The first hair transplantation procedures that were introduced in the 1960s and continued to be applied for about 40 years, were characterized by their extremely invasive, painful and bloody nature as well as by their very poor cosmetic results.
Plastic surgeons were the first to use relocation of skin flaps from the scalp with intact blood supply (flap surgery) in order to cover skin defects or bald areas. In these operations, a portion of the bald part of the head was excised and covered by a flap of skin originating from adjacent areas of the scalp. These interventions were particularly painful and bloody, were usually performed under general anaesthesia, and the cosmetic result was usually very poor.
In Plastic Surgery, nowadays, the application of skin flap transplants is still continued for specific indications, such as major detachment of the scalp skin due to injury, extended damages of the skin due to full depth burns, in cases of extensive skin cancer, etc. The use of skin flaps for surgical restoration of androgenetic alopecia, on the other hand, has practically been abandoned and is referred to here for historical reasons only.
Another plastic surgery technique for the treatment of male baldness that has seen widespread use in the past, was the so-called scalp reduction. In this procedure, a portion of the bald skin was excised, the adjacent skin was stretched with proper undercuts, and the wound was then sutured with the objective to reduce the extent of the bald part of the scalp. These operations were characterised by the existence of large and malformed postoperative scars and poor cosmetic results.
A modern, improved version of the scalp reduction technique that is used for cases of extensive skin absence or extensive scarring of the scalp due to burns or injuries, is the use of tissue expanders. In this procedure, which is typically performed under general anaesthesia, a tissue expander in introduced subcutaneously into the healthy portion of the scalp, and the wound is sutured. Next, over a period of 8-12 weeks, the tissue expander is gradually stretched with saline, which also results in a gradual stretching of the overlying skin of the scalp. When the dilatation is completed, a second surgery follows in order to remove the tissue expander and to excise part or all of the bald or scarred portion of the scalp; the gap in the skin then covered using the excess stretched skin of the scalp. This complex, lengthy and painful process has certain serious remedial indications, but is not used to cover male pattern baldness for aesthetic reasons, because of its highly invasive nature.
In the 1980s, the technique of punch grafting appeared, in response to the growing need for less invasive hair restoration techniques, as it began to be understood that head hairs grow in groups. In punch grafting, a circular knife (punch) of a large diameter (typically 0.5 mm) is used to remove a total of 20 to 30 hairs, which are then placed into a hole with a smaller diameter (typically 0.4 mm) which has been drilled into the receptor area of the bald part of the head.
Punch grafting was widely adopted during the decade of 1980-1990 but was gradually abandoned, as it was quite traumatic and bloody, characterised by unnatural cosmetic results, as large grafts of 20-30 hairs (plug grafts) cannot be placed close to each other and do not mimic the natural follicles that are much thinner, especially in the hairline area. The unnatural appearance of these plug grafts is known as the ‛doll-like effect’. In recent years, punch grafting has practically been abandoned, but there are still numerous cases of patients who have undergone hair transplantation with the punch graft method. Those patients now resort to plastic surgery and the FUE technique in order to restore the scars and the unnatural hairline.
FUT (Follicular Unit Transplantation) or Strip hair transplant technique came into use in the early 1990s and is performed with surgical resection of a portion of skin and hairs from a donor site at the back of scalp. The excised hairy skin section is submitted to a special treatment under the microscope and separated into grafts which are then inserted in the bald area. Depending on the technical training and experience of the team performing the FUT session, the grafts that are obtained in this manner can either be minigrafts (with 4-8 hairs) or micrografts (with 1-3 hairs). The skin in the donor site is sutured, leaving a permanent scar, the diameter of which depends on the suturing technique and the width of the missing strip, while malformed postoperative strip scars that need cosmetic restoration are not uncommon.
Better results in the final appearance of postoperative strip scar seems to be presented when the trichophytic closure technique is being used. The production with FUT or Strip technique of typically large diameter grafts with several hairs, which are not similar to the normal hair follicles of the scalp, often leads to unnatural aesthetic results, especially when multiple-hair follicles are implanted in the hairline area.
