A hair transplant is a procedure in which a plastic or dermatological surgeon moves hair to a bald area of the head. This procedure involves moving hair from the back or side of the head to the front or top of the head. City Facial Plastics in New York, under the management of a top-rated plastic surgeon Dr. Linkov, uses the latest FUE transplant techniques and works with the most experienced hair technicians for the purpose of creating the best and most beautiful hair implant results for patients in NYC.
What Is a Hair Transplant?
A Hair transplant is a surgical procedure that takes hair from one part of the body and moves it to another. In the past, results looked unnatural and recovery was painful. Now, using the latest technologies and techniques, beautiful hair restoration is possible. And the best part is that a hair implant is permanent when performed on the appropriate candidate.
What Are the Causes of Hair Loss?
The most common type of hair loss is due to genetic factors, called androgenetic alopecia. This can affect men and women but results in a different phenotypic pattern. In men, the frontal and temporal recession is common and is further classified by the Hamilton-Norwood scale. In women, there is a preservation of the frontal-most hairs but the central scalp shows thinning and that is best classified by the Ludwig scale.
Other reasons for hair loss include:
- Hormonal changes
- Certain hairstyles
What Are the Types of Hair Transplants?
Traditionally, hair is removed from the back and sides of the head and moved to the front of the head. However, nowadays we can take hairs from other body sites if available, such as:
- Arms/Legs (less favorable due to thinness)
And move them to other body sites as needed, such as:
- Pubic region
The scalp hairs have a higher graft survival rate (about 95%) compared to non-scalp hairs (about 75-80%).
Who Is a Good Candidate for Surgery?
A good hair implant surgical candidate is a man or woman with appreciable hair loss in a specific area on their body, most typically the scalp. The hair implant surgeon must have an area to target for the hair transplant and create the necessary density. It is important for the targeted area to have a stable pattern of hair loss, which is not progressive in nature. Celebrity hair transplant surgery has continued to popularize this procedure.
Who Is Not a Good Candidate for Surgery?
Patients with a scarring condition such as frontal fibrosing alopecia need to be very careful as the hair transplant will likely fail. Patients with certain underlying medical conditions that may impact healing, such as immunosuppression, also should be properly screened before a hair transplant in NYC is offered. Patients with unrealistic expectations about the potential of a hair implant need to also be carefully approached.
What Are the Ways to Harvest Hair?
There are two primary ways to remove donor hairs, including:
- FUT (Follicular Unit Transplantation): FUT involves removing a strip of hair, typically from the back of the head. The strip is processed under a microscope and the hairs are divided into follicular units and stored until they are ready to be planted. The advantage of FUT is that the procedure is generally faster compared to its alternative FUE and may deliver a greater number of donor hairs from the back of the head. Also, it is possible to leave the shaft of the hairs longer if needed for specific procedures such as eyebrow hair transplantation. The disadvantages of FUT are that it leaves a linear scar which is noticeable if the head is ever shaved and FUT is not a good harvesting option in other parts of the scalp and body areas.
- FUE (Follicular Unit Extraction): FUE is the modern approach to hair transplantation. It involves removing individual follicular units, which exist as families of 1-4 hairs. Using a variety of instruments described below, each follicular unit to be harvested is punched out using a punch size of 0.8mm-1mm on average. The tiny holes created to seal up and leave behind very small circular scars that are barely perceptible even if the scalp is shaved. Attention is paid not to overharvest, leaving enough hairs in between the punched grafts. The main advantage of FUE is avoiding a linear scar as well as an easier recovery with less pain and no sutures to remove. Also, the technique can be applied to the sides of the head and other body sites such as the neck and chest in some individuals. The disadvantage of FUE is the time and labor required to carefully remove the grafts.
What are FUE Methods?
The concept for FUE is to use a tool to remove a follicular unit graft without traumatizing the follicle. The tool must punch through the skin, keeping the hair shaft in the middle of it, and include some of the deeper subcutaneous tissue as a cuff around the hair while preserving the hair follicle bulb.
There are a few tools that can be employed in order to harvest (punch out) honor hairs using the FUE method, such as:
- Manual: A sharp or blunt-tipped manual punch is a cylindrical instrument that is rotated in the hand and through the skin around the hair shaft.
- Motorized: This is the most common method currently used for FUE and includes a few types of machines including ones made by Ellis, Devroye (WAW), Neograft, SmartGraft, and Trivellini (Mamba). The Ellis is a sharp punch system with a rotational mode only. The Devroye WAW FUE system has only an oscillating mode. The Neograft and SmartGraft systems are rotation mode only and come with a suction-based system. The Trivellini mamba system is digitally advanced and has three different modes (rotation, oscillation, vibration) which can be custom set per the doctor’s preference to adjust to the hair and skin quality of the patient. Using suction is possible with Trivellini as well. Dr. Linkov, as an experienced hair transplant specialist, prefers the Trivellini FUE system for its versatility and adaptability and usually uses the vibration setting to avoid traumatizing the hair follicle. The Trivellini FUE system is the newest and most advanced FUE system on the market and comes with blunt-tipped flared punches that further reduce injury risk to the follicle.
