eMedicine Specialties > Plastic Surgery > Hair

Hair Replacement Surgery, Hair Transplantation: Follow-up

Author: Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Coauthor(s): Gary D Monheit, MD, Associate Professor, Department of Dermatology, University of Alabama at Birmingham
Contributor Information and Disclosures

Updated: Jun 2, 2009

Outcome and Prognosis

The transplanted hair follicles typically appear to grow in the immediate postoperative period. Within a month, the graft follicles enter the telogen phase and are all shed. Hair regrowth then takes approximately 4 months, but the hair continues to improve in quality and quantity over the subsequent 2-4 months. Growth stabilizes at about 1 year and reports have indicated graft survival rates of over 95% in experienced hands.

The present techniques and technology of hair transplant surgery can give a proper candidate realistic and natural appearing transplanted hair. Using 2 or 3 hair transplant sessions, the candidate has a successful outcome.

Preoperative image of alopecia.

Preoperative image of alopecia.

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Preoperative image of alopecia.

Preoperative image of alopecia.



Immediately following micrograft placement.

Immediately following micrograft placement.

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Immediately following micrograft placement.

Immediately following micrograft placement.



Postoperative view following initial micrograft s...

Postoperative view following initial micrograft session.

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Postoperative view following initial micrograft s...

Postoperative view following initial micrograft session.

Future and Controversies

The most realistic transplants now are performed with micrografts that yield a realistic presentation. The latest technology can spare donated hairs so that each follicle takes and produces cosmetically acceptable hair. In addition, donor site morbidity is decreased and innovative donor sites are also being used.20 Follicular unit extraction is being performed to remove the follicular units under microscopy to maximize harvest and minimize morbidity.21,22 Initial work on culturing hair follicles could lead to unlimited grafts with minimal donor site morbidity.23

Further understanding of the hormone and follicular interaction may yield new medical management options.24 The new field of stem-cell research may present a completely new paradigm for the management of alopecia, including cultured hair grafts with improved viability and survival.

 


More on Hair Replacement Surgery, Hair Transplantation

Overview: Hair Replacement Surgery, Hair Transplantation
Workup: Hair Replacement Surgery, Hair Transplantation
Treatment: Hair Replacement Surgery, Hair Transplantation
Follow-up: Hair Replacement Surgery, Hair Transplantation
Multimedia: Hair Replacement Surgery, Hair Transplantation
References
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References

  1. Norwood OT, Shiell RC. Hair Transplant Surgery. 2nd ed. Springfield, Ill: Charles C Thomas; 1984.

  2. Ayres S 3rd. Prevention and correction of unaesthetic results of hair transplantation for male pattern baldness. Cutis. Jan 1977;19(1):117-21. [Medline].

  3. Unger WP, Stough DB, Jimenez FJ, et al. Hair replacement. In: Ratz JL. Textbook of Dermatologic Surgery. Philadelphia, Pa: Lippincott-Raven; 1998:499-545.

  4. Unger W, Nordstrom, Rolf EA. Hair Transplantation. 2nd ed. New York: Marcel Dekker, Inc; 1988.

  5. Alt TH. Scalp reduction as an adjunct to hair transplantation. Review of relevant literature and presentation of an improved technique. J Dermatol Surg Oncol. Dec 1980;6(12):1011-8. [Medline].

  6. Uebel CO. Micrografts and minigrafts: a new approach for baldness surgery. Ann Plast Surg. Nov 1991;27(5):476-87. [Medline].

  7. Barrera A. Micrograft and minigraft megasession hair transplantation results after a single session. Plast Reconstr Surg. Nov 1997;100(6):1524-30. [Medline].

  8. Brandy D. The exclusive use of mini-micrografting. American Journal of Cosmetic Surgery. 1993;10:111-115.

  9. Fan J, Wang J, Nordstrom RE. Standardized technique of transplanting micrografts in hair restoration surgery. A practical approach. Dermatol Surg. Sep 1997;23(9):829-33. [Medline].

  10. Nordstrom RE, Greco M, Vitagliano T. Correction of sideburn defects after facelift operations. Aesthetic Plast Surg. Nov-Dec 2000;24(6):429-32. [Medline].

