SCARRING - CICATRICIAL ALOPECIA

SCARRING/CICATRICIAL ALOPECIA

Definition and introduction

A large number of scalp disorders may destroy the hair follicles and result in scarring (cicatricial) alopecia. These include diseases that primarily affect the hair follicles as well as diseases that affect the deeper layers of skin (dermis) and secondarily cause follicular destruction.

Once established, cicatricial alopecia is a permanent condition that cannot be reversed by treatment. For this reason, it is very important to diagnose the hair or scalp disorders that may produce cicatricial alopecia as soon as possible in order to start a specific treatment and avoid diffuse follicular destruction.

The differential diagnosis between the diseases that cause cicatricial alopecia requires a biopsy (pathological examination). A scalp biopsy is therefore mandatory in all cases of cicatricial alopecia. The causes are summarized below:

Follicular diseases

·         Lichen planopilaris

·         Discoid lupus erythematosus

·         Keratosis follicularis spinulosa decalvans

·         Folliculitis decalvans

·         Traction alopecia

Dermal fibrosis

·         Localized  scleroderma

·         Radiodermeatitis

·         Pemphigoid

·         Chemical or physical injuries

·         Burns

The aim of treatment is to avoid further scarring and it is necessary to explain clearly to the patient that the hair that has been lost will not grow again. Surgical treatment of cicatricial alopecia includes excision of the scarring area tissue expansion or hair transplantation.

Lichen planopilaris

Lichen planolilaris is the most common cause of cicatricial alopecia.

Patients usually seek medical advice because they have noticed one or several patches of hair loss. A certain degree of itching is frequently reported. The clinical examination reveals a variable number of poorly circumscribed bald patches.

Discoid lupus erythematosus

Diagnosis of ‘discoid lupus erythematosus’ is strongly suggested by the presence of redness (erythema), prominent hair roots (follicular hyperkeratosis), thinning of skin (atrophy) and small blood vessels (telangiectasia).

 Folliculitis decalvans

This term is utilized a spectrum of scalp disorders characterized by painful acute inflammatory changes with or without pustules. Relapsing inflammatory episodes result in cicatricial alopecia and tufted folliculitis.

Although the bacteria Staphylococcus aureus may frequently be isolated from the pustules, folliculitis  decalvans is not an infective condition, but possibly represents an abnormal host response against staphylococcal antigens or toxins.

Keratosis follicularis spinulosa decalvans (KFSD)

This inherited condition usually becomes evident in infancy. Follicular papules are also evident on the eyebrows and cheeks. Alopecia, which is more prominent in the vertex, usually develops after puberty.

Its severity varies considerably in different patients.

Brocq pseudoarea

Brocq pseudoarea is not a separate entity, but represents the cicatricial outcome of lichen planopilaris. The scalp presents multiple irregular bald atropic areas, but no signs of inflammation.

 Involvement of the beard area has also been reported.

Localized scleroderma

Localized scleroderma of the scalp presents as a slowly progressing irregular patch of hair loss. The skin often shows a certain degree of erythema or pigmentation in the absence of follicular keratosis or scaling. The patch is often not completely bald, but presents some vellus or intermediate hairs.

                                        Serve atrophy with involvement of the hypodermis and muscles is a feature of fronotoparietal linear scleroderma (‘encoup de sabre’).  

Hair transplantation is a good treatment option for its management. However, there are some factors that reduce the chances of survival of the implanted grafts:

·         Poor blood supply

·         Fibrosis of deeper layers of skin

The following are the differences in hair transplant technique in such cases:

1.       The density of the implanted grafts is lesser

2.       A session of trial grafting of 100/150 grafts can be performed to look for the survival of implanted grafts. If the growth is good the transplanting the complete bald area can be attempted

3.       The angle of insertion of grafts is less acute

4.       The amount of tumescence anaesthesia administered is less

5.       Adrenaline is avoided in the anaesthetic solution.

Alopecia Areata

Alopecia areata

Introduction

Alopecia areata is a non-scarring form of hair loss that usually beings with round patch. It can involve any hair-bearing area of the body and is characterized histopathologically by peribulbar lymphocytic infiltrates. Cases of mild involvement show a marked tendency to spontaneous regrowth of hair. With the exception of androgenetic hair loss, alopecia areata is by far the most frequently occurring form of hair loss.

