Hair Transplantation

Hair Transplantation is a surgical procedure carried out under local anaesthetic, in which hair is transferred from the rear part of the scalp to the sparsely covered area. As a rule, the transplanted hair continues to grow in its new area naturally and as usual throughout the patient's life-time. Since the transplant procedure is carried out under local anaesthetic, any risks are virtually nil.

Up to the end of the 90's of the 20^th Century, hair transplants were performed by taking clusters of hair and transplanting them in thinly covered parts in order to fill out the sparse area. Even though the sparse areas were thickened with transplanted hair, it was easily discernible that the particular individual had undergone a hair-transplant, whose appearance was not at all natural.

As time went by, noticeable improvements in the methods of hair transplantation began, to the point that today it is feasible to perform hair-transplants without any fear of their being detected as such.

Consequently, there are nowadays many singers and celebrities who have had hair-transplants, and no-one has been able to discern them at all; the transplant being so good ,one could not do so.

The minimum age for hair-transplants is 25, as then it is possible to know clearly the manner of balding, its characteristics, its extent etc. Still, there are exceptions, where it is possible nevertheless to perform a hair-transplant before the age of 25, when the balding is localised and the patient has been getting preservative treatment – therefore, it is very important that the diagnosis be carried out by a dermatologist specialising in matters of hair and who can give the prognosis regarding the Alopecia and its possible continuation. In addition to this, it is important to know that in the transplanting of hair on males under the age of 40, it is reasonable to assume that the process of balding will continue, and that is why it is recommended to these men to be treated with Propecia in order to safeguard existing hair that was not transplanted.

Of course, the decision whether to continue taking the preservative goes to the core of the matter, and therefore, here too it is important that a specialist like Dr. Ginzburg should make the diagnosis.

There exist today a number of methods for hair-transplants where the main differences between them are in the field of the size of the implants, the equipment used by the operating doctor, the quantity of treatments and the method of taking the hair from the back of the head, it being the “donor area” as it were. The most widely used method today producing the best results is the F.U.T. Method.

It must be noted that Dr. Ginzburg does not use only one method. He matches the method to the patient and not vice versa, for each person goes bald differently, and one needs to discern the type of baldness, its location, the colour and type of hair, its density and the age of the patient.

HOW IS A HAIR-TRANSPLANT PERFORMED?

F.U.T. Follicular Unit Transplantation.

By this method, follicular units (units of 1-4 hairs growing together) separated with the aid of a microscope, are implanted. As aforementioned, the transplant is performed under local anaesthetic and is virtually painless during the transplantation and afterwards.For a quarter of an hour, the patient lies on his stomach while a strip of hair is taken from the back of the scalp. The follicular units are separated from the strip under a microscope by a proficient staff of six nurses. The attendance of a larger staff leads to a much faster return of the implants of units comprising from 1-4 hair follicles to the scalp. The use of a microscope facilitates the separation of the follicular units in a precise manner, without causing any damage to the hairs, thus producing 20% more units. Were it not for the use of the microscope in this procedure, a number of hairs might be cut and damaged at the time of their separation from the strip of skin that had been removed, and as mentioned the number of units would consequently be fewer than otherwise.

By the use of a special instrument the doctor makes tiny perforations in the balding area intended for transplantation, and the implants that will have been suitably prepared are inserted into the perforations. During the course of the hair-transplant, the patient is fully conscious and can even watch T.V. or listen to music. At the conclusion of the treatment, which lasts on average about 4-5 hours, the patients returns home, and on the morrow he can even shampoo his head.

The scar, that remains on the scalp resulting from the extraction of the hairs from the back of the head, is generally 1-3 mm (minimal) in size, which is covered and hidden by the existing hair around it, thus becoming unnoticeable.

In cases of hair-transplants in an area of conspicuous baldness, scabs will appear after treatment where the perforations were made. However, five days after the transplantation, by applying Fucidin cream, the scabs fall off together with the implanted hair, in a way that the root-hairs remain under the skin. The implanted hair begins to grow naturally about three months after the transplantation

at the rate of 1 cm per month in its new location. The final results can be seen already after 9-12 months.

The results of the transplantation that was carried out under strict control and by a specialist doctor are a cause for satisfaction and create the conditions in which 95% of the implants grow, out of the total number of transplanted hairs.

This method is good especially for those who have not yet become completely bald, those who are suffering from the phenomenon of balding and thinning of hair, because in these cases it is feasible to penetrate and merge the new hairs among the hairs already existing on the patient's head, and through the skill of the doctor harm to the existing hair is prevented.

