Procedure Details

Hair Transplantion

The following includes excerpts from a book chapter written by Dr. Ahn on hair restoration.

Ahn, Min S. "Hair Restoration." Current Diagnosis and Treatment in Otolaryngology- Head and Neck Surgery Ed. Anil K. Lalwani. New York: McGraw-Hill, 2004. pgs-979-983.

Why is hair so important?

In addition to the aesthetic effect of a full, natural head of hair, scalp hair has important biological and psychosocial roles for the individual. Biological functions include providing protection from potentially harmful environmental elements such as wind and cold temperatures, and dispersing hair follicle products such as pheromones in non-verbal human interaction. Hair loss has a profound effect on the person’s level of confidence and other people’s perception of that individual. Whereas only 8% of non-balding men state that losing hair would concern them, 50% of men with mild hair loss and 75% of men with moderate to severe hair loss express concern over the loss of hair. Men with hair loss feel older and less physically and sexually attractive than non-balding men. People’s impressions of those with hair loss are often unflattering and critical.

As a facial plastic surgeon, Dr. Ahn feels that he can provide the first step toward providing treatment for the person with hair loss. Sometimes, your doctor may be the only person who can broach the topic of hair loss without appearing judgmental or grossly inappropriate. Because of his understanding of normal hair physiology and the most common causes of hair loss, Dr. Ahn can provide effective care for those with hair loss. More specifically, after recognizing the presence of hair loss in the patient and making the appropriate diagnosis, Dr. Ahn will initiate further workup if necessary and discuss medical and surgical treatment options for the patient. The impact of such help can be profoundly positive.

Hair follicle anatomy and growth cycle

There are approximately 5 million hair follicles covering the body, 100,000 of which cover the scalp. An individual who does not suffer from androgenetic alopecia (male pattern baldness) normally loses 50-150 scalp hairs per day. After birth, no additional hair follicles arise, though the size of follicles and hair can change with age. A reduction of the total number of follicles only occurs with scarring or skin loss. Male pattern baldness, in fact, does not involve a loss of follicles, but a male hormone mediated alteration of their anatomy that causes hair loss.

Though hair follicles vary in size and shape, all have the same basic anatomy and growth cycle. Each follicle proceeds through three stages throughout life, growth, followed by involution, then the resting phase. After the resting stage, hair falls out and the follicle re-enters the growth phase. Follicles of different parts of the body have differing lengths of time spent in the growth stage-scalp follicles typically are in the growth phase for 2-8 years and produce long hairs whereas eye brow follicles spends 2-3 months in the growth stage and produce shorter hairs. 90% of scalp hairs are in the growth stage at any given moment.

Certain types of male hormones affect the length of time spent in the growth stage, therefore causing further loss of scalp hair. 

Male Pattern Baldness

Androgenetic alopecia (male pattern baldness) is the most common cause of hair loss and occurs in genetically susceptible individuals. Hair loss in both affected men and women typically begins between the ages of 12 and 40 and is variable in its rate of progression. Thirty percent of 30-year-old men and 50% of 50-year-old men suffer from male pattern baldness. Caucasian men are four times more likely than African American men to suffer from this type of hair loss.

How does it occur?

In the bloodstream, testosterone is converted to dihydrotestosterone (DHT) by an enzyme. DHT promotes beard, chest and axillary hair growth but also causes progressively shorter, finer lighter colored scalp hairs.

Hair loss patterns

Men- Male pattern baldness starts with recession in the temporal region followed by thinning of the crown. Further thinning of the crown results in a bald patch that may enlarge and combine with the progressively receding frontal hairline. This eventually results in a narrow rim of hair of the lower back of the head.

Women- Female hair loss occurs in approximately 10% of women with a thinning of the front or top of the scalp. The resulting hair loss is less evident and can be camouflaged with effective hair styling.

