Archives: Treatment

Feel Confident with Your Eyebrows

Eyebrow Transplantation

Eyebrow transplantation is an advanced technique best performed by experienced hair transplant surgeons who have mastered this process.

In general, the male eyebrow remains at or below the orbital rim, while the female eyebrow rises above the orbital rim. However careful observation will show many exceptions to these rules.

While eyebrow transplantation can be very rewarding, it is important to first determine the underlying cause of the lack of hair. The most common cause of eyebrow thinning is overplucking, followed by congenital absence of adequate eyebrow cover. Conditions such as trichotillomania or inflammatory causes of hair loss must be fully under control or excluded, otherwise the newly created eyebrow will be lost to the original condition.

When asked to recreate an eyebrow, the surgeon must carefully explore the desires of the patient, even more than with the hairline.

It is very useful for the patient to bring a photograph of his/her preferred eyebrow shape.

As with all hair transplant procedures, the patient must be informed that the hair shafts will fall out over the first 2-3 weeks, and new growth can be expected within 3 months.

Also, regular trimming of the transplanted eyebrow hair will be required.

Framing the eyes (the windows to the soul) with elegant eyebrows lights up the person’s face and accentuates the colour of the eyes. This provides a great sense of satisfaction for patients, accompanied by a sense of accomplishment for the surgeon.

“Dr André Nel is honest and very professional. In a world where so many are in it for the money, I was lucky to find Dr Nel. A surgeon with true skill and a man who keeps his promises.” – Tim

Natural Looking Beard

Why is Beard Hair Curlier?

We divide the face into a side view and frontal view for the purpose of beard transplantation. The side view includes the side-burns, the cheek beard, the jaw line beard and the beard below the jaw line. Of these four areas, the cheek beard is cosmetically the most important. In the frontal view, the fore beard, comprised of the moustache and goatee is the most prominent feature and higher densities of hair are present in these areas. The hair below the chin and jaw line that extends onto the neck is also considered to be part of the beard.

The density of beard hair is less compared to the scalp. The maximum density is over the chin and mid portion of the moustache. The calibre (thickness of the hair shaft) of beard hair is larger compared to the scalp. Beard hair shafts are also more elliptical (flatter) in cross section compared to scalp hair which is more oval or circular in cross section views. This is why beard hair tends to be curlier than scalp hair.

“Dr Nel’s systematic and pragmatic approach instilled confidence and belief in the process. Restoring my hair has given me a quiet sense of confidence and great satisfaction. It has been one of the best decisions of my life!“ – Mark

Using FUE / FUT for Beards

For beard transplants, grafts are removed from the donor area in the same way as in a routine FUE (follicle unit excision). The main difference is in the distribution of the grafts and the recipient site creation. We can use both FUT and/or FUE techniques for harvesting grafts to transplant into the beard area. One advantage of FUT strip harvesting is that the harvested hair shafts can be left longer in length which allows us to pre-determine the curvature of the hair and ensures that placement in the recipient sites allows for the hair shaft to curve towards the skin, giving a more natural appearance. This is even more important when transplanting eyebrows compared to beard transplants, but the basic principle for both recipient areas are very shallow recipient sites and implanting grafts with hair shafts curving towards the skin.

With beard transplants the frontal view is cosmetically more important than the side views and requires more density compared to the sides views.

During implantation, 1-hair grafts are placed over the superior outline (margin), similar to transplanting a scalp hairline.

Then combinations of 1-hair and 2-hair grafts are used in the other areas.

Implantation compared to scalp hair takes longer because the beard area provides less stability (loose tissue relative to the scalp).

We make use of nerve blocks to provide complete anaesthesia of the recipient area. After the nerve blocks, field anaesthesia is given.

Post-Surgery for Beard FUE/FUT

The post-operative phase for a Beard Transplant is much the same as the post-op phase for a normal scalp hair transplant.

Firstly, the FUE harvested areas will heal within 7 days and for the FUT strip wound we remove the sutures on Day 10 postop.

Similar to a scalp hair transplant, the transplanted grafts in the “recipient areas” of the beard require regular spraying (half hourly) with Normal Saline solution for the first 7 to 10 days post-op.

The first day after the procedure there might be slight drooling in some cases from the mouth angles (a consequence of the local anaesthesia), but this is usually minimal, if present at all.

There could also be some superficial blotches of small blood stains in the skin of the beard area, here-and-there but this is also minimal, and it usually resolves within 3 to 5 days.

Other than that the post-operative phase is uneventful and similar to a scalp hair transplant surgery.

Discreet Scar Removal & Camouflage

Hair Transplants Can Be Used to Camouflage Scar Tissue

Scars on the scalp due to injury or previous hair transplants can be rectified and camouflaged by transplanting single follicle units into the scar tissue.

We harvest the follicles used for scar correction via the FUE method.

In some cases we combine Follicle Unit Excision (FUE) technique by doing Scalp Micro-pigmentation (SMP), but this is always done a few months after the FUE procedure.

Doing both FUE and SMP (at a later stage after the FUE) provides the best solution for camouflaging scar tissue and making it blend in with the surrounding hair follicles.

“Dr André Nel is honest and very professional. In a world where so many are in it for the money, I was lucky to find Dr Nel. A surgeon with true skill and a man who keeps his promises“  – Tim

Combining FUE & FUT for Optimal Hair Restoration

Limited Donor Area Supply?

In some patients who have limited donor hair supply, where graft yield needs to be maximized and where the donor supply also needs to be protected for the future, it is often the best policy to combine FUT strip surgery harvesting with FUE technique harvesting to get the best of both worlds.

