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Hair Transplantation

Transplantation of follicular units involves moving the small naturally occurring hair bundles (follicular units) usually from the scalp's permanent donor area to the area of hair loss. This procedure can be performed to treat a variety of hair loss conditions in appropriately selected and diagnosed men and women. 

 

Follicular Unit Extraction (FUE), is one of two donor harvesting methods used to harvest the small follicular units. With the FUE technique follicular units are individually extracted from the patient's donor area using a small round micro punch. It has gained popularity in recent years, and is often described as a  “minimally invasive” procedure because it does not involve stitches, and the tiny round excisions are left open to heal without sutures. However, it must be noted that when thousands of small cuts are made in the skin, it is an invasive procedure and does constitute surgery. The actual transplantation occurs the same for both donor harvesting techniques, as the grafts are inserted using various tools and needles or micro blades into recipient sites( small incisions) in the areas where the patient has experienced hair loss.

The other method of donor harvesting involves taking a full thickness ellipse of skin and hair (strip) called follicular unit transplantation (FUT). It is referred to as a linear excision, or linear ellipse strip harvesting, and the small grafts are individually dissected using a microscope. The wound is closed usually with stitches, and this leaves a linear scar, confined to one area rather then diffusely distributed like the FUE. This technique has been successfully used by hair transplant surgeons for decades. While the FUE harvesting technique has gained popularity in recent years because it does not produce a linear scar, patients must be knowledgeable about potential risks too. Despite false advertising claims of 'a no scar technique', FUE almost always leaves small round scars which, when performed correctly, can be hidden with short hairstyles. When performed improperly, FUE can result in diffuse donor thinning and leave visible scarring.

The major difference between the two is in the method of extracting or harvesting the donor hair. For the same number of healthy and intact grafts, though, the harvesting method should have no impact on the final look of the transplant if the graft quality is the same.

In FUE, the follicular unit grafts (not necessarily hairs) are individually extracted using 0.8-1.0mm ‘drill bits’. The procedure is carried out manually or mechanically using a variety of equipment. Instead of a linear scar, there will be a large number of very small dot scars. While barely noticeable, FUE is not ‘scarless’.

 

FUE is more time consuming than Strip FUT, as it relies on spreading the extractions over a large area of the scalp, which significantly limits the number of grafts available to transplant in a session compared to the ‘strip’ method used in Strip FUT.

FUE is ideal for those patients who favour very short hairstyles, or the type of hair where you can see through to the scalp.

 

In some situations hair transplant is the only solution suitable for women who have undergone prior surgical rejuvenative procedures like facelifting and/or browliftingand lack hair due to exposed scars in the temples, sideburns, behind the ears, or elsewhere.

The low-positioned (compared with men) and rounded female hairline frames the female face and adds youth, beauty, and femininity to a woman’s face.When restoring the female hairline, it is important not only to create a suitable shape but also to precisely recreate all of the details of a female hairline. A female hairline may be rounder, more oval, rectangular (still with softened corners), or some intermediate between these shapes.

Scalp Surgery

In rare circumstances we can proceed with scalp reductions to decrease the balding surface area. This type of surgery is often done in stages. Pre-operative tissue expansion may be necessary and in some cases we use scal extension. 

Hairline Lowering

The hairline can be lowered surgically in women with high foreheads. This implies a scar that is placed behind the frontal hairline. Another option is hair transplantation, to try to descend the hairline with grafting. Both of these techniques can be used together. 

This is not a good indication in men, because they may loose the hair progressively in the frontal hair zone because of andogenic alopecia (AGA) after the surgery. That hair loss would then uncover the scar placed behing the hairline.  

All hair restoration surgeries will microscopically thin the scalp hair. The hairline lowering operation is no exception; however, the thinning is distributed throughout the top and back of the scalp, so it is imperceptible. 

Forehead reductions versus hairline lowering: we believe the preference for one name or the other has to do with the perception of the problem by the patient. This can be seen either as a hairline problem or concern for a large or tall forehead.

Scalp Micropigmentation (SMP)

Scalp micropigmentation (SMP) refers to medical tattooing of the scalp used for camouflaging purposes. SMP can be used to camouflage baldness either as a standalone procedure for someone who does not want to undergo a hair transplant or combined with a hair transplant (afterward as needed or desired) to enhance a surgical result. At other times, SMP can be used to camouflage a scar, for instance, a linear donor scar in the back of the head, with or without hair transplant into the scar. 