A person who has gone completely bald will require a number of transplants varying between 2-3 treatments on average, until maximum coverage of the scalp is attained. Especially good results are attainable in a situation wherein dense hair exists in the donor area.Thin hair in this area will lead to a thickening of the balding area, but the hair will remain thin, nonetheless its condition will yet improve and the area will be fuller than in its previous state. There are cases in which the taking of a strip of hairs and leaving behind a scar is not recommended, even if it be a minimal scar. Thus, for example among the youth who are used to going around with very short haircuts, the scar remaining after the transplant will appear despite its being minimal, and therefore the F.U.T. Method is not recommended for them.

Another example is that of patients who, in the past, underwent several transplants, and there is no possibility to take an additional strip of hairs, as the skin is no longer pliable. In such cases one can take from the donor area individual hair follicles via the F.U.E. Method.

What is the FUE technique

The F.U.E. technique is a new technique that came on the scene in the last decade. By using a piercing instrument with a 0.7 – 0.9 m.m. diameter , one is able to extract the follicular units one by one from the donor area. The follicular units are placed in a special liquid in which they are kept until one has completed extracting all the units which will later be inserted into the balding area. Since the donor area has a genetic trait of resistance to falling hair, that information passes on also to the implanted area, so that the transplanted hair grows permanently.

The FUE technique can be performed on any man, but is recommended mainly for men who sport short hair – the sign that remains after the extraction of the follicular unit is invisible, and after 4 days the patient can return to his regular way of life without feeling anything.

The FUE technique is used by means of a local anaesthetic, and it is most important that it be done by a doctor very experienced in this technique – One of the most important things is the extraction

of the hair follicle in its entirety, for without sufficient experience the doctor can easily cut the hair in the middle and fail to extract the entire follicular unit. With the FUE it is possible to extract on the average of 2000 grafts in one day, providing that the doctor has the appropriate state-of-the-art instruments, thus making it possible to extract the necessary quantity of hair as quickly as possible, so that the hair can be returned speedily to the bald spot.

With the FUE technique , one has to shave the donor area leaving 1 m.m. of hair in order to make it possible to see the direction of the hair at the time of its extraction. We mark the spot where the hairs are taken from and anaesthetise the area by means of a very thin needle that prevents the patient from feeling any pain – after 5 minutes the area is anaesthetised and the procedure can begin.

The patient lies on his side while the skilled staff begins to extract the follicular units – in order to extract them we use one of the most advanced instruments in the world, that makes it possible to extract 500 – 700 hairs per hour.One identifies the follicular unit by using spectacles that magnify the unit and with its help one can pierce around the unit as far as the dermis.

At this stage we make use of a special forceps in order to withdraw the whole follicular unit.

The special instrument comprises a blunt piercing needle that penetrates in a rotatory manner into the skin until the doctor senses that it has reached the dermis and then stops. It is most important to be precise, at this stage, about the penetration of the instrument at the correct angle in the same direction of the hair growth in order to succeed in extracting the hair in its entirety. It must be noted that a follicular unit can be made up of 1,2,3 or 4 hairs.

The next stage is the extraction of the hair – using 2 special forceps we grasp the end of the follicular unit and draw it delicately in the same direction that the hair grows until one senses that the hair is free of the dermis and the fat. This action is regarded as being microsurgical, and herein lies the extreme importance of the operating doctor's skill. Tiny holes of 0.6 – 0.8 diameter remain, with the result that there is hardly, if any at all, bleeding.

It is important to leave spaces between the hairs that are extracted so as not to leave empty areas, by extracting 1 out of every 3 hairs. At the conclusion of the extraction of the follicles, the whole donor area is left with perforations of a light redness; 24 hours later all the perforations are covered with scabs which fall off 4-5 days afterwards without any side-effects. Since the holes are so very tiny, they close up without any need for surgical work whatsoever. The donor area remains sensitive for the first 24 – 48 hours and can cause light itchiness in the perforated area due to the healing of the wounds.

In spite of the FUE Method sounding like a very simple technique enabling the hair extractions to be done one by one, the procedure actually takes a long time and demands great concentration and skill on the part of the operating doctor.

