Hair transplantation, also known as hair restoration, is a surgical treatment aimed at replacing hair in bald areas or filling up thinned out hair zones. The treatment mainly affects the scalp, but can also be applied to the beard, eyebrows, eyelashes and other parts of the body.
Hair transplant surgery is based on the first descriptions of the American physician Norman Orentreich of 1959. The hair grafts he originally used had a relatively large diameter of 4-5 mm, which is why the results at that time were often unnatural and aesthetically unsatisfactory. In 1981, the technique of micro hair transplantation was introduced by the Finnish surgeon Rolf Nordström. The micrografts improved the aesthetic treatment results considerably. Today’s modern techniques of hair transplantation were foremost developed with the description of hair follicular units by the physician Dr. John Headington in 1984.
All hair transplants in the AARE KLINIK are performed according to these modern techniques. They have been further developed and established in by Dr. Jerzy Kolasinki, long-time Vice President of the European Society of Hair Restoration Surgery (ESHRS) and member of the International Society of Hair Restoration Surgery (ISHRS). Through our cooperation, we ensure modern hair transplantation for our patients by specialists in this field with many years of experience.
Considerations
A hair transplant can be useful for female and male if you suffer from hair loss or thinning. Hair transplantation can improve your appearance as well as your well-being, even if a perfect appearance cannot be guaranteed.
When to consider hair restoration surgery:
- Male hair loss (androgenic alopecia)
- Hair loss in women (androgenic alopecia)
- Traumatic hair loss (post-traumatic alopecia)
- Hair loss through burns (post-burn alopecia)
- Inflammation (post-inflammatory alopecia)
- Hair loss from radiation
- Scars
- Loss of eyebrow hair, eyelashes or beard hair
- Loss of body hair (e.g. pubic hair)
Consultation
Careful planning is a prerequisite to a successful operation. This starts with a personal consultation at the AARE KLINIK. It is helpful for your doctor and surgeon to know your wishes, ideas and expectations of the operation in order to be able to give you a realistic idea of the possibilities and limitations of the operation.
- Communication of wishes, expectations
- Explanation of the possibilities and scope of the operation
- During the consultation, you will be informed about all treatment options, including the number of surgeries that are planned.
Before you decide to have a hair transplant surgery, we will give you detailed advice on your wishes and expectations and assess the chances for a successful treatment. The best candidates for hair transplantation surgery are patients with reasonable and realistic expectations and visible hair loss in a circumscribed area, i.e. if the recipient region with hair loss or thinning can be precisely defined (secret hairline corners, circular bald head on the back of the head) and the hair growth in the donor region is strong and stable, as is often the case on the back of the head. Not suitable for hair transplantation, however, are patients with advanced extensive hair loss, where there are hardly any areas to remove hair for transplantation without creating new gaps.
Examination:
- Medical history is taken
- Physical examination is performed
- Digital photos are taken
- Hair loss, thinning and pattern of baldness are assessed
- Hair density is measured (trichodensitometry)
- Safe donor area at the posterior scalp is assessed
During the physical examination, the hair density of the patient is determined digitally with a hair densitometer (trichodensitometry) and the quantity and location of the hair to be transplanted and the safe donor area are determined in order to guarantee the desired hair density in the recipient area and at the same time to avoid visible thinning of the hair at the donor site. In addition, digital photographs are taken, which are then used for objective analysis of hair loss on the screen and for planning the operation. On this basis we plan the hair transplantation together with you.
To plan the operation and to make a risk assessment we require:
- Full medical history
- Allergies or aversion to medications
- Any important medical reports
- Comprehensive information about any endocrine (hormone) disorder
A stable health condition and realistic expectations are good prerequisites for a hair transplant. Severe diabetes, cardiovascular disease, uncontrolled high blood pressure, inflammatory diseases of the scalp, patchy or circular hair loss are contraindications for a save and successful hair transplantation.
