Transplant Hair The complete Guide - Alliance 4 hair
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Hair
Transplant
The complete Guide
Methods
Cost
Clinics
Alternatives
Alliance4Hair (alliance4hair.com) is a cooperation of leading forums and patient plat-
forms dedicated to providing independent information for people with hair loss. In addi-
tion to the classical treatment with medication and alternative options, the topic of Hair Transplant
hair transplantation is also a major focus, because in many cases a permanent im-
provement of the optical appearance can be achieved.
Other alternatives such as micropigmentation (SMP) will also be presented in order to
The complete Guide
provide the entire spectrum of possibilities.
This range of options enables the patient to make an optimal decision. Because against Methods - Cost - Clinics - Alternatives
the background of one’s own wishes, the degree of hair loss, the financial possibilities
but also the circumstances of life, there are quite different approaches to a solution
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Alliance4Hair In cooperation with
Published by leading European Web Forums in cooperation with
acknowledged medical specialists
Independent Advice for surgery with no problems
Editor: Dr. Ludger Mentrup
Contact: info@alliance4hair.com
Publisher
ASCONEX medizinischer Fachverlag | Andreas Städtgen
Kapellenstr. 18, 65606 Villmar,
Telefon: +49 (0)6482 94904-55
E-mail: AS@asconex.de
2 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 3
Authors 6 Hair Transplantation on Vertex Area 68
Introduction 8 PRP - Alternative & Complementary Option 69
Alopecia 10 SMP: Alternative Option to Surgery 71
HOW HAIR WORKS AND CAUSES OF HAIRLOSS 11 SMP and Tattoo 71
Acute alopecia 13 The possible Tricopigmentation Treatments 73
Androgenetic alopecia 13 Tricopigmentation as part of the Fight against Hair Loss 74
Alopecia Areata 14 The Importance of adrressing to specialists of the Field 75
Cicatricial alopecia 16 Tricopigmentation and FUE, The Right Strategy 76
Medical Treatments for Hair Loss 17 Tricopigmentation Into Scar 77
Finasteride 17 Different Kinds of Scars to cover up 77
Dutasteride 18
Topical Minoxidil 18 Concealer 78
Spironolactone 18
Topical Prostaglandin 19 Practical Info - Find a clinic and consultation 80
Herbal Treatment 20
Searching for a clinic 80
Skin Diseases and Hair Loss 20 Consultation 83
Seborrhoic Excema 21 Expectations and Relation to Doctor - Psychology of Hair Loss 84
Psoriasis 22 Side Effects after the Hair Transplant 86
Lichen Planus 23 Aftercare Instructions 88
Lichen Planopilaris 24 post-operative SKIN-care 89
Swimming in water after hair transplant 91
Hair Transplant Planning 25 Waiting for the result 92
Status of Hairloss (Norwood) 26
The safe and safer donor area 28 Clinic Profiles 95
Donor reserve 29
Coverage Value 30
Automated Analysis with Ke-Bot 31
Hairline Design 32
FUT (Strip) Method 34
Concept of FUE and FUT 34
Follicular Unit Transplant -FUT 35
Opinion: Follicular Unit Transplantation or Follicular Unit Excision: Planning and
Decision-Making: 36
Opinion: Why opt for a Follicular Unit Transplant ? 46
What are the limits of these techniques ? 47
FUE Follicular Unit Extraction 48
FUE Technology 49
Basic FUE Devices - Insertion 53
FUE “Automatisation “ 55
FUE Stick & Place Technique 57
FUE KEEP Placer 59
Special Hair Surgery Applications 60
Facial Hair Transplant 60
Body Hair Transplant 62
Hair Transplant in Women 65
EyeLashes 66
4 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 5
AUTHORS
Raif Umut AYOĞLU, Dr. Özlem Bicer Marc Costin Milena Lardi Dr Pauline McCluskey Dr. Raphaël Meyer
Dr. Raif Umut graduated from Since 2004 she is working on Product developer & managing Milena Lardì is the Tricopig- Dr Pauline is an Irish FUE spe- LDirecteur Médical à la Clin-
Ankara University Faculty of hair treatments and hair trans- partner, Hairclinics mentation Technical Director cialist, working at The Glas-
plantations with all knowledge and trainer of the Beauty Med- ique de la Croix d’Or, Genève
Medicine in 2000. He began his gow Clinic, in Scotland. She Chirurgien Capillaire – My Hair
and love in order to turn this de- ical system. This system has prides herself on natural hair-
Cardiovascular Surgery training sire of our patients into reality. Managing director Sem- already obtained the approval Medical (Lyon, France)
and completed in 2007. In his 10 She is using all the latest in traMedo of both doctors and surgeons line design and lifetime donor Médecin Esthétique et
years as a Cardiovascular Sur- technology and without com- as a complementary or alter- management. She believes Lasériste (Lyon, France)
geon, he was the Chief Surgeon promising from health and native technique to surgery or good quality information is es- Ancien Chef de Clinique du
of the Institute for 5 years. He complying with law and ethics to pharmacological treatment sential for patients to make Centre Hospitalier Saint-Luc
completed his hair transplant R&D on scalp pigmentation informed decisions, and is St-Joseph (Lyon, France)
surgery training and began to began in 2005 thanks to Italian happy to provide virtual con-
and international partners. Ancien Externe et Interne des
perform FUE since 2017. He is a sultations via WhatsApp. Hôpitaux de Lyon (France)
member of FUE Europe
Dr. Ekrecm Civas Dr. Jean Devroye Dr. Bijan Feriduni Dr. Arslan Musbeh Dr. Patrick Mwamba Dr. Tayfun Oguzoglu
Dr. Ekrem Civas graduated in Since 2000, Dr Devroye has Dr. Feriduni is an internation- Dr. Arslan Musbeh has been In 2000 he first met Dr. Cole and Dr. Tayfun Oguzoglu started
Medicine 1993. In 1999, he com- specialised exclusively in hair ally recognised physician in performing hair transplant started hair transplant. In 2006 hair transplantation 1997 in Is-
pleted residency in dermatol- restoration. He developed the field of hair and eyelash surgeries for more than 16 Dr. Mwamba opened his own tanbul, at first FUT. He started
ogy and opened in 2003 his years. He uses different clinic, WHTC, in Brussels. He FUE in 2003 and motorized
own office in Gaziosmanpasa / this passion in the late transplantation and cosmetic
Ankara in hair diseases &hair 1990s, when he decided to and reconstructive surgery. methods such as FUE, DHI offers methods like Follicular Iso- FUE in 2007. He is a American
transplantation. He trained in go to the United States in Member of American Hair and Sapphire FUE. He per- lation Technique (FIT), Follicular Board of Hair Restoration
Canada and US, and worked in order to complete most of Loss Association and the forms only one patient and Unit Transplantation (FUT), Body Surgery Diplomate (ABHRS)
clinics in Poland, Sweden and his training under Dr John Coalition of Independent Hair maximum two patients as Hair Transplantation (BHT), and was granted Fellow
Spain. In 2011 he received the Cole (Atlanta, USA). Restoration Physicians. He is daily average operations "Donor Restocking" and tech- (FISHRS), by ISHRS to a small
American Board certificate in number. niques for the repair of failed or number of educator doctors
hair surgery, and in 2015 was often being asked to speak at
accepted to Fellow category international conferences and unsuccessful hair transplants.
in US. workshops.
