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.

Hair Replacements, Hairpieces and Wigs

A hair replacement (hair system or hairpiece) is partial synthetic or natural hair prosthesis that covers a part of the scalp which is bald, whereas a wig which covers the entire scalp. A wig is worn usually by women whereas the men prefer to wear a cap because of persistence of the hair at the back and sides of the head (occipital and temporal fringe in men with male patterned baldness).

Hair replacements can be attached to the scalp through a variety of mechanisms. They are summarized below:

·     Tape adhesives: are used for daily adherence so that the hairpiece can be easily removed at night time.
·    Glue adhesives: provide more durable bonding and can be used to keep a replacement in place for upwards of a month.
·     Hair weaving: uses existing hair to provide anchorage to the hair system through inter-weaving the two together. Weaving can also provide a month of time for a hair replacement to remain in place before maintenance is required. 
·     Hair clips: Hair replacement is secured with several sets of little combs that clip to a person’s hair.

These hair replacements require maintenance like:

·         Cleaning
·         Coloring
·         Repairing
·         Replacing
·         Bonding it back on scalp

 Hair styling requires special sensitivity and technique to provide proper blending and is usually carried out in specialized salons where men who wear hair replacements can feel more comfortable in that environment dedicated to their needs.

The benefits of hair replacement are that:

      ·      They can provide immediate gratification as opposed to a hair transplant that requires 6 months or beyond to see the result
·         Look more denser that the look after a single sitting of hair transplant
·         Less expensive
·         It is a good option in individuals with cannot undergo hair transplant because of underlying systemic diease like cardiac problem, coagulopathies etc.
·         Individual with extremely poor density in the donor areas

The disadvantages are:

·         They require regular maintenance. The maintenance fee over the years may be too high
·      The maintenance requires a lot of labor and time investment. In contrast the transplanted hair don’t require much extra care
·         The hair of the artificial replacement don’t undergo growth
·         The wearer is under a constant fear of displacement of the hairpiece
·         The wearer may develop social inhibition due the risk of being “caught”

These hair replacements provide cover up for a patient who is has undergone hair transplant for the transition phase (i.e. the phase when the growth of transplanted hair has not started yet). Such persons should understand two things:

·         Hair transplant results cannot match the excessive density
·         Hair transplant cannot provide the very low hairline as that of a hair replacement
·         They need to make some adjustment in the way a hair replacement is worn after the hair transplant

Nevertheless, most people seeking hair transplant are willing to compromise hair density and selecting the hair transplant only of the front and top of the scalp. They also accept the exposed, bald vertex for the freedom of having their natural hair. They must understand the limitations and advantages of hair transplantation after proper and thorough counseling by their physician.

There are some situations in which a patient wearing the hairpiece can consider undergoing hair transplant like:

1.       For individuals with advanced stages of hairtransplant (Norwood VII pattern): In those advanced persons of hair loss, wearing a hair replacement may be the best choice for that particular individual. The density of the hair in a well-constructed hair replacement does not match the hair loss from the sides (temporal regions). This unnatural pattern renders a look as if the individual is wearing a baseball cap. This is also called “lid effect’’. This can provide an excellent compliment in order to achieve a more natural appearance by transplanting hair in the temporal region to match the hairline of the hair system.

2.       Some individuals require a thick and dense natural hair restoration in the frontal hairline. The rest of the frontal scalp and the vertex is covered with a hairpiece.

Great advances have been made to increase the natural look of hairpieces today. Unlike the older hairpieces that were thick, synthetic, and poorly shaped which looked like “hairy rug”, today’s thin, laced front hair replacements are made of natural hair and almost undetectable. 

The reason modern hair replacements look less obvious is that the hairs are woven through a transparent mesh base that attaches to the scalp that can simulate natural hair emanating from the scalp. Another reason is that they contain significantly fewer hairs (closer to the natural hair density).

Dr Arika Sethi

Dr Pradeep Sethi

http://www.directhairtransplantation.com

Direct Hair Transplantation

DHT the most advance technique in hair transplantation

“Baldness” is the term used to describe the state of lack of hair on the head and androgenetic alopecia is the commonest cause of baldness. Approximately 50% of men are affected by the age of 50 years. One of the hallmarks of androgenetic alopecia is the conversion of thick terminal hairs into miniaturized; extremely thin (vellus) hairs. This process of miniaturization (i.e., shrinking of hair volume and growth length) is usually an indication that one is undergoing hair loss. The main mechanism for miniaturization relates to the shortening of the growth phase, i.e., the hair becomes “lazy” and does not grow to its full term. It typically begins in the frontal scalp and the vertex (crown area).

A significant proportion of women also suffer from hair loss. Unlike men, hair loss in females does not have any social acceptance. The chief complaint of women with female pattern hair loss (FPHL) is the ‘see through’ appearance of frontal hairline. These women suffer in silence for years together. The causes of hair loss in females can be: Female patterned hair loss (FPHL), telogen effluvium, hormonal imbalance, poor diet, diffuse alopecia areata. The progression hair loss in females (FPHL) is different from that of men. They experience diffuse thinning with no bald regions. Their frontal hairlines are relatively stable. 

Hair transplantation is a cosmetic surgery which provides extra hair ranging in number from 1000 to 5000 to the bald scalp. The hairs along with the roots (follicular units) are taken from the back of scalp and are transplanted on to bald area on the frontal scalp and the vertex. The modern methods of hair transplantation involve transplantation of individual follicular units and provide completely natural appearance. These hairs remain life-long. They grow and undergo cutting just like natural hair. However, the progression of baldness is not arrested after surgery and the transplanted hair grow after 3-4 months. A combination of medicines and surgery thus provides the best final result. There are two methods of surgey:

Follicular unit transplantation (FUT): A horizontal strip, 1-2 cm wide and 10-20 cm long is harvested from the back of head, and dissected under stereomicroscopes to yield follicular units. It leaves a single linear scar hidden by the hair at the back of head.

 Follicular unit extraction (FUE): The individual follicular units are harvested from the back and are then transplanted on to the frontal bald area. This propels the field of HT surgery one step closer to the elite minimally invasive status.

DHT (direct hair transplantation) is the latest innovation in the existing FUE technique. The idea behind DHT has been conceived and implemented by us at National Skin Clinic, Dehradun. It promises to yield better results


DHT before and after hair transplantation images