Etiology and associated diseases

The exact cause of this disorder is not known. It is thought to be caused by autoimmunity against our own hair follicles (roots). An association with other autoimmune disorders like vitiligo, pernicious anaemia, thyroid disorders has been reported.

Clinical features

A well defined patch of hair loss (usually coin shaped) develops on any part of the scalp. Grey hair may be seen growing from the patch. This patch may resolve on its own without any treatment. Sometimes, it starts increasing in size and new patches develop. This is called progressive alopecia and requires urgent intervention by a dermatologist.

Sometimes, it may spread to involve eyelashes, eyebrows and body hair.

When alopecia areata involves the hairline (front, sides or back), then that pattern is called ophiasic pattern.

Alopecia totalis is the term used to denote the loss of all scalp hair

Alopecia universalis is the term used to denote the loss of all body hair

Necessary therapeutic measures

Appropriate information on the course and prognosis of alopecia areata is needed. The patient should be informed that a spontaneous remission is always possible. In mild forms characterized by some round patches there is an 80% probability that spontaneous regrowth will occur within a period of 1 or 2 years. In cases of more extensive or total hair loss the prognosis is considerably less favourable, but a spontaneous regrowth of hair is never excluded.

Psoralen and ultraviolet A (PUVA) treatment

PUVA treatment with oral application of 8-methoxypsoralen can be categorized as effective but its practical applicability is rather limited because the UV light can no longer reach the scalp when hair is regrowing. The same is true for the ‘PUVA-turban’ treatment.

Local injections of corticosteroids

In exceptional cases of recalcitrant circumscribed bald patches, local injections of corticosteroids may be considered. However, in cases of more pronounced involvement this therapeutic approach is worthless.

Advice regarding prosthetic camouflage

In case of extensive or total alopecia areata the question of applying a wig should be discussed with the patient of applying a wig should be discussed with the patient. It is important to realize that wigs made of artificial hair appropriately fulfil the cosmetic requirements. Moreover, cleaning of a wig made of artificial hair is much easier. On the other hand, wigs made of genuine hair are more durable. For economic reasons it seems unjustified to demand that the health plan should take over the costs for wigs made of human hair for all patients with alopecia with alopecia areata.

Additional desirable measures

From a psychological point of view, it is important that the dermatologist shows commitment and offers the option of regular appointments. In this way the patient will not feel left alone with his problems, and he will learn to cope adequately with this disease which often tends to run a chronic course. In exceptional cases, however, the psychological support that can be given by a dermatologist may be insufficient, and in such cases the help of a specialized psychologist should be considered. It is important, however, that the physician and the patient himself both understand the aim of such psychological help. Such inter views cannot be offered with the aim to elucidate the ‘cause’ or ‘meaning’ of alopecia areata, or to induce regrowth of hair. Rather, the rationale of any psychosomatic approach is to offer support in coping with a cosmetically devastating disease. Dermatologists should be aware that many psychologists erroneously believe that their specialized knowledge and skills enable them to induce hair regrowth in alopecia areata. In reality, such psychosomatic approaches do not inhibit a spontaneous remission of alopecia areata.    

Dr Pradeep Sethi

Dr Arika Sethi

www.directhairtransplantation.com/

Correct Way of Shampooing And Conditioning The Hair

Hair care

The correct way of shampooing the hair

1.       Remove the knots of hair before head wash with a wider, thick toothed comb or brush. Since the hair is weaker and more fragile and wet, removing the entanglements and knots during the head wash may cause unnecessary breakage and hair loss.

2.       Use lukewarm water to wash your head instead of hot water.

3.       Once your scalp and hair are wet, take the shampoo on your palm and spread it on your palm. Then apply the shampoo on your scalp by placing the palm on the head and rotating it in a gentle, circular manner. This will improve the blood circulation in the scalp and all the debris or dirt accumulated on the scalp will be removed.