TRANSPLANTATION BY THE FUE METHOD IN OTHER AREAS

Apart from the mostly used place at the back of the scalp, one can also, using the FUE Method, extract hairs from other areas of the body, viz., chest, shoulders,hands,legs and even the beard. Those same hairs one can implant in other parts of the body,viz., eyebrows, beard and moustache. The extraction of hairs by the FUE Method from the body is more difficult than from the scalp, and I have had cases where even small scars remained in the chest area, so I, personally, would not readily recommend the extraction of hairs from these places.

PRO'S AND CONS OF TRANSPLANTATION BY THE FUE METHOD

Like everything, each technique has its pro's and cons. The advantages of the FUE technique are: One does not use scalpels, there is no need for stitches and so pain is minimal, there is less chance of bleeding (there being no strip surgery), healing of the wounds within 4 – 5 days – as opposed to strip which take a week to ten days, and the vestige that is left of each hole that closes up is minimal and is undetectable with the naked eye.

The disadvantages of the FUE technique are: The procedure takes 2 – 3 times longer and the amount of hair one can extract at one time is much more limited – with a strip one can extract on average about 3000 – 4000 hairs in one procedure, whereas with the FUE one can extract in the course of a whole day about 4000 hairs, depending on the differing hair structure of each patient. An added advantage is if a larger amount of hair is required for transplantation, one can use the same technique the next day, the following week or month or at any time of the patient's choice.

In the areas from which or into which hair has been transplanted will have a light redness, which, after about 3 weeks, will disappear completely. In the donor area, the hair will grow around it thus, even if there is some light redness remaining, it will be unnoticeable. After an FUE treatment the patient can feel free to go about with short hair without any need to hide scars as would be the case with the FUT treatment.

In the area from which the hair was taken or in the implanted area there could remain a light redness that would disappear completely within 3 weeks, maximum. In special cases, mainly in very light skinned persons, the redness may remain for up to 3 months, but would then disappear completely .

About 24 – 36 hours after the transplant, there may appear a swelling in the forehead that will descend to the eyelids because of the anaesthesia applied to the area of implant, and as a result of its strength, the anaesthetic is absorbed, but may descend to the eyebrows and eyelids. The swelling may last for 3 – 4 days after which it passes completely.

In order to prevent the swelling we have a special plaster which we apply to the upper forehead which prevents it in most cases, and up till today, most patients who undergo transplants do not suffer

from swelling.After the transplant little scabs are formed which look like little brown crusts, 1mm In diameter and which disappear after 4 – 5 days with shampooing.. Generally, after the transplant there is no need for special treatment for the implants. In the first 24 hours it is recommended not to wet the place and afterwards, during the first ten days one should shampoo the head very gently daily, and one should take care not to leave the implanted area for too long under water. Likewise, one must take care that during the first ten days the implanted area does not experience any trauma like over-scratching or rubbing with a towel (sometimes there is itching in the implanted area).

It is also recommended not to get involved in strenuous physical activity such as football, basketball or any other kind of activity involving the upper part of the body, that could result in a blow to the head,and also to refrain from entering swimming pools or the sea, and to over-exposure to the sun in the first three weeks.

PROCEDURE OF HAIR-TRANSPLANTATION BY THE FUE METHOD AT DR. GINZBURG'S CLINIC

The patient arrives at 8 a.m. or at 4 p.m., without fasting, wearing a buttoned shirt, and meets with Dr. Ginzburg in order to finalize details regarding the transplant, and to obtain answers to queries and questions that might arise at the last moment.

After the patient having signed his consent to the transplantation, the donor area is shaved with an electric razor, level 0 (it is not recommended to use a “cut-throat” razor as this does not allow one to see the root that is to be extracted.) Since the treatment may sometimes be lengthy, the patient is given a relaxation pill so that he may sleep awhile during the transplantation. There is no need for an infusion since the patient is only under a local anaesthetic.

The local anaesthetic is applied in the donor area which is numbed at that spot, as we anaesthetize only the skin and not the nerves, as is the practice in the dentist's chair. Therefore, within a few seconds the patient does not feel any pain except for a few pricks, which are the actual application of the anaesthetic.

The patient lies on his belly, with a special pillow which makes it possible for him to breathe unimpeded, and Dr. Ginzburg together with one of his team begin to extract the follicular units. By using special spectacles, they select the strongest hairs that would give the most natural appearance in the transplanted area.

The team separates the follicular units into 1,2,3 and 4 hairs, which are retained in a liquid at a low temperature to prevent any damage to them. After about an hour and a half to two hours, the patient turns over on his side after our having extracted about 700 – 800 follicular units, and we begin to extract hair from one side of the donor area and afterwards from the other side in order to achieve a homogenized appearance in the donor area.

