Surgical Treatment Options
Hair transplantation, which has gone through a major transformation over the years, was first introduced in the early 1800s. By the 1950s, Dr. Norman Orentreich introduced the new theory of donor dominance to the field of hair transplantation. He is thus considered to be the father of hair transplant. Over the years, more and more advanced and sophisticated methods have been introduced and tested.
Dr. Meshkin and Dr. Orentreich
Today’s Mega sessions of hair transplant using high-powered microscopes allow thousands of Follicular hair units to be placed in one session, transforming hair restoration into an art. Furthermore, with new harvesting techniques such as Follicular Unit Strip Transplant (FUT), Follicular Unit Extraction (FUE), Body Hair Transplant (BHT) and the new, more advanced closure technique Trichophytic Closure, patients are assured of less visible scarring in the donor area.
Follicular Unit Transplant (FUT): Strip Method
Strip harvesting is the most common and most efficient technique used to remove the hair follicles from the donor site. A single or double bladed scalpel is used to remove a strip of hair bearing tissue in the donor zone. The incision should be made very carefully to assure that the follicles are removed intact. Following removal of the strip, Dr. Meshkin closes the wound using the most advanced technique. Dr. Meshkin’s new closure technique makes the scar line virtually invisible after healing. Removal of the donor hair and closure of the wound while hair follicles are visible, allows for the least damage to existing hair – resulting in saving the donor hair for future use and, more importantly, maximum hair growth. For clients who are young, have limited donor hair, curly hair or very densely packed hair, this method is the most efficient.
Follicular Unit Extraction (FUE): Punch Method
This is another option for donor extraction. With this method we can extract follicular units from 1 to 3 hairs individually without any linear incision. Very small circular punches are used to extract the follicular units, which are then moved to the recipient area. FUE is more of a minimally invasive procedure than the linear harvesting technique. There is minimal discomfort in the donor area and no sutures are needed to close the donor. There is no linear scar formation, and there is less recovery time for healing.
This technique has become very popular amongst clients who prefer to keep their hair very short. However, there are many disadvantages to using this technique. Due to blind site incisions made in the donor area, there may be collateral damage to the existing donor hair. This could cause damage to the donor site and also the hair follicles being extracted, thereby resulting in poor growth and limiting the donor hair available for future use. Since hair loss is progressive, if a client is young and will continue to lose hair, is a patient with curly hair, a patient with more advanced hair loss or a patient with limited donor hair, this technique is not recommended. Other disadvantages for this technique include longer time for donor harvesting, higher expense, donor area shaving, multiple white spots in the donor area after surgery, and exposed donor area immediately following the surgery. At the time of your consultation, Dr. Meshkin will examine and test the donor area to see if you are a good candidate for the Follicular Unit Extraction procedure.
Trichophytic Double Layer Donor Closure
The Trichophytic closure of the wound is the most advanced closure technique that will yield the best result. It is used to close the wound while performing the strip method. Strip harvesting is the most common technique used to remove the hair follicles from the donor site. A single or double bladed scalpel is used to remove a strip of hair bearing tissue. The incision should be made very carefully to assure that the follicles are removed intact. Following removal of the donor strip, the upper or lower edges of the wound is trimmed approximately 1mm, then double layered suturing is used to close the wound. While suturing the last layer, the hair is allowed to come through the line. This technique is called Trichophytic closure, which allows for the most yield of donor hair and also makes the scar line virtually invisible after healing. While it is the best method, it requires more surgical skill and attention to be performed properly. If a clinic is not set up for more advanced surgical procedure, this technique is usually not offered or performed.
Ultra Refined Follicular Unit Transplantation
Hair restoration is going through very important evolution for improving both the naturalness and fullness that can be achieved from only one to two surgical procedures. Today’s new advanced Ultra Refined Follicular Unit hair transplant allows thousands of hair follicles to be placed in one to two sessions with the lateral Microslit grafting technique. This technique requires high-powered microscopes to divide the donor strip into its natural follicular unit. The microscopes are used to dissect and remove excess tissue attached to the hair follicles, therefore eliminating the skin gaps or dead space. Also by using very unique, small and customized needles for each individual client, Dr. Meshkin is able to make the recipient sites in very close proximity to each other in its natural orientation. This unique technique requires more skill and attention to be performed properly. These very small and minimally invasive incisions enable the surgeon to dense pack the frontal hairline and the crown area, and give the utmost cosmetic results.
Eyebrow and Eyelash Transplant
The cause of eyebrow/eyelash loss is evaluated via medical history and examination, prior to consideration of hair restoration. Causes may include:
- Systemic or local disease that causes hair loss must be under control to assure that hair restoration can succeed
- Obsessive-compulsive plucking (trichotillomania) must be treated to assure that restored hair will not be plucked out
- Trauma, burns or surgery may have resulted in formation of scar tissue; reconstructive surgery may be necessary before eyebrow/eyelash restoration. The degree of eyebrow loss may vary from complete to partial; the degree of loss may be a consideration in selection of the restoration procedure.
Some patients have no eyebrow/eyelash loss, but seek eyebrow/ eyelash enhancement for cosmetic reasons.
Eyebrow Hair Restoration
A number of procedures are available for restoration of all or part of the eyebrow
by follicular units either by using the FUE or FUT technique. Follicles are transplanted to the eyebrow area via the method best suited to the needs of the patient. Eyebrow restoration procedures are usually performed in an outpatient setting. Postoperative complications are usually limited to minor pain and swelling.
The purpose of transplantation of hair to the eyebrow is to recreate the eyebrow in a natural contour. Dr. Meshkin works with each patient to outline the eyebrow area to conform to the natural symmetry of the patient’s face. Depending on the size of the area to be transplanted, more than one transplant session may be required; two or more sessions several months apart are common.
Donor hair for the transplant is taken from a site that furnishes finer rather than coarser hair; finer hair is a better "match" for eyebrow hair. Donor hair is transplanted as units of one to two hairs. Each graft is placed into an incision prepared for it. The use of single hair grafts permits meticulous adherence to the eyebrow contour for a natural appearance.
As the transplanted hairs grow in their new position they may require occasional trimming as well as "training" with gel or wax.
For eyelash hair transplant finer hair is used from the donor area. The recovery is about one week and all the post op care is given to the client. Itching is a common and troublesome postoperative complication. If the patient gives in to temptation and scratches, there is risk for dislodging the hair grafts and initiating infection. Eyeglasses may be worn to deter scratching. Training of transplanted hairs into eyelash conformation is accomplished by use of lash oil and an eyelash curler.
Beard Hair Restoration (Beard and mustache Surgery)
Transplantation is the only procedure used to restore beard and mustache hair. Beard surgery is a very specialized procedure. As is the case for eyebrows, donor hair for transplantation must be coarser rather than finer. All grafts are single hairs meticulously placed into the Beard and mustache area. They have to placed according to the direction and the orientation of the existing hair to give the best natural result.
Surgical Treatment Options