It is the structure of the hair that determines the hairstyle. It is important whether the hair is curly or straight, black or light, thin or thick. The features that increase the quality in hair transplantation are that the hair is black, thick, and straight. Hair density means follicular units per square centimeter, and the number in the occipital area, that is, in the area where the grafts are provided, varies between 50 and 160. The ideal ratio for sowing is 25-35 follicles per square centimeter. Achieving a density above 25 is technically difficult and graft retention success may be reduced.
FUT (follicular unit transplantation) and FUE (follicular unit extraction) are the most commonly used transplantation methods. In FUT, the occipital region, that is, the strip above the nape, is removed and divided into grafts on the table. Transverse leaves a scar extending between the two ears and is rarely preferred in our country. In the FUE method, the grafts are taken as a unit with punch. In this method, although the scar is more in total, it is easily hidden with the remaining hairs as it is scattered over the area. This method is mainly used in our country, and we prefer this method. Sowing, that is, the transfer method is the same in both methods.
It is possible to take an average of 3000 micrografts (a piece of skin containing 1-3 hairs on average) at a time. Although this number can be increased to higher figures, the total procedure time will be prolonged and patient tolerance may decrease. If there are sufficient resources, it would be more appropriate to apply a second session the next day. FUE can also be performed on bleached hair. First of all, the hair is dyed with black paint just before the procedure and waited for a while. Blackening of the hair prevents uptake and subsequent loss.
In the FUE method, a manually manipulated pen-shaped punch tool or low-speed micromotors (0.7-1mm diameter) with a punch attached to the tip can be used. Both tools have their pros and cons. We prefer to take grafts with micromotor.
Before the transplantation, the composition of the scalp is extracted by performing a hair examination. According to the Hamilton-Norwood classification, the level of shedding, what is the hair condition in the recipient area, what is the hair density, thickness, and color of the donor area (occipital region between the two ears) are sought. Ludwig classification is used for women and the shedding pattern is different from men. Blood thinners such as aspirin and vitamin E are discontinued one week before the operation, and it is recommended not to drink alcohol during this period. Otherwise, bleeding that occurs during the procedure makes graft removal difficult.
The procedure begins with a light sedation, lying face down on a specially designed table for hair transplantation, and local anesthesia to the recipient area. Graft retrieval takes an average of 2 hours for 3000 grafts. This period may increase or decrease according to the structure of the skin. The grafts taken are prepared for sowing in petri dishes and on ice packs. When the procedure is finished, the treated area is wrapped with gauze and the patient is rested for a while. Local anesthesia is applied to the previously planned area in the head area of the patient, who is brought to a sitting position. Holes are drilled to place grafts with the slit or splitting technique, and the micrografts are placed in these holes with special tools, as a single in front and in double-triple as you go backwards.
This area is not closed after sowing is completed. Only the transmitting field is closed. Painkillers are recommended and the patient is called for control and washing after 3 days. A large amount of cream is applied to the planting area and the crusts are expected to soften for half an hour, and the cream is removed only with the pressure of the shower fountain. Until the 10th day, this procedure is taught to the patient and asked to do it.
On the 10th day, the crusts around the grafts are completely shed. After 2-3 mm of early growth, that is, approximately 1 month after the procedure, the phases of the hairs return to the resting (telogen) phase and begin to fall out. This shedding is normal. 3-4. They start to lengthen again from the first month and take their final shape around the 9th month. A new session is appropriate after this stage. The donor site is left open after the 3rd day. As the hair grows, the removed hairs are covered and appear as if they were not removed. Removed hairs do not grow back. The process performed here is dilution and can be diluted up to 60% depending on the hair structure. Since the direction of the hair is downward, the effects of the intake disappear in a short time.
In severe hair loss (such as Hamilton 7) transplantation may not be appropriate or expectations may not be met. In such cases, alternative methods are suggested. Sometimes, the recipient site may be insufficient for sowing in terms of skin or hair characteristics.
If excessive shedding occurs at an early age, shedding can be stopped by methods such as PRP and hair mesotherapy. However, the disadvantages of these methods are that the effect is visible as long as they are applied. A few months after it is cut, the shedding continues from where it left off. Oral finasteride and locally applied minoxidil are the leading drugs used for this purpose. Mesotherapy can be applied to the scalp by making a mixture with B vitamin complexes and dexpenthanol ampoules.
In men, hair transplantation for camouflage gives satisfactory results in patients who have developed scars in the beard area for any reason, such as burns or infection. Removing and suturing the scarred area leaves long and distinct scars. These tracks are visible from afar, like a fire path in a dense forest. A beard planted appropriately and according to the edge, hair density provides excellent camouflage.
