Treatment of Hairs problems

10.1 Hair transplant surgery (FUE & FUT)

Two Techniques: follicular unit extraction FUE & follicular unit transplant (FUT)

Natural hairs can be transferred in bald area of the head. Number of hairs in eyebrows, eyelid and moustache can be increased by hair transplant process. Roots of the hair on the back part of head & the body parts can be transplanted on the front part of head of same person. New transplanted hair appear like hair at donor site.

Hair transplant is well accepted procedure all over the world. It has high success rate and produces reliable aesthetic results. Hair transplant is a procedure of implanting natural hairs roots of one place to another place. Hair transplant is generally done in anterior (front) part of scalp area. New hairline can be created in more front part with the help of this procedure and thus broad or high fore head can be reduced.

In some patients, some of them require more extensive hair replacement to cover diffused hair loss. Some may need to add more density of hair in existing hairs or transplanted hair. Sometimes earlier hair transplant needs more boosting of new 2nd hair transplant to improve cosmetic appearance.

During the routine cases of hair transplant hair on back part of head are transplanted on front part of head. Hair on back part of the head have least cosmetic value as long as these are on back part of head. But the hair in back part of the head have longer life. So these transplanted hair have longer life. In males although the transplanted hairs remain permanent, the other natural hairs in front part of head may fall due to aging, if proper follow up treatment is not taken. Most of the patients have enough hair on head the for transplant. Hair on other parts of body can be transplanted on head. One should keep optimum expectation from body hair transplantation.

Procedures of Hair Transplant (Two):

There are two methods of hair transplant. These are follicular hair unit transplant (FUT) & follicular unit extraction (FUE)

A) Follicular unit transplant procedure (FUT):

The strip of hair for transplant is obtained from the area having most dense hairs i.e. from the back and side of the head under local anaesthesia. Then, this wound is stitched. This wound heals without visible scar. The hairs near the scar hide the scar.

The strip of the donor skin is divided into small follicular unit graft. In each follicular unit graft, there are 1 or 2 or 3 hairs. On average each follicular unit contain 1.5 to 2 hair roots. During trimming of follicular units, the excess skin around the follicle is removed under high magnification. A hole or slit is created by needle or special instrument of same usual thickness. Each follicular unit is carefully put into each recipient site in the small hole. So one can see the transplanted hair shafts immediately after surgery.

So there is no excess skin in transplanted units. Hairline created by transplant of such hairs is useful. There is less loss of hair in FUT procedure in comparison to loss of donor hair in FUE procedure.

B) Follicular unit extraction Hair transplant procedure (FUE):

Hair grafts can be harvested from back part of head or any other part of the body. In FUE small follicular units of hair is removed with punch of 1mm diameter & that is transplanted on the recipient area of head or part of body. With this method hair can be removed from any part of body. Such body hair transplant on the head may be performed if there are no donor hair or insufficient donor hair on the head. When donor hair follicle graft is harvested, small wounds are seen on this donor site which heal with or without scars. There are chances of transaction on deeper part of hair follicle so we get less than extracted number of donor hair. This is tedious & time consuming procedure.

Transplantation of body hair on the head:

This is done by FUE hair transplant technique as mentioned above. Some of the men have lot of hair on the body but they tend to loss hair from front part of head at early age. In these cause individual hair lose increases faster than usual male pattern hair loss. Quality of hair on the head is poor. So these men or women need transplant of body hair on the head. This method of hair transplant is time consuming. These body hair have less quality of hair growth. Single haired grafts create perfect frontal hairline. In front view, hair follicular unit containing single hair root are transplanted. In area behind, follicular hair grafts containing to two hair roots or three hair roots are transplanted. Thus, attempts are made to duplicate a subtle feathered look of natural hairline. With special technique and miniaturized vacuum technique minimum trauma is done in handling hair follicular grafts.