Women suffer from balding more rarely than men due to the protective effect of female sex hormones, namely estrogens. Hence, hair thinning in women most often occurs with menopause. However, it rarely leads to such extensive hair loss as in men. Women usually suffer from a thinning of hair in the central region of the scalp or a recession of the frontal hear line. Female hair loss can also be the first sign of hormonal dysfunction or severe endocrine disease. Therefore, in women with hair loss of unknown origin, endocrinological testing is mandatory prior to hair restoration surgery to exclude hormonal disorders that are frequently associated with hair loss, such as dysfunction of the thyroid (hyper- or hypoactivity), adrenal glands, pituitary gland and ovaries. Only women in whom the above-mentioned diseases were excluded should undergo hair transplantation surgery.
Male hair loss (androgenic alopecia) is the most frequent type of balding in case of men. Its reason is not fully understood. However, a genetic predisposition plays a major role. A man whose father, grandfather and brothers all suffer from baldness has smaller chances of hair preservation. Another important factor triggering this process is an active form of the male sex hormone testosterone called dihydrotestosterone (DHT). The appearance of this type of baldness is so typical that it is called “male pattern baldness’. Each stage of the process was precisely described and classified by the American hair transplant surgeon O’Tar T. Norwood. The Norwood classification allows to define the current state of hair loss and facilitates the specific planning of a corrective treatment. The process of androgenic baldness most often begins at the age of 18 to 20 years. At this age, conservative treatment using finasterid (Propecia) is possible, a medication that stops the production of DHT and thereby hair loss. Unfortunately, this treatment is not effective in all men and should be discontinued after 3 months if not successful. A rare side effect of finasterid is impaired potency in about 1 percent of cases, that subside after the treatment is stopped. It mainly affects older men. If the conservative treatment does not improve hair loss surgical hair restoration is an option in men of an age of at least 25 years. Generally speaking, the later the process of balding starts the better are the prospects of treatment.
Procedure
Individual factors and personal preferences determine the choice of surgical procedure to treat hair loss. There are different methods of hair transplantation, which can be used and partly combined depending on the individual situation and the preferences of the patient and surgeon. What they are and how they work will be explained during your appointment. Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE) and Platelet-rich Plasma (PRP) are potential options for treating hair loss.
FUE (Follicular Unit Extraction)
In FUE, individual hair follicles (grafts) are extracted from a larger area of skin on the backside of the head. In both methods, the hair is then implanted individually or in small groups (grafts) where it was previously missing. The backside or the entire head is shaved, and the donor site is numbed by the injection of a local anesthetic to allow a pain-free harvest of the grafts. Using a special automated punch of 0.8 to 1.0 mm diameter, single hair follicles are released from the scalp and extracted with special forceps. The tiny wound openings at the donor site heal spontaneously within a few days and leave minute punctual scars which will later not be visible in the hear bearing scalp. The follicular units (FU, grafts) include 1 to 4 hair follicles that are spared during harvesting to allow graft survival and hair growth after transplantation.
Following harvest, the grafts are stored in a nutritive solution to maintain their viability. The FUs are counted and sorted according to the number of follicles per graft. FUs with single hair follicles are then used to create naturally appearing hear lines while FUs with two or more hair follicles are transplanted in central areas of the scalp to create a dense hair growth. Small incisions of less than 1 mm size are made at specific angles in the scalp at the recipient site using microscalpels. The grafts are then implanted precisely for a natural distribution and orientation of the hair follicles. After transplantation, the grafts are „glued“ to the scalp by the body’s own wound serum and don’t need to be fixed artificially or by wound dressings. Smalls scabs that form at the donor site will come off spontaneously within 5 to 7 days after surgery.
The grafted follicles will grow new hair that will sustain for a lifetime. In some instances, further hair transplantation surgeries are indicated to obtain higher hair density, especially in patients with advanced baldness before the primary procedure.
Generally, FUE is performed as an outpatient procedure under local anesthesia. Depending on the number of grafts, the surgery may last 4 to 6 hours, sometimes even longer. Despite this, modern anesthesia allows a painless performance of these time-consuming procedures.