Low-Level Laser Therapy (LLLT)

Low-Level Laser Therapy (LLLT) in hair restoration utilizes cool lasers to stimulate hair growth and reduce hair loss. LLLT is based on the scientific principle of photo-biotherapy. Photo-biotherapy occurs when laser light is absorbed by cells and stimulates cell metabolism and protein synthesis. Although the exact mechanism by which laser light promotes hair growth is still unknown, it appears to stimulate the follicles on the scalp by increasing energy production and by reversing miniaturization (the process leading to thicker hair shafts and a fuller look).

 

Recent studies have shown that Low Level Light Laser Therapy (LLLT) appears about equal to the benefits of hair loss medications used over the short term in both men and women, although the long-term benefits are less clear.

 

The use of LLLT should be of particular interest to women in whom medical treatment and surgical options may be limited.

 

The treatment works best to strengthen and help weak or thin hairs grow stronger.  By stimulating the hair follicles, reducing inflammation and lengthening the growth stage of the hair follicles (Anagen stage) which are known to reduce in growth time as we age. In many ways you can think of this treatment as not only hair loss treatment, but also an anti-aging treatment for your hair.

Those who use traditional medication like Finasteride (Propecia) and Minoxidil (Rogaine) can also benefit as well from the laser hair treatment as its mechanism compliments these types of treatments, enhancing the results already achieved. Hair transplant patients can also use this type of treatment as a way of maintaining their original hair and preserve their investment in a healthier looking head of hair.

 

Studies show that the LLLT treatment for hair loss is equally beneficial for men and women and many cancer patients that have lost hair due to radiation or chemotherapy have now started to use the Laser cap to help recover their hair growth.

Medical Treatments

Medical hair restoration options include non-surgical hair replacement products such as Minoxidil and Finasteride, although it is recommended that they be used under supervision by a doctor or hair restoration specialist, since do-it-yourself hair growth remedies can have mixed results.

In discussing non-surgical hair replacement for women and men, it is also important to consider nutrition. A healthy diet plays a key role in an individual’s overall well-being, and is particularly important for maintaining healthy hair after transplantation. A diet that lacks essential nutrients can cause hair follicles to stop producing new hair.

Sometimes, it is worth considering delaying hair transplantation surgery, due to the various medical reasons for hair loss and particularly when hair loss begins at an early age. In this case, physicians recommend that patients use medical treatments or cosmetic agents to “camouflage” their hair loss.

Minoxidil has been a very successful treatment in many men, as well as women. Some women, however, start and stop usage of minoxidil for a variety of reasons. One reason is that they do not have realistic expectations for what minoxidil can accomplish. For example, minoxidil by itself may not entirely restore the density but thicken the current hair, further slow down the balding process, and overall improve one’s condition. During the initial application of minoxidil, some women may experience temporary shedding. When preparing for a surgery, he advises women to be on at least a 6-week period of minoxidil before surgery in order to “stabilize” hairs that would otherwise have a greater chance of temporarily shedding, known as “telogen effluvium”. Hairs that are “weak and unstable” are more likely to be affected by the scalp manipulation that happens during hair transplant, as many women are prone to shed hairs around a transplant following a surgical procedure. Although this type of hair shedding is limited, it can be disconcerting to women and can be minimized with proper preoperative medical therapy.

Finasteride (brand name Propecia®) is an orally administered medication for male pattern hair loss (MPHL). It is the only specific MPHL treatment approved by the U.S. Food and Drug Administration for prescription by a physician. Several years of investigation and use by more than a million patients show that finasteride has long-term effectiveness and safety in treating MPHL in men of all ages and all ethnic backgrounds. Finasteride is sometimes used alone or in combination with minoxidil (see Using Minoxidil (Rogaine)) to complement hair transplantation. Finasteride is not recommended for use in women.

Finasteride's effects in slowing hair loss and stimulating new hair growth work best for early to moderate degrees of hair loss. Men with extensive hair loss are unlikely to experience much regrowth with finasteride; these men are better candidates for hair transplantation or other surgical approach to hair restoration.

Finasteride is most effective in stimulating hair regrowth over the crown of the scalp. It is less effective in stimulating regrowth at the front of the scalp-where hair loss is commonly called a "receding hairline". Physician hair restoration specialists may prescribe finasteride to prevent further hair loss by the patient, and carry out hair transplantation to provide coverage at the frontal hairline.

