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HAIR TRANSPLANT
Dr Junaid Ahmad
PG3 Plastic Srugery Dept
Jinnah Hospital Lahore
ALOPECIA
ALOPECIA
lopecia is a loss of hair from the head or body.
• Androgenic alopecia
• Alopecia areata
erminology
• Alopecia totalis
• Alopecia universalis
ALOPECIA
t has adverse effect on
• Appearance of a person
• Social Life
• Self Esteem
• Psychological state
HAIR FOLLICLES
air are the appendages of skin
eated deep in dermis
row in single or groups of two three or four
surrounded by collagen
HAIR ANATOMY
PHASES OF HAIR GROWTH
nagen (Growth phase)
atagen (Shedding phase)
elogen (Resting phase)
NORMAL HAIR LOSS
he number of strands normally lost in a day
varies, but on average is 100
PATTERNS OF HAIR LOSS
n male-pattern hair loss, loss and thinning begin at the
temples and the crown and either thins out or falls out.
Female-pattern hair loss occurs at the frontal and parietal
or patchy
CAUSES OF ALOPECIA
ormone
utrition
nfections
rugs
rauma
HORMONES
ihydrotestosterone causes hair loss in genetically
suseptible patients
strogen increases the hair thickness so after
pregnancy females notice hair thining
MALE PATTERN BALDNESS
ore than 95% of hair thinning in men is “male pattern hair loss
• Male pattern hair loss is characterized by hair receding from the lateral
sides of the forehead
• A thinning crown leaving a horseshoe-shaped ring of hair around the
back of the head
pproximately 25 percent of men begin balding by age 30; two-
thirds begin balding by age 60.
MALE PATTERN BALDNESS
here is a great chance of receiving the baldness gene from
any of parents
here are muliple genes for baldness
he trigger for this type of baldness is dihydrotestosterone
MALE PATTERN BALDNESS
ale pattern baldness is diagnosed primarily on the basis of history
and physical examination.
/D
• Diffuse alopecia areata
• Acute and chronic telogen effluvium
• Early cicatricial alopecia
NUTRITION
igh animal protein diet (fast foods) and hypervitaminosis
with vitamin A causes more hair loss
eficencies of diet zinc and iron causes hair loss
INFECTIONS
inea Capitis
olliculitis
econdary syphillis
DRUGS
hemotherapy causes severe hair loss
ometimes even eyebrows are lost with
chemotherapy
TRAUMA AND BURN
cid and flame burn are common in our country
auses permanent hair loss
any times complete skin loss during trauma or burn is
replaced with skin grafts which lack hair follicles
OTHERS
adiation exposures
uto imune alopecia areata
yper/Hypothyroidism
ongenital alopecia patches
upus erythmatosis
SIGN AND SYMPTOMS
eceding hair line in males
or L shaped prominent hair lines in females
ncreased daily hair loss
lopecia associated with other diseases or factors should be
evaluated according to associated sypmtoms
TESTS
he pull test
he pluck test
calp Biospy
aily Hair Counts
OPTIONS FOR BALDNESS
edicines
have the rest of head
igs
MEDICINES
nly stop further loss and rarely regrow any hair with
medicines
ven if a stable growth is achieved it terminates with
discontinuing medicines
MEDICINES
inoxidil (Rogaine) is a nonprescription medication approved for male
pattern baldness and alopecia areata.
air regrowth can take eight to 12 months.
reatment is continued indefinitely because, if the treatment is
stopped, hair loss resumes again.
ost frequent side effects are mild scalp irritation, allergic contact
MEDICINES
inasteride (5 alpha reductase inhibitor) is used in male-pattern hair
loss in a pill form taken on a daily basis.
t is not indicated for women
reatment is effective within six to eight months of treatment.
ide effects include decreased sex drive, erectile dysfunction,
ejaculatory dysfunction, gynecomastia, and myopathy.
MEDICINES
orticosteroids injections of into the scalp can be
used to treat alopecia areata.
onthly basis oral pills
esults may take up to a month to be seen.
MEDICINES
ormonal modulators (oral contraceptives or
antiandrogens such as spironolactone and
flutamide) can be used for female-pattern hair
loss associated with hyperandrogenemia.
