HAIR TRANSPLANT TREATMENTS
Images courtesy of the Knudsen Clinic.
Dr Zhen XU
Dr Xu graduated from The University of NSW in 2003 and is a medical fellow of the Australasian College of Cosmetic Surgery. He has trained with leading experts in various areas of cosmetic medicine and surgery.
Dr Xu is extremely passionate about hair loss treatment and has spent a significant part of his post graduate training with The Australasian College of Cosmetic Surgery in Hair Transplantation.
Dr Xu also specialises in liposculpture, abdominoplasty, blepheroplasty, facial suture lifts, and cosmetic medicine (anti-wrinkle injection, dermal fillers, vein injection, and lasers).
Dr Xu’s believes every patient is unique and state-of-the-art treatments are tailored to suit individual patient needs.
Questions and Answers
IS HAIR TRANSPLANTATION SUCCESSFUL?
YES! Hair transplantation has been continually refined over the last 40 years and Australia has a proud record as a leader in developing and refining advances in this field. In experienced hands, approximately 90% of the transplant hairs will grow in the new position, permanently. Hair transplantation does not achieve your original haid density but generally provides good to excellent coverage.
IS HAIR TRANSPLANTATION SAFE?
Yes. Hair transplantation has a justified reputation as being very safe. Only a few patients experience minor side effects such as initial swelling and temporary numbness in the transplant area. Minor bruising is very uncommon. Complications are very unusual and may include minor infection at the graft site which easily responds to antibiotics.
IS THE PROCEDURE PAINFUL?
No. The procedure is carried out under local anesthetic and mild sedation (which makes you drowsy but awake) so that no discomfort is felt during the procedure. Mild analgesics are provided afterwards to relieve any minor discomfort felt over the 24-48 hours following the procedures.
Ice packs may be used for the first 48 hours after the procedure to minimise any swelling that may occur.
ARE THERE ANY SCARS?
A minor scar is created in the lower scalp donor area afrer removal of the donor skin. This is stitched closed with fine dissolving sutures and a new closure technique encourages hair to grow through the scar. In any event the surrounding hair covers the narrow scar easily. Even your hairdresser will have trouble seeing it.
The graft sites in the upper scalp heal with almost no scaring which may rarely be barely visible upon close inspection if seen at all. In any case it is effectively covered by the transplanted hairs.
HOW MANY PROCEDURES ARE REQUIRED?
This depends on the size of the area to be treated and the density required. A higher graft number per session will reduce the number of procedures. It will be discussed with you at the initial consultation.
It may be as little as two procedures.
WHEN DOES THE NEW HAIR APPEAR?
After the procedure small scabs or crust form on the grafts. These protect the grafts. After 7-10 days these will flake off by themselves or may be gently removed. At this time, some of the transplanted hair seen above the scalp will initially be shed. This is normal. However the hair roots or follicles below the skin will produce new hairs after 8-12 weeks. Each graft generally produces between 1-4 hairs. At first only a few hairs are seen, but many hairs are now growing beneath the skin and they will appear gradually over the next six months. The results are at first gradual and subtle.
Follicular Unit Transplantation
Hair transplant surgery is safe and effective. Usually over 90% of transplanted hair will grow and stay permanently after the procedure.
The most common form of scalp hair loss is called androgenic alopecia, or male pattern baldness. It is genetically inherited, and can occur in male or female. There are other causes for hair loss which may be reversible; Dr Xu will explore these possibilities at the initial consultation.
In androgenic alopecia, high levels of male hormone DHT (di-hydro-testosterone) are present in hairs on the front and top of the scalp. After puberty, these hairs start to shrink (rate of shrinkage varies between people) until becomes invisible. Hairs at the back and lower sides of the scalp have low levels of DHT, and therefore are permanent.
A follicular unit is a small skin graft containing 1-3 hairs in a naturally occurring group. Follicular Unit Transplantation involves the transfer of follicular units from the back and sides of the scalp (the donor area), to the upper balding scalp (the recipient site).
Follicular Unit Transplantation is performed as an outpatient procedure, under local anaesthetic with minor sedation. Once the local anaesthetic is injected, there is minimal pain for rest of the procedure. A strip of hair containing skin is removed from the donor area, and is dissected into follicular units under the microscopes by specialized technicians. These small skin grafts are then delicately planted into small needle sized holes in the balding area. By making needled sized holes, the surgeon determines the site and exit angulations of the grafts to achieve the most natural result, including very natural hairlines. The wound in the donor area is closed with dissolving sutures leaving a thin line covered by hairs around it. Bandaging is not required after the procedure.
