INTRODUCTION OF HAIR TRANSPLANT
A hair transplant is only possible if hair loss has no pathological causes. In case you are not affected by any disease, which should be excluded by a dermatologist, the genetic pattern of hair loss follows an individual progress which can be classified into a certain scale at the “Norwood´s baldness classification”. There will always remain a certain crown of hair on each male´s scalp for the rest of the life with permanent follicles. Due to genetic predisposition the remaining roots in this area are not affected by hair loss. This happens to every male person, even if a bigger amount of hair on the vulnerable and balding area will be lost after years.
During the procedure of hair restoration the follicles taken from this donor-area are being relocated to the bald or less hairy area of the scalp.
INDICATION OF HAIR TRANSPLANT
The method is shown in the following conditions:
When the patient is not accepted by scar
- When orientation is a less invasive procedure
- In patients where the donor area is very dense not to allow the strip surgery
- In patients with thinning or limited in those who require small sessions, including patients with male pattern thinning of Norwood Class 3 with a small area of alopecia or summit
- For the treatment of limited areas, such as transplantation of the eyebrows, whiskers
- In the treatment of small areas of alopecia secondary to the resolution of dermatological scars arising
- from traditional strip surgery scars
- If subsequent to trauma or neurosurgical procedures.
TYPES OF HAIR TRANSPLANT
There are a number of applications for hair transplant surgery, including:
- Androgenetic alopecia
- Eyebrow transplant
Frontal hair line lowering or reconstruction (naturally high hairlines without an existing hair loss condition)
If donor hair numbers from the back of the head are insufficient, it is possible to perform body hair transplantation (BHT) on appropriate candidates who have available donor hair on the chest, back, shoulders, torso and/or legs. Body hair transplant surgery can only be performed by the FUE harvesting method and, so, requires the skills of an experienced FUE surgeon. However, there are several factors for a potential BHT candidate to consider prior to surgery. These include understanding the natural difference in textural characteristics between body hair and scalp hair, growth rates, and having realistic expectations about the results of BHT surgery.
ANESTHESIA HAIR TRANSPLANT
In the past, surgical pain was alleviated by bizarre methods such as bullet’s bite and shots of alcohol. Fortunately, science progressed to its current state where we have a wide range of safe and effective anaesthetic agents to choose from as per our requirements. Anaesthetic agents reduce pain and anxiety. Hence, the patient becomes more comfortable and calm during surgery.
Hair transplantation is a minor surgery. Proper selection and administration of anaesthetic agent for surgery is important. The operating physician should be aware of dose, action, duration and potential toxicity.
At our DHT center, lidocaine and bupivacaine are used for providing local anaesthesia for hair transplantation.
It is a short acting anaesthetic agent commonly used in hair transplantation.It has a quick onset of action of 2-4 minutes. The effects last for 30-60 minutes. The duration of action is longer when combined with adrenaline i.e. 120 minutes. There is requirement of 1% lidocaine in donor area and 2% in recipient area. The recommended total daily dose of lidocaine is 300mg (maximum) in cases of tumescent anaesthesia. The amount can be increased when combined with epinephrine to 500mg.
It is a long acting anaesthetic agent used commonly in hair transplantation. Bupivacaine has a slower onset of action as compared to lidocaine and has a longer duration of action (120-240 minutes). Usually for field blocks, 0.25% bupivacaine is used while for peripheral blocks concentration used is 0.5%.
Buffering refers to neutralizing a solution. This is an important step in order to reduce pain associated with infiltration of anaesthesia.
PREOPERATIVE PROCEDURE OF HAIR TRANSPLANT
There are some important guidelines which one should follow to avoid any problem during the procedure.
- If the patient is taking ASPIRIN or other blood thinners then if possible it should be stopped with the consent and advise of a cardiologist at least 7-10 days prior to surgery.
- Avoid taking anti-inflammatory medicines one week prior to surgery.
- One should take their regular anti hypertensive medicine on the day of surgery.
