Simply put, hair transplantation involves taking a strip of hair from where you have more than you need and putting it where you need it most. Dominant hair follicles are essentially extracted from the back of the head, an area of permanent hair known as the “donor” area or site, and inserted into the balding or thinning areas of the scalp called the “recipient” area.
Hair transplantation is recognised as the most effective, long-term solution to male pattern baldness, the most common form of hair loss in men. Hair transplant surgery can be carried out in the early stages of hair loss, when the hair is just starting to thin, or in the later stages when baldness is more apparent. Either way, it is essential that the hair loss pattern is established before hair transplant surgery is undertaken. The procedure has also produced notable results for some women suffering from female pattern hair loss and for those with scars caused by facial surgery, burns, accidents, or various hair loss diseases.
HRBR is an expert in Ultra Refined Follicular Unit Transplantation (URFUT), the internationally recognised best practice technique of hair transplantation, which yields 20% more grafts from the donor strip than FUT with minimal scarring in the donor area. We take a unique approach in order to maximise the potential outcomes and our results speak for themselves, with patient feedback describing how, “it’s made a real and lasting difference…the outcome for me exceeded my wildest expectations…the operation and its results are an absolute miracle”.
First though, it is critical that patients fully comprehend a few very basic facts about hair transplant surgery so that expectations about this treatment for hair loss remain realistic.
Everyone has a permanent area of hair existing on the sides and back of the head. This region, known as the “donor” area or site, is immune to the hormone dihydrotestosterone (DHT) and thus unaffected by the balding process.
In Ultra Refined Follicular Unit Transplantation (URFUT), a thin strip of skin containing the permanent hair is surgically removed from the donor area and the resulting incision is stitched back together. This hair-bearing skin is then dissected and the resulting grafts, known as follicular units, are then inserted into the thinning or balding areas of the scalp.
URFUT is an intricate procedure in which HRBR is an expert. Not only that but we set the world class standard because of the unique approach we take to it and the singular set of processes we perform around it.
URFUT at HRBR
At Hair Restoration Blackrock (HRBR), we set the world class standard in URFUT due to the different way we approach the procedure which ensure that we consistently carry out superb quality work.
Having calculated the amount of donor hair necessary for the hair transplant surgery (using macrophotography and computer analysis) and having designed the hairline in conjunction with the patient, the hair to be transplanted is trimmed close to the scalp.
Once the donor hair-bearing skin is surgically removed in a thin strip, it is then slivered into very small pieces and the hair follicles diligently dissected by highly skilled technicians, selected for their expert manual dexterity, using state-of-the-art stereoscopic microscopes, specifically the Nikon SMZ 800 model. Excess tissue and the collar of skin attached to the graft are removed to ensure that when the hair exits the skin from the transplanted area it looks completely natural. If this epithelium (skin) is not removed it can lead to complications such as pitting and/or tenting, which can result in an unnatural appearance.
Due to the flexibility of the skin of the scalp, which can be greatly enhanced through scalp massage, the resulting incision can be stitched together again usually creating a fine scar which is covered by existing hair, even if it is short, and is only detectable on close inspection.
The resulting grafts, known as follicular units because their integrity in the skin is maintained, are then carefully inserted in miniscule surgical sites made in the thinning or balding (recipient) areas of the scalp, using the Zeiss head worn Loupe KS microscope. The size, shape and angle of these incisions are key to the cosmetic outcome of the hair transplant and will have been meticulously mapped out in partnership with the patient prior to surgery. The transplanted hair behaves as it was programmed to behave at its origins and will grow naturally for the rest of one’s life.
At HRBR, we treat a hair transplant like any other organ transplant in that hair transplant grafts are effectively “living organs”. Therefore, the time they spend outside of the body must be kept to a minimum to ensure not only graft survival but also the healthy function of the transplanted organ, i.e. natural hair growth.