An ideal patient is someone over the age of 25, with rate of hair loss stabilised on Finasteride, and there are sufficient donor hairs to be transplanted to the balding area, and to cover the donor scar.
The number of grafts required in hair transplant surgery depends on the size of the area to be covered and density required. It is usually between 500 - 2500 grafts per procedure. Further hair transplant surgery may be required if you continue to lose hair, or require more density. Medication can be used to slow or stop the rate of hair loss.
Side effects of Follicular Unit Transplantation are usually minor and uncommon; they include headache, itchy scalp, bruising, bleeding, swelling, inflammation, infection, pain, numbness, cysts, anaesthetic risk, poor scarring, pitting, wound breakdown, necrosis at recipient or donor sites, poor growth, and temporary shedding of hair surrounding recipient site due to trauma to scalp during the surgery.
Small crusts will form on each graft within 24 hours after the surgery; this can be rubbed off after 7-10 days. Some hair from the transplanted grafts will grow straight away, however most will shed within 1-2 weeks, and commence growing within 3 months, it will continue to thicken over the next 6-9 months. These transplanted hairs will not shrink because they are genetically resistant.
Follicular Unit Transplantation can also be used to cover up scalp scarring from trauma, burns or previous surgery (face-lift surgery or eyebrow-lift surgery) in both men and women. It can also be used to re-create eyebrows, and fill gaps in beard/moustache.
Follicular unit extraction (FUE) is another technique used in hair transplant surgery, it involves removing the follicular units one at a time from the donor area. This technique is more time consuming, and more expensive.
Male pattern baldness
Throughout every man’s lifetime there will come a point where he will experience some degree of male pattern baldness.
Possibly 25% of men aged 25 years and 50% of men aged 50 years and so on, will have considerable hair loss which increases with age yet also differs for every individual. The rate of hair loss will not be consistent as there will be periods where the loss of hair will be heavy and at other times may be hardly noticeable. It is, however, always progressive and lasting, usually first experienced usually around the temples or crown area and continues to join over a period of years until all hair at risk has been lost, leaving only the “back and sides.” The pace at which the loss of hair is experienced will depend not only on the inherited tendency of the individual, but also minimally due to environmental factors such as tension or anxiety.
It has been shown that the male hormone Dihydrotestosterone (DHT) must be present for the balding process to take place and lack of it, as in Eunuchs, will stop this kind of baldness from occurring. The “back and sides” hair is not vulnerable to Dihydrotestosterone and thus, is not involved in the process of balding.
There are some effective medical treatments available currently for the prevention of male pattern hair loss. They offer the possibility to slow and/or stop baldness from developing further. In some cases there have been results where regrowing of hair has been evident in a minor percentage of males suffering from baldness. There are numerous products available to help treat and prevent hair loss but only a minority actually succeeds in doing so. Minoxidil (Regaine) and Finasteride (Proscar, Propecia) are two products which both have had positive results. Not only should high-quality medicines be used to combat hair loss, but also physically and mentally being in a state of healthiness will be advantageous to encourage the development of healthy hair.
Female pattern thinning
Female pattern thinning is actually quite common yet not as profuse as in males. It is more common for the thinning of the hair to be located in the frontal area. Female hair loss runs in families, occurring in some individuals as early as puberty, and as can be imagined related to anxiety.
It is critical to examine and eliminate the possibility of a related medical problem as the cause of the hair loss. These include hormone imbalance and thyroid problems. Iron and zinc deficiencies are not common but can contribute to the loss of hair.
Female pattern thinning is most likely to be completely different to male pattern baldness, as Dihydrotestosterone (DHT) does not cause it at all. It is characterised by gradual thinning with age but in most cases never leads to complete baldness. Encouragingly the hair on the back of the head is spared and therefore it can be utilized for transplantation as also done in males. Minoxidil (Regaine) helps a little but Finasteride (Proscar, Propecia) does not help women.
Other types of hair loss
Telogen Effluvium: This is generalized hair loss all over the scalp resulting from chronic physical or emotional shock. The loss happens at about 3 months after the incident and will gradually regrow over the next 12 months.