Compared to FUT (see below), FUE can be advantageous in specific situations. The procedure does not require a long incision at the back of the head for graft harvest and avoids a scar that may be visible in men wearing short cropped hair. The method may be used in patients with a tendency to hypertrophic scaring and the recovery is usually faster than following FUT. Disadvantages are that a larger area of the head needs to be shaved and that less hair follicles may be obtained in patients with advanced baldness and a need for high numbers of grafts. Also, FUE is less suitable for patients with very curly hair.
If an FUE or FUT is advantageous in your specific case needs to be decided with your doctor individually, depending on your personal expectations and wishes.
FUT (Follicular Unit Transplantation)
In FUT, the hair follicles are extracted by removing a 1 to 2 cm wide strip of skin from the hair corona region at the back of the head. The strip of skin is then split into follicular units (FU, grafts) including 1 to 4 hair follicles by microsurgical techniques that spare the delicate hair follicles and allow graft survival and hair growth after transplantation.
As with FUE, the grafts are stored in a nutritive solution, counted and sorted according to the number of follicles per graft. FUs with single hair follicles are used to create naturally appearing hear lines while grafts with two to four hair follicles are transplanted in central areas of the scalp for a dense hair growth. As with FUE, small incisions are made at specific angles in the scalp at the recipient site and grafts are implanted precisely for a natural distribution and orientation of the hair follicles. The grafts are „glued“ to the scalp by the body’s own wound serum and don’t need to be fixed artificially or by wound dressings.
Hairs are only shaved at the hair donor site on the back of the head. After harvesting the strip of skin, the wound is closed directly using a special trichophytic suture technique that spares the surrounding hair follicles. The suture line can be covered by the surrounding hair and is virtually invisible after surgery. Depending on the type of skin, the scar may be 1 to 3 mm wide. The currently applied trichophytic suture technique minimizes scar width by letting hair grow through the scar. Thereby, the scar becomes even less visible even when a short hair cut is desired. Sutures are removed after two weeks.
As with FUE, the grafted follicles grow new hair that will sustain for a lifetime. Further hair transplantation surgeries by be indicated to obtain higher hair density.
Generally, FUT is performed as an outpatient procedure under local anesthesia. The surgery may last 4-6 hours and sometimes longer, depending on the number of grafts. However, modern anesthesia allows a painless performance even in time consuming procedures.
Compared to FUE (see above), FUT (strip technique) can be advantageous in specific situations. More grafts are gained, because all FUs from the strip of skin can be used. This is an advantage in cases where a high number of grafts is needed, as in advanced baldness. Also, not the entire head needs to be shaved and the donor site at the back of the head can easily be concealed by surrounding hair. However, FUT results in a long scar compared to multiple punctual scars of FUE that may be visible in patients with short cropped hair. a disadvantage compared to multiple micro
The procedure does not require a long incision at the back of the head for graft harvest and avoids a scar that may be visible in men wearing short cropped hair. The method may be used in patients with a tendency to hypertrophic scaring. And the recovery is usually faster than following FUT. Disadvantages are that a larger area of the head needs to be shaved and that less hair follicles may be obtained in patients with advanced baldness and a need for high numbers of grafts. Also, FUE is less suitable for patients with very curly hair.
If an FUT or FUE is advantageous in your specific case needs to be decided with your doctor individually, depending on your personal expectations and wishes.
PRP (Platelet-rich Plasma)
PRP is produced from the patient’s own blood and stimulates hair regeneration after injection in the scalp. This effect is presumably initiated by an enhanced blood flow in the skin with improved nutrition of the hair follicles. At a younger age or in case of early hair loss, PRP may be employed as the only means to stimulate hair growth. But it can also be combined with hair restoration surgery to improve the result after a hair transplantation.
Usually, 4 to 6 PRP treatments at monthly intervals are advised for an optimal stimulation of hair regeneration. The presence of remaining hair follicles is a prerequisite for a successful PRP treatment. Therefore, PRP by itself is only indicated in the presence of vital hair follicles in the early phase of hair loss.