WIGS
ale or female patients with trauma and burn
ost complete scalp hair
ost skin over most of scalp and grafted skin
SHAVE
• Andre Agassi famous tennis player
• Vin Diesel from fast and furious
• Ali Azmat singer and actor
• Many others
SURGERY
xpanders to increase hairy areas
calp reduction of bald areas
air transplants
HAIR TRANSPLANT
hoice of Procedure for
• Androgenic alopecia
• Female patchy baldness
• Eyebrow reconstruction
HAIR TRANSPLANT
reoperative
• Stop herbal medicines 3 weeks
• Cessation of smoking 3 weeks before
• Stop aspirin 1 week
• Massage scalp
• Start topical Minoxidil
• Photography
• Consent
HAIR TRANSPLANT
afe Donor Area
HAIR TRANSPLANT
ethods
• Strip Excision
• Follicle Unit Extraction
HAIR TRANSPLANT
trip Method
HAIR TRANSPLANT
tart with
• Trim donor area
• Oral Antibiotic
• Anxiolytic Diazepam
• Markings on the recipient site
• Position the patient
HAIR TRANSPLANT
osition the patient
• Prone during strip taking
• Sitting in a hair transplant chair in rest of
procedure
HAIR TRANSPLANT
arkings
• Take care of male pattern of hair
• Do not shorten the forehead
• Randomize the frontal line with
triangles for natural look
HAIR TRANSPLANT
• Marking should be zigzag
• Appropriate sized forehead
• Take care of fronto-parietal angles
• Discuss with patient
HAIR TRANSPLANT
teps
• Take the strip
• Silvering
• Dissection to individual hair
HAIR TRANSPLANT
aking the strip
• Povidone-iodine application
• Local Anesthesia
• Epinephrine injections infiltration
• Start incision in safe donor area
HAIR TRANSPLANT
HAIR TRANSPLANT
HAIR TRANSPLANT
HAIR TRANSPLANT
t is a team approach
good team will start with strip
bad team will result in loss of most of grafts and
bad results.
HAIR TRANSPLANT
ilvering is separating one layer of hair from the strip
HAIR TRANSPLANT
issection
• All silvers are then subject to dissection
• Graft are prepared as single double and
triplets
• Loupe magnification of 6x is used
• Trained team is requires
HAIR TRANSPLANT
good graft has pear shaped has protective
dermis and no epidermis
HAIR TRANSPLANT
HAIR TRANSPLANT
In the mean while wound is closed by triecophytic closure.
HAIR TRANSPLANT
ollicular Unit Extraction
• It is extraction of follicular units one by one
rather than taking whole stip
HAIR TRANSPLANT
ollicular Unit Extraction
• Benefits include
• Rapid
• No linear scar
• Less post operative pain
HAIR TRANSPLANT
ollicular Unit Extraction
• Disadvantages
• Expensive
• Reduce donor area density
• Patient has to shorten the hair at donor
area
HAIR TRANSPLANT
Punch is a sharp cookie cutter
Have hollow needle
Inserted around a hair follicle
Angle to minimize transection
HAIR TRANSPLANT
ypes of Punch includes
• Manual or Mechanical
• Blunt or Sharpe
lunt mechanical are better
• Less transection
• Rapid
HAIR TRANSPLANT
HAIR TRANSPLANT
ngles and Depth of hair follicles varies depend upon
patient and location of hair follicle
enerally 30 degree to 45 degrees
epth 4mm to 5mm
irection of hair must be kept in mind
HAIR TRANSPLANT
pecial Considerations for FUE
• Only 3rd
or 4th
follicle should be extracted as
the density of donor area is reduced
• More than 1mm extractor diameter leaves a
visible scar
HAIR TRANSPLANT
ombination of Strip and Follicles
Unit Extraction gives best results
ultiple sessions can be done
HAIR TRANSPLANT
o apply the grafts steps are
• Marking
• Incisions
• Placing/Transplant the graft
HAIR TRANSPLANT
• Supra orbital block is
given
• Marking is done before
draping
HAIR TRANSPLANT
HAIR TRANSPLANT
• Inclined incision are given
• According to natural hair
• Direction according to areas
• All incisions made
HAIR TRANSPLANT
• Final look after all incision
HAIR TRANSPLANT
• Grafts are placed
• Single in frontal area
• Then multiples hair grafts
• In the directions of incision
• According to markings
• Randomized for natural
HAIR TRANSPLANT
ost operative care
• Dressings for one day
• Soaking the scalp
• Ice along neck
• Shampoo after 48 hours
• Gels or oil applied twice daily
• Analgesics
HAIR TRANSPLANT
omplications at Donor area
• Necrosis
• Wound dehiscence
• Parasthesias
• Hypertrophied scar
• AV fistula
HAIR TRANSPLANT
omplications of recipient area
• Necrosis
• Folliculitis
• Ingrowing hair
HAIR TRANSPLANT
djuvant therapies
• Topical Minoxidil
• Finasteride oral
HAIR TRANSPLANT
HAIR TRANSPLANT
ecent advances
• Robotics
• Stem cells
THANK YOU

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Hair transplant