4.       Cover one region of head at a time. Like you may start from the frontal aspect, then move to left side of the head (temporal area), then the back (occiput) and finally to the right side.  Thus, you may need to take the small amount of shampoo every time for each region. This will ensure an even distribution of the shampoo on the scalp.

5.       How much to use? Take only that much amount of shampoo that is enough to produce small amount of lather. Too much lather indicates that either the shampoo is strong or excessive amount has been used.

6.       Those with long hair will require double amount of shampoo than those with short hair

7.       Keep the shampoo and the lather on your scalp and hair for few minutes

8.       Rinse with warm water. Rinse thoroughly. This is the most important part of the head wash. The water should be rinsed thoroughly many times so that all the shampoo from the scalp and hair has been washed off. Those with long hair will need to rinse more than those with short hair.

9.       A final rinse with cold water can be given to close the cuticle and hair will look shinier.

10.   For drying, wrap a clean dry towel around your head and hair to absorb the dripping water.

11.   Then dab your scalp and hair with towel. Don’t dry your hair by rubbing with a towel as this can damage the cuticle and make the hair weak.

12.   Then use a comb to remove the tangles. For people with long hair, great care is necessary at this stage. They should:

·         Remove the knots at the ends of the hair first rather than the roots

·         Make small sections of hair to remove the knots, rather than trying to comb the complete set of hair in one go

·         Prevent the traction force of combing to pass on to hair roots. This can the done by using a fingers to hold the bunch of hair, a few inches away from the scalp

Conditioning the hair

Conditioners can be used for softening the hair. They also help in removing the entanglement more easily. Apply the conditioner through the length of hair and keep it for 5 minutes. Then rinse thoroughly.

The usage of conditioners is not necessary. It should be used only if one feels that the hair are too dry and frizzy after shampooing.

Some myths about shampooing

·         Oiling is necessary before head wash: Dermatologist’s comment: No, oiling will make the scalp and the hair extra greasy, dirty and weak. It also stimulates the growth of fungus Malassezia furfur that can cause dandruff and thus aggravates hair fall

·         Baby shampoos are best for head wash: Dermatologist’s comment: No, the baby shampoos are usually alkaline (to prevent tear formation) and tend to make your hair drier.

·         Daily shampooing will cause hair fall: Dermatologist’s comment: No, just like any body part, the hair too require daily cleansing.

·         The shampoo that produces more lather and bubbles is the best: Dermatologist’s comment: No, it indicates that the detergent property of the shampoo will higher. The lather should not be too high or too less. A mild shampoo recommended for daily use is the best.

DANDRUFF/ SEBORRHOEIC DERMATITIS

Seborrhoeic dermatitis is characterized by inflammation and scaling in areas with a rich supply of oil producing glands (sebaceous glands), namely the scalp, face and upper trunk. Dandruff is the mildest manifestation of the disease.

Epidemiology

Seborrhoeic dermatitis is a common disease, and the prevalence ranges from 2 to 5% in different studies. It is more common in males than in females. The disease usually starts during puberty and is more common around 40 years of age.

Causation

They are now many studies indicating that the lipophilic yeast Malassezia plays an important role in seborrhoeic dermatitis.

Exacerbating factors

·         Parkinson’s disease.

·         Neuroleptic drugs.

·         Emotional stress.

·         HIV disease.

Clinical characteristics and course

Seborrhoeic dermatitis is one of the most common skin diseases. The disease is characterized by red scaly lesions predominantly located on the scalp, face and upper trunk. It is more common in males than in females. The disease usually starts during puberty and is most common around 40 years of age. The skin lesions are distributed on the scalp, eyebrows, nasolabial folds, cheeks, ears, central chest and back regions, axillae (armpit) and groins. Around 90-95% of all patients have scalp lesions and lesions on body are found in approximately 60% of the patients. The lesions are red and covered with greasy scales. Itching is common in the scalp.

Complications include skin thickening (lichenification), boils (secondary bacterial infection) and infection in ear canal (otitis externa). The course of seborrhoeic dermatitis tends to be chronic with recurrent flare-up. A seasonal variation is observed with the majority of patients being better during the summertime. Mental stress and dry air are factors that may aggravate the disease. A genetic predisposition is also of importance in the disease.