Medical Treatment

It is important to understand that no medical means exists that either restores all of the hair that has been lost or achieves the density of hair that existed prior to the onset of hair loss. Hair weaves and pieces offer a less than natural appearing option for coverage. Dr. Ahn advises patients undergoing hair restoration surgery to start medical therapy to maintain the existing hairs and therefore limit the amount of additional coverage needed through surgical techniques. Drug therapy is able to prevent further thinning of existing hair and can restore some of the coverage that has been lost. There are two options for drug therapy currently approved by the FDA, minoxidil (Rogaine) and finasteride (Propecia).

Minoxidil is a cream that is available in both 2% and 5% solutions. Both preparations have the effect of prolonging the growth stage. The 2% topical solution was approved in 1988 and a 5% topical solution in 1997 for over the counter use.  The 5% solution is more effective than the 2% solution in increasing hair counts. Both are applied to the dry scalp twice a day to maintain effectiveness. Once the treatment is stopped, gradual hair loss will occur. Minoxidil is FDA approved for female hair loss in both the 2% and 5% solutions.

Propecia prevents the conversion of testosterone to DHT and results in increased hair weight, converts more hair into the growth phase and reverses miniaturization of scalp hair. The FDA approved the use of once daily 1 mg tablets of finasteride based on a study showing 67% of the men have increased scalp coverage. Adverse effects relate to sexual dysfunction and are reversible. 1.8% of men experience decreased libido, 1.3% suffer from erectile dysfunction, and 1.2% experience ejaculatory dysfunction. Such adverse effects typically resolve with continued use. Finasteride is contraindicated in women who may become pregnant or are pregnant.

Follicular Unit Grafting

The technique that Dr. Ahn uses is the state of the art method known as follicular unit grafting. Dr. Ahn learned this technique while completing a facial plastic surgery fellowship with renowned hair transplant surgeon Sheldon Kabaker who practices in the San Francisco Bay area and is past president of the International Society of Hair Restoration Surgery.

Modern hair grafting methods have been refined from the original use of large grafts, causing a “pluggy” or “doll’s head” result into current techniques that provide for a natural appearance. Grafts with one, two and three hairs are harvested from the lower portion of the back of the head and when transplanted to the balding scalp, will survive and persist forever.

Follicular unit grafts refer to naturally occurring clusters of hair that include 1-4 hairs. Hair grows naturally from the scalp in follicular units that contain single hairs or 2-4 hairs. Robert Limmer in 1988 was the first to perform follicular unit transplantation (FUT) during which grafts of follicular units containing 1-4 hairs are individually harvested under stereo-microscopic dissection.

Dr. Ahn commonly performs sessions of 1000-1500 follicular unit grafts. Dr. Ahn performs the harvesting of the donor material and the design of the hairline. Expert technicians prepare the grafts using microscopes and place the grafts as well. Closure of the donor area is extremely important and Dr. Ahn uses a technique that allows hair to grow through the scar, making it virtually unnoticeable. After the session, some of the hairs will shed and ultimately growth of transplanted hair will not be noticeable for approximately 6-12 months. This hair is permanent and will proceed through the natural hair cycle without being susceptible to the hormones responsible for male pattern baldness. Often more than one FUT session is required to achieve adequate coverage depending on the extent of balding scalp.

Recovery

Some swelling of the forehead can occur for a few days. Most patients complain of little discomfort and many are able to return to work in just a few days.

Dr. Ahn’s Philosophy

Dr. Ahn wishes to emphasize that the goal of hair transplantation is to achieve a natural appearing result. The result, therefore, is coverage that provides a natural, mature appearance.

In designing the hairline, Dr. Ahn relies on his artistic eye and attention to detail to create a natural appearing result that frames your face. Dr. Ahn feels that his experience in all of facial plastic surgery gives him an advantage over those who are non-surgeons performing the procedure.

Your consultation with Dr. Ahn will last at least a ½ hour and is a one on one discussion with him. No hair consultants are part of the process. All pre and postoperative visits are with Dr. Ahn, who of course is the only surgeon who performs the surgery.

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