Hair Transplant

Hair Transplant

Hair transplant is the most common cosmetic surgery procedure performed on men today. The market is full of various products that treat hair loss without surgery. These products, which include shampoos, hair-care cosmetics, scalp massager and many more have no proven efficacy. At best these can temporarily increase the volume of existing hair, resulting in a denser appearance than before. Minoxidil and Finasteride are the two US Food and Drug Administration (FDA) approved Medical Treatment for Hair Loss, which have some proven benefit. Hair Transplant Results are unmatched by any of these alone or combined even if used for years.

Hair Transplant is the Best Treatment for Hair Loss and till date Hair Transplant remains the most affordable hair loss treatment and is the Gold standard treatment for baldness.

                                         IDEAL HAIR TRANSPLANT CANDIDATE

hair-transplant

Hair Transplant Surgery Pre-Operative Instructions

Before The Day of Hair Transplant

  1. no-smokingAvoid taking blood thinning medications like aspirin for a few days before the surgery. Take opinion of the physician supervising your treatment.
  2. If you are having Dandruff, it is advisable to take Ketaconazole/ Arcolane/Scalp shampoo daily 7 days prior to the Hair Transplant.
  3. Hair Transplant Results are jeoparadised by Smoking/Alcohol/Gutka etc and they should be stopped completely for 7 days before the date of Hair Transplant.
  4. Avoid any kind of exertion or stress and be relaxed. Take proper sleep at least one day before Hair Transplant.
  5. It is advisable to take alprazolam 0.5mg on the night before the hair transplant to get relieved of the anxiety of the surgery and get a sound sleep.
  6. Some tests such as Blood tests (CBC, coagulation profile, LFT, HBsAg, HIV-Elisa, Australia Antigen and ECG) need to be done 2 days prior to the hair transplant surgery.
  7. It is advisable to shave the possible body donor area (chest, pubic, armpit, back or thighs) hairs exactly 4 days prior to Body Hair Transplant.

Hair Transplant Day 

  1. no-tshirtAvoid wearing garments which need to wear from head to avoid causing loss of Hair Follicles transplanted while removing the garment. Wear regular shirts with buttons at the time of hair transplant.
  2. Take tablet Ceftum 500mg twice daily for one day before the day of hair transplant.
  3. Shampoo your hairs properly in the morning of the day of the hair transplant. No oil, sprays or gel should be applied to the scalp on the day of hair transplant. One can wear cap after shampoo to keep the hair free of dust.
  4. Have light breakfast or lunch before the procedure. Avoid oily and spicy food.
  5. It is advisable, not to carry valuables like gold etc to the clinic
  6. At least one relative/friend should accompany the patient to the Hair Transplant Centre.
  7. It is strictly advised, not to drive back home on the day of your hair transplantation as you might be receiving few medications during the procedure which can make you drowsy.

Follicular Unit Transplantation (FUT) Technique

Hair Transplant earliest technique is Follicular Unit Transplant Technique also called the Strip Method. In the strip method of hair transplant a strip of scalp bearing hairs of appropriate density is excised using either a single No. 11 or No. 15 blade. The blade is inserted at an angle to the scalp which parallels the angle of the hair follicles into the scalp to avoid any damage to the hair follicle roots. The use of tumescent solution for infiltration also minimizes the follicle transection by appropriately aligning the hair follicles and providing a plane between the hair follicle bed base and the larger nerve plexuses and vessels that lie within the deep subcutaneous tissue.

Hair Transplant by strip method, the width of the strip is determined by the laxity of the patient’s scalp in order to yield the maximum number of grafts while limiting the tension on closing the edges. The edges are closed in layers with the deeper layers closed using absorbable sutures (vicrly) and the outer layer with non-absorbable sutures (ethilon/prolene).

Hair Transplant Advantages by strip technique are: larger number of hair follicle units harvested in a shorter period, lower rates of hair follicle transection and the ability to include the protective surrounding tissue containing the stem cell. Another advantage of FUT technique is that the remaining scalp is left undisturbed and can be used for repeat harvesting of the hair follicles using either FUT method or the follicular unit extraction (FUE) method.

Hair Transplant by FUT technique has one important and bothersome disadvantage which is the resultant scar over the donor area which becomes visible when hairs are kept short. There are various Plastic Surgery techniques with which the resultant hair transplant scar can rendered almost invisible. Ask your surgeon about the technique he is going to employ to prevent the scar at the donor site during and after hair transplant.

