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Hair transplant education for prospective patients - Hair Transplant-Hair Restoration Topics - Hair Transplant section - Hairloss Experiences Hairloss Forum  Rating:  Rating
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 Posted: Wed Aug 25th, 2010 04:13 pm
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Dr Arvind
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Dear forum readers,
I find that the forum is sometimes divided between people who have extensive knowledge about transplants v/s others (many, I suspect lurkers), with limited information.

I hope, with your help, to compile a basic knowledge database for new readers.

It should be simple to grasp, logical and something the people can carry in their mind when they go for a consult/research.

-------------------------------------------------------

For sake of simplicity, I shall divide it into
1. The science behind hair transplant
2. The mathematics behind hair graft estimates
3. The art behind hair transplants
4. The pitfalls and some litmus tests before going for a transplant

Active participation from veterans as well as new readers will be most welcome.
Do not hesitate to voice your enquiries but do keep in mind that this thread is devoted to compiling a basic database, not specific philosophies of different good HT doctors (who may all be correct in their contrary views).

Regards,
Dr. A



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 Posted: Wed Aug 25th, 2010 04:15 pm
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Dr Arvind
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This section shall include the basic definitions in easy to understand language.
Please feel free to add or question.

1. Hair Transplant - The surgical relocation of hair roots from one part of the body to the other. Usually, the hair roots to be transplanted are taken from areas of the scalp/body that retain hair growth till ripe old age.

2. Follicular units - Hair grows in form of groups of 1, 2, 3 or 4 hair follicles. This group alongwith its sebaceous gland is called a follicular unit (also referred to as a pilo sebaceous unit)
The picture below shows the hairof the scalp buzzcut. On close inspection, you can see the groupings/follicular units.



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 Posted: Wed Aug 25th, 2010 04:20 pm
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Dr Arvind
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Types of modern hair transplants - 2 main type of hair transplants are considered the accepted standard at present.
The difference between both has to do with the method of extraction of the donor hair.
a). The strip FUHT/FUT method - This involves taking a hair bearing strip of scalp skin from the donor area. The resultant wound is closed with sutures or staples
b). The stitchless FUSE/fue method - Hair follicular units are extracted individually in a random manner

Pictures of the donor area immediately after extraction is shown in the pictures below
The strip FUHT donor area



The stitchless FUSE donor area (scalp)






Please note - The difference is in the extraction method only. The graft placement method is the same in both the methods. In strip FUHT, the strip is dissected into individual follicular unit grafts before placement.

For those desirous of reading more on the topic and viewing additional pictures can visit the following link
http://www.fusehair.com/node/566

Last edited on Wed Aug 25th, 2010 04:32 pm by Dr Arvind



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 Posted: Thu Aug 26th, 2010 09:03 am
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luc277
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Thank you for educating patients....

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 Posted: Thu Aug 26th, 2010 01:13 pm
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Dr Arvind
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Hair follicle v/s follicular unit graft

This is another topic that sometimes confuses the new readers.

Simply put, a follicular unit is a group of hair follicles as they grow in nature.
True! hair does not always grow as 1 hair per place.
In majority of instances, especially, in the scalp, it grows in groups of 2 or 3 hair per place. (refer picture above).
The picture below is a random example illustrating the concept of follicular units. Notice how even though the hair follicles splay as they go down, on the skin surface they grow close together in form of a unit.
Yes, right! a follicular unit.



Hair follicle per follicular unit differs in
- different races
- different areas of the body
- different areas of the scalp

However, as a basic thumbrule, for scalp, 1 follicular unit graft is atleast equal to 2 hair on average.

Therefore, if someone tries to con you by telling prices per follicle, take care and look closely. Most reputed HT doctors/clinics worldwide will always mention the fee per follicular unit graft (NOT per hair follicle).

For those desirous of seeing more detailed pictures and commentary, the following link is useful
http://www.fusehair.com/node/567

Last edited on Thu Aug 26th, 2010 01:13 pm by Dr Arvind



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 Posted: Mon Aug 30th, 2010 01:20 pm
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Dr Arvind
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Well, long time ago, before anyone had thought to differentiate the people going bald from "just balding" to "stark bald", there was this respected Dr. Tar'O Norwood.
He brought about the notion of classifying the extent of hairloss.
And believe me, he did a good job of it.
Even though most people will either -
a) feel their level of hairloss is not correctly reflected in the classification,
b) feel they are being classified in the wrong category by their HT doctors,

this classification brought about one of the first scientific steps in the field.And a reasonably accurate one.