- Robotic: The Artas robot has some automated features for extracting hairs, creating recipient sites, and placing the hairs (with the Artas iX). While a great marketing tool and helpful for reducing human fatigue with longer procedures, there are several disadvantages, which include:
- Cost – Since the robot costs about $300,000, the procedures are often more expensive to patients as the practice works to recoup the expense.
- Hair color – The robot requires darker hair to do the extractions. Patients with white or red hair need to dye their hair for the robot to work.
- Harvest location – The robot will only work where a flat grid can be applied, which limits the possibilities of harvest location.
- Time/Labor – The procedure is generally not any faster with the robot compared to motorized punch systems and still requires a team of technicians to complete the procedure.
There are several options for preparing the donor area for harvest, such as:
- Shave: The entire area to be harvested is shaved with an electric clipper down to about a number 1
- Partial shave: The lower back of the head is shaved down as above, the rest of the potential donor area is kept longer and trimmed carefully as needed for any further harvesting
- No shave: Only careful trimming is used with a scissor to leave enough surrounding long hairs to cover the harvested area and to make it less noticeable during recovery that you had a procedure
What Are the Ways to Implant Hair?
After the hairs are harvested from the donor site, they can then be implanted into the chosen recipient area. First, the recipient sites are made and then grafts are placed one by one. Board certified plastic surgeon in UES, Manhattan Dr. Linkov differentiates between two main instruments used to create recipient sites, these include:
- Needles: 18G-21G one-inch needles, which can be bent to control the exact depth of the hair follicle, can be used to make recipient sites. A 1cc or 3cc syringe can be used as a handle. Needles may facilitate ease of implantation due to their circular shape and may cause less bleeding and injury to surrounding hairs due to there being a partially blunt side to the needle.
- Blades: 0.5mm-0.8mm blades can be used with blade holders to create precise recipient sites. The depth can be controlled based on how the blade is inserted into the blade holder. Blades stay sharper longer than needles and can be used to control the fit of the graft with proper angulation and direction as the graft is more locked in.
Studies have shown no difference in the ultimate growth of hair whether needles or blades are used. The decision of which instrument to use depends on the surgeon and technician experience and preference.
How Many Hair Grafts Do I Need?
During the initial consultation at City Facial Plastics in Manhattan’s Upper East Side, Dr. Linkov will estimate a graft count based on your desired look, donor density, and density needed at the recipient site to create the proper appearance. The graft count is always an estimate as the final count will depend on the technical ability to harvest the intended number of grafts. But the estimated graft count will guide the amount of time needed for your procedure and the cost.
In general, procedures can be divided into small, medium, and large cases, based on the following graft counts:
- Small: <800 grafts
- Medium: 800-1400 grafts
- Large: >1400 grafts
Keep in mind that even a small hair transplant surgery is time-consuming and meticulous in nature. Procedures involving more than 2000 FUE grafts may require a two-day procedure.
What Leads to a Natural Appearance After a Hair Transplant in NYC?
There are several factors that lead to a natural hair transplant appearance, including:
- Density – Sufficient density needs to be created consisting of the native hairs and the transplanted hairs
- Angulation – Different areas of the body and scalp have hairs growing at a certain angle to the skin surface and this needs to be respected when designing the recipient sites for a natural hair implant result
- Direction – Following the correct direction of hair growth is very important for natural results
- Fading – At the hairline, for example, single hair grafts are placed at the leading edge and gradually 2, 3, and 4 hair grafts are added in as you progress further back to create a faded appearance
- Irregularization – Hair rarely grows in a perfectly straight line and therefore during a hair transplant it is critical to make irregular borders
Is the Doctor Actually Performing My Hair Transplant Surgery?
With the increasing popularity of the Neograft and SmartGraft platforms, the trend has been that doctors are less and less involved with the actual surgical hair transplant procedure. Often they simply design the hairline with a surgical marker and then disappear for the rest of the day, allowing hair technicians to perform the entire surgery. These technicians are certified by the Neograft and SmartGraft companies but they are not doctors and are not ultimately responsible for the result.
Dr. Linkov at City Facial Plastics in Midtown, Manhattan is a top-rated and reputable hair transplant surgeon who is intricately involved with every step of the hair implant process. He is there performing portions of the FUE harvesting and placement of grafts, and performs all of the recipient site creation which is the critical step. Dr. Linkov works with only the most experienced hair transplant technicians to provide the best results for his patients.
During your consultations make sure to ask the doctor which part(s) of the procedure he/she will be doing and how he/she plans to supervise the technicians throughout the procedure.
Is a Hair Transplant Only for Men?
Absolutely not. While men’s hair transplants are more common, they are also for women. The patterns of hair loss are usually different and the preparation for donor harvesting is also different. But the overall steps of hair transplant for women are similar.
How Much Is Hair Transplant Surgery?
The cost of this cosmetic surgery varies across the country and the world. Some practices charge based on price per graft and others charges a flat rate per hair implant surgery. In NYC, the hair transplant cost per graft generally ranges from $5-$10/graft. Certain parts of the country may charge as low as $1.5/graft. And countries such as India and Turkey offer packages with travel and hotel accommodations covered for a low price, but medical tourism can come at a price so patients must do their careful due diligence.
What Are the Risks of Hair Transplant Surgery?
Risks of this type of surgery include:
- Poor hair regrowth
- Overharvesting with a visibly reduced donor density
- Poor scarring
- Shock loss
- Adverse reaction to anesthesia
- Wound dehiscence (FUT)
- Unnatural appearance
How to Prepare for a Hair Transplant?
Avoid medications and supplements that can thin the blood and cause increased bleeding during surgery, such as:
- Vitamin E
- Gingko biloba
Refrain from smoking for at least one week before your procedure. Taking Vitamin C and Vitamin K before your procedure may help with healing and limiting bruising.
For body hair donor areas, if applicable, you will need to shave the area five days prior to the procedure to allow the hairs to grow out to the desired length for extraction. For scalp hair donor areas, you can leave the hair long to allow the surgical team to trim/shave as per the discussed plan for harvesting.
What to Expect on the Day of the Surgery?
Before your hair transplant surgery, you should avoid coffee, alcohol, and caffeine as these may increase bleeding and change how you respond to medications. Arrive at the office in comfortable, loose-fitting clothing. Do not apply any product to your hair and make sure your hair is clean. Take your routinely prescribed medications that morning as you normally do.
Bring in the procedure-specific prescribed medications to the office and the team will instruct you on how and what to take, but the usual cocktail includes:
- Antibiotic (ie. Cefadroxil)
- Anti-inflammatory (ie. Prednisone)
- Anxiolytic (ie. Valium)
- Sedative (ie. Ambien)
In addition, local anesthesia (lidocaine with epinephrine) will be used throughout the procedure to limit discomfort at the donor and recipient sites. Rarely, IV anesthesia may be recommended for certain body hair transplant procedures.
Plan to have a friend or family member arrive at the conclusion of your procedure to escort you home.
How Long Does a Hair Transplant in Manhattan, NYC Take?
These procedures are time-consuming endeavors. They can range from 3-12 hours in one day, and for larger cases, patients will need to come back the following day to finish the procedure. Cases typically start in the morning around 7:30 am, and if lasting more than five hours, a lunch break is given to the patient and staff.
What Is the Recovery From Hair Transplant Surgery?
For the first night, sleep with your head elevated on several pillows or in a recliner chair to prevent swelling, and place a towel under your head for possible light bleeding. You may gently clean your hair beginning the second day until five days with water in a basin that is carefully poured over the head. On the sixth day, you may begin to shower normally, letting the water hit your scalp as usual.
The transplanted hairs often will fall out with the crusts as soon as five to eight days after the procedure. The hair follicles remain in the scalp. Most of the rest of the transplanted hairs will fall out over the next two weeks. The new hair shafts will begin to grow in the 4-6 month window and will continue to grow. The final result is typically judged at 12 months, though it can take longer before all of the hairs grow in.
Is PRP Combined With a Hair Transplant?
If native hairs exist in the recipient area, especially if the hairs are miniaturized, PRP may be offered to prevent shock loss of those hairs after the hair transplant NYC procedure. PRP, or platelet-rich plasma, has been shown to reduce the incidence of shock loss.
What Are Alternatives to a Hair Transplant?
A hair implant is a permanent hair restoration option. Other permanent options, in the appropriate candidate, are surgical hairline advancement and scalp reduction surgery. Temporary, medical therapies for hair restoration include oral and topical agents as well as PRP.
Where Can I Get the Best Hair Transplant in NYC?
A lot of people wonder “how to easily find the best hair transplant near me?”. Dr. Gary Linkov is an ISHRS member and is considered top-rated hair transplant surgeons with experience in traditional scalp procedures as well as eyebrow, beard, and body hair implant. Dr. Linkov uses the latest FUE transplant techniques and works with the most experienced hair technicians to create the best and most beautiful hair implant results for his patients in NYC at facial plastic surgery clinic.
Hair Transplant Before and After
If you would like to explore hair transplant options, contact our City Facial Plastics office, located in Manhattan, NY, to schedule a consultation. Dr. Linkov is an internationally recognized facial plastic surgeon in New York City who can help you find the best procedure to obtain the look you desire to improve self-confidence in your appearance.