Hair replacement surgery consists of taking strips of hairy scalp from the back and sides of the head, converting the strips into grafts, and then transplanting these hair-containing skin grafts into the bald areas. Since the transplanted hair is your own, chances of rejection are minimal. The transplantation of this hair, referred to as "donor hair," does not change the hair's ability to grow or its color.

What Makes a Good Candidate?

The best candidates are men who are bald over a relatively small proportion of their scalp and who have a large area of donor hairs. But the hair color is also factor. Men with light colored or salt-and-pepper hair look more natural after surgery because these types of hair make for better matches. Also, thin hair makes for a better blend than thick hair.

How Is the Surgery Done?

Doctors can achieve natural results by transplanting very small grafts (micrografts) of hair into the bald area in groups of one, two, and three hair follicles. The grafts are placed close together, and the result is denser hair growth that is more natural looking.

The procedures for obtaining these small grafts vary. Richard S. Greene, MD, of Plantation, Florida has done more than 7,000 hair transplants. He prefers to "harvest" donor hair using a multi-blade scalpel. Other doctors, such as Riggs, use a single blade. Neither doctor uses a laser for harvesting hair. Instead, lasers are used to implant the grafts.

Aside from grafting, there are other procedures used in hair restoration. For example, scalp reduction is a surgical method that can effectively reduce a man's bald appearance. According to the International Society of Hair Restoration Surgery (ISHRS), it is often done prior to hair replacement surgery. In this procedure, patients with a good amount of dense hair on the sides and back of their scalp have their scalp stretched upward to cover as much of their bald area as possible, leaving less area in which grafts of hair follicles need be inserted. However, the ISHRS cautions that there can be complications with this procedure, including scarring, stretching back of the bald area, and the creation of an unnatural appearance called a slot deformity.

Scalp flap is another procedure, which involves moving entire segments of hair bearing scalp into a bald area. Patients with frontal baldness are ideal candidates since this procedure provides instantaneous hairline reconstruction. A different type of scalp flap, called a scalp lift, is used for treating hair loss in the crown of the scalp. This procedure involves moving the fringe hair on the sides and the back upward towards the center of the bald area in a U-shaped pattern. It is used in combination with hair transplantation and can achieve good results.

What Can You Expect?

After the procedure, the hair grafts and the donor sites will form small scabs. If you have enough surrounding hair, the scabs can be camouflaged with careful hair combing, and the scabs will usually come off in about a week. Typically the grafted hair will shed in 2-4 weeks. New growth will begin in 3-4 months. It may take up to a year for the hair to completely grow in.

A Careful Decision

If you are considering hair replacement surgery, Greene cautions that "doctor" does not mean "miracle worker." Doctors can only work with the amount of donor hair a patient has. Green also says that the doctor should be chosen after careful study of the certifications (eg, in dermatology or cosmetic surgery), number of years experience in this field, and references—preferably from satisfied patients and hair stylists who have had first-hand experience with the results. If you are a good candidate, you may be able to regain a full head of hair!