Angle of Hair Transplantation

A good quality hair transplant procedure is combination of art, science and surgical skill. A person contemplating to undergo hair restoration procedure should know a little about the artistry involved in this procedure to have completely natural and aesthetically gratifying result.

Angle of Hair Transplantation

In a hair-transplant procedure, emphasis should be given to the natural hair angles and directions for optimal naturalness of the final growth as well as for an extremely good appearance of visual hair density.

What Is Hair Angle?

The hair angle refers to the degree of elevation of a hair as it exits the scalp, i.e., how much tilt upward or downward the hair graft is situated in relation to the scalp. This angle is usually 10 to 15 degrees in the frontal hairline.

What Is Hair Direction?

The hair direction refers to which way the hair points, i.e., whether the hair points toward the left or the right and the degree of deviation from the central antero-posterior line.

Angles and direction of transplanted hair in different scalp regions

Angles of hair transplantation depend on the region of the head to which the graft is to be implanted.

1.      Anterior hairline-: The angle along the frontal hair line ranges from 10 to 20 degrees. So the grafts should be placed at this low angle of 10 to 20 degrees and the direction has to be forward.

2.      The temple region-: The temple hairs have a very low angle which ranges from 3 to 10 degrees and vary in their direction and angles as one move around frontal temporal angle from the frontal arm where the hair point anteriorly to the temporal arm of this angle where the hair points posteriorly (backwards) in the temporal triangle and inferiorly (downwards) in the sideburn area. Similarly, the angles also vary from 10 degrees in the frontal component to as low as 3 degrees in the temporal component.

3.      The midscalp region: - The hairs in this region leave the scalp at an angle of 30 degrees in the frontal part and it increase to 60 degrees in the posterior part of midscalp. The hairs are directed anteriorly with gradual lateral fanning.

4.      The crown region: - The hairs in this region have a radial fanning with a whorl pattern and the angle ranges from 20-50 degrees. The upper half of whorl has medium to high angles (25 to 45 degrees) whereas lower half has angles ranging from 15-20 degrees. The hairs in the vertex spin tightly around a central point and then fan outwards. It is important to carefully observe the changing direction and flow pattern outlined by existing vellus hair. To yield a natural aesthetic result the number of hair grafts required are more and the surgeon needs to have good experience in vertex reconstruction.

Frontal forelock or cowlick

It is a challenging job for the surgeon if the hair in the frontal forelock (cowlick) is present. If the hairs are vellus (extremely thin and not growing) then this region should be completely implanted with the follicular unit grafts. However, if the hairs are thick and growing, the follicular unit grafts should be implanted in between the existing hair with extreme precaution to preserve the native hair.

Hair Curl

Careful attention should be paid to the curl of the hair in the graft. The curl must always curl down and into the skin in the same direction as the incision site. In our clinic, we take extreme precaution to maintain the curl downwards. This is made possible due to specialized implanters that are loaded in such a way that the curl of the hair is pointing into the cylindrical cavity of the implanter at the time of loading it with follicular unit grafts.

FUE ( Follicular Unit Extraction) Hair Transplant

FUE Hair Transplant

FUE Hair Transplant stands for follicular unit extraction. It’s an advanced type of hair restoration surgery, in which the individual follicular units are extracted one by one from the donor area (back of head, beard etc) and are transplanted to the recipient region (frontal bald region).

Technique

In FUE, individual follicular units are removed one by one under local anesthesia with the help of tiny punches of 0.6mm to 1.25mm diameter. Each follicle is then implanted individually on the frontal bald scalp. This technique is less invasive so, leaves no linear scar, any post operative pain is minimized and the healing and recovery period is minimum.

FUE; Advantages over FUT

Follicular Unit Transplantation (FUT) is also known as “Strip Harvesting” hair transplant method is the older technique in which a strip of scalp is removed by the surgeon and this strip is dissected into individual follicular units by the surgical technician and then implanted on the bald region, while the wound is sutured back together.

The major drawback of FUT is that it leaves a long linear scar on the back and sides of head. The recovery period is 2 weeks and requires the stitches to be removed by medical personnel.

FUE on the other hand has a lot of advantages over FUT:

·         It does not leave a linear scar at the back of head, instead only small punctate scars remain which are not visible even on close inspection.

·         The patient can keep their hairs short.

·         Body hair harvesting has been made possible with FUE

·         Minimal post operative pain.

