terminology

Ways of marketing and oneupmanship sometimes create very confusing terminology for the layperson and following para will help to clarify I hope 1. HT or Hair Transplant was done as Punch Graft before the 20 years but due to bad cosmetic results it is no more done. Today the Follicular Method is the Gold Standard of Hair Transplant. In the older Punch method a circular hollow punch was used to remove a cylinder of hair bearing tissue from the donor site ( which contained hair roots or Hair Follicles). This was transplanted in the bald are. But this Punch Grafts grew 10 to 25 hairs in the bunch and that gave Baby Doll appearance. Later it was discovered that the naturally hair grows from the hair "Follicle" which can be in the group of one. two ,three or four and not in 10 to 25. This natural group of Follicles is called "Follicular Unit" or the "root" . The surgeons started separating the Follicular Units and that is also called "Graft". The method that uses such Follicular Unit Grafts is called Follicular Method. There are basically 2 methods of Follicular Transplant: (1. Strip Method and 2. FUE- stitch less method) In a usual "strip method" follicles are separated after strip is harvested from your donor site (from the back of your head). The donor area is closed by an absorbable stitch and the follicular unit grafts are individually dissected from the this strip for transplant. 2nd method which is more modern is "the stitch less procedure" (FUE- Follicular Unit Extraction). This does not involve removal of strip or stitches. The Grafts are individually extracted from the scalp with micro punch blade. As it is said there are more than one ways to skin a cat so are many minor variation in technique of FUE and are given different names as follows: Follicular Unit Extraction FUE - Most common and accepted name. FOX or FX ( Bill Rassman-LA) Woods technique, TOP-UP technique (Ray wood - Sydney) DHI (Direct Hair Implantation) FIT (Follicle Isolation Technique) (Dr. John P Cole-Atlanta & N.Y.)- SAFE (Surgically Advanced Follicular Extraction)- Dr. James A Harris- ENT Denver Colorado FUSE (Follicular Unit Separation Extraction) – Dr Arvind Poswal Follicular unit micro extraction (or FUM) - Dr. Epstein (NY) During the transition from old punch method to modern Follicular method there was a phase when surgeons cut the grafts of size smalled than that of a punch graft but bigger than that of Follicular unit they were named as "Minigrafts" or "Micrografts" and "Slot Grafts" or "MUG" ( Multi Unit Grafts) or "Paired Grafts" etc.

TESTIMONIALS

Dear friend you have posed a very practical issue and here are some more recent screen shots of the mails from my patients. I hope that helps. Click on each screen shot to enlarge.

DENSITY AND RESULT OF TRANSPLANT

	Asian	Caucasian	African
Density of Follicular Unit per sq. cm/ sq. inch/ sq. m. m.	60- 80 per sq. cm or 375 -500 per sq. inch or 0.8 per Sq. m. m.	100 per sq. cm or 625 per sq. inch or 1.1 per Sq. m. m.	60 per sq. cm or 375 per sq. inch or 0.65 per Sq. m. m.
Hair per per sq. cm/ sq. inch/sq. m. m.	120 – 160 per sq. cm or 750 -1000 per sq. inch or 1.6 per Sq. m. m.	200 per sq. cm or 1250 per sq. inch or 2.2 per Sq. m. m.	120 per sq. cm or 750 per sq. inch or 1.3 per Sq. m. m.
Total hair in scalp	80000	100000	60000
Total Donor graft available	Medium due to medium density and smaller size of donor	Maximum due to higher density and larger size of donor (> 35 cm x 7.5 cm = 262 cm2)	low due to low density and smaller size of donor
Donor hair character	More thickness	Average thickness but usually skin hair contrast is less esp. with blonds and light hairs	More 3 or 4 hair follicular units and curly hairs

In the head of an average male with a hair bearing area of approximately 80 square inch area,

The more the density, the more is the movable hair the number of square inches of scalp that can be moved depends upon the looseness of the scalp (something we call Scalp Laxity). The more square inches we can safely move, the more hair we can transplant