Treatment

General therapeutic guidelines

Seborroeic dermatitis is a chronic disease and to inform the patients about the risk for relapse and predisposing factors is very important. Stress and winter climate have a negative effect on the majority of patients and summer and sunshine have a positive effect.  

Avoidance of oil application on scalp and hair is a must

Regular head wash (daily/alternate days) with a normal shampoo is recommended

Recommended therapies

Antifungal treatment

Antifungal therapy is effective in the treatment of seborrhoeic dermatitis and, because it reduces the number of the Malassezia yeasts.                                                                                                                      Ketoconazole is very effective in vitro against the Malassezia yeasts. It can be prescribed in the form of topical shampoo/lotion. Severe cases may require oral ketoconazole. Shampoos containing zinc pyrithione, ciclopirox olamine, sertakonazole, fluconazole or selenium sulfide are also effective and widely used.

Corticosteroids

Mild corticosteroid solutions, creams or ointments are effective in the treatment of seborrhoeic dermatitis due to a non-specific anti-inflammatory activity.

Keratolytic therapy

When lesions are covered with thick adherent scales keratolytic therapy, especially in the scalp, is necessary.

Calcipotriol

It is a vitamin D3 analogue and effective in the treatment of seborrheic dermatitis

Antibiotics

Seborrhoeic dermatitis especially in the scalp and external ear canal may be secondarily infected with bacteria. In these patients topical or oral antibacterial therapy in combination with regular treatment are indicated.

Dr Arika Sethi

Dr Pradeep Sethi

@ http://www.directhairtransplantation.com/

Hair Science and Hair Growth Cycle

Introduction

With the beginning of the cultivation, mankind had the magnetic dip towards impressing others with their looks. The beauty of hair basically depends on individual’s health, diet, habits, job routine, climatic conditions and maintenance. Hair disorder is a common ailment of all age groups and both genders because of the infections, chemical agents & biological toxins present in the atmosphere and also due to physical factors, malnutrition and environmental pollution. The common problems occur with hair as hair fall, hair loss and their graying at an early age. They have become a general feature.

Hair Science

Hair is far more complex than it appears on the surface. We all know that it not only plays a vital role in the appearance of both men and women, but it also helps to transmit sensory information. By week 22, a developing fetus has all of its hair follicles formed. At this stage of life there are about 5 million hair follicles on the body. There are a total of one million on the head, with one hundred thousand of those follicles residing on the scalp. This is the largest number of hair follicles a human will ever have, since we do not generate new hair follicles any time during the course of our lives. Most people will notice that the density of scalp hair is reduced as they grow from childhood to adulthood. The reason: our scalp expands as we grow.

 Hair has two distinct structures – first, the follicle itself that resides in the skin and second, the shaft that is visible above the scalp.

Hair Growth Cycle

Hair on the scalp grows about 0.3 to 0.4 mm/day or about 6 inches per year. Unlike other mammals, human hair growth and shedding is random and not seasonal or cyclical. At any given time, a random no of hairs will be in one of three stages of growth and shedding: anagen, catagen, and telogen.

Anagen

Anagen is the active active phase of hair. The cells in the root of the hair are dividing rapidly. A new hair is formed and pushes the club hair (a hair that has stopped growing or is no longer in the anagen phase) up the follicle and eventually out. During this phase the hair grows about 1 cm every 28 days. Scalp hair stays in this active phase of growth for two to six years. Some people have difficulty in growing their hair beyond a certain length, because they have a short active phase of the growth. On the other hand, people with very long hair have a long active phase of growth. The hair on the arms, legs, eyelashes, and eyebrows have a very short active growth phase of about 30 to 45 days, explaining why they are so much shorter than scalp hair.

Catagen

Catagen phase is transitional stage and about 3% of hair is in this phase at any time. This phase lasts for about two to three weeks. Growth stops and the outer root sheath shrinks and attaches to the root of the hair. This is the formation of club hair.

