Many men and women suffer from either pattern baldness or thinning hair. In the United States alone, around 50 million men and 30 million women suffer from one of these conditions. Typically, by the time people recognize that they are losing their hair, 50 percent of their hair has already fallen out. At this time, they often decide to meet with a hair transplant doctor to discuss hair restoration. Michigan’s Dr. Pramit Malhotra understands that it is natural to be fearful of the appearance of hair plugs, but this technique hasn’t been used in 25 years. The current techniques allow hair restoration to be an essentially undetectable procedure once the transplanted hair grows in. Dr. Pramit Malhotra offers the latest hair restoration technology to Michigan men and women struggling with hair loss.
Every Head of Hair is Different
All of the best hair transplant surgeons will tell you that each hair restoration case is unique. People have different types of hair, ranging from straight to curly, thick to thin, dense to sparse, and in a variety of hues.
It is notable that men typically lose hair in a predictable way, known as male pattern baldness. Women can suffer from female pattern baldness, but most females experiencing hair loss will see a diffuse thinning of all of their hair. For men and women, the hair loss is usually a combination of inherited factors and their sensitivity to a hormone called DHT.
Where Does the New Growth After Hair Restoration Come From?
The source of your new hair is your own body. Unlike organ transplants, where a person receives a new part from a donor, you will get a hair transplant from yourself.
In pattern baldness, the hair stops growing in such areas as the crown, top, and front of the head, but it continues to thrive on the back and sides of the head. This hair is genetically programmed to be maintained and is not typically lost, even in severe cases of balding, making it a great source for donor hair.
FUE vs. FUT for Hair Transplant
When trying to choose the best method for a hair transplant, patients tend to consider the two main options available today: Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). Both hair transplant types have their own unique advantages, and a few potential drawbacks.
*Each patient is unique and individual results may vary.
Follicular Unit Extraction
FUE has a number of advantages, including the following:
- Little to no scarring in either the donor or recipient area; any scars are tiny, around the size of pinpricks
- Faster healing time since there are no incisions
- No extended exercise restrictions after the hair transplant
- Little to no pain during and after the procedure
- Ideal for patients who want to wear their hair very short
This type of hair transplant surgery is ideal for people who have either a very tight or a very loose scalp, since FUT can’t be done as successfully on such patients. People who don’t have appropriate donor hair on their scalp may be good candidates for FUE, since the follicles could potentially be harvested from other areas of the body.
A potential drawback is that FUE harvests grafts from a fairly wide area of the lower scalp, whereas FUT focuses on harvesting only the middle scalp area. The mid-scalp has the strongest and longest lasting hair, so hair transplant grafts taken from this area tend to be more successful upon transplantation. This means that FUT grafts may last longer, especially when the FUE uses a wide harvesting area to get sufficient follicles. It is critical that your plastic surgeon only harvest follicles from the safe donor area to achieve a long-lasting result.
Follicular Unit Transplantation
FUT has some significant advantages of its own, including the following:
- One single linear scar on the back of the scalp, which is typically covered by new hair growth very quickly
- Lower cost than FUE
- May be more efficient for patients requiring more than 3,000 grafts in a single hair transplant session
- FUT is ideal for people who need large areas of scalp covered, as it harvests an entire strip of the scalp at one time
For many people, the main drawback of FUT is that the single long scar is larger than the tiny pinprick-sized scars associated with FUE. However, this disadvantage is offset by the scar’s location toward the middle of the scalp, where even short hair growth can cover it in a matter of weeks or months. FUT often does cause more pain, often necessitating pain medication or ibuprofen up to 10 days after the hair transplant, particularly if a staple closure is used. FUE has exploded in popularity and is projected to overtake FUT as the most common hair restoration procedure.
Follicular Unit Transplantation with FUE
Dr. Pramit Malhotra has personal experience with hair restoration techniques, and he chose FUE for his practice because of how easy it is on patients, the lack of telltale evidence after the procedure is complete, and, most importantly, its natural-looking and confidence-restoring results.
Dr. Malhotra himself underwent the old strip surgery before FUE became available but now feels that FUE is the best procedure for the majority of hair restoration patients. He feels that hair transplant surgery is one of the safest surgical procedures in cosmetic surgery (if not the safest), with the lowest complication rate and highest level of patient satisfaction.
FUE is a unique method of harvesting hair follicles using the state–of–the–art FUE (Follicular Unit Extraction) technique. This automated transplant system has officially earned FDA clearance, making it the first hair follicle harvesting system to be granted clearance as the result of rigorous testing.
The FUE device uses a punch to surround a follicle in the scalp, then removes it with suction, as opposed to pulling or twisting it out. The follicles chosen for collection are scattered throughout the donor area, so there is no obvious sign of their removal. While each follicle leaves behind a tiny, circular mark, there is no noticeable pattern to draw the eye, unlike with Follicular Unit Transplantation, which leaves evidence of collection in the form of a linear strip scar.