With good decision making by the doctor, large sessions should not scar more than multiple smaller sessions but there may be a cost for aggressive decisions in large session transplantation if the doctor is not experienced in such procedures. So there is a balance between what can be done and what should be done. The real issue here is not if it can be done, but whether or not they will actually grow. Various factors affect the overall outcome of the transplant are

1. Density of the hair: A doctor can transplant as high as 50% of the original density but hair transplant is not an Olympic contest of how may grafts one can place in a sq. cm. But it is certainly an issue where you have to see that how many grafts really grow. It is important to focus more in the issues of coverage and fullness. Some studies have shown that by crowding the grafts more than 40 per square cm, blood supply may be compromised & the successful growth of these grafts starts to fall off significantly. If there is hair already present in the transplanted recipient area, there is great likelihood that it would damage the existing hair as well as obtaining poor growth. Well the area of grafting is important; the hairline needs higher visual density than the area behind it for cosmetic reasons.

2. Donor Laxity: Tight scalp restricts the harvestable number of grafts in a megasession because the width of the strip that can be removed becomes restricted.

3. Donor Area size: Assuming normal density of hair, a person with the Norwood Class 7 hair loss pattern (the worst case) will lose 70% of the total hair he was born with. This will leave him with a 3 inch by 14 inch wreath of hair around the back and sides of his head. This area is less in the Asian head due to smaller size of the head both in the hight and the length.

4. Donor Scarring: More the number of surgeries done more is the donor scarring and more is the possible loss in the scarring and therefore less is the available grafts. Therefore megasessions can harvest more number of total grafts than multiple smaller sessions which lead to multiple scars.

5. Hair shaft thickness. The coarser the hair, the better it supplies bulk. Hair bulk is a critical element in producing fullness and coverage. Coarse hair is better than fine and wavy is better than straight in giving the volume or coverage. For the same coverage given by 1000 hairs of 80 micron diameter one needs 1300 hairs of 0.7 micron and 1800 hairs of 0.6 micron and 2560 hairs of 0.5 micron diameter. A blonde with white skin, may only have to return 15% of the hair density, with coarse dark hair , you might get away with 25% of your original density, and if your hair is wavy with good thichness it may be even less. On the other hand Fair skin with thin black hair may require more number of grafts to be transferred to achieve the reasonable coverage. Oriental hair with good shaft thickness has better coverage capacity compared to thin Caucasian hairs.

6. Pre existing DUPA: For an African or Asian man under 25, a donor density of 120 per sq.cm. without “DUPA-Diffuse Un Patterned Alopecia” may make a good candidate with high quality hair, while a Caucasian with he same density having DUPA might make a very bad candidate for a hair transplant for many reasons..

7. The size of the balding area. The more bald you are, the more hair you might need. Sometimes, the goals has to be more realistic due to limited supply or a demand that is too high. One with the impaired vision aims for the best possible improvement in vision by the treatment but one with the loss of both eyes should aim of a helpful stick or a faithful leading dog. Stage 7 may have bald area of 250 sq.cm or more to give coverage to that area with average density of 30 would need 250 x 30 = 7500 grafts which need at least 2 sessions to give coverage.

8. The characteristics of your hair. African hair due to its curliness has a better coverage and volume giving capacity. The Italians and French had the best wavy hair. Straight is the most challenging, as found in many Asians.

9. Color/contrast between hair and skin color. This is critically important. A Class 6 pattern blonde person could reduce his hair population to 85% of its original density and still look full as the blonde hair and blonde skin have low contrast. The same applies to black hair and black skin, brown hair and brown hair, sandy hair and sandy skin and any skin color with white hair. Salt and pepper hair works very well. It difficult to achieve good result in people with white skin with black hair.

10. Length of the hair: Longer the hair the better the coverage and fullness. I normally advise the transplant candidate to keep transplanted hair long and not very short.

11. Elasticity of Recipient: Scarred or callous scalp tissue: The health of the scalp determines just how close you can place the grafts (for scalp that is atrophic and lost its infrastructure of blood vessels, glandular structures and fat; less density is often better). The reasonable upper limit of density numbers from a transplant perspective is up to100 - 120 hairs per square cm. This type of density, however, requires supple skin that still has elastic properties. Scars do not have this characteristic. Also scars have an abnormal blood supply when compared with normal skin. Much of the infrastructure and microcirculation in the vasculature is not present in scar, so transplanting very high densities may not produce good growth.

