Hair Transplant and Restoration - Hair Transplantation involves removing small pieces of hair-bearing scalp grafts from a donor site and relocating to a bald or thinning area.
The Truth about hair loss Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff and even excessive hat-wearing. All of these theories has been disproved.
It’s also untrue that hair loss can be determined by looking at your maternal grandfather or that 40-years-old men who haven’t lost their hair will never lose it. Hair loss is primarily caused by a combination of:
-Aging/A change in hormones/ Family history of baldness.
As a rule, the earlier hair loss begins, the more server the baldness will become. Hair loss can also can caused by burns or trauma, in which case hair replacement surgery is considered a reconstructive treatment, and may be covered by health insurance.
In FUHT [Follicular Unit Hair Transplant), a strip of hair bearing scalp is extracted from the donor area. The strip varies between 1cm to 1.5cm in width. The strip incision is then closed by dissolvable sutures or surgical staples as shown in the following picture. The sutures will dissolve and do not have to be removed. The strip is then dissected into individual follicular unit grafts.
FUE doesn’t leave a linear scare, it may be appropriate for patients who want to wear their hair very short. It is also an advantage for those involved in very strenuous activities, such as professional athletes, who must resume these activities very soon after their procedure.
The technique is also useful for those who have healed poorly from traditional strip harvesting or who have a very tight scalp. FUE also allows the surgeon to potentially remove hair from parts of the body other than the donor scalp, such as the beard or trunk, although there are many limitations with the process.
Possibly the most straight- forward application of this technique is to camouflage a linear donor scar from a prior hair transplant procedure. In this technique, a small amount of hair is extracted from the area around a linear donor scar and then placed directly into it.
Some patients desire FUE simply because they heard that FUE is less invasive than FUT or is non-surgical. The reality is that both procedures involve surgery and in both cases the depth of the incisions (i.e. into the fat layer right below the hair follicles) is the same. The difference is in the type of incision made. In FUE there are multiple round incisions scattered diffusely through the donor area and in FUT there is one single, long incisions in the middle of the donor area. FUE should be chosen if the multiple round incisions are preferred and not because the technique is “non-surgical”.
Superior FUE Technique
Superior FUE is an improvement over FUE. Superior FUE is the safest technique for extracting individual follicular units (FU’s) under direct visual control for hair grafting into bald/balding areas of skin. Superior FUE has been extensively used in treating patients with varying degrees of baldness.
Differences between Superior FUE and FUE:
The most important difference is the use of the needle for performing the separation of the hair follicle from its dermal attachments.
With traditional FUE, the punch is used to cut the dermis to a level where the hair roots are not damaged, but the FU can still be pulled out. However, the punch often goes deeper than required and hair roots get damaged. The reason for punch damage with FUE is due to:
Hairs emerging at a very acute angle to the skin while the cutting circumference of the punch is flat. So, when a flat punch follows the line of the hair shaft, it cuts the skin to different extents on different sides of the hair shaft. If one remains just within the permissible depth on the lower side of the hair shaft, i.e. just to the level of reticular dermis, the dermal attachments on the upper side are too thick for the FU to be easily pulled out. Therefore, the FU (follicular unit) breaks or cannot be extracted. If, on the other hand, one goes deeper, to reduce the dermal attachments on the upper side, the punch usually cuts one of the hair roots of the FU on the lower side. Therefore, the FU is damaged to some extent.
Distortion of the FU structure: When one presses on the skin with the punch, the skin sinks. As a result, hair roots of the FU get splayed/spread apart. This leads to an increased chance of damage to the hair roots as the punch cuts downwards.
It is because of these reasons that most ht surgeons maintain that traditional FUE leads to significant hair root damage.
The FUSE punch goes less deeper than what would normally be considered safe with FUE extractions. The skin depth which is not cut using the punch is what we call the safety margin. The safety margin is deduced by titration in the initial few graft extractions. While inserting the punch, care is taken to visualize that the LOWER side of the punch goes to the mid dermis level only (irrespective of the fact that the upper side of the punch remains in upper dermis). The remainder of the FU micro dissection & extraction is done by needle under direct magnified visualization and mild traction.
Liberally infiltrating the dermis with normal saline helps in reducing the distortion of the FU due to pressure of the punch (i.e. when the punch presses down, the skin does not sink too much).
In traditional FUE methods, only those limited patients with the following qualities get favourable results without unacceptable levels of hair root transections.
Compact FUs without too much and too early a spread of the hair roots FUs consisting of mostly straight hair, Comparatively weak dermal attachments
Benefits of Superior FUE:
- The needle based dissection is given more importance than the use of punch. It is not sufficient that the needle be used occasionally to separate a particularly tenacious FU. Rather, the needle is deliberately and regularly used for the final in vivo dissection of the dermal attachments of the FUs.
- Mild traction is exerted on the follicular unit, before using the needle, which brings the hair roots closer together. This further reduces the chance of hair root transection.
Thus, Superior FUE provides a much safer method of extracting FUs compared to traditional FUE methods. Numerous respected hair transplant surgeons have valid doubts about FUE leading to increased hair root transaction. They are entirely justified in that respect. But the way forward is not to stop our attempts of individual follicular unit extraction but rather to improve techniques so that hair root transections are limited to negligible levels.