What Does a Hair Restoration Consultation Involve?
Once you have determined that hair restoration is right for you, it’s time to come in and have a consultation with Dr. Pramit Malhotra, who will lead you in a thorough medical examination.
One of the most important measurements for him to take is with a hair densitometer. This instrument lets him calculate the density of your hair and just how many individual hairs are now growing in your follicular units. This will allow him to determine how much hair you have available to donate or move from the back of your head to the areas where it’s needed. In addition, he will talk with you about your hair restoration goals.
After an initial consultation, you will work with Dr. Malhotra to draw out a proposed new hairline. There is considerable artistry involved in this design, so it is important for patients to discuss their problem areas and goals with Dr. Malhotra.
The Hair Restoration Procedure at Ann Arbor Plastic Surgery
Due to the length of the procedure, most patients should plan to spend a full day in the office. The procedure can last about six to eight hours. Dr. Malhotra will start by using a cosmetic waxmarking pen to draw where the hairline will begin on the forehead, how the recession in the temples will be addressed, and how to achieve maximum hair density with the number of grafts allotted.
The hair will be trimmed so that the hair follicles can be viewed. A special antibiotic wash is used in the hair to decrease the chance of infection during the FUE procedure. Since the areas of skin removal are so small, the chance of infection is quite low: less than 1 percent.
Next, local anesthetic is administered to numb the scalp. Many of our patients are self-declared “wimps with pain,” so a specific mixture is used to make the numbing process quite easy. All areas are tested before the procedure begins, which allows Dr. Malhotra to confirm the patient is completely pain free.
The doctor will first remove follicles from the “donor” area at the back of the scalp. Since each follicle has one to four hairs, only about a third of the hairs from the donor area will be harvested. The follicles will then be carefully separated. The hair restoration team uses a small motorized instrument called a punch to score the skin around each follicular unit set to be relocated. Next, the suction device sucks the graft into a bacteria-free canister while bathing it with a moist solution. This is typically done with the patient in a face-down, massage-type position and is painless once the anesthetic has taken effect. Approximately 400 to 700 grafts are harvested per hour, so this process typically takes two to four hours.
After the grafts are harvested, the patient enjoys a short lunch and bathroom break.
The doctor then creates the hairline by making small incisions in the top of the head where the hair implants will be placed. The angle of the recipient sites is critical to maximize the effect of the hairs placed. A 1,000-graft hair restoration session done extremely well can look better than a 2,000-graft session done with poor skill and artistry.
Finally, the Ann Arbor hair restoration team will individually insert each follicle into the scalp where hair is thinning or missing. Since the transplanted follicles are the patient’s own, they are healthy and vibrant. Once grown out, they will be permanent, since the hairs retain their genetic programming from their origins in the “horse shoe” area, which keeps them from falling out. This process is painless, and patients typically watch movies during this portion of the procedure. Due to the effect of the Valium used for the procedure, some patients even sleep intermittently throughout the FUE process, or listen to music of their choice. Reading, however, is not permitted during the procedure.
Hair Restoration Recovery
Patients often take Tylenol for pain control for 24 to 48 hours after FUE hair restoration. They are often surprised at how easy the recovery is. A dressing will be placed for one or two days after the hair restoration procedure. Once this is removed, the patient may shower. An ointment will be applied to the donor area, and a moistening spray to the graft area.
One day after the FUE FUE procedure, patients will have incisions that may look similar to a rash. Small pin-sized scabs will appear on the second day. Generally, these last two to six days. Approximately one week after the FUE procedure, the patient may begin washing the scalp carefully using only the finger pads.
At the three to four month stage, the transplanted hair will begin to grow. Remember, however, that every FUE patient is unique. The hair will continue to thicken and lengthen. At this stage, the scalp may become itchy. This is normal, due to healing process. By the five- to six-month stage, the patient will notice considerable growth. Typically, approximately 50 to 60 percent of the visual change will have taken effect. The look will continue to improve for up to 15 months after the FUE procedure.
Choosing a Plastic Surgeon for Hair Restoration in Ann Arbor
Selecting a plastic surgeon for hair restoration is not a process to be taken lightly. You will be changing your appearance, and it’s important to work with a plastic surgeon who is well acquainted with hairline design and has an artistic touch to produce a result that looks completely natural. At Ann Arbor Plastic Surgery, our hair restoration goal is simple: If you still have some existing hair on your head, the transplanted hair will not be distinguishable from the hair already in place. A hairline must be created to suit your face and look natural not only now, but as you age. The key skill that differentiates average surgeons from excellent surgeons is how the hairline is designed.
Experience and Track Record
As is the case with any medical procedure, it pays to do comparisons before you commit to working with a physician for your hair restoration.
