The teenage patient had been suffered from trichotillomania, sometimes also known as trichotillosis or ‘trich’, an impulse control disorder where the patient repeatedly pulls out an area of hair. In this particular case, the patient had pulled out most of her upper eyelashes, having suffered from the disorder for the last 17 years.

The four hour cosmetic procedure involved taking hair from the back of the patient’s head and then grafting individual hairs in the eyelid to replace the lost eyelashes. Over the next four to six months, the lashes should start to thicken up. The eyelash replacement treatment cost around £3,500.

Trichotillomania often begins when patients are teenagers and can lead to depression brought on by the bald patches. Hair grafting offers a way for sufferers to look ‘normal’ again and allow the bald patches to regrow again.

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Hair loss can be caused by a number of different factors, the most common of which are aging, hormone changes, and a family history of baldness. Hair loss can also be caused by trauma or burns. However, as a rule of thumb, the earlier the hair loss starts, the more severe the end result will be.

There is a solution to the problem – through hair replacement surgery. However, the majority of hair replacement surgery uses your own hair. This means that you should have healthy hair growth at the back and sides of your head so that some of these hairs can be used as donors in the bald patches. If there is little hair left on the head, it may not be worth spending money on hair replacement surgery.

There are two main techniques that are used: Transplant techniques such as punch grafts, mini-grafts, micro-grafts, slit grafts and strip grafts are usually used for patients who are after a moderate change in their appearance. Flaps, tissue-expansion and scalp-reduction techniques are used for those who are looking for a more dramatic change.

Risks & Complications

It is important to note that although hair replacement surgery is normally safe, the results may vary from individual to individual and healing times and results may vary. The same sorts of risks apply in hair replacement surgery as with standard surgery – bleeding and scarring are the two most common complications.

With the transplant techniques, there is also the risk that the grafts will not ‘take’ properly. A transplant sees hair plugs moved into the bald patch. It is normal for the hair within the plug to fall out however sometimes the plugs fall out before re-growth has been established, meaning that the surgery for that area must be repeated. Transplant sites can also sometimes have small bumps form – usually these small defects can be covered or camouflaged with the surrounding hair.

It is also worth noting that hair transplant surgery will not stop hair loss – hair loss may continue as normal after surgery and the patient may end up with a patchy look, particularly if the new hair is next to an area of hair which is continuing to thin. Future surgery may be required as the hair continues to thin out.

The Surgery Itself

Hair replacement surgery is normally performed under local anaesthetic, although some of the more complex surgeries such as tissue expansion or flaps may be performed under general anaesthetic. Patients are usually offered a sedative to help keep them calm during surgery and to help keep them relaxed and comfortable. Under local anaesthetic, some

tugging or pressure may be felt but there should be no pain as the scalp should be fully anaesthetised.

Prior to the surgery, the hair at the donor sites will normally be trimmed down so that the surgeon can easily see where the hairs are growing from, and to help the access, removal and transplantation of the hairs.

Grafts
Usually hair transplant surgery involves taking small pieces of scalp with healthy hairs growing on it (known as the donor site) and moving it to an area of hair thinning. The grafts themselves will vary in shape and size – micro grafts are the smallest taking around 1-2 hairs at a time; next come mini grafts which move around 2-5 hairs; Slit grafts will contain around 4-10 hairs; round-shaped grafts take about 10-15 hairs; and lastly, strip grafts will take around 30-40 hairs at a time. The number of hairs transplanted will depend on the overall desired look, the hair coverage, and the properties of the hairs. For mini- and micro- grafts, up to 700 plugs may be transplanted in one session.

Most of the time, several rounds of surgery will be required to achieve a good look with your hair. To ensure that the scalp recovers full in between sessions, each surgery is normally a few months apart – this means the overall effect may take up to two years to complete. The number of surgeries required will depend on the hair coverage, hair type, colour and texture.

