Hair Transplant

Surgery

Twenty years ago, many people felt they risked looking like a Cabbage Patch doll if they chose surgery to eliminate baldness. Now, says Carlos Puig, D.O., director of Puig Medical Group, which is headquartered in Houston, better surgical techniques--used by increasingly skilled surgeons--are getting more eye-pleasing results.

"When I started in 1973 ... it was like the Stone Age," the cosmetic surgeon says, referring to the equipment and techniques in use. Now, he says, surgeons have learned to create a much more natural-looking hair line, using scalpels to cut either small slits or holes in the scalp to receive transplanted hair.

While there are numerous types of surgery, they can be sifted into two main categories: transplantation and scalp reduction.

Transplantation involves moving hair from densely covered sites on the sides or back of the head to bald areas of the scalp.

The key to success, explains Anthony Santangelo, president of the American Hair Loss Council, is to have good sites on the sides or back of the head from which to move hairs. Otherwise, patients can't expect ample coverage. Because their hair loss is diffuse, women generally lack good donor sites, making transplantation impractical for them.

The biggest improvement in transplants is with "micro" or "mini" grafts. "You're looking at one to two hairs shot into the head with a needle," Santangelo says. "It achieves a very, very fine, natural-looking hair line. The significant difference there is you need a lot of hair to do that."

Surgeons also use larger round plugs of seven to 10 hairs. Line grafts, the shifting of strips of nine to 12 hairs, are common, too.

One thing to keep in mind is that prosthetic hair fibers for transplantation are banned by FDA. Implanting them, according to Stephen Rhodes, acting chief of FDA's plastic and reconstructive surgery devices branch, caused a high incidence of adverse reactions, including infection.

If male-pattern baldness has left you with too much balding area to cover, you may benefit from scalp reduction: the surgical removal of large sections of a bald scalp. Extenders and expanders, elastic devices placed under the skin to stretch the hair-bearing scalp regions on the side of the head, have been used as a complement to reduction surgery.

Another surgical method is the flap technique, which rotates hair-bearing scalp areas from the sides or moves those areas from the back forward. The flap technique has the highest complication rate, though. Bleeding, scarring and infection can occur from surgery. But advances, such as knowing what size flap to use and how to enhance blood supply to the region, have cut down on the visibility of scars.

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