The most modern technique in hair transplantation today is FUE (Follicular Unit Extraction), which is done by transferring individual hair follicles from the occipital region to the thinned area. FUE was originally described in 2002-2003, when it was still in an experimental stage, and has since evolved gradually. Initially it was possible to transfer only a few hundred hair follicles, but today, with the use of automatic extraction devices, it is possible to perform sessions with several thousands of hair follicles in one day.
FUE has significant advantages over FUT, as the latter leaves huge, unsightly scars that remain permanently visible at the back of the head and possibly will remain painful for life. FUE, on the other hand, offers great aesthetic results without linear scars, pain or discomfort.
Advanced Hair Clinics has vast experience and expertise in the use of FUE, even in the most difficult cases. More specifically, we use Advanced FUE which includes extraction of individual follicular units with an automatic extractor (FUE Direct) and implantation of the hair follicles using an implanter device in one step, without the need to create sockets in the skin of the receptor site (One-Step Implantation), thereby substantially reducing bleeding, trauma, edema and postoperative pain after the FUE session.
In recent years, many promising robotic hair transplant systems have appeared (Robotic Hair Transplantation or ARTAS® Robotic Hair Transplant). Due to lack of sufficient accuracy, these systems cannot replace an experienced FUE hair transplantation team at present, but improvement of this technology in the future may at some point allow their generalised use.
Apart from hair transplantation, which up to date is the only scientific way to permanently restore hair growth in the bald part of the scalp, there are also various non-invasive and non-medical ways to cover bald spots that have been used at times or are still used today.
Hair prosthesis is a technique that can offer partial or total coverage of the bald part of the scalp by using a wig or special prosthesis made of natural or artificial hair in various colours, lengths or textures, depending on the person concerned and their facial features. The hair prosthesis is stabilised on the scalp with a special glue or with clips that hook onto the hair at the sides of the head (if any). The use of a prosthesis requires care and cleanliness of both the skin and the prosthesis itself.
Inadequate cleaning or bad application of the prosthesis may cause inflammation of the scalp, itching or chronic irritation. Due to pressure, the chronic use of a prosthesis gradually leads to atrophy of the bald part of the scalp, atrophy and loss of adjacent hairs that are partially covered by the prosthesis, and discoloration of the covered skin. The use of hair prosthetics and wigs for aesthetic reasons, which was particularly prevalent in the past in both men and women, is currently in rapid decline, firstly due to the progression of hair transplantation with FUE, and secondly because of the usually quite unnatural appearance of the prosthesis or wig.
One more factor is the high cost for the purchase and maintenance of a high quality (with natural hair) prosthesis, since the system needs changing on an annual basis, while the cost is close to that of a hair transplant. The main indication for use of a hair prosthesis today is the complete lack of hair on the scalp or total baldness, which can be observed in cancer patients who are undergoing chemotherapy or the very rare cases of Alopecia Areata Totalis. In such cases, the psychological shock caused by the rapid and total loss of hair is often unbearable, and the hair prosthesis can help substantially, both on a personal, psychological level and in social and professional context, especially since there is no indication of hair transplantation due to lack of a donor site.
Scalp micropigmentation or medical tattoo is a fairly popular technique to cover the bald part of the scalp or other special areas, such as post-surgical scars, eyebrows, etc. With this technique, a specially trained technician – theoretically under clean and aseptic conditions – injects dye into the patient’s skin, just like a conventional tattoo, with a very fine needle head, to simulate a hair print (micropigmentation).
From a relative distance, a tattoo can effectively camouflage the bald area, but from a close up view the final aesthetic result is rather poor, due to the lack of depth and volume in the painted ‛hairs’. One more disadvantage of the scalp micropigmentation is that it requires the application of several sessions due to the fading of dyes (bleaching); quite often, in areas that are exposed to the sun and have rich blood supply, such as the head, the pigments will gradually degrade, resulting in blurring, fading and discoloration of the tattoo, leading to a totally unnatural appearance which resembles a geographical map.