Hair Transplant by FUT: Separation of the hair follicles

fut-new

After harvesting the grafts, the hair follicle units obtained are dissected under microscopic visualization. Dissection under magnification is specially important to prevent follicle transection in this hair transplant technique.

In FUT Technique, hair follicles are separated into clusters of 1-4 hairs are transplanted. On an average a single naturally occurring hair follicle unit contains about 2.3 hair follicles.

The final separated hair follicle ready for hair transplant should have a pear shape where in the epidermis has been maximally trimmed and the dermal and subcutaneous tissue surrounding the follicle isthmus and bulb remains intact.

This optimal hair follicle shape is frequently achieved after FUT Technique, but infrequently from follicular unit extraction technique or robotic hair transplantation. The cushioning provided by these surrounding tissues has been found to maximize the hair follicle viability by minimizing desiccation during pre-insertion storage and mechanical trauma to the follicle from handling during hair transplant surgery.

Graft storage

Selection of proper storage solution has grown increasingly more important as “mega-session” hair transplantation involving slimmer grafts have become more common and out-of-body time has increased. Survival of transplanted grafts has been shown to decrease by about 1% per hour out of the body time. Factors which reduce the graft survival during this extended out-of-body time include ischemia-induced hypoxemia and subsequent adenosine triphosphate depletion, as well as ischemia-reperfusion injury. Three types of storage media (intravenous fluids, culture media and hypothermic tissue–holding solutions) help minimise out-of-body variations in pH, osmotic balance, antioxidant capabilities, and nutrient support to the follicles.

Preparing the recipient area

Various techniques are used to create and prepare the recipient area for transplantation of hair follicles. The critical element with donor area preparation is the angle and direction at which the hair follicles will leave the scalp leading to least damage to existing hairs and the creation of natural appearance of transplanted hair.

The most widely accepted density of hair follicle insertion at the recipient site is 30 hair follicular units per square centimeter. Some of the practitioners advocate for a denser packing of more than 40 follicular units per square centimeter. This can however compromise the viability of the grafts as the competition between the transplanted hair follicles for a limited blood supply increases.

Various techniques are used for recipient site creation and graft insertion. Blades may be cut to match the size of the follicular units to be inserted. Some use hypodermic needles to make incisions for hair follicle placement. Recipient site size increases as the surgeon moves posterior away from the hairline and the priority shifts from single, fine hairs to multiple, coarser hair follicular units.

A “stick-and-place” technique can be used to eliminate the time between which the recipient site is prepared and the hair follicle graft is placed within it.

A “spread-and-place” technique reduces the mechanical trauma from hair follicle graft handling as the hair follicle is placed into a smaller recipient site.

Hair Transplant Intraoperative Steps

hair-transplant-new

  • During Hair Transplant the patient is seated in a semi-recumbent position or prone position with head supported.
  • Preparation of the donor and recipient area is done with betadine solution and draping is done keeping all asceptic precautions.
  • Local anaesthetic is then injected. The donor area is injected superficially first, followed by a slightly deep injection along the entire hairline to create a field anaesthesia. Approximately 25 mL of 1:50,000 adrenaline solution is injected into the donor region for tumescence.
  • Wait for 15 to 20 minutes for the tumescent solution to act
  • The donor strip is then excised in a superficial subcutaneous plane to avoid trauma to the neurovascular bundle and other smaller vessels.
  • The donor-site incision is then closed in two layers with an absorbable suture for deeper layer and 3-0 Prolene suture for the outer layer.
  • Hair Transplant team is then split into two.
  • Number One Hair Transplant team consists of those who perform the slivering (sectioning of the donor strip into many narrow strips).
  • Number Two Hair Transplant team divides these narrow strips to harvest single hair follicles from them.
  • Excess tissue is excised to allow the transplantation of just these follicular units.
  • Graft cutting is performed with the help of binocular microscopes or microsurgical loupes for accurate dissection.
  • This process of follicle seperation is very demanding and time consuming but critical for the successful hair transplant procedure.
  • The grafts are cut on a Teflon cutting block by using size-11 /15 scalpel blades or double-sided razor blades.
  • While awaiting transplantation, the grafts are stored in cold preservative-free solution of isotonic saline or some other storage solution including dipping the hair roots in PRP solution which some centers claim to be Bio-FUE or some other fancy names.
  • While the grafts undergo dissection, the surgeon prepares the recipient sites. This can be done by customised blades or needles depending upon the surgeon’s choice. The recipient sites are made of appropriate size and direction while avoiding transection of existing hair follicles.
  • The harvested hair follicles are then inserted into the prepared recipient sites. This is an extremely challenging process and utmost care should be taken to prevent any trauma to the hair follicles.
  • Before finishing the procedure the surgeon once again inspects the whole recipient area and if few follicles are found popping out then they are again put inside.
  • Hair Transplant procedure should never be done in the hurry to finish the procedure. There should be no hurry to finish the procedure early as final outcome of the patient depends on how diligently hair transplantation is done on that very day.