Anagen Effluvium: Best known as a result of chemotherapy, this sudden loss of masses of hair can also happen in some form of scalp surgery.
Alopecia Areata: Small patches of hair loss usually associated with anxiety. Can recur but most commonly disappears.
Alopecia Totalis: Total loss of hair when Alopecia Areata becomes chronic. Can be difficult to reverse.
- Burns and other unintentional damage to the scalp.
- Ringworm and other severe infections.
- Nervous Tugging and Handling of hair called Trichotillomania.
- Autoimmune diseases such as Lupus and Lichen Planoparis.
- Breakage due to improper care and cosmetics.
- Females: pregnancy and oral contraceptives, which is usually temporary.
- Other very rare diseases.
- Treatment options
Today, there are many options available to hair loss sufferers, both medical and surgical, and this will be discussed and explained to you during your consultation.
At Rejuven8 Penrith Cosmetic Clinic we only offer the best treatments for hair loss that have been scientifically proven to be of benefit, and that produce the best possible results in the fight against the loss of hair.
Medical Hair Treatment has definitely improved with the introduction of Finasteride (Proscar, Propecia) and is now a viable option for hair loss sufferers who meet the criteria for using such medication. Minoxidil (Regaine) is still helpful for some individuals.
Finasteride seems to have gained better results than Minoxidil, and are both freely available, but the down side of any medical treatment application is that is has to be taken daily for life. Both medications can be taken together with a combined 75-80% chance of slowing the rate of hair loss or even producing regrowth in some patients. Finasteride is easier to use, more effective and more economical but it has been shown that it is not effective in females.
No matter what medication you choose there will be an ongoing cost. The rate of hair loss will not be any faster after you stop the tablet. Thus, having a break in the cycle/ forgetting to take Finasteride will mean your hair loss will start again.
With any medication, there will be contraindications, and some side effects so it is important that you thoroughly discuss this with Dr Zhen Xu comprehensively during your consultation so that you have a detailed understanding.
Progressive miniaturisation of the follicle that occurs in baldness is reversed with medical hair treatment.
Home laser treatment has now been shown in clinical trials to be as effective as Finasteride.
Micrografting or follicular unit transplantation has improved highly in the last 5 years. It is a minor surgical procedure performed in a day surgery with twilight anaesthetic. A small piece of hair producing tissue is taken carefully from the back of the head and dissected with the aid of microscopic vision creating micrografts of one, two and three hairs. Hair grows in the back of the head in groups of one, two or three (rarely 4) hairs. These groups of hairs are known as follicular units and need to be transplanted intact for the best and most natural growth to occur. It is almost impossible to do this without a microscope. These units are then planted into areas on the hairline where the level of density has decreased, therefore providing a natural looking appearance. Results of the new implanted hair follicles will be visible within 3-6 months post operatively.
Gone are the days of the old cornrow hairline, or plugged crown area that became more obvious as balding progressed over time. Today’s hair transplantation is easy and effortless and is completely undetectable. The advantage of hair transplantation is that they need no special or ongoing treatment, just shampoo, conditioner and hairdresser.
Procedures of up to 2000 follicular units can be performed in any one session, or alternatively can be performed over several sessions according to your needs. During your consultation with Dr Zhen Xu he will discuss your hair loss history with you and suggest the best option for you as an individual along with your expectations as to the final outcome.
A detailed consultation with Dr Zhen Xu is required before your procedure can be performed. The duration of the consultation will be around 30 minutes in which Dr Zhen Xu will discuss the following issues with you.
- Take a detailed account of your medical and hair loss history including any past procedures, current medications, any noticeable illness in either you or your family, and also any known allergies.
- Thoroughly discuss your treatment options for your particular hair loss pattern as to which will give you the best results.
- Discuss all aspects of the procedure with you. Suitability as a candidate, your personal desires and expected outcomes, anaesthesia, costs that will be involved etc.
- Post operative care
This is a good time to discuss with Dr Zhen Xu any concerns you may be feeling, or anything that you are unsure of. Dr Zhen Xu will be more than able to help assist in answering those questions and alleviate any anxiety you might be experiencing. If you wish to see where the procedure will take place you can also ask at this time.
Once you are confident and understand all the information that the doctor has discussed with you and wish to proceed to the next step, our clinic staff will then organize the following with you.
- A suitable time for your procedure to take place.