Keratin microfibers is another modern way of hair thinning coverage, especially in cases of early or moderate scalp thinning. On the other hand, in cases of baldness with complete loss of hair, keratin microfibers do not provide adequate aesthetic coverage. Keratin microfibers are available in a variety of colours to resemble natural hair, and are being spread out over the area of thinning like talc or powder. By static electricity, they adhere to the existing hair, increasing its volume and density. The microfibers are stabilized by using a hair spray and can be removed with shampoo. It is obvious that they can offer limited coverage in certain patients and for a short period of time, either for psychological, social or professional reasons, but in no way keratin microfibers constitute an effective or permanent solution against hair loss.
If the donor site is insufficient, hairs can be also obtained from the beard or the body and can be safely transferred to the affected area. Facial hairs develop fast and grow back at remarkably high rates, exceeding 95%. Due to the specific texture of these hairs (they are wilder and curlier compared to scalp hair) and the fact that the shafts on average are twice as thick as that of scalp hair, they are unsuitable for placement in the front hairline. However, if the donor site of the scalp itself is insufficient, they are extremely useful for the densification of the middle zone or the crown, and highly sufficient for the restoration of postoperative strip scars.
Body hair is another alternative resource of hair follicles for transplantation, especially in men who have rich body hair but insufficient donor site on the scalp. All regions of the body can be used as donor sites for body hair, such as the chest, the back, the arms and legs, the pubic region, etc., but it has been observed that the most reliable and potentially usable area for harvesting body hair grafts are the chest and the sternum. The final regrowth rate of body hair is highly unpredictable and usually ranges from 70 to 80%. Due to the very different life cycle of body hair, which usually progresses more slowly than the life cycle of scalp hair, the regrowth of body hair is extremely slow and may even take two years to complete.
Facial and body hair can only be used in hair transplantation with FUE method, which permits extraction of individual follicular units without incisions and permanent scarring. FUT or Strip technique has been used in these areas only to a minimal degree. The reason for that is because FUT/Strip technique leaves an aesthetically unacceptable, visible scar on the face or the chest, just for the purpose of obtaining facial or body hair follicles for transplantation.
Hair transplantation by transferring individual hair follicles (FUE) is currently the most ideal method for male and female hair loss. This hair transplant method is also used for the restoration of eyebrows or facial hair, as well as to cover scars left by Strip or FUT technique.
According to the ISHRS (International Society of Hair Restoration Surgery), the number of hair transplants performed worldwide is growing with approx. 18-20% per year, with the highest growth rates recorded in Asian countries (China ,India) and the Middle East.At the same time, hair transplants that aim to restore eyebrows or facial hair are becoming more and more frequent.
In recent years, the expansion of the modern FUE hair transplantation method, which allows hair restoration without causing permanent marks or linear scars in the donor site (as was the case with the older FUT or Strip technique), in combination with the natural-looking results that can be achieved, has contributed to even greater popularity of hair transplantation and has caused the decline of older, non-medical techniques whose goal is to cover the scalp such as prostheses or wigs, the use of which is constantly declining.
"Hair loss has been troubling many men and women ever since antiquity, and still is a source of psychological issues, especially in today’s challenging times. Nowadays hair transplantation is the most common cosmetic procedure in men in the Western world. This field of medicine is evolving day by day at fast pace and with impressive, natural results."
Dr. Anastasios Vekris, Plastic Surgeon
Scientific Director of Advanced Hair Clinics
FUE (Follicular Unit Extraction) is a hair transplantation method by which individual hair follicles are transferred; it has been used since 2003. It is the most modern method of hair transplantation and tends to prevail worldwide thanks to its minimally invasive nature. The procedure of hair transplantation with FUE requires extensive and specialised training of the plastic surgeon, as it is a very precise and difficult technique that is considered extremely demanding. FUE sessions usually last several hours, as each hair follicle is extracted and implanted separately under magnification. Learning and mastering the FUE technique requires from the surgeon to monitor and perform hundreds of interventions in order to reach a satisfactory level of speed and quality both in the extraction and implantation of the hair follicles.
