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Dr Asim Shahmalak’s guide to hair transplantation

Crown Clinic’s hair transplant surgeon Asim Shahmalak writes for some of the most prestigious medical journals in the world.

He recently wrote a 2,500 word guide to hair transplantation for PMFA– a medical journal for doctors working in plastic surgery. Here are some of the highlights:

Early developments

Modern hair transplant techniques were first developed in Japan in the 1930s, where surgeons used grafts to help restore eyebrow and eyelashes as well as the scalp hair of burns victims. It did not develop as a treatment for male pattern baldness until the 1950s when dermatologist Dr Norman Orentreich planted the first grafts in balding areas.

Techniques progressed from there and follicular unit transplantation (FUT), also known as strip harvesting, became the first popular method of hair transplantation.

FUT is where a strip of hair is surgically removed from the back or side of the scalp and follicular unit grafts (one to four hairs) are extracted and replanted in the balding area by the surgeon, using very small micro blades or fine needles. The main drawback with this method is that a scar is left in the donor area, which is visible if the patient likes to wear his or her hair short.

Early FUT procedures in the 1980s had mixed success. Patients could be left with plug-like doll’s hair, with several hairs sprouting together in unsightly individual clumps. However, techniques for replanting donor hair have improved, creating a much more natural blend with existing natural hair. Techniques for planting new hair evolved over time as surgeons became more experienced at performing the operation and shared knowledge at big conferences such as the International Society of Hair Restoration Surgery (ISHRS) Live Surgical Workshop in Orlando, Florida.

FUE and its development over the last 10 years

A different hair transplantation method, follicular unit extraction (FUE), was first developed as a technique in the 1990s by Australian physician Dr Ray Wood and his sister Dr Angela Campbell. They felt that cutting out a big patch of skin to harvest the donor hair was unnecessarily traumatic so developed a new technique where the follicular units were taken one-by-one, directly from the donor area, with fine needles. Early FUE techniques were fairly unsophisticated and there was noticeable scarring from punch grafts used to the remove the donor hair, which ranged in diameter from 1.5mm to 2mm. However, more recently, these punches have become much smaller – 0.6-1mm in diameter – meaning the scarring is almost indiscernible to the naked eye. The equipment improved and manufacturers were able to develop more sophisticated punches that limited scarring.

Modern day FUE treatments involve removing individual follicular unit grafts, containing one to four hairs, under local anaesthetic using tiny punches. The grafts are replanted in the donor area using a fine needle, typically over the course of one day. Most surgeons are able to transplant up to 4000 grafts in a single day, though operations commonly involve between 1500 and 3000 grafts. FUE is much more time-consuming than FUT and therefore it is more expensive – costing approximately 50% more per procedure.

Over the last five years FUT has been superseded as the most popular method for treating baldness in men and women by FUE. The fact that several high profile celebrities have had hair transplants using the FUE method could explain the rise in patients seeking this treatment. This shift in the preferences of patients has been apparent at Crown Clinic. Five years ago, 80% of my patients opted for FUT and 20% for FUE; now, it is the complete opposite, with 80% opting for FUE.

The main advantage over strip harvesting is that the scarring with FUE is minimal. Due to the smaller punch holes developed over the last five years, the scarring is barely visible two weeks after the operation. For the first few days, a patient has red pinpricks in the areas of the scalp used for harvesting but these fade. All incisions and cuts leave a scar, but an FUE scar is barely visible to the naked eye because each FUE scar shrinks to less than 0.5mm. I have also noticed a surge in men wanting to wear their hair short around the back and sides of the scalp – and this style favours FUE over FUT.

Patient selection

Hair transplantation is the only permanent long-term solution for baldness. Anyone who has experienced permanent hair loss may be a candidate for hair restoration surgery including men and women with pattern baldness. We do not operate on patients under the age of 25 – largely because it difficult to establish how a patient’s baldness will progress before that age. People seek transplants for a number of reasons but the most popular is to restore or change the shape of their hairline. People with areas of scarring from injuries such as burns from an accident may also be suitable for a transplant.

Patients may require more than one hair transplant procedure to cover the bald areas of their scalp. If a patient has experienced substantial hair loss it may not be possible to cover the balding areas in a single procedure. While the transplanted hair is permanent, patients may continue to lose their natural hair after a procedure because hair loss is a continual process. All men have a permanent ‘horse shoe’ of hair around the back and sides of their scalp which remains even if they suffer from severe male pattern baldness. This horseshoe is from where the donor hair is harvested. It is possible to do several procedures on most patients without the donor area thinning noticeably.

