Let’s talk about hair. Some of us will apparently spend a year and a half over our lifetime. Just washing, brushing, styling, and generally fiddling with our hair. With hair transplants beginning to take root in the public consciousness, I’m here to tell you how they work. We are covered with hair. Our entire bodies have the ability to grow hair, with the exception of our lips. The palms of our hands, and the soles of our feet.
That hair differs all over the body, but the way it grows is pretty much the same. Just underneath the skin, all bundled together with things like nerves, blood vessels, and sweat glands, are our hair follicles. Where individual hairs gradually increase in length as more cells are added to the base over time. As part of their natural cycle. Hairs stop growing and fall out of the follicles, to be replaced with new ones. When someone plucks their eyebrows, it’s only a short-term solution because the follicle can simply grow a new hair.
The problem comes when, for some reason or another, the hairs stop coming. And this can be caused by a number of things. Like a major trauma to the skin leaving scar tissue without any follicles. And without follicles, you can’t grow hair.
In another very common case, the follicles simply stop. They’re still there, like the perfect hair-making machines they are. But a hormone called di-hydro-testosterone comes along to interfere and switch them off. Although both men and women can suffer from this type of hair loss alopecia. It’s most often seen in men, where the follicles around the hairline. The top of the head, and right back to the crown, have the receptors for that particular switch-off hormone, and gradually just stop producing hair. Once the old hairs fall out, you’re left with what’s known as male-pattern hair loss. In both of these cases, hair transplants offer a solution, by transplanting not just the hair. But also healthy follicles, into the areas that need them.
Surprisingly perhaps, hair transplants kicked off in the 1950s. When doctors first realized that you could remove a hair follicle from one part of the body and successfully install it into another part. In the case of masculine hair loss, there is a safe zone of permanent hair growth around the back and sides of the head. From where it is healthy follicles can easily be extracted. However, the results of the initial transplant efforts were less than ideal. Surgeons would remove small pieces of skin almost three or four millimeters across. Each of which would contain around 20 hair-growing follicles. These ‘plugs’ as they were known would then be inserted into small holes or slits made in the hairless area in a kind of grid pattern.
The problem with this is that the follicles grew alright, but they grew exactly where they were put, and not where they weren’t. So the transplanted hair had the look of these weirdly regular tufts, very much like doll’s hair. Which I don’t think is a favored look for anyone. Thankfully, medical science has come a long way in the last few decades. And hair transplantation is now an almost unthinkably delicate and thorough procedure. Instead of transferring around twenty follicles together. Most modern transplants move just one or two at a time, in what are called ‘follicular units’.
To get an idea of how crazily laborious that is, take a look at your own hair in the mirror, and see how densely packed those hairs and those follicles are. Suppose picking them out and putting them back in one by one. And don’t bother trying to count them, by the way, there can be 100 follicles in every square centimeter.
So how do you separate all of those follicular units? One technique is called the strip method or, more ominously, Follicular Unit transplantation. This involves removing a thin strip of hairy skin from the protected part on the back of the head. Followed by a very sharp eye and even sharpening scalpel, slicing it up into individual follicles. The pelvic units penetrate the skin of the bald area into small pieces and the wound on the back of the head is closed with stitches or staples. Although this method allows surgeons to possibly retrieve thousands of follicles at once. It relies on a frightening object on a stable hand and leaves the patient with a long scar that cuts into his or her fine hair.
One way of getting around this is to go for a different technique, called Follicular Unit Extraction. Instead of slicing out a big portion of skin in one go, this method uses a punch tool that looks like a tiny drill almost, to cut around individual Follicle unit, retain the rest of the skin. What is left behind is the full load of small circular holes that hardly fill up to leave traces of understanding. It thins the hair in the safe area, but not overmuch noticeably. The follicular units from this extraction method are implanted into slits in the balding area just the same as with the strip method. And at this stage, there’s as much art as science involved. It’s the job of the surgeon to make sure the new hairs blend seamlessly into the existing hair.
This involves drawing a realistic hairline and using single follicular units at the edge to make a finer transition. Then, multiple units containing two or three follicles are put in on the top of the head to give a denser covering. During a single, very long procedure, up to several thousand individual follicles are painstakingly removed and reinserted into the scalp. It can then take up to 18 months for the new hair to grow. Sometimes, however, healthy follicles in the safe zone are not enough to cover the area where attention is needed. In the past, that would have meant making a compromise. Perhaps settling for a more waft do, or a more creative hairline.
But some surgeons are pioneering techniques to take follicles not only from the head but from other parts of the body. Body hair transplants involve taking hairs from the chest and back and very selectively, mind transplanting them onto the scalp. But it’s not all plain sailing when it comes to sticking your chest hair on your head. As I said before, hair grows differently in different parts of the body, and you might have noticed that chest hair tends to be a little bit coarse.
It can also grow at strange angles which, as anyone who has ever gone into battle with that one annoying tuft will tell you, maybe more trouble than it’s worth. So that’s hair transplants. After new improving new techniques there’s still no guarantee of success without multiple visits to the operating theatre. You can always embrace baldness if you don’t have that kind of cash, or invest in a hat if you’re self-conscious.