Hair Transplant in Women:

Women should keep same specific hairstyle. Considering her constant hairstyle, it is decided which area needs more hair transplant. The hairs transplanted in anterior area can cover bald area. Hairs can be coloured to decrease contrast between the hairs and the scalp. Increase in curl of hairs adds volume.

Typically patient will have activities as follows:

Patient signs the consent form for surgery. To reduce anxiety and pain appropriate premedication is used. He receives sedatives and antibiotics. With consultation of patient, the area of transplantation is confirmed. The new hairline is drawn onto the scalp. It is shown to the patient. Photo documentation is done. Patient is either in sitting or lying position. He relaxes and listens music or radio programme. His heart, blood pressure and oxygen saturation are carefully monitored. Each one receives full attention of staff. When one undergoes transplant of 1000 to 1200 graft, 3 to 5 hours are required and for about 2000 grafts 4 to 7 hours are required. Rest of procedure is explained above.

If bandage is given it is removed next day morning. Patient is fit to travel out of the town. He is encouraged to contact doctor at any time. Some patients may likely to develop temporary swelling on eye & face which last for 24- 48 hours. There are no complications in hair transplant. Undergoing this procedure is like visiting dentist. Rarely at donor site, slight numbness may last for few days.

After hair transplant, patient can resume his light work from 3rd or 4th day onwards. Stitches are almost invisible after three weeks. One should avoid any activity which creates pressure in transplanted area. For three weeks, active exercises should be avoided. Bath may be taken from 4 th day onwards. In next four weeks, cabs, crusts and effluvium fall off. Initially hair falls off from newly transplanted follicles. Time lag between temporary thinning of pre-existing hairs and regrowth of new hairs is called Telogen Effluvia. Then, hairs start growing after 3 months and they continue to grow for rest of the life.

After a week grafts appear pink and skin around the grafts is shiny. After two week, no sign of grafting of wound remains. Only 15% available hairs can be transplanted.

Results of hair transplant or replacement surgery depends upon texture, colour and weaviness / curliness of hairs, age of the patient, number of remaining hairs neglected illness status of the health.

Hair transplant on eye brow and eye lashes area for cosmetic reason:

Eyebrows and eyelashes are important for beauty of face. One needs symmetry of these areas for beautiful face. Sometimes in certain persons, the hairs of this area are lost due to physical trauma like accident, injury, thermal burns, chemical burns and electrical burns. Due to congenital problems and local or systemic disease, hairs may not grow in this area. Plucking of hairs for reshaping or due to disease like trichotillomania may cause hair loss. Sometimes medical and surgical treatment like radiation therapy, chemotherapy, surgery cause hair loss in this area. Detail history of hair loss informed by patient helps to assess possible causes of hair loss in particular individual.

They need enhancement of hair density with the help of hair transplant surgery. Before hair transplant in this area, systemic and local disease must be under control. The scar tissue trauma, burns, surgery needs excision before eyebrow or eye lashes restoration surgery.

Reconstruction or restoration of eyebrows:

If eyebrow is scarred or lost due to injury or disease, it can be reformed by hair transplant in that area or haired skin grafting. Partially, missing eyebrow can also be restored as cosmetically acceptable eyebrow.

Procedure of creating eyebrows:

A strip of hair bearing skin is removed from donor area of the scalp and is grafted at the site of eyebrow. To hide incision marks hairs are grafted into incisions also.

Restoration of eyelashes:

Fine hairs are selected from donor site and are transplanted. Generally, six hairs per lid may be adequate to create a natural look.

High hair line on oversized forehead:

Hair line lowering for women. Hair line should be to the point on her forehead when the skull starts to slope downwards. Some women have receding hair line and oversized fore head. So, even mild thinning of hairs is noticed earlier. Such women are in search of solution but often they do not realize what is wrong. They often feel it is balding. Actually, it is thinning of women's hair. As such, hairs are crowning glory with the face. Patients get tired of hiding her forehead under long bangs. They spend lot of time in camouflaging that unwanted features

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