Hair Transplant cosmetic Surgery in the United States

Junior (College 3rd year) ・Healthcare&Medicine ・MLA ・10 Sources

1.0 Introduction

This is a type of surgery carried out with an aim of restoring hair to places or areas of one’s scalp that are experiencing hair thinning or are bald. Many types of hair replacement surgery do exist. They include transplantation of the hair, but flap surgery expansion of the tissues in the scalp and the reduction of scalp surgery (Poswal et al., 518). All these can either be done singly or used in combination and their selection depends with the preferences of the patient.

2.0 Techniques used in hair transplant

2.1 Transplantation of the hair

The process of hair transplant involves a process a small piece of scalp that bears hair is removed from the donor and used as graft so that they are relocated to an area that is bald or that which is thinning. The grafts often differ in sizes and shapes. When the bunch of graft is round shaped it may contain close to 15 hairs. When the grafts are smaller and mini-grafted they can contain up to only four hairs (Patwardhan & Mysore, 51). With the micro graft the hairs are only utmost two. When slits are created in the scalp slit grafts are usually used they are in many cases made of between four to 10 hairs. For the strip grafts they take a longer and thinner shape with 30-40 hairs.

To achieve satisfactory fullness many surgical sessions may be needed with a healing interval of several months needed between one surgery and the other. The final results can be seen after close to two years. The color and texture of the hair determines the coverage one needs and the amount of hair needed as well. If the hair is coarse gray or even light better coverage is experienced unlike if the hair is fine and dark in color. In the first session usually large plugs are needed but again this is dependent on an individual and varies among people. However the average is usually 50. But when one is doing mini or micro graft they need close 700 each session of the surgery.

Before starting the process of surgery the area of the donor is trimmed to a short length so as to easily access the grafts and remove them (Dua & Dua, 81). A special tube like instrument is used in the case of punch grafts and it’s made of carbon steel that is sharp which is able to punch a round shaped graft out of the site of the donor and be replaced and be covered. In this case the frontal hairline is used. For all other types of grafts the doctor uses a scalpel in the removal of small sections of scalps bearing hair. These are then divided into sections that are tiny and then transplanted in holes or slits that are tiny present in the scalp. The doctor in most cases injects small amounts of solutions that are saline in the patient’s scalp so as to maintain a good strength of the skin.

The site holes of the donor are then closed with stitches in cases of punch grafts where one needs only a single stitch (Rose, 369). In the case of other grafts a scar that is small and in a straight line is seen to occur and is concealed with the hair surrounding it. For proper and healthy supply/circulation of air the placement of the grafts need to be done at about one-eighth of an inch from each other. In the subsequent sessions any spaces present in between the plugs can be filled with other grafts that are additional. The doctor has to take great care in the removal and placement of these grafts so as they ensure the hair that was transplanted grows in a direction that is natural and also the growth at the donor site does not get any bad effects (Umar, 336). Once the session is done the cleansing of the scalp is done and gauze used to cover the treated area. A pressure bandage is at times worn for utmost two days. However some doctors let their patients to undergo recovery minus the bandages.

2.2 Tissue expansion

This is a technique too which can be used for hair transplant in the treatment of baldness. The leaders in tissue expansion are the plastic surgeons. This procedure is usually used in surgery that is reconstructive in nature so as to repair wounds that result from burns and injuries that may have led to extensive loss of the skin (Bernstein & Rassman, 408). The application of plastic surgery techniques has been successful in baldness transplant yielding results that have appeared significant in covering short periods of time.
In this kind of technique a tissue expander device which is balloon like gets inserted beneath the scalp that has hair which often lies just next to the area with baldness. The device then gets gradually inflated with water that has salt for a number of weeks. This causes the skin to undergo expansion and grow new cells (Harris, 285). As a result of this a bulge occurs beneath the scalp that bears hair after some weeks. Once this skin has undergone enough stretching which may take like two months following first session of operation a procedure is carried out to ensure the expanded skin comes and covers the adjacent area that is bald.

