Division of Plastic Surgery

Cosmetic Plastic Surgery

Hair Replacement Surgery

What causes hair loss?
Hair loss is believed to be primarily caused by a combination of:

aging
change in hormones
illness
family history of baldness
burns
trauma

Generally, the earlier hair loss begins, the more severe the baldness will become.

Hair loss is not caused by:

poor circulation to the scalp
vitamin deficiencies
dandruff
excessive hat-wearing
a gene passed on from an individual's maternal grandfather

What is hair replacement surgery?

The interest in hair replacement has significantly increased over the past ten years. Two out of every three men and one in five women suffer from hair loss. For men, the main cause of a diminishing hairline is heredity. Hormonal changes such as menopause can cause both thinning and hair loss in women.

There are a number of hair replacement techniques that are available, although hair replacement surgery can not help those who suffer from total baldness. Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are four primary different types of hair replacement methods, including:

hair transplantation - during hair transplantation the surgeon removes small pieces of hair-bearing scalp grafts from the back or sides of the head. These grafts are then relocated to a bald or thinning area.

tissue expansion - in this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then required placing the newly expanded skin over the adjacent bald spot.

flap surgery - flap surgery is ideal for covering large balding areas. During this procedure a portion of the bald area is removed and a flap of the hair-bearing skin is placed on to the bald area while still attached at one end to its original blood supply.

scalp reduction - scalp reduction is done in order to cover the bald areas at the top and back of the head. This technique involves the removal of the bald scalp with sections of the hair-bearing scalp pulled together filling in the bald area.

Possible complications associated with hair transplantation procedures:

patchy hair growth
Sometimes the growth of newly placed hair has a patchy look especially if it is placed next to a thinning area. This can often be corrected by additional surgery.

bleeding and/or wide scars
Tension on the scalp from some of the scalp reduction techniques can result in wide scars and/or bleeding.

grafts not taking
Occasionally there is a chance that the graft may not "take". If this is the case, surgery must be repeated.

infection
As in any surgical procedure there is the risk of infection.

About the procedure:

Location options include:
- surgeon's office-based surgical facility
- outpatient surgery center
- hospital outpatient
- hospital inpatient
Anesthetic options include:
- general anesthesia
- local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed) for adults
Probable length of procedure: Several surgical sessions are usually needed to achieve satisfactory fullness, with a healing interval of several months recommended between each session. It may take up to two years before seeing the final result with a full transplant series.
Recovery period: Plugged or grafted hair falls out within a month or two after surgery, which is normal and almost always temporary. After hair falls out, it generally takes another month or more before hair growth resumes. A surgical touch-up procedure may be needed to create more natural-looking results after the initial incisions have healed. This may involve blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts, or slit grafts.

This page was last updated on: September 20, 2007.

For more information about UM Division of Plastic Surgery or to make an appointment, please call 1-800-492-5538 or 410-328-2360 (patients) or 1-800-373-4111 (physicians).