Very few doctors today are specialised in FUE. Plastic surgeon Dr. Anastasios Vekris can count himself among the most acknowledged experts, with experience of thousands of hair transplant surgeries in Greece and abroad. Dr. Anastasios Vekris has trained many Greek and foreign physicians and has established many hair restoration clinics in Greece, in Europe and in the Middle East.
The procedure that is being followed during an FUE hair transplant session is the following one: The physician first plans the donor area, the area from where the grafts will be extracted. For the application of local anesthesia is being used a lidocain-adrenalin solution. Hair follicle units are removed by a special automated device, easily, quickly and painlessly, and are maintained in a moist environment at 3-4 °C. The area of implantation is then determined and the doctor proceeds, under local anaesthesia, to the surgery. The implantation of the hairs is performed one by one, using a special device. The procedure doesn’t require the creation of holes at the receptor area (One-Step Implantation, FUE Direct). Thus, the trauma in the receptor site is minimised and the results are completely natural.
Hair growth reaches 95-98%. Most hairs are maintained from the very beginning, while some may fall out during the first two months and gradually grow back. A percentage of 70-80% of the final result is achieved after 4-6 months, and 95-100% after 12 months. Typically, the new hair growth is completed earlier in the region of the forehead, and may be delayed by several months on the crown. The new hair behaves and grows naturally and can be cut as it normally happens for regular hair.
At Advanced Hair Clinics, Dr. Anastasios Vekris after years of experience and research has developed the hair restoration technique One Step Implantation or Advanced FUE, by which the grafts are implanted directly in the affected area under the right angle, without creating holes or causing traumas to the skin.
Hair transplantation is currently the most popular cosmetic treatment amongst men, and is no longer reserved just for the few. Patients do not hesitate any longer to discuss their problem with dermatologists and plastic surgeons, who are the only specialist doctors to diagnose and treat hair loss. Hair transplantation has three main objectives:
Achieving uniform and complete coverage, without permanent injuries to the donor and recipient sites or the creation of permanent scars.
Offering natural-looking results with proper distribution of hair and a natural hairline. This is achieved by using thin, single-haired follicles in the hairline in a wavy or zig-zag arrangement.
Accomplishing maximal density, depending on the needs and particularities of each individual. In general, a density of 50-70 hairs/cm² is considered to be acceptable, but if a good donor site is available, the problem is limited, and high density of the new hair is desired, densities of more than 120 hairs/cm² can be achieved.
According to statistics, 2010 saw a doubling of hair implantation procedures in relation to the previous decade. Since then, the number of hair transplants worldwide increases by about 20% annually. Hair transplantation can be performed:
Any man or woman aged 18 or older can undergo hair transplantation. Due to the minimally invasive nature of the modern FUE technique, which is performed under local anaesthesia, practically anyone can undergo the procedure, with the exception of patients with very serious health problems, such as a recent myocardial infarction or stroke, or under conditions of severe immunosuppression. Therefore, with the exception of patients who suffer from very serious pathological conditions (e.g. severe heart disease, severe immunosuppression, etc.), all adult men and women are suitable candidates for hair transplantation.
Special categories of patients, e.g. patients with cardiac or respiratory problems, diabetics, patients with clotting disorders, patients with thyroid diseases, etc., can safely undergo hair transplant, subject to prior discussion between the hair surgeon and their physician and subject to appropriate regulation of their medication. Ideal candidates are those with relatively restricted and well-defined alopecia of level I-IV on the Norwood scale, with a good donor site and relatively stabilised hair loss. Small scars that have been stable over time can be treated equally effectively.
