HAIR TRANSPLANT SURGERY

 

At present, two surgical techniques are adopted, both of which derive from the FUT (Follicular Unit Transplant) method.

 

1. Strip Harvesting
The oldest technique used since 1990 and still very popular nowadays. It involves removing a group of follicular units in a strip of scalp from the back of the patient's head.
With this technique, the follicular units are kept intact and damage to them is avoided.
Each follicular unit has 1 to 3 hair follicles and rarely 4, but on average there are 2.2 per unit.


The follicular units are then separated with extreme care with the use of special microscopes and cold light, and then the separated units are placed in an adequate solution at the correct temperature until the procedure of transplanting the follicular units starts.
There are many factors that contribute towards achieving the optimal end result. The most vital part is the dependability, experience and skills of the surgeon and his team.


The following factors are required in order to obtain successful results by using this technique:
- Correct removal of the scalp strip
- Closure of the donor region with minimal scarring
- Proper separation of the follicular units
- Always keeping the follicular units in the proper solution and at the correct temperature
- Making each hole or slit in the recipient area in the proper direction, angle and size
- Creation of the most natural hairline possible
- Insertion of the follicular units with maximum care so that they remain in the correct place and position without becoming damaged
- Assurance of a correct post-surgery plan The separation of follicular units is crucial for the end result. It is essential to have a well-trained team to separate the follicular units in accordance with the number of hairs in each unit .


2. FUE (Folicular Unit Extraction)
This technique is used for hair transplants in both the head and rest of the body and involves using a punch, preferably up to 1mm in diameter to remove follicular units from the donor area and to insert them one at a time in the recipient area.  Of course, the use of punches is not new, having already been used by Dr. Tamura in 1944 to insert pubic hairs on women. However, the great difference is in the punch size, and nowadays a punch is used for each individual follicule.


By adopting the FUE technique, the work to separate the follicular units is avoided and it is also unnecessary to make slits, so it is less invasive.
This technique demands great experience and must be performed manually, with the method and position of the follicular units to be removed being followed at all times.

With the improvement of FUE technique, in the end, the results of the surgery are great.


The scientific community will probably pronounce more on this technique in the future.
Nevertheless, the FUE technique offers several advantages, e.g.:
- The donor area is larger
- It is ideal for beards, moustaches, eyebrows and other parts of the body
- It is ideal for patients who like their hair very closely cropped
- It is less invasive, without cuts and leaves no scars


3. BHT (Body hair transplante)
This is not a different technique, but rather a method where the Strip Harvesting technique or the FUE one may be used.  The latter is used more frequently and consists of inserting follicular units into the intended body area, such as building an eyebrow, as can be seen: All these procedures have their advantages and disadvantages and it is up to the surgeon to look into each case and proceed in accordance with the most adequate ethical and technical aspects.

 

 

Surgery

 

 

 

Before surgery the patient's head is shampooed and the

measurements and adequate markings are made. 

The patient is then medically evaluated with all vital signs

being checked, and if everything is in order, he/she is lightly sedated.

After that, the anaesthetic is applied in the surgery area. 


It is extremely important and fundamental for us that our patients

remain calm when in contact with the surgeon and do not feel pain

during the course of the surgery. Dr. Cruz Dinis is therefore extremely careful to pierce or cut only when he is sure that his patients can no longer feel any pain.
For this purpose he uses a cream with local anaesthethic and a special syringe called Dermojet.

 

The surgical procedure varies according to the technique adopted. If it is Strip Harvesting, surgery starts with removing a strip of scalp from the donor area and the size depends on the number of follicular units that are intended to be transplanted.

After this step and before closing the surgical wound, scurf treatment is carried out on the upper edge of the surgical wound so that hairs are able to grow over the entire wound after it cicatrises.


Following the scurf treatment, the wound is stitched. The result is a fine, delicate scar that is practically invisible and completely covered by hairs.


The follicular units are then separated by a specialised team and this is done according to the number of hairs in each unit. This separation is an extremely careful procedure to ensure that there is no damage to the follicular units and that their anatomy and blood irrigation are preserved, thus ensuring the integration of all the transplanted units.
Insertion of the follicular units is carried out with special, last generation implanters, without leaving any kind of mark.


As regards the FUE technique, the surgery starts by shaving the donor area.


Following anaesthesis, hundreds of follicular units, (sometimes up to three thousand in one session) are extracted, one by one, from the donor area by means of a 1mm-diameter punch, and are simultaneously inserted into the recipient area, always in accordance with the angular slope of the natural hair. The establishment of the follicular units in the recipient area is similar to that of the Strip Harvesting system.


With regard to the recipient area, and in particular cases of frontal baldness, it is extremely important to pay attention to the forehead hairline.

In this connection, Dr. Cruz Dinis uses a method which he calls the Viroj line, in honour of the innovator of this method, Dr. Viroj Vong.

Over many years, Dr. Viroj photographed hundreds of monks in order to find out how hairs are distributed in the forehead area.

He then classified the hairlines into 3 different types.

Thereafter he started creating moulds based on the hundreds of hairlines he had studied. By using these moulds on his patients he produced forehead hairlines with quite natural appearances, thus achieving excellent results.
Some cases where Dr. Viroj's technique has been adopted (see side images).
Dr. Cruz Dinis applies the same method on his patients and in this way also makes hairlines with quite a natural look.


Finally, after all the follicular units are inserted, dressing of the donor area is carried out and a special substance is applied to the recipient area in order to protect the transplanted hair.

 

The surgery generally takes between 5 and 10 hours depending upon the number of follicular units inserted.

After the surgeries, the patients are re-examined by Dr. Cruz Dinis, take a snack and then return the following day to have their heads washed and receive post-surgery advices.

 

Strip Harvesting

Head Preparation

Surgery Planning

Hair Folicules

FUE Placement

Folicules examination