Permanent Vs Temporary Hair Roots

On our scalp we have two types of hair roots; permanent, the androgen resistant roots and temporary, the androgen sensitive roots. Usually the permanent hair/roots remain on the back side and the sides of the head, up to 2-3 inches above the ear lobule. Rest of the hair roots on the scalp, i.e. on front, top (vertex) are temporary. In some males, the roots just below and back side of the top of head and nape of neck, i.e. posterior hair line are temporary also. Only expert and highly intelligent surgeons can distinguish between the permanent and temporary roots. When we call it temporary, it does not mean that these hairs will definitely fall. Who will become bald at which point of time is difficult to predict. But whoever is a male, is a potential for baldness, because of the male hormone – Testosterone running in his blood. Many people think that, the baldness is due to some hormonal imbalance, which is not true. The male hormone testosterone is responsible for giving us the male qualities. And this same testosterone is responsible for the male pattern baldness. Why this happens in case of human males and not seen in other male animals is not known.

In male pattern baldness (MPB) also called Androgenetic Alopecia (AGA), the temporary hair gradually becomes thin and the area eventually becomes completely bald. The age of onset varies between 18-35 years of age. Once the baldness started the speed also varies from person to person. The age of onset, speed and severity are variable. If the baldness is running in family then the chances of getting bald is more, but it is impossible to predict accurately the course of familial baldness also.

In surgical hair transplantation, the aim is to transplant permanent (hormone resistant) hair roots from the back side of scalp to the bald scalp. Sometimes permanent roots are extracted from the beard and chest also. As we know, beard roots are thick and stay permanently. Chest roots are unpredictable in their growth rate.

While performing hair transplantation, the surgeon should be very careful not to transplant the temporary roots. Mostly it happens when with over enthusiasm for any reason the surgeon harvests hair from the UNSAFE donor area, too much towards the vertex or too much towards the nape area. If these temporary roots are planted on bald area, they will grow definitely. But when the natural process of baldness will progress, there will be loss of temporary roots from the back side of head. At the same time there will be also loss of these temporary roots on the front, where they are planted. 

On an average, in FUE and DHT technique a maximum of 2000-2500 roots can be extracted and planted in a single session of 6-8 hrs. Very rarely roots beyond this number can be harvested without going into the temporary UNSAFE area.

Planning for the Hairline in Hair transplant Surgery

Planning of hairline design and follicular grafts placement is of extreme importance to the successful aesthetic and natural final result of a hair transplant. It is one of the most intricate aspects of the procedure. It is difficult to master, and therefore this is the area where the most mistakes are made.

Men with MPB:-

While planning a hairline in men it is very essential to remember that thinning is a process which continues throughout life, and that there is a limited quantity of hair available for harvesting from the permanent donor region. There is a possibility of running out of enough hair to transplant both the frontal as well as crown regions. As a matter of fact, in most cases of MPB, it is usually sensible to correct the front one-third to half of the scalp and leave the crown completely. Another alternative is to wait for the right time when the front region of the head gets completed and then decide considering the concern of the patient with the crown and is there adequate hair left to treat that area.

We can divide the scalp into some important zones; the three regions with good potential to be treated are the frontal region, mid-scalp, and vertex (crown).

For recreating a frontal hairline, we draw a line from the midline anterior most point or mid-frontal point (MFP). Usually we place this point at 7-11 cm above the midglabellar line, approximately at the point where the fore head transitions from being vertical on the front to gradually sloping posteriorly.

In the next step, a curved line is drawn from the mid-frontal-point (MFP) moving upward and to the lateral side of the apex, which is the highest point of the fronto-temporal recessions.

While transplanting the frontal and mid-scalp regions, a keen eye should be kept on the mid-portion of the posterior hair line which must not advance the vertex transition point (VTP). Ahead of the “VTP” the hair direction starts changing and the hairs of the crown start taking the shape of a whorl, and there is a radial swaying in a 360 pattern.

