Authors : Dr. Akhilendra Singh .

Introduction

• Scalp hair is a human characteristic that conveys aspects of self-image, identity, ethnicity, and health, among other attributes.
• Our hair frames our face.
• Thus, it is not surprising that baldness may result in disturbed self-perception and psychosocial interactions

Hair transplantation surgery, similar to other cosmetic surgery ,has enhanced by a wide margin over the previous decade. Reconstructing a new hairline is an art requiring surgical as well as artistic skills.

Hair transplantation is a minor surgery ,which needs major artistry.In this surgery, hair roots are harvested from the permanent zone of the scalp, beard and body and implanted on the balding areas. In about 6-10 months the implanted roots grow into full length hair just like a tree grows from a seed.These hair will continue to grow throughout the life . This hair retains its characteristics of growth after it is transplanted to the bald area, this is known as “Donor dominance” postulated by Norman Orentreich(father of modern hair transplant).This characteristic of donor area hair is the scientific basis for the success of hair transplantation.

Currently FUE method of hair transplant is widely accepted technique and give excellent natural results.

FOLLICULAR UNIT EXTRACTION (FUE)

It is a new technique. Here, there is no cutting of skin strip but the hair-follicles containing 1 to 4 hair are carefully selected and individually removed from the donor area and implanted into the bald or recipient area. Major advantage of FUE is that donor area is considerably enhanced because apart from scalp, hair grafts can be extracted from beard and body also(pic1-3), which is very crucial in coverage of higher grade of baldness.

Figure 1	Figure 2

Figure 3

Direct Hair Transplant/Implant(DHTDHI/)

Direct hair transplant/implant is improvised version of traditional FUE technique in which the critical limiting factors like “out of body exposure” and consequently hair grafts viability is taken care by simultaneous extraction and implantation of grafts. It is dedicated team work of hair transplant surgeon and skilled technicians. Currently worldwide method of hair transplant is shifting towards DHT/FUE method from strip method. .. (pic 4)

Figure 4

Advantages of DHT

1. Time period between extraction and implantation of hair grafts (outside body time) is reduced from hours to minutes/seconds.
2. As hair grafts are delicate so “No Root Touch technique” is used to avoid the chances of damaging hair roots and grafts are implanted by holding from shaft.
3. The chances of graft survival is almost 100% in DHT.
4. Results we can achieve earlier (pic5-6), and final outcome will be outstanding (pic7-8).
5. Hair transplantation by Unger & Shapiro.

Figure 5

Figure 6

Figure 7

Figure 8

TABLE 1.1 Key Concepts

• Ongoing hair loss affects the density and cosmetic appearance of the procedure Net density =HT—ongoing hair loss
• Caliber of hair follicles will help determine the perceived density of the procedure. An equal number of thick and thin hair follicles will not create the same perceived density
• Limited donor ,so there is nothing called unlimited hair transplant.

TABLE 1.2 Preoperative Course

• Routine preoperative blood work is required
• Review consent form and written pre/postsurgery instructions at least 24 hours before surgery. All questions should be answered before surgery
• Prophylactic antibiotic as indicated

TABLE 1.3 Postoperative Course

• Resume normal activities immediately, but avoid heavy exercise, smoking for 2 weeks
• Overnight dressing removed on post-op day 1
• Prednisone 40 mg once daily for 3-5 days, given to help reduce frontal edema
• Antibiotic and NSAIDs for 5 days
• Advised to shower on day 1 but do not pick/scratch at hemorrhagic perifollicular scabbing
• Antibiotic ointment applied to donor region for 1 week
• Majority of patients return to work 2-3 days postop and feel cosmetically comfortable
• First follow –up 1 month after surgery
• Final density 8-10 months after surgery

Figure 9

Figure 10

Sequale

• Epidermis and dermis along with the shaft of the transplanted hair falls off as scabs in 2-3 weeks
• It usually takes six to nine months to appreciate the result of a hair transplant
• Second procedure must be at least six months after the first sitting.

Frequently asked questions (FAQs)

Q.Does the implanted hair continue growing ?

The implanted hair is taken from the donor area that is characterized by a genetic attribute different from other parts of the scalp in that it is resistant to balding. Therefore, the implanted hair continues to grow all the patient’s life and it can be treated like natural hair for all purposes – haircuts, shaving, dyeing etc.

Q.Is the hair transplant always successful ?

As long as the patient carries out the doctor’s instructions, the transplant will always be successful in accord with the matched expectations that were enunciated at the consultation stage, and in most instances it is impossible to tell that the patient had undergone a hair transplant.

Q.Is a hair transplant a complicated operation ?

The hair transplant is carried out under local anaesthetic and therefore there is no need for hospitalization. At the conclusion of the transplant , the patient is free to go home, also can drive and return to activity a day later.

Q.May one go back to work immediately after the transplant ?

During the first week there are wounds that change into scabs in the implanted area, and therefore one should wear a cap in order to hide them . He can return to his regular routine on very next day. It is recommended to abstain from vigorous physical activity involving the upper part of the body for two weeks, thus allowing the recuperation to be faster and more successful.

Q.Is the hair transplantation a painful procedure ?

The transplant is conducted under a local an aesthetic and done by means of tiny injections into the donor area from which the hair is taken and into the implant area. Afterwards the patient does not feel any pain, can watch a movie, listen to music and relax.

Q.What are the side effects of hair transplantation ?

There is no long lasting side effects. In particular cases swelling does appear in the area around the forehead and eyelids after the transplant, but disappears two days later – nowadays swelling is prevented mostly by affixing a special adhesive dressing to the upper forehead for 2 days, in addition to an anti-swelling medication.

References-

1. Hair transplantation by Marc R. Avram& Nicole
2. Hair Transplant 360 for Physician
3. Annals of plastic surgery 2010
4. J CutanAesthetSurg2010 ;3:69-75
5. International society of hair restoration surgery website
6. Association of hair restoration surgery India website