Male hair loss is primarily caused by circulating dihydrotestosterone (DHT), aging and genetics. Generally, the earlier hair loss begins the more severe it will become. Burns and trauma can also cause hair loss. Fortunately, hair restoration surgery has improved a great deal from the days of unsightly punch grafts. Modern methods of follicular unit transplantation provide an exceptionally long-lasting result.
Hair grows in follicular units of 1-4 full thickness hairs and 1-2 fine vellus hairs. Each hair has multiple supporting components, the shaft (hair you see), which is produced by the follicle. Each follicle consists of a small muscle (arrector pili muscle), sebaceous gland, nerve and blood vessels. The follicular units are surrounded by a band of collagen known as the perifolliculum. It is the follicular units of 1-4 hairs that are transplanted. Follicular units can be transplants from any site to any other site but then will retain the characteristics of the donor site. This is known as donor dominance and provides a foundation of hair restoration. For obvious reasons the hair at the back of the head is usually preferred as a donor for typical male hair restoration.
The most common cause of male hair loss is androgenetic alopecia (male pattern baldness) and is due to DHT. The hair behind the ears and on the back of the head tends to be resistant to the effects of DHT. Due to donor dominance these DHT resistant follicular units can be transplanted to the front of the scalp and will continue to remain resistant to DHT.
Hair transplantation can be performed with local anesthesia alone or in combination with oral or IV sedation. Most patients prefer some method of sedation. It takes multiple hours to complete a typical surgery mainly related to the time involved in harvesting and placing the follicular units. The more units transplanted, the longer the procedure takes.
Each hair transplantation procedure is made up of two surgical procedures. First the donor hair is harvested. In male pattern baldness a strip of hair bearing skin is taken from the back of the head from behind one ear to the other. The donor site is then closed and generally heals with a narrow scar that is well hidden by the remaining hair. Follicular units are then harvested from the donor strip with the aid of loupes or a dissecting microscope by a team of technicians.
While the follicular units are being prepared Dr. Szutz will use a set of small surgical blades to make small incisions that dictate the location, angulation and size of each follicular unit to be placed. Once all recipient sites are made, the technicians will place one follicular unit in each incision. Generally one hair unit is placed at the hairline, two hair units posterior to the one hair units and three and four hair units farthest posterior. This arrangement provides a natural appearing hairline and fullness.
The donor and recipient sites generally heal well with mild pain. Expect some scabbing of the recipient sites. These scabs will fall off in several days. Light duty work can be performed in a day or two but many people wait until the scabs fall off before returning to work. Heavy physical labor should be avoided for about two weeks. In two to four weeks the shafts will fall out of the transplants follicles. This is expected. The follicle will remain and grow a new shaft in three to five months. It will take roughly a year before full results are seen.
As a general rule hair transplantation is not a one time procedure due to several factors. First, the time involved in dissecting follicular units from the donor strip and than placing the units limits how many can be performed in a day. The native follicles in the recipient area and surrounding areas will continue to be affected by DHT throughout life and thus the area of hair loss will spread. It is not uncommon to need two to three procedures. The procedure is generally not repeated sooner than eight months. This is to allow all the previously transplanted units to grow and thus allow for accurate surgical planning. The length of time can be much longer depending on patient preferences and amount of balding.