The most common clinical cases of hair loss are found in men at a young age. Sometimes, it can start in your adolescence or early twenties but it usually appears later. At 50 years of age, more than half of white men have a visible sign of baldness that is generally referred to as the male-pattern hair loss. It tends to slowly develop. It can start like a soccer booth shape or a bald point on the top of the head and this type of hair loss can cause a slow thinning and balding for years.  The most effective treatment for hair loss is considered the hair transplant surgery.

Hair transplant implies the removal of small grafts from the scalp that is cut into smaller pieces to be used as grafts. These grafts are then transferred to a bald area or area where the hair is scarce. The grafts created in this way differ in size and shape. Small round punch grafts contain around 10 to 15 hairs. The much smaller mini-grafts contain about two or four hairs. Linear or rectangular shaped grafts however, which are inserted into slots created on the scalp, contain about 4 or 10 hairs each. Strip grafts are long and thin and contain 30 to 40 hairs.

In general, a few surgical sessions may be needed to obtain satisfactory results were the thinning or baldness is replaced with healthy hair and a healing period of several months is recommended between sessions. It can take up to two years before seeing the final result with a series of complete transplants. The amount of coverage you will need is partially dependent on the color and consistency of your hair. Thick, gray or light hair allow better results and coverage than dark hair colors. The number of large transplanted caps in the first session varies with each individual, but the average is about 50. For mini- or micro-grafts, the number can be up to 700 per session.

Procedure for Hair transplant

• Grafts. Just before the surgery, the "donor area" (the area from which the grafts derive) will be trimmed so that the grafts can easily be accessed. For punch grafts, the doctor will most likely use a special tool similar to a tube made of sharp carbon steel that punches the graft from the donor site, so it can be relocated in the area which will be covered. For other types of grafts, the doctor will use a scalpel to remove small scalp sections, which will be divided into even smaller sections that will be transplanted into small holes or slots on the scalp.  When grafts are taken, the doctor may periodically inject small amounts of saline solution in the scalp to keep the skin strength intact. The holes of the donor's site can be closed with stitches but this depends on the type of grafts that were used. Typically, these stitches are usually hidden with the surrounding hair. After completing the graft session, the scalp will be cleaned and covered with a gauze. You may need to use a pressure bandage for a day or two. Some doctors allow their patients to recover without a bandage, but this decision will be made depending on your case.
• Tissue expansion. Another technique used in the treatment of baldness or thinning is tissue expansion. This procedure is very common for people who have suffered from burns when there was a lot of skin loss. Its application in hair transplant surgery generated dramatic results as it lead to significant coverage over a relatively short period of time. In this technique, a balloon-shaped device is inserted under the scalp that is located next to a bald area. The device is gradually inflated with salted water for a period of weeks, which makes it expand the skin and makes it grow new skin cells. When the skin under the hair has stretched enough (about two months after the first procedure) another procedure is performed to bring the skin that was previously extended over the bald spot to cover it.
• Flap surgery. This procedure that has been successfully performed for over 20 years is able to quickly cover large areas of baldness and is customized for each individual patient. The dimension of the flap and its positioning depends to a large extent on the objectives and needs of the patient. A flap can do the work of 350 or more punch grafts. A section of the bald scalp is cut and the flap of scalp is lifted while still being connected to one end. The hair flap is brought to its new position and is sewn in place, while still remaining "linked" to its original blood supply. As it heals, you will notice that the scar is hidden by hair, which grows at the edge of the incision. In recent years, plastic surgeons have made significant progress in flap techniques, combining flap surgery and scalp reduction for better crown coverage or with tissue expansion, to provide better front coverage and a more natural looking hair line.
• Scalp reduction. This technique is sometimes known as advancement flap surgery because the sections of the hair scalp are pulled to fill a bald spot. Scalp reduction is for covering the bald areas in the upper part and the back of the head. It is not advantageous for the front hair line cover. After injecting the scalp with local anesthesia, a bald segment of the scalp is eliminated.  The model of the section of the eliminated header skin varies widely, depending on the patient's goals. If a large amount of coverage is required, the doctors commonly extract a scalp segment in an inverted Y shape. The skin surrounding the area is loose and pulled, so that the sections of scalp can be sewn together.