12. Skill and Ability of the surgeon and team: to transfer this number safely the size of the instruments for making sites, the skill of the surgical team at placing grafts tightly together

13. Other Characters; emerging angle, oiliness, sheen, static electricity etc.

POST OPERATIVE RECOVERY

Dear friend this is a very useful question for all those who want to undergo HT to be answered. I give you a calendar of recovery and for resuming various activities: The following table is the general guideline for the anticipated course for the average patient undergoing Hair Transplantation.

Time after HT	Progress & Recovery	Activity possible or required
Day 1 Immediately after surgery	Heavy headedness, mild headache or rarely momentary giddiness. Need some pain killer. Grafted site may ooze some blood.	Grafted and the donor site needs to be washed gently after 4 to 5 hours with baby shampoo and spray of clean water. Can comb the hair carefully with the wide toothed comb. A short walk, watching TV etc. Go to the sun with a cap on for 2-3 months Eat every thing that you like. Sleep on the back; avoid sleeping on sides or on tummy. Sit at 45 degree angle with the back and the head bent backwards. Avoid “yes” & “No” neck movements of neck. No Tobacco; smoking (healing and hair growth problems) or alcohol. Avoid hand kerchief or Bandana on the recipient. Passive sex (masturbation) is ok
Day 2	Some soreness, tightness and numbness. Need some pain killers	Hair Oil can be used ( may even help to soften the scabs) Can use ice packs for 2-3 days on forehead to avoid swelling
Day 3-4	Soreness begins to disappear. Occasional pain killers needed. Some numbness may continue Scabbing is largely gone if properly washed. Moderate redness may be present. Some swelling may appear on forehead. Hair transplant grafts should have firmly set in and humidity/sweating should not affect them	Active Sex is Ok now
1 week	Soreness is generally gone. Occasionally some numbness persists. Redness is minimal to absent. Swelling is usually gone. Scabs start separating& the hair may also fall along with the scab but the graft is taken by the body.	Can start full aerobic exercise ( walk, run, yoga etc but no sit ups, pull ups or weight lifting)
10-12 days	Grafts are now well incorporated in the body and it is ok to remove the scabs by rubbing during the bath
2 weeks	Looks and feels like a 4-day-old beard. Sutures begin to absorb. Discomfort is gone.	Hair cut, colour, style, use of relaxer or bleaching etc is possible provided the wounds are healed and the scabs are gone. Sports can be started. Concealers like Toppik can be used and Non comedogenic Sun screen lotion can be used to protect scalp Scalp massage is possible now
1 month	Transplanted hair is shed as the follicles enter a dormant phase. Knots at the ends of the absorbable sutures fall off.	Can start weight lifting, pull ups, or sit ups. Sun bathing,
3-6 Months	Transplanted hair begins to grow first as very fine hair. Any residual numbness in the donor area is generally gone.	Scalp exercise to facilitate the 2nd Hair Transplant session can be started now.
8 months	Transplanted hair becomes combable or groomable but transplant appears thin as hair continues to grow and thicken. Slight textural change in hair is occasionally present.	It may be possible now to go for 2nd session of transplant now
1 year	expect over 95% of the grafts to have grown
1-2 year	There may be additional fullness during the second year. Any textural change in hair usually returns to normal

Usual Time of Recovery and Resuming of activities:

Pain, discomfort or tightness in the donor area: 2-5 days

Swelling: Immediate swelling of anaesthesia disappears after few hours but the post operative swelling although less common these days may appear after 24 hours and usually disappears in 3-5 days

Numbness: the head lasts because of anaesthesia for few more hours after surgery but numbness above the stitches may last from 1-12 months.