Dr. Koray Erdogan Dr. Lars Heitmann Andreas Krämer Dr. Özgür Öztan, Dr. Fares Seffen Dr. Nathan Yadun
Dr. Koray Erdogan founded in Dr. Lars Heitmann is one of Since 1998 Andreas Krämer is Dr. Özgür was graduated from Doctor Fares Seffen, a hair Dr. Nathan Yadun is passion-
2001 his own hair transplant the few hair surgeons in the one of the most important Ankara University Faculty 2000 transplant specialist in ate about hair transplanta-
clinic, and participated in nu- world who performs all steps clinic-independant patient and founded HLC Clinic Ankara in Tunisia holds the European tion and has been practicing
merous conferences. He devel- personally, without delegat- advisors. He regularly visits 2003. He created the fundamen-
oped his own unique FUE sys- Inter-University Diploma in this discipline since 2003 in
ing any surgical steps to as- many clinic and if famous for tal of Beard Hair Transplantation the Treatment of Baldness Rouen (France).
tem known as the “Sequential with the Bifurcated Needle and
Technique”. In 2016, he sistants. Exclusively manual his participation in TV (obtained at the Claude
graft removal, formation of got the patent for it. He is one of
founded World FUE Institute the few doctors who perform Bernard Lyon 2 University,
and he was elected president the recipient openings and He is specialized in hair
Stick and the Place technique in France). Dr. Seffen actively
2018 insertion of the grafts. transplant, eyebrows, beard
the world. He is the current Presi- participates several times a
dent of FUE Europe Hair Trans- and unshaven FUE
year in the various events
plant Society, an ISHRS member and workshops.
and a Membership Committee
member .
6 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 7
So be careful and don't put everything - motorised procedure) is selected
and certainly not your few remaining ◇ high-quality and modern instruments
hairs - on one card. Less is more: Don't and aids are used (yes, they really
get a lot of hair for little money, but get cost money!)
Introduction the best possible result with as little hair ◇ the OP takes place in EU or in a neigh-
as possible. bouring EU - area instead of Turkey of
Hair loss is touching millions - but with even more far away places
the development of Hair Transplant Inform yourself! Don't trust every word
Surgery new options are making it possi- from the internet, EVERY doctor will show So there are many points to consider, and
ble to reduce impact and make you look you examples of super patients. we like to help you with this extensive
younger in a few hours of surgery. publication to plan your surgery in the
Clarify your goals: best possible way.
But be careful - Hair is not replaceable by
today's standards, so think carefully be- Nothing against a hairline like at 16 years So one of our targets is to inform you
fore you make a decision. Think also - but keep thinking: How do you want to complete and showing all different op-
about alternatives / additions: look in 5 / 10 or more years ? Are there re- tions. So we assembled a highly acknowl-
serves? edged group of specialists, which take
◇ short hairstyle over sections of their specific compe-
◇ loose hair What are your wishes? tence.
◇ Scalp pigmentation (trico-pigmenta-
tion) ◇ Hairline
We like to thank them all for their support
◇ Density
!
◇ Budget
◇ Language Options The Team of Alliance4Hair
If your money is not enough - wait a little
instead of making a mistake with a "bar-
gain"!
Price differences:
There is a wide price range from 0.50
cents to 5 EUR per graft (and more). Ev-
erybody likes to save, but here "Tata" is
compared to Mercedes.
It always gets more expensive when
◇ the surgeon works carefully and takes
his time (which is usually good for the
◇ Sensible medication hair follicles and the result) 1,000 folli-
cles per day or even in 30 minutes, de-
Also be sceptical to heavy advertising. pending on the technology, are realis-
Man is a biological object, and biology tic values and are reflected in the
does not give any guarantees. "Guaran- price
tee" of whatever kind won´t help you if ◇ the operation is performed by a doctor
there is a problem with your surgery, the (not an assistant)
hair is simply gone and can´t be replaced! ◇ the manual FUE (instead of FUT or
8 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 9
The diagnosis of this loss requires a con- HOW HAIR WORKS AND CAUSES OF any given time. This phase lasts about 3
sultation and sometimes an examination HAIRLOSS weeks.
called "trichogram" (some hairs are taken
from different areas of the scalp and ob- Dr. Raphael Meyer 3) The telogen phase: Rest phase
Alopecia served under a microscope). Baldness is
WHAT IS A HAIR? The hair is dead and is going to be re-
defined as baldness when the fall is on
In dermatology, alopecia refers to the ac- the forehead, above the temples and at placed by a new hair, which when the
The hair follicle is an appendix of the skin time comes will cause its predecessor to
celeration of hair loss. Alopecia is gener- the top of the skull. Sometimes a hor- of the skull. It evolves either as down or fall out. Nearly 10% of the follicles are in
ally referred to as alopecia if this hair loss mone test is necessary in women. The re- as hair depending on several parameters this phase at any given time. This phase
exceeds 100 hairs per day over a longer sults of these tests indicate one of the including age and hormonal status. A hair lasts about 2 to 6 months.
period of time. Baldness (the condition of following problems. is an organ in its own right with a singular
a bald person) is the ultimate develop-
and complex organisation. It is to be con- HOW MANY HAIRS DO YOU HAVE ON
ment of alopecia.
sidered as a hair with its own specificities. YOUR HEAD?
USUAL AND ABNORMAL HAIR LOSS Hair has an aesthetic role, protecting the
skull as well as thermoregulation. They On average, an adult human hair has al-
A person has an average of 100,000 to are organised in follicular units (FU): a sort most 120,000 hairs, which are constantly
150,000 hairs and loses about 40 to 100 of common base for random groupings of being renewed, alternating phases of
hairs per day (permanent loss), with 1 to 4 hairs. growth, involution, resting and then fall-
peaks of up to 175 during seasonal ing out. Depending on each patient, their
changes (seasonal loss in spring and au- Follicular units are the unit of measure- age and their ethnic origin, a variable
tumn). It is during this phase that hair is ment used in hair implantology. number of hairs and therefore of UF can
most often renewed. Hair loss is consid- be observed.