Case studies

FUE patients at Crown Clinic include the model Calum Best, presenter of Homes Under The Hammer Martin Roberts, Gogglebox star Chris Steed and the football pundit Didi Hamann.

The TV doctor Chris Jessen has had two FUT transplants with our surgeon Dr Shahmalak.

Complications

As with any surgery, there can occasionally be complications such as an infection, which can usually be remedied with antibiotics. Also, there is a chance that the new follicles become ingrown hairs, leading to cysts, though this complication is rare. These ingrown hairs need to be removed and the cysts burst. With all hair transplant procedures there is a transection rate – recording the number of grafts that fail to take hold in the donor area. Transection rates for FUT and FUE vary between clinics. A low transection rate is a good sign of quality because it reflects the expertise of the surgeon in placing the grafts. The gold standard for the FUE transection rate is 5%. The more skilled the surgeon, the lower the transection rate. It is very difficult to find average figures because clearly if a surgeon has a poor transection rate, they do not want this fact advertised.

Side-effects and postoperative care

The patient will need a week to recover from the transplant. It is recommended that they sleep slightly upright with several pillows for the first few days after a procedure to stop them damaging the new hair. The patient should wear a buttoned-up shirt for a week or so afterwards, because removing a t-shirt or jumper after a procedure can displace the transplanted hair.

In the first two weeks after a transplant, nearly all the transplanted hair falls out due to the trauma of being moved to a new location on the scalp. This is known as ‘shock loss’ and is only temporary [15]. Between eight and 12 weeks later, the new hair will begin to grow from the transplanted follicles. The new growth will progress over the next six to nine months but it can be a year before a hair transplant can be shown off to its full effect.

Our Surgeon

Dr. Asim Shahmalak

Dr Asim Shahmalak is a world-renowned hair transplant surgeon who performed the UK’s first eyelash transplant in 2009. He runs Crown Clinic – one of Britain’s most successful and best known hair transplant clinics. He has treated a number of high-profile industry leaders and celebrities including the medical broadcaster Dr Christian Jessen, best known for Channel 4’s Embarrassing Bodies.

Expert hair transplant surgery by Dr Shahmalak

Related Articles

Hair transplants – where hair from the back of the scalp is extracted and transplanted in balding areas – may be a well-known or even commonplace procedure nowadays, but did you know that body hair transplants are also possible? 

Body hair transplants are certainly a lesser-known procedure, but still one that can be viable for the right candidate – here’s what you should know. 

How do body hair transplants work? 

Body hair transplants work in a very similar way to traditional hair transplants, except that hair is extracted from – you guessed it – donor sites on the body. Patients seeking this type of transplant have typically undergone several hair transplants already and exhausted their supply of donor hair on their scalp. However, for some patients, a body hair transplant is a preferable option if they have naturally thin, patchy hair or if they have acquired a scalp injury that impacts the typical donor areas.

Generally, donor areas for body hair transplants are the abdomen, chest and back. Hair follicles on the arms and legs may be in abundant supply, but the hairs tend to be too fine to use on the scalp. 

The body hair transplant process itself closely mirrors traditional hair transplants. The donor area is shaved before the surgery, and during the procedure the hairs are extracted from the donor area under local anaesthetic, before being transplanted into the thinning areas of the scalp. The length of the procedure depends on how many grafts are needed and the recovery process is comparable to standard hair transplants. 

Can hair be transplanted from the head to the body? 

Body hair transplants can work the other way around, where hairs from the scalp are transplanted in other areas of the body. A common example of this is eyebrow transplants, but head hair can be transplanted in other areas such as the chest or pubic region. Although a less common form of surgery, it can be an option for people who have lost body hair through genetic or external factors such as chemotherapy or injury. 

What are the results of body hair transplants? 

It’s worth noting that often body hair transplants do have a lower success rate than typical hair transplants, partially due to the lower levels of compatibility between the hairs on the head and the hairs on the body and the different structures of the hairs. However, during your consultation you will be able to discuss any potential issues with your surgeon. 

To find out more about body hair transplants and to find out if you may be a suitable candidate for the surgery, get in touch with Crown Clinic. 

