What is a hair transplant?

Hair transplantation consists of the redistribution of hair follicles (or hairs with germinal cells) from the permanent zone or posterior and lateral areas of the scalp to the bald area or area with lower hair density.

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Why is back and side hair permanent?

It is permanent because it is genetically coded to last your whole life, that is, it is not affected by androgenetic alopecia, of which two factors are manifested:
1. Male hormone or androgen (testosterone)
2. Paternal or maternal (genetic) inheritance that creates a special sensitivity to androgen action to the hair follicle.
So when these two factors come together the dreaded alopecia or baldness will occur sooner or later but never on the back or side of the head. If you look at people suffering from alopecia, we can see that although this is quite severe, they always keep hair on the back and side of the head.

Why doesn’t hair fall once transplanted to a bald area?

Many years ago it was shown that the hair of the scalp still maintained its genetic characteristics intact even if implanted in any other part of the body, either on another area of the scalp, the beard, mustache, eyebrows, chest, pubis, etc. This feature is called donor dominance.
In 1959, the father of the hair transplant, New York dermatologist Dr. Norman Orentreichshowed that when transplanting small circles of skin from scars with hair to a zone of burned skin, hair grew.
Although previously in 1939, the Japanese doctor Shoji Okuda had already realized and published the same technique, his work was forgotten after the outbreak of the II World War, and it was not until 1992 when they heard about it.

What is transplanted exactly? The concept of follicular units

In the same way that a plant needs ground between its roots to root well, hair follicles need some tissue around to “catch” or vascularize. Hair follicles (hairs) are naturally born in groups of 1 to 6, sharing anatomical structures that must be preserved. This set of follicles are called follicular units. The size of a follicular unit is 1 mm or less.
1. Two follicular units of a hair follicle each.
2. A follicular unit composed of 4 hair follicles, sharing the erector muscle of the hair and the sebaceous gland.
The grafts that will be transplanted are an entire follicular unit, therefore the grafts will contain 1 to 6 hairs.
The transplantation performed with follicular units obtains very natural results, avoiding the aspect of “wrist hair” that was so frequent in transplants of years ago.

Types of Follicular Units

What is the most important thing in a transplant?

Hair transplantation is not a complex or traumatic surgery, it is a very delicate surgery in which it is necessary to take into account many details, so that the result is absolutely natural and satisfactory. Among these details we will highlight:
● Direction: The direction of hair varies along the scalp. In the upper zone, growth goes upwards; At the entrances the direction of the hair varies very quickly, lateralizing as we go towards the temple; On the crownthe eddy or eddies that always exist must be reproduced.
Following the direction of natural hair growth we will achieve an absolutely natural result.
● Angulation: the angle of exit of the hair is more acute in the first line capillary and at the crown, almost flat at the level of temporal peaks and 45° or greater on the uppermost part of the scalp.
The natural reproduction of the exit angle of the hair allows us to achieve an optical effect of higher density in the final result.
Density: depending on the area that we have to repopulate and the amount of follicular units that we can obtain, we can get higher or smaller density (follicular units per cm²).
If the area to be repopulated is not very large, we have a dense packing technique, defined as implantation greater than 35 follicular units / cm².
At the Trius Institute we have performed this technique, achieving densities of 50 Follicular units / cm² where the area to be repopulated was larger, which will provided more density, to achieve an optimal result.
Design: prior to the intervention, a detailed design of the areas to be repopulated is prepared, always predicting a vision of the future, since the transplanted hair will never fall, we have to predict the result of the transplant after 10 – 20 years.
The design of the first line is crucial to achieve an absolutely natural result, therefore:
1- The first line is a zigzag shape, just as natural hair is in this area.
2- The incisions are smaller than 1mm to accommodate follicular units containing only one follicle.
3- To achieve maximum naturalness in the long term, it is important to design the first line with a certain degree of entries, since these are present in the vast majority of men of a certain age.

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Do you have any questions?

How many grafts are needed for a transplant? How many can be applied?

Depending on the degree of alopecia in the frontal, middle and crown 2-3 transplant sessions may be necessary.
The number of grafts per session can be vary, depending on the surface of alopecia to cover, the amount of hair in the donor area, characteristics of the hair as well as each specific patient.
The most common scenario is to have sessions of 3,500 or more grafts representing 8,000 by approximately.
It is therefore of vital importance to first visit Dr. Trius so he can assess your specific case and provide a correct personalized plan.

It is painful? How will it turn out?

Hair transplant surgery today is relatively painless. Prior to the intervention, a mild sedative is administered to aid relaxation and helps you sleep in case you want to. This way, the application of the local anesthesia goes unnoticed.
Once the area is anesthetized, you will not notice any discomfort at all. You can even get up to go to the bathroom or have a snack if you are thirsty or hungry.
Once the surgery is finished we will cover the scalp with a bandage for the first 3 days to protect and promote healing in the donor area and to reduce swelling on your face. We will also provide a hat to leave the clinic. It is recommended to have someone to accompany you back to your home or hotel.

How is the postoperative process?

For the first 2 days after transplantation you should take it easy although there is no need for absolute rest. Something cold should be applied to the forehead and also a thermal water spray to keep the grafts moist and the affected area clean.
The next day you must come for a consultation, where we will perform a checkup and the first head wash, teaching you to do it yourself at home over the next few days.
In about 24 hours a small scab will form on the surface of each graft which will fall off in 7 to 10 days.
During the 3 days after the transplant, you must take medication: Antibiotic and anti-inflammatory, in some cases it is necessary to take an analgesic the evening after the intervention mainly after having “The strip “(FUSS) technique, as you will notice some discomfort due to the inflammation of the area later. This does not happen with the “no scar” technique (FUE), therefore a postoperative analgesia is not necessary.
After the 10th day (after a visit with your doctor) you can get your hair cut. At Instituto Trius we collaborate with good professionals who will advise and treat you with special care for your first hair cuts, like Alma Hair Spa Salon, very close to our Center.

When does the new hair grow?

Most of the small pellets that are observed emerging from the grafts at the end of the intervention, will fall off during the first month. The root will remain in arresting phase (telogen) for 3 months. A few which have not fallen will continue to grow (anagen phase). For this reason, a month after surgery we perform a PRP (Platelet Rich Plasma LINK), to stimulate the implanted hair follicles metabolism.
Transplanted hairs usually begin to grow around 3 months after the transplant in an asynchronous way, that is, they do not all come out at once, but progressively, so that the final result is seen after the first year of the intervention.
This hair will behave naturally throughout your life. As you get older, there may be a slight loss of hair density on the head, which could also affect transplanted hairs which can be replaced as long as there is enough space between each hair to put a new follicular unit, approximately 1 mm.

Can a transplant be performed in an area that still has hair?

The advantage of replacing hair as it is lost, is that it clear bald areas aren’t visible, and therefore we will not create a drastic change of look.
It is in this type of transplant that the “vision of Future” is paramount. It is probable, and depending on the speed of hair loss, a 2nd or 3rd transplant may be required over time.
To minimize the need for a 2nd transplant, it is advisable to have medical treatment that slows down the hair loss of the area we are dealing with.
The disadvantage in this type of case is that due to surgical trauma in the transplanted area, a part of the native hair enters a rest phase or Telogen and falls temporarily during the 2 months following transplantation. After 3 months, both the natural and transplanted hair which has fallen during this phase begin to grow