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Educational topics for laymen loosing hair (by Dr. A)

Dr. A s Clinic

Dr. A s Clinic

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#21
Quoting Dr. A
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Graft estimates




Dear forum readers,
Graft estimates is another important topic for patients researching HT options for themselves.

How does the doctor give graft estimates for a patient?
The wrong way to do this is to limit the graft estimates to the number of grafts the doctor/clinic can perform e.g., I have come across Norwood 6 level of baldness patient given graft estimates of 2500 grafts at some clinic.

What is happening in this scenario?
At best, there is a miscommunication. The doctor maybe telling the patient that 2500 grafts is the total number of donor grafts he can perform for the patient. The patient on the other hand may tend to believe that 2500 grafts will give him good coverage (maybe even a full head of hair).

So for the prospective patient it is important to keep the following information in mind -

The full non balding adult scalp has average 100,000 hair follicles (or 40,000 follicular unit grafts).

The numbers may differ among different races. The blond Caucasian have higher number of total follicular unit grafts while on the other extreme are the negroid and the Oriental/fast east people.

Nevertheless, one gets a base idea.

Now, if you look in the mirror and see that half the original hair have succumbed to the effects of male pattern hairloss (hair have vanished/miniaturised); you would realize that the number of follicular units lost is approximately 20,000 (half of the original 40,000).

2500 or even 5000 follicular unit grafts are not going to return the original head of hair back to you.

What you will need to do is sit down with your doctor and devise the sort of hair restoration you plan. Depending on the HT doctor €™s philosophy and capability, he should let you know the total number of fu grafts available for transplant at his hands.
Then he will let you know what he can accomplish with the said number of grafts.

If what he can accomplish is alright with your expectations, go ahead.

Else, you will atleast be clearly in the picture and may decide that HT is not worth the trouble for you.

There is more on this topic but that for later.

P.S. - meantime, you may like to research about how much total donor fu grafts YOU have available for use.


Regards,
Dr. A
http://www.fusehair.com

Facebook @DR.AClinic
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Dr. A s Clinic

Dr. A s Clinic

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#22
Quoting Dr. A
......................................................................

BHT - the preshaving protocol

Dear forum readers,

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.

Regards,
Dr. A

http://www.fusehair.com

Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
Youtube @hairtransplantcentre
blogspot @hairrestorationeducation
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Last edited:
Dr. A s Clinic

Dr. A s Clinic

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#23
Quoting Dr. A
......................................................................

2 effluviums - a must read

Dear forum readers,

There is Anagen effluvium and telogen effluvium.
Both of these are not classic male pattern baldness. However, its very important to understand about 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 then 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 hairloss around the occiput that occurs 2 to 3 months after birth.
In order for a large number of hair 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.
A 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 bloodloss, 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 hair coming out. Usually between 20 to 30. This test will be positive even in the scalp areas resistant to pattern hairloss, 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 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.


Regards,
Dr. A
http://www.fusehair.com

Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
Youtube @hairtransplantcentre
blogspot @hairrestorationeducation
Tumblr @drarvindposwal
 
Dr. A s Clinic

Dr. A s Clinic

Valued member
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#24
Quoting Dr. A
.........................................................................

Testing for local anesthetic sensitivity




Dear forum readers,

It is a vital small detail.
In case you have not had local anesthetic ever in your life (or in recent years),a test dose of local anesthetic should be performed before the start of your procedure.
While relatively rare, Xylocaine (local anesthetic) sensitivity is something your treating doctor should watch out for.

Regards,
Dr. A
http://www.fusehair.com


Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
Youtube @hairtransplantcentre
blogspot @hairrestorationeducation
Tumblr @drarvindposwal]
 
Dr. A s Clinic

Dr. A s Clinic

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#25
Quoting Dr. A
.........................................................................

Recipient slits - pre prepared v/s stick and place

Dear forum readers,
This is a topic that is not discussed often. But I feel that it merits attention.