Hair transplant for women

Women experience a certain degree of hair loss generally caused by aging, diseases or hormonal changes after menopause. Women tend to have thinning throughout the scalp instead of losing hair in patches, as this is more common in men. To correct the problem, some women choose to use a wig or hair extensions. Others had success using a topical prescriptive drug. The effectiveness of these drugs varies in some patients and simply avoids greater hair loss without stimulating any new appreciable growth.  Hair transplant surgery can be the answer for those where these options failed or simply want a better outcome.

Mini-grafts are usually a surgical treatment for filling thinning areas so good candidates for this procedure must have a dense hair growth on the back of the head. Mini-grafts are collected from this dense area and are re-established in the thinning areas to create a more complete appearance. Occasionally, flap and tissue expansion procedures can be used if the individual is considered a good candidate.

If you are considering a hair transplant procedure, it is important to understand that you will never have the coverage you've had before your hair loss, but surgery can camouflage the areas where you lost hair and give it fullness.

What to expect after Hair transplant surgery?

After the hair transplant surgery, the areas of the scalp where hair follicles were harvested and the region where they were relocated may feel tender, swollen and bruised. However, this is a normal reaction and will generally go away after a few days after surgery. Even though discomfort is usually minimal after surgery, any pain can be alleviated with regular over the counter medication, like ibuprofen which will help with both pain management and reducing inflammation. If your hair transplant procedure involved scalp grafts, you may experience shedding about a week after the procedure, but many patients are able to go back to their normal daily activities about two to five days after the procedure. Once the healing and restoration procedure is over, the results become more apparent. It is important to remember that it is normal that in the first few weeks you experience hair loss. After this, you will notice your hair growing back again for good, at a rate of about ¼ to ½ of an inch a month. This varies, however, on the patient. Some patients may still experience new growth even after 12 months following the hair transplant procedure.

Hair transplant risks

Surgery for hair transplant is generally considered safe if performed by a qualified and certified plastic surgeon. However, the outcome is not very predictable as patients’ healing abilities and reactions differ. As in any surgical procedure, infections, bleeding and scars may occur.

When it comes to transplant procedures, there is a risk that some grafts will be repulsed. If after the surgery you experience progressive hair loss or your hair looks unnatural and patchy, you may need additional surgery.

Hair transplant success rate

Although hair transplant is more effective than over-the-counter hair restoration products there are certain aspects you need to consider before having one. Just like regular hair, transplanted hair will thin and fall over time and for people with hair follicles that no longer grow hair (dormant hair follicles) hair transplant may not be as effective as plasma treatment. Not everyone is a good candidate for a hair transplant; they are mainly used to restore hair if you are balding or naturally thinning or if you lost hair due to an injury. Moreover, most transplants are done with your existing hair so they may not be as effective for people with thick scars on their scalps or people who lost their hair due to chemotherapy.

Is a Hair transplant permanent or temporary?

Hair transplantation, sometimes called hair restoration, is a procedure that uses micrografting technology to give their hair follicles to other areas of the scalp that thinner. The results of a hair transplant are visibly long and are considered permanent. People who have already experienced a significant hair thinning on the scalp are the typical candidates of a hair transplant.

After the hair follicles are grafted in areas where hair is thinning, some time is needed for healing. In fact, it is normal that some of your hair fall during the first three months after the procedure.  Healing can take somewhere between 6 and 12 months. But once the healing process is completed, the transplanted follicles begin to cultivate the hair that complete the bald patches on the scalp. This is the hair that will continue to grow naturally.

The movement of hair follicles is permanent. But like the rest of the hair follicles, the transplanted ones could also stop producing hair as they used to. It is possible that your first hair transplant procedure is not your last. There are some candidates who will be informed by their doctor who need multiple "sessions" of transplant surgery to achieve the results they want. Other candidates are satisfied with the results after their first hair transplant has been healed.

When the hair transplant procedure is performed, it will take time before you can see the results.  As transplanted hair sections begin to heal, you can notice that you lose even more of your hair during the first few months. Your plastic surgeon should reassure you that this is normal and expected.

Once the hair transplant has completely curated, you will see follicles of your hair that starts making an appearance. The hair will grow and in the end will be the same consistency and length that the rest of your hair. Hair transplants performed by micro-grafts can be cut, designed and colored according to your preferences. 

If hair thinning continues after the procedure, your hairline will not recede as the old pattern of natural hair loss. Your plastic surgeon will discuss with you a plan to make sure that your hair does not look patchy in the coming years after your transplant.

