One of the most common conditions impacting both men and women is hair loss. On average, we lose between 50 and 100 hairs a day, with excess loss and thinning affecting 70 percent of all men by age 70 and 50 percent of women by age 50. For those who struggle with hair loss, hair transplant surgery might be the best option for restoring confidence. We sit down with hair transplant surgeon Mr. Christopher D’Souza MBBS, owner and founder of The D’Souza Clinic and president of the British Association of Hair Restoration Surgery (BAHRS), to find out what’s involved in the procedure.
A Guide To Hair Transplants For Beginners
What Is A Hair Transplant?
‘A hair transplant involves moving or transplanting hairs in their follicular units from one place to another,’ says Christopher. ‘We use follicles from the permanent zone of your scalp – back and sides – which is not affected by androgenetic alopecia to build up the density in the area required (usually around the hairline, temples and crown).’
What Does The Process Entail?
In terms of the process itself, there are two main surgical techniques to consider: Follicular Unit Excision (FUE) and Follicular Unit Transplantation (FUT). Christopher outlines how each one works, along with their pros and cons, below:
Follicular Unit Excision (FUE)
‘Follicular Unit Excision (FUE) formerly known as Follicular Unit Extraction, has become much more popular in the last few years. Around 90 percent of our cases are FUE and this is due to the demographic of our patients. More and more men are deciding to treat their hair loss at a younger age and FUE is often more suited to younger men. This is because the area of hair loss to be treated is usually small and FUE does not leave a linear scar.’
So, how does it work? As Christopher explains: ‘With FUE, each follicle is punched out individually by a very small punch, usually only 0.9mm in diameter, a tiny scar is left behind, but is covered by a short haircut, perhaps grade 1.5 or 2. This gives men more flexibility when it comes to hair styling.
‘The biggest downside with FUE is that the number of grafts (strips of skin containing hair) that can be obtained may often be less than with Follicular Unit Transplantation (FUT). The number of grafts one can harvest safely is determined by the density and the surface area of the donor, this will vary from person to person. It is important not to over harvest (take too many grafts), otherwise the back of the head can start to look patchy.’
Follicular Unit Transplantation (FUT)
‘Follicular Unit Transplantation (FUT) is also known as linear strip excision, strip surgery or strip harvesting. It is an older technique, but in many patients can prove to be the right option,’ says Christopher. ‘In the majority of cases more grafts can be achieved than with FUE which is advantageous if there is a large area of hair loss to be treated.
‘With the FUT technique a thin strip of hair bearing skin (hence the name ‘strip surgery’) is taken from the back of the head. This leaves a linear scar and although most often only a few millimetres in width, it does limit your hair length to perhaps grade 3 or 4. This is the main downside of FUT surgery.’
Are There Any Misconceptions Surrounding Hair Transplants?
While a great option for those struggling with hair loss, hair transplants are rarely talked about outside of clinical settings – making it easy for misconceptions to pop up. One of the biggest, according to Christopher, is that they simply don’t work. ‘Some patients believe that hair transplants don’t work, which is ultimately not the case (and we fortunately have consistently good results which we can use as examples). A good hair transplant should look natural – almost undetectable – but some people also believe that hair transplants can look very noticeable.’
Another misconception is that non-surgical hair restoration is no longer needed once you’ve undergone a hair transplant, or that it’s not needed at all. ‘There are a limited amount of grafts that can be transplanted, and with ongoing hair loss the non-surgical side of hair restoration (the preservation of existing hair) is essential. Most of our patients use medication to stabilise their hair loss. This is especially important in younger patients who may not yet be good candidates for surgery. Common options are Minoxidil (Rogaine) and Finasteride (Propecia); each has benefits and possible side effects, so you should consult a specialist before beginning treatment with either.’
What Should We Expect From The Procedure?
The process itself is split into three steps: consultation, surgery and recovery. Each step is important for the procedure to take full effect.
‘The consultation process is essential in identifying suitable patients and to set realistic expectations,’ explains Christopher. ‘Before booking a hair transplant you must consult with the operating surgeon. Patient selection and operative planning is one of the most important aspects of hair restoration. Patients who are rapidly losing hair do not make good candidates for hair transplant surgery – the reason being that you can only place grafts where there is no hair at the moment. If you go on to lose your existing hair you can end up with an unnatural appearance.
‘I would advise patients seeing a few hair transplant surgeons to see who they feel most comfortable with. They should also choose someone who is a member of the British Association of Hair Restoration Surgery (BAHRS) and the International Society of Hair Restoration Surgery (ISHRS), the only qualification in hair transplant surgery is the American Board of Hair Restoration Surgery (ABHRS).’
‘The day of surgery goes quite quickly for most patients – hair transplant surgery is performed under local anaesthetic and most people pass the time by watching TV or listening to audiobooks. The local anaesthetic stings when it goes in but the rest of the day should be pain free. There are three stages of the day: incision making (that is where the grafts are going to be placed), removing the follicles either through FUE or linear strip excision and then placing of the grafts. As mentioned, FUE involves cutting the back and sides very short – linear strip excision does not require any hair cut.’
On average, it takes around two weeks for grafts to settle and become properly secure, and during that time you need to be very careful with your hair. ‘We advise our patients to take at least a week off work, or two weeks if they want to go back without much evidence of any intervention. The first five days are the most important as the grafts are very delicate and it is essential that they are not dislodged during this time. We advise our patients to spray the grafts with normal saline and to sleep with a neck pillow. There are a couple of medications, some painkillers and a low dose of steroids. We don’t give antibiotics routinely.’
What Are The Risks & Benefits?
‘There are risks with any surgery, but if performed correctly then hair transplant surgery is a very safe surgery. The most common problems we see are more to do with repair work, where a patient has had a poor transplant performed. This could be inappropriately low, straight hairline design, poor density, over harvested donor, inappropriate angulation of grafts.’
And the benefits? ‘A hair transplant can aesthetically make a big visual difference to a persons overall look. The shape of the face can be redefined and often our patients say they have a new lease of life. I am also pleased to hear that many of our patients manage to undergo a transplant without colleagues or friends identifying what they have had done – they do however get compliments from many saying they look very well.’
Does It Work For Everyone?
‘While you never get 100 percent take of the grafts in a hair transplant, we consistently get good results. Nothing in medicine however is guaranteed. As mentioned, one of the most important aspects of hair transplant surgery is patient selection. Someone in their mid-20s who is rapidly losing their hair and not on any preventative hair loss medication is not a good candidate for hair transplant surgery as they will inevitably end up with an unnatural result and be disappointed with the outcome.’
How Much Does It Cost?
That depends on the size of the case, says Christopher. ‘The average case size in our clinic is 1800 to 2000 grafts – price-wise that would be £7000 – although the cost will vary depending on the size of the case and the clinic.’
Is There Anything Else We Should Know?
‘Hair transplant surgery has become a lot more mainstream and many patients are seeking out treatment at a younger age. The demographic of our patients has changed significantly,’ says Christopher. ‘This is why it is so important to consult with an experienced hair transplant surgeon who will be honest in their assessment and set realistic expectations.
‘There is currently a rise in black market clinics in the UK, where the surgical steps of the procedure which should be performed by the surgeon are being inappropriately delegated to non-medical staff. The trend for this started overseas but it is now happening in the UK. There is a lot that can go wrong with hair transplant surgery and the procedure should not be viewed as trivial. As previously mentioned, I would strongly recommend patients seek out a surgeon who is a member of the BAHRS and ISHRS, and has ABHRS diplomate status.’
You can book a consultation for a hair transplant at thedsouzaclinic.com
Featured image: Drew Hays, Unsplash