Hair transplantation is a popular surgical procedure for growing permanent natural hair over bald areas of the head. It is done by transferring a person's own living hair from the back of the head (Donor Area) to grow permanently in areas of baldness (Recipient Area). It can also be done over the area which is not completely bald but where some hair is still present. Since all the roots are not taken out from one place; the donor area is not noticeable and looks the same.
Male Pattern Baldness – also called androgenic Alopecia is the cause of hair loss in 90% of men. Androgenic Alopecia is an interplay of both genetic and hormonal factors. It results in shortening of the Anagen phase of the hair cycle and miniaturization of hair follicles leading to baldness.
In 1959, Norman Orentreich from New York reported that hair-bearing scalp (auto-grafts) could be successfully transplanted from the back of the head to the balding front and top. Based upon his experiments, hair restoration surgeries were carried out all over the Western world using 10-20 hair follicles in each punch graft during the 60s. Owing to the problems of blood nourishment to the center of the graft along with the graft contraction – a peculiar unsightly toothbrush like appearance occurred. Dr. Nordstrom was the first to start 4 to 6 follicles in hair grafts & Dr. Headington, the first to start single follicle hair transplant.
Follicular unit hair transplant is a long procedure which requires 6-8 hours. It involves careful dissection of the follicles with the help of a trained staff. Single follicle hair graft has about 85-90% survival rate and 3 follicle hair grafts have an even higher survival rate.
Tricophytic Closure
This method, also called FUT involves removal of a strip of superficial layer of the hair bearing scalp from the back and sides of the head (Donor Area). The strip is then further dissected into fine follicular units with the help of stereo microscopes and is transplanted on to the bald area (recipient area).
The big advantage this method provides is that it covers a relatively wide area as it provides scope for extracting more grafts in a single session. If the donor area permits, we can transplant up to 4000 follicular units in a single session. Hair Transplant centres that use stereo microscopes have a lesser chance of the precious graft wastage (transection) during graft harvestation.
This method leaves a linear suture line in the donor area which remains hidden beneath the hair even on the day of surgery. By virtue of the latest refinements in the surgical techniques, this can be minimized by tricophytic closure. This technique helps in minimizing the scar which is nearly invisible and new hair grows through it in most of the patients.
The survival rate of grafts is very important to achieve good results after hair transplantation. We at Dr. Kumar's Relook Hair Transplant Centre take utmost care at every step of the procedure. This includes preparing fine micro holes on the bald area for implanting the prepared follicles, continually maintaining low temperatures, use of no-touch technique method along with an enhanced speed of transplanting. This results in a significantly increased survival rate of grafts when compared to the other centres. The centres having experience in performing this procedure along with skilled surgical assistants and microscopic magnification can provide the desired results. This is a time-tested gold standard in hair restoration surgery.
Hamilton Norwood classification
FUE HT is now a popular technique for HT in which a Hair Restoration Surgeon extracts the healthy hairs (follicles) by drilling around the follicles from the back of scalp, beard and chest and plucking them in a precise way.
These follicles are then further transplanted on the recipient [bald areas] in a fashion similar to that in FUT technique, the rest of the process remaining the same for both techniques of HT. This technique is much less invasive, technically less demanding, relatively easy & a less recovery period.
Not all candidates are suitable for FUE HT. Pts with Hamilton Norwood classification type I, II, III, III vertex and to some extent type IV with good healthy dense donor areas are preferred candidates. Know your category. Although any candidate can undergo FUE.
Virtually pain free : FUE HT is virtually pain free, in fact both FUE & FUT are equal as far as pain factor is the concern. In FUT a small strip is anesthesised with local anesthesia whereas in FUE a larger area is anesthesised for the procedure.
Technically Less Challenging : FUE HT is technically less challenging, relatively easier, and can be performed in an OPD whereas FUT is demanding needs a good team work with a skilled surgeon leading the team.
Needs a Shaved Scalp : The entire donor areas (back of scalp) needs to be trimmed down, almost shaven Look for the follicles (grafts) to be harvested. This is an area of concern especially in females undergoing HT where an FUT is preferred.
Large donorArea : Almost the entire donor area needs to be anesthesised & scarring though minimal is over a large area in comparison to FUT wherein a fine thin linear line(scar)[see images] is present by trichophytic closure if done by an expert plastic surgeon.
During the procedure, once the strip is removed from the donor area, the two ends are approximated by suturing. The new method of suturing which significantly reduces the incidence of scar on the donor area is called "Trichophytic Closure".
This method (Trichophytic closure) not only enhances the aesthetic outcome of the surgery but also reduces the post-operative complications by enhancing the complete healing of the scar without leaving a trace of it. One can also appreciate the growth of hair from the scar area in the later stages which only underscores that the tissue at the suture area is alive.
To achieve mastery over such a subtle technique, it needs and involves lot of dedication and practice which is possible only at Hair Transplant and cosmetic surgery clinics devoted completely to Hair transplantation.
Not all patients with Hair loss are suitable/require Hair Transplantation.
Patients who are young and in the early stages of baldness can be treated with medical therapy to stop the progression of baldness, as well as promote hair growth. Frequently, even the younger patients require hair transplantation depending upon their psychological and social obligations like marriage issues, anxiety, low self-confidence, location & area of baldness etc.
Various Camouflaging Methods are available which provide a quick, simple, easy but cheap look-alike of natural hair. This gives off an artificial look which affects the confidence of the person. These are the artificial ways to cover the bald areas. The so called specially prepared shampoos, lotions, oils and herbal preparations so vigorously marketed in the electronic & print media simply do not work.
Wig hair is made from either synthetic acrylic fibres or human hair. They are of two types: Interwoven and the worn-over. Though modern wigs provide immediate coverage, they can be easily spotted out by other people causing embarrassment and low self-confidence when dealing and interacting with others. They may become uncomfortably hot causing sweating during summers, thereby reducing patient compliance. They are usually associated with numerous problems like itching, dandruff, detectability and maintenance.
All these methods have their own disadvantages and therefore cannot be worn for lifetime.
Though all these methods are swift and less expensive they are temporary in nature and can never match the natural appearance of hair transplantation which is gold standard in hair restoration and much more cost effective in the long run.
In cases where hair transplant cannot be performed due to various limitations (e.g. poor donor area), camouflaging techniques are recommended to boost the confidence levels of the patients and to improve the over-all appearance.