Scabs: by regular cleaning usually gets cleared by 3-7 days if it is there it can be removed by rubbing during bath after 12 days

Sun Exposure of scalp is avoided for 2-3 months by use of cap/ cover or Sun block

Passive sex is possible even from day 1 and active sex after 2-3 day is Ok

Avoid smoking for 3-6 months

Walking is ok from day one

Aerobic exercise (walk, run, yoga etc but no sit ups, pull ups or weight lifting) after 1 week

Weight lifting after 1 month

Hair cut, colour, style, use of relaxer or bleaching etc is possible after 2 weeks provided the wounds are healed and the scabs are gone

Grafted hairs will fall some along with the scabs and the rest by 1 to 2 months

New hairs start growing by 3-6 months and Transplanted hair becomes combable or groomable but transplant appears thin as hair continues to grow and thicken. Slight textural change in hair is occasionally present. There may be additional fullness during the second year. Any textural change in hair usually returns to normal

MEGASESSION & HOW MANY GRAFTS CAN BE DONE IN ADAY?

Well with the evolution of Hair Transplant procedure there came more enterprising surgeons and patients who demanded more grafts in one session. In 80s and 90s where most surgeons used to offer 500 to 1000 graft every session and would ask the patient to take multiple sessions. Meaning of Mega session varies from centre to centre; but over 1000 grafts is usually considered as mega session. The limit of mega session depends on many factors:

1. Willingness of surgeon and patient
2. Well trained and well equipped team for taking the endeavour efficiently and quickly. It is well organised effort by a well experienced team only this can be delivered successfully.
3. Donor capacity or density. Every individual’s donor site I different. There are some Asians with the donor density of only 50- 60 Follicular Units per sq. cm where as there are some Caucasians with about 150 FU per sq. cm. density. So there can be vast difference in the number of harvest from the same size of area in both these individuals. Most Asian heads are shorter that the longer heads of the Caucasian and the same may be true for the height of the donor area too. So Caucasians can donate larger area of skin and therefore larger number of grafts too.
4. Donor Laxity: Well tight scalp can not mobilise large strip of skin and therefore laxity of scalp is one very important feature to determine for the mega session.

With all these factors considered there are number of times where over 4000 grafts have been grafted in a day by us.

The main benefits of the Mega session are:

1. Goals accomplished quickly

2. Fewer traumas and damage to donor hair and less donor scars considering multiple scars of smaller sessions

3. More graft harvest than multiple small sessions. Smalller sessions have higher likely damage to the donor follicles while strip removal and also dut to scarring

4. Comparatively less expensive for patient in terms of travel, surgical and off the work time.

Usually it is safe in the hands of experienced surgeon there can be some potential Downsides of Mega session:

1. Necrosis of the skin if it is done without taking in to consideration of the skin laxity.
2. Poor growth: The grafts after harvesting have to be well preserved and should be placed back in the body within 8 to 12 hours otherwise their survival rate goes down. Some times Mega session is done for dense packing of the limited recipient area. The dense packing over the 35- 40 graft per sq.cm. would lead to lower survival rate.
3. Stretched Donor scar if the donor area is closed under too much tension
4. Slightly higher Anaesthesia risk: due to larger dose of Local Anaesthetic agent is consumed in larger area and for longer period of surgery

HIGH SALT IN THE WATER

It is a common myth that salty water causes hair loss. High salt in the water of sea or bore well etc ( or for that matter even chlorine in the swimming pool water) can damage the cuticle ( a tough outer cover of the hair shaft) thereby affect the texture of the hair and may make it dry and brittle. But this water does not reach to the hair root and therefore only the hair outside the skin get affected. The growing capacity and the part of the hair that emerges from the skin does not grow abnormal But most importantly it does not lose its capacity to grow because of high salt. Well had it been so all your hair might have been affected and all that go for swim or all in your area should be bald. The hair loss you are describing is more likely to be due to Genetic and hormonal reasons ( you can make it certain by having your hair mapped for Miniaturization) Due to the stress of your work pressure in your new location this genetic hormonal effects might have aggravated.

WHAT CAN GO WRONG IN HT?

Hair transplantation does not penetrate any body cavities like skull, chest or abdomen. Hair Transplant is a skin surgery & is like taking off moles or warts. In over 550 procedures I have not seen any serious complications happening. The procedure is done under Local Anaesthesia and not general anaesthesia and therefore you are awake all the time and the any serious side effects are practically by passed.

