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Hair transplant education for prospective patients

Dr Arvind

Dr Arvind

Valued member
2 effluviums - a must read

There is Anagen effluvium and telogen effluvium.
Both of these are not classic male pattern baldness. However, it is very important to understand them.

A lot of hair loss happenings/coincidences can be explained if these 2 are understood.

First, we shall talk about telogen effluvium

Telogen effluvium (TE) In animals, hair/fur goes into synchronized telogen and are shed. This is called telogen effluvium. It occurs in humans during phases of extreme stress, malnutrition, post pregnancy or when under certain drug therapy. For telogen effluvium to occur a significant proportion of hair have to switch from anagen to telogen at the same time. The hair are shed 2 to 3 months later.
Telogen effluvium may be acute or chronic. When hair sheds persistently for more than 6 months, its termed chronic. Chronic telogen effluvium is more common in females.
Acute Telogen effluvium is seen in many infants as a band of hair loss around the occiput that occurs 2 to 3 months after birth.
In order for a large number of hairs to simultaneously switch from the anagen phase into the telogen phase, the body has to undergo some systemic injury.
There is usually a lapse of 2 to 3 months between the inciting cause and the hair shed. Therefore, it is often difficult to identify the exact cause in many cases.
Telogen effluvium is not caused by topical medications. But because there is a required time lapse of several months between the inciting cause and the excessive shedding of hair, the exact cause of the telogen effluvium is often not positively identified.

Hair shed is known to occur 2 to 4 months after pregnancy. This can be considered a classic example of telogen effluvium.

Other suspected causes of telogen effluvium include menopause, severe illness, job change, crash diets, major surgery, severe blood loss, heavy metal poisoning etc. Hyper and hypothyroidism, SLE, end stage renal disease are other reasons. Medications, including anticoagulants, anti inflammatory agents, retinoids, calcium channel blockers etc. are some known causative factors of TE.
In all cases, the common factor is some form of physiologic stress several months before the hair shed.

Diagnosis 1. Hair pull test : Hold a bunch of hair between the thumb and fingers and pull firmly. Unlike in normal conditions, where 2 to 4 hair may shed, one notices a high number of hairs coming out. Usually between 20 to 30. This test will be positive even in the scalp areas resistant to pattern hair loss, like the occiput area. At the same time, note that there are no slick bald patches like in alopecia areata.
The hair that get pulled out in the test will be club hair.
An obvious history of an inciting cause and the time frame between the physiological insult and the actual hair shed is usually sufficient to clinch the diagnosis.
A biopsy is usually not required.

Treatment. Telogen is actually a variation of a normal hair shedding process, which occurs prematurely and in a synchronized manner in TE. Therefore, there is little in way of treatment except for reassurance.
One must eliminate or treat the inciting physiologic event. Assuming there is no repeat of the physiologic insult, the hair should get replaced in 6 to 12 months.
In certain cases, telogen effluvium can coincide with early stages of Male pattern hairloss. In such cases, the hair that replace the shed hair may be miniaturized, giving the impression that the inciting physiologic event gave rise to male pattern hair loss.
Hair transplant is not recommended treatment for Telogen Effluvium.
 
P

PTA35

Member
Hey this is really nice post. Thanks for the post. You guys have provided great information. I am shocked by the photographs it proves that science can do anything.
 
Dr Arvind

Dr Arvind

Valued member
Dear forum readers,
While this is not a topic strictly dealing with hair transplant surgery, I think the medical approach is very integral to the complete treatment.

However,should medicines be prescribed compulsorily to the patients or should they be optional.

My personal belief is to inform the patient about the pros and cons of medication and then leave it to them to make their own informed decision.

I feel sad when patients tell me that they were told to take finasteride, minoxidil or certain other medication for the rest of their life after hair transplants. (Sometimes, even when they are not going for a hair transplant). Doctors should take care before making such dispensations.

Its ok if its a life threatening situation and as a doctor you tell someone that you have to take this medicine regardless for the rest of your life. In hairloss, my personal belief is that we need to tell the patients of the possible adverse effects before they make their own educated decision on whether they want to use the medications lifelong/longterm basis.

Please feel free to share your feelings on this. I, and forum readers, would welcome your input.

Regards,
Dr. A

 
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Dr Arvind

Dr Arvind

Valued member
Shockloss is probably one of the least understood topics in hair transplant.