 

For many men, the inability to grow a beard is something that they feel particularly self-conscious of. For those who can grow a beard, they often find that it doesn’t always grow in a uniform fashion, resulting in patchy facial hair.

Beard transplants are a permanent way to create a natural-looking, full beard. If you’re thinking about taking the plunge, here’s what you need to know if you’re considering undergoing beard transplant surgery.

What happens during a beard transplant

Beard transplants are carried out through either follicular unit extraction (FUE) or follicular unit transplantation (FUT). FUE is the most common transplantation technique for beard transplants, which involves individual hair follicles being removed from the donor area and transplanted in the sparse areas of the beard.

The surgeon will determine the direction that the hair should grow in to make sure the new hairs blend in seamlessly with the existing beard hair and to create the desired look.

If you’re a good candidate for beard transplantation

To be eligible for a beard transplant, prospective patients must have an adequate supply of donor hair – this is typically hair from the back of the head, as it tends to be one of the last areas to go bald.

However, beard to beard transplants are also sometimes an option for disguising smaller areas of hair loss. This technique involves follicles being taken from the area below the jawline and transplanted in the sparse areas.

When having your beard transplant consultation, your surgeon should give you a thorough examination to determine if you are a suitable candidate for surgery and discuss your options with you.

What the potential side effects are

Although beard transplants are a generally safe procedure, it’s important to follow the aftercare instructions provided to reduce the risk of infection. Your face and scalp may experience minor swelling and irritation in the days after the surgery, but this will be eased by sticking to the aftercare routine.

FUE surgery does often cause some scarring in the donor area, but the scars are so small that the natural hair growth will disguise them.

How much a beard transplant costs

The price of the beard transplant depends on several different factors, such as the number of hair grafts required. During your consultation, your surgeon will be able to give you an accurate quote for the surgery.

Booking a beard transplant consultation

Crown Clinic is one of the UK’s most reputable hair transplant clinics, offering state-of-the-art facilities and procedures under the care of Dr Asim Shahmalak, a world-renowned hair transplant surgeon. If you’d like to find out more about beard transplants, get in touch or book a consultation.

Whether you’ve had a disastrous haircut that you’re desperately trying to grow out or are simply bored of your current hairstyle, there’s a good chance you will have searched for ways to grow your hair faster – but is that actually possible?

It’s worth noting that even the healthiest hair only grows around an average of half an inch per month, or six inches over the course of a year. Understandably, this can make people feel as if their hair is growing at a glacial pace – especially when you consider that we also lose up to 100 hairs per day.

How does the hair grow?

Hair grows from the follicle – or root – that is underneath the skin. The blood vessels in the scalp around the base of the follicles supply the roots with oxygen and nutrients, which will help the hairs to grow.

Does scalp massage help the hair grow?

Scalp massagers – brushes with soft, silicone bristles designed to be used when washing the hair – are currently proving popular, but are they actually worth the money?

Although scalp massage can increase blood flow to the scalp, and therefore bring more nutrients to the follicle, there is no evidence that massage will stimulate hair growth. However, scalp massagers can help to remove product buildup and excess oil from the scalp, which will improve the overall health of the hair.

Does cutting hair make it grow faster?

One of the biggest hair myths around is that getting regular hair trims can make the hair grow faster. This is, of course, completely false. Hair grows from the follicles, which are unaffected when the ends are cut off the hair.

Getting a trim can get rid of split ends, which occur when the ends of the hair become dry and damaged. Split ends can gradually progress up the length of the hair, meaning that hair is more prone to breakage – so if you feel as if your hair has been the same length for months, it could be due to split ends. Keep on top of them with regular trims to keep your hair looking healthy.

Will hair vitamins help my hair grow?

Although you will have undoubtedly seen countless influencers pushing pastel-coloured supplements on their Instagram feeds, claiming they have transformed their hair, this unfortunately isn’t true in most cases.

If you are suffering from hair loss due to a nutritional deficiency, then supplements may boost your hair growth, but you will need to consult with a GP to make sure that you are getting everything you need. If you have no deficiencies, hair growth supplements are unlikely to have any impact on the hair.

There may not be any quick fixes to hurry along your hair growth, but the best thing you can do for the health of your hair is to look after your overall health – take a look at Crown Clinic’s expert advice to find out how to keep your hair looking its best.