On the other hand, less good candidates for hair transplantation are men with a high degree of thinning (level V-VII on the Norwood scale) with a small or thin donor site, and women with diffuse hair thinning, where either the distance between the hairs in the receptor site is not enough to securely install new hair follicles, or the donor site is equally thin and weak. Generally, it is considered that a donor area with a density of less than 90 hairs/cm² is unsuitable for transplantation.
The doctor who will perform the hair transplantation is one of the most decisive factors for the success or failure of the operation. International standards require specialised training in hair transplantation by plastic surgeons or dermatologists, who ideally should be members of the International Society of Hair Restoration Surgery (ISHRS). The training in hair restoration must be comprehensive and cover the fields of modern techniques and the FUT or Strip method, but also of the FUE technique, as well as restoration of failed cases and restoration of scars created by earlier transplantation techniques, such as FUT or Strip.
The training of a doctor who is considered experienced in hair transplantation should also include restoration of special cases such as female alopecia, transfer of hair from other areas besides the head (face, beard, chest, back, etc.), and restoration of special areas such as facial hair (moustache, beard, sideburns, eyebrows and eyelashes).
The skillfulness of the doctor is the primary factor for the success of the result; he plays a key role in the transplant team, performs the local anaesthesia required for the extraction and implantation of the hair follicles, and prepares the design of the hairline and the distribution of the hair follicles.
Many doctors perform hair transplantations, but only few achieve absolute success and natural results. The qualifications and experience of the plastic surgeon are the key factor to success. Cautious supervision of a detailed intraoperative and postoperative protocol is an essential factor for the successful completion of a hair transplant session. In the hands of an experienced transplantation team, the FUE method can offer results that exceed 95-98% after 12 months. There are cases in which the final growth even exceeds 100%, thanks to the fact that during the implantation of the hair follicles with the One-Step Implantation technique (Direct FUE), there is no handling of the hair follicles. As a result, follicles are transplanted that contain partially transected hairs. Research has shown that even partially transected hairs can develop at a rate ranging from 30-70%, depending on their length, due to the fact that they contain cells which may lead to the development of new hairs, thereby further enhancing the final result.
Regarding the commonly asked question of what is the ideal age of a patient that wishes to undergo a hair transplant session, the answer is that there is no less or more suitable age to undergo a first hair transplant session. As the clinical manifestation of androgenetic alopecia varies from one person to another, there are young men, even under the age of 20, with very extensive hair loss of level V or over on the Norwood scale. On the other hand, there are patients above 60 years of age with a very restricted thinning of Norwood level II-III. Therefore, the suitable age for the first session is determined by the clinical picture of each patient, and depends mainly on the psychological impact of hair loss on the patient. In other words, the proper age for hair transplantation is when the thinning has started to become apparent and adversely affects the patient’s psychology. It is advisable to undergo one’s first hair implantation session at a young age, before all hair is lost, and to repeat the procedure after a few years.
Given that androgenetic alopecia is a gradually progressing condition that is largely associated with the action of androgens in the body, the hair loss and thinning will accompany the patient throughout his entire life after puberty. Especially between the ages of 20 and 40, the phenomenon of hair loss is quite intense. If the first hair transplant session is performed at a young age, it is almost certain that the patient will need a second surgery in the future because of the continued hair loss. Therefore, he should be informed accordingly.
A key factor in the success of hair transplantation and the quality of the final result, is the extent of the problem and the degree of thinning. Localised alopecia in the forehead or crown can be treated satisfactorily even in one meeting, with excellent density. On the other hand, cases of extensive baldness of Norwood level V-VII usually take 2-3 sessions in order to achieve good coverage, provided that there is a sufficiently rich donor site. In some cases, an insufficient donor site in combination with a large extent of baldness may lead to the forced choice to either cover only a specific area (e.g. the forehead), or to perform a more sparse implantation over the whole bald area, which leads to poorer aesthetic results.