There are actual cases of shockloss as well as incidental progression of male pattern baldness being mistaken for shockloss.

For ease of understanding, I shall divide shockloss into 2 categories:

1. Permanent shockloss
2. Temporary shockloss.

In simple terms, when the hair follicle is subjected to trauma, it may cease to grow (temporarily or permanently depending on the extent of trauma).

In older techniques, permanent shockloss was frequently observed. The reason was simple. The recipient sites were too large and often care was not taken to make them parallel and in between the pre existing hair growth. As a result, the pre existing hair follicle was transected and would not grow back.

If care is taken to make the recipient slits tiny and parallel to the pre existent hair growth, the risk of damage to the pre existent hair is greatly reduced.

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Besides these, there are numerous other reasons that may cause temporary shockloss ranging from over tumescence, excessive dosage of epinephrine, blunt instrumentation in making recipient slits, trying to transplant in between reasonably dense hair etc.
Awareness about the causes of shockloss is the single biggest way to minimize its chances.
 
Dr Arvind

Dr Arvind

Valued member
Customisation of hair transplants as per the patient requirement
Dear forum readers,
This is another often overlooked aspect of hair transplants.

One must spend time with the person and ask him/her what they want. This is one question I ask my patients and they are usually surprised.

Dr. A - What do you want?
Pt - Of course, I want hair. ;)

Dr. A - I need to know
1. what bothers you most about your hair,
2. your priorities in terms of the different areas of hairloss,
3. the sort of hairline you want
4. Depending on how much donor you have, how much do you want to use right now given your age and your family predisposition to further hairloss.

Pt - You are the doctor, I guess you are the best judge.


This is where I stop. Remember, as a hairloss sufferer and as a recipient of a hair restoration, you are the one who is going to look at the results everyday in the mirror.

To one person, the bald crown may be more bothersome while another may want a really youthful hairline even if the crown is bald or thinning.

This personal psychological aspect is something that you as a patient must communicate to your HT doctor.
Even better, see multiple results, search for a person with hairloss and hair characteristics similar to yours and the resultant transformation and point it out to your doctor that this is what you want. If it is something he feels unrealistic or not possible for you, he will say so. If not, then atleast you will look in the mirror and be able to think that ... yes, this is what I wanted (not that this is what my HT doctor thought best for me).

Regards,
Dr. A
 
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bullitnut

bullitnut

4 awesome repairs with SMG
Great points made Dr Arvind, and i would bet this happens a whole lot too where a patient does not know exactly what they want out if there surgery.
 
Bigmac

Bigmac

Administrator
Staff member
Dr Arvind wrote:
Customisation of hair transplants as per the patient requirement
Dear forum readers,
This is another often overlooked aspect of hair transplants.

One must spend time with the person and ask him/her what they want. This is one question I ask my patients and they are usually surprised.

Dr. A - What do you want?
Pt - Of course, I want hair. ;)

Dr. A - I need to know
1. what bothers you most about your hair,
2. your priorities in terms of the different areas of hairloss,
3. the sort of hairline you want
4. Depending on how much donor you have, how much do you want to use right now given your age and your family predisposition to further hairloss.

Pt - You are the doctor, I guess you are the best judge.


This is where I stop. Remember, as a hairloss sufferer and as a recipient of a hair restoration, you are the one who is going to look at the results everyday in the mirror.

To one person, the bald crown may be more bothersome while another may want a really youthful hairline even if the crown is bald or thinning.

This personal psychological aspect is something that you as a patient must communicate to your HT doctor.
Even better, see multiple results, search for a person with hairloss and hair characteristics similar to yours and the resultant transformation and point it out to your doctor that this is what you want. If it is something he feels unrealistic or not possible for you, he will say so. If not, then atleast you will look in the mirror and be able to think that ... yes, this is what I wanted (not that this is what my HT doctor thought best for me).

Regards,
Dr. A
Nice post Dr Arvind.
 
I know that the Advanced FUE hair transplant techniques(follicular Unit Extraction) is the best way to transplant the hair on the bald ares of the scalp. This is one of the effective techniques to grow the hair in a much effective way.
 
S

Samira

Member
Wow, what a great and informative thread.It's good to see all the required hair transplant information at a single place. Thanks for sharing.
 