- One should avoid all multivitamins 7 days before hair transplant as these medicines may lead to comparatively increased bleeding during the procedure.
- Smoking and alcohol should be avoided as it may hamper the healing and also may reduce the uptake of the grafts. If at all one can start these around 2 weeks after the surgery.
- Strenuous activity or exercising should be stopped at least one week before surgery. The supplements used in gym should be stopped at least 3 days before surgery. One can start exercising after 2-3 weeks of the hair transplant.
- Use of minoxidil to be avoided 3-4 days prior to surgery.
- One should wear comfortable clothes on the day of the procedure like a comfortable shirt which button downs the front is preferable and T-shirts should be avoided. During the procedure patient is required to change the cloths and put on the hospital gown.
- One should carry loose fitting cap or bandana.
- Preferably one should take his or her regular breakfast on the day of the transplant and patient should be accompanied by someone, as it is not advisable to drive back home due to effect of sedative or local anesthesia.
- Hair color and dye is to avoided at least one week before surgery.
- One should wash the hair properly but the use of hair spray to be avoided on the day of the hair transplant.
- Any infection like cold, cough should be reported to the doctor before hand, if required surgery should be postponed.
PROCEDURE OF HAIR TRANSPLANT
After thoroughly cleaning your scalp, a surgeon will use a small needle to numb an area of your head with local anesthesia. Next, they’ll use a scalpel to remove a round section of your scalp covered with hair. Then they’ll sew the scalp closed.
The surgeon will separate the removed portion of scalp into small sections using a magnifying lens and sharp surgical knife. When implanted, these sections will help achieve natural-looking hair growth.
The surgeon will make tiny holes with a blade or needle in the area of your scalp receiving the hair transplant. They’ll gently place hairs in these holes. During one treatment session, a surgeon may transplant hundreds or even thousands of hairs.
After the graft, gauze or bandages will cover your scalp for a few days. A hair transplant session can take four hours or more.
Your stitches will be removed about 10 days after surgery. You may require up to three or four sessions to achieve the full head of hair you desire. Sessions occur several months apart to allow each transplant to fully heal.
POSTOPERATIVE PROCEDURE OF HAIR TRANSPLANT
Advances in wound care allow for semi-permeable dressing, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have the patient shampoo the day after surgery. Shampooing is important to prevent scabs from forming around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.
During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out. This is referred to as “shock loss”. After two to three months new hair will begin to grow from the moved follicles. The patient’s hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.
COMPLICATIONS OF HAIR TRANSPLANT
There are some minor, temporary complications:
Temporary Thinning of Pre-Existing Hair
Although rare, after the surgery some pre-existing hair can thin. The pre-existing hair will return to normal, full condition within a few months of the surgery.
Some bleeding is normal and will stop with simple pressure. Persistent bleeding occurs in about one in a few hundred cases. Additional stitching is rarely required.
Pain is usually rare and fairly minimal. Half of our patients do not require any pain relievers, and the others take Solpadeine or Panadol for a few days.
Some transient numbness is inevitable, usually in the donor area, and generally lasts from 3 to 18 weeks. It is rarely troublesome or long-lasting.
Hiccups may occur after surgery. The cause is not known, but hiccups seem to occur more frequently after hair transplantation than scalp reduction. The incidence of this complication is about 5%. It usually lasts several hours to several days.
Some itching commonly occurs but is rarely troublesome and lasts only a few days. Shampooing the hair daily will help the discomfort.
There is rarely any swelling. When there is, it can affect the forehead and the area around the eyes and last 1 to 2 days. In about 1% of cases, a “black eye” can develop.
This happens in one in several thousand cases and is easily treated with antibiotics.
Keloid scarring occurs only in pre-disposed individuals, and even more rarely (one in one thousand cases) this scarring can cause a ridging effect.
One or more cysts may occur in the recipient area when many grafts have been inserted. They usually disappear by themselves after a few weeks or immediately with various simple treatments. They are usually no more than 2 or 3mm in diameter, i.e., the size of small pimples.