Hair Transplant Surgery
Hair transplantation is a very safe, minor surgical procedure that involves removing a strip of permanent hair-bearing skin or extracting one follicular unit at a time using (FUE or follicular unit extraction) from the back or sides of the scalp (Donor Area). Most patients opt for strip excision. This strip is then carefully dissected into follicular units containing as little as a single hair up to five hairs. Each follicular unit contains one to five hairs with an average of 2.3 hairs per follicular unit. The donor area is then carefully sutured and hidden by the surrounding hair. To minimize scarring Dr. Goertz emphasizes that the donor area is sutured with a “running” monofilament suture at a depth of only 2 millimeters; this avoids any unnecessary damage to the surrounding follicles and also allows for a more “comfortable” post operative recovery. Many hair transplant surgeons use staple to repair the donor area, but in Dr. Goertz’s opinion he has found this to be detrimental to patient comfort and a less adequate repair. He does not utilize staples even though they are a time saver.
The follicular unit grafts are meticulously planted into the bald or thinning area of the scalp (Recipient Area). This creation of very small single hair grafts has allowed very natural, feathered hairlines to be grafted avoiding the abrupt, “pluggy look,” that was typical many years ago.
Within 24 hours, small crusts will form on each graft that shed in approximately 7-10 days. Occasionally, these newly transplanted hairs will continue to grow right away and not go into a resting phase, but that only happens less than 10% of the time. The grafted hairs will often start to grow by 6-12 weeks after the procedure and will continue to grow for a lifetime. After surgery patients are provided with a mild analgesic to relieve any discomfort felt the night following the procedure.
Patients may be asked to use moist compresses or sprays and to sleep in a semi-upright position for 2-3 days following the procedure to minimize swelling. The small crusts that initially form on each graft may be camouflaged by any existing hair that can be combed over the recipient area.
The Frontal Hairline
A natural front hairline is the most important attribute of hair transplantation surgery and cannot be over-emphasized. This one area of the transplant will be the overriding factor, above all others, by which you judge the quality of your hair transplant result.
Dr. Goertz carefully designs your frontal hairline and this is where art must mimic nature. The height and contour are carefully designed to conform and enhance your natural features. He also variegates the hairline contour to imitate nature as closely as possible.
A natural hairline is not a “line” at all, but an erratic arrangement of hairs that are spaced more sparsely at the front edge. In the hairline, the hairs become denser as you progress through the first centimeter of hair. We mimic this by blending in 1-hair follicular unit grafts at the very front and increasing the density as we move back from the hairline.
Pitting and Hair Angle
Grafts must be placed at an angle to mimic the natural angle found. This is more manageable to groom and also avoids the continual “surprised appearance” that results from hair placed perpendicularly to the skin. We take special care to follow proper angles throughout the process to give you back your natural appearance.
“Pitting” of grafts occurs when the tiny amount of skin that surrounds the hairs of the FU graft is placed deeper than the surrounding scalp skin. When this occurs, there will be a slightly dark, “pitted” appearance to the exit site of the hair, as if there were a small dark line drawn around the hair where it comes out. This is particularly noticeable at the frontal hairline. We avoid this by placing the hair in the recipient sites with the grafts sitting up about ½ millimeter above the scalp.
Hair Density
With a megasession often your desire for density can often be achieved in one session, however sometimes more than one surgical procedure is required to provide the desired density and coverage.
Density is also a function hair caliber and hair color. Dark hair on a light scalp will always appear thinner than blonde or white hair on a light scalp. We achieve density not by the number of grafts but by the number of hairs that are transplanted. We ensure quality by the appropriate mix of grafts from single hair follicular units to grafts containing up to five hairs.
The amount of available donor hair is fixed. We will help you maintain realistic expectations in terms of desired hair density and areas of coverage.
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