the head and then trimmed into mini and micro-grafts.

Types of Hair Transplant

There are two main types of hair transplant surgery. These mainly include-

1. Follicular Unit Transplant, which is commonly known as FUT or 'strip surgery'

2.  Follicular unit extraction, commonly known as FUE.

The main difference is the method of extracting the transplanted hair. FUT and FUE are really complimentary forms of HT, not competing methods of which one must make a choice.

FUT versus FUE

The '90s saw the gradual introduction of a very refined surgical procedure now known as "follicular unit hair transplantation" or "FUT". This exacting and labour intensive procedure transplants hairs in their naturally occurring one, two, three, and four hair "follicular unit groupings" in which they grow naturally.

The concept of creating the entire hair restoration using exclusively follicular units was proposed by Dr Robert Bernstein and was described in the 1995 Bernstein and Rassman publication "Follicular Transplantation". Critical to the success of the follicular unit hair transplant procedure was the introduction of the binocular microscope by Dr Bobby Limmer of San Antonio Texas in the late 1980s.

Dr Limmer found that by using the microscope to examine the donor tissue he and his staff were able to successfully isolate and trim the naturally occurring follicular units into individual grafts. Dr Limmer shared his techniques and findings with his colleagues and together with Drs. Bernstein, Rassman and Seager, was a persuasive advocate for the follicular unit hair.

The process involving follicular hair transplants is considered to be the most effective among hair restoration methods. In a follicular hair transplant, the surgeon transplants hair from the permanent zone in the back of the scalp onto the affected areas.

If you need a large area covered, then you most likely want to go for FUT because it is the more economical in terms of the number of grafts for the price paid. If you absolutely, positively don't want strip surgery as you are worried about scarring, then FUE is your only alternative. Contrary to popular belief, both methods leave scars. FUT will leave a narrow line across the back of your head, whereas FUE will leave little unpigmented dots across the back of your head. The only difference is that the FUE scars are not concentrated together and therefore harder to detect when wearing hair very short.

There is no doubt that FUE procedures are harsher on the grafts than FUT procedures. Because of this, the final growth yields tend to be lower for FUE compared to FUT. But BOTH procedures work for the most part.

Hair Transplant Cost

FUT surgeries are performed by reputable surgeons around the world however FUE is mostly available through a number of specialists, the vast majority of reputable ones that I know of are in the United States and Canada. Pricing for FUE from these reputable surgeons is currently close to $7- $11 US dollars per graft for FUE, and depending on what level on the Norwood Scale, a scale used to measure the progression of male pattern baldness, can be quite costly. Pricing for FUT from these same surgeons is normally in the range of $4-6 per graft, however, in Asia and Eastern Europe prices can be even lower.

Does cheaper means better?

Many of my clients do sometimes look to cut costs by using other surgeons especially in countries such as India, Pakistan, Thailand and Eastern Europe. Although I'm sure there have been success stories via this route please remember in these countries there is little guarantee or action available to you if something does go wrong. I have seen hair transplant using the FUT method, although not a horror story in terms of scarring or suffering, it did not yield the expected results of a more established surgeon placing the same number of grafts (2,000). He is therefore left with poor hair coverage but now has lost the option to 'shave it all off' due to huge smiley-faced scar in the back of his head!

Check, Check and Check

It is recommended that you should consider the hair transplant surgery option only after having tried the non-surgical treatments on the market. Then when you certain you wish to get a hair transplant I would advice thoroughly researching reputable doctors, of course, price is always an issue, but in the case of hair transplants, it should not be the most important factor. Indeed the money saved is nothing compared to the trauma of having to live with a badly scarred scalp for the rest of your life. If you decide to go for more budget surgeon, please do insist on seeing photos of the surgeon’s previous work and do not be afraid to ask for contact details of their previous patients.