How a Hair Transplant Works
Male and Female Hair Loss
Physicians divide hair loss, or balding, into scarring or non-scarring alopecia. Scarring alopecia includes a variety of diseases that cause patchy hair loss due to internal disease or trauma, or certain straightening agents. Stress can also cause hair thinning in a generalized way in all areas of the scalp. Only one type of hair loss will produce a distinctive pattern of loss in men and women. This is called female and male pattern baldness and is a genetic disorder. This disorder is primarily caused by the affects of dihydrotestosterone or DHT on the hair follicle. Men, and even women, have a certain amount of male hormone in their bodies, which is broken down by the enzyme 5 alpha-reductase, into DHT.
For female hair loss, the effects of DHT on the hair follicles causes a slow thinning of the hair on top of the head over many years. The hormonal mechanisms for female pattern baldness, however, involve more than DHT and are still under investigation. This produces the Ludwig patterns 1, 2, and 3. Loss of estrogen after menopause adds to this effect. In rare cases, women may have diffuse thinning all over the scalp, rather than pattern baldness. Diffuse thinning is generally not treatable with hair transplantation, while female pattern loss usually is.
In men, distinct and progressive male pattern baldness usually starts in the 20’s, 30’s, or 40’s and continues briskly for eight to fifteen years. After that it slows down, but continues on a gradual and progressive course for life. Again, as in females, the result of the interaction of DHT with the hair follicles is the main cause for pattern baldness. Since men have considerably more DHT, we presume this is the reason for the more rapid progression.
In both female and male pattern baldness, there is a gradual
miniaturization of the hairs produced by affected follicles until they
eventually stop growing and fall out. This is why a person's hair will be finer in texture for several years before actual baldness occurs. In pattern baldness, the hair around the sides and back is immune to the effects of DHT. This hair is also immune to DHT, if it is moved to another area of the scalp. It is this concept of donor dominance that makes a hair transplant permanent.
Steps of The Procedure
Hair transplantation is a minor surgical procedure confined to
the skin. It is performed under local anesthesia and is a safe procedure with few complications. With the introduction of the CompuMed Wand (pictured to the left), patients are administered local anesthesia in a nearly imperceptible process. Designed by dentists to alleviate the negative stigma associated with needle injections, the CompuMed Wand is a computer controlled delivery system that Dr. True and Dorin employ to offer their patients the maximum comfort while administering anesthesia. Patients are given a small dose of oral Valium prior to surgery for its calming effect and to counteract the momentary agitation some patients have from xylocaine/epinephrine. Patients should feel absolutely nothing during the procedure. Local anesthesia, when properly done, is 100% effective.
In our landmark study published in the Journal of Dermatologic surgery in 2001 the Compumed pump was shown to not only produce significantly greater comfort during the procedure but also to reduce post operative pain.
Once the anesthesia is administered, the first portion of the procedure is
donor harvesting. Donor harvesting is performed exclusively by either Dr.
True or Dr. Dorin. In Follicular Unit Transplantation (FUT), a strip of hair
bearing scalp is removed from the sides and or back of the head. The area is
then sutured with two-layer closure, which will result in a very fine scar
hidden within the remaining donor hair. We utilize the double layer closure
as it produces the thinnest scar possible. In addition to this closure
technique, we now incorporate an additional technique called Trichophytic
Donor Closure. This innovative method involves trimming the upper margin
of the harvested area, which when brought together with the lower margin with
sutures will ultimately enable hair to grow right through the scar.
THE END RESULT IS A VIRTUALLY INVISIBLE SCAR. We believe this breakthrough
in donor closure to be of tremendous significance and should alleviate fears
of visible donor scars, which were common with older techniques.
Because of the elasticity of the scalp, this process may be repeated in
subsequent procedures. Each time a procedure is done, the scar from the first
procedure is removed so that at the end of a treatment course there is only
one donor scar. The nearly invisible scar is completely camouflaged within
the remaining donor hair.