  11. Barrera A. The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp. Plast Reconstr Surg. Sep 2003;112(3):883-90. [Medline].

  12. Harris JA. Follicular unit transplantation: dissecting and planting techniques. Facial Plast Surg Clin North Am. May 2004;12(2):225-32. [Medline].

  13. Lee SJ, Lee HJ, Hwang SJ. Evaluation of survival rate after follicular unit transplantation using the KNU implanter. Dermatol Surg. Aug 2001;27(8):716-20. [Medline].

  14. Swerdloff J, Kabaker S. The state of the art. Donor site harvest, graft yield estimation, and recipient site preparation for follicular-unit hair transplantation. Arch Facial Plast Surg. Jan-Mar 1999;1(1):49-52. [Medline].

  15. Marritt E. Patient selection, candidacy and treatment plan for hair replacement surgery. Facial Plastic Surgery Clinics of North America. 1994;2.

  16. Unger WP. Hair transplantation: current concepts and techniques. J Investig Dermatol Symp Proc. Dec 2005;10(3):225-9. [Medline].

  17. Shapiro R. Principles and techniques used to create a natural hairline in surgical hair restoration. Facial Plast Surg Clin North Am. May 2004;12(2):201-17. [Medline].

  18. Martinick JH. The latest developments in surgical hair restoration. Facial Plast Surg Clin North Am. May 2004;12(2):249-52. [Medline].

  19. Barrera A. Hair restoration. Clin Plast Surg. Apr 2005;32(2):163-70. [Medline].

  20. Woods R, Campbell AW. Chest hair micrografts display extended growth in scalp tissue: a case report. Br J Plast Surg. Dec 2004;57(8):789-91. [Medline].

  21. Tan Baser N, Cigsar B, Balci Akbuga U, Terzioglu A, Aslan G. Follicular unit transplantation for male-pattern hair loss: Evaluation of 120 patients. J Plast Reconstr Aesthet Surg. 2006;59(11):1162-9. [Medline].

  22. Gokrem S, Baser NT, Aslan G. Follicular unit extraction in hair transplantation: personal experience. Ann Plast Surg. Feb 2008;60(2):127-33. [Medline].

  23. Er E, Kulahci M, Hamiloglu E. In vivo follicular unit multiplication: is it possible to harvest an unlimited donor supply?. Dermatol Surg. Nov 2006;32(11):1322-6; discussion 1325-6. [Medline].

  24. Hamada K, Randall VA. Inhibitory autocrine factors produced by the mesenchyme-derived hair follicle dermal papilla may be a key to male pattern baldness. Br J Dermatol. Apr 2006;154(4):609-18. [Medline].

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Further Reading

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Keywords

hair replacement surgery, hair transplant, hair transplantation, micrograft, minigraft, alopecia, hair growth, male pattern baldness, baldness, androgenic alopecia, male pattern alopecia, cicatricial alopecia, traumatic alopecia, traction alopecia

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Contributor Information and Disclosures

Author

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

Coauthor(s)

Gary D Monheit, MD, Associate Professor, Department of Dermatology, University of Alabama at Birmingham
Gary D Monheit, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Academy of Facial Plastic and Reconstructive Surgery, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and International Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Medical Editor

Joseph A Molnar, MD, PhD, FACS, Associate Professor of Plastic and Reconstructive Surgery, Associate Director, Burn Unit, Wake Forest University School of Medicine
Joseph A Molnar, MD, PhD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Plastic Surgeons, North Carolina Medical Society, Peripheral Nerve Society, and Wound Healing Society
Disclosure: KCI, Inc.  Honoraria Speaking and teaching; Integra Life Sciences Honoraria Speaking and teaching; Clincal Cell Culture Grant/research funds Co-investigator; KCI, Inc Wake Forest University receives royalties Other

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark E Krugman, MD, Assistant Professor of Plastic Surgery and Clinical Professor of Otolaryngology-Head and Neck Surgery, University of California at Irvine School of Medicine
Mark E Krugman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society for Laser Medicine and Surgery, and American Society of Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
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