Hair transplantation aims to restore a more youthful appearance for those distressed by hair loss, particularly androgenetic alopecia. This activity reviews the evaluation and management of patients undergoing hair transplantation and explains the role of the inter professional team in improving care for patients who undergo this procedure

Objectives:

• Identify the anatomical structures, indications, and contraindications of hair transplantation.
• Describe the equipment, personnel, preparation, and technique in regards to hair transplantation.
• Review the appropriate evaluation of the potential complications and clinical significance of hair transplantation.
• Summarize interprofessional team strategies for improving care coordination and communication to advance hair transplantation and improve outcomes.

Anatomy and Physiology

t is essential to understand the relevant anatomy and physiology of hair, and the hair cycle, in order to maximize the outcomes of hair transplantation. Key elements in hair restoration include[5]:

• Hair follicle – composed of a hair shaft, two surrounding sheaths (inner and outer), and a germinative bulb. The follicle divides into three sections: infundibulum (from the skin surface to the sebaceous gland duct), the isthmus (from the sebaceous duct to the arrector pili muscle insertion), and the inferior segment (from the muscle insertion to the base of the matrix) 
• Bulb – the deepest segment of the hair follicle which contains the hair matrix (creates the hair shaft), dermal papilla (regulates growth), and melanocytes (produce color).
• Terminal hair – thick, pigmented hairs at the top of the scalp, beard, axillary, and pubic regions, all of which are androgen-sensitive. The hair elsewhere on the body, including the parietal and occipital scalp, are androgen-independent.
• Vellus hair – this is fine, short, non-pigmented hairs (“peach fuzz”) found on the adult that covers much of the body.
• Follicular Unit (FU) – a naturally occurring group of hair(s) seen on the scalp consisting of several terminal hairs (usually 1 to 4), a sebaceous gland and duct, and an arrector pili muscle. The collagen band which surrounds the FU is called the perifolliculum

Clinical Significance

Hair transplantation represents a powerful tool that can restore a more youthful appearance to those affected by androgenic alopecia. When performing hair transplantation, proper patient evaluation and execution of a comprehensive treatment plan can produce safe, reliable, and satisfactory outcome

Nursing, Allied Health, and Interprofessional Team Monitoring

Close follow-up during the initial post-operative period, either by a wound care nurse and/or clinician experienced in the post-operative care of HT, should monitor the patient for possible complications including infection and ingrown hair formation. The patient should receive counsel that loss of the implanted hairs normally occurs after several days and may take several months to grow. There may also be surrounding native hair loss at the donor or recipient site, though the patient should understand that this “shock loss” is normally transient and to expect a full recovery after a few months