Although the risks are very minimal and serious or long term side effects are exceedingly rare , for the consumers knowledge I have tried to collect extensive list as under:

A: Easily avoidable by a good doctor and patient:

1. Infection of the donor and transplant sites: I have never seen any serious infections as the scalp has a wonderful blood supply which prevents and protects against these infections. This occurs if the sterile techniques are not used ( e.g. disposable needles, sterilized instrumentations etc.) if poor post operative hygiene is kept.
2. Swelling in the operated site: The head may look swollen at the end of the procedure due to the anesthetic fluid in the tissue for a few hours. This gets alright by the next morning. The swelling due to the surgery is a natural reaction after 24 hours but this is usually minimal and lasts for 2-5 days. Mild Swelling after surgery is common. The swelling may work its way down to the eyes three or four days after the surgery this may frightening although it eventually goes away. Sleeping with the face down for first 3-4 days could swell your face by dependent edema- so avoid that position for 3-4 days. Sit with the head bent backwards to bypass the swelling to the back side of head instead of coming to the front. Sleeping on side would make your side swell up due due dependent edema your ear may change the position for a day or two until the swelling subsides. but the use of post-operative steroids may be helpful at reducing or eliminating swelling. Rarely delayed swelling could be due to allergic reaction to the Minoxidil application started post operatively.
3. Itching if the operated site: Seen usually during healing phase so in a way good indicator of healing. This could be due to dryness or allergy to Minoxidil application. This is also temporary symptom for a few days but can easily be taken care of by proper scalp cleaning and supplementing with hair oil or other skin emollient e.g. conditioner for the dry hair, for few days.
4. Flaking: If you do not wash your hair vigorously after 10 days of hair transplant, you will have crusting that may last for a month or more. Dry skin that may follow a hair transplant requires good skin care in terms of shampooing not just hair but also the skin underneath. For people with dry skin and hair may supplement some hair conditioner or hair oil.
5. Reaction.s to the local anesthetic: This occurs if you are sensitive/ allergic to it or if you are given over dose. Even this is exceedingly rare because the medications used like Lignocaine and Sensorcaine are intensively studied local anesthetic agents and have very high safety margin and their safe dosage are well defined. Local anesthetic toxicity can result in seizures, respiratory depression or arrest, hypotension, cardiovascular collapse or cardiac arrest. Paracetamol, aspirin, vitamins, alcohol and other such substances should be absolutely safe, but on very rare occasions, each of these can kill. When used in ‘overdose’ and untreated, these medications (including Lidocaine) can be lethal. This can although very rarely occur esp. in patients who had pre existing conditions, such as gross obesity, known cardiac disease, epilepsy, chronic obstructive pulmonary disease, and liver disease that can significantly affect anesthesia dosage and care. In all such cases most of the adverse events can be avoidable with skilled medical care
6. Mild pitting or tenting around the transplanted hair: this can be avoided by making appropriate size holes and making the appropriate size grafts. Easily avoidable by a good hair transplant surgeon.

