Before & After Photos
What is hair replacement surgery/hair transplantation?
Hair replacement surgery is a cosmetic procedure performed on men and women who have significant hair loss, thinning hair, or bald spots where hair no longer grows. The procedure can enhance your appearance and your self-confidence through hair replacement techniques that use your existing hair.
DHT (Dihydrotestosterone) is a natural metabolite of the human body and the main reason for hair loss in both male and female pattern baldness. In male pattern baldness hair typically grows only in a horseshoe shape around the head. Female pattern baldness is characterized by diffuse thinning of the hair on the entire scalp, although some women have hair loss that mimics male pattern baldness.
Am I candidate for hair replacement surgery/hair transplantation?
All hair replacement techniques use your existing hair (from “donor sites”) for transplantation techniques.
Hair transplantation for male pattern baldness depends upon the concept of “donor dominance” of hair follicles. That is, hair taken from the head below the top of the ears are genetically programmed to never fall out. Those hairs can be transplanted to the frontal hairline, never to be lost due to further balding.
Most women have female pattern baldness, and do not have donor sites usable for transplantation. If the thinning pieces of hair and accompanying follicles are removed from one area and transplanted they will not be stable enough to grow.
Due to the diffuse affect DHT has on female hair, a very small percentage of women are good candidates for hair transplant. This small group includes:
- Women who have suffered hair loss due to mechanical or traction alopecia (non-hormonal)
- Women who have had previous cosmetic or plastic surgery and are concerned about hair loss around the incision sites
- Women who have a distinct pattern of baldness, similar to that of male pattern baldness (hairline recession, vertex thinning on the crown or top of the scalp and a donor area that is not affected by androgenetic alopecia)
- Women who suffer hair loss due to trauma, including burn victims, scarring from accidents and chemical burns
- Women with alopecia marginalis, a condition that looks very similar to traction alopecia.
The best way to determine if you are a candidate for a hair replacement surgery is through a consultation with a dermatologist or plastic surgeon at Cleveland Clinic Cosmetic & Plastic Surgery Center.
How do I prepare for hair replacement surgery/hair transplantation?
Preparing for hair replacement surgery at Cleveland Clinic Cosmetic & Plastic Surgery Center includes discussing a number of questions about your health, desires and lifestyle with your dermatologist or plastic surgeon, including:
- Why you want the procedure, your expectations and desired outcome
- Your medical conditions, drug allergies and medical treatments
- Your use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs.
Your Cleveland Clinic dermatologist or plastic surgeon may also:
- Evaluate your general health and any pre-existing health conditions or risk factors
- Take photos of your hair loss for your medical record
- Discuss your hair replacement surgery options
- Discuss likely expected outcomes of hair replacement surgery and risks or potential complications.
How is a hair replacement surgery/hair transplantation performed?
Hair replacement surgery at Cleveland Clinic Cosmetic & Plastic Surgery Center is typically performed as an outpatient procedure with the use of local anesthesia or local anesthesia and conscious sedation. There are several different types of hair graft methods, with the actual process generally including:
1.) Selecting and harvesting hair from the donor area.
For most people this will be from toward the back area of the head. Your specific level of hair loss plays a vital role. If you don't have enough natural growing hair on your head, you may not be an ideal candidate for surgery. Harvesting hair from the donor area involves removing small pieces of hair-bearing scalp grafts from a donor site and relocating them to a bald or thinning area.
Grafts differ by size and shape, including:
- Punch grafts – a cluster of about 10 to 15 hairs
- Mini-grafts – a smaller cluster of two to four hairs
- Micro-grafts – consists of just one or two hairs
- Round or square grafts – a traditional graft that contain up to 20 hairs
- Slit grafts – contains up to 10 hairs
- Strip grafts – contains up to 40 hairs.
2.) Closing the donor area.
Once an appropriately-sized strip of donor hair is removed, the incision is then stitched up. (Typically, these stitches are removed about 10 days after surgery and will leave behind a small scar that can be concealed by your own hair).
3.) Transplanting the hair grafts.
After the donor strip is removed, tiny grafts are then prepared for hair transplant surgery into your balding areas. Most times the hair grafts at the front hairline will contain between one to three hairs each. As the grafts are transplanted further back from your hairline, the numbers of hairs per graft will increase.
Your dermatologist or plastic surgeon at Cleveland Clinic Cosmetic & Plastic Surgery Center will tailor a hair replacement surgery method that will best suit your needs.
What are the different types of hair replacement surgery/hair transplantation procedures?
The different types of hair replacement surgery procedures used at Cleveland Clinic Cosmetic & Plastic Surgery Center include:
- Punch Harvesting
- Punched grafts are gently lifted with forceps and placed into donor sites that are closed with sutures or skin staples.
