Hair transplantation, the moving of hair from the parts of the scalp unaffected by male pattern hair loss (back of the scalp) to the front and top, has been performed for over forty years.

The past several years have seen marked improvements in the technique and quality of hair transplantation; gone are the days of "corn row" and "plug"-style transplants. Physicians today can completely mimic the natural groupings of hair follicles, creating consistently natural appearing transplanted hair. The standard today for all patients undergoing hair transplantation is to have long-term natural appearing transplanted hair.

Over the past two years our office developed the LED polarized magnifier to help create recipient sites between existing hair follicles on the scalp. In a recent study, Dr. Avram concluded polarized LED magnification allowed for shorter operating times, less transection of existing hair allowing for maximum density from each procedure.

The Consultation
The consult is perhaps the most important part of a hair transplant. Dr. Avram and staff will answer all questions regarding hair loss, transplantation, and other treatment options. It's critical to create realistic goals for each patient and to explain clearly what hair transplantation can and cannot do, as well as whether a patient is a good candidate for surgery. Factors, such as the amount of donor hair, hair caliber, volume, rate of ongoing hair loss, and texture will help determine the perceived density of the hair transplant.

The net perceived density from a transplant is the amount of hair follicles transplanted plus the caliber of the hair follicle minus the amount of ongoing hair loss. With an equal number of hair follicles transplanted, patients with thick wavy hair will have a greater perceived density from a procedure than someone with fine straight hair.

Our office also has photos available of patients on whom we have performed surgery and can arrange for patients to discuss the procedure with other patients who have already had hair transplantation.

An Overview of The Surgery
The procedure is performed in our office under local anesthesia and usually takes 3-4 hours. The donor hair is taken from the back of the scalp under local anesthesia. The "donor strip" is closed with sutures that are removed 7-10 days after surgery. The patient's existing hair on the back of the scalp will cover the sutures and resulting scarring, so that even the day after surgery no sutures or scarring are evident.

The donor scar will not be visible unless a patient decides to shave their hair.  In patients that would like to shave their posterior scalp, removing natural 1-3 follicular groupings using 1mm trephines will often but not always result in a less visible donor scars. The disadvantages of the technique, commonly referred to as follicular unit extraction (FUE), include longer operating time, less donor hair removed , and greater transection of hair follicles.  In our study, less than 5% of patients are good candidates for FUE and the vast majority of patients benefit from removing a “donor strip”. 

The donor hair is separated into its natural follicular hair groupings, or grafts. A staff of 3-5 highly skilled surgical assistants with thousands of hours of hair transplant experience typically creates 800-1800 grafts in 30-45 minutes.

While the 1-4 hair grafts are being created, the patient's recipient sites (balding skin) is anesthetized under local anesthesia, and hundreds or thousands of recipient sites are created using a needle so small no scars or textural changes occur in the frontal scalp. They are created in a dense but random manner throughout the balding scalp to produce the maximum density possible with each surgery, while appearing completely natural one and even thirty years after surgery.

Post Surgery
Following surgery, an overnight dressing is applied and the patient is free to go home. Patients may resume normal activity (barring heavy exercise for a few days) immediately after the surgery. About 50% of patients will take 1 or 2 mild pain medications the first night after surgery. There is "crusting/scabbing " in the recipient sites (transplanted sited), which lasts 6-10 days, although the vast majority of our patients return to work 2-3 days after surgery with no obvious cosmetic signs of surgery. The transplanted hair follicles will grow 4 to 6 months after the surgery. Patients are also encouraged to contact us with any questions they have at any time.