2.3 Flap surgery

This surgery has been done for close to 20 years since its invention. It’s used by many patients because it covers large areas of baldness in a quick manner but it’s often customized for every patient. The goals of the patient and their needs determine the size of the flap and how they should be placed. Close to 350 or more punch grafts can be done by only one flap.
In this process only a section of a bald scalp is usually cut out and a skin flap bearing hair is lifted off the surface but still attached at one end (Bernstein & Rassman, 407). The flap that has hair is then brought in the new position and sewing in place done but remain tethered to the original supply of blood. The scar gets camouflaged during the healing process if not it becomes obscured using the hair that has relocated whose growth reaches the very edge of the incision. Flap techniques have seen tremendous advancements through plastic surgery where for better coverage scalp reduction and flap surgery are often combined. The combination can also be done using tissue expansion so as to give proper frontal coverage and a good natural hairline.

2.4 Scalp reduction

It’s also referred to as advanced flap surgery this is because some sections of scalps that bear hair are often pulled forward or undergo advancement to fill the crown in the bald area. This process covers bald areas both at the back and top of the head. It therefore does not benefit the coverage of the frontal hairline.
A local anesthetic is usually injected in the scalp followed by a segment of the bald scalp being removed (Rassman et al., 723). Depending on the goals of the patient the pattern of the section to be removed on the scalp varies. A segment of the scalp can be removed in an inverted Y-shaped if the doctor needs to remove a large amount of coverage. Some of the excisions may also be U shaped or be pointed on an oval manner. All the skin which surrounds the area that has been cut gets loosened and pulled to assist the sections of scalp bearing the hair to come together and get closed using stitches. At this point the patient feels a strong tugging with occasional pains.

3.0 Guiding procedures with illustrations

Before surgery-the candidate for hair transplant is supposed to have hair loss that is noticeable together with growth of hair that is healthy at either the back or sides of their heads so as to be used as donor areas (Umar, 334).

Step 1

An instrument which is tube like is used to punch round grafts form the site of donation so as to be placed in the desired area that needs the transplant


Upon enough stretching of the skin beneath the hair then it becomes surgically placed in the bald area

Step 3

In the case of flap surgery there is cutting of a section of the bald scalp followed by the sewing of a hair bearing skin into place

Step 4

Scalp surgery patterns vary widely but they all meet the ultimate goal of joining the hair and the scalp so as to get the bald covered

4.0 Detained surgery process

The surgeon starts off by cleaning the scalp and injecting some medicine to numb the back side of the head. The doctor then chooses either to use follicular unit strip surgery (FUSS) or follicular unit extraction (FUE). If the surgeon chooses to use FUSS he or she removes a strip that is 6-10 of the skin from the back side of the patient’s head. He then sets it aside and embarks on sewing the scalp to close it (Patwardhan & Mysore, 51). This is followed by the immediate hardening of the area using the hair around it. The strip of the removed hair is divided into close to 2000 grafts which are tinny and each has single hair or a few hairs.

Depending on the type of the hair, color and quality plus the size of the place that the transplant has to be done the number and type of graft is known. For the FUE procedure the surgeon shaves the back side of your scalp followed by the removal of hair follicles and the area heals using small dots and gets covered by the existing hair. From that point the procedures are the same as described above depending with the one chosen. Once the graft is prepared the doctor cleans the area a
Where the hair has to be taken and numbs it. This is followed by creating holes or slits using a scalpel or even needles where the graft is placed. The process takes 4-8 hours depending on the process chosen.


5.0 Results and recovery

Once surgery is complete the scalp appears tender. One may take painkillers for some subsequent days (Rose, 369). The surgery may ask the patient to wear bandages over the scalp or not. Antibiotics may be prescribed or even drugs for anti inflammation. After the operation most people resume normal life close to 5 days. In the period of 3 weeks post surgery the hair that was transplanted falls out and one starts noticing new growth in a few months. 60% of the new hair growth occurs 6-9 months later. Some hair growing drug such as minoxidil can be recommended to the patient. This drug improves hair growth after processes of transplant.