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Donor area prepped for second surgery one year later. The scar, which is very fine, was created before Trichophytic donor closure became a routine practice. The scar will be removed in the second Procedure.
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A donor scar produced with Trichophytic Closure. The scar is barely visible Because of the hair growing through it.
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Follicular Unit Extraction
With Follicular Unit Extraction (FUE) the donor area must be extensively shaved. Once anesthesia is complete, individual follicle units are superficially excised and extracted using tiny extraction punches and fine tip forceps. No sutures are required with this technique. The tiny puncture sites heal on their own leaving barely perceptible tiny scars scattered throughout the donor zone.
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Right after FUE surgery
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7 days later
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5 months later
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Graft Production
Once harvested, the strip is then microscopically dissected into
the naturally occurring bundles of follicles, or follicular units.
These tiny grafts of skin contain units of 1-4 hairs. The natural
architecture of the average donor area is ? single follicular units,
double follicular units, and 3-4 hair follicular units. The microscopic
dissection process if performed by specially trained registered nurses and
surgical technicians. By keeping follicular units intact, we assure
optimal growth rates.
The high rates (98 – 100%) of graft survival that are uniformly produced
in our procedures occur because of meticulous attention to detail in graft
handling and preparation. Tissue is placed in chilled saline and maintained
moist and cool throughout the transplanting process.
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follicular units prepared microscopically
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graft technicians dissecting follicular units
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Dr. Dorin creating receptor sites
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Receptor Sites
The receptor sites are the tiny incisions into which the follicular unit grafts will be placed. The creation of receptor sites is truly the artistic portion of the procedure. The sites are exclusively created by either Dr. True of Dr. Dorin. Both doctors use our own unique custom cut to size micro blades to make the sites. These blades range from .7 mm to 1.3 mm in width and are created for each patient based specific individual criteria. The size of the patient's grafts, the character of the recipient skin, and the density at which the grafts will be placed all determine the customization of the receptor blades. This practice enables the doctors to perform an ultra refined transplant at densities of 50 grafts per square centimeter. Dr. True and Dr. Dorin combine coronal, saggital, and a blend of coronal-saggital receptor sites to produce artwork that is specific to each patient. Design nuances such as direction and angle of hair growth, hairline shape, crown whorl, and overall hair flow are attained by subtly varying the combination and orientation of these tiny incisions. We believe a denser, more natural result is achieved through this methodology.
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Pure follicular unit transplant
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Micro-mini graft transplant
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Punch graft transplant
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Graft Placement
Once the doctor has completed his design, a team of nurses and/or certified surgical technologists will place the grafts into the incisions. The grafts are carefully placed using very fine forceps. The placement process usually takes a few hours and the patient is watching television while the work is being done. At True & Dorin we are proud of the skill level of our technicians. Most of our staff has been an integral part of the practice since the early 1990s and have each placed over two million grafts. Each team of technicians is assigned to only one case per day.
The grafts are preserved in saline under the ideal temperature conditions during the placement process. They are handled with the accuracy, delicacy, and precision necessary to assure optimal survival. Once the grafts have been placed, the doctor will inspect the transplanted area to insure the grafts are properly placed. A hair dryer is then used to blow cool air on the grafts, which will help form a natural adhesion and set the grafts in place. Bandages are not necessary, and the patient will wear a baseball cap for the trip home.
The patient will then watch the post operative DVD before leaving and the doctor will answer any questions about the post operative process. Although our patients are ambulatory at he time of discharge, we discourage driving after the procedure. The patient will return the next day for a check up and then at 10 days for suture removal. During the 10 day post operative period patients can expect to have very little difficulty or discomfort. Normal activities may be resumed in a day or so, and strenuous activity may be resumed after suture removal. Follow up visits are recommended every four months for the first year after treatment.
You will return the next day for a check up appointment, and then in 10-14 days for a suture removal appointment. Follow up visits are recommended every four months for the first year after a FUE hair transplant.
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