Graft insertion

For insertion of hair follicle Jeweler’s forceps or similar non-toothed forceps are used to gently place the grafts into the recipient sites. Transplanted hair follicle viability is maximized by minimizing the mechanical trauma to the follicle during its insertion. This is accomplished by handling the dead portion of the hair (the part of hair which lies outside the scalp) rather than the sub-epidermal portion of the hair follicle itself. Some hair implantation devices allow for near-simultaneous recipient site creation and hair follicle insertion.

no-scar-technique

Follicular Unit Extraction (FUE) Technique

FUE3In this technique individual hair follicles or group of 2-4 follicles (follicular units) are extracted either manually or with a motorized rotating punch device. The punch used for this is similar to skin biopsy punch and comes in various sizes from 4.5mms to 0.8mms. The punch is inserted into the donor area encircling the follicle unit to be extracted. The punch is pushed inside with rotating movement and to a depth sufficient enough to release major attachments of the hair follicle with the scalp skin. The punched-out follicles are then manually extracted with forceps or with the motorised suction device which employs no touch technique for follicle extraction.

Follicular unit extraction technique has the advantage of not creating a linear scar resulting in a shorter and more comfortable recovery time and allowing the patient to keep their hair short after the procedure.

The disadvantages of follicular unit extraction (FUE) technique are: creation of numerous hypo-pigmented round scars in the donor area, an increased follicle transection rates and it is more time consuming for both the patient and the physician. In follicular extraction technique a larger donor area is needed for extraction of smaller number of follicles. The number of hair follicles extracted with this technique are less as compared to the strip technique leading to multiple sessions for larger bald areas. This technique also renders the scalp donor area unfit for further follicle extraction using the strip technique.

Separation of The Follicles from The Grafts

fue5After harvesting the grafts, the follicular units obtained are dissected under microscopic visualization. Dissection under magnification is specially important to prevent follicle transection.

In follicular unit transplantation, hair follicles are separated into clusters of 1-4 hairs are transplanted. On an average a single naturally occurring follicular unit contains about 2.3 hair follicles.

The final separated hair follicle ready for transplantation should have a pear shape where in the epidermis has been maximally trimmed and the dermal and subcutaneous tissue surrounding the follicle isthmus and bulb remains intact.

Follicular unit extraction technique has the advantage of not creating a linear scar resulting in a shorter and more comfortable recovery time and allowing the patient to keep their hair short after the procedure.

The disadvantages of follicular unit extraction (FUE) technique are: creation of numerous hypo-pigmented round scars in the donor area, an increased follicle transection rates and it is more time consuming for both the patient and the physician. In follicular extraction technique a larger donor area is needed for extraction of smaller number of follicles. The number of hair follicles extracted with this technique are less as compared to the strip technique leading to multiple sessions for larger bald areas. This technique also renders the scalp donor area unfit for further follicle extraction using the strip technique.

Graft Storage

Selection of proper storage solution has grown increasingly more important as “mega-session” hair transplantation involving slimmer grafts have become more common and out-of-body time has increased. Survival of transplanted grafts has been shown to decrease by about 1% per hour out of the body time. Factors which reduce the graft survival during this extended out-of-body time include ischemia-induced hypoxemia and subsequent adenosine triphosphate depletion, as well as ischemia-reperfusion injury. Three types of storage media (intravenous fluids, culture media and hypothermic tissue–holding solutions) help minimise out-of-body variations in pH, osmotic balance, antioxidant capabilities, and nutrient support to the follicles.

fue-transplant

Preparing The Recipient Area

Various techniques are used to create and prepare the recipient area for transplantation of hair follicles. The critical element with donor area preparation is the angle and direction at which the hair follicles will leave the scalp leading to least damage to existing hairs and the creation of natural appearance of transplanted hair.

The most widely accepted density of hair follicle insertion at the recipient site is 30 hair follicular units per square centimeter. Some of the practitioners advocate for a denser packing of more than 40 follicular units per square centimeter. This can however compromise the viability of the grafts as the competition between the transplanted hair follicles for a limited blood supply increases.

