Hair transplant is a surgical technique that removes hair follicles from one part of the body, called a 'donor site', to a bald or balding part of the body known as a 'receiving site'. This technique is mainly used to treat male pattern baldness. In this minimally invasive procedure, transplants containing hair follicles that are genetically resistant to balding, (like the back of the head) are transplanted onto a bald scalp. Hair transplants can also be used to restore eyelashes, eyebrows, beard hair, chest hair, pubic hair and to fill scars caused by accidents or surgeries such as face-lift and previous hair transplants. Hair transplantation differs from skin grafts in grafts containing almost all epidermis and dermis around the hair follicles, and many small transplants are transplanted rather than one strip of skin.
Because the hair grows naturally in the grouping of 1 to 4 hairs, the technique during harvest and hair transplant "follicle units" in their natural grouping. Thus modern hair transplants can achieve a natural appearance by mimicking the original hair orientation. This hair transplant procedure is called follicle unit transplantation (FUT). Hair donors can be harvested in two different ways: harvest striping, and follicle unit extraction (FUE).
Video Hair transplantation
Procedures
pre-operational assessment and planning
In the initial consultation, the surgeon analyzes the scalp of the patient, discusses their preferences and expectations, and suggests them about the best approach (eg single vs. double sessions) and what results might be expected. Pre-operative fisciscopy will help to determine the existing hair density, so that the postoperative transplantation of newly transplanted hair transplants can be accurately assessed. Some patients may benefit with preoperative topical minoxidil applications and vitamins.
During the few days before surgery, the patient did not take any medication that could cause intraoperative bleeding and resulted in a poor transplant. Alcohol and smoking can contribute to poor graft survival. Postoperative antibiotics are usually prescribed to prevent wound or graft infection.
Methods of harvest
Transplant surgery is performed on an outpatient, with mild sedation (optional) and local anesthetic injections. The scalp is washed and then treated with antibacterial agents before the donor's scalp is harvested.
There are several different techniques for harvesting hair follicles, each with its own advantages and disadvantages. Regardless of harvesting techniques, proper extraction of the hair follicle is essential to ensure the survival of the transplanted hair and to avoid transection, cutting the hair shaft from the hair follicle. The hair follicle grows slightly to the surface of the skin, so the transplanted tissue must be removed at an appropriate angle.
There are two main ways in which a donor graft is extracted today: excision-taking strips, and extracting follicle units.
Path capture
Taking tracks is the most common technique for removing hair and follicles from donor sites. The surgeon takes a piece of skin from the posterior scalp, in the area of ​​good hair growth. A single, double, or triple blade surgical blade is used to remove pieces of hair tissue from the donor site. Each slice is planned so that the whole hair follicle is removed. The strips are cut about 1-1.5 x 15-30 cm. When closing the resulting wound, the assistant begins to dissect the graft of the individual follicular unit, which is a small group naturally formed from the hair follicles, from the strip. Working with Stereo-Microscope binoculars, they carefully remove fibrous and fatty tissue while trying to avoid damage to the follicle cells to be used for grafting. The latest closure method is called 'Trichophytic closure' which results in much smoother scratches in the donor area.
The surgeon then uses a very small micro knife or fine needle to puncture places to receive the graft, placing it in a predetermined density and pattern, and incurs a consistent wound to promote a realistic hair pattern. Technicians generally do the final part of the procedure, putting individual grafts in place.
Line retrieval will leave a thin linear scar on the donor area, which is usually covered by the patient's hair even with a relatively short length. The recovery period is about 2 weeks and will require stitches/staples to be removed by a medical officer or a subcuticular suturing can be done.
Follicular unit extraction (FUE)
By Extraction of Follicular Units or FUE harvesting, individual follicular units containing 1 to 4 hairs are removed under local anesthesia; This micro removal usually uses a small punch between 0.6 mm and 1.0 mm in diameter. The surgeon then uses a very small micro knife or fine needle to puncture places to receive the graft, placing it in a predetermined density and pattern, and incurs a consistent wound to promote a realistic hair pattern. Technicians generally do the final part of the procedure, putting individual grafts in place.
FUE takes place in one long session or multiple small sessions. FUE procedure is more time consuming than strip operation. FUE operation times vary according to the surgeon's experience, the speed at harvest and the patient characteristics. This procedure can take from several hours to extract 200 graft for scar correction for two consecutive days of operation for a 2,500 to 3,000 graft megasession. With the FUE Hair Transplant procedure there are restrictions on the nomination of the patient. Clients are selected for FUE based on fox tests, although there is some debate about these uses in client screening for FUE.
FUE can provide very natural results. The advantage of lane harvesting is that FUE harvests negate the need for large areas of scalp tissue to be harvested, so there is no linear incision behind the head and does not leave a linear scar. Because each follicle is removed, only a small scar, a dot that remains invisible and postoperative pain and discomfort are minimized. Since no removal of sutures is required, recovery from Micro Grafting FUE is less than 7 days.
Disadvantages include increased operating time and higher costs for patients. This is challenging for new surgeons because the procedure is physically demanding and the learning curve for acquiring the required skills is long and difficult. Some surgeons note that FUE can cause a lower ratio of successfully transplanted follicles compared with striping.
Transplant follicle unit
Follicle unit transplantation (FUT) is a traditional hair transplantation method that involves extracting straight-line hair containing skin from the back or side of the scalp. The strip is then dissected to separate individual grafts.