B. Occur in spite of the best care by Doctor:

1. Wide scar: Scarring always happens when the skin is cut, but newer techniques of wound closure usually prevent that from occurring at socially detectable levels. With each successive procedure there is possibility of slightly wider scar 5% after 1st 10% after 2nd surgery and more after 3rd. More chances in dark or black people. Rarely do these scars become cosmetically significant unless one shaved his head and in that case, all such scars will be seen no matter how perfect the healing is. Wide scars can best be corrected by planting some FUE hair in the cosmetically visible area and some times hair colored tattoo in the scar helps. People with keloidal tendencies should avoid this surgery.
2. Bleeding: spotting of blood on the pillow the next morning due to some oozing from the stitch area is not uncommon for 2-4 days and is event less and one should keep the stitched area clean by twice daily shampooing for period of 10 days . Some oozing from the recipient site is usual and that requires twice daily gentle shampooing with spray bottle if possible to prevent crusting. Sudden late bleeding from the donor up to 2 weeks could be due to some strenuous activity or that from recipient area could be due to dislodged graft. This may require immediate pressure at the site of bleeding with the clean finger tip for 7 minutes by watch and once it stops you may consult your doctor.
3. Numbness or hypersensitivity above the donor area (This can happen only in strip method due to cut superficial nerves FUE does not have such a problem) or recipient site (usually temporary for 3-6 months – till the new nerve growth takes over). Massage or tapping of the hypersensitive scar help to retain the sensitivity.
4. Redness in recipient area: Generally, the redness goes away after about a week or two. This is due to what is known as "Histamine positive skin". It is the way how your body reacts to irritation with resultant vasodilitation (more blood flows through your skin). This is more common in white or fair skin and very rare in dark or black skin. The good thing is; redness will slowly fade away in few weeks. Use of steroids ointment for a few weeks will expedite this fading. Copper Peptide shampoo may help. A disguising light makeup (Couvre, Toppik or Nenogen) is also useful at times. avoid sun irritation.
5. Failure of the hair to survive the procedure or Poor hair Growth - this happens if there is improper technique or wrong case selection of Hair Transplant (alopecia areata or scarred area. Poor hair growth may be attributed to the smoking during the post operative period because out of those who had poor growth were smokers.
6. Shock loss occurs in the recipient area especially in young( below 30years and females) in first 3 months following surgery. The best way to reduce the risks for shock loss in males is the use of Finasteride 1mg to be taken orally 2-4 weeks prior to the surgery and for the subsequent few months and in females Minoxidil and Low Level Laser Therapy may help beside reassurance. Usually the miniaturized hairs of the recipient area shed and some may be lost permanently.
7. Pimples or Folliculitis or cysts: It is not uncommon to have a few pimples in the first few months as the new hairs grow in. Folliculitis or cysts in the scalp are most often caused by (1) remnants of the previous hairs that were not shed but put below the skin or (2) pieces of the sebaceous glands that are putting out sebum below the skin and collecting below the skin, or (3) grafts that were placed too deeply or piggybacked one on top of the other (4)Ingrown hairs. This is cared for by just keeping the scalp clean. Sometimes popping these pimples yourself works, or doctor can drain the cyst. Wet warm compresses will help. Steroid application may work in initial period of pimple. Sometimes these ingrown hairs have infectious which might require an antibiotic.
8. Wavy or rough transplanted hair: This although rare to see could be due to 1. poor support of sparse transplant 2. bent ir partly folded roots while transplant or 3. microscopic scars in graft is influencing the direction of hair growth and the character of the hair.This usually corrects after one hair cycle (about 3 years). As a temporary solution use of gels, mousses, and good conditioners will help to solve this problem.
9. Difference in color of transplanted hair and the native hair: Donor hair has thicker shaft and have heavier pigments due to lower exposure to sun compared to the hair on the top . As a result sometimes the native hairs may look lighter in color compared to the transplanted hair. This difference usually fade over a period due to bleaching effect of sun on the transplanted hair.
10. Delayed hair growth: On occasional cases the hairs started growing after 8 to even 12 months post operatively. The reasons for that are not accurately known. Minoxidil to increase the scalp blood supply and Laser comb may be of some help at least theoretically

So your biggest risk is in the choice of your surgeon.. Choose a surgeon with a good reputation with proper facilities, experienced staff. Lastly, choose someone with whom you feel comfortable. Do your homework, shop around, make visits to their offices for consultations and ask to see plenty of before and after photos of their previous work.