Various techniques are used for recipient site creation and graft insertion. Blades may be cut to match the size of the follicular units to be inserted. Some use hypodermic needles to make incisions for hair follicle placement. Recipient site size increases as the surgeon moves posterior away from the hairline and the priority shifts from single, fine hairs to multiple, coarser hair follicular units.

A “stick-and-place” technique can be used to eliminate the time between which the recipient site is prepared and the hair follicle graft is placed within it.

A “spread-and-place” technique reduces the mechanical trauma from hair follicle graft handling as the hair follicle is placed into a smaller recipient site.

Graft Insertion

grafts-insertionFor insertion of hair follicle Jeweler’s forceps or similar non-toothed forceps are used to gently place the grafts into the recipient sites. Transplanted hair follicle viability is maximized by minimizing the mechanical trauma to the follicle during its insertion. This is accomplished by handling the dead portion of the hair (the part of hair which lies outside the scalp) rather than the sub-epidermal portion of the hair follicle itself. Some hair implantation devices allow for near-simultaneous recipient site creation and hair follicle insertion.

Megasessions of Hair Transplant

Megasessions in hair transplant surgery means any hair transplantation surgery where the normal limit of number of graft transplanted in one sitting is surpassed. On an average in a single sitting of hair transplant surgery 2500 to 3500 hair follicles are transplanted. When around 5000 to 6000 hair follicles are transplanted in one sitting then such sessions of hair transplant is called megasessions. Among all the techniques for hair transplantation only the strip surgery (FUT) alone or in combination with other techniques is capable of delivering such high number of grafts in limited time. Patients get more dramatic results and the downtime for complete restoration procedure is reduced by many months. Financially also these megasessions are more viable for the patients.

The secret of these megasessions is to employ a bigger team of hair transplant surgeons. The team is divided into groups and each group has responsibilities shared and more work can be done in less time making this surgery possible. These megasessions have superseded the more advanced techniques of hair transplant like FUE/Robotic hair transplant. Megasessions are providing patients with previously unimagined results in a single surgery.

Direct Hair Transplant

Direct Hair Transplant procedure is the latest breakthrough in the hair restoration field. It is most innovative and advanced technique of hair transplantation. Direct hair transplant is comparatively fast and completely painless.

In the DHT technique each hair follicle is extracted one-by-one from the donor area and then these hair follicles are implanted directly to the recipient area. There is no need of slit or hole formation over the donor area before the hair follicle transplantation. There occurs no delay in the grafting and implanting of the grafts leading to increased survival of the grafts. The survival of extracted hair follicles depends on various factors and some of the important factors are: Graft Hydration, Cold Temperature, Prevention of infection and Mechanical trauma during handling of the graft.

In direct hair transplantation there is no handling of the hair roots and hence no damage to the hair follicle during the whole procedure starting from the harvesting of the graft to the implantation of the hair follicle. As graft is not exposed to the environment hence there are no chances of infection or graft desiccation.

Advantages:

  • No linear scar over the scalp
  • Grafts can also be harvested from areas other than the scalp, hence specially suitable for patients having very sparse hair over scalp.
  • Grafts are directly transplanted over the bald area of scalp without exposing them to the    external environment leading to better graft survival.
  • No desiccation and mutilation of hair follicles due to separation of the hair follicles from the    graft in other techniques.
  • Less discomfort for the patient as all the procedures can be done in the sitting position.
  • Less invasive, minimal risk of infection and complications.
  • Minimal post-operative medications and care required.
  • Faster healing as it uses smaller diameter punches.

It is one of the finest techniques of hair transplantation with maximum graft survival rates.

Body Hair Transplant

One of the most important principles in plastic surgery is “REPLACE LIKE WITH LIKE”. Hairs from the scalp are the best replacement for the bald areas of scalp but unfortunately some patients do not have enough hair over the head to achieve fruitful result. In such cases, it is possible to transplant body hairs which are similar to head hairs in structure and quality. Hairs may be taken from the beard area, armpits, chest, abdomen, back, arms and the legs. Few thousand grafts can be taken from all these areas combined varying from patient to patient. Patients having insufficient body hair cannot undergo this process.

Body hairs are removed by using FUE technique, leaving no scar line over the recipient site. FUT and Robotic hair transplant cannot be used to harvest hair follicles for body hair transplant. Finer punches are used to harvest hair grafts for body hair transplant. The finer the punches used the better is the healing of the donor area. The hair follicles are then transplanted over the donor area as in FUT/FUE/DHT techniques. Once the donor hair is transplanted they become permanent and can be trimmed and styled as usual.

