However it is only in the past decade or so the surgical techniques of some physicians have made it possible to re-create the look of a man's original, natural hairline.

Of all the male cosmetic procedures performed a hair transplant is the most popular and growing in popularity and of all cosmetic procedures for men, hair surgery has the potential to produce the most dramatic change in one's appearance.

However achieving the correct end result can be very traumatic for the patient.

The new methods of micro grafting produce some wonderful and dramatic results.

It would be almost impossible to detect a good transplant, provided a competent surgeon carried out the work.

Under a skilled surgeon, the nightmares that used to be associated with hair transplants have virtually gone, and by using smaller plug grafts with microsurgery, hair transplants offer a very realistic solution to a new head of hair.

Hair transplantation is the medical process of relocating permanent hair from the lower back and sides of the head. T

hese hairs are transplanted into areas of thinning and balding along the top and towards the front of the head, where after a short resting period they grow and will continue to grow for a lifetime.

The entire reason why hair transplants are permanent, and not just a temporary cosmetic procedure, lies in a simple physiological fact that every man has a horseshoe-shaped area of hair around the back and sides of the head.

Often referred to as the monk's fringe, this area contains hair, which is genetically programmed before birth to last a lifetime. That's why even the most severely bald men you ever see will still have this area of permanent, lifetime growing hair at the back of their head.

The genetic information in these hair roots causes them not to be sensitive to male hormones (androgens) which begin to appear during puberty.

In most men, hairs along the top and at the front of the head are in varying numbers and to varying degrees, sensitive to these hormones.

Over a period of years the hairs begin to respond to these hormones by withering and decreasing the length and diameter of the hair shaft until they revert back to being little more than "peach fuzz" growing out of the follicle.

The loss of hair tends to follow set patterns of recession, most notably above both temples of the forehead and at the crown, forming a "Friar Tuck" type bald patch. This is what is referred to as male pattern baldness.

Expectations

The major reason for complaints regarding hair transplants is that most people's expectations are far too high.

The surgeon and/or consultant should state clearly and precisely what results can actually be achieved, as opposed to what the client expects. Hair transplants cannot give anyone more hair than they have, they can only redistribute the hair that is already there.

These shattered expectations are often the cause of bitter disappointment to the patient. Good results can be achieved but will never achieve the same head of hair you had when your were eighteen or nineteen.

A patient should also be aware that any treatment they have, has to thicken an area of thinned hair.

In twelve months time the original hair may also be lost so you will only have the transplanted hair left, thus you may need further treatment at extra cost, something you should always be aware about.

Age must also come into question with regards to hair transplants.

It is very rare for anyone under the age of twenty one to be treated, the reason being that it is still far to early to tell to what extent his hair loss is going to advance.

The upper age limit is not so critical and successful transplants have been carried out on patients up to the age of sixty-eight.

Types of Surgery

There are as many as six different ways that hair can be surgically replaced. Flap grafting, strip grafting, mini flap grafting and square grafting are four methods.

These methods are not used much nowadays and should be avoided if a clinic suggests them to you.

They all involve taking a large strip of skin with the hair roots intact and replacing them in an area at the top of the head.

These results are usually very poor and hair growth can be very erratic and looks poor as the hair can grow back in any old style.

The other two methods are plug grafting which is what everyone associates as a hair transplant and the newer named micro grafting which as the name implies is a smaller method than plug grafting.

The best results for plug grafting are obtained on the crown as the surrounding hair makes it difficult to notice the plugs.

When performed on the front hairline they can leave a less than pleasing effect rather like a doll's head or a toothbrush.

Micro Grafting

Nowadays clinics all use different terms to describe transplants, such as micro grafting or mini grafting.

Micro grafting as we will call the treatment, is the most common type of hair transplantation procedure performed today and, the procedure that produces the most natural results.

Micro grafting depends upon the use of larger grafts to create density and smaller grafts to produce naturalness.