PREOPERATIVE CARE

Well following preoperative cares you should take

1. Avoid tobacco in any form for a few days before and after the surgery. Tobacco can reduce blood flow to the skin and thereby can affect you healing process adversely.can increase the bleeding during surgery
2. certain medications few days in advance e.g. Blood thinning agents like Aspirin or Anticoagulants etc. ; pain killers like Ibuprofen; medications for depression and vitamins; Local Scalp application of Minoxidil etc. These medication can at times may increase your blood loss
3. Alcohol, Tea and coffee a day before to avoid more bleeding during the procedure
4. Scalp exercise:If your scalp is tight, you can put your hands double clasped holding your skin of the back of your head and slide the skin up and down. Most people have about 1/2 inch of skin movement, those with tight scalps have less than that. With this exercise done 3-6 times a day for a few minutes at a time, your scalp laxity will go up. This in turn will allow easy closure in donor site and you can expect better donor scar.
5. Give a good shampoo wash in the morning of the procedure
6. Keep a large size cap with you when coming to clinic
7. a shirt and avoid T shirt or thermal because later need putting on from the top of the head after the procedure and that may rub with the grafted site.
8. One very important thing is to have hearty breakfast in the morning before coming to the clinic because you need stamina for 4-6 hours of procedure
9. your vehicle only if you are not going to drive back home.
10. If you have gray or white hair and are regularly coloring your hair color your donor site day before the procedure taking care that the part of the hair near the skin of the scalp get coloured well. This makes the graft dissection easy.

FUE: ADVANTAGES OVER STRIP METHOD (FUT)

FUE has following main benefits over the conventional strip method

1. Donor healing is faster 3-5 days compared to 10-15 days in strip method.
2. Practically pain free recovery due to absence of stitches
3. No linear scar in the donor area so even very short hair style can easily be worn. Strip method leaves a linear donor scar which shows up if the donor hair is short and therefore one needs to keep the donor hair long
4. Strip method at times leads to anaesthetic area just above the line of stitch for a few months. This is not seen in the FUE
5. Other fringe benefits according to me are

• Less bleeding
• Entire procedure performed by doctor & not given to technician
• For athletes or people who must resume full activity right after the procedure.
• Minimally invasive, less-traumatic and patient friendly
• Body hair Transplant is possible only by this method - so larger donor site. This is not possible by Strip Method. Even advanced stage can be treated (NH6-7) with sufficient hair by additional use of Body hair.
• For people who have had a lot of prior transplant surgery that has left bothersome scars, follicular unit extraction allows the doctor to work around the scars and select individual follicular units.
• Provides an alternative when the scalp is too tight for a strip excision
• Ideal for repairing donor scars that cannot be excised
• One can choose one hair or multi-haired graft

ARTIFICIAL HAIR - BIOFIBRE

There are 2 brands of Artificial Fibres available. Biofibre from Italy (http://www.biofibre.com) and Nedo of Japan. These are Polymer Fibres and usually supposed to be inert. They give instant visual improvement because you do not have to wait for them to grow. They also require local anesthetic and the procedure is also a surgery The down sides are :

1. They do not grow
2. They are lost by about 15% a year so there life not more than 10 years.
3. They need regular (daily) cleaning care by special cleaning agents under their protocol.
4. Monthly cleaning of their base by the doctor with special instruments to remove the deposited debris is necessary
5. They may be occasionally rejected by the body due to foreign body reaction or allergic reaction and granuloma formation



Pus formation and granuloma at the site of Artificial fibers that needed surgical removal

6. Being a foreign body and partly exposed to the exterior they are vulnerable to the infection and abscess which may require repeated Antibiotic courses. If the Antibiotics do not take care of the infection they may require surgical cut to remove it. This would leave permanent ugly scarring of your scalp.
7. Because of the above reasons some countries like USA have banned its human use.
8. They are more expensive than the Hair Transplant

I have had bad experiences and I have stopped recommending it.

AMINEXIL OR MINOXIDIL?

Well this product based on Aminexil has a credibility due to backing of company like L’Oreal. But the product is not tested according to FDA standard so no body can say that which one is better. But it is supposed to be working in the similar way as Minoxidil by increasing the the period of Hair Cycle. As for the safety also minimal data of credibility is available about Aminexil. Minoxidil is a FDA approved medication for prevention Hair Loss and has been well studied and its effects are well documented.

HAIR WEAVING,WIG & HAIR TRANSPLANT

Hair Transplant is the surgical procedure by which hair are transferred from the back of the head to the front. It is a permanent method where hair permanently grows and that can be cut coloured and styled. The hair does not require any special maintenance.