PRP by itself is not useful in advanced hair loss or baldness, once many or most hair follicles have died. But in these cases, PRP can be used supplementary to hair restoration surgery in order to promote the healing (take rate) of transplanted hair grafts and to prevent further hair loss. For an optimal effect, 3 to 4 PRP treatments at monthly intervals with a repetition after 6 months are recommended. For the maintenance of hair growth, a yearly repetition of the PRP treatment is indicated.
Risks
Serious complications are very rare with hair transplantation. Nevertheless, every patient has be informed of the risks associated with the surgical procedure:
- Hematoma (bruising), bleeding and swelling
- Healing problems or infection
- Numbness in the area of operation (temporary or permanent)
- Circulatory problem of skin (skin slough)
- Scars
- Unsatisfactory hair growth and aesthetic result
- Secondary surgery
Overall, hair restoration surgery is a safe procedure when undertaken by an experienced plastic surgeon. You can help to minimize the risks by following the advice of your surgeon. Minimal bleeding from the donor site usually subsides within a few hours. Swelling of the scalp, forehead and sometimes the eyelids resolves within a few days. In some cases, inflammation of the scalp may need to be treated with antibiotics. In extensive hair transplantations, numbness of the scalp skin may last for 3 to 6 months.
Preparation
Our aim is to make the time before and after the procedure as comfortable as possible. We will give your full information on all necessary preparations for the surgery. By following a few recommendations, you can support our care:
- To aid the healing process avoid smoking for two weeks before and after the operation.
- Avoid medication that increases the risk of bleeding, like aspirin, non-steroidal anti-inflammatory drugs, as well as vitamins and homeopathic remedies for two weeks prior to the operation.
- If you have short hair, it can be an advantage to allow it to grow before the surgery. Longer hair will help you to cover the traces (fresh scars) of surgery.
- The hair should be washed on the evening before surgery or in the morning on the day of surgery using a mild disinfectant shampoo.
- All chemical hair treatments (coloring, bleaching) should be avoided for four weeks after the operation.
- As it is an outpatient procedure, make sure that you can be collected and cared for by someone for 24 hours after the procedure.
Day of surgery
In most cases, hair restoration surgery is performed under local anesthesia as an outpatient procedure at the AARE KLINIK. In individual cases, when necessary, the procedure can be undertaken in general anesthesia as part of a short inpatient stay at the AARE KLINK.
During the operation you will receive various medications for your wellbeing as needed. Depending on individual cases and the length of operation, you will have a local anesthesia with sedation or a general anesthesia. The sedative given to you orally before surgery will decrease the feeling of anxiety before and during the operation. For your safety, your heart rate, blood pressure, oxygen supply etc. are monitored during the operation.
In FUE, the hair at the back of the head is shaved in a fashion that allows the donor site to be covered by surrounding hair, if grown long enough, until the hair at the donor site has regrown again. While the local anesthetic is applied, you may feel a slight pain at the injection site and a faster heartbeat as a result of a small quantity of adrenaline that is added to the local anesthetic to prolong its anesthetic effect and to reduce bleeding during the surgery. In FUE, the single follicular units are harvested with a special oscillating punch (hybrid punch) of 0.8 to 1.0 mm diameter that releases the hair follicles gently from the scalp. The integrity of the grafts is continuously checked as a prerequisite for graft healing. Grafts are removed with atraumatic micro-forceps and the integrity of grafts is continuously checked as a prerequisite for graft healing. Gafts are counted and sorted, based on the number of follicles per graft, and are kept moist in saline solution until implantation. Implantation of the hair grafts is performed by two surgeons in a so called “four-hand-stick-and-place”-technique, that minimizes the time interval between graft harvest and implantation to optimize graft viability. Correct graft position and orientation is noted to ensure a natural and dense hair growth. Often 1’000 to 2’000 hair grafts are transplanted, which may take 4 to 8 hours of surgery.
You can return home a few hours after the operation. Mostly the pain after a hair transplantation is mild and can easily be treated with pain medication. In the evening of surgery, a moderate headache can be experienced.
If you are an outpatient, you should have someone to care for you continuously for 24 hours post operation. We also offer the possibility for a short inpatient stay at the AARE KLINIK if required. If you are an inpatient at the AARE KLINIK, you will remain there until the following day.
