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Capillary Micrograft

IML answers the most frequently asked questions of patients medical consultation on hair transplants.

Capillary Micrograft

1. Why do people go bald? What is the main cause of alopecia?

In the majority of cases going bald is a condition and not a disease. Boldness is frequently caused by a genetic predisposition influenced by circulating male sex hormones (androgens). This is why is most common form of alopecia is androgenetic alopecia in virtue of its androgenetic origin.

Other causes of alopecia, whether definitive or transitory, may be congenital ectodermal dysplasias, immunological disorders, dermatitis and dermatosis, endocrine diseases, psychological alterations and stress, or cicatricial sequelae from trauma or surgery.

The first thing to be done is to identify the cause of alopecia, so that it can be studied and staged before a diagnosis is reached.


2. How is alopecia treated?

Taking into account that alopecia is a hereditary condition in most cases, there is not much we can do to fight such genetic predisposition. Nonetheless, hormones can be blocked or modulated by administering an antiandrogen (androgen antagonist) such as finasteride.

The combined administration of finasteride with minoxidil, a vasodilatator and direct stimulant of the capillary cycle, is very effective and a fundamental part of the therapeutic arsenal to prevent the progression of alopecia and to preserve the volume of hairs in the affected individual. In partially or totally bald areas, hair transplantation is the only alternative to recover lost hair density.


3. Who can undergo a hair transplantation procedure?

Men and women over the age of 18 can be candidates to undergo a hair transplantation procedure. This minimally invasive technique is performed on an outpatient basis without interfering with the patient´s routine activities and does not pose a risk factor that may alter the course of other clinical conditions. The specialist will assess the indication, appropriateness and the specific preparation needed for the transplantation in each individual case.


4. Who is qualified to perform hair transplantation?

There is no specific specialist certification in capillary transplantation but it is clear that a qualified experienced physician should perform the procedure in a medical setting. Since it is a surgical technique, the surgeon should be a specialist who is familiar with the principles of tissue transplantation and plasty and graft biology.

This is why the most qualified physician should be a plastic surgeon with ample experience and specific training in capillary hair transplantation. The patient has the right as well as the obligation to have these requirements met.


5. What is the difference between capillary transplantation and other techniques for alopecia?

The capital difference is that a capillary transplant is a medical treatment and as such it has been included in medical texts, with the required scientific rigor and contrasted studies that prove its effectiveness.

The procedure consists in grafts containing follicular hair units that are transported from a healthy and abundant donor area to the recipient region that lacks hairs, also called alopecic area. It is not like the rest of cosmetic procedures that do not cause any harm but do not obtain precise and proven results.


6. Is it then the best option to recover hair density?

It is the only option. If you want to have more hair or recover the hair you have lost, the only solution is to transport the hair follicle to devoided areas or hair will not grow out of the blue.

Another aspect is to preserve already existing hairs. Scientific studies clearly show, once again, that the only effective products to preserve hairs are finasteride and minoxidil, which stimulate the capillary cycle and are widely used by thousand of patients worldwide.

Other treatments based on vitamins, aminoacids, capillary lotions, anti dandruff or anti seborrheic shampoos, or other diet supplements may help, at best, to look after the hair and roots you already have but are no good to have more hair.


7. Does hair transplantation provide a definitive solution?

Absolutely. Transplanted hairs are extracted from the posterior and lateral side of the head. These areas are not genetically susceptible to hair fall caused by hormones and thus follicles extracted from these areas and transplanted into the recipient area will vascularise following their normal growth cycle. Moreover, because grafts are used, healing in the bed of thinning areas will facilitate embedding of the graft for life.


8. What happens if there is no donor area?

Where are donor hairs extracted from? In androgenetic alopecia the posterior and lateral regions of the head are preserved and can thus be used as donor areas. If there were no hair there, sufferers would not be bald but sick.