Hair weaving is a method of fixing (anchoring) the wig to your own hair. They weave your own hair in a “U” shape and with the thread the wig is tied to your own hair. This is a temporary method with lot of maintenance. It is in the long run, more expensive than the other options like hair transplant. And the expenses don't stop there. First, you will always need two hairpieces -- one that you wear and one that is being re-styled. Soon (usually in about a year to 18 months), you will need to replace both. Although human hair is used, it is constantly being dyed, brushed and permed to match your hair. After a while, just like your own hair, each hair strand breaks or becomes over-processed and the material it is attached to starts breaking down from the constant reattachment. You will also have to visit the hair centre every four to six weeks to have your hair trimmed and have the piece reattached and blended. Sweating and local hygiene is at stake and the constant burden of wig is also cumbersome. Stress on your existing hair, can cause permanent damage to your remaining hair.

A wig is a non-surgical hair addition by external hair-bearing device or cap added to existing hair or scalp to give the appearance of a fuller head of hair. Wig is known by various names like hair weaves, hair extensions, hairpieces, toupees, Hair Integration, non-surgical hair replacements and partial hair prostheses. Devices may consist of human hair, synthetic fiber or a combination of both. The device may have various bases a textile net in which hair weft can be tied or specialized polymer silicone

in which hairs fibers can be injected etc. It may be ready made or custom made.

It can be hand tied or machine made. Custom-fitted, hand-tied, human-hair wig are the best but most expensive.

All techniques use either the existing hair or the skin as anchor sites

EXISTING HAIR: Weaves (use thread)fusion (Use clips)

bonding (use double sided tape or adhesive liquids),

cabling, micro links, beading are general terms of techniques all attached to the client’s existing hair. All these techniques use the existing hair structure. TO THE SKIN: Includes adhesives such as two-sided tapes and new improved waterproof liquids. Vacuum bases- held on by suction through an air tight fitting foundation. All are used to provide more security for the active lifestyle, and they are all dependent on the growing existing hair and therefore must be reattached or tightened as the existing hair grows. (Techniques that stress your existing hair, such as weaves, can cause permanent damage if done incorrectly or on an inappropriate candidate. Even temporary clips attached too tightly can cause permanent hair loss.)

HAIR LOSS DUE TO CHANGE OF PLACE

The change of place has no relations to your hair loss. Excess mental tension due to work load may be the reason for your hair loss iitiation at the early age. There are natives of Mumbai who are bald and there are migrants in Mumbai who have good hair at much older age than you have. Your hair on the top is affected but the air at the back and the side are OK ; had it been due to Mumbai weather or water your hair on the back and side would also get affected by the that. Well pattern hair loss is due to genes and the hormones and is proven beyond doubt. Although ill health, certain medications, acute mental stress, pregnancy in women etc. can initiate this pattern hair loss at a young age.

DUPA nad DPA

Diffuse Unpatterned Alopecia (DUPA) is a condition where the hair has miniaturization (over 30%) throughout the scalp without a particular pattern to it. It is a relatively stable condition that may appear at any age. Senile alopecia in old age has similar features. DUPA in women with pattern hair loss is relatively common esp. in post menopausal cases. DUPA is believed to be, genetic and hormonal. In 50 % case it responds to Finasteride 1mg by 12 months; in slowing down its progress and in about half of male patients it get better by reversal with Finasteride. Half of patients have no effect of the medications. Using minoxidil would require a massive application to the entire scalp, it is worth trying. I also prescribe some nutrients like vitamins, minerals and amino acids. Cosmetic products like Dermmatch or Toppik alone or in combination are very useful for both DUPA and DPA and they are safe to use for regular use. The significance of this condition is that Hair Transplant in this condition may not be very satisfactory and therefore are often refused.

There is another condition called Diffuse Patterned Alopecia (DPA) is an androgenetic alopecia characterized by diffuse thinning in the front, top, and vertex of the scalp in conjunction with a stable permanent zone in male ( one can compare it with female pattern hair loss). Usual pattern loss in male is by beginning of loss in frontal or crown area and but in DPA the hair loss starts in the front, mid scalp and crown altogether. Diffuse Patterned Alopecia is usually associated with the persistence of the frontal hairline the hairline of the Norwood II or III type hair loss.