Advantages of BHT

  1. Rescue procedure for those having very sparse hair over the scalp.
  2. Large number of grafts can be harvested.
  3. Grafts can be harvested from multiple sites by increasing the team members thus saving the overall time of the patient.
  4. Graft harvest and hair transplantation can be done simultaneously as the donor and recipient areas are farther from each other and most of the procedure can be done in supine position.

Robotic Hair Transplant

Robotic hair transplant is slightly advanced technique from the recently popular FUE technique. The difference between FUE and Robotic hair transplant is that instead of the doctor it is the robot which is actually harvesting the graft. So the variables which affect the hair transplantation surgery are all the same except for the graft harvesting step. The only real advantage of robotic hair transplant is that it saves you from the really pathetic trichologist. Due to the software used in the robotic hair transplant to calculate the direction of the hair follicle there is less transaction of the graft as compared to the FUE technique. The robot can also create recipient sites for the placement of follicular unit grafts according to an aesthetic plan designed by the physician but this step should be best left for the doctor to finish.

Potential Advantages of Robotic Procedures Over Manual FUE

  1. Increased accuracy of graft harvesting
  2. Increased survival of harvested follicular units
  3. Reduced harvesting time
  4. Computerized selection of follicular units to maximize hair and minimize wounding
  5. Easier extraction of grafts from the sides of the scalp
  6. Easier extraction of grafts in patients from different racial backgrounds or with atypical hair characteristics
  7. Increased speed and accuracy in creating recipient sites

 Disadvantages of Robotic Hair Transplant Over Manual FUE

  1. Sky rocket prices for the procedure.
  2. The robotic hair transplant technology is still in infancy as many critical steps of hair transplantation surgery are still the way they were more than 50 years back.

Other Indications

Beard And Moustache Hair Transplant

The trend of keeping beard and moustache has come back again. In various regions of India it is socially very important to keep moustache. They are considered one of the status symbols for them. Some men might have sparse moustache hair or some have patchy loss of moustache and for them hair transplantation is very good option. This facial hair transplant may become the only permanent solution for him.

beard-moustache-transplant

The procedure of facial hair transplant is similar to the hair transplantation over the scalp. The donor area for facial hair transplantation is back of the scalp and most common technique used for harvesting the grafts is follicular unit extraction (FUE) technique. This method is a minimally invasive procedure and can be used to restore hair density on different areas of the face. For finer hairs follicles can be harvested from the side of the scalp. In some situations hair over the chest can also be used. These hairs can be shaved and cut also.

Eyebrow Hair Transplant

eyebrow-transplant

Eyebrow transplantation is done to restore the hair of eyebrows when they are overly thin, sparse or completely missing. The loss of eyebrow hair can be due to electrolysis or laser hair removal, over-plucking, thyroid or other hormonal imbalances or trauma due to surgery, burns or any accidents.
Hair transplantation to restore the eyebrow hair is a well established and popular technique to give fuller and right shaped eyebrows specially in women. In eyebrow transplantation hairs from just above the ear or from the side of the head are taken to transplant to the eyebrow region. The number of hairs required in each eyebrow depends upon the density and the desired shape. The whole process is performed under local anaesthesia. Brow restoration is beautiful and permanent solution to hair loss in eyebrow areas.

Eyelash Hair Transplant

Eyelash hair transplantation is the latest and most challenging of all the hair transplant procedures. Eyelashes play a very important role in enhancing beauty of a woman. Women do every effort to enhance the length of lashes to make their eyes look bigger and dazzling. At the same time if they get damage or there is loss of eyelashes due to any trauma or disease then they have very negative impact and can make the most beautiful face look average. This procedure also suits the women who need to thicken and enhance the appearance of their eyelashes.

The eyelash hair transplant is a very delicate procedure as it requires correct choice of donor hair and perfect placement of these hairs at an angle and position which gives the eyelashes the natural look. Even a single hair follicle placed in wrong direction will make all the efforts go down the drain. To give a natural look a single hair follicle is transplanted at one time under microscope. In this procedure 60 to 70 hairs are transplanted to each eye. The whole process takes 2-3 hours and oral/mild sedatives are given during the procedure. Maintenance of the eyelashes is needed and they grow faster than the normal eyelashes and hence are to be trimmed short once a month.

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