Hair transplant

HAIR TRANSPLANT

Dr Junaid Ahmad

PG3 Plastic Srugery Dept

Jinnah Hospital Lahore

ALOPECIA

ALOPECIA

A

lopecia is a loss of hair from the head or body. • Androgenic alopecia• Alopecia areata

T

erminology• Alopecia totalis• Alopecia universalis

ALOPECIA

I

t has adverse effect on• Appearance of a person• Social Life• Self Esteem• Psychological state

HAIR FOLLICLES

H

air are the appendages of skin

S

eated deep in dermis

G

row in single or groups of two three or four

surrounded by collagen

HAIR ANATOMY

PHASES OF HAIR GROWTH

A

nagen (Growth phase)

C

atagen (Shedding phase)

T

elogen (Resting phase)

NORMAL HAIR LOSS

T

he number of strands normally lost in a day

varies, but on average is 100

PATTERNS OF HAIR LOSS

I

n male-pattern hair loss, loss and thinning begin at the

temples and the crown and either thins out or falls out.

Female-pattern hair loss occurs at the frontal and parietal

or patchy

CAUSES OF ALOPECIA

H

ormone

N

utrition

I

nfections

D

rugs

T

rauma

P

regnancy

O

thers

HORMONES

D

ihydrotestosterone causes hair loss in genetically

suseptible patients

E

strogen increases the hair thickness so after

pregnancy females notice hair thining

H

yperandrognemia in both sexes can cause

alopecia

MALE PATTERN BALDNESS

M

ore than 95% of hair thinning in men is “male pattern hair loss • Male pattern hair loss is characterized by hair receding from the lateral

sides of the forehead • A thinning crown leaving a horseshoe-shaped ring of hair around the

back of the head

A

pproximately 25 percent of men begin balding by age 30; two-

thirds begin balding by age 60.

MALE PATTERN BALDNESS

T

here is a great chance of receiving the baldness gene from

any of parents

T

here are muliple genes for baldness

T

he trigger for this type of baldness is dihydrotestosterone

MALE PATTERN BALDNESS

M

ale pattern baldness is diagnosed primarily on the basis of history

and physical examination.

D

/D• Diffuse alopecia areata• Acute and chronic telogen effluvium• Early cicatricial alopecia

NUTRITION

H

igh animal protein diet (fast foods) and hypervitaminosis

with vitamin A causes more hair loss

D

eficencies of diet zinc and iron causes hair loss

INFECTIONS

T

inea Capitis

F

olliculitis

S

econdary syphillis

DRUGS

C

hemotherapy causes severe hair loss

S

ometimes even eyebrows are lost with

chemotherapy

TRAUMA AND BURN

A

cid and flame burn are common in our country

C

auses permanent hair loss

M

any times complete skin loss during trauma or burn is

replaced with skin grafts which lack hair follicles

OTHERS

R

adiation exposures

A

uto imune alopecia areata

H

yper/Hypothyroidism

C

ongenital alopecia patches

L

upus erythmatosis

T

elogen effluvium

SIGN AND SYMPTOMS

R

eceding hair line in males

T

or L shaped prominent hair lines in females

I

ncreased daily hair loss

A

lopecia associated with other diseases or factors should be

evaluated according to associated sypmtoms

TESTS

T

he pull test

T

he pluck test

S

calp Biospy

D

aily Hair Counts

T

richoscopy with hitech camera and software

OPTIONS FOR BALDNESS

M

edicines

S

have the rest of head

W

igs

S

urgery

MEDICINES

O

nly stop further loss and rarely regrow any hair with

medicines

E

ven if a stable growth is achieved it terminates with

discontinuing medicines

MEDICINES

M

inoxidil (Rogaine) is a nonprescription medication approved for male

pattern baldness and alopecia areata.

H

air regrowth can take eight to 12 months.

T

reatment is continued indefinitely because, if the treatment is

stopped, hair loss resumes again.

M

ost frequent side effects are mild scalp irritation, allergic contact

dermatitis, and increased facial hair.

MEDICINES

F

inasteride (5 alpha reductase inhibitor) is used in male-pattern hair

loss in a pill form taken on a daily basis.

I

t is not indicated for women

T

reatment is effective within six to eight months of treatment.

S

ide effects include decreased sex drive, erectile dysfunction,

ejaculatory dysfunction, gynecomastia, and myopathy.

O

nce treatment is stopped, hair loss resumes again.

MEDICINES

C

orticosteroids injections of into the scalp can be

used to treat alopecia areata.

M

onthly basis oral pills

R

esults may take up to a month to be seen.

MEDICINES

H

ormonal modulators (oral contraceptives or

antiandrogens such as spironolactone and

flutamide) can be used for female-pattern hair

loss associated with hyperandrogenemia.

