An Approach to Hair Transplant Surgery

A closer look at the steps involved to achieving a new head of hair

Hair Transplant Surgery at a Glance

Hair transplant surgery is an intricate process that requires the utmost care to be taken by both the hair transplant surgeon and the patient. When you embark on this journey, you will do so in close partnership with your doctor, who will guide you through the whole process.

If you qualify as a candidate for hair transplant surgery, it is very important that you commit fully to the post-operative protocol in order to ensure the best possible result. As with any medical procedure, there are many factors that have to be considered before surgery can take place and this basic process is outlined in the article below.

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In this article we will take a closer look at the steps involved in approaching hair transplant surgery. These steps can be divided into nine main categories, namely the Pre-operative Evaluation and Counselling of the Patient; Medical Treatment; Qualify for Surgery; Donor Evaluation; Patient Goals and Expectations; Recipient Area Planning; Hairline Design; Planning for Future Hairloss;  and Medical Clearance for Surgery. This in-depth process will provide the information required to decide whether hair transplant surgery is possible and if an acceptable result can be achieved. Other topics covered in the article include pre-, intra-, and post-operative protocols.

Pre-operative Evaluation and Counseling

When a patient first comes forward with the desire to undergo hair transplant surgery, a consultation with Dr. Nel is required. In this consultation a thorough assessment will be made of the patient’s current hair loss status. The patient’s goals and objectives will be discussed to ensure everyone is on the same page and have a clear understanding of what needs to be achieved.

Patient Assessment

This would include a thorough assessment of the patient’s Donor vs Recipient Area ratio as it presents now and projected into the future. The patient’s general physical health, mental and emotional health and goals and objectives are assessed. The hair characteristics are evaluated and taken in to consideration, such as the hair color, hair shaft caliber, the texture and if there’s a curl-and-a-wave and how the hair color contrasts with the scalp color. Hair transplant surgery also requires commitment from the patient to take medical treatments in order to prevent progression of the Androgenetic Alopecia (AGA) process. Because AGA is mediated by the Genetic Code, it predicates that the medical treatments be taken life long.

Medical Treatment

Medical treatment is an essential part of hair transplant surgery. The only way to prevent the AGA process from continuing is to take medical treatment. If the AGA process is not contained, then native hair follicles (residual hair follicles that were not transplanted into the recipient area) will continue to miniaturize after hair transplant surgery and eventually disappear, resulting in ongoing thinning. The transplanted follicles will remain and are not affected by the AGA process, but you would want to keep your native (residual) hair follicles and maximize their hair shaft caliber to maximize your hair volume post transplant and keep it there for the long run and that is why medical treatment is essential, otherwise you will simply be treading water. Younger patients especially under the age of 22 and other patients will always be advised to go on a trial of medical treatment before committing to surgery.

Additional Considerations

  • Age Younger patients are encouraged to take medical treatments first before considering hair transplant surgery, in order to establish their long term commitment, which is a major factor going forward. Older patients with medical conditions and who are using multiple medications are carefully screened and those with systemic conditions have to get clearance from their consultants, eg, someone with a heart condition would have to get clearance from their cardiologist first to determine whether they qualify for surgery.
  • Sex All female patients have to undergo various blood test to eliminate potential systemic conditions and possible shortages in essential spore elements. Female pattern hair loss usually involves a wider array of potential causes when compared to male pattern hair loss. There are also differences in the donor area, and the required medications for treating hair loss.
  • Causes of Hair Loss Sometimes hair loss can be brought on by non-androgenetic alopecia. Conditions such as Scarring Alopecias, Telogen Effluvium, Alopecia Areata, Alopecia Totalis and Universalis and hair loss secondary to trauma, infections, chemotherapy and systemic illnesses such as Hypothyroidism and Iron Deficiency Anaemia have to be excluded. These conditions have to be addressed before hair transplant surgery can commence.
  • Patient’s Goals and Objectives An important factor to consider is the patient’s goals and objectives. It is essential that the surgeon and the patient agree on the expected outcome prior to surgery. .

Donor vs Recipient Area

An in-depth evaluation of the donor area is done to determine its density and size. The doctor has to make an assessment of the current Donor vs Recipient Area ratio and also project into the future what might happen.

Hairline Design

The hairline design is the most critical aspect of hair transplant surgery simply because there is no place to hide and the hair shafts in the transition zone of the hairline are directly visible and their appearance creates an immediate aesthetic impression to an external observer.  The main objective is for the hairline to appear as natural as possible and it should also be at a suitable height for the patient’s age.

Planning for the Future

Considering potential future hair loss is important in the design and planning of the recipient area zone. The hair transplant has to be done in a way that compliments future progression of the Androgenetic Alopecia process. There is no guarantee that a patient will commit to taking medical treatments for the rest of their life and planning for this reduces the chances of an abnormal appearance many years down the line should the AGA process continue. The main purpose of continued medical treatment is to maximize hair volume and prevent areas of disconnect between the transplanted follicles and residual hair follicles.

Medical Clearance for Surgery

Medical clearance is always required, and particularly relevant for older patients. These include patients who are on multi-medications, those who suffer from systemic illnesses and the over-sixty patient. It also includes patients who have had multiple previous hair transplant surgeries.

Pre-, Intra-, and Post-operative Protocols

I advocate and implement  a specific protocol to minimize the chances of shock loss post surgery and this starts during the pre-operative phase, is followed through into the intra-operative phase and also extends into the post-operative phase. Shock Loss entails the shedding of hair post-surgery from the residual follicles that were not transplanted. This happens as a result of stress on the surrounding follicles caused by the surgery, and is a natural reaction in both men and women. This happens when some of the residual hair follicles go into the resting phase or Telogen and cell division stops and the hair shaft is shed after which the hair follicle regroups and eventually sprouts a new hair shaft when it emerges from Telogen into the new growth phase (Anagen) three months later and the condition resolves Shock Loss affects 10-15% of men, and 40-50% of women on average who undergo hair transplant surgery, but it almost always recovers fully within 3 to  5 months after hair transplantation surgery. At The Hair, Skin & Wellness Clinic we follow strict protocols in order to prevent and minimize shock loss.

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