HOW DOES A HAIR WORK?
ered pathological if a person loses more
than 100 hairs per day over a longer pe- HOW MUCH HAIR IS NORMALLY LOST
Hair grows irregularly and unsyn- EACH DAY?
riod of time, up to two months. chronously, in cycles (15 to 20 in a lifetime)
with phases of varying length. Every day, on average, 50 to 100 hairs fall
out physiologically.
Three phases follow one after the other:
The phases of the hair cycle WHAT ARE THE CAUSES OF HAIR LOSS?
1) The anagen phase: growth phase
The anagen phase is the hair growth phase. This is the longest period of Hair loss or alopecia affects both men
the hair cycle, which lasts 2 to 5 years. The majority of the hair on our heads Hair grows at an average rate of 1cm per and women, causing psychological and
is therefore in the anagen phase. month. Normally, 85-90% of the follicles social repercussions that vary from one
are in this phase at any given time. This patient to another, but are always nega-
The catagen phase is a resting phase lasts from 2 to 6 years. This in- tive. The main cause is androgenetic
phase in which the hair no longer tense production phase requires growth alopecia. Without being exhaustive, there
grows. It lasts about 3 weeks, factors, nutritional intake (iron, proteins, are many forms of alopecia which can be
which is significantly less than the zinc, vitamins) and hormones (oestrogens grouped into two categories: scarring
previous phase. and thyroid hormones in particular). and non-scarring.
The hair does not grow during the 2) The catagen phase: Involution, degra- 1) NON-SCARRING ALOPECIA :
telogen phase, but remains bound dation phase
to the hair follicle. At the end of this phase, the old hair falls out and gives Androgenetic alopecia :
way to a new follicle in the anagen phase, the hair cycle begins again. The hair stops growing, but remains in
place. Statistically, 2% of the follicles are - In men: it is codified in the Norwood/
in this phase at Hamilton classification
10 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 11
- In women: it is codified in the Ludwig than growing hair. This repeated pulling ACUTE ALOPECIA ANDROGENETIC ALOPECIA
classification out leads to progressive fibrosis (scar-
ring). it can be associated with chemotherapy Androgenetic alopecia is a gradual loss
Telogenous effluvium : treatment, stress, severe nutritional defi- of hair due to the influence of male hor-
Pseudopelade de Brocq : ciencies, iron deficiency, hormonal disor- mones. It usually occurs between the
It is a temporary hair loss, without minia- ders, acute radiation; localized alopecia: ages of 30 and 40, in an average of 70%
turization. Sometimes seasonal (spring, Hair loss is thought to be linked to an in- it can be caused by skin problems (tumor, of men, but in some cases it can occur as
autumn), following childbirth, trauma, flammatory process of the scalp caused burning, hair loss), radiotherapy or para- early as the age of 16. There are many
surgery, diet, high fever, or linked to a thy- by a disorder of the immune system, sites (ringworm, lichen); alopecia areata: causes of hair loss, the traditionally impli-
roid problem or to taking medication or where the scalp appears whiter and Alopecia areata appears to be of au- cated hormone being dihydrotestos-
an iron deficiency? smoother without visible follicles. toimmune origin (cellular mediation terone (or DHT). However, the scientific
mechanism), characterized by a more or community agrees that it is not the only
A sudden synchronisation of the follicles All causes of scalp scars: accident, less large "patch" involvement and at one one responsible, so epitestosterone could
in the terminal phase (telogen) is then ob- surgery, burns, radiotherapy, infection or more sites. This form of hair loss can play an important role in this process.
served. (lichen planus), inflammation, system dis- affect the entire head and is known as
ease (lupus)... total alopecia and sometimes the entire This hair loss usually begins in the tem-
Alopecia areata : ples and temples (on the front of the
body: It is Alopecia universalis, and in this
case there is no hair or hair all over the head) and in the vertex (the top of the
This is a priori an autoimmune disease,
body.. head). It is characterized by hair thinning
without the mechanism being perfectly
and loss, which can occur suddenly in
known. It can affect part of the hair, in
some individuals and more slowly in oth-
the form of bald patches, but can also
ers. The Hamilton Scale, modified by Nor-
affect the entire hair system (universal
wood, makes it possible to classify bald-
alopecia). It is a chronic pathology, diffi-
cult to treat with risks of recurrence. For-
tunately, the hair can also grow back on
its own in the long term, and this is the
case for the majority of bald patches.
Trichotillomania :
This is another cause of patchy hair loss,
linked to the compulsive pulling out of
one's own hairs and/or hair. It affects
both adults and children (often transient
in the latter), and may require psychologi-
cal help.
2) SCARRING ALOPECIA :
Alopecia by traction :
Hair loss is the consequence of too much
traction (bun, African braids, hair pulled
back too much). The hair then tends to
break and fall out, resulting in a greater
proportion of hair falling out
12 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 13
ness between 1 and 7, where 1 is the ab- ALOPECIA AREATA The most common form of this condition regardless of sex or ethnicity, and has an
sence of baldness and 7 is the maximum usually resolves on its own or with treat- overall lifetime prevalence of around 1-
alopecia (total hair loss at the gulfs and Dr. Pauline McCluskey ment, with full regrowth taking months or 2%. It more commonly affects younger
vertexes). years. However in rare cases the hair loss people (most patients get it before the
Alopecia Areata is a type of hair loss that
may be permanent, or it may develop into age of 40), and people with a family his-
It should be noted that the references typically presents as the sudden devel-
a more advanced form. tory or this or other autoimmune condi-
established by the Nordwood scale do opment of one or more coin-sized
tions.
not cover all cases. A considerable num- patches of thinning hair or baldness, usu-
ber of men are affected by alopecia simi- ally on the scalp or beard. Up to half of people with this condition
lar to that traditionally found in female may also experience pitting and ridging
Alopecia Areata is sometimes referred to
subjects and measured by the Ludwig of the nails. And the more advanced and
as 'Autoimmune Alopecia' because it is
Scale. persistent the hair loss, the more likely it
thought to be linked to an inflammatory
is to be associated with psychological
A study from 2011 shows that androge- process, whereby T cells (a type of lym-
conditions like anxiety and depression.
netic alopecia is not caused by the de- phocyte or white blood cell in the body's
crease but by the inactivation of the immune system) mistakenly attack the There is no cure for Alopecia Areata, but
stem cells contained in the hair follicle. body's own hair follicles during anagen it will usually resolve itself spontaneously
These cells do not turn into "precursor (growth) phase. within a year or two, or will improve with
Alopecia Totalis occurs where the dis-
cells" in the hair, so the follicle atrophies ease progresses to cause total hair loss treatment. Generally speaking it is less
It is also sometimes called 'spot bald-
and only microscopic hairs are produced. over the whole scalp. And Alopecia Uni- likely to regrow quickly if you get it
ness', because of the characteristic small
Thus, a bald man has the same number versalis is the name given for hair loss younger, or if it covers a larger area of
round patches of baldness it causes.
