Limiting Pain from Injections in Hair Transplantation

The First Injection 

Most of the patients are more anxious during their first injection. If the first injection causes pain to them then they will be more and more anxious for forthcoming injections. Thus at DHT Clinic we try and make the first injection and all other following injections simpler and almost painless for the patient in the following manner:

Concomitant Physical Stimulation

Just recall, when our finger gets burn we unconsciously and immediately shake it, in a fierce manner. We do this because in this manner we try to reduce our pain by shaking or vibrating the affected area. Similarly in order to reduce pain during hair transplantation surgery, we use vibrators to shake the affected area in order to reduce the pain. In order to diminish the perception of painful stimuli touch, pressure and vibrations are used during the surgery. This helps to distract the patient and minimize his pain.

Cooling

In ancient ages icing was used to achieve numbness of any aching body part. The hypoesthesia achieved by this cold induced numbness temporarily blocks the pain perceiving receptors. We use sterile cold packs, ice boxes and doctor ice to make the injection sites numb, so that pain during prick is almost nil.

Reducing the Needle Caliber

Small caliber needles causes less pain then large ones. This potential of small caliber needles is utilized only when the rate of injection is slowed. We use 31 gauge, the thinnest possible needle in the world. It is also known as insulin syringe. With help of this insulin syringe, and slow rate of injection, the pain is minimized almost to zero.

Rate of Injection

Rate of injection also plays a major role in reducing the pain. If one reduces the rate of administration of local anesthetics, then the pain can also be reduced. We inject the anesthetic solution at extremely slow rate which cause slow tissue expansion and thus very less pain.

Depth of Injection 

While injecting the local anesthetic and the tumescent solution we are extremely careful about the depth or the PLANE of injection. If we prick beyond mid dermis level then the pain perception will be more as the receptors for the same are located at that level. So we keep the tip of the hypodermic needle in the PLANE above mid dermis. In addition to alleviating pain, this move also enhances the blanching effect of the tumescent anesthesia.

The OT & Surgery Environment

The OT and surgery environment also has a significant impact on the pain’s experience. We at DHT Clinic play soothing music and involve you in rich conversations with the doctors, keeping your areas of interest as priority.

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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.

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