Certain diseases cause alopecia (congenital diseases, immunological diseases, psychogenic diseases). In these instances, different specific medical tests would need to be done to establish a diagnosis in order to evaluate if the hair transplantation is possible or indicated in such cases.

Hair graft transplantation has also proven effective to cover alopecic plaques of cicatricial, psychogenic, inflammatory or degenerative origin, and thus, its indications have been extended to resolve the sequelae left behind by some conditions of the scalp.


9. How is hair removed?

The removal of the hair graft is a fast and minimal procedure that lasts 20 minutes and is carried out under local anaesthesia. A 20 cm long x 1 cm wide flap of superficial scalp tissue with ingrown hair is removed from the occipital region of the head. The wound is closed directly by means of a single suture stitch that extends from one end to the other. The stitch is removed after 12 days.

This is the invasive part of the procedure that the patient has to come to terms with. It must be said that the procedure leaves a lineal, invisible scar that is hidden under the patient´s own hair. The bonanza of the technique lies in that sufficient tissue from the own patient is available with no problem of rejection. Once the flap is detached, the hair follicles are immediately extracted hair by hair by the doctor’s assistants.


10. How are these hair grafts implanted?

Next, the surgeon draws, together with the patient, the most appropriate design according to the patient´s aesthetical features, age and degree of alopecia. Local anaesthesia is then applied in the recipient area and a few mini-incisions are made using specific instrumentation. It is in these incisions where grafts will be implanted one by one.


11. How many hair grafts are implanted in one session?

A flap strap of these dimensions contains 1500 follicular units on average. Each strap may contain one, two, three or four hairs, and consequently a mean of 5000 hairs are transplanted per session.

This allows us to cover a surface as big as the palm of the hand in one single session, which is sufficient in most cases, both in the crown of the head and on the sides. In advanced cases, 2 to 3 sessions may be necessary.


12. How many hair transplant sessions can you have?

If you have androgenetic alopecia, you are always going to have a certain donor area. The limitation is the elasticity of the hair scalp. You need to wait 12 months between one session and the following to recover elasticity. In this fashion, some patients may have as many as 4 transplantations.

Some famous people undergo regular minisessions that do not require such a wide donor area and they grow more abundant hair in much less time.


13. Does the patient bleed a lot?

No. A vasoconstricting aesthetic mixture that prevents bleeding is injected at the time the flap if removed from the donor area and then when the hair is implanted in the recipient area.

Moreover, the depth reached in 2 to 3 mm, as so no vessel, nerve or important structure is damaged. W are proud to report that we have had no complications or sequelae in any of the over 500 transplants we have performed.


14. Is it painful?

No. Local anaesthesia is injected into the donor and recipient areas, as if you were at the dentist. The patient only needs to endure the discomfort caused by the anaesthetic shots but remains fully awake and comfortable.

We do not administer sedatives, hypnotics or any other medication that might make the patient depressed or agitated or otherwise interfere with the patient´s standard medication. We prefer the patient to be collaborative and to be aware of what is happening. If sedation is required because the patient if of a nervous type or the patient prefers to be sedated, then sedation is applied rigorously by an anaesthesiologist.


15. How long does the procedure last?

The whole procedure lasts a total of 4 hours. This procedure is more an exercise in patience for both the patient and the doctor than a tedious operation. Some aesthetic centres even go on to publicise their patients talking on the mobile phone or watching TV whilst hairs are being transplanted, which is absolutely possible. IML does not allow these practices because hair transplantation is a medical procedure and as such requires full compliance with all asepsy and antisepsy regulations of a standard operating room.


16. What is the patient´s self-perception after the transplantation?

When can the patient resume normal activities? The patient leaves the clinic fully conscious and by his feet. He should wear a hat for protection and bandages covering the wound area that will be removed the next day. Excepting how the treated area may look, all patients feel well and can continue with their normal activities the day after the procedure. Intense physical activity is discouraged for at least 3 weeks.