The patient can request at any time to go to the toilet or to take a drink, and we take into consideration having a lunch break.

If we dealing with 1000 implants, the whole transplantation usually ends early with no need for a meal.

THE SUITABLENESS OF A PATIENT FOR TRANSPLANTATION BY THE FUE METHOD

A young man used to going about sporting very short hair or even “bald” (0 on the hairdressing razor), subsequently, and even if a transplantation by the FUE method is performed, the scar will be visible even though it be miniscule.

A patient who is interested in transplanting hair via FUE and in the donor area there is sufficient hair to fill in the baldness.
Men who are comparatively lightly bald and who need to fill in those bald patches, e.g. men with baldness in the Norwood style , level 3, or forehead.
Instances of scars as a result of transplants by the FUT method with the aim of blurring the scar.
Patients who do not have enough scalp flexibility and it is not possible to extract a strip.
Patients who have a tendency to scarring – wide or conspicuous, so that it is not possible to extract a strip.
Patients who have undergone thus far several FUT type transplants, the scarred area does not allow for taking another strip.
Patients who have scalp scars as a result of skin diseases, accidents or burns.
Sportsmen who have to return to physical activities with minimum delay.
Patients who are not interested in remaining with scars or pain after the transplant .

HAIR-TRANSPLANTS FOR WOMEN

Alopecia in women, in contrast to men, can come about for many reasons. Therefore it is very important that a dermatologist examines the patient in order to arrive at an accurate as possible diagnosis. It is necessary to do blood tests, since shedding of hair or baldness can have a hormonal background. Shedding can increase as a result of strenuous dieting,stress, post-operative trauma,birth, stopping to take birth-control pills, over-occupation with one's hair such as tying with a rubber band and pulling it to make a pony-tail, sleeping with bunched-up hair, smoothing of hair and in addition taking particular medications known to be causes of hair falling out.

Women, like men, can also lose hair for genetic reasons, what are called Typical Female Androgenetic Alopecia. Such baldness can occur at any age but about 50% of women who reach menopause suffer from hair loss in varying degrees that may bring about future baldness.

Baldness in women is different from that of men – a woman generally loses hair but does not reach total baldness like a man, and the donor area can be sparse as in scalp regions (in contrast to men where the donor area is always hairy). Therefore, for women, great skill is required of the doctor who must decide if the woman is or is not suitable for hair-transplantation, and many times it may require a combination of transplantation and medical treatment.

When a woman is suitable for hair-transplantation, it means that the donor area from which the hair will be taken is sufficiently rich in hair and the implant area is sufficiently bare of hair, so that it would be possible to implant without harming the existing hair. There are cases where the whole scalp is sparse of hair, and so the patient is not suitable for transplantation. For women hair-transplantation is the last option she has, and it is preferable that she try medical options before deciding on a transplant.

One arrives at the decision on a hair-transplant only after an understanding between the doctor and the patient has been reached that all the medical treatments have not helped, and that there are indeed areas without follicles which one can yet feasibly fill by implantation. There are some women who go bald, like men, in patches, and in such cases one can achieve good and natural results. Then there are cases where the baldness occurs behind the frontal line of the scalp, which is typical of female baldness, even in such a case it is feasible to perform a good transplant. An additional option for hair-transplantation for women is ,when following on from pulling and stretching the hair incessantly, the original line has been lost, the same applying to women who have undergone face-lifts that left behind scars on the scalp. In all such cases one can achieve good results providing the donor area is sufficiently rich in hair. In the event that such is not the case, it would require 2 transplants to achieve completely satisfactory results.

Hair-transplants are performed under a local anaesthetic, so that any risk is virtually nil. The female patient is awake during the course of the entire procedure and feels only a few pricks in the donor area and in the implant area, after which the area is numb and there is no pain at all during the transplantation.

YOU HAVE A LOT OF HAIR... BUT NOT IN THE RIGHT PLACE!

The majority of people suffering from baldness do not know that there is such a thing as total baldness. Almost in every male there exists a U-shaped strip of hair in the lower region of the scalp. The difference between the upper and lower hair strips on the head is that the lower strip is characterised genetically in such a way as to enable it to grow all his life.

