Dr. Bishan Mahadevia's - Latest Tips and Resources

Saturday, March 27, 2010

FUE and lateral damage

FUE Technique is sufficiently advanced now so that to avoid less trauma to not only the follicular unit to be extracted but also to the follicles around that. The strip method in fact while cutting out the strip and then while making the slivers and then cutting the individual grafts from the slivers can damage more number of grafts than done by individual follicular extraction.

1. When follicular units are extracted the cut is only made till the level of sebaceous glands and the part of the follicle below that level which is harboring stem cells and is important for the growth is not touched with knife by the techniques that we use so not only the follicle to be extracted but follicles around that are not damaged. 
2.The  lower part of the follicle is any way loosely attached  to the surrounding and easily come out without cutting.
3. More over we use tumescence ( inflate tissue with saline) this separates the follicular units from one another so that while extracting one the other does not come in the way.
4. We use smaller punches with 0.75 to 1mm diameter which which avoids the lateral trauma to the surrounding follicles check the attachment.

FUE or FUT which method is better?

There are 2 methods of Hair Transplant as per the latest evidences following are our views:
1. FUHT or Strip method ( a conventional method that requires stitches  at the back and leaves a permanent linear scar which at the back that does not make it possible to wear a short hair style and sometimes gives pain and numbness for a few weeks to few months. Healing time is longer due to a long cut at the back)

2. FUE (With recent advances this modern and stitch less method that does not leave a linear scar on the back of the head and heals faster and practically pain free post operatively. Final outcome is better). We use 0.75 to 1 mm micro punch with depth control and use Lorenzo technique for extraction.

The difference between the 2 methods is essentially in harvesting the roots from the back side of the head and the method of grafting and the final outcome of both methods in the area of hair loss (recipient area) is the same. We now strongly believe that FUE is except for the cost is superior method than the FUT (Strip method).

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Shock loss or Reactive loss or Post surgery effluvium

Shock Loss , Reactive Loss or Telogen effluvium, Shock fall out:
It is reaction to the surgery esp. that on the scalp because the scalp is stressed by surgery and some of the hairs may fall out in 2 to 12 weeks some are permanent and some can be temporary. Most likely the miniaturized hairs are likely to fall out.  This can happen mostly in recipient area but can rarely also happen in the donor area esp. in the FUT or strip method and less commonly in FUE method due to its minimally invasive nature. The Shock loss is unpredictable although factors to be considered are:

Age: young ( <30) more with active inadequate stabilization of hair loss it is common but in Older age patients with stabilized hair loss has les chances of shock loss.
Sex: male more common than female but it is more significantly visible in females
            Male more likely to be permanent in female more likely to regrow
Miniaturized hairs (i.e. the hair that is at the end of its lifespan due to genetic balding): more likely to be permanently lost unless Finasteride supported
Terminal Hairs ( Healthy) : more likely to grow back in 4-6 months
Transplanted hairs: shock loss is less common but can grow back in 4-6 months
Temporary Loss: The terminal or healthy hair shock fall out is usually tempoaray and they grow back by 4-6 m9onths
Permanent loss: usually of the miniaturized hairs or of the terminal hairs that is damaged or transected while making the incision for grafting in between the hairs.
Protection: by starting Finassteride 1mg ( or Dutaseride 0.5mg) per day at least 2 weeks before until the at least 6 months post op in males. In females Finasteride is useless and Minoxidil may be useful to some extent.
How can one minimize Shock loss:
1         by using smaller incisions for recipient area ( using smaller grafts rather than using minigrafts)
2         Limiting the depth of incisions
1.       Minimizing the adrenaline use in recipient area
2.       Reducing the packing between the existing hairs
3.       Minimizing the tension of the donor area
4.       Using Finasteride from at least 2 weeks before the procedure and for 6 months after the procedure.
5.       Spacing the 2 sessions of transplant at least 1 year apart
6.       Avoid operating on the young patients who are in the actively losing state and have high miniaturization. Put them on Finasteride & or Minoxidil for a few months before contemplating transplant.
7.       Plan to use enough FU and transplant through the highly miniaturized hairs rather than avoiding that area so that in case of shock loss of highly miniaturized hairs the area is sufficiently compensated with the healthy transplanted hairs. In areas of extensive miniaturization, it may be appropriate to transplant follicular units in the same density as one would if the area was totally bald ass the miniaturized hair may be lost by the time transplants grow.
However, regardless of the “claims” of a particular surgeon, the process is a natural response of hair follicles and the risk cannot be eliminated completely.

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