- There is decrease in self esteem / confidence.
- Person looks 10 yrs older.
- Difficulty in appearance for job interviews and getting married.
- Reluctance to display profile picture on facebook and whatsapp etc.
- Most common cause is hereditary in 90% cases and others are 10% like dandruff , dietary deficiency (iron , protein , vitamin ) anaemia , hyper tension , side effect of long term drugs , immune deficiency (malaria , Typhoid , Dengue Fever , Cancer ).
- Excessive smoking, tobacco, alcohol.
- Improper diet, Indigestion, Constipation, Severe Mental Stress , Inadequate sleep (Insomnia ) for 6-8 hrs etc.
- Hormonal changes or imbalances -: Child birth , post menopausal , post pregnancy , PCOD
- Diseases like diabetes , Lupus , Thyroid disorder
- Hair Treatments- Hair extension , straightening (thermal or chemical ), over excessive brushing , hair coloring , excessive use of color dye.
Basically divided into 3 groups-
I.) Medical Treatments -: Oral medications , Shampoo, Oil , Tablets etc . Stem Cells Therapy , LLLT (Low Level Laser Light Therapy ), PRP ( Plasma Replacement Therapy ), Mesotherapy etc.
II.) Non – Surgical -: Artificial hairs (hair wig) , Hair Weaving (Knots ), Bonding (clips or hooks ) , Hair Fusion (Adhesives ).A patch of artificial hair is used to cover the area of baldness
III.) Surgical Treatments -: Hair Transplant
- FUT – Follicular Unit Transplant
- FUE – Follicular Unit Excision
- FUT+ FUE (Combo)
- BHT- Body Hair Transplant
- DHT – Direct Hair Transplant
Till date only 2 US – FDA drugs have been approved for hair loss as follows -:
- Minoxidyl -5% in male & 2 % in female, international recommended dose is 1 ml Bd for both male & female for 6 months to 1 year .
- Finastride 1 mg OD in males only for 6 months to 1 year usually without any side effect and 5 mg twice a week in post meno pausal female .
- LLLT (Low level laser therapy) ,PRP( Platelet rich plasma) , cyclical therapy for hair loss ( Finastride free preparation)
Ans : Hair transplant is a almost / nearly solution to baldness , a latest technique , cosmetic procedure , whereby we take a person’s own hair root from the back of the head and transfer to the front in the area of baldness, it grows just like any other natural hairs , every month they will grow, you can have a subsequent hair cut , can apply oil , comb , shampoo, color ,dye , style to your choice ,keep rough & tough , they stay for rest of your life (transplanted hair life) and not a person physical body life. and never fall , even if you clean shave them ,they will re-grow again.
Hair Transplant is a One day procedure, done under local anaesthesia, where a team of 6-8 members operate for 6-8 hour transplanting one by one hair roots from the back of scalp to the front. Throughout the procedure the client remain fully awake, talks comfortably to the doctor , listen music inside Ot ,and have a tea & lunch break in between process , and at the end of procedure ,he walks down comfortably to his home. There is no hospitalization, No dietary restriction, he takes a sound sleep at night, without pain, from the next day morning he can resume his normal work /office , there is no bed rest required.
Ans : Types of Hair Transplant – There are 4 types of hair transplant depending on the technique by which hairs are harvested .
I.) FUT – : ( Strip method , most common , gold standard method ) – An elliptical strip of hairs is harvested from the back of scalp safe zone (donor area ) which hair along with the hair roots . The strip is taken out on a very thin superficial layer of skin and the defect is closed primarily with very fine absorbable stitches which leaves a very faint scar mark .( 1-2 mm thin line ) Which will be hidden in the hairs at the back ,and by a new technique called trychophytic closure of scar, hairs will grow even through that 1mm thin line so as to camouflage the scar .
Advantages of FUT -:
- A large number of grafts can be harvested from safe donor zone in a single setting (3500-4000FUG ) depends on the donor area density to cover a Norwood Grade – VII in a single setting .
- Since the hairs are dissected in loop magnification under direct vision the rate of transaction of hair follicles is minimum (less than 1% )
II.) FUE – Minimal Invasive method, (no cut, no stitch, almost no scar , no pain) – Hair follicles are harvested from the safe donor zone of permanent hair with the help of standardised hair punches, manual or motorised (0.8mm,0.9mm,0.10mm in diameter ). The hair punch goes around the direction of hair up-to the hair root and pluck it out one by one , the defect heals spontaneously by secondary intention leaving minimal scar .
Advantages of FUE -:
- As compare to FUT, its a minimum invasive technique where relatively less skin and fat is harvested from body so the post operative comfort level of client is much more better ,the post operative pain & discomfort is minimal (practically painless )
- No stitches are applied so the client need not to come back for stitches removal .