of hairs as a man without baldness, but that affects the whole scalp, face (includ- scalp.
they are not very visible due to their mi- The patches may be smooth and com- ing eyebrows and eyelashes) and the rest
croscopic size. Topical steroid treatments are available,
pletely bald, or they may contain signa- of the body (including pubic hair).`
and in severe cases an oral steroid may
ture 'exclamation mark' hairs. These hairs
be offered for a short period. Other treat-
typically appear wider and darker at the
ments that modulate the immune sys-
top (distal shaft), and thinner and lighter
Another form of the disease is known as tem may also help to control the
at the bottom where they meet the skin
Diffuse Alopecia Areata, which presents progress of the disease. Counselling may
(proximal shaft). They are short (around
as a sudden thinning of hair across the be offered to manage the psychosocial
3mm), because they are structurally
whole scalp, sometimes also rapidly turn- consequences of Alopecia Areata. And
weak and break easily.
ing grey. It is important to correctly dis- camouflage options may also be helpful,
The presence of these hairs, which can tinguish this from other conditions like particularly the use of hairpieces or wigs.
be seen either with the naked eye or by Medication-Induced Hair Loss or Telogen
Effluvium. Hair transplantation is not usually ad-
trichoscopy, strongly suggests a diagno-
vised for patients with Alopecia Areata,
sis of Alopecia Areata. In general, a
The precise cause of Alopecia Areata is because the underlying autoimmune
greater number of exclamation mark
not yet fully understood, but it is thought condition is likely to be ongoing. There-
hairs present means the disease is cur-
to be a combination of genetic and envi- fore the transplanted hair may be at-
rently more active, and that particular
ronmental influences. A number of genes tacked by the immune system and fall
area of hair loss may increase in size.
have been identified that are associated out too, and new patches may also de-
The inflammation caused by Alopecia with this disease. It can be triggered (or velop elsewhere in the scalp at any point.
Areata is generally not painful, however reactivated) by physical or psychological
some patients may feel itching, tingling stressors, such as a virus, trauma or se-
or burning sensations in affected areas. vere stress.
Alopecia Areata affects people equally
14 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 15
CICATRICIAL ALOPECIA Mix: Acne keloidalis, Acne necrotica and type determination. MEDICAL TREATMENTS
Dr. Ekrem Civas What are the causes of cicatricial How Is The Treatment In Cicatricial FOR HAIR LOSS
alopecia? Alopecia?
Scarred alopecia defines permanent hair Raif Umut AYOĞLU, MD
loss in which the hair follicles are dam- The cause of the various cicatricial The treatment is aimed at stopping the
aged and replaced by scar tissue and alopecias is not well understood. How- course of the disease and does not re- Hair plays an important role in identity,
cause permanent hair loss. The course of ever, all types of cicatricial alopecias in- gain the lost hair. The diagnosis should be self-perception, and psychosocial func-
the disease and hair loss vary. It can volve inflammation directed at the upper made early and treatment should be tioning. Hair loss can be a devastating
progress insidiously over the years with- part of the hair follicle where the stem started. As the treatment is delayed, the experience that decreases self-esteem
out symptoms, or it can watch very cells and sebaceous gland (oil gland) are scar area will increase. and feelings of personal attractiveness
quickly in months. located. If the stem cells and sebaceous while also leading to depression and anxi-
gland are destroyed, there is no possibil- Various medical treatments are given in ety.
Skin findings such as hair loss, skin rash, ity for regeneration of the hair follicle, active disease. After the stable period,
dandruff, increased or decreased pig- scar excision or hair transplantation on Although hair surgery popularity is rising,
leading to permanent hair loss.
mentation, pustules and draining sinuses the scar can be planned. medical therapy is an important part of
may occur in the affected scalp areas. It Secondary cicatricial hair loss can occur hair loss treatment. The overall goal of
is not contagious and can be seen in for various reasons. Destruction of the treatment in AGA (Androgenic Alopecia)
both men and women in all age groups. It hair follicle is incidental to a non-follicle- is to stop miniaturization and improve
has no inherited feature. directed process or external injury, such hair density. Because of the nature of the
as severe infections, burns, radiation, or pathology, nearly all medical treatments
What are the types of scarring tumors. require lifelong compliance and continu-
alopecia? ity. Conversely, for getting better results,
Who is seen more? medical therapy must be started in early
It is divided into two as hair loss due to stages of hair loss.
primary and secondary reasons. It can be seen in both sexes and all ages.
There is no scientific study on the inci- Male and female hair loss pathology is
In primary scarring type, hair follicles are dence. There are scientific studies show- slightly different. That is why medical
directly affected by the disease and are ing that it is familial. treatment choices can be different in
lost permanently; It provides indirect de- gender.
struction of hair follicles due to reasons Are There Diseases Associated With Ci-
such as accident, trauma, radiation and catricial Alopecia? Finasteride
infection in secondary scarring hair loss.
It is usually alone, there is no other con- Oral
Primary cicatricial alopecia; It is divided comitant disease, otherwise it is seen in
into three types as lymphocytic, neu- healthy men and women. Oral Finasteride is one of the two drugs
trophilic and mixed. which is FDA approved for the treatment
How Is Cicatricial Hair Loss of androgenic alopecia (AGA). It inhibits
Lymphocytic: Chronic cutaneous lupus Diagnosed? 5-α Reductase (5AR) type 2 enzyme
erythematosus, lichen pilanopilaris, which turns testeron to Dihidrotestes-
frontal fibrosing alopecia, graham little The patient's story is important. How did teron (DHT). Suggested dose is 1 mg/day.
syndrome, classical pseudopelad, central it start, was itching and rash accompa-
centrifugal cicatricial alopecia, alopecia nied, is there a history of trauma or acci- Finasteride increases hair count, hair
mucinosis, keratosis follicularis spinulosa dent. It is diagnosed by the dermato- thickness, and length. Effect on hair
decalvans scopic examination of the patient by the count is greatest on the vertex scalp,
absence of follicle ostia. then frontal scalp, and bitemporal sides.