WIGS

M

ale or female patients with trauma and burn

L

ost complete scalp hair

L

ost skin over most of scalp and grafted skin

SHAVE

• Andre Agassi famous tennis player• Vin Diesel from fast and furious• Ali Azmat singer and actor• Many others

SURGERY

E

xpanders to increase hairy areas

S

calp reduction of bald areas

H

air transplants

HAIR TRANSPLANT

C

hoice of Procedure for• Androgenic alopecia• Female patchy baldness• Eyebrow reconstruction

HAIR TRANSPLANT

P

reoperative• Stop herbal medicines 3 weeks• Cessation of smoking 3 weeks before• Stop aspirin 1 week• Massage scalp• Start topical Minoxidil• Photography• Consent

HAIR TRANSPLANT

S

afe Donor Area

HAIR TRANSPLANT

M

ethods• Strip Excision• Follicle Unit Extraction

HAIR TRANSPLANT

S

trip Method

HAIR TRANSPLANT

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tart with• Trim donor area• Oral Antibiotic• Anxiolytic Diazepam• Markings on the recipient site• Position the patient

HAIR TRANSPLANT

P

osition the patient• Prone during strip taking• Sitting in a hair transplant chair in rest of

procedure

HAIR TRANSPLANT

M

arkings• Take care of male pattern of hair• Do not shorten the forehead• Randomize the frontal line with

triangles for natural look

HAIR TRANSPLANT

• Marking should be zigzag• Appropriate sized forehead• Take care of fronto-parietal angles• Discuss with patient

HAIR TRANSPLANT

S

teps• Take the strip• Silvering•Dissection to individual hair

HAIR TRANSPLANT

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aking the strip• Povidone-iodine application• Local Anesthesia • Epinephrine injections infiltration• Start incision in safe donor area

HAIR TRANSPLANT

HAIR TRANSPLANT

HAIR TRANSPLANT

HAIR TRANSPLANT

I

t is a team approach

A

good team will start with strip

A

bad team will result in loss of most of grafts and

bad results.

HAIR TRANSPLANT

S

ilvering is separating one layer of hair from the strip

HAIR TRANSPLANT

D

issection• All silvers are then subject to dissection• Graft are prepared as single double and

triplets• Loupe magnification of 6x is used• Trained team is requires

HAIR TRANSPLANT

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good graft has pear shaped has protective

dermis and no epidermis

HAIR TRANSPLANT

HAIR TRANSPLANT

In the mean while wound is closed by triecophytic closure.

HAIR TRANSPLANT

F

ollicular Unit Extraction • It is extraction of follicular units one by one

rather than taking whole stip

HAIR TRANSPLANT

F

ollicular Unit Extraction • Benefits include• Rapid• No linear scar• Less post operative pain

HAIR TRANSPLANT

F

ollicular Unit Extraction • Disadvantages• Expensive • Reduce donor area density• Patient has to shorten the hair at donor

area

HAIR TRANSPLANT

Punch is a sharp cookie cutterHave hollow needleInserted around a hair follicleAngle to minimize transection

HAIR TRANSPLANT

T

ypes of Punch includes• Manual or Mechanical• Blunt or Sharpe

B

lunt mechanical are better• Less transection• Rapid

HAIR TRANSPLANT

HAIR TRANSPLANT

A

ngles and Depth of hair follicles varies depend upon

patient and location of hair follicle

G

enerally 30 degree to 45 degrees

D

epth 4mm to 5mm

D

irection of hair must be kept in mind

HAIR TRANSPLANT

S

pecial Considerations for FUE• Only 3rd or 4th follicle should be extracted as

the density of donor area is reduced• More than 1mm extractor diameter leaves a

visible scar

HAIR TRANSPLANT

C

ombination of Strip and Follicles

Unit Extraction gives best results

M

ultiple sessions can be done

HAIR TRANSPLANT

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o apply the grafts steps are• Marking• Incisions• Placing/Transplant the graft

HAIR TRANSPLANT

• Supra orbital block is given

• Marking is done before draping

HAIR TRANSPLANT

HAIR TRANSPLANT

• Inclined incision are given• According to natural hair • Direction according to areas• All incisions made

HAIR TRANSPLANT

• Final look after all incision

HAIR TRANSPLANT

• Grafts are placed• Single in frontal area• Then multiples hair grafts• In the directions of incision• According to markings• Randomized for natural

HAIR TRANSPLANT

P

ost operative care• Dressings for one day• Soaking the scalp• Ice along neck• Shampoo after 48 hours• Gels or oil applied twice daily• Analgesics

HAIR TRANSPLANT

C

omplications at Donor area• Necrosis• Wound dehiscence• Parasthesias• Hypertrophied scar• AV fistula

HAIR TRANSPLANT

C

omplications of recipient area• Necrosis• Folliculitis• Ingrowing hair

HAIR TRANSPLANT

A

djuvant therapies• Topical Minoxidil• Finasteride oral

HAIR TRANSPLANT

HAIR TRANSPLANT

R

ecent advances• Robotics• Stem cells

THANK YOU