- Selective segregation of graft due to harvesting – here we have a choice to selectively harvest FUG containing 4,3 & 2 hair as compare to 1 hair graft so that the total volume and density of transplanted hair will be more as compare to FUT for the same no. Of graft. It should be preferred in clients specially young students who routinely keep zero cut hair style as the scar is minimal and not visible.
Limitation of FUE–
- Since It a blind procedure, the hair punch goes around the direction of the hair up to the hair root and does not see the hair roots directly. so the rate of transaction of hair root is between 2-5 % even in the best of the hands .so the maximum no. of graft that can be harvested from safe donor zone scalp , depending on the donor area density is usually 3000- 5000 FUG.
- When we harvest one FUG , technically we have to leave at least 1 FUG in all 4 directions up, down, right & left only than we can harvest the nearest graft. That means we cannot harvest adjacent grafts otherwise there will be decrease in donor area density or a bald patch will be formed in donor area.
III.) BHT – Body Hair Transplant (Beard or Chest hair to scalp– Permanent Hair from body parts other than head like beard , chest , arms , legs , back , abdomen , axilla, pubic are transferred to the area of baldness by FUE .
Indications of BHT -:
- When the area of baldness is big (Grade 6,7 ) and the donor area density of scalp is less .
- When the client does not operate for FUT method and wish to get covered a big area of baldness by FUE technique in that case the maximum number of grafts from the back of scalp are harvested and the remaining are harvested from beard and chest by FUE method.
- Beard hair are used for post trauma burn scars to increase the density of scalp hair
- Chest hair are thin and finer are used to reconstruct temple triangle.
IV.) FUT + FUE Combo– Its a latest technique where a big area of baldness can be covered in a single setting with maximum hair grafts at a minimal cost using FUT + FUE thus avoiding the need for a subsequent second session. usually 3000 – 3500 FUG by FUT and remaining 1000 – 1500 by FUE
- Avoiding the need of a second setting
- Its economical , cost effective
- Upto 4000- 5000 FUG can be transplanted in a single setting .
Ans : Hair transplant is a minor OPD procedure done under local anaesthesia. In 98% of the cases usually no side effect occurs, in less than 5% cases (usually diabetics) a few side effects may occur as follows :-
- Infection (Follicilitis) – Inflamation of the hair follicles in recipient and donor area which may manifest in the form of small rashes , pustules , single or multiple accompanied with redness & itching usually in first 4-6 weeks of surgery .These are not harmful and are treated by oral and topical anti biotic & anti septic shampoo betadine surgical scrub by which they get subsided within 3-5 days .
- Swelling Forehead and face -: Its not a side effect ,but a sequel of surgery . A mild swelling may occur which usually get subsided within 5-7 days.
- Numbness or loss of sensation in donor or recipient area ( less than 5% cases ) which usually subsidized within 2-3 months of hair transplant . This is due to unavoidable transaction of superficial nerve fibres. Coconut oil massage for 10 minutes BD for 2-3 months in the donor area is advised which leads to recovery of sensation within 2-3 months.
- Dryness & itching in the recipient area -: Its a good sign of wound healing occurs in 10- 5 cases in the first 2-3 weeks of transplant , application of natural pure aloevera gel is beneficial .
Ans – Hair in scalp exist in naturally occurring units or groups of 1,2,3 or rarely 4 hair which is known as one follicular unit graft, in a coverage Indian male person usually 40-50 % FUG contain 1 hair , 30-40 % FUG contain 2 hair and remaining 10-15% FUG contain 3 or 4 hair graft.
Ans : Charges depend on the following factors.
- Area of baldness (small or big )
- Donor area density of scalp (low or high )
- Budget of the client (whether he wish to cover the whole area of baldness in single or multiple settings )
- Technique involved (FUT/FUE alone or FUT+ FUE combo , BHT )
The basic charges are as follows -:
- FUT + FUE combo for Giga session – Rs 40 / FUG
- FUT( Commonest , Gold Standard , Strip method ) – Rs 45 / FUG
- FUE ( Stitchless , practically scarless method ) – Rs 50 / FUG
- BHT ( Body Hair from beard & chest to scalp – Rs 60/ FUG
Ans : This again depends on the
a.) Donor area density of scalp,
b.) budget of the client and
c.) the technique involved . FUT/FUE alone or in Combo .
At our centre , a well equipped standardised OT and instruments ,using a latest technology (FUT+FUE combo ) we are specialist in covering a big area of baldness in a single setting (3500-5000 FUG ) which is known as giga session . If the area of baldness is big and the budget of client is limited then he can get the whole area covered in 2-3 settings . In the first setting the area on front (hair line ) and top (central tuft ) , which is most important and visible is covered with an average of 2000 FUG (b/w 1500-2500FUG ) to give a natural look after 6 months when the results are visible he can get the area at the back covered by a subsequent single setting .