There are 2 basic ways of making the recipient slits.
  1. Make all of them at one go, before transplanting the grafts (pre prepared)[/*]
  2. Make one slit at a time and simultaneously place the graft into the slit. Then proceed to make the next slit and so on €¦ (stick and place method)

    I personally prefer the first.
    Reasons[/*]
  3. All the slits are made at one go keeping in mind the angulations and densities, by the doctor (in pre prepared method).[/*]
In stick and place method, there is a wide time interval between making the complete slits during which the directions, angles etc. could vary
  1. In stick and place method, (unless the procedure is a very small one),the recipient slits would be made by more then one person. That could lead to a difference in aesthetics in the final result.
    [/*]
  2. In stick and place method, there is a very real possibility of graft popping out from the previous slit when a new slit is made adjacent to it.
    Leading to avoidable graft trauma.[/*]
  3. To avoid this popping out the graft placer may make the recipient slits further apart, leading to a low density transplant
    €” €” €” €” €” €” €” €” €” €” €” €” €” €”
    In view of the above, I prefer that all the recipient slits be made at one go and do not advise the stick and place method.
    [/*]
Regards,
Dr. A
http://www.fusehair.com

Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
Youtube @hairtransplantcentre
blogspot @hairrestorationeducation
Tumblr @drarvindposwal
 
Dr. A s Clinic

Dr. A s Clinic

Valued member
Likes
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#26
Quoting Dr. A
.........................................................................

Trimming of grafts v/s placing them direct

Dear forum readers,

This is another interesting topic.

Once the grafts are extracted, should they be implanted as such or should the excess tissue be trimmed. This is even more important for the grafts extracted by the fue method.

In my opinion, and experience, it would be very bad if the grafts were not trimmed of excess tissue.

The reason is very simple. In older times, recipient holes were made. Nowadays we make recipient slits . There is a crucial difference between the two. When making a hole, tissue is taken out (much like digging a pit in ground). When making a slit, no tissue is taken out (somewhat like an injection needle going in and coming out).

So, when a recipient slit is made and filled with an untrimmed graft, one is putting in excess tissue which may likely lead to cobblestone appearance (you are stuffing up a hole that does not exist).
One needs to put in the bare necessary minimum to acheive the most aesthetic result.

So, in my personal opinion, if someone says that their USP is that they are just extracting the grafts and placing them into recipient slits without touching or trimming them under magnification, they are not only doing less work, they are making a virtue of their lethargy.

Remember, we are not transplanting skin .
When transplanting follicular unit grafts into slits, its our duty to transplant the follicular unit alone, with bare minimum excess baggage.

Regards,
Dr. A
http://www.fusehair.com

Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
Youtube @hairtransplantcentre
blogspot @hairrestorationeducation
Tumblr @drarvindposwal
 
Dr. A s Clinic

Dr. A s Clinic

Valued member
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#27
Quoting Dr. A
.........................................................................

Hair transplant training for doctors

Dear forum readers,

Who are the doctors that get formal and comprehensive training in hair transplant?
None.
When we need surgery for eye, we search for eye surgeons. Doctors that are formally trained in the field of eye surgery. It is taken for granted that only trained eye surgeons would perform eye surgery.

Similarly, it is assumed, mistakenly, that only doctors formally trained in hair transplant would offer hair transplant.

Any doctor, from any field of medicine, can offer hair transplants.
—————————————————————————
Where can doctors get formal and comprehensive training in Hair transplant?

In no medical college. In no medical speciality.

If modern hair transplant methods were routinely practiced and training offered in medical colleges and the hospitals affiliated to them, we would see patients going to those institutions for their hair transplants.
————————————————————————–
Combination of the above two factors is partly responsible for the majority of bad hair transplants we continue to see today.
It is a sad but true state of affair that we hope to rectify. But for now, it is important for the prospective patient to be aware of these facts and understand the true reason why it is so important to do their research prior to getting a hair transplant done.

Regards,
Dr. A
www.fusehair.com

Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
Youtube @hairtransplantcentre
blogspot @hairrestorationeducation
Tumblr @drarvindposwal