·         Fast recovery within a week.

·         Helpful in individuals with tense scalp.

·         The important work of separating the hair follicular unit is not left to technicians rather the hair transplant doctors extract follicular units themselves so the chances of graft damage while handling is minimized leading to high graft survival rate.

·         Moreover, the FUE grafts spend much less time outside the body which ensures maximum survival.

All these advantages of FUE have made it a very popular and more preferred hair transplant technique of these days. 

Implementation of Direct Hair Transplantation

Dr Pradeep and Dr Arika have made continuous efforts to improve the results of hair transplant surgery.  Dr. Pradeep Sethi conceived and implemented the idea of “Directhair transplantation (DHT)” and has been using this method for hair transplantation past five years. In this most advanced hair replacement procedures grafts are planted as soon as they are extracted. This advance technique was designed to improve the speed of the follicular unit extraction and minimize the chances of graft desiccation, infection and mechanical trauma.

This new advanced technique works on ‘No Touch’ technique. Our hair roots contain stem cells. These cells can give new hair roots. The grafts are extracted from the donor area usually (Back head, beard, sometimes chest etc) and are planted to the bald area within few minutes. The hair retains the characteristics of the donor area when they are moved to a new location and will continue to grow. The grafts are held at hair level only and are transplanted by special patented instruments, thus there is no handling of root and this make the chances of crushing the root nil. The grafts are safely planted on the bald area within seconds. This allows fast and effective planting of the follicle while keeping the risks of damage to the follicles almost nonexistent. The grafts stay outside the scalp for minimal time and this increases the chances of graft survival to 100 %. The grafts do not shed after surgery. This technique has increased the speed of the hair restoration procedure, the transit time is reduced, the mechanical handling is nil and therefore there is no chance of graft infection.  We use "ultra refined micro grafts" for the natural density. This new DHT technique has given better results than other hair transplantation techniques. The grafts do not shed and the real hair starts appearing after 3-4 months. At times around 5% of hairs keep on growing from the day of the hair transplantation procedure, in some patients, this percentage is even higher. The hairs that grow after surgery are completely natural they can undergo regular cutting and styling.

This new  innovative technique of Direct hair Transplantation has allowed Dr Sethi to increase the number of follicular unit grafts he can transplant daily from approximately 2000 to 3000 per day.

Dr Arika underwent ACLS (advanced cardiac life support) training at ITC-HIHT on 9, 10th January, 2013.

Dr. Arika Sethi MD (AIIMS, New Delhi) is a Gold Medalist from the Prestigious Lady Hardinge Medical College (New Delhi). She did her MD from AIIMS, New Delhi. She was a brilliant student during her student life.

She published 12 National & International Papers in a short span of 3 years of MD training at AIIMS.She has a keen interest in Hair Restoration, Pigmentation, Anti-ageing & Vitiligo Surgeries.

Experience

1. Internship: Lady Hardinge Medical College and associated Smt. Sucheta Kriplani, Ram Manohar Lohia Hospital And Kalawati Saran childern’s Hospital, New Delhi, 12 months of clinical rotations in Departments of Medicine, Surgery, Obstetrics & Gynecology, Paediatrics, Ophthalamology, Community Medicine, Dermatology, Venereology and Leprology, Forensic Medicine, Orthopaedics and ENT.
2. Post Graduate resident: for 3 years (2004-2006) at All India Institute of Medical Sciences, New Delhi. Includes 4 months of dermatosurgery posting, 4 months in Venereology, 10 months exclusive posting in dermatology ward. Teaching activities: weekly case conferences, dermatopathology conferences, seminars, journal clubs, weekly bedside teaching rounds in ward.
3. Senior resident: for 3 years (2007-2010) at HIHT university, JollyGrant, Dehradun. Includes OPD, Dermatology ward, In patient dermatology consultation, Dermatological emergencies, Dermatology CME, undergraduate teaching.
4. Senior Consultant Dermatologist: for 2 years (2010-till date) at National Skin Clinic, Dehradun. Performing laser surgeries, laser hair removal, chemical peeling, dermabrasion, vitiligo surgery, melanocyte transplant, scar revision, earlobe repair, Hair transplant (more than 150 cases)

