The hair transplant ‘boom’: everything you need to know before undergoing surgery

It is likely that on some occasion you have come across someone you know and have noticed a change in their hair density, and may even have an enviable hairline. Hair transplantation has become an increasingly popular trend.

As explained by Dr. Andrés Merlo, specialist in Plastic, Aesthetic and Reconstructive Surgery and precursor of the technique of hair microtransplantation in Granada, a hair graft, implant or transplant consists of a redistribution of the patient’s own hair, taking a certain number of follicular units or roots from specific areas of the scalp, called donors, to implant them in other areas where hair has already been lost (recipient areas) and make it grow again in them, pursuing an aesthetic purpose.

It basically consists of a transfer of hair roots from one area of the body to another in the same person. Hair grafting can be performed on eyebrows, beard or, more commonly, on the scalp. In the latter case, the implanted hair grows in the areas affected by alopecia in a gradual and very natural way, restoring and rejuvenating the patient’s image in a surprising way.

How does hair transplantation work?

The follicles or roots are always extracted from the areas of the scalp that are free of hair loss genes, which are the posterior and lateral regions of the head where hair never falls out, and then they are implanted in other body areas of the same patient where there was hair before. It is a genetically resistant hair autograft, there is never rejection and in a few days the mobilized hair follicles are integrated in their new location ensuring the growth of new hair that will never fall out.

The result is that the hair extracted from the donor area will grow in the area where it has been transferred, but will no longer grow in its original location. With modern surgical techniques amazing results are achieved and the marks of this type of surgery are virtually undetectable.

Current techniques: FUE and FUSS

Currently there are two main techniques based on the same basis: the transfer of hair from one area of the scalp of the same patient to another. These are the FUE technique (Follicular Unit Extraction) and the FUSS technique (Follicular Unit Strip Surgery). Both share the same final or implantation phase, which is common to both. What differentiates them is the way the follicular units are extracted from the donor area.

The FUE (Follicular Unit Extraction) technique uses drills for extraction, avulsions or pulling out of the follicular units leaving small craters scattered throughout the area that scarring generate multiple punctate scars and a decrease in the overall density of hair in the donor area.

On the other hand, the FUSS (Follicular Unit Strip Surgery) technique is an eminently surgical technique, to be performed exclusively by surgeons. It consists in the extraction of a strip of scalp skin from the donor area, which is then divided into sheets that are fragmented into the different follicular units thanks to the use of special backlighting devices. The closure of the donor area is surgical, with cutaneous plastias and a special suture, called Trichophytic, which is a method that makes the hair grow along the scar line and finally prevents it from being visible.

Both techniques can be used to perform successful micro-implants, although each has its own indications and virtues. In general, the more specialized technique, FUSS, can always be used in all patients (men and women of any age) and in all cases. In principle it has no restrictions, but its use requires surgical knowledge and experience, making it a superior technique limited to surgeons.

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In contrast, the FUE technique is a more mechanical technique that is currently widespread, does not require surgical skills, can be performed by healthcare personnel without surgical qualifications, and presents a series of restrictions regarding its correct use and indications. In general, given the enormous investment of time involved in this technique, the special preparations required (shaving of the head), the uncomfortable position of the patient on the table (face down) and the lower hair load of the follicular units obtained (number of hairs per follicle), its main indication is in young men with minor degrees of alopecia (small receding hairline), being contraindicated in higher degrees of alopecia (serious damage to the donor area, low density), in the crowns (very poor density, surgical failure), in older people (uncomfortable position, long surgical times) and in all women, for aesthetics (head shaving) and insufficient density in the result. In these cases the FUSS technique should always be used.

The natural thickness of the hair in the donor area should also be considered, when the hair is constitutionally thin, the FUE technique is also not indicated.

The dangers of traveling to Turkey for transplantation

The reasons are primarily economic. Turkey is a top tourist destination and in recent years has been incorporating the health offer that began with hair implants and has now been extended to virtually all plastic and cosmetic surgery.

The rates for implants in Turkey are very variable, but given the great proliferation of clinics and the great competition to attract “tourist-patients”, mainly in Istanbul, the prices have evolved downwards. In addition, in order to make the offer more attractive, health tourism agencies have been created which offer “packages” to patients, which include travel, hotel and hair surgery for a fixed price, but it should be noted that 90% of these clinics do not have health approval in our country, since sometimes patients are operated on in hotels, private apartments, warehouses and other similar facilities without any type of health guarantee.

This type of clinics only perform the FUE technique, in a very mechanized way, by system, without differentiating degrees of alopecia or particularities of each patient, since the diagnosis is made through online consultations without previously exploring the patient and after the surgery there is no follow-up or subsequent revisions. For this reason I often receive in my office patients with complications from surgeries performed in Turkey. Obviously, in Istanbul there are also good clinics run by real surgeons, who practice in a very professional manner, but at costs similar to those in force in our country.

Advice prior to surgery

The basic advice is to go to an experienced professional to make a good examination and a correct diagnosis, indicating the most appropriate technique for your case. You should also make sure that the center where you are going to be operated on is approved, preferably a hospital operating room, and the participation of an anesthesiologist to guarantee the safety of the procedure is highly advisable.

The patient must also ensure that he/she will receive the necessary postoperative medical support and follow-up during the year following the surgery, which is the average time in which the definitive result of the implant is achieved.