HAIR REPLACEMENT SURGERY OR BALDNESS SURGERY
Aesthetic surgery:
This document has been conceived under the authority of the French Society of plastic Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION, AIMS AND PRINCIPLES
Baldness is particularly poorly lived in both men and women.
The introduction of micrografts has transformed this surgery. It allows, in fact, reduce the importance of interventions and residual scarring.
However in the treatment of baldness, there is no single technique that can be applied to all cases.
The principle of these treatments is always the same: collect hair near the crown, where it is assured that they will never fall, to transpose them to the regions of the forehead and the tonsure.
Currently, four types of techniques are used:
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MICROGRAFTS
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FLAPS
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SCALP REDUCTION
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SCALP LIFT
All these processes may be used in the same patient. It is necessary a proper analysis of each case and to take into account several parameters: the importance of baldness, suppleness of the scalp, hair quality and patient wishes. Depending on their age and the progression of the baldness, the strategy best suited to each case will be decided.
Your surgeon should have experience of all these techniques to advise you better in your case.
BEFORE THE OPERATION
A preoperative assessment is normally conducted as required.
If general anaesthesia is required, the anaesthetist will be seen in consultation, not later than 48 hours before surgery.
No medication containing aspirin should be taken within 10 days prior to surgery.
TYPE OF ANAESTHESIA AND HOSPITAL STAY
Type of anaesthesia:
Most interventions can be done under local anaesthesia.
Hospital stay:
The procedure can be practiced in outpatient basis, that is, with a same-day discharge after a few hours of surveillance.
However, in some cases, a short hospital stay may be preferable.
The admission is so in the morning (or even the day before in the afternoon) and the discharge is permitted from the next morning.
THE PROCEDURE
Each surgeon has his/her own technique that he or she adapts to each case in order to obtain the best results.
The methods are different depending on the type of technology adopted:
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MICROGRAFTS: the surgeon harvest one long strip of scalp, 8 to 10 cm wide and 1 to 2 cm long, from the crown, which will be cut into small fragments, each containing one to three hair (micrografts) or 4 to 8 hair (minigrafts). So many holes are made in the balding area for the implantation of grafts.
A small crust will form on each implant, which will fall after about two weeks, causing hair loss around the implants that will grown again around the 3rd month.
Several sessions are needed on the same receptor site to get a proper density. The operation is very light and takes place under local anaesthesia.
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FLAPS: The process involves taking a long band of 15 to 18 cm and 3 cm wide pedicle, including the necessary blood supply that is not cut, which is rotated around the pedicle to be placed in the frontal region.
It is the only process that allows a single operation to provide a high density of hair in the frontal region. But the flap technique has some risks that need to be explained by your surgeon.
The operation is performed under local anaesthesia but may take several days before resuming work.
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SCALP REDUCTION: the surgeon removes a portion of the bald area and immediately closes it by adjusting the elasticity of the scalp.
Usually an area of 10 to 12 cm long and 3 to 4 cm wide can be removed. This technique finds its interest in the region of the tonsure and in patients with a good elasticity of the scalp.
The procedure is done under local anaesthesia and allows early resumption of activities. It may be repeated two or three times a few months apart.
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SCALP LIFT: it is a more complicated technique that combines at the same time a large scalp reduction with one o two flaps for covering the frontal region. Such a process could cover some large baldness in only two stages.
It is most often performed under general anaesthesia and usually requires a work leave of 8 to 10 days.
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Hair loss: 2 to 3 weeks after the intervention in the periphery of the grafted area is very common. It is usually temporary.
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Hematomas: mostly harmless, they can be drained if they are too important.
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Infection: is really exceptional after scalp surgery, except a few micro-abscesses developed on a stitch and easily handled by small local care.
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Abnormal wound healing: very rare at the level of graft donor sites.
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Epidermal Cysts: They can appear on the hair transplant and often spontaneously eliminated. Otherwise, they are easy to remove and do not compromise the quality of the final result.
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A temporary alopecia: can occur on a flap. It appears to the 3rd week and may be more or less important. After the regrowth of hair, they will have a normal look and density.
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Skin necrosis: is occasionally seen in the flap techniques, usually limited and localized. Important necroses are, in fact, exceptional.
The prevention of necrosis depends on a correct indication and the performance of a prudent and correct surgical technique.
AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP
Usually is necessary a work leave of 4 to 8 days.
For micrografts, usually a thin crust forms on each plug that falls between 8 to 10 days. The transplanted hair will fall with the crust and then push between the second and third months. They grow about 1 cm per month.
In the reductions, flaps and scalp lifts, hair does not fall and the sutures will be removed around the 8th day.
The shampoos are generally allowed 48 hours after the operation.
The practice of a sport can be resumed gradually from the 4th postoperative week.
Some headache-like pain may persist for several days, which will be relieved by prescription painkillers.
The postoperative course is mainly marked by the appearance of edema (swelling) and ecchymosis (bruising) whose size and duration are highly variable from one patient to another.
THE RESULT
A period of 3 to 6 months is necessary to assess the outcome of micrografts and in all cases at least two interventions are needed to obtain a sufficient density of hair.
For the other techniques, the result is immediate.
The goal of this surgery is to bring improvement and not to achieve perfection. If your wishes are realistic, the result should give you great satisfaction.
DISAPPOINTING RESULTS
They may result from a misunderstanding of what is called a reasonable expectation. It is thus a lack of density after micrografts or inhomogeneous distribution of hair after a flap.
POSSIBLE COMPLICATIONS
The correction of baldness, although carried out mainly for aesthetic reasons, none the less is a real surgery, which involves the risks associated with any medical procedure, however small it may be.
We must distinguish complications from anaesthesia than those associated with surgery.
With regard to general anaesthesia during the consultation, the anaesthesiologist will inform you the anaesthetic risks. You should know that anaesthesia induced reactions in the body are sometimes unpredictable and more or less easy to control: having recourse to a fully qualified anaesthesiologist, practicing in a real surgical context, make the risks statistically almost negligible.
Be aware, in fact, that the techniques, anaesthesia drugs and monitoring methods have made great progress in the last twenty years, providing optimal safety, especially when the procedure is not performed in an emergency basis and in a healthy person.
Regarding the surgical procedure: selecting a qualified and competent plastic surgeon, trained for this type of intervention, you may limit the risks, although they never disappear completely.
Fortunately, real complications are uncommon following an operation performed according to the usual rules. In practice, the vast majority of operations do no present any problem and the patients are fully satisfied with their results.
However, despite their rarity, you still know the possible complications:
In total, we should not overstate the risks, but just be aware that surgery, even apparently simple, always has a small share of hazards. The recourse to a qualified plastic surgeon can assure you that it has the training and competence required to avoid these complications, or treated effectively if necessary.
GENERAL CONCLUSIONS ABOUT BALDNESS SURGERY
Baldness surgery has made important progress permitting today in many cases to propose a technique and a therapeutic strategy adapted to each case and resolve in this way by simple micrografts or by other techniques the aesthetic problems posed by the loss of hair in men and in women.
All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.
These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.
Our advice is for you to keep this document and to read it and think it over carefully after your consultation.
Once you have done this you will perhaps have further queries, or require additional information.
We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.
"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).
This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.
The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.