Chief areas of interest

• Dermatopathology
• Dermatosurgery
• Pediatric dermatology

Awards

• Got 2nd prize in young dematologists competition for presentation of research work in IADVL annual conference (Delhi) held on 18.12.2005.
• Vishnupriya Debi Award for best paper published in IJDVL during the year 2006. Paper: Verma KK, Bansal A, Sethuraman G. Parthenium dermatitis treated with azathioprine weekly pulse doses. Indian J Dermatol Venereol Leprol 2006 Jan-Feb; 72(1): 24-7.
• Got gold medal in Ophthalmology for getting highest aggregate marks during Final MBBS (2001)

Research

1. THESIS: Evaluation of weekly azathioprine pulse versus daily azathioprine (2004-2006)
2. Clinical and pathological study for epidermal nevi
3. Clinical study of Reiter’s disease
4. Comparison of patch test results with ISS and Photopatch series in patients with suspected photosensitivity
5. Evaluation of patch test with footwear series antigens and ISS in patients with suspected footwear contact allergy.

Presentations

• Poster presentation: “Systematised nevus comedonicus” at IADVL conference 2007, Chennai
• Case presentations at Clinical combined rounds (3 times) at AIIMS
• Case presentations at monthly IADVL meet held at AIIMS (3 times) in 2004, 2005, and 2006
• Conducted CMEon vitiligo at KDMIPE auditorium, ONGC, Dehradun on 29th February, 2011.
• Oral presentation at 4th spring meeting at International society of dermatologic surgery (ISDS) conference, held at Gurgaon on 12.4.2012. “DHT: A novel innovation in the existing FUE technique”
• Conducted CME on “Hair transplantion: An answer to baldness” held at IMA hall, Dehradun on 7th July, 2012.

Membership

• Indian Medical Association (IMA)
• Indian association of dermatologists, venereologists and leprologists (IADVL)
• Association of cutaneous surgeons of India (ACSI)
• Association of hair restoration surgeons (AHRS)

Publications (http://www.ncbi.nlm.nih.gov/pubmed?term=Bansal%20Arika)

1. Verma KK, Tejasvi T, Verma K, Sethuraman G, Bansal A. Severe mucocutaneous Behcet's disease treated with dexamethasone pulse. J Assoc Physicians India 2005; 53: 998-9.
2. Sethuraman G, Fassihi H, Ashton GH, Bansal A, Kabra M, Sharma VK, McGrath JA. An Indian child with Kindler syndrome resulting from a new homozygous nonsense mutation (C468X) in the KIND1 gene. Clin Exp Dermatol 2005; 30: 286-8.
3. Verma KK, Bansal A, Sethuraman G. Parthenium dermatitis treated with azathioprine weekly pulse doses. Indian J Dermatol Venereol Leprol 2006 Jan-Feb; 72(1): 24-7.
4. Bansal A, Sethuraman G, Sharma VK. Pachyonychia congenita with only nail involvement. J Dermatol. 2006 Jun; 33(6): 437-8.
5. Sethuraman G, Sugandhan S, Bansal A, Das AK, Sharma VK. Familial pigmented purpuric dermatoses. J Dermatol 2006 Sep; 33(9): 639-41.
6. Bansal A, Sethuraman G. Lymphangioma circumscriptum of the tongue. Indian Pediatr 2006 Jul; 43(7): 650-1.
7. Khaitan BK, Bansal A, Bhat R, Das AK. A neurofibroma with an unusual morphology. Acta Derm Venereologica 2006; 86: 266-7.
8. Khandpur S, Bansal A, Sharma VK, Bhatti SS, Singh MK. Twenty nail dystrophy in vitiligo. J Dermatol 2007; 34: 189-92.
9. Khandpur S, Bansal A, Ramam M, Sharma VK, Das AK, Singh MK, Prasad HK. An unusual presentation of cutaneous tuberculosis: Verrucous tuberculid mimicking Kyrle’s disease. Int J Dermatol 2007; 46: 1298-301.
10. Sharma VK, Sethuraman G, Bansal A. Evaluation of photopatch test series in India. Contact Dermatitis 2007; 56: 168-9.
11. Malhotra A, Bansal A, Verma KK, Khaitan BK. Large superficial basal cell carcinoma on face treated with imiquimod 5% cream. Indian J Dermatol Venereol Leprol 2006; 72: 373-5.
12. Bansal A, Kumari R, Ramam M. Fixed drug eruption due to cross reaction between two azoles used for different indications. Indian J Dermatol Venereol Leprol 2008; 74(1): 81.