Telogen

Telogen is the resting phase and usually accounts for 6% to 8% of all hair. This phase lasts for about 100 days for hair on the scalp and long for hair on the eyebrow, eyelash, arm, and leg. During this phase, the hair follicle is completely at rest and the club hair is completely formed. Pulling out a hair in this phase will reveal a solid, hard, dry, white material at the root. About 25 to 100 telogen hairs are shed normally each day.

know more about hair science and hair cycle @ http://www.directhairtransplantation.com

Hair grooming

The use of hair cosmetics is ubiquitous among men and women of all ages. Virgin hair is the healthiest and strongest but basic grooming and cosmetic manipulation cause hair to lose its cuticular scale, elasticity, and strength. The science behind modern shampoos and conditioners has led to the development of rationally designed products for normal, dry, or damage hair.

Hair grooming products

Shampoos:  formulations and diversity

Cleaning hair is viewed as a complex task because of the area that needs to be treated. The shampoo product has to also do to things – maintain scalp hygiene and beautify hair. A well-designed conditioning shampoo can provide shine to fibers and improve manageability, whereas a shampoo with high detergent properties can remove the outer cuticle and leave hair frizzy and dull.

Formulations of shampoos

The number of shampoo formulations on the market can be overwhelming but when the chemistry behind those marketed for “normal hair” or “dry hair” is understood, shampoos for “normal” hair typically have lauryl sulfate as the main detergent and provide good cleaning of the scalp. These are best utilized by those who do not have chemically treated hair. 

Categories of shampoos available for the following hair types.

• ·         Normal hair
• ·         Dry hair
• ·         Oily hair

·         Tightly kinked hair

Hydrolyzed animal protein or dimethicone are added to conditioning shampoos, also commonly called 2-in-1 shampoos. These chemicals create a thin film on the hair shaft to increase manageability and even shine. For individuals with tightly kinked hair, conditioning shampoos with both cleaning and conditioning characteristics that are a variant of the 2-in-1 shampoo can be beneficial.

Some baby shampoos can cause increased hair dryness because of their alkaline pH.

Conditioners

Conditioners can be liquids, creams, pastes, or gels that function like sebum, making hair manageable and glossy appearing. Conditioners reduce static electricity between fibers following combing or brushing by depositing charged ions on the hair shaft and neutralizing the electrical charge. Another benefit from conditioners is improved hair shine which is related to hair shaft light reflection. Conditioners may also improve the quality of hair fibers by reapproximating the medulla and cortex in frayed fibers.

There are several hair conditioner product types including instant, deep, leave-in, and rinse. The instant conditioner aids with wet combing; the deep conditioner is applied for 20-30 minutes and works well for chemically damaged hair. A leave-in conditioner is typically applied to towel dried hair and facilitates combing. A rinse conditioner is one used following shampooing and also aids in disentangling hair fibers.    

   

Hair oils

Oiling is not recommended for good hair and scalp health. It causes increased scalp itching, dandruff and hair loss. It can also aggravate skin problems like acne (pimples) and pityriasis versicolor.

Know more about hair grooming @ http://www.directhairtransplantation.com

Science of hair waving

Science of hair waving

Introduction

Since ancient cultures curly hair represented femininity and beauty. Women with straight hair purchased expensive wigs or spent hours for hair ondulation with water and heat, which was temporary.

Ÿ Permanent hair waving is a two-step chemical treatment modifying hair protein to achieve and retain a curly shape.

Ÿ The chemical treatment involves a thioglycolate reduction reaction that plasticizes hair while being wound on a rod. The following oxidation step with hydrogen peroxide reforms the hair in a new curly shape.

Ÿ Curl retention depends on hair thickness, rod diameter, and hair quality.

Ÿ Undesirable hair damage can occur with the wrong choice of perm and neutralizer, too much heat, incorrect processing time, or improper perm solution amount.

Chemophysical principles of hair waving

Because of hair’s great elasticity and strong resilient forces, it quickly resumes its original straight shape. Therefore it has to be softened and subsequently rehardened chemically to maintain a conformation change. Especially with permanent waving, it is important to select a reversible reaction to allow repeated treatments without hair destruction. The sulfur bridges of the amino acid cystine, linking the proteins, are best suited.