The variety of hairline placement patterns depend on multiple factors such as the age of the patient, nationality, extent of present and possible further thinning hair loss patterns and expectations An isolated frontal forelock may be planned if the patient is very bald or very young patient with a possibility of getting very bald in the future.. This is one of the safest ways to accomplish a conventional hair relative to a considerable balding area.

The Crown:-

The crown, when transplanted does not give as much cosmetic gain as compared to the front. Some men show less concern about the vertex as they do not notice it and are unwilling to treat that area. Limiting crown transplantation just to a single or two sessions of light coverage can provide the patient as well as the surgeon with additional donor hair in reserve if any concern arises in the future.

RE- CREATING A NATURAL HAIRLINE:-

Hairline that is too angulated, symmetrical and sharp can be eye-catching and render an unnatural look. The anterior hair line is a little wavy (or feathered) in an irregular manner, so that the hair line is softened and abrupt straight lines are avoided. An initial defined zone of evenly spaced single hairline. Anterior to this zone, micro-irregularities employing three to four single-haired FUs are utilized in clusters as well as scattering random. Single-haired FUs, placed erratically in front and between groupings. In this way the hairline is softened and abrupt straight lines are avoided. What is created is a gradually increasing density in a hairline zone, approximately 5-10 mm in width.

Dr Pradeep Sethi, MD (AIIMS, New Delhi)

Dr Arika Sethi, MD (AIIMS, New Delhi)

dhtclinic@gmail.com

www.directhairtransplantation.com

429, Street number -8, Rajender Nagar, Dehradun

+91-8057541540, 0135-2750096

Stem cells hype in Hair Transplantation

There is a lot of hype going on about stem cells in the world of hair transplantation. This forced us to write this article for the better understanding about stem cells among our patients.

Our hair follicles contain some committed stem cells in the bulge area. These stem cells in tandem with other cells of the hair follicles sustain the hair follicle structure and maintain the hair cycle. However, how these stem cells exactly act is not known. There are some unknown factors which regulate these stem cells.
In our lab, with the help of some eminent stem cell scientists of India we have already extracted these stem cells two years back and we injected this stem cell solution into the completely bald scalp as well as thinning scalp. But, this solution has not grown any new hair.

Nowhere in the world, as of today, are stem cells producing new hair. Producing new hair means cloning. Hair cloning is a mirage today. Probably, these stem cells solutions can help to prevent hair fall just like minoxidil, scientifically, nothing more than that.

Every day we get to see a lot of advertisements related to stem cell hair duplication. This article is to aware the patients who inquire about the role of stem cells in hair transplantation.

On pubmed (which is the online dictionary in medical research) search about stem cell in hair transplantation nothing is found. That means no one has published any scientific evidence of stem cell hair regeneration on human scalp!

Practical Hair Density possible in Hair Transplantation

On an average, an adult human scalp contains 100,000 follicular units in total.  In baldness, there is already 50% loss of follicular units in the bald looking area. On an average the density of a non bald scalp is 80-100 follicular units per square cm. This density varies from person to person.

Hair transplantation can hide the baldness in single sitting, but it cannot provide the natural density in one session. In hair transplantation, doctors can plant 25-35 follicular units (FU) per square cm, which is much less than the normal density, though this much density can hide the baldness with artistic planning of the grafting. For normal density, a second sitting of 25-35 follicular units (FU) per square cm is required. Sometimes, a third sitting may be required for natural density.

In the front hairline, usually single FUs are grafted for natural look. In this area, 35-45 FUs can be planted in 1 square cm. In the crown and vertex area, the double and triple FUs are planted.

With over enthusiasm if more than 40-50 FUs are planted in 1 square cm then the chances of growth will be less because there will be competition between the grafts for blood supply.  This competition among FUs will result in death of a lot of hair follicles as well as necrosis of skin. That means permanent loss of follicle and permanent scar on head. This can be better understood with an example: In plantation in our garden, we are always advised to keep a minimum distance in between the plants for optimum growth; else most of the plants die.