Ans : Giga session is to cover a big area of baldness in a single setting by implantation, more than 3500 FUG (upto 4000-5000 FUG ) this can be done either by
I. FUT alone -: Provided donor area density is high , scalp laxicity and circumference of head is big
II. Combination of FUT + FUE -: Taking out the maximum number of grafts by FUT ( Taking maximum length & width of strip ) up to 3000-3500 FUG usually and the remaining grafts by FUE from above or below the strip from permanent hair bearing zone .
III. FUE alone -; taking maximum number of grafts from donor area scalp depending on density (3000-3500 FUG ) and the remaining via Body Hair Transplant (beard or chest hair 1000-1500 FUG ).
Ans : Following a transplant we usually give medications (shampoo, tablets, lotions ) for 6-9 months till complete hair grows . These medications act as a fertilizer which increase the quality, texture, density of the rest of the hairs and control further hairloss and strengthens the hair roots and delays the miniaturization / falling of rest of the hairs under genetic influence .
When we are covering the area of baldness by transplant then ideally , if the surrounding adjacent hairs have a lower density which are susceptible to fall in future( under genetic influence ) , then ideally these adjacent low density zone should be made dense by transplanting hair in the space between two natural adjacent hairs if the budget of the client allows, so that in future even if this genetic susceptible hairs fall then that area will not appear bald again nor does this require the second session of transplant because transplanted hairs are already present there in high density .
Following the first transplant in the front & top area if rest of the hair at back of the scalp fall then it won’t cause much problem because the transplanted hairs in front if allowed to longer will cover the area at back . If the rest of the hairs fall leading to a big area of baldness following the first setting, then you can get it covered in subsequent 2nd session of Hair Transplant.
- Stop smoking , tobacco , alcohol, anti platelet drugs (aspirin ), any other drugs for hair ,Nutritional supplements , multi vitamin tablets 7 days prior to surgery and to be stopped for 7 Days after surgery .
- If the client use hair dye / color then he need to get it done 1-2 days prior to surgery .
- Stop Gym , heavy exercise , vigorous, strenuous exercises , sports 3 days prior surgery .
- A head wash with routine anti dandruff shampoo to be done daily as a prophylaxis 7 days prior surgery and head wash with betadine surgical scrub (as an anti septic prophylaxis ) twice a day for 2 days before surgery .
- Avoid friction on the transplanted zone by avoiding wearing tight T-Shirts , Helmets , application of oil.Avoid anti platelet drugs (eco- aspirin ) for 3 days after surgery.
- Avoid very high protein diet like protein shakes for 3 months after surgery.
- Avoid gym , heavy weight lifting , strenuous exercises and sports till 3 weeks after surgery.
- Keep head end elevated by using 1-2 pillows below the head for 3 weeks of surgery.
- Plenty of fluid (water ) intake , 10-15 glass of water or 2-2.5 litres of water / day
- Fresh fruit juices consumption in abundance .
- High protein diet germinated grams , pulses(daal ) soyabean seed, milk & milk products ( curd , cheese , butter milk ), egg white , white flesh (chicken , fish , sea foods )
- Green leafy vegetables (contains multi vitamins & anti oxidants ), Amla
- Avoid fatty spicy fast foods , alcohol , tobacco , smoking .
That the volume and density of transplanted hair, the client is going to get by a hair transplant will be an APPARENT VOLUME (roughly 50% of normal volume) & APPARENT DENSITY or COSMETIC density or OPTICAL Density of hair (between 30-40, average 35 FUG /sq.cm) AND NOT the real volume or real density of natural existing hair (60-80 FUG/sq.cm).
Ans- The transplanted hairs are permanent but not immortal. Most common cause of baldness in 90 % of the cases is hereditary and genetic, since the transplanted hair roots do not contain the receptors on which the gene acts so they stay for rest of their ( hair) life.
The transplanted hairs are permanent with respect to heredity reason (90%) only but they may fall under the influence of remaining 10 % of causes like –
- Due to consumption of excessive alcohol (more than 100 ml /day), smoking or tobacco, mental stress, environmental pollution (Laptop & mobile radiation .
- Irregular diet, unhealthy diets and lifestyles, indigestion , Age related Senile degeneration.
- Severe seborrhoic dermatitis of scalp .
- If patient develops any other disease like diabetes, hyper tension, thyroid disorders or undergo procedures like angioplasty, cardiac bypass surgery etc, in this case the side effects of prolonged use of their medication may cause loss of transplanted hair.
- Immune compromise conditions like dengue, typhoid, malaria, HIV, Hepatitis B,C , Cancer etc.
There will always be a scar in the donor area of scalp irrespective of the technique (linear scar in FUT & dotted scar in FUE) which will in any case be hidden in the hairs at the back. This scar may be tender on palpation for up to 3-6 months of surgery.
If the patient keeps very short hair on the side n back of scalp around 1mm (zero cut hair) in that case FUE dotted scar will not be visible but a linear FUT scar may be visible.