The conditions for permanent waving to be well tolerated are:

 Low temperature (20-50®C), convection or contact heat;

ŸShort process time (5-30 minutes); and

 Mildness to the skin.

A permanent wave occurs with two solutions:

1. Solution 1: the perming lotion, which contains a reducing agent, a “thiol” compound, designed to split off about 20-40% of hair cystine bonds.
2. Solution 2 : a fixing lotion, which contains an oxidizing agent, usually hydrogen peroxide, designed to rebuild cystine  bridges between proteins at new sites in the curled hair shape. It must be emphasized that permanent waving is a two-step procedure where the chemical reaction and physical effects run in parallel reduction of disulfide-bonds, softening of hair, lateral swelling and length contraction, stress development and protein flow, then re-oxidation of cystin bonds and deswelling, fixation of a new curly shape.         

For more Information regarding Hair solutions visit us at  http://www.directhairtransplantation.com

Seminar on Treatment of Hair Loss and Hair Transplantation

We felt privileged and humbled by your presence in the press conference.

Hair: Some facts

There are around 1 lac hair roots on our head. These roots grow and fall in cycles. Every day, we lose 50-100 roots and these many roots come back.

There are certain myths about hair in our society.

Myths:

Daily shampoo increases hair fall

Oiling is good for hair

Use of water at new place increases hair fall

Truth:

1.       We should shampoo daily or at least alternate day.
2.       Hair oil does not increase the hair length, rather causes dandruff.
3.       If the hair fall is more than 100 strands per day and the density is regularly coming down, then one should consult doctor.

If someone is suffering from hair fall, then he/she should count the fallen hair strands. Like, how many on pillow, during hair wash, during combing etc.

There are some effective medicines which can prevent hair fall. These medicines are different for male and female and should be prescribed by the doctor.

Hair Transplantation:

If any part of head is completely bald or more than 50% of hair is lost, then hair transplantation is a solution.  Hair transplantation is a minor but very delicate surgery performed by highly experienced and qualified doctors. In this, permanent hair from other parts of body (usually head, sometimes beard, chest etc) is transplanted to the bald area. The transplanted hairs grow naturally. They remain for the rest of life, undergo normal regular cutting, and are absolutely maintenance free.

Usually hair transplantation is undertaken by males, and it is also successful in females. For the first time in Uttarakhand and Uttar Pradesh, National Skin Clinic has started modern and sophisticated hair transplantation.  Dr Pradeep Sethi and Dr Arika Sethi, who are trained from the prestigious AIIMS, New Delhi is constantly doing research on hair transplantation techniques. They invented the DHT (Direct Hair Transplantation) method of hair transplantation. In this technique hair roots are planted in the body very fast, within minutes employing NO TOUCH technique. This DHT technique is highly advanced than the other techniques of hair transplantation like FUT and FUE.  This DHT method is being presented at various national and international conferences. Because of its unparallel results Hair transplantation doctors all over world are gradually shifting to this technique.

Other uses of Hair transplantation:

Other than baldness, we are using hair transplantation in vitiligo on face, scar on face, post burn moustache,beard and eyebrow, eyelashes

National Skin Clinic is also doing the modern research on “Hair Cloning” for the first time in India with some rare stem cell scientists. We are also in the process of making a new instrument which will do the “Single step Hair Transplantation”.

We are attending all the national and international conferences on hair transplantation, and delivering talks in these gatherings and providing international standards in the field. We are also getting national and international reviews because of our location in Dehradun  which is at the foothills of Himalayas.

The treatment of hair loss and hair transplantation requires a lot of experience, expertise and international exposure. Patients need the right information.

With all your help we conducted a seminar/camp on 4^th November, Sunday 10 AM-1 PM, at our clinic in Rajendra Nagar to provide this awareness to the general public.

We request you to cover this press conference in a big way, so that maximum people will get the benefit. We also invite you to the camp on Sunday and cover the same.

Humbly

Dr Pradeep Sethi, MD (AIIMS)

Dr Arika Sethi, MD (AIIMS)

National Skin Clinic, Rajendra Nagar

08057541540

http://www.directhairtransplantation.com

When and When not to go for Hair transplantation surgery

When not to go for hair transplantation (HT)?

