Capillary Microsurgery or Capillary Graft

Hair transplantation is a minimally invasive surgical technique (meaning that it does not require hospitalization) that improves capillary density in patients with different types of alopecia. Hair is transplanted using micro grafts, in which follicular units (FU) are transplanted from the occipital region, which is genetically more resistant to alopecia, to areas of alopecia.

Hair transplantation is a therapeutic tool that is not intended to replace medical treatment, but rather as a complement to it.

Micrograft (or hair transplant) is a surgical intervention that is the most advanced solution for hair recovery for both men and women.

The hair implant is a very simple procedure. Firstly, a hair examination and clinical history evaluation should be completed by a specialist in order to determine if hair transplantation is a viable treatment option for the patient.

If hair transplantation is recommended, the specialist will mark the area of the scalp in which the hair grafts will be inserted, while also ensuring that the transplanted hair aesthetically suits the patient according to his or her age, race, and facial structure.

During the operation, the medical team extracts the hair follicles from the back of the head and transplants it to the designated area, inserting the hair at the same angle or direction of the original hair, thus achieving a very natural and aesthetic appearance.

Hair implants can also be performed in other areas, such as beards and eyebrows.

The procedure for removing hair follicles for transplantation can be performed in two different ways: 1) FUE technique: unit by unit manual extraction, or 2) FUSS Technique (also known as FUT, FUG, or strip technique) removing a strip of skin with follicles from the scalp.

STRIP TECHNIQUE (FUSS, FUT OR FUG): Harvests healthy hair follicles from skin grafts. This process consists of cutting, using local anaesthesia and small incisions, a strip of tissue from the back of the head, from which donor hair follicles are extracted. The hair follicles are separated one by one by an expert clinical team before being individually transplanted to the new areas.

FUE TECHNIQUE (FOLLICULAR UNIT EXTRACTION): With this process, the hair follicles are individually extracted from the back or the side of the head using “punches” of 1 mm or less. Through a mechanized system, the entire follicular hair unit is then extracted, leaving a small hole that will heal quickly.

Once the follicular units have been obtained (regardless of the extraction technique), the next step is to implant the follicles in the new area.

Currently, there are two implantation methods: the classic technique with forceps and the DHI or Implanter.

In the classical technique, incisions are made into the scalp with needles, steel, or special scalpels called Sapphire. The hair follicles are then placed into the incisions with forceps.

In the DHI or Implanter method, the same instrument makes incisions and inserts the hair follicles at the same time.

Not everyone is a candidate for a hair graft. A specialist needs to evaluate the patient and determine the type of alopecia first before hair surgery can be prescribed. Sometimes, there may be cases in which the use of hair grafts is not the most appropriate option, due to insufficient hair follicles in the donor area or low density. There may also be cases in which the patient suffers from a disease that is not compatible with some of the techniques used.

There is no age limit when undergoing a hair graft, as long as the patient is in good health, does not suffer from any medical conditions that are incompatible with the procedure and has a suitable donor area. However, doctors prefer not to perform the procedure on patients who are very young, so that they can monitor the evolution of their alopecia and due to the low hair density achieved as a final result.

The number of follicular units required for a graft depends on several factors and is tailored to each patient on a case by case basis, which is why an initial assessment by a qualified professional from the field is so important.

The transplanted follicle has the same characteristics as the hair from the donor area, therefore, it is considered to be hair protected from hormonal damage; however, it is still a hair follicle and can fall out due to mechanical, chemical, psychological or pharmacological factors.

It is unlikely, since it is the patient’s own hair and no antibodies are created by the body that would detect the implanted hair as a foreign substance; nevertheless, there is a possibility that between 8-10% of the grafted hair will not grow.

Medical recovery is usually quick, but not the aesthetic aspect, which will require 7-14 days of recovery so that the patient does not notice the signs of intervention on the scalp.

The procedure as such is not painful, however doctors apply local anaesthesia for the comfort of the patient during the procedure and in this way facilitate the surgical and recovery process of the patient.

The duration of the procedure depends on the technique used and the number of follicles to be implanted. If the FUE Technique is used, the surgery can last between six and eight hours. In any case, it is not an operation that requires hospitalization, so the patient can go home after undergoing the hair transplant.

The postoperative period of the hair implant is usually very well tolerated, since it is an outpatient surgical intervention and the techniques are less and less invasive. After the surgery, which usually lasts about 6 hours, the patient will be able to go back to his or her normal routine immediately.

After surgery, patients may have:

– Redness of the skin in the receiving area.

– Inflammation or swelling of the scalp, forehead and sometimes even the eyes. This only lasts a few days.

– Itching or pruritus (mild to moderate degree), mainly due to the formation of scabs.

– Post-surgical telogen effluvium: Some patients may experience worsening of their capillary density in the first 3-4 months after surgery due to the stress of the procedure on the area.

– Low survival of the transplanted follicles: this is the most prominent cause of concern for patients, since it means that treatment produced less than optimal results.  In many cases, there is no specific cause, although most cases are due to lichen planus pilar after surgery.

By following the instructions for postoperative care, these potential complications can be significantly reduced.

Though not essential, it is strongly recommended since this makes it easier to mark the areas on the head where the transplant will be performed.  Furthermore, it is aesthetically more appealing after surgery.

Once the postoperative period of the hair transplant has passed, the appearance of the area that received the transplanted hair will be very similar to what it had before the surgery, and it will remain in this “stationary” phase for approximately 4-5 months. The transplanted follicular units will begin to grow exponentially from 4-5 months to 12 months in the frontal area and 18 months in the crown.

In some patients, it is possible that during the first 3 months after surgery capillary density is lowered due to the telogen effluvium from the stress of the surgery that the non-transplanted hair follicles suffer from.