- A deposit to secure your procedure time
- Organising a routine blood test (compulsory for all patients)
There is no need to have a haircut for the procedure; in fact if the hair is a little longer than usual it will help to camouflage sutures and the transplanted hair grafts.
- Wash and dry your hair as usual the day or morning before the procedure but do not apply treatment lotions or sprays.
- Wear comfortable clothes, preferably a front buttoning shirt or blouse-no tight collars.
- Eat normal light meal the day before the procedure and nothing by mouth for 3 hours before you arrive. Alcohol and aspirin thin the blood and cause excessive bleeding during the procedure so no alcohol should be taken for at least 2 days prior or aspirin compounds for two weeks pre-operatively.
- Arrange for someone to pick you up after the procedure and give us their number so we can call when you are ready to be taken home.
- Country patients should try and organize to stay in the city overnight as driving long distances after the procedure is not sensible.
- Please give us as much notice as possible if you decide, for any reason to change your procedure date.
Hair replacement being an elective procedure may provoke nervousness and anxiety. This is completely normal and understandable. The last thing we want to do is make you feel uncomfortable in any way, and if you have any last minute questions we will be there to assist in any way we can. Our staff is caring and friendly and above all exceptionally professional in their approach to looking after your every need.
After your procedure
- Rest, sleep, read or watch television for the rest of the day and the same for the next day.
- Lying slightly raised on 2 or 3 pillows overnight sleeping face up reduces the incidence of black eyes.
- Take pain relieving medication and sleeping tablets provided when necessary.
- Hair may be carefully washed, conditioned and dried washed 24 hours after your procedure. A hat/cap may then be worn. Hair dryers may be used on cool setting only.
- Try to minimize bending, stooping or straining for at least 2 days post operatively.
- No strenuous physical activity including swimming for a week and no contact sports for 3 weeks post operatively. Take car when getting in and out of cars and in any other situations that may cause bumps to the head. Protect the head from sunburn as much as possible.
- Report to the clinic any bleeding, infection, swelling or excessive discomfort. Any temporary hair loss (Anagen Effluvium) should also be reported.
- Hair and scalp should be washed daily for 1 week, after this time you can return to your normal routine.
- Medical certificates can be issued when required but usually 2 days off work is sufficient.
- Should you have any concerns post operatively please do not suffer in silence, as simple solutions are often available. Simply call the clinic number on (02) 98243044.
What you should know?
Hair replacement surgery is normally a safe and effective way to regain your own hair. Like all surgery, however, any cosmetic surgery involves some level of risk.
We will do everything possible to ensure a successful outcome while you are under our care, but you must also follow our instructions very carefully. In this way we will minimize the possibility of complications.
Below is a list of complications which are rare but sometimes do happen. All are minor and self-limiting. It is important that you discuss these thoroughly with Dr Zhen Xu at your consultation.
- Adverse drug reactions
- Bleeding or oozing
- Black eyes
- Poor growth (in scars)
Should any of these surprises happen, we will handle them very carefully and professionally. You will be carefully monitored following your procedure so that if any of the above does occur, we will be able to help you.
Remember though to ensure the best possible outcome of your procedure for you and your doctor, you MUST disclose all medical conditions, illnesses, familial tendencies etc. and current medications at the time of your consultation with Dr Zhen Xu. This is a priority to allow us to maintain your medical safety and highest standards at all times.
All of our procedures rooms are fully equipped with the necessary medical and surgical equipment and monitors, and all instruments are thoroughly cleaned and sterilized for your safety and to meet the safety required operating standards. All this is provided for you in our friendly and comfortable environment.
Questions and Answers
Q. Who is a candidate for hair replacement surgery?
A. Virtually any man or woman who is experiencing some degree of hair loss can qualify as a candidate for hair replacement surgery. There are no age limits, however your consulting doctor will need to thoroughly discuss your medical history with you before advising the best treatment for you.
Q. Will it hurt?
A. No two patients react the same way to surgery. However most patients report little to no discomfort. Mild sedation is administered throughout the procedure and you are more than welcome to discuss your individual needs with Dr Zhen Xu.
Q. Should I start now?
A. The earlier you commence your hair replacement procedures the less noticeable it will be to others, easier to camouflage and avoid embarrassing confrontations.
Q. How much does hair replacement surgery cost?
A. After a thorough examination of your hair loss and discussion of various options and your expected desires, we will provide you with a realistic estimate of costs. Hair replacement costs less than you think and its your for life!