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29May 2019

Hair Transplantation

Nature has pointed out that in men a part of the scalp hair does not atrophy or loss. Instead they live a long life through, for they are accordingly resistant against hair loss. These resistant hair follicles are located in a somewhat horseshoe shaped region (posterior and lateral parts) of the scalp. The areas serve as donor region, from where genetically resistant hair follicles are taken and eventually transplanted to the bald areas. The transplanted hair follicles fall out during the following 2-5 weeks due to the transplantation stress, only to reappear after a lapse of around 6 to 8 months after resting phase. After this, a new and healthy graft grows.

In hair transplant, no new hair in produced. It is a mere re-distribution of already existing hair. The attainable density and possible position of the future hairline also depend on the number of donor hair follicles.

Hair transplant procedure:

Follicular unit extraction (FUE) is a suture less method of hair restoration in which hair follicles areextracted from the back of head under local anesthesia with the help of special micro punches. This differs from strip-harvesting because, in strip harvesting, a strip of skin is removed from the patient and then dissected into many individual follicular units. The follicular units obtained by either method are the basic building blocks of follicular unit transplantation (FUT). These follicles are implanted in the bald area ideally one at a time.

On the day of surgery, the entire donor area from the back of the head is trimmed to 1–2 mm length. The patient lies in the prone position on the operating table. Local anesthesia with Xylocaine 2% is diluted with saline to obtain 1%, and this will be injected slowly over the entire donor area.

Step 1: The grafts are then extracted from the donor area with the help of 0.8 and 1 mm special micropunches The extraction of follicles is done under 2.5 – 5× magnification.

Step 2: Then we will gently take out the graft with the help of forceps. The extracted grafts are thenpreserved in saline or cool Ring er’s lactate solution

Step 3: The extracted graft may consist of 1 to 4 or rarely even 5 or 6 hairs and this will be separatedaccordingly. This is the most time consuming and tedious part of the whole procedure.

 Step 4: After the extraction is over, follicles are implanted directly into the region suffering from hair lossusing potential tools like implanters.

Alternative methods of hair restoration:

Alternative to hair restoration surgery include wearing a hair piece, wig, hair weaving, scalp reduction, systemic & topical medications, Robotics and doing nothing. They can be tried individually or in combination. Each has its own merit and demerits.

Preoperative instructions:

For better outcome, it is necessary to follow certain simple precautions before the procedure.

During the first few visits in the consultant’s offices, it is the duty of the consultant to extract and the duty of the patient to provide all the previous medical and surgical history, drug allergy. This valuable input is important for planning the surgery and arriving at a realistic expectation.

Certain medicines like Vitamin E supplements, Aspirin, lbuprofen, Gingkobiloba should be stopped at least 3weeks before the procedure. This will help in minimizing bleeding during the procedure. Anticoagulant drugs like Warfarin, Coumadin should be stopped 1 week before the procedure

It is observed that by stopping alcoholic and smoking as early as 2-3 months before the procedure helps in better graft uptake.

Also, it is advised to take to take vitamin-C supplements for at least two weeks before the procedure.

Risk, Side effects and possible complications:

Hair transplantation is well tolerated procedure. Although there is no alarming complication due to the hair transplant procedure but there may be minimal changes of certain risks and side effects is always a possibility as with any surgical procedure done in the body.

Most hairtransplantee’s feel discomfort in the form of numbness, tightness, itching,pulling sensation in the donor area. They will settle within 1-2- weeks. There will be pit scarring (FUE) but scaring will reduce with time.

Temporary bleeding, infection, head ache, hypertrophic scar, keloid formation although rare, is a known complication.

Another rare phenomenon observed in the donor site is the shock loss of existing hair. The hair usually grows back over time and very rarely the shock loss may be permanent. This is dictated by the phase of hair cycle at the time of procedure. This is unpredictable.

At the recipient site:

The hair transplantee will experience mild swelling, oozing, pimple like red spots, and scab formation in the transplanted site. All these will subside within 2 weeks.

Other complication that have been mentioned in literature and is a possibility include infection, bleeding, epidermoid cysts, elevation or depression of grafts, irregular/uneven/delayed hair growth, failure to live up to patients expectations.

Anesthesia, medications and allergies:

I understand that for the hair transplant procedure to be done, certain medications like sedatives, local anesthetic agents, anti-anxiety drugs, antibiotics have to be administered. They will be given in the form of tablets injections, intravenous infusions.

I understand that the medications will be issued only after careful history taking from me about the previous drug allergies. Moreover, the injections will be given after test dose. However, in spite of all precautions; I was explained that there is still a possibility of developing, allergy or reaction to the medicines used.

Unforeseen condition:

That in spite of all efforts, precaution and anticipation during each step of the procedure, there is still very small percentage of encountering an unforeseen condition.

I don’t hold the consultant and the medical term responsible for these unforeseen conditions. Further I authorize the concerned consultant and his/her team to perform all medically necessary procedures required to treat, relieve or palliate the condition. I also authorize the medical team to shift me to a higher center if required to treat the unforeseen condition.