We achieve this in two ways, firstly, by taking the donor strip in two separate procedures on the same day, which granted increases the surgical operating time but ensures the viability of the grafts by decreasing the time out of the scalp. Secondly, our transplant team consists of a total of 24 people made up of qualified hair restoration surgeons, nurses and technicians, who are rotated approximately every 30 minutes in order to ensure that the grafts are handled with extreme care and transplanted back into the patient in the most effective and time efficient manner. Refreshing the team in this way prevents fatigue and repetitive stress (“ROS”) injuries and thus prevents any potential damage to the grafts during the transplant process. This is key because of the limited supply of hair in the donor region which means that every single hair graft is precious and must be protected. By looking after our technical staff and continuously training them, we not only exceed international best practice standards but also ensure the viability of the donor grafts.
Ordinarily, once Androgenetic Alopecia is diagnosed and hair transplant surgery recommended, no further tests are required in the vast majority of cases. For potential female patients where the cause of hair loss is unknown, we recommend an appointment with a consultant dermatologist.
In keeping with HRBR’s commitment to excellence and efforts to exceed standards of best practice, we include a pre-operative assessment complete with electrocardiograph (ECG) for all surgery patients as a matter of course. This 45-minute review checks every patient’s general health by taking a detailed medical history along with weight, blood pressure and oxygen saturation readings, and confirming the presence of any allergies. The donor area is closely examined using macrophotography and a hair count is taken. A hair density count is also recorded and groupings of 1-, 2-, 3- and 4-hairs are assessed – this is vital information required to accurately plan the distribution of hair follicles. There is also time spent on an initial design to see where the patient might like the hairline to be. Finally, any questions or concerns are discussed at this time with the qualified and experienced hair transplant nurses who carry out this routine assessment.
Including this stage prior to the hair transplantation is not only in the interest of patient safety but it allows us to cater for a patient’s physical and emotional needs. It also encourages a more relaxed encounter, more time to ask questions and think about the information being imparted.
On the morning of the procedure, HRBR’s medical and technical team meets in the lecture room for a comprehensive case conference, where the medical details of the patient in question are discussed. A personalised day-plan, taking into account the individual’s medical condition and specific requirements for the hair transplant, is then devised by the whole team. The patient is brought to the clinical photography room where the seven members of the design team design the hairline using laser technology. On reaching a unanimous decision, this hairline design is presented to the patient for approval, making the whole procedure very much a “team effort”.
Pre-Operative Preparation/About the ECG
Today, hair transplant surgeries routinely take between eight and ten hours. This longer theatre time could pose a potential risk to a patient’s heart due to the possibility of prolonged exposure to adrenaline. In response to this risk, albeit slight, we at HRBR decided to add an ECG to the pre-operative assessment which is conducted before the actual procedure. We not only follow but exceed the highest standards set out in the clinical guideline document published by the National Institute for Clinical Excellence (NICE) in the UK, namely “Pre-Operative Tests: The use of routine pre-operative tests for elective surgery.”
While NICE recommends that, for planned minor surgical procedures, a resting ECG is carried out on those over 65, we provide pre-operative testing for all our patients. Over a twelve-month period, 176 HRBR patients had pre-operative assessments from which 27 ECGs were sent to the cardiologist for testing, with seven of these, all under the age of 65.
The electrocardiograph is performed using a Mac 1200 ST 12-lead ECG machine with automatic interpretation. Any abnormal ECGs are sent to a cardiologist who prepares a written report/interpretation and who will recommend and carry out any necessary further investigations. The gap between the pre-operative assessment and the procedure date offers enough time for any further cardiac evaluation without interfering with the scheduled surgery.
Once they are in good general health, the majority of men who may have significant thinning or baldness are ideal candidates for hair transplantation. The first step in determining your suitability is to arrange a private consultation with one of our qualified hair restoration doctors. During this initial assessment, your hair loss will be investigated in order to reflect on the best possible solution for your hair loss problem.