Realistic expectations of the patient who is interested in hair transplantation are an important factor in achieving the desired result. It must be explained by the physician and understood by the patient, that hair transplantation is a medical method for the restoration of alopecia, and in no case can substitute nature or reverse the process of hair loss, restoring the patient’s current condition to the one it was before his puberty. Also, in cases of very extensive alopecia, the patient must understand that it is impossible to fully restore the scalp. Furthermore, in specific cases such as eyebrow transplantation, it should be made clear that the new hairs tend to grow and will have to be trimmed regularly. Proper information on the doctor’s part ensures the selection of suitable candidates for hair transplantation and the understanding, from the patient’s end, that hair transplantation is a medical method with indications and limitations.
The success of a hair transplantation always depends on the successful natural integration of the transplanted hairs among the existing hairs, and on the application of appropriate conservative treatment, usually with minoxidil 5% and Hair Loss Treatment with autologous growth factors in order to maintain the existing hair.
Every case is examined individually and the cost of each hair transplantation session with FUE varies. The price for a hair transplant depends on the extent of the problem, the number of grafts implanted, the possible difficulties during surgery, and the duration of the session. The duration of a long one-day session ranges from 7-8 hours. The cost will rise significantly if larger areas need to be covered, which typically require two-day sessions in order to achieve full coverage. In cases where a few dozen follicles are required, e.g. to cover a small scar, the cost is quite low. Therefore, the cost increases according to the duration of the session. Cases in which a prior treatment with strip technique (FUT) has caused considerable damage and scarring in the donor site are more difficult, but do not change the cost of the session.
Specialised interventions with an increased level of difficulty are the thickening of the eyebrows and facial hair, the use of body hair, and the so-called unshaven FUE sessions. Provided that the donor site is very good and the hair is cut short, one long daily session allows the transplantation of 2000-3000 or even more follicles, equivalent to more than 6000-8000 hairs, achieving excellent density and coverage, if distributed correctly.
At Advanced Hair Clinics, the calculation of the cost is based on the duration of the session that is required to cover the bald area to the fullest possible extent, with optimum density, with no upper limit to the number of hairs or hair follicles to be extracted and implanted, under the sole condition of safety and health of the donor and receptor sites. We find the approach of some hair transplant ‛clinics’ to charge their sessions according to the number of hairs or hair follicles highly spurious and misleading, since the patient is not in any way able to count the hairs or hair follicles implanted during a session.
Hair transplantation is a completely safe procedure. It is performed at the clinic, under local anaesthesia, while the patient is awake and can talk, listen to music or even watch TV. Any inconvenience that maybe caused to the transplantation area is negligible. Most patients feel a little pulling in the donor site for 1-2 days. Mild analgesics rarely need to be prescribed. The area should be kept hydrated during the first 3 days with regular sprays of saline.
Some of the new hairs may be shedded during the first 2-8 weeks, but this does not have to worry the patient, as the roots remain and will produce new hairs over the following months. This effect can be minimised by the use of minoxidil 5% immediately after the operation. The next day after the hair transplant, the patient visits the clinic where the donor and receptor area are checked and the hair is carefully washed for the first time. After 3-4 days the patient can return to work, as it is not noticeable that the patient has undergone a hair transplantation. Finally, it is recommended to avoid intense physical exercise and swimming for one week.
In the case of an unshaven FUE session, the patient can return to his professional or social activities within 24-48 hours, as there are no visible signs of hair transplantation because the new grafts are implanted between the existing hairs.
With FUE method, complications such as mild folliculitis or a small swelling of the forehead are few or none, occurring in percentages of under 1%, and subside immediately.
Folliculitis, which is a local inflammation in the new follicles that appears during the first or second week after the operation, will subside with the topical use of an antiseptic shampoo and antimicrobial lotion applied for a week.
Post-operative swelling in the region of the forehead or around the eyes rarely occurs; it may appear approximately 24-72 hours after the completion of the hair transplantation session, and can be minimised by taking cortisone orally for 3-4 days.
Another immediate complication is a small degree of local bleeding in the site from which the hair follicles were removed. This is a common complication after the FUT or Strip method, but is very rare in cases of transplantation with the FUE method.