Sorry, no pictures. A man has to do his own legwork at times.
This time I will not help you. If you want to read more about Norwood classification, go ahead, use google, and punch in the words.
When I did, I got 391,000 results.



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Results - http://www.fusehair.com/image
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 Posted: Tue Aug 31st, 2010 01:49 pm
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Dr Arvind
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Is my hairloss genetic?

This is another oft asked question.
Many people want to believe that their hairloss is due to a disease and will be reversed completely by curing the disease.

That may be the case in some. Unfortunately, not in all.

I have found an easy way to help differentiate and explain the type of hairloss is by understanding the concept of pattern hairloss .

Androgenic alopecia, or the commonest form of balding follows a pattern.
The hairloss starts in the temples, hairline and/or the crown. There will be variations, but it almost never effects the sides and the back of the scalp

Diseases usually do not follow the same pattern.

Some diseases where you may experience hairloss but which are not androgenic alopecia are -
* Alopecia areata, globalis and universalis . For further reading see this link
http://en.wikipedia.org/wiki/Alopecia_areata

* Psoriasis . Additional pictures and information is available at
http://www.fusehair.com/node/570
http://www.psoriasis.org/home/

* Hormonal imbalances (especially thyroid).

* Lichen planus. Additional information and pictures available at http://www.dermnet.org.nz/scaly/lichen-planus.html

* Post chemotherapy, or due to injury (burn, surgical or accidental)

* Trichotillomania . Additional information about this unusual condition can be found at http://en.wikipedia.org/wiki/Trichotillomania

* Traction alopecia (due to sustained and long term traction on the hair roots). Two commonest sub groups affected by this are Black women wearing tight braids and Sikh gentlemen wearing hair tightly under their turban.

There are many more rarer causes and maybe veteran readers will be able to add them to this thread. But to keep this short, I will desist. Sufficient that you get a brief idea of the types of hairloss.


A good first step is to contact your family physician as the first step. He should be able to rule out or advise tests for hairloss due to reasons other then androgenic alopecia.



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 Posted: Thu Sep 9th, 2010 03:16 pm
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Dr Arvind
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Anesthesia, bandages and the post operative look


All this means a lot for the patients. The appearance especially can have a serious impact on the planning of the vacation post HT.

Anesthesia - Hair transplant is an out patient procedure, does not require overnight admission and is performed under local anesthesia. The area to be operated upon is numbed and the patient is conscious through most of the procedure.

Bandage - This varies. There are some clinics that do not apply any bandage and others that leave the bandage on for a couple of days. My personal preference is to apply a light bandage (it usually goes around the head) overnight. The bandage can be removed by the patient himself, the next morning. There is no need for repeated bandaging.

The post operative look - Its best explained by pictures.
This link shows what the scalp looks like from just before, during, just after the hair transplant procedure as well as how it looks 7 days after.
http://www.fusehair.com/node/573



This link shows what the recipient area looks before, immediately after and then at intervals of 1 month, upto 8 months after hair transplant. Pictures courtesy of the patient available at
http://www.fusehair.com/image/tid/111


Let me know if you need additional inputs on this topic.



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http://www.fusehair.com
Results - http://www.fusehair.com/image
Videos of results - http://fusehair.com/drupal/node/631
Email - fusehair1@gmail.com
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 Posted: Sun Sep 12th, 2010 02:14 pm
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Dr Arvind
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Body hair to scalp

I meet many who have lots of body hair as well as extensive hairloss.
The question uppermost in their mind - If hair can be transplanted, why not transplants the thousands, even millions of hair some have, on their body, to the scalp and finish the problem once for all.

After having spent years researching this special field, I have found the answers that are clear when viewed from my side. But for someone to understand from the other side, it may take an effort.

Before I try to explain, just keep in mind "Nature kept it simple". Whether we understand the simple is up to us.



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Results - http://www.fusehair.com/image
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 Posted: Sun Sep 12th, 2010 03:09 pm
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Dr Arvind
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Hair, even though they look similar whether on scalp, beard or body, differ greatly in their characteristics.