Although not as common as in men, women suffer from hair loss too for a range of reasons resulting from genetic determination, various medical conditions, surgery, injury, or even from wearing tight hairstyles. At HRBR, roughly one in ten of our patients are women and depending on the type of hair loss, they may or may not be suitable candidates for hair transplant surgery. We request all women interested in attending HRBR to attend a dermatologist first in order to attain a diagnosis as to the cause of their hair loss.
Deciding on the “best time” to undergo hair transplant surgery is when you deem your degree of hair loss to be unacceptable. A hair transplant is not something to desire because you are worried about future hair loss or “so no one will notice.” As the hair loss pattern is usually not discernible for those under the age of 25, young men may not necessarily be suitable candidates. Therefore, they are frequently, in the first instance, recommended a course of medical treatment for hair loss to which they usually respond very well.
The amount of hair needed for transplantation is estimated according to the present balding pattern, the likely future pattern and the volume of donor hair. The follicular units in a candidate with high donor density usually contain multiple hairs, while those in someone with low donor density often contain only one hair. A larger donor strip can be removed in an individual with a very loose scalp, whilst a long narrower donor strip will be extracted in an individual with a tight scalp. The number of grafts which may be required for hair transplantation will be estimated during a consultation with one of our hair restoration surgeons.
Extent of Hair Restoration
The purpose of a hair transplant is to redistribute hair in order to improve one’s appearance but not to create more hair, and certainly not enough that would cover a full head. Having said that, performed properly on the right candidate, a hair transplant can produce very real cosmetic and psychological benefits.
The extent to which a large area of baldness can be covered will depend on the size of both the bald and donor areas. In cases of extensive baldness, a procedure known as a scalp reduction may be useful in reducing the size of the bald area. Transplanting is then carried out according to the URFUT procedure.
Use of Technology
Stereomicroscopes are widely accepted as the gold standard in hair transplantation as they can yield 20% more grafts from the donor strip than with the FUT. This equipment is expensive and demands more skill and manpower, which is possibly why they are only found in a select number of hair restoration clinics across the globe. HRBR relies on stereomicroscopes at every step of the transplant procedure and believes that it is impossible to carry out a modern hair transplant without the use of high powered magnification. As such, our medical team uses the Nikon SMZ 800 for graft preparation and the Zeiss head worn Loupe KS microscope for graft placement.
Although laser hair transplantation can claim some degree of success, indications so far suggest that the results are inferior to those achieved through traditional hair transplant surgery. Lasers are therefore not in common use and HRBR does not advocate this technique at this time. You will, however, hear of us using “laser technology” in designing the hairline in collaboration with the patient prior to surgery.
The moment a patient walks out of the HRBR clinic after hair transplant surgery is far from the last contact he or she has with our team. As part of the post-operative care programme, patients are seen by one of our qualified surgeons on the day immediately after the procedure, when we check the transplanted grafts and issue a list of post-operative instructions for home care as well as some rare side effects to watch for in order to ensure the best chance of success. Both a six-month and 12-month check-up are also scheduled to keep track of progress.
In terms of a timeline guide, it should be understood that a hair transplant does not produce a dramatic overnight effect. The hairs contained in the transplanted grafts actually fall out three to four weeks after surgery but the follicle which grows the hairs remains anchored beneath the scalp and will begin to grow a new hair about three to four months after the transplant. Some benefits are noticeable at about four to six months after surgery while the full effect will be seen between a year and 18 months. This subtle regrowth blends seamlessly with existing hair and continues to grow forever.
Other Scalp Surgeries
At HRBR we do not carry out the following surgeries, however, for reference;
Scalp reduction, carried out under local anaesthetic, is where a large bald area of skin is removed. The resulting scar left on the scalp must be camouflaged in due course by grafting directly onto it.
Scalp flap surgery is where an entire segment of hair-bearing scalp is transferred to a bald area. The associated risks include improper hair direction at the hairline and, more seriously, the partial or complete loss of survival of the flap and the hair within it. This relatively uncommon procedure is performed by only a handful of hair restoration surgeons, and not those of us at HRBR.