“Dr Nel not only restored my hairline and my confidence; he reversed and repaired my previous surgery that was botched by another surgeon.” – T. Walker

Combining FUT and FUE is Good in the Following Cases

Limited Donor Supply

Patients with limited donor supplies and large recipient areas where the maximum number of grafts need to be harvested in order to achieve the best possible aesthetic result, while still protecting the donor area from over-depletion.

Protecting The Donor Area

Patients where we simply want to harvest a specific number of grafts, e.g. 2500 grafts, but we do not want to be limited by what can be harvested via an FUT strip only.

This then enables us to do a relatively conservative FUT strip harvest with regard to the strip width, which allows for minimal wound closure tension and a thin scar line, camouflaged by trichophytic closure.

EG: We take a conservative strip width and length that delivers only 1800 grafts, and harvest the balance of 700 grafts via FUE technique. The grafts are harvested in a balanced and even way, protecting the donor area for the future.

5,000+ Hair Grafts Safely

Patients with good donor areas who want large amounts of grafts transplanted in one session, e.g. harvesting 5000 grafts or more.

This requires a near maximum FUT Strip harvest while still remaining within safe parameters as far as strip width is concerned, because the balance of the grafts can be harvested via FUE technique.

Using this approach, half the graft total can be harvested via FUT strip surgery and the other half via FUE technique. It enables a large amount of grafts, but a good balance is maintained by combining FUT and FUE harvests.

FUT Hair Transplants

Optimal Harvesting of Grafts from Safe Donor Area

A Highly Reliable Procedure

FUT (Follicle Unit Transplant) surgery, also known as FUS/T (Follicle Unit Strip Transplant) is a procedure used to harvest a strip of hair follicles from the donor area at the back and sides of the head, allowing for sufficient hair follicles to be transplanted into the recipient area.

Follicle Unit Transplant surgery is considered one of the best methods to harvest grafts from the “heart” of the Safe Donor Area (SDA).

Once the strip of skin has been harvested, the hair follicles are cut from the tissue strip under stereo-microscopic vision and then transplanted into the recipient area into the recipient sites.

“The hospitality and constant care during and after the procedure was simply 5 star treatment. I’m proud to say that my results have been life transforming“ – R McDonagh

Hair Transplant Grafts

The incision made to harvest the strip of skin will ultimately leave a linear scar.

This should not be of great concern, as the scar will be very thin and hair growth surrounding the scar will cover the area sufficiently.

By doing a Trichophytic closure, the lower edge of the Follicle Unit Transplant wound is beveled and this allows hair shafts to grow through the scar and thereby providing added camouflaging of the scar.

Therefore the scar will almost not be visible when the hair is combed open around the scar and it will certainly not be visible once the hair returns to its usual length and hangs over the scar area.

FUT Hair Transplant Post-Operation

FUE Hair Transplants

A Minimally Invasive Procedure

Follicle Unit Excision (formerly Follicle Unit Extraction) is a hair transplant technique involving a minimally invasive procedure to harvest hair follicles from the safe donor area at the back and sides of the scalp.

Those follicles are then transplanted into areas where hair loss has occurred.

This surgical procedure is done by using a specialised punch to harvest the hair follicles from the donor area.

The grafts are sorted and stored temporarily in organ storage solution and normal saline at cooler temperatures, then processed before transplanted into the recipient areas with hair loss.

Hair Transplant Grafts

Why Is FUE Ideal for Hair Loss?

Follicle Unit Excision offers the patient remarkable results with denser hair growth in the required areas.

This procedure also offers patients a permanent solution to hair loss conditions, making it one of the most popular methods of hair loss treatment.

Follicle Unit Excision harvesting as a method for hair transplant surgery is suitable to both men and women.

Advantages of FUE Hair Transplant Procedure

No Linear Scar

With Follicle Unit Excision the follicles are harvested one-by-one using a sharp circular punch that leaves a small round wound that heals within a week.

Over a 12 to 18 month period the scar shrinks leaving a very small slightly depigmented dot on the skin which is barely seen on a bare scalp and completely covered and not visible when the donor hair has grown out.

Less Nerve Damage

Because the punch sites are small and distributed randomly over the whole Safe Donor Area, nerve damage is less when compared to FUT strip surgery where some of the occipital nerves are severed during the cutting of the strip.

However, peripheral nerves regrow over a period of 18 months and in both FUE and FUT harvesting the sensation returns on the back of the scalp. With Follicle Unit Excision the sensation returns quicker and there seems to be less numbness during the recovery phase.

Less Invasive

Because a small punch is used and not a scalpel that cuts into the tissues, the healing time is much quicker, and no sutures are required as the punch sites are so small they heal by themselves through secondary intention.

Scalp Laxity

With an FUT procedure, scalp laxity is often less after surgery where with FUE the scalp laxity tends to be better maintained post healing.

Graft Selection

FUE allows Dr. Nel to ‘cherry pick’ grafts that are necessary for an optimal result.

Especially during FUT/FUE combination procedures, by doing FUE specific grafts with 3 hairs and 4 hairs can be targeted in areas where they are more prevalent.

Use of Body Hair/Beard Hair

The advent of FUE has allowed for the extraction of non-scalp hair from the beard or chest areas in patients with limited donor supply.

Recovery Period is Relatively Quick

The tiny dots caused by the small punch used for the Follicle Unit Excision will heal within a week.

Retains Donor Growth Patterns

FUE causes minimal disruption to the hair direction and angles of growth in the donor area.