Hair Transplant - Technical Info

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There are many aspects that make up a successful hair transplant result. The skills of the Doctor and their technician team is one major aspect. The skills required overlap between medical ability and an artistic side. Both can be learnt to an extent. But the best results are achieved when there is an innate understanding and skill. The goal is to make the greatest cosmetic improvement with the minimal impact to the hair and skin. As a result, creating natural looking hair growth while minimising any negative effects or changes to the hair or skin. These are the fundamentals of good medical practice.

Hairline Design and Placement

The hairline not only consists of the typical frontal area. But is a continuous line from the sideburn. To the temporal recession and then along the front to the other side of your head. Besides the natural graft placement the design is crucial. To restore a cosmetically pleasing look. Frame the face naturally. Complement the natural bone structure.

The placement does have to be aggressive to look good. Often a subtle change can make a big improvement. There needs to be a high degree of artistic ability and medical expertise. A jagged front edge is first created. This ensures a soft front line. Rather than straight symmetrical line. Single hair follicular units make up the front line. This achieves a natural aesthetic result. Complementing the changes from from one side of the head to the other. The surgical expertise to alter the orientation and angle of the hair position.

Hairline height is determined by a number of issues. Technically, the pattern of hair loss. Compared to the quality of the hair characteristics. To be able to maintain a balanced head of hair in the future. As hair loss is often progressive. Then aesthetic issues or bone structure. There are a variety of facial shapes. The majority of men have a square structure. It´s not exact science. But often categorised as below:

Round

Oval

Oblong

Triangular

Pear-shaped

Hairline planning can be a compromise between the patient and the doctor.  On occasions, individuals have a tendency to want the hairline too high or too low. A low rounded adolescent hairline will look fine on a younger man. But, not with the facial features of an older man. The younger man still has vivid memories of their original hairline.  Often there is a desire to create the same appearance. A middle-aged man may fear that an aggressive hairline may seem unnaturally low for his age.

The apex of a male hairline is always the lowest point. With a female hairline it is the opposite. From the apex the hairline moves across the forehead. The up to the recession points. Before back down to the temporal area. This look resembles the letter “M” shape. The new design needs to consider a number of factors. Such as the age and current hair loss stage, progressive hair loss and the donor hair characteristics of the individual.

Crown Design & Graft Placement

Sometimes it may be felt the crown is the neglected area.  Some like to make a demarcation line. But it’s not that easy to measure. Probably easier to measure the hairline, frontal third, mid-section and then crown as regions. The crown opens on all sides. From the frontal and sides to dropping at the back. In some cultures, the area expands further, expanding down each side and back. A small crown can easily be a circle say, 6×6.  To measure, for those proficient in maths the PY equation applies. Giving the values of the circle.

This makes it hard to treat the crown. Where to start, and how many grafts to use. How to place the grafts and whether the surface area will expand.  If the crown opens by 1cm the surface area has dramatically altered. Should you start working in the crown first? You must be mindful not to “backload” their head of hair. Concentrating on the crown and not addressing the frontal loss. In conclusion, crown work and artistic design go together. In some cases, the crown can be hard to treat, especially in younger candidates.

Recipient Sites & Dense Packing

This is vital to the look of a hair transplant result.  The doctor is careful to assure that the grafts will grow out in a natural direction. Including angle, orientation, and pattern of growth. With the attention on not damaging the adjacent hairs. The Doctor creates the recipient sites. The density alters on the area and the hair characteristics. The angle and direction of the slit are also dependent on the position. As well as the number of hairs in the graft. The grafts are placed using magnification. To ensure the precise placement of the grafts. As well as not to damage or crush the hair bulb.

The trimmed grafts have very little volume other than the functional follicle. Both the length and the depth of the slit are important for the hair transplant. The microcirculation is just beneath the hair follicle.  If the incision is too deep this can be damaged. It is essential to minimise trauma to the surrounding tissue. If too aggressive, damage can occur to the surface of the scalp. As a result, creating a ridge or cobblestoning over the scalp. Resulting in an unnatural ripple left through poor slit making. With precise placement, it is now possible to create a higher density of hair than in previous years, and this will give a much more pleasing result for the patient.

This is the art of placing the follicular units close enough together to ensure a natural result/density in one pass; for example, the design of the hairline not having large gaps between each hair and having to place in between at a later date. The number of follicular units placed will alter dependent on certain factors, hair characteristics, hair shaft quality, ethnic origin, hair colour, curl, and your existing hair density. Dense packing is a great skill, being able to successfully place the follicular units close together without compromising the growth of each hair; the angle of the site and the size of the gauge used will all affect the result.

