Hair transplant

Before and after hair transplantation (mini / micrograft method)

The hair transplant or hair transplant is the transplantation of body hair. Hair transplants are mainly used for hair loss , both in men and women. The intervention is discussed in society as an emotionally charged topic, especially for men.

history

Since the 18th century there have been reports of dislocations of hairy skin parts in animals and humans - with varying degrees of success. Until the 19th century there were no significant developments in this regard. In 1939, the Japanese doctor Shōji Okuda ( 奥 田 庄 二 ) first described the punching technique (punch technique) in hair transplantation. He used small punches to transplant hairy parts of the skin into other areas of the scalp and into eyebrows and mustaches. The transplanted hairy parts of the skin also successfully produced hair in their new position. However, Okuda only intended this procedure for burn victims. He did not yet consider the possibility of using his technique against the widespread androgenetic hair loss , also known as hereditary hair loss.

In the 1960s, the techniques were expanded significantly by Norman Orentreich . In 1986 the Munich doctor Manfred Lucas presented the comprehensive treatment with mini and micro grafts at the VII. International Congress of Dermatologic Surgery in London and was thus one of the first in the world to propagate this procedure.

The latest method, the removal of individual hair follicles, was first described by the Japanese Masumi Inaba. This method was refined in 2002 by WR Rassman and called Follicular Unit Extraction .

The various techniques vary widely, with comparative controlled studies largely lacking. For a good end result, it is crucial that the hairline is natural (e.g. with swirls and waves).

Methods of hair transplantation

Punch

The punch technique is the oldest method. Dr. Okuda transplanted hairy parts of the skin with 4 mm cylinders. The harvested grafts produced very unnatural, tuft-like results.

Strip & Insert Mini / Micrografts (MMG)

This method is the most common hair transplant method in Germany. A hairy strip of skin is removed from the hairline and divided into so-called middle skin parts and smaller skin parts with hair roots. These individual hairs or hair islands are also called mini or micro grafts. Then the grafts are placed in the previously prepared areas. The procedure is performed while sitting under local anesthesia and takes between 3 and 9 hours, with the majority of the time being used to prepare the grafts.

Strip removal & insertion of follicular units (FUI or FUT)

This method is the further development of the mini / micrograft technology. A strip of hairy skin is also removed from the hairline here. However, this is broken down into the natural bundles of the hair (follicular units) under a high-resolution microscope. These follicular units (FU) are then planted in the previously prepared areas.

Follicular Unit Extraction (FUE)

Hollow needles for FUE hair transplantation

Follicular Unit Extraction (FUE) describes the extraction, temporary storage and implantation (insertion) of follicular units (FU). The units are natural groupings of one to four (in rare cases five) hairs, so-called grafts. This method is currently one of the most modern hair transplant options.

These follicular units are of great importance for hair transplantation, since hair does not grow individually but in natural bundles. In the case of an FUE transplant, these hair groups (usually from a small group of around 1–5 naturally belonging roots) are removed from the hairline area with a hollow needle and inserted into the corresponding areas. Extraction needles are used for the procedure, which can remove grafts with a size of 0.5 mm to 1 mm. Before transplanting, there is a health check for the group. The grafts are kept in a nutrient solution until they are implanted. The doctor then transplants the follicular units into the bald head areas. It is mostly inserted with tweezers into a small slit in the skin, which is achieved with specially made blades with a width of 0.6–1.5 mm. An injection cannula can also be used. The correct angle of the hair and a density suitable for the recipient area must be observed.

The big advantage is that the removal point does not have to be sewn, it closes itself on the same day. Smaller scabs may be visible for about a week after surgery. Even if small, punctiform scars are likely to remain, they can hardly be seen with the naked eye. Another great benefit of this method is the ability to transplant body hair as well. When transplanting body hair, however, it must be noted that these usually have a different structure and color than scalp hair. The disadvantage of the FUE method is the increased time required for individual removal. The workload for such a treatment is very intensive. There are now hollow needles in which the rotary movement is carried out by a motor, which enables them to be removed much more quickly. The greater weight and speed of these devices creates the risk of damage to the hair or surrounding tissue.

Cross punch method

It has been reported several times in the literature that a more aesthetically pleasing treatment result can be achieved if the insertion angle is taken into account when the transplants are implanted.

Since curly hair basically conceals the scalp underneath better than is the case with straight hair, the crosspunch technique tries to achieve better optical coverage of the scalp even for straight hair. For this purpose, the bores in the recipient surface are set at angles of about 5 to 8 °, which are slightly stepped from one another, so that the transplants inserted later also have a slight angle of inclination to one another. In this way, the effect of better scalp coverage, which curly hair naturally brings with it, is also made possible for straight hair.

In order to achieve a natural-looking result, it must be ensured that the hairline's natural growth direction is taken into account when reconstructing the hairline and that the crosspunch technique is only used after the hairline has been reconstructed.

Hair robot (hair transplant robot )

Recently, hair robots have also been used for hair transplants. The technology was initially developed in the USA and is also possible in German-speaking countries. The acquisition costs of a hair robot for the doctor or the clinic are over half a million euros plus license fees.

The advantage of the technology lies in the avoidance of scars and the computer-precise removal of the most vital grafts and thus a higher yield of the hair follicles ("growth rate"). At the beginning of the procedure, a scan of the back of the head is carried out to identify and then remove the most suitable hair. The hair is inserted manually by the surgeon.