One more delayed side effect of hair transplantation is the absence of hair growth due to technical issues, inexperience of the transplantation team or doctor, improper maintenance of the hair follicles, or incorrect implantation. An additional, delayed, side effect of hair restoration may be an unnatural effect, due to bad alignment of the hair follicles or wrong design of the hairline.
The possible side effects of hair transplantation, whether immediate or delayed, are usually preventable and can be avoided by proper selection of candidates or appropriate medication (in cases of immunodeficiencies such as diabetes, and in cases of people who cannot, safely, undergo local anaesthesia). For example, if a patient has recently suffered acute myocardial infarction, the procedure should be postponed to a later, safer time. Alternatively, in such cases the patient should have to be regulated with appropriate medication. In the case of diabetes mellitus, the patient should take broad spectrum antibiotics in order to avoid the aforementioned side effects.
On the contrary, FUT technique is often accompanied by complications such as chronic pain in the region of the scar, numbness in the skin above the scar, and the formation of a hypertrophic or unsightly scar. Aesthetic issues after a session with FUT or strip technique are frequent, as an unpleasant side effect is the formation of a permanent scar in the donor area which may become visible when the patient cuts his hair short. Actually, many patients who have undergone hair transplant with FUT technique avoid to cut their hair due to the obvious malformed scar. These side effects are avoided with the modern Advanced FUE method, as there are no permanent scars.
If performed correctly with the modern Advanced FUE method, hair transplantation does not have any serious side effects, either immediate or later. In Advanced Hair Clinics, Plastic Surgeon Dr Anastasios Vekris and his team apply special protocols before and after the session that minimize the probability of complications.
Failure of a hair transplantation may be due to factors that have to do with poor patient selection, inexperience of the transplantation team, inexperience and lack of knowledge by the doctor who performs the transplantation, or technical issues that affect the quality of the result. In particular, if the needs for coverage and density and the possibilities of the donor site are not determined first, i.e. no proper preoperative assessment has been carried out, chances are that the clinical outcome will fall short of the expectations of both the patient himself and the transplantation team. Another factor for failure may also lie in the choice of the wrong technique. It has been observed that patients who have previously undergone a scalp restoration surgery with FUT or Strip method and are left with extensive or deformed scars in the donor site, have significantly reduced the width of the donor site and the quality of the hair follicles, resulting in an insufficient donor site to achieve proper results.
As far as the experience of the doctor and the transplantation team is concerned, international standards state that only properly trained hair surgeons who are specialised in plastic surgery or dermatology should be involved in hair transplantation. Nevertheless, it still happens that non-specialist doctors or doctors from other fields of expertise (e.g. ophthalmologists, gynaecologists, general physicians, etc.) present themselves as experienced hair transplantation doctors when in fact they lack both the technical expertise and the required experience. In such cases, many technical errors can occur that lead to failure of the procedure. Failure of transplantation may often be due to technical errors during the procedure, either during the extraction or the implantation of the hair follicles, but usually in the implantation phase. These errors are related to damages to the hair follicles during extraction or during cross sectioning (destruction and reduction of growth potential).
Errors may be associated to a large extent with poor maintenance of the hair follicles after they have been extracted from the head. The main factors for better survival of the hair follicles are humidification and storage at low temperature. If the follicle dries out or is maintained at high temperatures, damages occur on a cellular level that may affect its viability. This is also a factor that may lead to the failure of a transplant. Finally, during the placement of the follicles there are several factors that can lead to failure of the procedure, in particular with respect to the depth of implantation of hair follicles. If the follicle is planted too deep, it may be encapsulated in the skin during healing, and lead to formation of a cyst. On the other hand, if positioned too superficially it can lead to dehydration, drying and eventually loss. Technical errors during installation of the hair follicle are considered the most common factors that lead to failure of hair transplantation.