After surgery
The scalp donor site is treated by antibiotic spray. A dressing is usually not necessary. The scalp should be kept moist on the first day using saline solution frequently. The hair may be washed with a mild disinfectant shampoo starting three days after surgery.
It is important to realize that recovery from an operation varies for every individual. During the first days after hair restoration surgery you should lay with your head and upper body in a raised position to prevent swelling. A few days after the surgery, swelling of the forehead and eyelids may occur that can be treated by applying cold gauze and small doses of steroid medication. Only take prescribed pain medication and do not take medication like aspirin.
After FUT, stitches are removed after 2 weeks from the back of the head. Any irregularities, asymmetry, swelling or bruising should disappear with 2-3 weeks. Any feelings of numbness should subside within a few weeks or months.
You will have numerous postoperative check ups at the AARE KLINIK to make sure your recovery is optimal. Depending on the type of job performed, you can return to work after one or two weeks. You will be informed about when you will be able to resume physical exercises. All patients receive detailed postoperative recommendations before leaving the AARE KLINIK.
Outcome
One week after surgery, small eschars covering the hair grafts will start coming off. It is recommended to start massaging the treated scalp regions applying baby oil which will fasten the healing process and reduce the itching sensation of the scalp. Transplanted hair will fall out within two weeks after surgery due to the surgical trauma that prompts the hair follicles to go into the telogen (resting) phase of the hair cycle. New hair begins to grow after three months at a speed of 1 cm per month. You may see the early effects of hair restoration surgery after 5-6 months. It takes 6 to 12 months before the outcome of hair restoration surgery can be fully evaluated.
With hair restoration surgery, existing hair in the treated may also fall out moderately. In order to limit this side effect, it is recommended to apply Regaine 2-5% (minoxidil) and Propecia (finasteride) alternatively before surgery. It is also reasonable to continue the treatment sometime after surgery. After FUT, the scar on the back of the head will be swollen and pink initially and will soften and become pale within the next few months. Even though a scar always remains after hair restoration surgery, its position and appearance will render it almost invisible.
It is important to remember that hair restoration usually involves two or even three surgeries. After the entire bald region is covered at the first surgery, during the second surgery the hair density is enhanced for a more natural appearance. The results of hair transplantation are substantially satisfactory to the majority of patients. Many of them emphasize a considerable improvement in self-esteem and relations with other people. The effects of hair restoration are generally long-lasting. However, the aging process and hair loss continue after the surgery and further treatment may be necessary.
Costs
Hair restoration is a purely aesthetically motivated operation and therefore the costs have to be covered by the patient. In some cases of hair loss inflicted by illness or trauma, medical insurance may cover the costs. The costs of hair transplantation vary depending on the extent number of hair grafts and procedures needed to achieve the desired result. Therefore, the exact costs can only by ascertained after a personal consultation.
The costs mainly depend on the number of hair grafts and surgeries needed to obtain the desired result:
- CHF 5-6 per graft, i.e. CHF 5’000-6’000 for 1’000 grafts, CHF 10’000-12’000 for 2’000 grafts, etc.
- 5% discount on second hair restoration surgery
- 10% discount on third hair restoration surgery
The overall costs are made up of:
- Surgical fee (including consultation and post-operative care):
- Technical infrastructure costs (AARE KLINIK)
- Medication
- Diagnostics (laboratory, ECG, scans, etc.)
Appointments for hair transplantation with Dr. Scheufler in Bern
If you plan a hair removal you should have a comprehensive consultation. Only in this way can you be sure whether the type of transplantation will lead to the hair you expect. In addition, your consultation will give you a good impression of our experience in the field of hair transplantation Feel free to ask for before and after photos to get an idea of what the results look like.
PD Dr. Oliver Scheufler, board certified plastic, reconstructive and aesthetic surgeon and author of this website, is pleased to be at your service for a personal consultation. Besides his main occupation at the AARE KLINIK, Dr. Scheufler is also scientifically active and lectures at the University of Basel. He also was a visiting professor at Duke University (USA). Please do not hesitate to contact him if you wish a professional consultation!