Whereas a normal graft will hold about twelve hair roots, a micro graft will hold about three or four hair roots, provided that the surgeon is skilled enough.

The mini-grafts (which are smaller than the old plugs) are generally used in the central part of the scalp where they give "bulk" to the transplant, but on their own don't normally look completely natural. Smaller micro-grafts are then placed in front of, and around, these larger grafts to produce a more natural, soft hairline and overall appearance.

A completely natural hairline is now possible by transplanting micro grafts to give a patient a natural look, something that is not possible with full sized grafts.

By using a combination of large grafts at the back and using progressively smaller micro grafts towards the front it is now possible to obtain excellent results that are virtually impossible to detect.

Hair roots could be transplanted one hair at a time if so required. Whilst this procedure would be completely undetectable, the finished effect would not achieve the thickness that can be obtained by using a combination of large and small grafts.

Transplanting hair roots one by one would be very time consuming and is extremely expensive.

In the normal plug grafting technique healthy hair roots from the back and the sides of the scalp are transferred to the top of the scalp where needed by using an instrument called a trephine.

This instrument has a circular cutting edge and the circular grafts it takes will vary in size from 2mm diameter to about 5mm diameter.

As many as 600 grafts could be removed from any one patient, although a maximum of 50 grafts should be removed in any one session of treatment.

Nowadays the donor tissue is removed with a multi-bladed knife that produces long thin strips of donor tissue, although single strip harvesting now appears to be a superior method.

After anesthetizing the donar area, a strip of scalp about ½" to 1" wide and 4-5" long is removed. Since the scalp is very elastic, the resultant gap is easily pulled together and sutured closed.

The hair on the back of the head conceals the small thin suture line

The surgery team then divides the donor hair strip, which contains thousands of hairs, into individual "grafts".

Micro-grafts contain one or two shafts of hair. Mini-grafts contain three to eight shafts of hair per graft.

With these techniques the surgeon transplant as few as one or two hairs at a time, which creates a more natural look rather than the "toothbrush" or "plug" effect.

These hair grafts are then implanted into recipient sites in the balding area. Micro-grafts are inserted into tiny punctures in the skin and mini-grafts into extremely small (0.5 mm to 2 mm) openings.

This achieves a more natural appearance. This is a big improvement over previous techniques where transplants were inserted into holes in the scalp. This often resulted in an abnormal, compressed hair.

Recipient sites are made in several ways. Some physicians use punch holes, some linear slits, and others use a "slot" method that creates a narrow elongated oval incision.

As techniques develop, we may expect that in time a standardized method will emerge.

The goal of all the various procedures is to obtain a more dense, natural appearance for the patient which allows the hair to grow in its natural manner.

The cosmetic effect of the placement of the grafts, the insertion angles, and the combinations of grafts are dependent of the skill and the "artistry" of the transplant surgeon.

The shape of the patient's face and predictions of areas of future hair loss must be planned carefully for optimal cosmetic results.

Most patients normally used to need three treatments to achieve an acceptable head of hair.

However nowadays the number of sessions could vary from one to six depending on how much work is involved, particularly since micro grafting techniques mean that one treatment can be suitable and involve very little discomfort and inconvenience.

Does It Hurt ?

Yes is the simple answer - The amount of pain varies between patients.

A lot of people say that it is like a visit to the dentist, however as with dentists there are good surgeons and bad surgeons.

Probably the most painful part of the procedure is during the injection of the anesthetic when a large number of injection are made to the donor area.

Often the patient is given a mild sedative to relax them before any treatment is carried out. It is normal in some cases to spray the area with a freeze spray to reduce the pain of the injections.

About fifty percent of customers will probably experience swelling on the forehead and face after a transplant.

This can be treated with an ice pack but in some cases is extremely noticeable and a return to work usually needs to be ruled out.

Patients have commented that their skull felt like a lump of wood for weeks afterwards.

They were aware of something having been done to their scalp but were not in any pain. The effects always seemed to wear off.