Surgical Treatment for Baldness /Hair Loss / Alopecia

Surgical Treatment for Baldness /Hair Loss / Alopecia

Baldness typically refers to excessive hair loss from your scalp and can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss or alopecia.

About 90 percent of the hair on most people's scalps is in a two- to six-year growth (anagen) stage at any given time. The other 10 percent is in a two- to three-month resting (telogen) phase, after which time it is shed. Most people shed 50 to 150 hairs a day. Once a hair is shed, the growth stage begins again as a new hair from the same follicle replaces the shed hair. New hair grows at a rate of approximately one-half inch each month.

Hair loss may lead to baldness when the rate of shedding exceeds the rate of regrowth, when new hair is thinner than the hair shed or when hair comes out in patches.

As a rule, the earlier hair loss begins, the more severe the baldness will become. Hair loss can also be caused by burns or trauma, in which case hair replacement surgery is considered a reconstructive treatment, and may be covered by health insurance.

It's important to understand that all hair replacement techniques use your existing hair. The goal of surgery is to find the most efficient uses for existing hair.

Hair transplants and scalp reduction surgery are available to treat androgenetic alopecia when more conservative measures have failed.


During transplantation a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several hairs, from the back or side of your scalp. The plugs are then implanted into the bald sections. Several transplant sessions may be needed as hereditary hair loss progresses with time. After initially falling out, the transplanted hair regrows, and will continue to grow in the new area for as long as it would have grown in the area from which it was taken. It also has the same color and other characteristics as the hair in the donor area from which it was taken.

Usually, only one of the following three areas can be treated during any session: the frontal area extending from the hairline to a line drawn more or less vertically from the ears, the mid-scalp area extending from that point to the point on the scalp where the head changes from being more or less horizontal to the ground to a more vertical orientation, and the vertex area or “crown” which is the balding area furthest back on the scalp.

Hair replacement candidates must have healthy hair growth at the back and sides of the head to serve as donor areas. Donor areas are the places on the head from which grafts and flaps are taken. Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result. There are a number of techniques used in hair replacement surgery. Sometimes, two or more techniques are used to achieve the best results.

Hair transplanting is most commonly performed for Male Pattern Baldness (MPB) and Female Pattern Hair Loss (FPHL). However, it can also be used to produce hair in scarring secondary to surgery, trauma or burns. A relatively new technique referred to as Follicular Unit Extraction (FUE) skips the removal of a strip from the donor area. A small, round punch similar to a small cookie cutter is used to excise each individual FU directly from the donor area. It has the advantage of avoiding the production of a linear scar in the donor area but is more time consuming, expensive, and more likely to result in injury of the FUs. Nevertheless, it is advantageous for some patients, for example those who have very tight scalps or who have a tendency to healing with bad scars. It may also prove to be an effective way of removing hair from the body and transferring it to the scalp.

Initially, there are small crusts on the recipient sites. These fall off usually within 3 to 10 days. Post-operative pain is nearly always completely controllable with relatively mild “pain killers” such as Tylenol 3, Vicodin or Percocet. Such pain killers are usually necessary only for the first 1 or 2 nights after the procedure. Temporary mild-to-moderate swelling of the forehead usually occurs approximately 2 to 3 days after the operation and lasts for 3 to 7 days. Approximately 1 out of every 50 patients has no swelling and 1 out of every 50 patients has severe swelling that may cause “black eyes” that last for 7 to 10 days.

Hair replacement surgery is an individualized treatment. To make sure that every surgical option is available to you, find a doctor who has experience performing all types of replacement techniques-flaps and tissue expansion as well as transplants. Look elsewhere if your doctor tells you that he or she has perfected one technique that can "do it all."


Scalp reduction, as the name implies, means decreasing the area of bald skin on your head. Your scalp and the top part of your head may seem to have a snug fit. But the skin can become flexible and stretched enough for some of it to be surgically removed. After hairless scalp is removed, the space is closed with hair-covered scalp. Doctors can also fold hair-bearing skin over an area of bald skin in a scalp reduction technique called a flap. Scalp reduction can be combined with hair transplantation to fashion a natural-looking hairline in those with more extensive hair loss.

Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. If you're interested in these procedures, consider only board-certified dermatologists, plastic surgeons or cosmetic surgeons, and check local and state medical boards for a record of patient complaints before choosing a doctor. Consult with this doctor to confirm the cause of your hair loss and review all treatment options, including nonsurgical ones, before proceeding with plans for surgery.

You may need a surgical "touch-up" procedure to create more natural-looking results after your incisions have healed. Sometimes, this involves blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts, or slit grafts. Or, if you've had a flap procedure, a small bump called a "dog ear" may remain visible on the scalp. Your doctor can surgically remove this after complete healing has occurred.


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