- Using a scalpel blade, an elongated strip is cut from the donor site. The donor tissue is dissected into grafts for transplantation.
- Strip harvesting
- Similar to the excision method, except two or more scalpel blades are mounted in parallel to cut strips of donor tissue.
- Flap surgery
- A procedure that is capable of quickly covering large areas of baldness, with one flap having the ability to do the work of 350 or more punch grafts. A section of bald scalp is cut out and a flap of hair-bearing skin is lifted off the surface while still attached at one end. The hair-bearing flap is brought into its new position and sewn into place, while the remaining skin is "tethered" to its original blood supply. While technically more challenging, flap surgery yields immediate results.
- Scalp reduction (also known as advancement flap surgery)
- Sections of hair-bearing scalp are pulled forward or "advanced" to fill in a bald crown. After the scalp is injected with a local anesthetic, a segment of bald scalp is removed. The pattern of the section of removed scalp depends on your needs. If a large amount of coverage is needed, doctors commonly remove a segment of scalp in a reversed Y-shape. Excisions may also be shaped like a U, a pointed oval or some other figure. The skin surrounding the cut-out area is loosened and pulled, so that the sections of hair-bearing scalp can be brought together and closed with stitches.
To prepare the recipient sites for transplantation, your dermatologist or plastic surgeon may use one of several techniques including:
- Single hair (micro-grafting) and slit grafting
- Slits are made in the scalp using a scalpel or needle; a method used most often to recreate a frontal hairline
- Dilators are inserted directly into the scalp to push aside the scalp and allow insertion of micro-grafts or mini-grafts
- Punch grafting
- One- to four-millimeter diameter punches create a “hole” where the graft is inserted
- Laser-assisted grafting
- Uses a carbon dioxide laser to create recipient sites.
Just before your surgery, the "donor area" will be trimmed short, allowing for the grafts to be easily accessed and removed. Before grafts are taken, your dermatologist or plastic surgeon will inject local anesthesia with epinephrine to minimize bleeding. The donor site holes may be closed with stitches for punch grafts, with a single stitch closing each punch site; for other types of grafts, a small, straight-line scar will result. The stitches are usually concealed with the surrounding hair.
To maintain healthy circulation in the scalp, your dermatologist or plastic surgeon will space the grafts so that each graft is surrounded by healthy skin. In later sessions, the spaces between the plugs will be filled in with additional grafts.
Dermatologists or plastic surgeons at Cleveland Clinic Cosmetic & Plastic Surgery Center are highly skilled in removal and placement of grafts to ensure that the transplanted hair will grow in a natural direction and that hair growth at the donor site is not adversely affected.
After the hair replacement surgery is complete, your scalp will be cleansed and covered with gauze. You may have to wear a pressure bandage for a day or two to help with healing.
What results can I expect?
Hair replacement surgery does not produce an instantaneous head of hair. In most cases, the hairs fall out of the grafts immediately after hair transplant and do not regrow for approximately three months. The donor sites gradually heal to leave slight scarring but this is concealed by “lifetime” hair growing around the site.
Generally, several surgical sessions may be needed to achieve satisfactory fullness and a healing interval of several months is usually recommended between each session.
The amount of coverage you'll need is dependent upon the color and texture of your hair, as well as the amount of bald area to be covered. Coarse, gray or light-colored hair affords better coverage than fine, dark-colored hair. The number of large plugs transplanted in the first session varies with each individual. For mini-grafts or micro-grafts, the number can be up to 700 or more per session.
Follow-up with a dermatologist or plastic surgeon at Cleveland Clinic Cosmetic & Plastic Surgery Center is the best way to ensure the most successful overall results from hair replacement surgery.
What is involved in recovery?
Most people feel well within a day or two following surgery, although they may have some facial and eyelid swelling.
Is hair replacement surgery/hair transplantation safe?
All surgical procedures carry some risk.
Possible side effects or complications from hair replacement surgery/hair transplant include:
- Numbness or tightness (temporary)
- Swelling of the forehead and/or face
- Scarring at donor site or recipient site
- Poor growth of grafts
- Unnatural appearance of transplanted hair.
Why Choose Us
If you’re considering hair replacement surgery, look for a dermatologist or plastic surgeon with specialized training and significant experience performing these procedures. Consider going to an expert who is affiliated with a major medical center, such as Cleveland Clinic. Ask your dermatologist or plastic surgeon about credentials, training and how many hair replacement surgery/hair transplant procedures he or she has performed.
Is this procedure covered by health insurance?
Like all cosmetic procedures, hair replacement surgery is not typically covered by health insurance. Ask to talk with a financial representative from Cleveland Clinic Cosmetic & Plastic Surgery Center who can explain costs of the procedure and if insurance coverage is an option for you.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.