Patients should be keen to discuss bruising, swelling and drainage with their doctor. Any strenuous activity usually increases blood flow to the scalp and thus the patient is usually advised to avoid any activities that may be strenuous to prevent any form of the transplants or incisions from bleeding (Poswal et al., 518). Such activities can be avoided for like three weeks. Sexual activities also need to be avoided at least for 10 days post surgery. Getting back to normalcy depends on the complexity and length of the surgery that one has had.
Most patients get dismayed by the falling out of their new hair after a period of six weeks but this is quite normal only that it’s normal and should not worry the patient in any way. Once the period of hair falling out is done another five to six weeks may be needed before resumption of hair growth normalcy (Karacal et al., 88). At this stage the patient expects about half an inch of growth per month. Some of the follow up procedures include a surgical touch up 9although not necessary) to just create a look that is more natural after the healing of the incisions.
This procedure involves filling in of the hairline by the use of combination of mini, micro and slit grafts or blending. For a flap procedure a dog ear which is a small bump can remain visible on the scalp. This gets removed surgically by the doctor after healing is complete. It’s therefore good for the patient to anticipate a touch up procedure and the surgeon can predict how extensive the follow up visits should be.

6.0 Cost of treatment

The cost of carrying out hair transplant largely depends on the amount of hair to be moved. It however ranges from 4000 to 15000 US dollars and in this case it’s not covered by many insurance plans (Dua &Dua, 79).

7.0 Side effects

This process is only safe if done by qualified and experienced surgeons that are certified by the plastic surgery board. However the physical reactions vary among individuals as well as the healing abilities. The outcome is therefore not predictable in a complete manner. Infections are likely to occur just like in any surgical procedure. The scalp reduction procedure may result to excessive bleeding with some scars which are referred to as ‘stretch backs’ that result from the tension during the process.
Another risk during the transplant procedure is that it’s not guaranteed that some all the grafts are to take place. Some may not. Its normal for the hair within the plugs to fall off before re-growth is established in the new locations. In such cases the plug may die and surgery has to be repeated. Small bumps may be noticed by patients with plug grafts on the scalp which are seen forming at the sites of transplant (Avram & Rogers, 1711). With progress hair loss after surgery there comes an unnatural patchy look especially in situations where the newly placed hair is found lying next to the patches of the hairs which continues thinning out. This also may call for additional surgery.

8.0 Conclusion

Hair transplant is a technique that is being adopted by many USA residents following an increased number in the level of baldness. This increase is associated with the changes in lifestyles and the chemical consumed in foods. It’s a good procedure if done well by the right expert. It restores one’s confidence in them by improving their looks.

Works Cited

Avram M, & Rogers N. ‘‘Contemporary hair transplantation’’. Dermatology Surgery 2009;35:1705–19.
Bernstein RM, & Rassman WR. ‘‘Follicular unit transplantation’’: 2005. Dermatology Clinic 2005;23:393–414; v.
Dua A, & Dua K. ‘ ‘Follicular unit extraction hair transplant’’. Journal of Cutanaceous Aesthetic Surgery. 2010;3(2):76-81.
Harris J. ‘ ‘Robotic-assisted follicular unit extraction for hair restoration’’: case reports. Cosmetic Dermatology 2012;25:284–7.
Karacal N, Uraloglu M, Dindar T, & LIvaoglu M. ‘ ‘Necrosis of the donor site after hair restoration with follicular unit extraction (FUE): A case report’’. Journal of Plastic, Reconstruction, Aesthetic Surgery. 2012;65:e87-e89.
Patwardhan N, & Mysore V. ‘ ‘Hair transplantation: Standard guidelines of care’’. Indian Journal of Dermatology, Venereology and, Leprosy. 2008;74(7):46-53.
Poswal A, Bhutia S, & Mehta R. ‘ ‘When FUE goes wrong!’’ Indian Journal of Dermatology 2011;56:517–9.
Rassman WR, Bernstein RM, McClellan R, & Jones R. ‘ ‘Follicular unit extraction: minimally invasive surgery for hair transplantation’’. Dermatology Surgery 2002;28:720–8.
Rose PT. ‘ ‘The latest innovations in hair transplantation’’. Facial Plastic Surgery 2011;27:366– 77.
Umar S. ‘ ‘Hair transplantation in patients with inadequate head donor supply using nonhead hair: report of 3 cases’’. Annals of Plastic Surgery. 2011 Oct;67(4):332-5.

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