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Hair transplant has come a long way from days of Punch hair transplant in 1950’s to Follicular Unit hair transplant (FUT) , the dream of “ no visible scarring” in the donor areas now looking like a possibility. In FUE, the grafts are extracted as undivided follicular unit in two step or three step technique where the method of transplantation remains the same as in the traditional FUT.
The addition of latest automated FUE technique seeks to overcome some of the limitations in this new technique and it is now possible to achieve thousands of grafts in one day in trained hands.
In FUT, donor harvesting is done by single strip method with elliptical excision of donor, followed by suturing. The disadvantage of this method is resultant linear donor scar.
In FUE, the principle that the area of attachment of erector muscle to the follicular unit is the tightest zone. Once this is made loose and separated from the surrounding dermis, the interior segment can be extracted easily.
The main anatomical limitation of the technique is that it is not possible to identify the bulge of the hair from outside and hence the procedure is blind. Also since the hair with intact unit splay at the lower end and diverge in different directions, the process of extraction can result in a higher transection rate. The procedure is also .slow as each unit has to be pulled out slowly . However, with experience the hand eye coordination speed of the doctor, transection rate can be improved.
Hair is a skin appendage. Up to 7 – months the foetus is covered by long soft hair. Genetic and racial factors control the response of the hair to androgen hormone.
The life of a hair cycle varies up to about 3 years. Each hair grows at the rate of about 1 Cm per month and this is known as “Anagen” phase. This is followed by fairly abruptly by the “Catagen” phase stage of involution in which the end of the hair forms a club and is shed. This is followed by “Tolegen” which is known as the resting stage, during which no activity. The number of hairs which shed from the scalp each day ranges from 5 - 300. There are some 300, 000 hairs on the scalp and 1 % are in catogen at any one time and the rest are completing 3 year cycle.
Where there is a systematic illness or shock or psychological state such as pregnancy, many of the older hairs may pass into catogen. Earlier for that partialmoult of longer hairs may occur after a few years later.
This is known as telogen Effluvium the hair recovers completely within few months.
The method of extraction is different but, transplantation is the same as Fut. It is a structure-less method of hair restoration in which hair follicles are extracted from the back of the head or othere preferable sites under Local Anaesthesia with the help of micro-punches and implanted in the bald area.
The extracted graft may consist of 1 to 4 or rarely even 5 or 6 hairs.
This has many causes. Most important is physiologi sexual maturation. This is due to shortening of the Anogen and consequently in an an increase of the proportion of hairs in tologen. It is an androgen dependent. In its mildest form it is represented by Bi-temporal (Frontal either side) recess skin. This occurs in 90% of men and 80% of women. Fronto-temporal loss and thinning of the vertex occurs in 25% women by age of 50 years and 60% of men at earlier ages. The next important factor for this is the sex hormone – Testosterone.
Certain illnesses also cause the baldness including seborrhic eczema, dandruff, lichenplanus and scalp infections.
Also, scalp hair is damaged by certain cosmetic Procedures including prolonged traction permanent waving or hot combs vigorous brushing with old or poor quality nylon brushes or strong selenium-contaning Shampoos.
Certain hormonal imbalance and drugs too cause hair loss.
Congenital defects of hair shaft including pilli – tori also cause for flattened and twisted hair reflecting light unevenly.