Robotic hair restoration
Robot hair restoration device using camera and robotic arm to assist surgeon with FUE procedure. In 2009, NeoGraft became the first FDA-approved robotic surgery device for hair restoration. The ARTAS system was approved by the FDA in 2011 for use in harvesting the follicular unit of a brown-haired and black-haired man. Despite the advantages of robot hair restoration systems, there are still some disadvantages such as relatively large punch sizes compared to what is used in other FUE methods, and the high costs associated with the device.
Operation type
There are a number of applications for hair transplant surgery, including:
- Androgenetic alopecia
- Eyebrow transplant
- Frontal hairline lowering or reconstruction (high natural hairline without existing hair loss condition)
If the hair donor number from the back of the head is not sufficient, it is possible to perform a body hair transplant (BHT) in the right candidate who has donor hair available on the chest, back, shoulders, body and/or legs. Hair transplant surgery can only be done by FUE harvesting method and, thus, require experienced FUE surgeon skills. However, there are several factors for potential BHT candidates to consider before surgery. This includes understanding the natural differences in texture characteristics between body hair and scalp hair, growth rates, and having realistic expectations about the results of BHT surgery.
Post-operative treatment
Progress in wound care allows for semi-permeable dressing, which allows seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable receiving areas should be protected from the sun, and shampooing begins two days after the operation. Some surgeons will have a patient shampoo the day after surgery. Shampooing is very important to prevent scab forming around the hair shaft. Scabs are attached to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days postoperatively.
During the first ten days, some transplanted hair, the inevitable trauma of their relocation, may fall out. This is called "shock loss". After two to three months, new hair will begin to grow from follicle-driven. The patient's hair will grow normally, and continue to thicken for the next six to nine months. The next hair loss may only come from an untreated area. Some patients choose to use drugs to inhibit the loss, while others plan the next transplant procedure to deal with this possibility.
Maps Hair transplantation
Side effects
Hair thinning, known as "shock loss", is a common side effect that is usually temporary. Patches are also common, because fifty to a hundred hairs can disappear every day. Postoperative hiccups have also been seen in about 5% of transplant patients.
History
The use of both scalp flaps, in which a group of tissues with a genuine blood supply shifts to an area of ​​baldness, and the free graft dates back to the 19th century. In 1897, Menahem Hodara successfully implanted hair removed from the scalp area that was not exposed to the scars left by the favus. Modern transplantation techniques began in Japan in the 1930s, where surgeons used small transplants, and even "graft follicle units" to replace broken eyelashes or eyelashes, but not to treat baldness. Their efforts did not get the world's attention at the time, and the trauma of World War II made their progress isolated for two decades.
The modern era of hair transplants in the western world was introduced in the late 1950s, when New York dermatologist Norman Orentreich began experimenting with free donor grafts to bald areas in patients with male pattern baldness. Previously it was thought that transplanted hair will not grow more than the original hair on the "receiver" site. Orentreich points out that such grafts are "dominant in donors", as new hair grows and survives as it did in the original home.
Advancing the theory of donor domination, Walter P. Unger, M.D. defines the "Safe Donor Zone" parameter from which the most permanent hair follicles can be extracted for hair transplantation. Since transplanted hair will only grow in its new place as long as it is in its original place, this parameter continues to serve as a fundamental foundation for harvesting hair follicles, either by strip or FUE method.
Over the next twenty years, surgeons work on smaller transplant transplants, but the results are only minimal, with 2-4 mm "spark plugs" leading to a doll-like appearance. In the 1980s, strip excisions began to replace plug techniques, and Carlos Uebel in Brazil popularized using a large number of small graft, while in the United States William Rassman began using thousands of "micrografts" in a single session.
In the late 1980s, B.L. Limmer introduced the use of stereo-microscope to dissect single donor strips into small micrografts.
The unit follicle hair transplant procedure continues to evolve, becoming smoother and minimally invasive because the size of the incision of the graft becomes smaller. This smaller and less invasive incision allows the surgeon to place a large number of transplanted follicle units into a particular area. With the new "gold standard" of ultra fine follicle hair transplants, more than 50 transplants can be placed per square centimeter, when appropriate for the patient.
Surgeons are also more concerned with the angle and orientation of transplanted grafts. The adoption of the "lateral gap" technique in the early 2000s, allowed hair transplant surgeons to direct 2 to 4 hair follicle grafts so they spread throughout the scalp surface. This allows transplanted hair to lie better on the scalp and provide better coverage to the bald areas. However one disadvantage is that the lateral incision also tends to disrupt the scalp vascularization more than the sagittal. Thus, the sagittal incision cuts less hair and blood vessels assuming the cutting tool has the same size. One of the big advantages of sagittal is that they do a much better job of sliding in and around the existing hair to avoid follicular transfers. This certainly makes a strong case for doctors who do not require shaving of the receiving area. The lateral incision divides the existing hair perpendicular (horizontal) like T while the sagittal incision runs parallel (vertically) on the side and between the existing hairs. The use of a perpendicular (lateral/coronal) slit compared to parallel (sagittal) gaps, however, has been widely debated in the patient's hair transplant community. Many hair transplant surgeons generally adopt a combination of both methods based on what is best for each patient.
Future research and techniques
Stem cells and papilla dermis cells have been found in hair follicles. Research on these follicle cells can lead to success in treating baldness through hair multiplication (HM), also known as hair cloning.
References
External links
Media related to hair transplantation on Wikimedia Commons
Source of the article : Wikipedia
0 Comments