A few of them that impact greatly on the coverage provided per transplanted graft are :

1. The %age of hair in active growth phase (Anagen)

2. The duration of the anagen/growth phase of the hair

3. The physical characteristics of the hair (diameter, color, curl, length etc.)

The scalp hair has the longest period of anagen (3 to 4 years) and a high %age of hair that are in anagen stage at any one time (aproximately 85%).

Compared to this, the body hair growth phase is very short (4 to 6 months) and a huge %age of the hair are often in the resting/telogen phase.

In addition, the body hair have more singles/graft, a thinner diameter, shorter length.

Thus, in most cases, they provide less coverage per graft when compared to the scalp donor hair.

-------------------------------------------------------

However, that does not mean body hair can not be used for transplant. We have often used robust body and beard hair in suitable cases.

For those desirous of reading more about body hair transplantation (including guidelines to BHT ), visit this link
http://www.fusehair.com/body_hair_transplant



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http://www.fusehair.com
Results - http://www.fusehair.com/image
Videos of results - http://fusehair.com/drupal/node/631
Email - fusehair1@gmail.com
B-104, C R Park, New Delhi, India
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 Posted: Mon Sep 20th, 2010 12:31 pm
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Dr Arvind
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Body hair to scalp

This link shows pictures comparing the hair grafts of the same person taken from scalp, body and beard donor areas.

http://www.fusehair.com/node/567





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Results - http://www.fusehair.com/image
Videos of results - http://fusehair.com/drupal/node/631
Email - fusehair1@gmail.com
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 Posted: Fri Sep 24th, 2010 12:26 pm
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ELITEJONES
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thanks for sharing...very informative post.....highly recommended..

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 Posted: Sun Sep 26th, 2010 01:01 pm
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Dr Arvind
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Lateral slits

Lateral slits is an oft misunderstood topic.
For sake of explaining, I shall classify slits into
- sagittal slits
- coronal slits, and,
- lateral slits.

Lateral slits are not necessarily sagital or coronal. Their direction is not related to the skull but to the direction of growth of the emerging hair follicular unit/ hair follicle.

But before I do, I will upload a close up picture of a non balding scalp.




At this close up, you can not and need not worry about the sagital and coronal planes.
What you see is
1. The direction of the hair follicles as they emerge from the skin.
2. The alignment of the hair in the individual follicular unit

The picture below shows
1. Lateral slits in blue and, for sake of comparison,
2. Sagital slits in red.


Please note that the lateral slits and sagital slits appear perpendicular to each other, but that may not always be the case.
For example, in the crown swirl area, where the direction of hair growth changes constantly, the direction of the lateral slits will change accordingly. The direction of the sagital slits will not.

Let me know if you have any questions/doubts.
Regards,
Dr. A

Attached Image (viewed 2975 times):

12_image205.jpg



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Results - http://www.fusehair.com/image
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 Posted: Mon Sep 27th, 2010 11:48 am
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zionaxel
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It is an interesting read, how is Zaydens repair coming along?

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 Posted: Fri Oct 1st, 2010 06:28 pm
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ELITEJONES
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wow Great work done... very helpful for those who lose hairs in early age....


source:--discountbeautydepot.com/

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 Posted: Sat Oct 2nd, 2010 03:14 pm
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Dr Arvind
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The Safe donor area for harvesting donor grafts from the scalp.
Following are some pictures that give an idea of the safe donor area.



Attached Image (viewed 1989 times):

12_image207.jpg



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Results - http://www.fusehair.com/image
Videos of results - http://fusehair.com/drupal/node/631
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 Posted: Fri Oct 8th, 2010 01:53 pm
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Dr Arvind
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zionaxel wrote: It is an interesting read, how is Zaydens repair coming along?

Dear Zionaxel,
Zayden had his third stage hair repair done recently.
Regards,
Dr. A



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http://www.fusehair.com
Results - http://www.fusehair.com/image
Videos of results - http://fusehair.com/drupal/node/631
Email - fusehair1@gmail.com
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 Posted: Fri Oct 8th, 2010 02:02 pm
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Dr Arvind
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BHT

Simply put, BHT stands for Body hair to scalp transplants.
No! it does not mean transplanting scalp hair to various assorted body areas.

