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Currently there is not proven method to create new hair, however, there are several alternatives to get back a full head of hair. After the age of 40, some men begin to lose their hair, although there are cases of men in their youth – between 20 and 30 years old – who start to notice hair loss from an early age. Generally, balding is hereditary or due to dihydrotestosterone (DHT), a male hormone linked to testosterone.

The hair follicles gradually become smaller and, as the follicles shrink, the hair becomes finer and finer. At the beginning of this stage, this problem can probably be helped to a certain point with medication; however, if the problem persists and serious thinning or balding sets in, the solution is a hair transplant.  

Frontal balding or receding hairline is the most common pattern of hair loss whilst the hair at the back of the head shows much more resistance against DHT, lasting a lifetime. In women, hair loss usually begins after the menopause. The reason for this is that, when the level of oestrogen drops, the testosterone present in women gets an edge and starts to affect the hair.

When hormone imbalance occurs, the follicles start shrinking, hair starts to thin, the strands also becoming finer and weaker, altogether of much poorer quality.  There are two techniques that are available for hair transplantation: FUE (Follicular Unit Extraction) and FUSS (Follicular Unit Strip Surgery). In certain cases, a combination of the two might be used.

What are follicles?

The hair follicle is actually the pocket below the skin from which the hair strand grows. Each follicle naturally holds between 1-4 strands (thick) and, in addition 1 or 2 fine hairs and attached inside the top of the follicle are sebaceous glands, fed by a blood supply, surrounded by nerves and a tiny muscle and lubricated by its own oil gland.

The amount of hair to be transplanted is determined during the initial consultation with the specialist, who will evaluate your case and decide on the most suitable solution for the best outcome. In people with more than 80% hair loss or in older people, the results will be satisfactory, however, in younger people the results are better.

Hair transplants

This is the procedure used for alopecia or any type of hair loss, be it on the head or non-scalp areas of the body (e.g. eyebrows) where hair has been lost owing to various reasons (scars, burns, etc.).

Although hair grafting can be used for several complaints, the main procedure is as an answer to hair loss. The main advantage of surgery compared to other aesthetic or cosmetic treatments is that it is a natural solution, minimally invasive, permanent and increasingly more available to the average person.

The current techniques allow thousands of follicles to be extracted from areas not affected by alopecia to be implanted in the bald areas. The area from where the hair is extracted is called the “donor site” (normally from the back of the head) and the area where the hair is transplanted is called the “recipient site” (front, top and crown).

The objective of a hair transplant is to redistribute hair from an area where the hair is genetically programmed not to ever fall out (donor site) and take it to the thinning or bald areas (recipient site). Once the follicles are transplanted, the hair will start to grow in its new place. The transplanted hair needs approximately 5 days to adapt to its new surroundings and properly take root. The hair of the transplanted follicle will grow and eventually fall out naturally, leaving no visible signs of the hair transplant. The new hair will start to grow from approximately of 3 months onwards, at about one centimetre per month. Six months after the procedure, 70% of the hair will have appeared, taking on a fuller look and it will continue to get thicker and fuller over the following months. By 10-12 months after the procedure, the new image will be complete.

Hair transplants are carried out by a team of surgeons and nurses who are highly trained in the procedure and combine the latest surgical techniques with their artistic skills, in order to attain a natural looking head of hair. The angle and correct placing of the hair is vital and achieving a density of 60% will lead to the best results.

It is worth keeping in mind that it is possible to combine the procedure with the use of medications and cosmetic products which will contribute towards maintaining and improving the results of the transplant, e.g. the use of PRP (platelet-rich plasma).

The main techniques used for hair transplants are FUE (follicular unit extraction) and FUSS (follicular unit strip surgery).

FUE technique

Follicular Unit Extraction is an advanced method for hair loss which involves stitches and typical scarring.

This technique is designed to restore hair by individually removing healthy hair follicles from the back of the head to transplant them where needed, grafting them one-by-one into the bald areas of the head. FUE is the least invasive procedure of all hair transplants, and is ideal for those patients who favour very short hair or those whose scalp does not have enough elasticity for the alternative strip method.

FUE can also be used in combination with the more traditional FUSS (strip) technique in order to attain maximum coverage of the head.

The FUE (Follicular Unit Extraction) technique is ideal for people who:

· Do not have an extensive “donor site”.

· Have little scalp elasticity.

· Have already been through various FUSS procedures because of their minimal donor site and little scalp elasticity.

· Favour short hair.

· Do not require an extensive transplant (small areas, eyebrows, scars, etc.).

Over the last few years, Follicular Unit Extraction (FUE) has been the most popular technique for hair transplants. With this technique, the follicular units are extracted one-by-one using microsurgical instruments to make tiny incisions under a microscope.

Unlike the other technique, Follicular Unit Extraction (FUE) avoids making the traditional incisions in the donor area. The follicles are extracted simultaneously via micro removal punches of between 0.6 and 1.0 mm which, once healed, are virtually undetectable on the scalp.

FUE is an outpatient procedure and it is possible to achieve between 500 up to 2500 grafts in just one session; this would take approximately 6-8 hours and can be done under local anaesthesia. Occasionally, in special cases, it may be necessary to carry out more than one session in order to achieve the desired result.

FUSS technique

Follicular Unit Strip Surgery (FUSS) is the technique which is most used globally. It allows a natural and undetectable result. This method involves the removal of a strip of hair from a donor region of the scalp (back of the head) of approximately one centimetre wide and from 10-30 centimetres long, depending on the number of grafts necessary.

Once the strip has been removed from the donor area, the follicular units are meticulously separated using a microscope and then planted in the recipient area. Depending on the area available in the donor area and the area to be covered in the recipient area, it is possible to separate from 3500 up to 9000 hairs in one session.

The advantages that the FUSS technique offers are:

· Very high success rate

· Allows extensive areas to be transplanted

· Higher possibility of integration

· Slightly less expensive

As with the FUE procedure, FUSS can be carried out under local anaesthesia. Depending on the number of grafts needed, the procedure can take between 4-8 hours and, occasionally, might require more than one session.

Complementary treatment

Apart from the surgical procedures, it may also be necessary to take certain medication to avoid natural hair loss due to hormonal issues. In addition, after procedure certain cosmetic treatments may be recommended, along with supplements and PRP (platelet-rich plasma) which will contribute towards maintaining and improving the results of the transplant.

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