By using modern techniques, we carefully take the hairs of the donor area (the rear region of the head), one or two follicular units at a time, and implant them in new places in the frontal area of the head. The pain is hardly felt. There are patients who do not feel anything at all, and so can return to their occupations within a few days. Slowly and consistently the hair begins to grow and to fill the sparse areas. After about 3 months, the scalp begins to fill up with transplanted hair, and after 6 months a 50% result is evident , and after about a year we see a conclusive result. When the patient sees the results for himself, he feels much younger than his actual age, something that raises his self-esteem.

In the meantime, the donor areas heal so perfectly that even the hair-dresser who is familiar with the client's head would be hard put to recognise what has been done. More than 90% of men go bald in their lifetime as a result of the phenomenon known as Male Pattern Baldness (MPB). This refers to the result of a hormonal change that causes a follicular unit (hair follicles) to contract and grow progressively slower until nil growth.

The hair in the selected donor area (at the rear region of the scalp) is not at risk of male baldness, but continues to grow all life long, the same applying if the hair is implanted in other areas of the scalp. People will in the future reach various levels of baldness, as one can see in the table of baldness.

WHAT ARE THE ADVANTAGES OF ONE DOCTOR OVER ANOTHER REGARDING HAIR TRANSPLANTATION?

Without any doubt training and experience are the most important considerations in the choice of the attending physician. Dr. Ginzburg has an international reputation, a pioneer in the field of hair transplantation in Israel, and extremely experienced who has performed over 5,000 successful transplants since 1991, at which time he completed his internship in surgical hair transplantation.

When we speak of a “successful hair transplant “ , what is meant is, the transplant in which the hair was received and continued to grow all the patient's life. Dr. Ginzburg emphasises and states that a “good” transplant is one that cannot be discerned as it looks completely natural.

A very important component in the hair transplant procedure is the artistic aspect and the perfectionist nature of the physician. As a classic artist, he works in order to achieve excellent results; the creation of exact shades and colours to mingle the existing hair with the implanted hair. Every hair that is implanted by him is examined strictly so as to form a complete conception, the creation of a natural appearance with the passage of time. Dr. Ginzburg is concerned not only with the present look of the hair, but also of the look and profile of the whole head in the years following the transplant.

Over the years many actors and communal personalities suffering from balding problems have come to Dr. Ginzburg. These are people whose hair is an important element in their careers. Dr. Ginzburg initiated amazing changes to their hair appearance, and likewise to many more thousands of women and men who longed to look and feel much better about their appearance.

At the consultation all the stages of the hair transplantation are explained to the patient in great detail through questions and answers. As well, Dr. Ginzburg will lay before him matching expectations and explain candidly if he will be able to fulfil them. After checking the patient's age, hair type, manner of balding, hair quality and his life-style, Dr. Ginzburg will explain to the patient how the treatment would be performed on his type of baldness, and what his hair would look like at the end of the treatment and in the months to come.

Before starting the treatment the patient will receive again an explanation of the procedure both orally and in writing. The patient will be given a light tranquillizer according to need, will put on a gown and get on to the surgical chair. A large percentage of patients felt no pain at all during the surgical intervention. After applying a local anaesthetic, the follicular units are extracted surgically from the donor area and implanted into the selected area.

The transplanting lasts generally about 3 – 4 hours, depending on the case. After a short rest the patient returns home. In most cases the patient can go back to work on the day after the transplant. A return to physical activity is allowed only about ten days later.

In the event of the transplant being performed on the frontal part of the scalp , Dr. Ginzburg affixes a special adhesive dressing to the upper forehead in order to prevent swelling. This dressing must remain on the forehead for 4 days, which can be concealed during that time by wearing a hat.

An additional treatment can be performed at the patient's request and according to the circumstances of the case, and we would then recommend the best procedure from a medical point of view on how to achieve the goal.

In the majority of cases, relatives and friends of the patient are not able to discern a hair transplant. The greatest satisfaction is when the patient comes to Dr. Ginzburg a year later for a check-up, and sees the “Before” photograph, and even he can hardly believe that he was so bald prior to the transplant. “Appearance isn't everything”, but despite this, through painless, simple surgical intervention, it is feasible to improve the appearance and to create a good feeling of acceptance and self-esteem, so why not ?

Since 1991 Dr. Ginzburg has invested all his energy, experience and skill into helping so many sufferers from balding problems to improve their visage and feelings. Dr. Ginzburg also performs transplants in various part of the world, is invited to lecture at all conferences to do with hair , and since 2009 has been an elected member of the Directorate of the International Society of Hair Restoration Surgery – ISHRS.ORG .In 2012 was reelected to be member of the board of directors.