Splitting Follicular Units

The word “graft” is commonly used to refer to the quantity received from a hair transplant. A hair transplant result is often referred to as “x” number of grafts. But, a graft can simply be skin tissue that contains hair in this case. It does not correctly represent the reality of what has been transplanted.  A graft should represent an intact group of hairs, known as a follicular unit.  This can be from one to four hairs per unit. As an average when transplanted this equates to an average of 2.2 hairs per graft, so 3000 grafts being approximately 6600 hairs. Small procedures or if a higher number of single hair units are required will reduce this ration.

Splitting of hair groups does sometimes occur on a small scale and does not alter the ratio of 2.2 hairs per graft/unit. But if splitting increases the hair number does not change but the number of grafts increases. This can affect the result achieved and if paying per graft increase the cost without justification.

Transection

Can occur with either FUT or FUE although more discussed with the FUE technique as there are a greater possibility the transection rate increases out of control. There can be a number of negative effects if a hair unit is split, or “transected”, for example, take a 3 hair unit is split into 2 and 1 hair, this would then make up 2 “grafts” instead of 1. Transection can also kill the hair by damaging the follicular unit. By splitting follicular unit vital growth or survival factors of the unit could be damaged or lost, protective fatty tissue around the unit, genetic information, muscle receptors, and other glands may be missing or damaged. Leaving a partial follicular unit in the donor has no real benefit to the patient and often can later miniaturise due to trauma anyway.

There is usually no reason to split the graft with FUE as by the nature of the technique the hair units can be cherry-picked from around the scalp and enough single hair units, for example, can be found for hairline work, splitting and leaving hair in the donor can be detrimental and of no benefit and also reduces the hair count per graft so the patient loses out on their natural number groupings.

Hairline-Design
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Graaft-Transection
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Body Hair Follicular Units
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Hair Loss Check Consultation Assessment

Shockloss

Loss can occur to the native hair in the recipient area and sometimes but less common in the donor area, “shock loss”. The medical term for shock loss is effluvium, meaning shedding. This can occur when grafts are placed in an area which has hair; there can be some trauma and tissue reaction to the surgery that can cause the existing hair to shed prematurely. Shock loss usually affects the miniaturised hair nearing the end of its lifespan and is most likely to be shed at some point in the near future. Some healthy hair will be shed, but it invariably regrows.

Shock loss is more common when a large session is performed through thinning hair. Shock loss can also occur in the donor area, more so with larger strip procedures, it is certainly less common, but can still occur. For most patients, effluvium is not a major issue and should not be a cause for concern; their hair looks a little thinner or loses body and lustre. This is generally during the first months post the transplant when the transplanted hair is still in the dormant phase.

It is easier to place grafts around hair that is shaved but this does not mean shock loss does not occur; it is just not as noticeable as the hair is shaved. Incisions must be customised to the individual patient; if you limit/customise the size of the incision site, and limit the width and length of the tool used to make recipient sites then you can greatly reduce the chances of shock loss. There are a number of factors that can help reduce the effects of shock loss, smoking/drinking in the coming days to the procedure. In general, the more miniaturisation one has the more likely will be shedding from surgery. In addition, the number of grafts placed in one surgery and the proximity in which they placed to one another will increase the trauma to surrounding follicles.

Checking The Grafts Under Magnification

The two techniques for harvesting hair differ in respect with the Strip technique the FU are intact in the donor strip whereas FUE the FU‟s are individually removed so already separated from each other, this means no need for dissecting and generally means less trimming of the graft is required. With Strip the FU‟s remain in the donor strip, this strip is placed in a holding solution to protect the tissue. The strip is divided into smaller sections and then into the individual units by the tech team. Aside of this process is to trim off any excess fatty tissue around the unit, this ensures the grafts are thin so can be placed close enough together to dense pack as well as to stop unnatural pitting or ridging of the skin in the recipient area

The two techniques for harvesting hair differ in respect with the Strip technique the FU are intact in the donor strip whereas FUE the FU‟s are individually removed so already separated from each other, this means no need for dissecting and generally means less trimming of the graft is required. With Strip the FU‟s remain in the donor strip, this strip is placed in a holding solution to protect the tissue. The strip is divided into smaller sections and then into the individual units by the tech team. Aside of this process is to trim off any excess fatty tissue around the unit, this ensures the grafts are thin so can be placed close enough together to dense pack as well as to stop unnatural pitting or ridging of the skin in the recipient area.

This process within the hair transplant procedure must be carried out under stereo microscopes and by skilled technicians with precision and accuracy. Some hair types are harder than other to dissect even under microscopes, blonde or white hair or very fine hair make this more challenging. This excellence to precision during the process is vital; each follicle unit harvested for transplant must be preserved and prevented from being damaged as this would compromise the overall result.


Learn more about Follicular Unit Transplant (FUT) and Follicular Unit Extraction (FUE)


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