Understanding Hair Transplant: Basics & Beyond

Millions of people worldwide suffer from hair loss, but it doesn't define who you are. Contemporary hair transplant surgery provides hope and long-term fixes that restore more than just hair; they also restore self-assurance, confidence, and the ability to face every day with renewed pride. This is where your path to regaining your crown begins.

Hair transplant surgery is a low-trauma cosmetic surgery that entails grafting healthful hair follicles from one section of the scalp (the donor area) to balding or thinning areas (the recipient area). It relies on the donor dominance concept, which states that hair follicles from the back and sides of the head are genetically immune to the dihydrotestosterone (DHT) hormone, the leading cause of male pattern baldness. The relocated hair follicles maintain their own genetic traits even after transplantation, so that they will continue to grow naturally where they are relocated. Such makes hair transplant a permanent solution for baldness, as the relocated hair will keep growing for a lifetime.

Understanding Hair Growth Cycles and Follicular Units

Hair growth is a multistep biological process that happens in cycles. Knowing the cycles is essential to understanding how hair transplantation is performed. The cycle of hair growth has three main stages: anagen (growth phase), catagen (transitional phase), and telogen (resting phase).
During the anagen stage, which may extend for several years, hair grows actively out of the follicle. This is succeeded by the catagen phase, a brief transition in which growth ceases and the follicle retracts. Then, at the telogen phase, the hair rests before ultimately falling to be replaced by new growth.
Follicular units are the natural aggregations of hair follicles that develop together within the scalp. Each unit usually consists of 1-4 hairs and related structures like sebaceous glands, nerves, and tiny muscles. In hair transplantation, maintaining these naturally occurring follicular units is important to achieve natural results.
The idea of follicular units completely changed hair transplantation procedures. Unlike previous techniques where bigger "plugs" of hair were transplanted, current methods try to maintain and move these natural follicular units. Such an understanding of hair growth's natural structure allows surgeons to produce results that follow nature's design.
When doing a hair transplant, doctors remove these follicular units either as a strip of tissue (Follicular Unit Strip Surgery or FUSS) or as separate units (Follicular Unit Extraction or FUE). Either way, the integrity of these follicular units must be kept intact if graft survival and natural-looking hair is to be achieved.
The anatomy and physiology involved in hair growth have crucial roles in determining success in transplantation. The hair follicle penetrates deeply into the dermis and at times into the subcutaneous tissue. It is composed of this intricate mini-organ consisting of the dermal papilla, which supplies nourishment to the hair, and the bulge region, which holds stem cells that are essential for regeneration of the hair. Maintenance of these structures during transplantation guarantees the ongoing growth cycle of transplanted hair follicles.

Donor dominance is a term used to describe the idea that hair follicles retain their genetic identity even when transplanted elsewhere. This theory forms the foundation of contemporary hair transplantation.

The donor dominance theory is responsible for why the proper donor site selection is so important in hair transplantation. The surgeon has to pay close attention and select and harvest the follicles in areas that are actually DHT-resistant in order for the transplanted hair to survive long-term. This is usually done by choosing follicles from the occipital and temporal areas of the scalp, which are usually most resistant to androgenic alopecia.
The law of donor dominance also explains why hair transplant is an everlasting solution for baldness. Because the transplanted hairs have the same genetic resistance to DHT as before, they will keep growing throughout the life of the patient, just as they would have done at their native site. But what must be kept in mind here is that not all transplanted hairs survive the surgery, and that's why surgeons usually factor in some graft loss when designing the treatment.
In the course of transplantation, these DHT-resistant follicles are individually removed, processed, and then planted into the recipient areas. The incisions are made by the surgeon in the balding areas, making sure they follow the natural angle and direction of the hair growth. This careful attention to the natural direction of growth, along with the natural properties of the donor follicles, leads to transplanted hair that appears and functions just like natural hair.
The recovery stage after transplantation is an important time. The transplanted hair can initially fall out in a phenomenon called "shock loss," leading to transient hair thinning and bald spots. This, however, is a natural process. After a few months, the new growth of hair starts emerging from the transplanted follicles, slowly thickening over time. This process simulates the normal hair growth cycle, as transplanted follicles resume a new anagen (growth) phase after treatment.
The success of hair transplantation also relies on having adequate donor hair for extraction. The best candidates for the procedure are individuals with stable androgenic alopecia and sufficient donor hair density. Contraindications are active inflammatory scalp disorders and some psychological disorders that could result in unrealistic expectations regarding the outcomes of the procedure.
See the article “Hair Transplant Techniques”