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SURGERY TO CORRECT BALDNESS

Candidates

The level of self-confidence an individual has plays a large role in how one accepts hair loss. Many patients experience great anxiety or loss of self-esteem when faced with natural hereditary baldness. It is no wonder then that in our youth-oriented society, hair transplant procedure to combat alopecia, the medical term for baldness, have gained in popularity among the approximately sixty to seventy percent of men and the small percentage of women who experience baldness of one degree of another. Beginning hair transplantation before one is completely bald is an excellent idea. This allows some existing hair to be combed over the new plugs or slit-strip grafts while a patient is waiting for the grafts to grow newly transplanted hair.

The current procedure for treating baldness is a highly successful surgery, termed hair redistribution or hair relocation, and involves removing hair follicles from areas of well endowed, genetically predetermined hair-bearing scalp to areas of hair loss. Some patients with preexisting medical or psychological conditions may not be candidates for this procedure, and these conditions may make it inadvisable for them to complete the surgery and its multiple stages.

However, those patients who experience the condition of male pattern baldness (the M-shaped recession of the hairline commonly found in males), or baldness resulting from accidents, operations, burns, radiation treatment, infection, or even those candidates who have lost their eyebrows, are good candidates for this procedure, which is completed to improve appearance. In instances such as those listed above, your insurance carrier may cover the cost. To determine whether or not you are covered in these instances, you will need to contact your insurance agent.

Patients should realize early on that the full head of thick hair which was present before the balding process will not reappear as a result of this procedure. Also, the patient must realize that transplanted or relocated hair may fall out initially, only to grow back in two to three months. With proper hairstyle and grooming techniques, a patient can achieve an appearance close to that of full hair growth.

It is not possible to gain more hair through surgery. The hair transplants of a donor, rather than the individual patient, would likely be rejected by the body's protective mechanism. At present, there is no known method for overcoming rejection.

The Consultation

During the consultation, a medical and family history and examination will be performed pertinent to your hair loss pattern. Recommendations will be made that include the recommendations for grooming techniques, camouflage techniques, the use of newer medications available, and finally, your candidacy for alternative surgical procedures.

The Surgery

Patients are urged not to cut their hair before the transplant sessions begin. The longer the hair is, the better the donor site is camouflaged, and the hair is more easily combined over the newly transplanted hair. It may be necessary to trim a small amount prior to surgery; however, postoperative, this area is entirely inconspicuous.

The surgery may be done under "twilight" anesthesia on a special operating table that allows a patient to sit up during the entire procedure. For Juri-flap candidates, one of the operative stages is done under general anesthesia. Complications, such as bleeding and infection, are possible, but extremely rare. The often quoted myth that hair transplantation is painful is untrue. With proper sedation and anesthesia, today's transplant procedure is virtually pain-free.

The transplantation may involve a widely and successfully used "punch" technique, which has been utilized since the late 1950's. This, however, is usually complimented and enhanced or replaced by the current techniques of mini- and micro-grafting of one to four hair follicle units. By the use of these additional one to four follicle grafts, we can refine the hairline more naturally than the traditional circular graft plugs. The grafts are taken from the hair-bearing areas of the scalp (usually from the back or sides) with an instrument similar to a cookie cutter. The grafts, which are approximately one to three millimeters in diameter, are placed in the balding areas. The donor grafts are meticulously prepared, and then inserted with great care into the spaces at the recipient site.

The grafts are spaced far enough apart so that nourishment from the surrounding blood vessels is sufficient to insure the survival of the transplanted graft. This is an important factor because if all the grafts were transplanted at one time, they would probably die due to insufficient nourishment. With the additional advance of using slit-strip grafts and mini- and micro-grafts, up to 500 grafts may be placed in one session. Typically, three or four sessions are planned over a one year to 18 month period.

Mini Grafts

The mini graft procedure is a relatively new technique to replace hair. I recommend this procedure for patients with some residual hair. Mini-grafting, micro-grafting, and follicular grafting are contemporary concepts and techniques utilized to relocate the maximal amount of natural looking and density hair to areas of the scalp with thinning or baldness. The techniques are highly reliable and can be tailored to a particular patient's anatomy and schedule. During the consultation, a personalized plan will be outlined.

Number of Surgeries

Depending on the patient's degree of baldness, it may take from three or four surgeries to five or six surgeries to obtain the desired look, depending on the individual's situation, time between the sessions, and the number of transplants done per session. The number of surgeries and the length of time in which to complete them will be addressed in your personal consultation with the surgeon prior to surgery.

The Healing Process

The normal healing process causes a small, thin line or scar to develop, since the donor site is closed with a stitch. A very fine, small scar which is unnoticeable except under close observation, will develop. New growth will usually cover any scar. As for the donor sites of the grafts, they will shrink to the point of also being unnoticeable and are all hidden by surround hair. Between surgeries, the surgeon and patient are able to monitor the new growth and determine the success of the procedure.

Any patient who has worn a hairpiece may continue to wear it after the procedure until new hair growth occurs. Hair grows at the rate of approximately one-half inch per month. Therefore, transplant patients will wait approximately six months after surgery to comb the transplanted hair over the newly transplanted areas.

Careful hair styling and grooming are essential to achieve the optimal effects of this punch graft transplantation procedure. The results of this particular procedure should last a lifetime.

Alternatives:
Scalp Reduction and Juri-Flap Replacement

Other procedures exist, also completed on multiple stages, which can be used in relation to hair transplantation and may be suggested in consultation.

Scalp Reduction

In one procedure, called scalp reduction, a serial excision of the scalp is made, which brings together the front of the balding area with the back of the balding area to join the hair-bearing areas of the scalp. This is an excellent adjunct to hair transplantation because it allows the surgeon to concentrate on putting the plugs in the front of the hairline and does not have to spread them out too thinly all over the top of the head. Patients with a U-shaped balding pattern are good candidates for this procedure.

This procedure can be done three to five times, spaced two to three months apart. After each reduction, the scalp skin tends to stretch and loosen, requiring more bald scalp to be removed. Finally, the hairline is brought close enough together so that normal grooming techniques cover the midline scar and provide hair cover to the top of the head. Some patients may be benefited by the placement of scalp expanders, which will allow the bald scalp to be reduced in a lesser number of sessions. This technique, despite popular misconception, does not move the ears progressively higher on the scalp, nor does it over the lower portion of the hair line above the ears.

Juri-Flap Replacement

Other exciting recent technological advances now allow surgeons to advance the hairline and remove the balding portion of the scalp in as little as three steps performed within a six week period of time instead of several months to two years for multiple transplantations.

As such, I may suggest a procedure called the Juri-flap replacement, that involves the placement of a temporal occipital (side and back parts of the scalp) scalp flap that has your own thick hair density of the sides moved to the balding areas of the scalp. This is best for frontal hairline balding or hair loss. This allows for the massive transfer of genetically determined permanent hair to be cosmetically deficient areas. This procedure can be completed when baldness results from either hereditary factors or injury.

The procedure requires careful thought in planning the hairline so that it appears natural. The ultimate result in terms of density of the frontal hairline is a thicker, denser amount of hair compared to hair transplant. Other factors that can determine possible Juri-flap candidates are the pattern of the baldness, the specific anatomic features of the patient, and other particular variations that may correspond to the patient's desires. Specifically, the Juri-flap can provide thicker hair quicker than hair transplantation, but does require more extensive surgery.

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