As you choose a provider, you really are choosing a team of individuals to help you meet your hair restoration goals. Each person has a specific and important role to make sure every step is followed to maximize your comfort and results. The patient care coordinator will serve as your main contact in the practice to answer your questions, calm your nerves, and make the process effortless. The surgeon will provide expertise and artistry for the procedure. The hair transplant technicians will make sure the grafts are harvested and placed without trauma so that they will grow into beautiful, thick hair.
It is important that you find out in what field the physician you are considering completed their “residency” or training. Many physicians in hair restoration are not plastic surgeons. If a person is not a plastic surgeon but is very experienced in hair restoration, we recommend you have an in-person consultation to confirm that you feel comfortable the office is professionally and safely run before proceeding.
In the end, choose a surgeon who is known in the hair restoration industry for knowledge, expertise, and a devotion to helping patients achieve their best appearance.
Meet Dr. Pramit Malhotra
Dr. Malhotra is board certified in plastic surgery and otolaryngology, and he performs both surgical and non-surgical treatments. He is a hair transplant patient himself as well as a hair doctor. Faced with early balding in his 20’s, he was determined to restore his hairline. He had tried all medical and folk remedies available, including Rogaine™, folic acid, and even topical mustard oil! He understands how important a full head of hair is to men and women, and he has a personal passion for helping patients seeking hair restoration.
Hair Transplant FAQs
Can Signs of a Hair Transplant Be Hidden?
The ability to completely hide your hair transplant depends on how much existing hair you have that can cover the grafts you received. Some patients may be able to shave the sides of their head but leave the top of the hair from 1 to 3 inches, depending on density. These patients would be able to return to work in five to eight days after their hair restoration, and no one should notice anything unusual. There are also topical products that work quite well to hide the transplant.
What Does FUE Cost?
Automated FUE hair transplant costs can vary widely from one patient to the next. Generally, the more grafts required, the higher the cost will be. Some FUE providers charge by the graft, while others charge by the session. The typical cost range is from $4,000 to $10,000, depending on how many follicles must be transplanted to reach the patient’s goals. The per–graft cost varies between $5 to $7 nationally.
Dr. Malhotra performed the surgery, and did a beautiful job. I really do like him. He is so gifted, in so many ways. Jackson and Allegiance Health is so fortunate to have him here.
The surgery was performed at the Out-Patient Surgical Center across from the hospital.
Further, I would like to share with you that I received tremendous service and care. The staff could not have done one other thing for me that would have made my care any better than what I received.
They all are real professionals. These staff members are a real asset to Allegiance Health. It was without doubt the most pleasant experience that I have ever had in any medical facility. They are top-notch.*
How many hair grafts will I need?
Someone who is almost completely bald and looking to completely replace a head of hair will need more hair grafts than someone who wants to fill in a bald spot. People start with about 20,000 hair follicular units. Once patients lose 50 percent of their hair, they will start to notice significant loss. However, with 4,000 to 6,000 hair grafts, an elegant hairline can be designed for someone who is bald. 500 hair grafts will cover an area about as big as a silver dollar. An area the size of a CD or DVD will require approximately 2,000 hair grafts. For denser or wider coverage, you’ll need more. Common goals in hair replacement include:
- Creating a clean frontal hairline to frame the face.
- Adding density to areas that are thinning or bald.
- Increasing density in an area where a hair transplant has already been performed.
It takes one year to see the full results of a hair transplant. Over time, you’ll see the hair from the transplant get thicker and longer. After 10 to 12 months, you and your doctor can decide whether you want a second transplant to add more hair, which will require additional hair grafts.
Hair for a graft is usually taken from the back and sides of your head. The number of hair grafts that can be harvested will depend on the density of the hair follicles in that area. During a transplant, you don’t want to leave the donor area looking thin or patchy. The thickness of your donor hair will determine how full-looking your hair restoration procedure results will be. Curly or wavy hair will also make hair implants look thicker. If you are light skinned with dark hair, you will need a higher graft count to help hide the color of the scalp.
How Are the Hair Grafts Maximized?
The angle of implantation of each graft is very important. If the angle of the implanted hair is maximized, you can create a roof shingle effect that covers the scalp with the least amount of hairs. This is why certain 2,000 hair graft surgeries from one surgeon look so much fuller and natural than surgeries performed by other surgeons.
It’s important to keep hair restoration cost in mind when you are looking at what can and cannot be done. Typically, patients have about 6,000 lifetime hair grafts that can be harvested from their scalp. A typical hair restoration case is 2,000 hair grafts. Our goal is to maximize your first procedure so that you don’t have to have another one, though you may elect to have another procedure in the future to thicken your hair at a later date.
Learn More About Hair Restoration in Ann Arbor, MI
Double board certified plastic surgeon Dr. Pramit Malhotra can answer all your questions about a hair transplant at Michigan’s Ann Arbor Plastic Surgery. Call our Jackson office at (517) 789-9800 or our Ann Arbor office at (734) 913-5100 or schedule a consultation online today.