For doctors, dense packing is an ongoing learning process; the goal is to achieve density while staying within the scalp’s safe limit of vascular damage. 

Alopecia Totalis

Introduction

Alopecia totalis is the loss of all scalp hair. It is believed to be an autoimmune disease, the immune system attack hair follicles causing hair loss.  Stress is another contributor of Alopecia totalis.  Excessive hair loss occurs at once in the case of illness or cancer treatment, autoimmune disorders, stress or hormonal changes. Environment can also contribute to the cause of this disease. It can affect both male and female under the age of forty.

Symptoms

Alopecia totalis may start as a receding hair line growing gradually or sudden. In the beginning patches of hair loss can be seen on the scalp along with tingly feeling or pain. In some cases hair loss seems to be affecting one side of the scalp. This further can lead to a total baldness. Another indication of Alopecia is to be able to pull out ones hair easily.

Diagnosis of Alopecia totalis 

Although one knows that Alopecia totalis means hair fall in large amount, still doctor will examine your medical history, physical examination and a family history as there is an unknown genetic cause that makes your immune system to attack hair follicles and causes Alopecia totalis. Examination of scalp for hair fall patterns is done and the doctor also looks at the individual hairs. Blood samples are taken to know the causes of the diseases. If you have just begun to lose hair vitamins or medications helps to slow down the hair loss. But in cases of total hair loss hair can regrow only after hair transplant surgery.


Treatments

Methotrexate and corticosteroids are most popular treatments for Alopecia totalis . These medications usually come in the form of creams or injections and are applied to an affected area. These are effective where the patches of hair loss are small. Elocon ointmet and minoxidil can also be used.

Dr Pradeep Sethi, MD(AIIMS),         Dr Arika Sethi, MD(AIIMS)
Direct Hair Transplantation Center
Dehradun/Rishikesh/Gurgaon
Ph:   +91-8057541540
dhtclinic@gmail.com

www.directhairtransplantation.com 

Dr Pradeep and Arika Sethi, gave a talk on "Skin and hair care: myths and facts" at Defence Electronics Applications Laboratory (DEAL)

Dr Pradeep and Dr Arika gave a talk on "Skin and hair care: myths and facts" at Defence Electronics Applications Laboratory (DEAL), Dehradun on 12th January, 2012. The talk was well received and a lot of productive, fruitful discussion was there following the completion of talk. The scientists asked a lot of relevant and genuine questions, that were answered by Dr Pradeep Sethi.


Dr Pradeep Sethi, MD (AIIMS),         Dr Arika Sethi, MD (AIIMS)
Direct Hair Transplantation Centre
Dehradun/Rishikesh/Gurgaon
Ph:   +91-8057541540 
www.directhairtransplantation.com

Hair Transplantation cost

The cost of carrying out a quality hair transplant is considerable as the process requires a team of highly skilled medical staff and technicians. On any one transplant surgery there may be up to 10 technicians, nurses and surgeons working on each patient. There is no low-cost method of providing a permanent solution to hair loss by surgical means. Therefore, if cost is the principal factor guiding your decision about whether or not to have a hair transplant, we strongly advise that you do not have surgery but that you consider the medical treatments instead. Having an inferior quality hair transplant carried out can have serious, negative and long-term consequences.

As one patient said: “You never remember the price of a good job and you never forget the price of a bad one”.

The price per transplanted follicular unit graft is Rs 40-80 depending upon the technique that a person wants to go for.

We estimate the numbers of follicular units as accurately as we can in advance of surgery but, as the density of follicular units varies all over the scalp, the actual number of follicles transplanted may be slightly higher or lower than our estimates. A careful audit is kept during surgery and you will only be charged for the actual number of follicular units transplanted.

Dr Pradeep Sethi, MD (AIIMS),         Dr Arika Sethi, MD (AIIMS)
Direct Hair Transplantation Center

Dehradun/Rishikesh/Gurgaon
Ph:   +91-8057541540 
dhtclinic@gmail.com
www.directhairtransplantation.com