Do hair transplants look real and natural?
The journey starts during the initial consultation with the hair transplant surgeon. There must be good understanding by the surgeon of the patient’s goals and objectives. The patient must also have realistic expectations. In order to have the best possible result the patient must be prepared to combine long term medical treatment with surgical treatment. A commitment to long term medical treatment will provide the best chance of arresting progression of the Androgenetic Alopecia process which allows for the transplanted areas to blend seamlessly with the non-transplanted areas and thereby minimizing zones with miniaturized hair follicles.
Maintaining and maximising hair density
Maintaining and maximising hair density is achieved by taking medical treatment and this allows the patient to be on the front-foot by controlling the AGA (androgenetic alopecia) process. The mainstay of medical treatment remains 5-alpha reductase inhibitors that reduce the formation of DHT with less binding of DHT to Androgen Receptors (AR) and reversal of the miniaturisation process of follicle units. This can only be achieved by taking the medications long term and continuously. If follicles with Androgen Receptors allow to miniaturise beyond a certain critical point, the Arrector Pilli muscle detaches and this is the point of “no return” for a follicle unit. The reason for this is that Epidermal Stem Cells are delivered to the Bulge Area of a hair follicle via the blood supply of the Arrector Pilli muscle (Sinclair et al), so once the Arrector Pilli muscle has detached from the miniaturised follicle it can no longer be salvaged or “turned around” and that follicle unit is lost forever. Without medical treatment those who undergo hair transplant surgery merely “tread water” because existing follicles with AR will continue to miniaturise and disappear over time despite adding new hair follicles devoid of AR from the SDA (safe donor area) – new follicles are added but existing old follicles are disappearing. The negatives for not taking medical treatment after a hair transplant are as follows: The total hair mass index (HMI) or hair volume will increase after the surgery but return to what it was before or even worse if no medication is taken as the miniaturizations process continues with regard to non-transplanted hair – so the aesthetic effect is not as good as it will otherwise be when the patient takes medical treatment long term. In addition to 5-alpha reductase inhibitors, products such as ketoconazole shampoo, dermaroller, low level light therapy, Serenoa repens (Saw Palmetto) will further amplify the effect of increased hair mass index (hair mass volume). Essentially the medical treatment net effect in the end is to maximize hair shaft calibre of hairs affected by AGA. This is mostly achieved by lengthening the Anagen (Growth) Phase of hair follicles. Hair shaft calibre is the most critical factor in increasing or decreasing hair mass index (HMI). For every 10 microns that a hair shaft increases or decrease in diameter, there is a 36% volume effect either way. So, in the end it is not about the “number” of hair follicles or hairs but the average calibre of hair shafts. The cumulative effect of an increase or decrease in hair shaft calibre (hair mass index) is enormous and makes the difference between hair with volume that provides good scalp cover versus hair with poor volume (low calibre hair shafts) that does not adequately cover the scalp allowing the reflection of light to be seen from the scalp creating the appearance of thinning hair cover or balding areas.
A natural looking hairline
The seal on achieving a natural look is by creating a hairline that resembles and looks exactly like a non-transplanted hairline. The hairline, and the part and the whorl area vulnerable areas that are completely exposed to the observers eyes. Those are the areas where an unnatural appearance can be spotted the easiest. By following the principles of hairline design allowing for a transition zone that flows into a defined zone and having an irregular random external hairline border is essential in establishing a natural look. Also, using single grafts in the transition zone, followed deeper by two hair follicles and then three and four hair follicles closer to the frontal core is critical in creating a natural look.
You need the help of an experienced and expert hair transplant surgeon
By applying these principles and techniques mentioned above along with several other factors that contribute to optimal follicle care and in the hands of an experienced and expert hair transplant surgeon and his/her team who will ensure that the follicles are treated optimally during the harvesting, trimming, storage and implanting phases and also by providing guidance during the post-operative phase, extremely good and natural looking results with adequate density can be achieved on a consistent basis.