Hair Replacement

It is estimated that one in five women will experience some degree of hair loss. Women usually don't develop big bald spots. The thinning of the hair tends to be distributed throughout the scalp and is a process that usually takes years before it becomes obvious to others.

Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff, and even excessive hat-wearing. These theories have all been disproved.

Of course hair loss can also be caused by burns or other trauma to the head. In this case hair replacement surgery is considered a reconstructive treatment, which may be covered by health insurance.


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Hair replacement candidates must have healthy hair growth on the back and sides on the head to serve as donor areas. People who smoke should stop at least two weeks before surgery. Smoking inhibits good blood flow to the skin and might interfere with the healing process.


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In the initial consultation the surgeon will evaluate the patient's hair growth and loss, review his or her family history or hair loss and find out if the patient has had any previous hair replacement surgery. The surgeon should also be aware of the patient's goals and expectations.

The surgeon will give specific guidelines on eating, drinking, smoking and taking or avoiding vitamins or medications. The patient should arrange for someone to drive him or her home after the procedure and for some assistance during the first couple of days is necessary.

Hair replacement is usually performed on an outpatient basis. It rarely requires a hospital stay.

The surgery will most often be performed using a local anesthesia along with a sedative. The scalp will be insensitive to pain, but some tugging or pressure may be felt. For more complex cases involving tissue expansion or flaps, general anesthesia may be used.

There are several surgical procedures which a surgeon can perform to help treat hair loss. Hair Transplantation is the most widely used technique. Small grafts of healthy, hairbearing skin are removed from the sides and back of the scalp and transplanted into the areas of baldness. These grafts may vary in size from one single hair up to 30 hairs in standard graft, measuring one-fifth of an inch in diameter. Multiple hair transplant sessions are necessary since these grafts, commonly referred to as plugs, are spaced far enough apart to allow sufficient blood circulation, ensuring healthy growth of the hair. The transplanted hairs go into a temporary resting phase and will usually appear in approximately three months. These grafts continue to produce hair on a permanent basis.

A second technique is called Scalp Reduction. This is a procedure which is often combined with either hair transplantation or scalp flap procedures. The bald scalp on the top and crown of the head is removed surgically and the adjacent skin, which has healthy growing hair, is stretched to diminish the baldness. Several sessions are usually necessary. This method may completely cover the bald area of the crown or diminish the area significantly so that less hair transplantation is necessary to correct the baldness.

The Scalp Flaps procedure moves large sections of hair-bearing skin from the side and back of the scalp into the bald area. There are several different flaps which are presently available. An advantage of this procedure is that there is no temporary hair loss, therefore, existence of healthy growing hair in the newly constructed hair line is immediate. As with the two previous procedures, usually several scalp flaps are necessary to correct significant baldness.

How the patient feels after surgery depends on the extent and complexity of the procedure. Any aching, excessive tightness, or throbbing can be controlled with pain medication prescribed by the physician. If bandages are used, they will usually be removed one day later. The patient may gently wash his or her hair within two days following surgery. Any stitches will be removed in a week to ten days. Be sure to discuss the possibility of swelling, bruising, and drainage with the surgeon.

Strenous activity increases blood flow to the scalp and cause the transplants or incisions to bleed. Therefore the patient may be instructed to avoid vigorous exercise and contact sports. Some doctors also advise that sexual activity be avoided for at least ten days.

Many patients who have had transplants (plugs or other grafts) are dismayed to find that their "new" hair falls out within six weeks after surgery. Remember, this condition is normal and almost always temporary. After hair falls out, it will take another five to six weeks before hair growth resumes.


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As in any surgical procedure, infection may occur. Excessive bleeding and/or wide scars, sometimes called "stretch-back" scars caused by tension may result from some scalp-reduction procedures.

In transplant procedures, there is a risk that some of the grafts will not "take." Although it is normal for the hair contained within the plugs to fall out before establishing regrowth in its new location, sometimes the skin plug dies and surgery must be repeated. At times, patients with plug grafts will notice small bumps on the scalp that form at the transplant sites. These areas can usually be camouflaged with surrounding hair.

When hair loss progresses after surgery, an unnatural, "patchy" look may result-especially if the newly-placed hair lies next to patches of hair that continue to thin out. If this happens, additional surgery may be required.

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