If somebody is suffering from recent onset rapid hair loss, then hair transplantation is not a solution for his/her problem. Such patients should consult a dermatologist for medical therapy which may include medicines (both oral and topical formulations), platelet rich plasma, mesotherapy etc. However, once baldness has set in, then hair transplantation can provide permanent, natural, growing hair to cover the bald scalp.

Women should be thoroughly investigated for reversible causes for hair loss like iron deficiency, thyroid abnormalities, polycystic ovarian disorders, drug induced hair loss etc.

Patients with unrealistic high expectations of a full head should also refrain from HT. The surgery can produce a modest improvement in the grade of baldness, it does not give miraculous results in single sitting.

Patients having progressive alopecia areata, and progressive cicatricial alopecia (due to discoid lupus erythematosus, lichen plano pilaris, morphea) should also refrain from HT.

When to go for hair transplantation (HT)?

In the following clinical situations, HT should definitely be offered as a treatment modality by the health care physicians.

1. Male pattern baldness (MPB): All patients with male pattern baldness of Norwood-Hamilton grade ranging from I to VII, can undergo hair transplant after proper counseling about the methodology and expected results.
2.  Female pattern baldness (FPB): After ruling out medical causes and dermatological      disorders, women having advanced stages of FPB, can undergo hair transplant.          Ref: http://www.ncbi.nlm.nih.gov/pubmed/20487684(Jiménez-Acosta F, Ponce I. Follicular unit hair transplantation: current technique. Actas Dermosifiliogr. 2010 May; 101(4):291-306.       Stable scarring alopecia due to burns, injury, skin disease
3.  Stable vitiligo (on hair bearing areas)     
4. Scar camouflage (for face)

Direct Hair Transplantation is the most advanced no stitch, no touch, ha...

Hair Transplantation techniques: An update

Hair Transplantation techniques: An update

We have around 1 lac hair follicles (roots) on our head.  In baldness, we lose the temporary hair from the frontal head. Baldness is seen after 50% hair roots are lost.

Hair Transplantation Procedure:

 Hair transplantation is a minor but very delicate surgery done by highly experienced, qualified doctors. In this, permanent hair root from other part of body (usually head, sometimes beard, chest etc) is transplanted on the bald area. These hairs grow naturally after an incubation period of 1-3 months.

These permanent roots remain for the rest of life and undergo regular cutting. They don’t need any maintenance.

Usually hair transplantation is undertaken by males, and it is also successful in females.

We perform hair transplantation by three methods:  FUT, FUE and the most advanced DHT.

FUT: Follicular Unit Transplantation 

This is the oldest method of hair transplantation. Here a strip of skin containing hair roots is taken from the permanent zone of head (backside). The strip is dissected under microscope to individual “grafts” containing hair roots. This method leaves a scar on the donor site. This is more technician dependant.

FUE: Follicular Unit Extraction

In this method, individual grafts are harvested, leaving no scar on the donor area. This is a stitchless method.

DHT: Direct Hair Transplantation

While doing hair transplantation over the years, we were constantly striving to improve the results and reduce all the limiting factors.

Here, the grafts are extracted and immediately planted by a NO TOUCH technique.  The transit time (i.e. the time period for which grafts stay outside body) is reduced to minutes.  The procedure is carried by the doctors only, not left to the technicians. We named this technique as Direct Hair Transplantation (DHT)

Table:

	FUT	FUE	DHT
Percentage of time during which the doctor operates	30%	50%	100%
Graft handling by the doctor	30%	50%	100%
Transit time, time period during which the graft remains outside the body	2-5 hours	3-5 hours	Within minutes
Chances of graft survival	70-85 %	80-90 %	98-100 %
Storage solution	required	required	Not required
Mechanical handling	more	less	least
Chances of graft dessication	more	less	least
Chances of graft infection	more	less	least
Scar after surgery	A linear scar remains on the occipital scalp	No linear scar, no stitches, no scalpel	No linear scar, no stitches, no scalpel

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