Neutrophilic: Folliculitis decalvans, dis-
secting cellulite Biopsy is required for definitive diagnosis Finasteride’s side effects include lowered
16 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 17
libido, erectile dysfunction, reduced ejac- In connection with all these effects, the Spironolactone is growing in popularity mended in premenpausal women.
ulatory volume, temporary reduction in rate of side effects is also high. Dutas- for treatment of FPHL. Its antiandrogen
sperm count, testicular pain, depression, teride is often preferred in patients with effect is used for treatment. Spironolac-
and gynecomastia. Reduced libido as the insufficient or unsuccessful finasteride tone used in combination with minoxidil Topical Prostaglandin
most frequent side effect, whilst gyneco- treatment. has been shown to demonstrate greater
mastia and depression were not reported efficacy when compared to spironolac- Prostaglandins (PGs) play an important
at all. Forums, Internet Sites, and Social Topical Minoxidil tone alone. role in regulation of the hair cycle. La-
media channels exaggerate persistent tanoprost is a PGF2a analogue. Cetirizine
sexual side effects associated with finas-
Topical Side effects include headache, de- has been found to decrease PGD2 pro-
teride, but controlled clinical trial data creased libido, menstrual irregularities, duction. Information on this medications
Minoxidil is promote hair growth through
have found a low incidence of sexual side orthostatic hypotension, fatigue, and hy- are very limited. Further studies with
vasodilation and stimulation of hair folli-
effects that abate on stopping treat- perkalemia. Other potential side effects longer follow up times are needed to ex-
cles into the growth phase. Topical mi-
ment. These side effects are temporary. include gynaecomastia and feminization; plore the efficacy and safety of this
noxidil has been shown to shorten telo-
Most of them disappered after medica- therefore, it is not recommended for use drugs.
gen, prolong anagen, and increase hair
tion usage has been stopped. Random- in men. Also oral contraception is recom-
follicle size. Paradoxical hair shedding
ized trials have found finasteride de- Medication Intended Method of Dosage FDA Adverse Effects
can occur at the beginning of the treat-
creases prostate cancer risk. On the Gender Administration Status
ment due to stimulation of exogen as tel- Minoxidil M,F Topical %2and %5solution Approved Alergy ,Contact
other hand, finasteride decreases 2 times per day Dermatitis ,Hypertri
ogen follicles re-enter anagen. Applied
prostate specific antigen levels which im- cosis, and
twice daily to involved areas of a dry Cardiovascular
pacts on prostate cancer screening in
scalp. Hair growth is seen within four to Effects
men. M,F Oral 2,5– 5 mg / per day Not
eight months and stabilizes at 12 to 18 Hipertricosis , Limb
Approved Edema
months; thus a year of treatment is ad-
Topical Finasteride M Oral 1 mg per day Approved Decreased Libido ,
vised before assessing efficacy. Common Erectyl dysfunction ,
side effects include: contact irritant der- Ejaculation
Topical finasteride associated with sig- disorder ,
nificant decreases in rate of hair loss, in- matitis, facial hypertrichosis and cardio- Gynecomastia ,Psyc
creased total and terminal hair counts, vascular effcts. Propylene glycol is hologic
impairments, and
and improved hair growth assessments responsible for this allergic reaction. The PSA level changes
with less systemic side affects. The pre- 5% foam however is free of propylene
Dutasteride M,F Oral 2,5mg /day Not Decreased Libido,
liminary results on the use of topical fi- glycol, which correlates with a lower risk Approved Erectyl dysfunction,
for skin irritation. ejeculation disorder,
nasteride are limited but thus far appear and Psychologic
safe and hold promise. impairments
Oral
Spiranolakton F Oral 25mg/ twice per Not Headache,
Dutasteride day and increased Approved Decreased Libido,
Oral Minoxidil, an antihypertensive drug, as tolerated until Menstrual
200mg/day. irregularities,
Dutasteride inhibits both Type 1 and Type was first identified to improve hair loss in
Hyperkalemia,
2 5AR. Dutasteride is three fold more effi- male androgenic alopecia in 1980. It is Feminization of men
used for patients who have contact re- and male fetus.
cacious at inhibiting type 1 5AR and a
actions for topical forms. Prostoglandin M ,F Oral Not
hundred fold more efficacious at inhibit- Approved
( Latanaprost ,
ing type 2 5AR than finasteride. Dutas- Cetirizine)
teride provides greater suppression of Herbal Recommmend Oral
Saw Palmetto dose
DHT than finasteride. However, not FDA Spironolactone Green Tea
M
M,F
Oral, Topikal
Oral 320mg/day
approved for AGA. Pumpkin Seed M Oral 700mg/day
Rosemary M,F Oral, Topikal 500mg/day
Grape Seed M,F Oral 800mg/day
Licorice M Oral , Topikal 400mg/day
380mg/day
M:Male , F:Female
18 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 19SEBORRHOIC EXCEMA ciated with internal organs. A number of
factors increase risk of developing sebor-
Herbal Treatment Dr. Ekrem Civas rheic dermatitis, including:
Saw Palmetto is extracted from palm
tree berries. It effects like Finasteride by
Skin Diseases and Seborrheic Eczema, Seborrheic dermati-
tis
Neurologic and psychiatric conditions,
such as Parkinson's disease and depres-
blocking 5-α Reductase enzyme. The Hair Loss Seborrheic dermatitis is a common skin
sion
constents of beta sitosterol and fatty
acids are responsible for its effect. Dose condition that mainly affects scalp and A weakened immune system, such as
of 320 mg/day is effective. also oily areas of the body. It is a eczema seen in organ transplant recipients and
that appears as yellow oily dandruff people with HIV/AIDS, alcoholic pancre-
Green Tea is a powerful antioxidant. Its crusts on the scalp, face, eyebrows, the atitis and some cancers
anti-inflammatory and stress inhibitory edge of the nose, cheeks, inner and outer
effect which may influence hair growth . parts of the ears, and pink red rashes. Seborrheic Eczema is a hereditary dis-
Green tea can stimulates human hair ease?
growth via its proliferative and antiapop- Seborreic eczema do not cause any harm
totic effects on dermal papilla cells by in- to patients other than cosmetic appear- No it is not.
hibiting 5-α Reductase. ance.
In which seasons is it more common?
Pumpkin Seed oil and its extract have in- What is the cause of Seborrheic
hibit 5-α Reductase activity with a dose Eczema? It is more common in winter. The disease
of 400 mg/d for 24 weeks. It’s effective for is milder in summer.
treatment of AGA. This type of eczema is caused by the ex-
cessive increase of the fungal microbe Does the disease increase with food?
Rosemary acts by improving blood circu- Malaszesia that lives harmlessly on our
lation and improving vascularity helping skin and the excessive response of the No food is involved in the development of
the regeneration of follicles similar effect skin defense system. the disease.
that is provided by Minoxidil.
How common is Seborrheic Eczema? What are the symptoms of the disease?
