Because informed patients are so important to the success of any plastic surgery, Dr. Robert H. Stubbs, a Canadian and American Board Certified Plastic Surgeon has prepared this web info for you. The web info will give you a basic understanding of the procedure - when it can help, how it is performed and what results you can expect. It can not answer all your questions, since a lot depends on the individual patient and the surgeon. Please ask a certified Plastic Surgeon about anything you do not understand.


A: Hair loss is primarily caused by a combination of aging, a change in hormones and a family history of baldness. As a rule, the earlier hair loss begins, the more severe the baldness will become. Hair loss can also be caused by burns or trauma, in which case hair replacement surgery is considered a reconstructive treatment. Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff and even excessive hat wearing. All of these theories have been disproved. It is also untrue that hair loss can be determined by looking at your maternal grandfather, or that 40-year-old men who have not lost their hair will never lose it.

Once you have determined that hair replacement is the best option for you, you can feel comfortable knowing that board-certified plastic surgeons have been successfully performing this type of procedure for more than 30 years. To date, there is no medical treatment that can restore a natural full head of hair. Surgical hair replacement still remains the best option.


A: Hair replacement can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations - they must be realistic.

It is important to understand that all hair replacement techniques use your existing hair. The goal of surgery is to find the most efficient uses for existing hair. Hair replacement candidates must have healthy hair growth at the backs and sides of the head to serve as donor areas. Donor areas are the places on the head from which grafts and flaps are taken. Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result. There are a number of techniques used in hair replacement surgery. Sometimes, two or more techniques are used to achieve the best results.

Transplant techniques, such as punch grafts, mini-grafts, micro-grafts, slit grafts and strip grafts are generally performed on patients who desire a more modest change in hair fullness. Flaps, tissue-expansion and scalp-reduction are procedures that are usually more appropriate for patients who desire a more dramatic change. Remember, there are limits to what can be accomplished. An individual with very little hair might not be advised to undergo hair replacement surgery.

One in five women will experience some degree of hair loss usually caused by aging, illness or hormonal changes after menopause. For some it is simply inherited. Women tend to experience a subtle thinning all over the scalp rather than losing hair in patches as is common in men. Drugs can help some women prevent further loss but they do not stimulate any appreciable new growth. Hair replacement surgery may be a solution.

Mini and micro grafts are usually the surgical treatment of choice for filling in thinning areas. Good candidates for this procedure should have dense hair growth at the back of the head (the donor area).

If you are considering a hair replacement procedure, it is important to understand that you will never have the coverage you had prior to your hair loss, but surgery may camouflage the thin areas and give you more fullness.


A: All surgery carries some uncertainty and risk. Hair replacement is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is a certified Plastic Surgeon. See the Special Consent to Hair Replacement Surgery.

Infection and bleeding are possible but uncommon. Some patients have a tendency to form poor scars. At times, stretch-back scars can form after scalp reduction procedures. These are caused by excessive tension. In transplant procedures, there is a risk that some of the grafts will not "take." Although it is normal for the hair contained within the plugs to fall out before establishing regrowth in its new location, sometimes the skin plug dies and surgery must be repeated. At times, patients with plug grafts will notice small bumps on the scalp that form at the transplant sites. These areas can usually be camouflaged with surrounding hair. When hair loss progresses after surgery, an unnatural, "patchy" look may result - especially if the newly placed hair lies next to patches of hair that continue to thin out. If this happens, additional surgery may be required.


A: In your initial consultation, we evaluate your health, determine your hair growth and loss, review your family history of hair loss, and find out if you have had any previous hair replacement surgery. Be honest in discussing your expectations. We will be frank with you, describing the procedure in detail and explaining its risks and limitations. We will also explain the anesthesia used, the location where surgery will be performed and the total costs involved.

During this consultation, be sure to tell us about any medications (especially aspirin or other pills that affect clotting), vitamins or other drugs you are taking. Smokers should consider giving up the habit before and after surgery. Then, a complete physical along with blood and urine analysis is arranged.


A: The patient should not have had anything to eat or drink after midnight prior to surgery. Pre-op medications should have been taken. Also, transportation and post-op care arrangements should have been made.

Most hair replacement procedures are performed under deep sedation and local anesthesia. Small areas can be gently "frozen" and done without the need for sedation. Hair replacement usually takes two to three hours, but the time required may vary considerably depending on the amount of work being done. During this time the patient is carefully monitored.

Hair grafting involves transplanting small pieces of hair-bearing scalp from a donor site and relocating them to a bald or thinning area. Several surgical sessions are usually needed and the final result, depending on the area of baldness being covered, may take a few years. The amount of coverage that you will need is partly dependent upon the color and texture of your hair. Coarse, gray or light-colored hair affords better coverage than fine, dark-colored hair.

Flap surgery involves removing a section of bald scalp and filling this area with a hair-bearing strip that is still attached to its blood supply at one end. One flap can do the work of 350 or more regular punch grafts.

Scalp reduction is used to reduce bald areas at the top and back of the head. Hair from the sides is thereby pulled up and donor hair can be used to cover the important front hairline area rather than wasted at the less visible top.

After surgery, the patient is then monitored in the recovery area for a few hours prior to discharge. t is mandatory for a patient who has had deep sedation to have someone stay with them the first night after surgery. The medications may affect judgment and co-ordination for 24 hours.


A: Follow-up visits vary according to the patient and the procedure. Most patients are seen again within a few days.

Early post-op instructions usually include taking prescribed medications and keeping your head elevated to reduce swelling. Bandages, if used, are usually removed in two days. After this, the hair may be gently washed. Strenuous activities increase blood flow to the scalp and may cause the incisions or grafts to bleed. Therefore, these activities, especially contact sports, should be avoided for 3-4 weeks.


A: Most patients who are realistic are very pleased with their results. Touch-up procedures, to obtain the most natural look are quite common after hair replacement surgery. Mini and micro-grafts are frequently used, secondarily, to blend or fill in the hairline. See the Surgical Art Gallery for examples of this procedure.

  Back to PSURG Home Page