Hair transplant and Trypophobia

Trypophobia is the fear of groups of small holes like a honeycomb. When having a hair transplant sometimes the procedures involved create small groups of tiny engravings in which hair grafts will be placed, which can make this surgery very stressful if you suffer from a trypophobia. These phobias are not always explained easily and many may seem irrational. The fear of water, hydrophobia or going outside, the agoraphobia, and many others can seriously affect a person's life. However, what clinical interventions have shown is that these fears can be managed.

If you have trypophobia and that prevents you from solving hair loss problems with a hair transplant, certain management strategies can help with this. The first step would be to collect information on the transplant procedure. Discussing your fears with an experienced doctor would therefore be the right direction to go. A profound knowledge of what a hair transplant implies will increase your trust and reduce your anxiety. Doctors will explain that during the hair transplant procedure, you will not be able to see the cluster groups of hair transplant. The only problem that can trigger a state of panic is the idea of it. However, a variety of management techniques are available to manage this occurrence. Anyone can experience anxiety. The surgeon can prescribe a sedative medication.  Breathing exercises can help a lot, not just to calm the body, but also the mind. Even meditation exercises can be useful. Sometimes, having a friend or relative around you, can help keep you calm during the procedure. You can also choose to see the operation when it is performed, but that depends largely on the clinician involved to assess whether it will be useful or harmful.

Non-surgical treatments for Hair loss

Treatment can reduce great hair loss and could also stimulate regeneration, as some men even grow some of their hair back. Men who tend to see the best results begin treatment shortly after realizing they are losing hair.

The Food and Drug administration (FDA) in the United States have approved the following pharmacological treatments to treat male-pattern hair loss:

• Minoxidil as Topical Ointment (available without a medical prescription) is widely available in stores and online, this is the most used treatment for male-pattern hair loss. In clinical trials, it has been shown that minoxidil reduces hair loss, stimulates hair growth and strengthens existing hair. While the minoxidil can help, it is unlikely to see the total regrowth. Apply it on the scalp, twice a day every day. Some men respond to Minoxidil better than others, and some men cannot see any difference. If Minoxidil works for you, it may take up to six months to see the results. It is important to follow the instructions, applying Minoxidil twice a day every day. When Minoxidil is used, some men can develop an irritated scalp. The new formulation, which is a foam, seems to reduce this risk.  Other possible side effects include headaches. If you see a dermatologist, your dermatologist can add a prescribed medication to your treatment plan. This can improve the results. If you stop using Minoxidil, the new hair that grew can fall and this can usually occur within three or four months. Dermatologists report that some men say that their hair loss is worse than before they began to apply Minoxidil. What is happening is that you are seeing hair loss that would have happened if you had never treated it.
• Finasteride (prescription drugs). This is a prescription drug that would need to be taken long-term.  Studies have shown that finasteride has slowed down the reduction of hair loss of about 80% of 90% of men who take it. Some men even see some hair grow back, which tends to occur in men who start finasteride when they notice the first hair loss signs. You will have to take one pill every day. If finasteride helps, you will most likely start seeing results in about 6 months. Possible side effects have been reported. These include loss of libido (desire to have sex), the inability to obtain or maintain an erection, swelling and tenderness in their breast and depression. It has been reported that sexual side effects can continue after a patient stops taking finasteride. Due to the severity of these side effects, your dermatologist will want to know more about you before prescribing Finasteride. Your dermatologist will give you a complete exam and will ask you for pre-existing conditions and medications you take.  If finasteride is part of your treatment plan, you can take it alone or use it together with Minoxidil. To maintain the results, you should continue to take a pill every day. Once you stop taking this medication, returns hair loss.

Depending to the location and extent of hair loss, your dermatologist can recommend a procedure called Platelet-Rich Plasma (PRP). While PRP is not a permanent solution, maintenance treatments can help you keep results. PRP can be used alone or dice before a hair transplant to improve the results.

If your dermatologist recommends PRP for you, here's what you can expect:

• A small amount of blood will be drawn and positioned on a machine that separates red plasma blood cells. Your plasma is injected into your scalp.  This takes about 10 minutes.
• You must return for multiple injections. During the first three months, you need to come in once a month and after the first three months you can come back once every three or six months. In a few months, PRP can help reduce hair loss.
• Shortly after, some patients see thickening of their hair or even regrowth.

Conclusion

Hair loss is very common among both men and women and it is important to note that treatment is available, both surgical and non-surgical. Talk to a plastic surgeon if any non-surgical treatments failed and see if you may be a good candidate for hair transplant surgery.