Hair transplantation

Author: Prof. Dr. med. Peter Altmeyer

Co-Autor: Hadrian Tran

All authors of this article

Last updated on: 10.04.2021

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Synonym(s)

Own hair transplantation

Definition
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Transplantation of autologous, hair-bearing skin in hairless areas. Principle: After transplantation of hair-bearing full skin into an alopecic recipient area, the genetic information of the transplanted tissue cells for hair formation remains intact (e.g. in the area of the hair cortex); hair roots do not lose their original properties (donor dominance) and continue to produce new hair at the transplantation site.

Indication
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Scarred alopecia (atrophying inflammation of the scalp, injuries, burns, continuous traction, radiation damage), androgenetic alopecia in men (Norwood I-VII) and alopecia androgenetica in women. Burnt-out alopecia areata, replacement of beard hair (e.g. harelip correction), reconstruction of eyebrows, eyelash transplantation after Alopecia mechanica, replacement of pubic hair, Alopecia triangularis congenita

Implementation
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There are two different operation methods:
  1. Swing flap techniques (e.g. rotational flaps according to Juri; only rarely used).
  2. Autologous full skin grafts
    :The grafts are inserted into the recipient region as so-called square grafts, strip grafts or punch grafts.
    • In punch grafts (method according to Okuda and Orentreich), so-called standard grafts of 3.0-4.5 mm in diameter are taken occipitally from the hairline and inserted into reception holes of the same size in the alopecic area. Aesthetic disadvantage: tufted hair growth.
    • In the micro method (1-2 follicles) or mini-graft method (3-5 follicles) (according to Lucas), grafts with a diameter of 1.6-1.8 mm are used. This gives good to very good cosmetic results. Procedure in LA. Patient sits upright or in prone position. Removal of a narrow strip of skin in the hairline region. The wound is continuously closed atraumatically with monofilament sutures. Preparation of the 1.6-1.8 mm grafts. Micrografts are implanted in the area of the hairline, minigrafts behind it. The implantation channels are created by motor-driven circular blades (Holes method). Alternative: Slit-shaped implantation channels with a fine lancet-shaped blade (slit method). Arrangement and spacing of the drill holes of 0.8-1.5 mm diameter should be irregular, not too dense (danger of necrosis) and not too light (too little optical effect). The implantation holes or slits can also be applied with a suitableCO2 laser if the experience is sufficient. In any case, strict attention must be paid to the future direction of hair growth. The transplants are inserted with micro-tweezers. The grafts are held in position by adhesive forces and the action of the body's own fibrin, so that no special fixation measures are required. With the slit technique there is more of a risk of graft dislocation. Over 1000 mini- and micrografts can be transplanted per session. On average, 400-700 grafts are needed per operation. The optimal hair density can be calculated using trichodensitometry. Post-operative application of a sterile protective bandage (no pressure bandage!) for one night. Strict care must be taken to ensure that the grafts cannot stick to the dressing, as they will be torn out when the dressing is removed. Already after 3 days the patient can wash his hair himself with a mild shampoo. The stitches in the donor area should be removed after about 2 weeks.
      The transplanted hair falls out temporarily postoperatively (after about 3-4 weeks). After 3-4 months the follicles continuously produce new hair.

Notice! For hair transplants, the preoperative planning and education of the patient is of particular importance. Hair transplantation is a redistribution of still existing hair. The patient must know that even after several treatments, only a hair density of 40-80% of the hair density in the donor area can be achieved. Thickening operations can be carried out after 3 months at the earliest. The future hairline should not be too deep, but rather slightly higher. The marking and discussion of the hairline is done together with the patient before the local anaesthetic. An exact photo documentation is to be paid attention to. Carried out in special dermatological clinics.

Contraindication
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Disturbance of the bleeding and coagulation time, hypertension, diabetes mellitus, tendency to keloid formation and all diseases that lead to a disturbance of wound healing.

Complication(s)
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  • Bleeding
  • Pain
  • Swelling
  • Itching

Authors

Last updated on: 10.04.2021