Recent evidence supports that in many cases of female hair loss, the underlying condition is inflammatory in nature, i.e., the scalp shows signs of subtle inflammation. Accordingly, a short 3-month period of topical steroid with minoxidil may be helpful (but not always) to reverse or slow down this inflammatory process. 

Low-Level Laser Therapy (LLLT) – One of the major advances in hair-loss treatments is home-based therapy for hair loss using low-level laser therapy (LLLT). LLLT has been used for quite awhile but the accessibility to the treatment was difficult. In the past, a person was required to make multiple weekly visits to a physician for such treatments making compliance to the treatment near impossible. Recent advances have allowed far superior home technology that is easy to use that can be very beneficial for women and men who are losing hair and can either supplement minoxidil or serve as a standalone method of treatment. 

 

Scalp Micropigmentation(SMP) refers to the use of a medical tattoo in the scalp in order to camouflage baldness. It can be very helpful for women who do not want to undertake a hair transplant or it can be used to subtly to improve a hair-transplant result.The procedure is quick and easy, and it creates immediate results by decreasing color contrast between the scalp and hair color. 

 

There is increasing evidence that Platelet-rich plasma (PRP) injected into the scalp helps stabilize hair loss and/or help some regrowth. In our experience that is particularly true for the crown and midscalp areas. 

Hair Loss

Hair loss diagnosis is crucial and could warrant further medical work-up.

Male pattern baldness is the most common form of hair loss in men (androgenic alopecia, AGA). Up to 70% of men will be affected by pattern baldness at some point in their lives. Although male pattern hair loss is genetic, it is not always predictable: even if it runs in a patient’s family, it is not always possible to know at what age hair loss will begin, or how an individual’s hair growth patterns will be affected. However, most people find that their hair loss increases as they get older.

The most effective male pattern baldness treatment is surgery, but other options are available as well, including hair restoration medication and low-level laser therapy. In particular, young men suffering from hair loss are advised to avoid hair restoration surgery until their hair loss pattern and progression is fully revealed.

In women, there are a number of possible reasons for female hair loss.

Causes of female hair loss can range from androgenetic alopecia (female pattern hair loss) to scalp conditions, stress and illness.

Female hair loss treatment will depend on its cause. Medications like minoxidil can help improve this condition. Other options include laser therapy, often in the form of a cap device, and hair restoration surgery, where hair is transplanted to the bald areas.

Stress, suboptimal nutrition, and illness can also be reasons for female hair loss. In addition, causes for temporary female hair loss may include iron deficiencies from anemia and post-pregnancy, thyroid disorders (such as hypothyroidism), and chemotherapy. In all cases, it is best to consult with a hair restoration surgeon to determine the causes and potential treatments for female hair loss.

Preventive measures, from medical treatments to platelet-enriched plasma injections, can improve the health of your hair.

 

Many people wonder what causes hair loss. The causes of hair loss vary depending on a number of factors, including genetics (this is often what causes baldness or alopecia), illness (such as thyroid disease), and medications you may be taking. The best way to uncover hair loss causes and find out whether they are preventable is to see a physician.

What causes hair loss in men and women is also related to lifestyle. Factors such as stress, exposure to chemicals or UV rays, smoking and consuming alcohol can play a role in triggering or exacerbating the loss of hair (and can also affect recovery from hair restoration surgery). It is also important to be aware that certain types of hairstyles, including braids, tight ponytails and hair extensions, can cause tension and trauma to the hair follicle, leading to hair loss.

There are several scalp conditions that can cause an itchy scalp, hair loss, and flaking; most can be treated with topical scalp meds. Among the most common is dandruff, which causes dead skin cells to flake and fall from the scalp onto the shoulders. Although it is a nuisance and is unattractive, this condition is primarily cosmetic; it does not result in a dry scalp, hair loss, or other serious consequences, and can generally be treated using dandruff shampoos that contain ketoconazole, zinc pyrithione tar or selenium oxide.

Other common conditions include excessive oiliness (seborrhea), and oily crusts adhering to inflamed, itchy, moist scalp skin (seborrheic dermatitis, also known as cradle cap in infants). The latter condition tends to be the most severe and should be treated by a dermatologist or other physician. However, an itchy scalp and hair loss rarely go hand-in-hand. However, regular scratching of the scalp can lead to hair breakage.

Hair can also be restored post-traumatically by corrective scalp surgery and by scalp expansion, which can give excellent results.

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