Let’s talk about hair.
Some of us will apparently spend a year and a half over our lifetime, just washing, brushing,
styling and generally fiddling with our hair.
Not me of course, I just wake up like this.
With hair transplants beginning to take root in the public consciousness, I’m here to
tell you how they work.
We are covered with hair.
Our entire bodies have the ability to grow hair, with the exception of our lips, the
palms of our hands, and the soles of our feet.
That hair differs all over the body, but the way it grows is pretty much the same.
Just underneath the skin, all bundled together with things like nerves, blood vessels and
sweat glands, are our hair follicles, where individual hairs gradually increase in length
as more cells are added to the base over time.
As part of their natural cycle, hairs stop growing and fall out of the follicles, to
be replaced with new ones.
When someone plucks their eyebrows, it’s only a short-term solution because the follicle
can simply grow a new hair.
The problem comes when, for some reason or another, the hairs stop coming.
And this can be caused by a number of things, like a major trauma to the skin leaving scar
tissue without any follicles.
And without follicles, you can’t grow hair.
In another very common case, the follicles simply…stop.
They’re still there, like the perfect hair-making machines they are, but a hormone called di-hydro-testosterone
comes along to interfere and switch them off.
Although both men and women can suffer from this type of hair loss – alopecia – it’s
most often seen in men, where the follicles around the hairline, the top of the head,
and right back to the crown, have the receptors for that particular switch-off hormone, and
gradually just stop producing hair.
Once the old hairs fall out, you’re left with what’s known as male-pattern hair loss.
In both of these cases, hair transplants offer a solution, by transplanting not just the
hair, but also healthy follicles, into the areas that need them.
Surprisingly perhaps, hair transplants kicked off in the 1950s, when doctors first realised
that you could remove a hair follicle from one part of the body and successfully install
it into another part.
In cases of male pattern hair loss, there tends to be a safe zone of permanent hair
growth around the back and sides of the head, from which healthy follicles can easily be
extracted.
But, early transplanting efforts tended to give less than ideal results.
Surgeons would remove small patches of skin around three or four millimetres across, each
of which would contain around 20 hair-growing follicles.
These ‘plugs’ - as they were known - would then be inserted into small holes or slits
made in the hairless area in a kind of grid pattern.
The problem with this is that the follicles grew alright, but they grew exactly where
they were put, and not where they weren’t, so the transplanted hair had the look of these
weirdly regular tufts, very much like doll’s hair.
Which I don’t think is a favoured look for anyone.
Thankfully, medical science has moved on in leaps and bounds in the last few decades,
and hair transplanting is now an almost unthinkably delicate and thorough procedure.
Instead of transferring around twenty follicles together, most modern transplants move just
one or two at a time, in what are called ‘follicular units’.
To get an idea of how crazily laborious that is, take a look at your own hair in the mirror,
and see how densely packed those hairs and those follicles are.
Imagine picking them out and putting them back in one by one.
And don’t bother trying to count them by the way – there can be 100 follicles in
every square centimetre.
So how do you separate all of those follicular units?
One technique is called the strip method or, more ominously, Follicular Unit transplantation.
It involves removing a thin strip of hairy skin from the safe zone at the back of the
head, then, with a very sharp eye and an even sharper scalpel, slicing it up into individual
follicles.
The follicular units are inserted into small slits in the skin of the bald area, and the
wound at the back of the head is closed with stitches or staples.
While this method lets surgeons get at potentially thousands of follicles in one go, it relies
an awful lot on a steady hand, and leaves the patient with a long scar that cuts right
across what was their best bit of hair.
One way of getting round this is to go for a different technique, called Follicular Unit
extraction.
Instead of slicing out a big portion of skin in one go, this method uses a punch tool that
looks like a tiny drill almost, to cut around individual follicular units, leaving the rest
of the skin intact.
What’s left behind is a whole load of tiny circular holes that heal to leave barely perceptible
scars.
It thins the hair in the safe zone, but not too noticeably.
The follicular units from this extraction method are implanted into slits in the balding
area just the same as with the strip method.
And at this stage there’s as much art as science involved.
It’s the job of the surgeon to make sure the new hairs blend seamlessly into the existing
hair.
This involves drawing a realistic hairline and using single follicular units at the edge
to make a finer transition.
Then, multiple units containing two or three follicles are put in on the top of the head
to give a denser covering.
During a single, very long procedure, up to several thousand individual follicles are
painstakingly removed and reinserted into the scalp.
It can then take up to 18 months to see the effects as new hair grows in.
However, sometimes, the healthy follicles in the safe zone aren’t enough to cover
the area needing attention.
In the past, that would have meant making a compromise.
Perhaps settling for a more wafty do, or a more creative hairline.
But some surgeons are pioneering techniques to take follicles not only from the head,
but from other parts of the body.
Body hair transplants involve taking hairs from the chest and back and – very selectively,
mind – transplanting them onto the scalp.
But it’s not all plain sailing when it comes to sticking your chest hair on your head.
As I said before, hair grows differently in different parts of the body, and you might
have noticed that chest hair tends to be a little bit...coarse.
It can also grow at strange angles which, as anyone who has ever gone into battle with
that one annoying tuft will tell you, may be more trouble than it’s worth.
So that’s hair transplants.
As a cosmetic procedure it still comes with a pretty hefty price tag – around two pounds
fifty per hair.
And even though precision and robotic surgical techniques are constantly improving, there’s
still no guarantee of success without multiple visits to the operating theatre…and I guess
the bank.
If you don’t have that kind of cash you can always embrace the baldness, or if you’re
self-conscious, invest in a hat.
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