Background Information:

What are the other Names for the Procedure?

• Follicular Unit Transplantation (FUT)
• Hair Replacement Surgery
• Mini Follicular Groupings

What is Hair Transplant surgical procedure?

Hair Transplant is a surgical procedure designed to improve baldness. In this procedure hair and skin from the side and back of the head (called graft), is relocated to the front balding areas. There are many kinds of hair graft, which include:

• A micrograft, which contains 1 to 3 individual hair follicles
• Follicular groupings have 4 to 6 hair follicles
• Punch grafts contain 10 to 20 hair follicles 

What part of the Body does the Procedure involve?

A Hair Transplant procedure involves the hair and the scalp.

Why is the Hair Transplant surgical procedure Performed?

A Hair Transplant is performed for the following reasons:

• To improve noticeably receding hairlines
• To remove bald patches or improve baldness

What are some Alternative Choices for the Procedure?

• Medications (Minoxidil, topical solutions for both men and women; Finasteride oral medication, which is given for men only) are sometimes prescribed for hair growth
• Scalp reduction involves the surgical removal of bald scalp. Sometimes, certain devices are placed under the skin to stretch the hair-bearing scalp

What are the Recent Advances in the Procedure?

Stem cells and dermal papilla cells for hair follicles are under research trials, for hair cloning purpose.

What is the Cost of performing the Hair Transplant surgical procedure?

The cost of Hair Transplant procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Hair Transplant and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.pennmedicine.org/hairtransplant/

http://www.plasticsurgery.org/cosmetic-procedures/hair-replacement.html

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Hair Transplant surgical procedure:

How is the Hair Transplant surgical procedure Performed?

• A Hair Transplant procedure involves the removal of a small strip of hair-bearing scalp from the back and sides of your head
• The donor area is then carefully closed in such a way that the scar is hidden by the remaining hair
• The (removed) hair is microscopically divided, processed into different sizes, and placed in the recipient (bald) areas
• The transplanted hair, usually grow like normal hair

Where is the Procedure Performed?

A Hair Transplant procedure is usually performed in an out-patient surgery center facility, a physician’s clinic/office, a special hair transplant clinic, or a hospital, for a more complicated procedure. The individual can usually go home, once the procedure is completed.

Who Performs the Procedure?

A Hair Transplant procedure is performed by any of these medical personnel, with assistance from an anesthesiologist:

• Plastic surgeon
• Occasionally, by a physician, having experience in performing such a kind of procedure

How long will the Procedure take?

• For a Hair Transplant procedure, sometimes more than one session is required
• Each session usually lasts for about 3-4 hours

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Hair Transplant procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Hair Transplant surgical procedure?

A thorough physical examination is the only test required, before the procedure.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Hair Transplant procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• What are the alternatives to the procedure?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Hair Transplant surgical procedure:

What kind of Anesthesia is given, during the Procedure?

• Local anesthesia injections are administered in both sites; the site from where the hair is extracted, and to the site of its relocation
• Local anesthesia with injection and sedation, may be needed in more complicated procedures

How much Blood will you lose, during the Procedure?

Since Hair Transplant is a less invasive procedure, the amount of blood loss is minimal.

What are the possible Risks and Complications during the Hair Transplant surgical procedure?

There are general factors that increase the risk of getting complications during the procedure, which include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Infection in the surgical wound
• Anesthetic complications
• Accidental injury to the neighboring tissues

What Post-Operative Care is needed at the Healthcare Facility after the Hair Transplant surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Hair Transplant surgical procedure:

What are the possible Risks and Complications after the Hair Transplant surgical procedure?

The possible risks and complications that may arise after a Hair Transplant procedure are:

• Excessive bleeding
• Infection in the surgical wound
• Irregular scarring and reduced blood circulation
• Hair loss
• Hair thinning (shock loss)

What is the Prognosis after the Surgery?

• Individuals are expected to be patient because, it usually takes several months to notice, if the procedure was successful or not
• However, the final results of a Hair Transplant procedure are permanent, with outstanding results

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• Signs of an infection
• Fever
• Dizziness
• Muscle aches
• Fever
• Feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Hair Transplant surgical procedure?

At home, the following post-operative care is recommended, after a Hair Transplant procedure:

• Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
• Avoid all activities that are physically strenuous for about 2-3 weeks
• Ask your physician for instructions, regarding shampooing or wetting your hair
• Bandages and stitches are removed, per the physician’s discretion
• Complete the course of prescribed medication
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, if necessary
• Take antibiotic medication to help combat or prevent infection

How long does it normally take to fully recover, from the Procedure?

It usually takes several months to notice, if the procedure was successful or not.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Hair Transplant surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility, physician’s office, or hospital
• An anesthesiologist (if anesthesia was administered)
• A plastic surgeon, or the physician who performs the procedure

The patient is advised to inquire and confirm the type of billing, before the Hair Transplant procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA