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More than 250 million people in my country suffer from hair loss, and the hair loss population has gradually become younger in recent years. What is the principle of hair transplantation technology chosen by many people with hair loss? Can it save the hairline of those born after 1990?

Written by reporter Zhao Ling Edited by Ding Lin

New Media Editor/Li Yunfeng

Interview experts

Xie Xiang (Chief Physician, Department of Plastic Surgery, Peking University Third Hospital)

"Friends! I really regret not getting a hair transplant sooner!"

“It’s been one year since the hair transplant, and I love my hairline now!”

"One-time investment, lifelong benefit from hair transplantation experience."

In recent years, we have seen more and more advertisements for hair transplants, whether on virtual social platforms or on subways and bus stops. According to data from the National Health Commission, more than 250 million people in China are suffering from hair loss, and those born after 1990 have become the main force in hair transplants.

What is the principle of hair transplantation? Is this kind of beauty treatment, which is similar to "taking money from one pocket to pay for another", reliable? Can people with hair loss rely on this last "self-help trick" to solve the problem once and for all?

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How many steps are there in hair transplantation?

Just as planting a tree requires first cultivating a seedling, the "seedlings" needed for hair transplantation cannot be created out of nothing. So, where do they come from?

First of all, we need to clarify a concept: hair not only grows from hair follicles, but also absorbs nutrients from the body through hair follicles. Therefore, the essence of hair transplantation is not hair, but the transplantation of hair follicles.

The "Mediterranean" hair loss that troubles many people is actually a type of seborrheic alopecia, scientifically known as androgenic alopecia. Under the influence of male hormones, some hair follicles gradually shrink and degenerate, but the hair follicles at the back of the head are relatively "immune" to this. Therefore, for most people with hair loss, the healthy hair follicles at the back of the head are what can save the hairline.

Xie Xiang, attending physician of the Plastic Surgery Department of Peking University Third Hospital, explained to reporters: "To put it simply, hair transplantation can be divided into three steps, namely extracting hair follicles, separating hair follicles and planting hair follicles."

Among them, there are currently two main technical methods for extracting hair follicles, abbreviated as FUT and FUE.

FUT stands for "Follicle Unit Transplantation". This technique can only shave the hair on the back of the head. The doctor uses a surgical method to cut a strip of scalp containing hair follicles from the back of the patient's head, and then divides it into follicular units one by one. The part where the scalp strip is removed is closed by suturing, and it will eventually become a thin scar.

FUE stands for "Follicle Unit Extraction". This technique does not require surgery, but requires shaving a patch of hair at the back of the head to facilitate the doctor to use a follicle extractor to disperse and extract follicle units. The wounds produced in this way are scattered dot-shaped scars and do not require sutures. After the operation, the hair density in the hair removal area is reduced, but it is generally not too obvious.

The above two methods of hair removal have their own advantages and disadvantages. The doctor should comprehensively consider the specific situation and requirements of the hair transplant recipient and determine the surgical method. At present, FUE technology is more easily accepted by the public because it is less invasive and has a short recovery period.

After the hair follicles are extracted, they need to be separated and trimmed, which is the second step of the hair transplant process. "Because the extracted hair will be surrounded by fat or skin, which will hinder the implantation of the hair follicles, the excess tissue around the hair follicles needs to be trimmed to make them neat and clean for implantation. In addition, according to the needs of the operation, some hair follicle units containing 2-4 hairs should be divided into single hairs to make the operation more natural." Xie Xiang said.

The last step is to plant the hair follicles. There are three methods: 1. First use a gemstone knife to make a hole, then use planting forceps to implant the hair follicle unit; 2. Use a needle or other punching tool to make a hole, and then implant the hair follicle unit; 3. Put the hair follicle unit into the hair transplant pen, pierce the skin with the pen tip, and implant the hair follicle unit. Although these three methods are different, they can all implant the hair follicle unit into the planting area well without leaving obvious scars.

Xie Xiang said that the above two hair removal techniques and three implantation techniques have their own advantages and disadvantages, and they need to be considered in combination with the actual situation of each hair transplant recipient to make the most suitable combination plan.

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Will the back of my head be bald?

Since hair transplantation is so dependent on the back of the head, if the hair on the back of the head cannot be transplanted or is not enough, are there other methods? For example, transplanting leg hair or chest hair? "In fact, it is feasible in theory, and there are many such cases abroad." Xie Xiang said. However, this solution is not very feasible in China, because Asians have relatively less and finer body hair. Transplanting such hair to the head will greatly reduce the aesthetics. In addition to hair, the only thing Chinese people can use is beard. People with well-developed beards can choose to extract beard follicles to the part of hair loss.

(Image source: freepik.com)

If your own hair follicles are no longer sustainable, can you transplant hair follicles from a friend (who has extra hair)? Unfortunately, allogeneic transplants will produce immune rejection reactions, and the hair will fall out even if transplanted. Xie Xiang said: "Hair is part of the skin, and its rejection reaction is the strongest, much stronger than the rejection reaction of transplanted kidneys, livers, etc."

But the hair follicles at the back of the head are a "non-renewable resource" after all. If they fall off again after being transplanted to the top of the head or forehead, wouldn't the back of the head become bald?

"Healthy hair follicles in the back of the head generally grow well, and the clinical transplant survival rate is very high. Moreover, the hair in this area is insensitive to male hormones and generally does not fall out," said Xie Xiang.

In addition, for the sake of overall aesthetics, the doctor will evaluate the patient's current hair condition before the operation. "If the patient needs to transplant so much hair that the back of the head is bald, we generally do not recommend hair transplant surgery. After all, a bald back of the head will also affect the overall aesthetics."

(Pictures from the Internet)

However, even if the newly implanted hair does not fall out, the original hair will still fall out. It turns out that seborrheic alopecia is a gradually worsening process. It may start at the age of 17 or 18 and continue until the age of 50 or 60, during which the hairline will continue to "drift". Suppose a patient around 30 years old transplants hair from the back of the head at the hairline or the top of the head. After several years, the transplanted hair may still be dense, but the area around it that originally had hair may become a "vacuum" state due to hair loss, thus forming a "moat"-like scene.

"To prevent this, we generally recommend that patients take medication. Oral medications such as finasteride and topical medications such as minoxidil are effective in controlling hair loss," said Xie Xiang. "This is not something that can be done overnight. It requires long-term persistence. We recommend taking medication for life, just like treating high blood pressure and diabetes, but many people are reluctant to do so. This is also a dilemma."

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Hair transplanters "know more"

According to the data from the National Health Commission, more than 250 million people in China are suffering from hair loss, of which 69.8% are under 30 years old, and the largest proportion is young people aged 26 to 30, up to 41.9%. In the 12 years since he started working at Peking University Third Hospital, Xie Xiang has seen many young people seeking hair transplants, and their ages are indeed concentrated around 30 years old.

How have patients changed compared to the past? "They know more," said Xie Xiang. Nowadays, people have more and more channels to obtain information. Searching for "hair transplant" on a certain social platform, the search results include not only the hair transplant process, but also price references and how to bargain. All of them have been sorted out and shared in detail. It can be said that there is everything you need, with pictures and texts.

"Some people do detailed research in advance, while others have been to other hair transplant hospitals or related institutions. Although these people have certain knowledge, they still have only a limited understanding," Xie Xiang said helplessly. "Last week, we met a patient who had been to a hair transplant institution for consultation and learned about some specific techniques. As soon as he came, he asked me, 'Which is better, FUE or microneedle?' I could only tell him, 'These two are not the same concept. One is to extract hair follicles, and the other is to transplant hair follicles.'"

Many young people only have simple communication with the so-called "consultants" of hair transplant institutions, but these consultants themselves often do not perform surgery. Therefore, Xie Xiang recommends that hair transplant recipients communicate with the doctor as much as possible on the premise of choosing a regular hospital or institution, and have a sufficient understanding of the morphological design of the entire hair transplant area, the density of hair implantation, etc., so as to maximize the guarantee that the effect of hair transplantation meets expectations.

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