Hair loss in women

Hair loss in women often has genetic causes, with thyroid diseases or hormonal changes often being the triggers. Not only the hair loss itself, but also increasingly thinning hair can be the result. In this case, drug treatment is usually sufficient. The causes of hair loss can be emotional, physical or psychological stress. The following factors can trigger a loss of head hair: hormonal changes (menopause), skin diseases, operations, thyroid problems, pregnancy, extreme stress.

Hair transplant cost

The cost of a hair transplant is usually not based on the area, but on the number of grafts. By making a flat rate of the costs per transplanted follicular unit, calculation programs can help with the representation of the expected costs. An exact calculation of the required follicular units is not possible with this either, since the density of the hair in the zone adjacent to the target region must also be included in the cost estimate. For this reason, the exact cost can only be given after an examination or with the help of photographs of the affected areas.

Treatment options

With the use of micrografts / FUE, hair transplants (hair root grafts) are not only used in the top of the head with hereditary hair loss (alopecia androgenetics), but also a. also at

• Reconstruction of eyebrows
• Eyelash transplantation after alopecia mechanica
• Beard replacement after hare lip correction
• Replacement of pubic hair
• cicatricial traumatic alopecia
• burned out alopecia areata
• Alopecia triangularis congenita

for use.

Individual evidence

1. ↑ T. Dirschka et al. a .: Guide to aesthetic medicine . Elsevier, Germany, 2002, ISBN 3-437-23090-5 , pp. 248-284.
2. ↑ Claudia Becker: Headdress: Why are men vain when it comes to hair? In: THE WORLD . April 13, 2013 ( welt.de [accessed December 22, 2017]).
3. ↑ https://www.bunte.de/stars/wotan-wilke-moehring-haartransplantation-61978.html. Retrieved December 22, 2017 . 
4. ↑ Shoji Okuda: The study of clinical experiments of hair transplantation . No. 46 . Japanese Journal Dermatology and Urology, 1939, pp. 537-587 .
5. ↑ A. Berger et al. a .: Plastic surgery . Springer, 2004, ISBN 3-540-00129-8 , p. 13. (online)
6. ↑ Norman Orentreich: autografts in Alopecias and Other Selected Dermatological Conditions . In: Annals of the New York Academy of Sciences . tape 83 , no. 3 , November 1, 1959, ISSN  1749-6632 , p. 463-479 , doi : 10.1111 / j.1749-6632.1960.tb40920.x ( wiley.com [accessed November 14, 2017]).
7. ↑ Damkerng Pathomvanich, Kenichiro Imagawa: Hair Restoration Surgery in Asians Springer . Springer Science & Business Media, 2010, ISBN 9784431996590 , p. 133.
8. ↑ WR Rassman, RM Bernstein, R. McClellan, R. Jones, E. Worton, H. Uyttendaele: Follicular unit extraction: minimally invasive surgery for hair transplantation. In: Dermatologic Surgery Volume 28, Number 8, August 2002, pp. 720-728, PMID 12174065 .
9. ↑ A little belly and bald head, and you're out. (PDF) In: Süddeutsche Zeitung. Retrieved December 18, 2017 . 
10. ^ R. Azar: Minimally Invasive Hair Transplantation . Springer, Germany, 2015, ISBN 978-3-642-54559-7 , p. 22.
11. ↑ A. Meves et al. a .: Intensive course in dermatology . Elsevier, Germany, 2006, ISBN 3-437-41162-4 , pp. 392-395. (on-line)
12. ↑ R. Azar: Minimally invasive hair transplantation . Springer, Germany, 2015, ISBN 978-3-642-54559-7 , pp. 79–84
13. ↑ Mohammed Alhaddab, Thomas Kohn, Mark Sidloi: Effect of graft size, angle, and intergraft distance on dense packing in hair transplant . In: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et al.] Volume 31 , no. 6 , June 2005, ISSN  1076-0512 , pp. 650-653; discussion 654 , PMID 15996414 .
14. ^ Yong Miao, Bing-Cheng Liu, Zhe-Xiang Fan, Zhi-Qi Hu: Evaluation Indicators of Aesthetic Effects on Hair Transplantation . In: Annals of Plastic Surgery . 77 Suppl 1, February 2016, ISSN  1536-3708 , p. S30–31 , doi : 10.1097 / SAP.0000000000000778 , PMID 26954740 , PMC 4972479 (free full text).
15. ↑ A. Lehmann: Own hair transplantation using the cross punch method . In: Journal for Aesthetic Surgery . tape 10 , no. 1 , March 1, 2017, ISSN  1867-4305 , p. 43–46 , doi : 10.1007 / s12631-016-0070-3 ( springer.com [accessed April 29, 2018]).
16. ↑ A. Lehmann: Own hair transplantation using the cross punch method . In: Journal for Aesthetic Surgery . tape 10 , no. 1 , March 1, 2017, ISSN  1867-4305 , p. 43–46 , doi : 10.1007 / s12631-016-0070-3 ( springer.com [accessed April 29, 2018]).
17. ↑ Parsa Mohebi, (2013). MODERN HAIR RESTORATION - A Complete Hair Loss Guide For Men And Women. 1st ed.
18. ↑ Cosmetic surgeon Darius Alamouti: "Anyone who is overweight today has already lost" . ( handelsblatt.com [accessed December 18, 2017]).
19. ↑ Oliver Bertram: This is how a hair transplant works . ( menshealth.de [accessed December 18, 2017]).
20. ↑ Innovative hair transplantation in Herne. Medicine. In: derwesten.de. Retrieved December 2, 2015 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !