Hair transplants have progressed a lot over the years. We have gone from being very limited in what we were able to do for patients, doing sometimes painful surgery which would leave ugly scars and unnatural results to virtually undetectable, very natural looking results with short recovery times.

But the principle has always remained the same: hair transplants have always been a procedure of moving autologous (i.e. obtained from the self) hair producing follicles from one place to another. A process also known as grafting. In most cases (but not always) they’re moved from areas of higher density in the scalp located in the temporal, parietal and occipital zones (usually what we describe as the Safe Donor Area) to areas that are in (frequently desperate :P) need of hair.

So, grafting relies on the body’s ability to regenerate from damage. This is why we can cut tiny grafts of hair follicle containing skin and implant them in the desired areas. After about 48 hours, vessels from the recipient area are already starting to connect with the vessels from the grafts and at about 3-5 days post-op, new blood vessels are forming - a process known as neovascularization.

Looking at the other end, it also relies on the graft’s ability to be cut off from blood supply (ischemia) for multiple hours and still survive. This is a process which we have refined over the years by manipulating temperature and the medium in which they are momentarily placed for storage. The cell metabolism slows down to a crawl and in a way they go into a power-saving mode. - like when my Apple Watch has almost no battery and only lets me check the time. It’s still on, but it’s hanging on for its life to the little juice it has.

Refrigerated quad Petri dish containing grafts separated by number of hairs.

It is only when these two aspects (neovascularization and recovery from ischemia) intersect that the grafts will take and grow normally in their new “home”, allowing us to do the marvelous work we’re so privileged to do.

Another completely crucial aspect of a hair transplant is of course the knowledge and technical ability of surgeon and team to perform all steps the surgery whilst ensuring that the grafts survive. They have to do it all without crushing, transecting, breaking or stripping the grafts, letting them desiccate, losing them (yes, losing them), getting them too cold or too warm, etc etc (there are quite a few ways of damaging such small and delicate structures and damage to grafts is one of the most common causes for low graft survival).

Here I am implanting grafts into the crown area of this patient.

So, whilst hair transplants are becoming more and more popular, they’re still an organ transplant, and should be treated with the care and respect due to something that is finite and non-renewable. Once they’re gone, they’re gone and being diligent in ensuring survival is the only way that a hair transplant works in the first place.

And of course, we can only say that they “work” when they actually provide natural, aesthetically pleasing results. But that goes into a different aspect of hair transplants that I would like to get to in another post.