Hair transplantation is one of the most rapidly evolving procedures in aesthetic surgery, with regular improvement in techniques.The recent advances in technology and the concept of using follicular unit grafts have made this procedure reach a new height.
Hair transplantation is based on the ‘theory of donor dominance in androgenic alopecia.’ If a graft is taken from an area destined to be permanently hair-bearing and transplanted to an area suffering from male pattern baldness, it will, after an initial period of effluvium, grow hair in its new site as long as it would have at its original site.
Hair restoration surgery can benefit anyone who has experienced permanent hair loss including male and female patterned baldness (Androgenetic Alopecia, AGA), men or women who want to change the shape of their hairline, patients with scarring from injuries, or scarring skin diseases and those who want to thicken or restore eyebrows, beards etc. But the most common indication is Male Pattern Hair Loss. AGA causes a huge psychological distress to patients. Depending on the type, grade and severity of hair loss, the management options such as drugs, surgery (Specially number of follicles) are decided.
Not all hair loss patients are to be operated, since nowadays patients demand surgery but may not need one. As a result, trichology is changing from disease-oriented specialty to a desire satisfying one. This has led to a debate as to whether such patients are indeed patients or should they be termed as clients.
| Patient | Client |
| Has a disease Mostly needs medical treatment Fear of consequences of disease, fear of infection and progression of alopecia Accepts treatment willingly Easier to counsel about side effects Easier to handle if there is a side effect Respectful towards doctor; doctor is dominant |
Has a desire Mostly needs a procedural treatment Well aware; often has read well; knows or thinks he knows what treatment is needed Wants options Paranoid about side effects Demanding; aggressive Demands equal relationship |
Counselling the patient, with respect to the disease process, possible effects and adverse effects of the medications along with the probable expected outcome plays a vital role.
Design of anterior hairline is the most critical step in hair restoration surgery. It should be designed in a way that it not only fulfils the present demand, but also matches aesthetically with changes in the facial features and hair loss with advancing age. Density, direction, angulation, thickness of hair, and multifollicular units, all need to be kept in mind while creating a hairline and the different zones.
FOLLICULAR UNIT TRANSPLANTATION (FUT)
The goal of strip harvesting is to excise the strip from the safe donor area with minimal injury to the neurovascular bundle and give a minimal scar. Indian skin, however, is prone to hypertrophic scarring. Due to this and several other problems, I believe that Follicular Unit Extraction (FUE) is a significant advancement in this field.
FOLLICULAR UNIT EXTRACTION (FUE)
- It is a technique of harvesting intact individual FU’s directly from the donor area using a small punch.
- The resultant small holes heal with minimal and inconspicuous scarring.
- Does not produce a linear scar.
- Low pain and great results
Surgery on recipient area involves different steps such as hairline design, anesthesia, density, methods of implantation and postoperative care. Different aspects of transplantation in the recipient site that need consideration include distribution, shape and direction of slits, density, packing and hairline design. A surgeon needs to be aware of different methods of implantation. Postoperative care is of importance in ensuring optimum results.
Complications in hair transplant (HT) can be due to general causes or those specific for HT. Most complications are infrequent, minor and can be avoided by proper technique. Most common donor area complication is donor scarring (least with FUE). Most common recipient area complication is postoperative edema, which in my experience goes away in 3-4 days
I use body hair in combination with scalp donor hair or by itself in hair restoration procedures over scalp in advanced grades of androgenetic alopecia when there is paucity of scalp donor hair. Beard hair being thicker provides more optical density when transplanted in the scalp