Grape seed showed an activity in the
It is seen around 5% in the society. How- Although it varies from patient to pa-
proliferation of hair follicle cells and hair-
ever, patients are often unaware of this tient, it occurs with thin white-yellowish
cycle-converting activity from the telo-
situation. scabs on the red pink background, espe-
gen phase to the anagen .
cially on the nose edge, cheeks, inner and
Licorice has powerful hair growth activity Is it related to dandruff in hair? back part of the ear, eyebrows and scalp.
by blocking 5-α Reductase enzym. Most patients have no discomfort. Some-
Dandruff formation on the hair is a mild times it can occur on the chest and
form of seborrheic eczema and occurs in armpits. It may watch with dandruff on
half of adults. the scalp.
Not everyone with dandruff has sebor- How is the disease diagnosed?
rheic dermatitis, but most patients with
seborrheic dermatitis also have dandruff. It is easily diagnosed by clinical examina-
tion. However, in some cases, dermato-
Is Seborrheic Eczema associated with in- logical examination and laboratory tests
ternal organ diseases? may be required to distinguish it from
other diseases (fungal diseases, psoria-
Seborrheic eczema is not a disease asso- sis, rosacea, atopic dermatitis).
20 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 21Can the disease be cured completely? PSORIASIS skin diseases should be kept in the inac- LICHEN PLANUS
tive phase. Because the results obtained
Symptoms of the disease can be tempo- Dr. Özlem Bicer with hair transplantation may be less Dr. Pauline McCluskey
rarily eliminated with the treatments ap- effective in patients with skin diseases
plied. It is not always possible to be fully Hair transplantation for patients suffer- Lichen Planus is a chronic inflammatory
such as dermatitis,psoriasis. Patients
cured. ing from atopic dermatitis, seborrheic condition that can affect the skin, nails
who have this kind of dermatologic prob-
dermatitis and psoriasis and mucosal surfaces (such as the inside
lems should have to know that Hair
Treatment of your mouth). It is relatively common,
Dermatitis and psoriasis are chronic dis- transplantation is not a contraindication
affecting up to 1% of the population.
Medicated shampoos, creams and lo- eases that attack with acute inflamma- for them if everything is under control.
tions are the main treatments for sebor- tion. The patient will always experience The disease is believed to be autoim-
rheic dermatitis. this problem on the scalp. This means mune in nature, meaning that it is caused
that the disease will be active or inactive when your immune system attacks cer-
in certain periods . The most critical point tain parts of your skin, mistakenly believ-
is that the treatments applied for the ing them to be 'foreign'. It is not infec-
disease do not produce permanent solu- tious.
tions. Moreover, these dermatological
diseases may be the main reason for hair Symptoms of classical Lichen Planus typ-
loss. In this case, doctors do not recom- ically include numerous small, flat, shiny,
mend hair transplantation treatment un- itchy, red-purple bumps on the surface of
less the patient has a case of androge- the skin, often around 1-3mm in size.
netic alopecia. Even if patients with der- However as there are a number of sub-
matitis and psoriasis also have androge- types of the disease, it may present
netic alopecia, there are important crite- differently, eg:
ria for hair transplantation. The dermato-
logical disease that the patient suffers ◇ white patches on the inside of your
from should be got inactive. To do this, cheeks and gums
doctor or dermatologist regulates the oil ◇ rough and grooved fingernails or toe-
balance of the patient's skin and blood nails
circulation. If necessary, oral medication ◇ different shaped lesions such as
and treatment products such as sham- straight line or ring-shaped
poo should be used. All these drugs
While there is no cure, Lichen Planus on
should be prescribed by the doctor of pa-
the skin tends to go away itself within a
tient before the hair transplant surgery.
year or two. And there are a number of
After this dermatological treatment, a
treatments available that can help re-
hair transplant intervention should be
duce the discomfort from the symptoms
planned to risolve hair loss problem of the
of the disease.
patient.
Regardless of all these diseases, first of
all the doctor should perform a dermato-
logical analysis in the general hair trans-
plant consultation. In case of dermato-
logical disease diagnosis, the correct
treatment process should be followed.
After hair transplantation, as much as
possible, the patient's dermatitis or other
22 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 23LICHEN PLANOPILARIS through a prolonged 'passive' phase lar units”. They vary in size from a single
where the patient does not experience hair to a four hair follicular units. With an
Dr. Pauline McCluskey any symptoms or further hair loss. How- average of two hairs per follicular unit or
ever it is fairly common for the condition graft in relation to a hair transplant pro-
Lichen Planopilaris (LPP) is one of the
common forms of scarring alopecia, and
to 'reactivate' some time later. Hair Transplant cedure. Following the dissection, trim-
happens when the Lichen Planus disease Once the disease is truly inactive, ideally Planning ming and cleaning under magnification.
Technicians start to place the follicular
affects areas of the skin containing hair after a few years without any symptoms
It has taken decades for surgical hair units in the recipient sites.
follicles, such as the scalp. after stopping medication, a patient may
restoration to arrive at the current state-
be considered a possible candidate for
Symptoms of Lichen Planopilaris include of-the-art techniques. Over the years
surgery.
itchiness, pain, burning or sensitivity. there has been a number of donor har-
There always remains however a small vesting and graft placement techniques.
As the disease progresses, it attacks and All with varying degrees of risk. That in-
risk that the surgery itself may reactivate
destroys the follicles, typically leaving ar- cluded unsightly scarring to unnatural
the condition, so it is very important that
eas of smooth scalp containing no visible hair placement and poor yield. Older
patients are monitored and followed-up.
follicle openings. These patches may methods included punch grafting, flap
gradually expand in size, and several surgery and scalp reductions. Before fi-
patches may join up to form a larger nally arriving at Follicular Unit Grafting
area. The hair follicles surrounding these techniques of donor management and
patches of hair loss may appear red, graft placement. Follicular Unit Trans-
scaly or spiny. plant (FUT) and Follicular Unit Extraction
(FUE).
Your doctor may suggest a skin biopsy in
order to confirm a diagnosis of LPP. Permanent Hair Restoration
As with Lichen Planus elsewhere on the Surgical hair restoration (hair transplan-
skin, Lichen Planopilaris is a chronic (long- tation) permanently moves hairs follicles
term) condition, but one which usually to areas previously affected by hair thin-
'burns out' and becomes inactive over a ning and loss. Even with advanced
period of some years. stages of male pattern baldness. Men re- One hairs units are used along the hair-
tain a band of hair around the sides and line. Along the very front three or four ir-
Available treatments, such as steroids, regular rows. Two-hair follicles are posi-
back of their heads. This hair is geneti-
typically aim to calm the immune system, tioned behind the single hairs. Then fol-
cally strong. Being immune from the
manage the symptoms of the disease lowed by the three and four-hair follicles.
affects of the DHT hormone. That trig-
and preserve the remaining hair. However Attention is paid to the correct angula-
gers the male pattern baldness gene.
any hair loss caused by LPP is usually per- tion and direction. Along with the in-
Affecting the hair over the top of a man´s
manent, as the follicles have been de- crease in density. The surgeon can mimic
head. With a hair transplant. The doctor
stroyed and replaced with scar tissue. nature, ensuring the outcome is com-
"harvests" hair follicles from the back and
sides of the head. When transplanted pletely natural.
