Hair transplant process checklist: These four things must be made clear!

Author: Yang Dingquan, Chief Physician of China-Japan Friendship Hospital

Reviewer: Zhang Yi, Chief Physician, Peking University International Hospital

After taking medication and adjusting your lifestyle, if your hair loss still does not improve and your appearance becomes worse, have you ever thought about hair transplantation?

So what should you pay attention to before and after hair transplantation? And how should you choose the hair transplantation method that suits you? This article will answer them one by one.

1. What examinations need to be completed before hair transplantation?

① Dermoscopy:

Healthy hair follicles and a healthy scalp are the basis for successful hair transplantation. Therefore, before hair transplantation, we must do a dermatoscope or trichoscope examination.

A dermatoscope is like a cardiologist's stethoscope and a dermatologist's third eye. It can magnify the scalp and hair follicles by 20-40 times, and clearly show the diameter, color and surrounding scalp condition of the hair follicles. It helps us determine whether the hair in the donor area is in a resting phase (hair in a resting phase cannot survive after transplantation), whether folliculitis exists (not suitable for hair follicle extraction), whether the blood supply to the transplantation area is sufficient, whether the scalp environment is healthy, whether there is inflammation, dandruff, fungal infection, etc., to help us determine whether the transplanted hair can survive.

Figure 1 Original copyright image, no permission to reprint

Generally speaking, people who need hairline adjustment and scarring alopecia do not need to make too much preparation. If there is no problem in the dermoscopy, hair transplantation can be done. If it is androgenic alopecia, and drug treatment for 6-12 months cannot completely restore hair growth, hair transplantation combined with drug treatment can be considered. If scarring alopecia is caused by lichen planus, hair transplantation can be chosen only after the condition has stabilized for 2-3 years and does not recur.

② Routine preoperative examination:

Although hair transplantation is minimally invasive, it is still a surgery after all, so routine preoperative examinations are also required, such as whether the coagulation function is normal, whether there is anemia, and whether there are infectious diseases (hepatitis B, AIDS, syphilis, etc.).

③Evaluation and design of hair transplantation plan:

Before hair transplantation, the height and shape of the hairline need to be designed, and the area to be transplanted and whether there are enough hair follicles in the donor area need to be evaluated. Generally, about 40 hair follicle units, or about 80 hairs, are required to be transplanted per square centimeter.

2. Do I need to stop taking medication or shave my hair before hair transplantation?

For many people who want hair transplants, they usually use finasteride and minoxidil for treatment. Finasteride can mainly inhibit 5α-reductase, prevent excessive conversion of testosterone into dihydrotestosterone, and cause miniaturization of hair follicles, so that hair follicles can maintain a good growth state. Since finasteride generally has little effect on intraoperative bleeding, it can be used continuously before surgery.

However, minoxidil is the opposite. It is a vasodilator that can dilate blood vessels, making it more likely to cause excessive bleeding during surgery. Therefore, it is generally required to stop using minoxidil 2 weeks before hair transplantation.

In addition to minoxidil, other drugs that can promote blood circulation, anticoagulation, and vasodilation also need to be discontinued, such as aspirin, which is generally required to be discontinued three days in advance. Some immunosuppressants are also recommended to be discontinued because they may affect wound healing, and then resumed one week after surgery. Of course, the specific implementation still needs to be based on your own situation and under the guidance of a professional doctor.

In addition, in addition to stopping medication appropriately, is it necessary to shave or wash the hair before hair transplantation?

In fact, although not everyone needs to shave their hair, shaving hair will have a better effect on hair transplantation and will often facilitate the operation. This is because it will be more convenient to extract hair follicles after shaving, the quality of the extracted hair follicles will be higher, the efficiency of the operation will be improved, complications will be reduced, and the survival rate of hair follicles after hair transplantation will be higher accordingly.

The night before hair transplantation, patients are advised to wash their hair thoroughly, because it is generally required not to wash their hair for three days after hair transplantation. Washing in advance is helpful to keep the scalp in a good condition and make the new hair transplant easier to survive.

3. How to choose the surgical method for hair transplantation?

Hair transplant surgery requires three steps: hair follicle extraction, sorting, and transplantation. Depending on the method of hair follicle extraction, it can be divided into two commonly used basic procedures, namely FUT and FUE.

FUT is to take a strip of scalp with hair follicles from the donor area, and then take hair follicles from the scalp strip and implant them in the hair transplant area. This method of hair removal is relatively fast, but it is painful and will leave a linear scar on the back of the head, and the recovery time is long.

The current mainstream method is FUE, which is to use a tiny trephine to remove hair follicles from the scalp one by one under local anesthesia. The number of hair follicles removed needs to be more than the number of transplanted follicles. This method only leaves a dot-shaped scar, which is small, recovers quickly, and looks more natural, but it takes a long time.

Figure 2 Original copyright image, no permission to reprint

At present, on the basis of the two basic technologies of FUE and FUT, some more sophisticated methods have been derived on the market, such as hair transplant robots and long hair transplants. These methods basically only use more advanced artificial intelligence technology when taking hair follicles, or use finer trephine, or consider the direction, angle, and thickness of hair more carefully when taking and transplanting hair. Fundamentally speaking, they still have not broken through the two basic technologies of FUE and FUT, so we should also pay attention to rational analysis when choosing, and not fall into the "concept trap".

4. How to care and follow up after hair transplantation?

Generally speaking, the survival rate of regular hair transplant surgery can reach about 90%. You need to go to the hospital 3 days after the operation to wash your hair with the help of a nurse, and return to the hospital 7 days after the operation to clean the blood scabs. At this time, the hair follicles are basically strong, and you can wash and care for them normally at home. When choosing shampoo, try to choose a mild shampoo with a pH value of 6-7, and use your fingertips to gently rub your hair, and avoid scratching your scalp with long and sharp nails, which may cause damage to your scalp and hair.

The transplanted hair may fall out within 2-3 months after the hair transplantation, but new hair will grow again after 3-4 months, and the ideal effect (for men) can be achieved after about 9 months. It is recommended to return to the hospital for a follow-up examination 1, 3, 6, and 12 months after the operation. If the condition remains stable after one year, no follow-up is required. However, if the patient is suffering from male pattern baldness, it is recommended to persist in the treatment after the hair transplantation to maintain the growth of the original hair.