Hair restoration surgery today for aesthetic (not reconstructive) purposes almost exclusively involves only hair grafts taken from the back of the head and transplanted to areas of hair loss. Larger flaps and scalp reductions are rarely practiced today for male or female pattern hair loss but reserved principally for hair loss due to cancer, trauma, or other injury.
The principle of modern hair restoration is based on Norman Orentreich's theory of "donor dominance" in which donor hair taken from the back of the head (where even the baldest man still has hair) will not be lost after transplantation by retaining the donor characteristics and genetic programming of the donor hair. This situation is a double-edged sword. Because the transplanted hairs will remain permanently, the patient can be assured that those hairs will not be lost over time. However, because the hair remains permanently, loss of surrounding non-transplanted hair may make the original transplant result look less dense over time or even starkly unnatural unless further sessions are undertaken to camouflage the result.
Think of the scalp as an ever-expanding canvas (bald scalp) that needs to be covered with ever dwindling paint (usable donor grafts). This dilemma is at the heart of every hair transplant endeavor. As one extreme, the patient in his early twenties rapidly losing hair is the most unsafe patient to transplant because he will most likely run out of usable donor hair and be left with an unnatural result as his surrounding hair is lost around the transplanted hairs. At the other extreme, the patient in his mid sixties who has minimal hair loss is a very safe candidate because he has proven to have lost very little hair over a longer lifetime and will most likely not need further transplant sessions and should have enough hair in the donor bank to cover further recessions. Most individuals fall somewhere between these two extremes.
OBesides the expanding canvas (balding scalp), the physician must evaluate carefully the donor area for how much and what kind of paint is available (donor hair) to do the job. A high density of donor hair is perhaps one of the most important criteria that can help a physician guide a patient as to the likelihood that he will attain a good result as well as determine how much future paint is available to paint in the canvas. The thicker and curlier nature of the donor hair is other favorable criteria that will enhance the aesthetic density of the result.
Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today's most advanced techniques transplant these naturally occurring 1-4 hairs "follicular units" in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This hair transplant procedure is called Follicular Unit Transplantation (FUT). Donor hair can be harvested in two very different ways;
For several days prior to surgery the patient refrains from using any medicines which might result in intra-operative bleeding and resultant poor "take" of the grafts. Alcohol and smoking can contribute to poor graft.
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