The results of hair transplantation with the FUE method are stable and permanent. They start to appear as early as one week after implantation. The hairs will develop gradually and there may occur a phase of hair loss between the second and eighth postoperative week. Regrowth of the lost hairs will start towards the end of the second month after transplantation and will gradually be completed within twelve months. There is research that shows that in 5% of patients, the results of a scalp restoration can still be enhancing even eighteen months after the surgery. The results gradually appear over a period of twelve months, but there are also known cases where the results of implantation are still enhancing even 18 months after transplantation.
The percentage of follicles that regrow after transplantation with the Advanced FUE method exceeds 95% and often reaches 100%. The results of hair implantation after a session with transfer of hair follicles from the beard have similar success rates. In scalp restorations with transplantation of hair follicles derived from the chest or other body parts, the regrowth rates may be slightly lower, i.e. 60-70%; also, the regrowth development of the hair follicles may be slower. In cases of restoration of scars caused by injury or pathological reasons, the regrowth rates of the transplanted hair follicles can vary between 60-90%. The growth rate depends on the quality of the scar (soft or hard), its blood supply, and other factors.
Regarding whether the results look natural, that depends on the experience of the surgical team and the doctor who performs the procedure. Ideally, the hairline needs to be planned correctly – where needed – in order to harmonise with the facial features of the patient. The first step is to determine how the hair follicles will be distributed over the scalp and at what density, taking into account the natural features of each head.
The natural look of hair transplantation is influenced by factors such as the growth angle of the existing hairs. The implanted hairs need to be aligned with the existing hairs in such a manner that they grow in the same direction, while the natural distribution of the various follicles should also be taken into account. This means that the front of a normal hairline should consist only of single-hair follicles, behind which a transitional zone is created with both single and double-hair follicles. More dense follicles should be placed behind the front line, primarily in the central region of the head in order to achieve a higher density. The results of the hair transplantation depend to a great extent on the experience of the surgical team and the technique used. In terms of percentage of growth, the results of hair implantation with either FUE or strip technique may be comparable.
Usually the FUE method gives better results in terms of naturalness, because it can produce single-haired follicles with a smaller diameter, while the FUT or Strip method in most cases renders thicker grafts (which don’t look natural if placed in the front line) instead of individual follicles. Another important issue, is whether or not holes (slots) are created in which the hair follicles are placed. With Advanced FUE, where the follicles are implanted with a special implanter in one step without creating slots (One Step Implantation), we notice that due to the restricted damage to the skin and the smaller amount of bleeding, regrowth is faster and in higher rates compared to the classical FUE or Strip techniques.
Hair transplantation today is an important field of research. In a few years:
At Advanced Hair Clinics we have vast experience, as Dr. Anastasios Vekris, internationally renowned in the field of hair restoration, and his team have successfully performed numerous cases, most of them quite demanding, both in Greece and abroad. All hair restoration surgeries are either performed or supervised by plastic surgeon Dr. Anastasios Vekris, guaranteeing the best possible results. Advanced Hair Clinics performs the largest by far FUE hair transplant sessions in Greece, which is also evident from the patients’ results.
Anastasios Vekris completed his postgraduate studies at Kyonpook University, in Korea, under the famous researcher in the field of hair loss Dr. Kim. Dr. Vekris was the first to introduce and develop Advanced FUE hair implantation and One Step Implantation, using a special automated hair extraction and implantation device without holes or injuries (Direct FUE).
Dr. Anastasios Vekris has trained most doctors who currently perform hair transplantation in Greece and many doctors and nurses abroad. He has founded several hair restoration clinics in Europe and the Middle East, at which he currently has an advisory and training role.
The hair transplant teams of Advanced Hair Clinics consist of professionals who are highly trained in the use of the FUE method to treat specific or rare cases such as eyebrow transplantation, beard transplantation, FUT (strip) scars restoration, and transfer of hair follicles from the face or the body.
Advanced Hair Clinics has been awarded as Best International Hair Clinic by the International Medical Travel Journal in 2016 & 2017, being recognized for the high quality of medical results and service that offers with dedication to its patients.