For punch grafts, the surgeon may use a tube-like instrument that punches out the graft at the donor site. For most other types of a graft, a scalpel will be used to remove the sections of scalp. The sections may be further divided into smaller sections before being transplanted. The grafts will typically then be transplanted into small holes of slits in your scalp.

When the grafts are removed, small quantities of saline solution may be injected into the scalp to help it maintain the proper skin strength. The grafted sites may be stitched closed which may cause a small, straight scar. Scars can normally be hidden with the fully grown hairs in the area. When the surgery is complete, the scalp will be cleansed and the covered with gauze. Some patients will need to wear a pressure bandage for a couple of days.

Circulation is key in the scalp. To preserve the circulation, the grafts will be placed around half a cm apart from each other. In future surgeries, the gaps between the grafts will be filled to give a natural look.

The Tissue Expansion Technique
Some patients, particularly those who have suffered burns or trauma to the scalp, may have the tissue expansion technique applied to their surgery.

With tissue expansion, a tissue expander (a balloon-like device) is inserted under a piece of normal hair growth which is next to the area of baldness. Over a period of weeks, the tissue expanded is slowly filled with salt water. This causes the skin over the top of the balloon to expand and grow new skin cells. The area of scalp over the balloon will bulge, particularly after the device has been under the skin for a few weeks.

Normally it takes about two weeks for the skin to have stretched enough, although the actual time will depend on how much tissue is required. A further surgery is then done to remove the balloon and to place the expanded piece of healthy scalp over the bald area.

Flap Surgery
Flap surgery is a great option for those who have a large area of baldness that they want to cover quickly. Flap surgery has been around for over 20 years therefore is a well-known technique.

Flap surgery involves cutting out a section of bald scalp. A flap of hear-bearing skin is then lifted off the surface whilst still remaining attached, stretched into it’s new position and then stitched into place. This method has the advantage that the ‘new’ piece of scalp remains attached to it’s original blood supply. Although the size of the flap varies from patient to patient, one flap can cover the same area as 350 punch grafts.

Flap surgery can be combined with other forms of hair transplant surgery such as scalp reduction or tissue expansion to create a more natural, tailored look.

Scalp Reduction
This technique is sometimes referred to as ‘advancement flap surgery’ because sections of hair-bearing scalp are pulled forward to fill in bald areas in the crown. As such, scalp reduction is usually only used where bald areas at the top and back of the head need to be covered.

During scalp reduction, a section of bald scalp is removed. The skin around the cut is the loosened up. The edges of the cut are then brought together and stitched up. This part of the surgery may be slightly painful and most patients can feel the tugging of the surgeon.

Post-Surgery

The time taken to heal will depend on the type of surgery and the natural healing rate of the patient. Aches, tightness, throbbing and pain are all par for the course, however your surgeon should give you painkillers to help.

If you have been given bandages, they will normally be removed after one or two days. Hair can normally be washed after two or three days however care must be taken. Stitches will normally be removed after one or two weeks.

Vigorous exercise should be avoided for at least three weeks as strenuous exercise will cause an increase of blood flow to the scalp and this may cause the implants and grafts to bleed. Contact sports should also be avoided for three weeks for the same reasons.

You should see your surgeon several times in the following weeks after surgery to ensure that your healing is progressing at a good rate. It is important to follow the instructions of your surgeon carefully to help you heal as fast as possible.

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Please note that each individual’s needs are different and that a full consultation with an approved consultant is advised.

Botox
Tummy Tuck (Abdominoplasty)
Breast Enlargement (Augmentation Mammaplasty)
Breast Lifts
Chemical Peel
Collagen/Fat Injections
Dermabrasion
Ear Surgery (Otoplasty)
Eyelid Surgery (Blepharoplasty)
Facelift (Rhytidectomy)
Facial Implants
Forehead Lift (Browlift)
Hair Replacement Surgery
Laser Facial Resurfacing
Liposuction
Male Breast Reduction (Gynecomastia)
Nose Surgery (Rhinoplasty)

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