S

soumya17

Member
Nowadays most of Men and Women are facing the problem of Baldness and Hair Loss. The people are becoming more conscious about their looks and its natural for hair loss to become a cause of worry so Hair Transplantation becomes very common in the present era. Hair Transplantation will be examine when you are facing problems such as Thinning of Hair, Occurring Bald Spots and Receding Hairline. This problem can be solve by many techniques such as FUE, FUT, PRP Therapy and Meso Therapy. Most important fact about Hair Transplantation is that its results are quick and long lasting.

Hair Transplantation contains many techniques they are :

* FUE -
FUE stands for the Follicular Unit Extraction. In this method individual hair follicles are extracted from the donors regions and implant it in the donors bald region. This hair follicle can be implant in the form of grafts and per graft contain 1 to 3 hair follicle. The Cost of FUE depends on this grafts only. This procedure is quick and painless, Local anesthesia is been used while this process and the patient will be at very ease at the time of surgery. The most important fact about this FUE is, it will not leave scars after the surgery.

* FUT -
FUT stands for the Follicular Unit Transplantation. This is a surgical process in which a strip of hair is taken from the back of the head of donor and then hair are extracted from the strip and implant it in the donors bald region. The extraction is done by using a specific tool. This is also know as the Strip Harvesting. This Strip Harvesting is a effective process for growing a natural hairline with a permanent result. This process involves the local anesthesia during the time of surgery.

* PRP :
PRP stands for the Platelets Rich Plasma. This Therapy is best for the Hair fall. Its a non surgical process, In which donor's blood samples are taken out which contain platelets, that holds strong healing components so it will be modified in such a way that its power gets multiplied to produce large quantities of the growth factors and then inject that into donors scalp. The injecting process is done through the injection or by roller. Its outcomes will stop the Hair Fall and also raise the volume of Hairs. No pain and scar will be visible.

* Meso Therapy :
Meso Therapy is one of the best remedy whose facing the problem of Hair Loss and Baldness. Its a Non surgical process and will also raise the volume of hair with the natural growth. Its a process in which multivitamins, nutrients and also proteins are inclined to the donors scalp. It will increase the number of cellulite's in the donors body. Meso Therapy has multiple uses, it can be useful for Weight Loss, Wrinkle Reduction, Alopecia, Body Sculpting. Its a painless process so the anesthesia is depend on the patients choice.
 
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J

JoeF

Valued member
Great post; spreading the good work and knowledge on hair restoration.
If deciding to undergo a hair transplant always ask the following questions:
1. What is my donor area like
2. What is the hair loss likely to look like in 5, 10, 20 and 30 years.
3. Will I have enough donor hair to cover my entire scalp, if not, what to you recommend? Now and in a few years.
4. How many hair restorations procedures will I likely require.
5. What will my density look like on my crown, middle area and hair line.
6. If unsure get multiple advice until you are fully confident and getting true advise.

These are always important questions to ask in planning to get the best hair restoration procedure and to always have satisfied patients.
Let's give knowledge to patients and show how great hair restoration can be upon getting proper advise and know the result you will achieve.
 
R

radio_nowhere

member
This is one beast of a thread haha! Gonna take a few hours at least to go through all the info! I'm losing a LOT of hair but i'm not sure if it is enough to warrant going under a knife or not. I'll read this first and then see! Thanks Doc. Arvind.
 
Dr Arvind

Dr Arvind

Valued member
Dear readers and soumya17,

I suggest you start an independent thread for what you are saying...and especially if you are a doctor or working for a HT clinic.

Putting this false information regarding benefits of prp and mesotherapy on this thread can be misleading.

So, for the record readers,
I have not come across ANY convincing study or research that proves prp or mesotherapy will stop hairfall and increase hair volume. Many people may mislead hairloss sufferers in this way.

Google it - prp was first used in dentistry and orthopedic surgeries because it showed better healing in the suture wounds.

Period.

Regards,
Dr. A

P.S. - this is another myth like years ago when readers read claims that transplanted body hair take on scalp hair characteristics. No, they do not.


soumya17 wrote:
This problem can be solve by many techniques such as FUE, FUT, PRP Therapy and Meso Therapy.

* PRP :
PRP stands for the Platelets Rich Plasma. This Therapy is best for the Hair fall. Its outcomes will stop the Hair Fall and also raise the volume of Hairs. No pain and scar will be visible.

* Meso Therapy :
Meso Therapy is one of the best remedy whose facing the problem of Hair Loss and Baldness. Its a Non surgical process and will also raise the volume of hair with the natural growth.
 
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