Some patients may even resume their activities later on the same day, although at least one day off from work to rest is recommended.


17. Does the face get swollen after the procedure?

Swelling of the face is not common, although some people are more prone than others. Swelling will depend on the particular characteristics of each patient, on the implanted area (more chance on the sides and around the crown or top of the head) and on the number of implanted grafts.

If oedema is present, the application of ice locally and an anti-inflammatory usually resolves the swelling in 2 to 3 days. Since we cannot know beforehand which patients will develop swelling, we usually prescribe an anti-inflammatory during the postoperative course and for people whose job involves seeing people, we recommend they take 3 days off work.


18. What sort of postoperative care should be observed after the transplantation?

The patient must maintain his regular hygiene after the procedure. The head should be washed once a day using a small cosmetic brush followed by a gentle massage of the area with the fingertips.

This ensures that grafts remain clean and that the small scabs that form after the transplantation fall off after 10 days. In terms of medication, an antibiotic, analgesic and an anti-inflammatory is prescribed for 3 days.


19. How long does it take for the transplanted hair to grow after the transplantation?

Growth follows the normal growth cycle of the transplanted hairs and part of them fall off, synchronising 3 moths post-transplantation. After 3 months hair growth takes place at the normal rhythm 1 cm per month, and so it takes 9 months to see the final results.


20. Do all the transplanted hairs grow?

On average, 90% of the grafts take. In some patients, this can go up to 95% and in some it can go down to 80%. In any case, these figures suffice to ensure good results and adequate amounts of hair on the scalp. The final objective is to have a good clinical result with which the patient is satisfied, with a better quality and larger amount of hair, regardless of the variable graft take percentage.


21. Does transplanted hair look natural or does it look like doll’s hair?

The appearance is completely aesthetical and natural since the patient´s own hair is used, hair by hair, following the correct orientation, with an aesthetical design concept in accordance to the harmony of the face, using microsurgery instruments skilfully used by the surgeon and his assistants. These actions result in fantastic results with no trace of the procedure.

Patients report that people who do not know them do not notice anything artificial and those who do know the patients and did not know anything about the procedure tell them that they have more hair or that they look better.


22. Do treatments fail or are there any bad results?

The technique does not fail. Independently of whatever the“take rate” may be, all patients have more abundant and better quality hair.

According to an epidemiological study, results are good or optima in 89% of cases. Nonetheless, the percentage of satisfied patients is even higher (93%), 95% have their expectations met and 97% would recommend the procedure. What you need to make the patient see is to have realistic expectations, in accordance with this overall aesthetics and age, and that the characteristics of his or her hair are uncheangeable.

In a transplantation, hair is taken from one healthy part of the head and moved to another. Patients with dark, thick or curly hair will have better results than those who have blond, fine or straight hair.


23. When the new hair has come out, is there any special care plan that needs to be followed?

No special care is required. Transplanted hair can be washed every day, it can be grown longer, it can be combed, dyed, or handled according to the patient´s preference. It is your hair and you can do with it as you like.


24. Is this a costly procedure? Can it be financed?

Our study identified a relevant piece of information and that is that most patients with a certain degree of alopecia have already tried some treatments and over a period of time end up spending much more than what the transplant procedure costs.

Nonetheless, these treatments have not achieved any improvement and patients have not recovered hair. Within the group of aesthetic procedures, hair transplantation is more affordable than breast prostheses (breast augmentation), a face lift, abdominoplasty (tummy tuck), or other procedures. Even if the procedures represents a small financial effort, all patients are totally satisfied and do not remember the money spent on having hair again with no added medical risks.

Moreover, at IML, we offer financing arrangements to meet your particular needs. Cost should not be the reason to stop a patient from having a hair transplantation procedure. The first thing to do is to get accurate information and to undergo the procedure in a clinically safe environment and by skilled hands.

Contact Instituto Medico Laser now for a free informative consultation.