Hair Transplantation: Simple And Superficial Procedure
Hair transplantation is a simple & superficial procedure that involves extracting
live root bearing hair follicles from the donor area (back & sides of the head) and implanting them on to the recipient area (bald area). These transplanted hair roots behave and grow similarly to the hair from where they are extracted.
After re-growth, these transplanted hairs can be managed just like natural, existing hair. They can be shampooed or dyed and doesn"t require any medicines to maintain growth. Even after complete shaving or tonsuring, these hairs will grow back and continue to do so for the rest of the life.
It is primarily aimed to treat baldness in both men and women. It is also used to restore eyebrows, moustache and beard and to fill the scars caused by accidents, burns and surgeries like facelifts etc"
As the hair follicles grow in groups of 1 to 4 or 5 today"s most advanced techniques help in transplanting these groups of follicles also called as Follicular Units (grafts) and thus achieving almost natural looking results.
Latest techniques like"
Ultra Refined Follicular Unit Grafting (URFUG)
Dense Packing
Mega & Super Mega Sessions
Trichophytic closure
Equipment
STRIP METHOD or FUT
FUE or DHT Technique
The very latest method is combining both FUT and FUE techniques in a single session.
URFUG:
The graft or unit usually consists of a small group of hairs in a configuration that naturally exists on the scalp. On an average 1.8 to 2.5 hairs per follicular unit are seen. With the help of Stereo microscopes and Video microscopes the strip extracted from the donor area is separated into individual grafts or units containing 1 to 4 or 5 hairs. From the beginning of the hair transplantation surgery there are various types of grafts that are implanted on to the bald area. They are "
The father of HT was Dr. NORMAN ORENTREICH who used the standard 4mm round punch graft. Over the past 10 yrs there is a great revolution in graft preparation. Initially they are like round grafts (8 to 20 hairs), Slot grafts which consists of (6 to 15 hairs), Traditional Slit grafts containing (3 to 10 hairs) and Micro Slit grafts as Double FU (DFU), Triple FU (TFU) and Quadruple FU (QFU) are found. All these grafts are cut to the size and implanted through a punch or slot or slit created on the bald area, giving the odd, tufted appearance and causing dimpling, pigmentary changes depression and elevation of grafts over the recipient area. The most advanced technology leads to the development of ULTRA REFINED FOLLICULAR UNIT GRAFTING which consists of naturally occurring intact group of hairs as a separate unit. These can be implanted on the recipient area through needle and micro slit technique which makes the latest transplants as undetectable transplants.
Dense Packing:
The natural density of the follicular units per square centimeters ranges to 80 - 120 grafts on an average we consider 100 grafts per sq.cm. Sometimes it may be low less than 60 per sq cm (blacks) or more greater than 140 per sq cm (hispanic, whites).Initially due to mini grafts able to implant only 10 to 15 or 20 grafts per sq cm was done giving corn-row pattern or dolls head appearance.
Due to the advanced URFUG technology able to implant 35 to 45 grafts per sq cm i.e., Dense packing giving undetectable appearance.
But this technique needs good team work and experience. For the dense packing the stick and place method gives excellent result.
Mega & Super Mega Sessions:
"Normally the routine sessions include grafting of 1000 to 1500 (in abroad).
"Mega session includes implantation of 2000 to 2500 grafts in a single session.
"Super mega session includes implantation of 3000 to 3500 grafts in a single session.
"Giga session includes 5000 grafts and more.
"Our center average ranges from 2500 to 3000 grafts per session, of course it depends on the individual need and supply of donor area.
Trichophytic closure:
In FUT method we excise a narrow strip of the hair bearing donor area from the permanent zone. We immediately close the edges of the excised area which leaves a permanent scar on the back. Normally this scar doesn"t show hair growth. To minimize the scar we do a specialized technique to close the wound edges. In this method we deepithelize the upper or lower or both edges and suture it with 4-0 vicryl (delayed absorbable). Later the hair grows through the scar.
Exception: In spite of our efforts wide scar is seen in cases of Keloid tendency and connective tissue disorders as they are hereditary in nature.
Equipment:
For slivering we use Mantis microscope.
For dissection we use Video microscope and Stereo Microscopes.
For Implantation we use Binocular Loupes (2X to 4.5X).
For FUE technique we use Safe Scribe Machine for graft extraction.
All these help to create almost natural looking and undetectable transplants
The donor hair can be harvested in 2 methods.
"Strip Method / FUT
"FUE
Strip Method:
The process of removing a strip of hair bearing scalp from the back and sides of the head (donor area) and dissecting the strip into ultra refined follicular units which are then transplanted onto the bald area (recipient area) is called as Follicular Unit Transplantation (FUT).
As the follicular units are harvested from a strip, this method is commonly called as "Strip Method". This method can leave a scar on the donor area which can be concealed under the patient"s own hair on the day of the surgery itself. But due to the recent advancements in this field of hair transplantation, the scar can be minimized by using a technique called "Trichophytic closure". This method helps in minimizing the scar which is almost invisible after few months and even new hair growth is seen through the scar in most of the patients.
The advantages of this method are:
"Wider bald area can be covered even in a single session.
"Dense packing is possible giving a more natural looking appearance.
"Less expensive
"Higher survival rate of the grafts
"Very minimal / negligible graft wastage (up to 1 %)
"Quick recovery time.
Disadvantages:
"More team is required for performing this method.
"Scar at the donor site".but, can be minimized by "trichophytic closure".
"Experience, good equipment with excellent team work plays a major role.
FUE:
Also commonly called as "Suture less technique" or "No Scalpel technique". In this method, individual follicular units are extracted by using tiny punches of sizes between 0.7 mm to 1.25 mm in diameter. These follicular units are then transplanted on to the bald area using either micro-blades and forceps or stitch and place method. This method also leave very tiny pointed dot like scars on the donor site, scattered all over the area which heals by 72 hrs post operatively.
Advantages:
"Suture less surgery.
"Minimal tissue damage.
"Doesn"t require a large team to perform.
"It is only method for transplanting body hair.
"Preferred method for restoration of hair on burnt patches, eye brows and moustache & beard.
"Donor area heals within 3 days. No typical scar seen.
Disadvantages:
"Graft wastage may be 3 to 10 %.
"May give mottled appearance in the donor area if not done properly.
"Require more no. of sessions when compared to FUT to cover an identical bald area.
"Expensive when compared to FUT.
"Demands more concentration and time from the surgeon / doctor.
"Not ideal for covering wider areas in a single session.
Who should consider this procedure?
"Patients who like to keep their hair short (
by: Balu Mahindra
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