Hair transplantation is one of the most popular and reliable procedures for treating alopecia, which affects approximately 67% of men and 24% of women. Androgenetic alopecia is the most common scalp condition treated with hair transplantation.

Also, people affected by trauma, burns and other types of alopecia can also benefit from these techniques. The risks associated with hair transplantation are minimal and success rates are usually high for properly screened and evaluated patients.

During the hair transplant procedure, the specialist dermatologist transfers resistant hair follicle units from the occipital region to the areas affected by alopecia.

There are two main methods of obtaining hair follicles from the donor area: FUT strip removal surgery and the now prevalent Follicular Unit Extraction (FUE).

FUT is now mainly used in women in combination with FUE due to the impossibility of universally cutting the hair of women, as is usually done in men.

FUE

• Increased number of grafts received
• Less visible scars
• The density of the donor site is not a significant deterrent
• Less postoperative pain
• Reduced postoperative healing time
• Allows selective targeting of follicular groups of a specific size and number of hairs per graft
• The surgeon can target hair outside the typical donor area, such as the parietal scalp, chest, back, beard and pubic area, if needed.

FUT

• Shorter surgical time
• Less bleeding at the donor site
• Single lane provides a limited number of grafts of 1,000 to 1,500
• Longer postoperative healing time
• Creation of a linear scar at the site of the skin strip
• No need to cut the hair

Indications for hair transplantation

The ideal hair transplant candidate has a healthy scalp, good general health, good quality hair in the donor area and reasonable expectations. The indications for hair transplantation are:

1. Male and female alopecia Norwood stage III to V for men and Ludwig stage II for women
2. Traction Alopecia (Trichotillomania is an obsessive-compulsive disorder characterized by repetitive hair pulling)
3. Frontal fibrotic alopecia (with limited expectations of success, the patient must understand that the results will probably not be optimal)
4. Lichen planopilaris-follicular lichen (with limited expectations of success the patient must understand that the results will probably not be optimal)
5. Discoid lupus erythematosus (with limited expectations of success the patient must understand that the results will probably not be optimal)
6. Folliculitis decalvans (with limited expectations of success)
7. Facial hair restoration for eyebrows, beards and sideburns after facial trauma or burns.

The active phase of frontal fibrotic alopecia, lichen follicularis and discoid lupus erythematosus cicatricial were contraindications for hair transplantation in previous years.

Patients affected by one of the scarring alopecias should be free of active disease for several years (at least two years) before attempting a hair transplant.

In recent years we have made several attempts with unexpected positive results, transplanting candidates with forms of scarring alopecia that until recently we rejected them, because we considered them – we characterized them as inoperable cases.

Contraindications

• Alopecia areata
• Fever, itchy scalp, scaling, erythema and rash suggestive of an inflammatory condition
• Medical history of dermatological conditions, metabolic syndrome, autoimmune diseases, systemic infections, local infections, malnutrition or vitamin and mineral deficiencies, recent childbirth, history of scarring, chemotherapy and radiation exposure can all affect the results
• Medicines that can affect hair growth
• Psychiatric history. Anxiety, eating disorders, trichotillomania, emotional trauma, and body dysmorphic disorder all put the patient at higher risk for outcome dissatisfaction and excessive expectations
• Young people <25 with an unknown course in the development of alopecia Complications

When the surgical procedure is performed in inappropriate places by non-specialized dermatologists and in many cases without the presence of a doctor, the possibility of complications is high.

In other circumstances, complications are rare, when the operation is performed by a medical team and in sterile conditions.

• Swelling
• Pain
• Bleeding
• Folliculitis
• Allergic reactions to lidocaine
• Lidocaine overdose
• Cellulitis of the scalp
• Temporary or permanent numbness of the scalp
• Telogen effluvium
• Epidermal cysts and ingrown hairs
• Contamination

Medical conditions complicating hair transplantation

• Smoking
• Diabetes
• Extensive dilution
• Advanced sun damage to the scalp

Conditions of a successful hair transplant operation

Mathematically speaking, bristles with larger shaft diameters give them more surface coverage. Therefore, candidates with larger caliber hair can expect to achieve much denser coverage compared to patients with finer caliber hair.

Candidates whose donor has more than 80 hair follicles per cm² are excellent candidates. Those with a count of less than 40 follicles per cm² are considered poor candidates for hair transplantation, and the physician must set expectations for specific candidates accordingly.

People with fair skin and candidates with fair hair have more impressive results and in fewer grafts than those with dark hair, as the color contrast between hair and skin is less noticeable. Proper technique helps alleviate most of the problems with transplanting patients with dark hair.

The patient must also understand the need for a conservative approach when recreating the frontal hairline to have a natural look that lasts without exaggeration.

Candidates should have realistic expectations and understand that additional hair transplant sessions may be needed to achieve the desired results.

Alopecia causes reduced self-esteem and social withdrawal in sufferers. Hair transplantation represents a powerful tool that can restore a more youthful appearance. When performing a hair transplant, proper patient evaluation and execution of a comprehensive treatment plan can produce safe, reliable, and satisfactory results.