The idea is to use the hair growing on the body as an additional donor supply. The hope is to get rid of "donor limitation".



The first and foremost thing to remember about Body donor hair is that it is an additional donor, not an alternate donor source.

Body and beard hair have different characteristics then scalp hair.
They have different -
1. Length,
2. Calibre/diameter,
3. Curl,
4. Sheen and texture,
5. %age of hair in anagen/growth phase,
6. Duration of Anagen/growth phase,
7. Predisposition to greying, etc...

Assume that the transplanted body and beard hair will retain their original characteristics after transplant.

The doctor and the prospective patient should plan their HT based on the above.

Additional information about BHT and some case studies can be found at
http://www.fusehair.com/body_hair_transplant

We have formulated Guidelines for BHT that we advise prospective patients to follow.



Guidelines for BHT -
These guidelines are based on our follow up observations in patients.

1. Preshave the body donor areas 3 to 5 days before the extraction. It is a simple step and very helpful to pinpoint the actively growing hair that need to be used.

2. Use only the body donor hair in active growing phase for purpose of transplant. Do not use telogen hair.

3. Assume the transplanted body hair will retain their original characteristics (length, calibre, color, predisposition to greying, curl, anagen/telogen %ages and hair growth cycles).

4. Factor in the impact of growth cycles and characteristics of the body donor hair proposed to be transplanted.

5. Mix the various body as well as scalp donor hair in any particular area of scalp.

Regards,
Dr. A



____________________
http://www.fusehair.com
Results - http://www.fusehair.com/image
Videos of results - http://fusehair.com/drupal/node/631
Email - fusehair1@gmail.com
B-104, C R Park, New Delhi, India
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 Posted: Fri Oct 8th, 2010 03:10 pm
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Dr Arvind
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BHT - the preshaving protocol

A larger %age of hair follicles are in resting/non growing phase on the body donor areas.

It is advisable to use only the actively growing hair for transplant.

Preshaving the body donor areas is a simple, non invasive method to locate the actively growing hair.

Please note - The body donor areas should be wet shaved with a razor (trimming with a hair trimmer alone will not suffice), 3 to 5 days before the procedure.

If you have very dense and long hair growth, you may first buzz cut the hair with a trimmer, followed by shaving the hair flush with the skin using a razor.

The duration of the anagen/telogen phase plays an important part overall, while the %age of hair in telogen gains increasing importance with each passing hair cycle.

Talking of durations -
Following is an extract


--------------------------------------
Hair Growth Tables
There are many factors that affect individual hair growth. These growth tables should only be used as a very generalized guide.

Telogen (%) Anagen (%) Duration of Activity

Scalp 15/ 85/ 2-6 years
Eye Brows 90/ 10/ 4 - 8 weeks
Cheeks 40 - 50/ 50 - 60/
Beard (Chin) 40/ 60/ 1 year
Moustache 45/ 55/ 16 weeks
Arm Pit 70/ 30/ 16 weeks
Pubic Area 70/ 30/ months
Arms 80/ 20/ 13 weeks
Legs & Thighs 80/ 20/ 16 weeks

Carl W. Bushong, Ph.D., LMFT
Richard A. Martin, Jr., M.D., FACEP
Kimberly L. Westwood, CPE, CCE
et al.

--------------------------------------

While the scalp donor hair have a growth phase of, an average, 3 years, most body hair have a growth phase lasting approximately 4 to 5 months.


Therefore, unlike scalp to scalp transplants, BHTs will show a marked cyclic variation.

Also while 85% of the scalp hair are in growth phase at any particular time, 40 to 80% of the body hair may be in telogen (non growth phase).

Thus, the significance of the Preshaving protocol.



____________________
http://www.fusehair.com
Results - http://www.fusehair.com/image
Videos of results - http://fusehair.com/drupal/node/631
Email - fusehair1@gmail.com
B-104, C R Park, New Delhi, India
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 Posted: Sun Oct 10th, 2010 10:45 pm
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JJ09
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Great post Dr Arvind, is it known if hair, scalp or otherwise retains its original growth cycle when transplanted…for example, if a follicle was extracted with 9 months of growth left in its cycle, will this time frame continue once transplanted and the dormant phase is over?
 
In regards to the telogen phase of a particular hair, is it known how long this may be?



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