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Artificial Hair Implants

What if I have no hair to give?

Hairs for a hair transplant are harvested from a donor area and implanted in a recipient area. There are cases when a patient doesn't have enough hair in the locations commonly used for harvesting which is when alternatives might be explored.
 
Artificial, or synthetic, hair implants were introduced in the 1970s as a new technique for hair restoration. However, because of frequent severe and adverse side effects, the U.S. FDA banned the implantation of industrial fibers (such as polyester, modacrylic, and polyacrylic fibers) in 1983. 
 
Still, the council concerning medical devices in the European Union recognized the artificial hair implant technique as a medical act in 1996. 
 
The product that brought the procedure back into the limelight in Europe is Biofibre. Biofibre Hair Implantation is a surgical technique being used in many countries outside of the United States.

What are biocompatible fibers?

Biocompatible fibers are polyamide fibers available in 13 colors, different lengths (15, 30, or 45 centimeters), and in various shapes such as straight, wavy, and curly. Because of the variety of colors and textures, these fibers can fulfill different patient requests.
 
They are also available in a new high-density version called Medicap High Density (MHD) which allows for each implant to have three hairs implanted as the final result.

How are the fibers implanted?

The implant technique is a surgical technique performed by a manual or automatic implanter under local anesthesia. A small hooked needle places the root of the fiber under the scalp at the Galea level, where the root can be held by fibrous tissue. 
 
The root is a reversible knot that ensures correct anchorage of the implant and allows for a total fiber extraction if needed. In case of non-treatable side effects or unsatisfactory results, each fiber can be pulled out entirely, with no residue left in the scalp.

Who is not a candidate?

Unsuitable candidates for the use of biofibres include patients with or with a risk of:
  • chronic scalp disease (including non-stabilized alopecia areata),
  • diabetes mellitus,
  • hepatitis A, B, or C,
  • autoimmune diseases,
  • chronic scalp diseases,
  • and severe psychosis.
Before deciding on synthetic hair implants, surgeons often require that their patients do extensive blood testing and urine analysis to rule out some of these underlying conditions.
 
The treatment is also not recommended when there is a lack of personal hygiene or when the patient is employed in a dusty or dirty environment.

How many fibers are implemented?

Patients initially only receive a small number of fibers, about 100 fibers. This is done to ensure that the person is not allergic to the fibers and will not reject them immediately.
 
If the patient tolerates the fibers, more extensive sessions can be done after a month. An average implant of 600-1000 fibers per session is often appropriate and is performed at one-month intervals. The average total number of fibers for one patient is 2300.

Do the fibers fall out?

The synthetic fibers are gradually rejected by the body which can lead to them falling out. Depending on the size of the treated area, spontaneous fiber loss is 10-20% per year. Hence, providers who offer this treatment recommend the following to stay safe:

  • safe fibers
  • suitable implant instruments
  • trained surgeons
  • careful patient selection
  • and proper aftercare follow-up

Even when these criteria are met, patients still experience fiber loss and have to get additional fibers placed almost every year.

What are the side effects?

The literature reports a 6-13% rate of allergic, inflammatory, or infectious complications. Approximately 2% of those complications were not solved and required fiber extraction. These are mainly caused by a bacterium called Staphylococcus aureus.
 
Severe adverse reactions include osteomyelitis (inflammation and swelling in the bone) and infective endocarditis (an infection that affects the bloodstream). More serious adverse side effects can develop as the infection spreads to the nearby bone. From there, endocarditis infection can occur once the infection gets into the bloodstream.

Do the results look natural?

The final results can look natural, but you should keep in mind that these fibers cannot grow. They can be cut to the patient’s desired length at the time but will never grow any longer later on. Thus, most of the time, the patient is limited in how they can style their hair.

Should artificial hair be avoided?

Overall, biocompatible fibers appear to be safer today than they were in the 70s and 80s. Research shows a high satisfaction rate, but we need to consider that there might be a publication bias. There are plenty of risks and, although results can look natural, they require regular maintenance -  yearly at a minimum. 
 
Importantly, biocompatible fibers, dissolvable threads, and many other non-invasive aesthetic devices lead to many risks and challenges that must be weighed against the aesthetic benefits they sometimes offer

The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.

Written by Aleksandra Božović | Edited by Dr. Gary Linkov
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