Hair Transplants Explained In Detail

Today, hair loss is being tackled via various routes. From medication and non-invasive procedures to hair transplants that are finished with tricopigmentation, while innovative stem cell treatments are also making their appearance. Hair surgeon Bijan Feriduni, a European authority in the field of hair transplants that he performs in his private clinic in Hasselt, closely follows developments. “Of all aesthetic procedures, hair transplants have the most long-lasting results. Often, you will even have a strong head of hair for the rest of your life afterwards. But everything stands or falls with the right selection of patients,” emphasizes Dr. Feriduni. “Men with the male, hereditary form of hair loss (androgenetic alopecia) are usually excellent candidates. They are confronted with receding hairlines or those typical pater crotches. This can also be an excellent choice for women with a long forehead or a more M-shaped hairline with deep hairlines that bother them. But diffuse hair loss over the entire head, which is more common in women with androgenetic alopecia, is an absolute red flag for transplantation, partly because the donor area is significantly thinned. This also applies to hair loss due to medical causes such as autoimmune diseases (alopecia areata), thyroid disorders or others,” Feriduni emphasizes.

EXTENSIVE RESEARCH
Whether a hair transplant will be successful depends mainly on the donor hair present, from which the surgeon must be able to harvest sufficient hair follicles to migrate to the balding areas. “Hence the importance of examining and measuring this in detail during an initial extensive consultation. In addition to the quantity of donor hair, which is usually located in such a ring at the back of the head, we also check the quality. Finally, you must keep an eye on the possible evolution of the patient's hair over the next decades. It must also continue to look natural in the long term. Suppose you reconstruct the hairline at the front of a man of around 40, but that he develops a bald crown years later. A new transplant can fill that, provided that he still has sufficient donor hair. Otherwise, that man ends up with an intact hairline but a bald area on the head. In our clinic, after such an initial examination, we have to tell around 40% of people that a transplant is not the right choice for them.”

EXTERNAL HAIR DONORS?
Men aged 50 to 60 with a receding hairline generally appear to be very suitable. “Because we are already seeing the end of the pattern of hair loss here. They are often helped after one transplant, while it is more difficult to predict the further evolution of younger men exactly.” Transplanting hair follicles from an external donor is not possible. After all, the skin forms a strong immunological barrier to prevent foreign intruders from entering the body. These hair follicles would die. “I don't think that's a bad thing, because something like that could open the door to all kinds of abuse in certain countries. There are exceptions where it is possible. For example, I once had an identical twin, one of whom had lost his hair after an accident. We were able to restore his hair by transplanting donor hair from his brother with identical DNA.”

MORE REFINED TECHNIQUES
Today, the state-of-the-art method for transplanting hair is FUE (Follicular Unit Extraction), in which individual hair follicles from the donor area are removed from the scalp using a fine, hollow needle. The instruments used for this are increasingly technologically accurate, which greatly reduces the risk of scarring. The doctor then reconstructs the hairline and makes tiny incisions with custom-made blades, where the harvested hair follicles are reimplanted. It is important to take into account the direction of hair growth, the density and a soft transition with the hairs that are still present. “This technique can also be used in women to lower the hairline, among other things. Contrary to popular belief, we only have to shave a small part of their head hair where the hair follicles are harvested. This is done at the back, so that it can easily be camouflaged by the overhanging hair on the crown. If they wear their hair in a bob at the front for the first few weeks after the treatment, you will not notice the procedure. Unlike some other aesthetic procedures, people want a hair transplant to be subtle. The result should be visible, but not the procedure itself.” The FUT technique (Follicular Unit Transplantation), which used to be widely used, is largely outdated because it has a higher risk of scarring and takes longer to recover from. In this technique, hairy skin strips are removed in their entirety under local anesthesia, after which hair follicles are prepared for replanting.

FINISHING TOUCH
As a finishing touch for transplants of larger areas, so-called tricopigmentation is used to reduce the contrast between hair and skin. This is a non-invasive treatment in which micropigments from the shade of your hair are applied to the scalp to enhance the visual effect of hair. This increases the optical density of your hair. “However, unlike tattoos or micropigmentation, this is a non-permanent treatment. This usually lasts for about 1 to 2 years, which has the advantage that you can respond to a changing hair color. With whiter or graying hair, a dark scalp would give a rather bizarre appearance.” In women with diffuse hair loss who are not eligible for transplantation, tricopigmentation can also create the effect of a thicker head of hair.

CORRECTIONS
Because hair transplants are labor-intensive and therefore very expensive, quite a few men and women travel abroad where you can have a new haircut for less than half the Belgian rates. This is not an unqualified success for everyone, as Dr. Feriduni notices in his practice where about a third of his work consists of corrections. This can include aesthetic retouches because the hairline has taken on a completely unnatural shape or has been made too low. Sometimes, the pieces of hair that grow angularly in men's faces at the temples have not been taken into account. Then you see the hairs growing in round curves and you get a kind of Mickey Mouse effect. "Such a repair is possible if there is still enough of your own donor hair present. If that is not the case, then harvesting chest or beard hair follicles is our only alternative. But these hairs follow a completely different, shorter growth cycle than the hairs on the head, which means they are not ideal donors."

COST PRICE
The improved techniques do provide better results, but they will not reduce the prices of transplants in the future. Expect to pay around 8,000 to 10,000 euros for a complete transplant that easily takes eight to ten hours. “You should know that during such a procedure I work together with six nurses and an assistant physician to transplant all the hair follicle units one by one. Despite the more refined instruments, this will always remain meticulous manual work. Working faster will be at the expense of quality. If the price for a transplant abroad is very cheap, it is therefore impossible to do it in the same qualitative way. As a patient, it is therefore extremely important to thoroughly inform yourself about the treatment in advance with a doctor and not just with a hair consultant. Do your homework, check platforms on the internet about this and find a competent hair surgeon.”

What happens after the transplant?
The first week after a major hair transplant you may experience swelling, itching, mild irritation, sensitive skin and small scabs. From the second and third week onwards, these scabs disappear and most hairs fall out. Due to ‘shock loss’ this can also temporarily happen around the donor area but it all comes back. This is the ‘ugly duck’ period in which you look less good than before but after three to five months new strong hairs grow from the relocated hair follicles. After about a year you will see the final result of a fuller head of hair.

Also with stem cells
Meanwhile, regenerative medicine is also not standing still. In addition to PRP treatments that boost hair growth by introducing platelets rich in growth factors, there are also other promising techniques in the pipeline, such as selecting stem cells from fatty tissue. Using a specific procedure, the growth factors are extracted from these stem cells and reinjected into the scalp. This approach has not yet been approved in Europe, but promising results are being recorded in countries where doctors are already allowed to use it. “I expect that this will also be possible here in the near future as an additional regenerative treatment, in addition to medication and transplants,” says Dr. Feriduni.