Patients with active LPP are not suitable
candidates for hair transplantation, be- correctly the hair grow. Permanently in
Follicular Unit Techniques
cause the transplanted follicles will be the new area.
attacked by the ongoing disease The latest hair transplant techniques
Follicular Unit Grafting
process. largely differ in respect to donor hair
Regardless where on the scalp hair grows management. The extraction techniques
The progression of the disease is some- to remove the hair follicles from the
in groups. Hair groups are called “follicu-
what unstable, and it may appear to go
24 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 25donor area. Each technique has pros and STATUS OF HAIRLOSS (NORWOOD) VII: The most severe form of hair loss and external auditory meatus but has not
cons. Some candidates are more suitable only a narrow band of hair in a horseshoe reached the vertex.
for one technique over the other. Some This picture shows two major patterns of shape remains on the sides and back of
have the luxury of choosing the tech- the Dr. O’Tar Norwood's complicated the scalp. Remaining hair is usually fine VA: The area of hair loss includes the ver-
nique they prefer. While some benefit male pattern baldness classification sys- and not dense. tex. Hair loss more severe than VA cannot
from combining the techniques into one tem. This system is based on the Hamil- be distinguished from Types VI or VII.
session. As a result, maximising the num- ton scale and is often called the Nor- Variant A:
ber of grafts that can safely be removed wood-Hamilton scale.
IIA: The hairline is anterior to the coronal
in one session. Also help repair patients
I: Small to no recession of the hairline. plane 2 cm anterior to the external audi-
maximise their donor hair characteristics.
tory meatus.
II: Triangular, often symmetrical, areas of
The donor hair management is the main
recession at the frontotemporal hairline. IIIA: The hairline has receded back to a
difference in the techniques. The remain-
point between the limit of IIA and the
ing aspects of the hair transplant proce- III: Small hair loss enough to be consid- level of the external auditory meatus.
dure are relatively the same. The grafts ered as baldness according to Norwood.
are divided, cleaned and checked by the There are symmetrical deep recession at IVA: The hairline has receded beyond the
hair technicians. Performed under magni- the temples that are sparsely covered by
fication. Separated into the natural hair or bald.
groups of one to four hair follicular units.
The placement of the hairs is the same. III vertex: The hair loss is mostly from the
The technicians place the hairs units into top the head (vertex) with limited reces-
the ready made recipient sites created sion of the frontotemporal hairline that
by the Doctor. does not exceed the recession seen in III.
IV: More severe frontotemporal recession
than in III and there is sparse hair or no
hair on the vertex. The two areas of hair
loss are separated by a band of moder-
ately dense hair that extends across the
top. This band connects with the fully
haired fringe on the sides of the scalp.
V: The vertex hair loss area is separated
from the frontotemporal area but it is
less distinct. The sparse band of hair
across the crown is narrower and the ver-
tex and frontotemporal areas of hair loss
are larger.
VI: The bridge of hair that crosses the
crown is gone and only sparse hair re-
mains. The frontotemporal and vertex ar-
eas are joined together and the extent of
hair loss is greater.
26 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 27THE SAFE AND SAFER DONOR AREA tensions, braiding …) that destroys the DONOR RESERVE The donor area starts from the left ear to
donor area the right ear.
Dr. Patrick Mwamba Dr. Musbeh Arslan
3. Secondary cicatricial alopecia (from
1. Anatomy criteria based on Norwood burns) that impaired the classic donor Whats the donor area
classification of hair loss. area How to estimate the grafts
FUE Hair Transplant is a pattern bald- number based on the donor
Consider everybody as a Norwood 7 and 4. Rebuild temples points and frontal hair ness treatment procedure. It consists on area Capacity
do not harvest beyond it. Anatomy land line with nape hairs (considered as Body removing the hair follicles from one part
marks (pretragal line, occipital protuber- hair transplant) of the body ‘’called donor area’’. Then, re- The hair transplant surgeon estimates
ance) and measures help to define it. implant them on the baldness zone the grafts number according to donor
RULE OF THUMB: called recipient area. The surgeon can’t area’s capacity.
2. Progression of hair loss overtime create donor hair. The donor area is ex-
showed that the hairs in the safe donor -Look at or assess hair caliber ceedingly important to achieve the hair The factors taken in consideration during
area can also thin out and fall. Some pa- transplantation. the evaluation of the donor area:
tients end up with a pattern higher than -Look at and assess hair pigmentation.
the classic NW7. The elliptical area just For the FUE hair transplant, the main ◇ The age of the patient
above the protuberance occipital up to These signs give you a better under- donor area is the back side of the head. ◇ The baldness level
the mastoid region seems to hold very standing of the probability of the har- This zone is genetically coded. The donor ◇ The hair loss statue
good and is the best choice for strip vested hairs to last longer in the recipient hair follicle will grow hair on the recipient ◇ the density of hair follicles per cm
surgery . It is the safer donor area. area. area. They will never fall. square
◇ the hair type ( Fine, thick, curly..)
3. Use the dermatoscope to determine Except from overharvesting, you need to
the safe and safer donor area according rule out MPB or any other diffuse hair loss The maximum of follicles extracted per
to the criteria or signs of miniaturization: pattern to perform surgery while harvest- session is 3500-4000 from a high dense
thinning or decrease in hair caliber and ing out of safe donor area. donor area.
depigmentation of hairs. If the ration is
CONCLUSION: The Extraction phase
above 15%, the area is considered as NO
SAFE. Process
SURGERY + MEDICAL THERAPY MUST
BE COUPLED TO ASSURE The principle of the FUE (Follicular Unit
4. During surgery, you can look at the an-
agen/telogen ratio. Extraction) technique is harvesting the
SUSTAINABLE AND LASTING RESULTS.
hair follicle (graft) one by one with a mi-
5. Conclusion and take-home message: cro-motor punch. The diameter of the
There is no guarantee for donor perma- punch diameter depends on the hair
nence; therefore there is no such thing as type. The size of the punch varies from
“safe donor “ area. We have to anticipate 0,7 mm to 0,9 mm.
and prevent shedding by encouraging
patient to commit to medical therapy to Each graft removed area never grow hair
slow down the process. on the donor area. The hair follicle is re-
moved from the root and transplanted in
When to harvest out of safe donor the recipient area. This makes the extrac-
area tion phase very important.
1. After overharvesting in the regular safe The grafts extraction phase performed
donor area by unskilled team will damage the donor
area. When the extraction is not made in
2. In patient with traction alopecia (ex- homogenous way, the donor area will
28 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 29have patches and low density. The ex- COVERAGE VALUE cently developed KE-Bot robotic scan- AUTOMATED ANALYSIS WITH KE-BOT
traction must be performed by a special- ning system, the calculation becomes
ist surgeon to avoid any graft damage. Dr. Koray Erdogan very accurate, allowing the surgeon to re- Dr. Koray Erdogan
spect the calculated Coverage Value by
The Coverage Value calculation was de- The KE-Bot, the newest FUE innovation
determining the total number of ex-
veloped by Dr. Koray Erdogan as an ob- by Dr. Koray Erdogan, is an advanced ro-
tractable grafts from each scalp area
jective method to standardize scientific botic 360-degree circular scanning sys-
(occipital, parietal and temporal). This is
tem that evaluates all aspects of hair
an extremely important concept when
transplantation through high definition
considering the trends in FUE surgery
photography that provides 3-D scalp
where multiple surgeries and mega-ses-
modeling and data collection from every
sions are becoming more common.
angle.
This includes the pre-surgical determina-
tion of each hair’s caliber and density in
criteria for calculating coverage through the donor area, and overall donor capac-
two components; density and thickness. ity thereby assisting the surgeon to ob-
This criteria addresses not only overall tain extremely accurate extraction site
coverage, but also creates a standard for calculations with potential transection
avoiding donor depletion, an issue that rates. Additionally, the KE-Bot calculates
has been an area of trepidation to hair Coverage Value (an important calculation
transplant surgeons for some time and also developed by Dr. Erdogan) affecting
The donor area reserve especially where higher graft counts are both the donor and recipient areas to in-
concerned. Since the two items of great- sure adequate homogenization and den-
The hair implant doctor takes absolute est concern to both the patient and sur-
care to safeguard every hair during the geon is donor capacity and good cover-
procedure. The donor area differs from age, this is the main objective of the Cov-
patient to patient. If the hair loss is un- erage Value Calculation.
stable, the surgeon needs to estimate a
reserve of the donor area for a second With Coverage Value, the question of hair
Hair Transplant. coverage is determined by establishing
area through a geometrical formula; the
multiplication of the number of hairs in a
given area of the scalp by the hair’s
thickness. With the assistance of several
tools, and especially now with the re-
30 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 31sity without overharvesting while taking HAIRLINE DESIGN Treatment : Laser resurfacing , peeling ,…
into consideration normal hair loss with
aging. Dr. Patrick Mwamba
Moreover, KE-Bot is able to determine 1. HAIR LINE IS THE ICE ON THE CAKE
the number of grafts placed in previous FOR HAIR TRANSPLANT SURGERY
surgeries by counting previous extraction
We have different rules and criteria to
sites. Post-surgically, it scans the recipi-
build the hair line ( finger rules , Da Vinci
ent area and determines the actual num-
rules ,…) . Mastering them will help you to
ber of grafts placed and the density ob-
achieve natural and sustainable results
tained while reporting authentic transec-
overtime .
tion rates in relation to the number of
placed grafts. A. It happens that the hair line looks un-
natural
Although the KE-Bot is presently in lim-
ited production, it promises to be i. Wrong location ( too low ) while hair loss
adopted by surgeons worldwide due to continue to progress to an extensive
its extreme accuracy. stage
ii. Pluggy look because of bad technique (
misangle grafts , pitting , cobblestone ,..)
iii. Plugs in the hair line
2. FUE CAN CORRECT IT BY ELEVATING
THE HAIR LINE
A) You can use extraction with small
punch and let it heal by secondary inten-
tion .
Possible when the skin is soft , with good
hair angle .
B) Combine extraction with punch and
stiches to decrease the wound size
Big plugs , misangled grafts , scarring tis-
sue
COMPLICATIONS :
- White dots
- Skin depigmentation and discoloration
- Uneven skin surface
32 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 33CONCEPT OF FUE AND FUT a different way of removing the hair side FOLLICULAR UNIT TRANSPLANT -FUT
by side. Here, each hair or, more precisely,
The principle of hair transplantation is hair bundle is operated on individually FUT has been the standard donor har-
simple in concept: one takes a hair away from the scalp with a hollow needle. The vesting method for many years. Follicular
FUT (Strip) Method from its previous location, including the
tightly fitting growth areas in the skin tis-
advantage for the patient is that the Unit Transplant removes a hair bearing
strip from the donor area. The technique
long and sometimes unsightly scar can
sue, and plants them in a desired loca- be avoided. is commonly known as "Strip" as it de-
tion in the head. What sounds so simple notes the method of extraction. The strip
in principle, however, is considerably more Even though FUE has become increas- is taken from an area rich in a high den-
difficult in practice. This is mainly due to ingly popular worldwide, there are still nu- sity of hair follicles from around the back
the fact that hair with its substructures merous hair surgeons who also use the and sides of the head. Situated well
is very small. strip method to a greater or lesser ex- within what is considered to be the donor
tent. area safe zone. The area affected by the
FUT (Strip) male pattern baldness gene. Along the
In the following chapter we would like to occipital bone that slightly protrudes at
The first major breakthrough in hair present the two methods in more detail the back of the head.
transplantation was achieved with the so that the patient gets an impression
so-called FUT or strip method: Here, a why he or she should choose one of the The length and width of the strip is de-
larger strip of skin and hair is removed two methods and how this is done. pendent on certain factors. The number
from the donor area, which is then care- of grafts required to treat the area of
fully dissected by assistants under the hair loss is calculated. The next step is to
microscope. measure the donor hair density. This is a
calculation of how many follicular units
there are per cm 2. At least three mea-
surements are taken around the back
and sides of the head. Within the area
the strip would be removed. The skin lax-
ity is measured. Too tight or too loose can
affect the closure by suture. This can be
tempered by the width of the strip to re-
move any undue tension when being
closed.
Once the strip length and width is calcu-
lated the area can be shaved and
cleaned. Prepared with a local anaesthe-
sia ready for the Doctor to make the inci-
sion to remove the strip and then suture
The edges of the skin strip are then sewn the area. The sutures can differ depen-
together, leaving only a longer scar on dent on the Doctor. From self dissolvable
the back of the head to be covered by to permanent to staples. Suturing and
the hair that continues to grow there. closure techniques can allow for hair to
grow back through the scar line. This can
FUE help to camouflage the area. Even with a
Shortly before the turn of the millennium, short hairstyle a good FUT suture line can
various medical practitioners developed be hard to detect.
34 © Alliance4hair - 2021 - All Rights Reserved © Alliance4hair - 2021 - All Rights Reserved 35You can also read
