Hair has three sections. The outer protective layer, called the cuticle, is thin and colourless. The second layer, called the cortex, is an important part. It gives the hair strength, colour and thickness, and determines whether it will be straight or curly. The third layer is the medulla, and it is typically made up of a row of cells which are two to four columns wide. Its exact function in the hair is unknown. The final element is the follicle, a sac within the scalp where the hair is generated. Strands of hair are rooted in these hair follicles in the skin, and glands called sebaceous glands surround the follicles.
A hair shaft is to a follicle, what a blade of grass is to a grass seed. That is you can not have one with out the other. It also means to achieve results like GROW MORE HAIR are only achieved when there are MORE HAIR FOLLICLES in the area. In the same way, to GROW MORE GRASS on a section of earth, you need more seeds to achieve that result.
Dr Okuda (left), a Japanese dermatologist, performed the first recorded attempts of hair transplantation on humans. In 1939 he reported in Japanese dermatological journals his results from treating various burns victims by transplanting plugs of hair from the permanent hair zone into burnt scar tissue on the scalp, eyebrow and moustache regions. Dr Okudanever mentionedhair transplanttreating male or female pattern hair loss and it is unlikely that he realised the potential of his work. His reports never made it outside Japan and he was killed during WorldWar II..
Dr Norman Orentreich (right) of New York, completely unaware of Dr Okuda’s previous work, described a similar procedure he had performed in 1959. Dr Orentreich is considered to be the father of modern hair transplantation because he realised the application of the procedure in the treatment of baldness, and also because he recognised the importance of donor dominance.
The success of any hair transplant procedure is dependant upon the incidence of donor dominance. Simply stated, this is the phenomenon whereby hair-bearing skin taken from the permanent zone at the back and sides of the scalp and transferred to the balding areas at the front, top and crown will retain its original programming (or resistance to the effects of the male hormone) and will grow hair and continue to grow hair for as long as it would have in its original position. Since those early days in New York, the science and art of hair transplantation has evolved to become the most commonly performed procedure on men in INDIA today. To fully explain the advancements that have been made, it is necessary to look back at how the procedures were performed.
RENAISSANCE CLINIC INDIA performs both follicular unit grafting (FUG) and follicular unit extraction (FUE) as a simple walk in walk out procedure under local anesthesia. These procedures usually involve the movement of thousands of tiny hair follicles from the balding resistant areas at the back and sides of the scalp to the areas at the front, top and crown that are susceptible to hair loss.
Once the procedure is completed the patient can leave our clinic with a thin headband type bandage covering the donor area at the back and sides of the scalp. The recipient area at the top of the head does not require any bandaging and the patient is free to wear a cap or bandana immediately after surgery.
A patient is shown with his existing hair taped up to expose the donor region undergoing FUE with individual hairs being removed from the donor area. To perform an FUE procedure a large area at the back and sides of the scalp is clippered down to a #1. Now the surgeon will make a tiny circular incision around each follicular unit. As each incision is made the graft is then carefully extracted one by one from the scalp. These are then given to the surgical team who will check them under the microscope and further trim them if required. The small holes from which the grafts are extracted are so small they are left to heal on their own. From here on the procedure is much the same as the FUG.
Following either procedure scabs are evident on the top of the scalp for about 7-10 days. Some minor swelling may occur in the forehead region 3 days after the procedure. Patients can generally return to normal activities within a couple of days after the procedure with some limitations on exercise, smoking and drinking. The new hair will begin to grow through about three months after the procedure with final result expected about 18 months after surgery.
A patient is shown with his existing hair taped up to expose the donor region undergoing FUG with a linear strip of hair bearing skin being removed.
Follicular Unit Grafting at RENAISSANCE CLINIC involves removing a thin strip of hair bearing skin from the region at the back and sides of the scalp. once this piece is removed the the two edges are brought together and sutured closed. The patients hair directly above the incision covers the area so it is not noticeable.
This strip of hair bearing skin is then given to a team of surgical assistants who dissect this one piece into thousands of follicular unit grafts containing 1, 2, 3 or 4 hair grafts. During this process the grafts are kept suspended in a special solution that ensures they are kept cool and hydrated and can survive many hours outside the body.
As the graft dissecting continues tiny incisions are made in the scalp areas to be treated with very fine gauge needles. The surgical team are able to control all aspects of angle, depth and density to ensure a natural result. The grafts are then placed into these incisions with a very fine pair of tweezers. The 1 hair grafts are placed in the front hairline with the 2 hair grafts placed directly behind. This allows us to create a gradual hairline zone that mimics nature. The 3 and 4 hair grafts are then placed into the forelock region and through the mid scalp for maximum density.
If you could view hair under a microscope you would see that hairs do not grow singly (as is the common belief), but in naturally occurring groups of up to four hairs. These groupings are known as follicular units. This is how the hair used to grow in those areas where it has receded, and using these natural groupings is how we will replace it.
They are not to be confused with micro grafts. Micro grafts are dissected without the aid of magnification and whilst they can be cut into grafts containing one to four hairs they are not necessarily from the same follicular unit. The resulting growth rate and subsequent appearance are neither dense nor natural when compared to the results achievable with follicular unit grafting.
The binocular stereoscopic dissecting microscope allows us to identify and dissect these follicular units whilst sculpting around the sebaceous glands and other appendages crucial for the grafts survival. The resulting grafts are the smallest possible grafts you can achieve that will experience a very high growth rate in excess of 95% in the hands of the right surgical team.
Most importantly with grafts of this size we are replacing the hair in those areas where it has been lost in the same way that it used to grow, in naturally occurring groups of one to four hairs. The follicular unit is the foundation for restoring a natural looking head of hair.
The front hairline is the most critical aspect of any surgical restoration. In the past people have equated the look of a transplanted front hairline to that of a “row of corn” or “dolls hair”. Modern surgical methods have allowed us to overcome the shortcomings of the past through the use of two significant changes.
1.The use of follicular units in the front hairline containing 1 to 2 hairs only and the ability to place them very close together to achieve a high density.
2.The use of an irregular diffuse wave pattern that mimics a natural hairline with minimal or no hair loss. The natural hairline is an irregular zone with a soft transition from forehead through sparse, fine hairs to the thicker denser hairs approximately 1 to 1.5cm behind the front hairline. For many patients the natural appearance of the front hairline is the single biggest factor in determining the success of the procedure.
The first 1.5cm is constructed out of three distinct zones of varying densities and graft sizes. The use of these three distinct zones allows us to produce the natural results that defy detection as a transplanted hairline. In most cases the depth of Zone 2 can extend to as much as 2.5cm in the bi-temporal region as is consistently found in mature men with limited or no hair loss.RENAISSANCE CLINIC has performed many procedures on the front hairlines of men and women.
The above comments are general and apply in many cases but not all. There are a number of variables such as age, future balding, patient’s features, skin colour, and hair type and colour that will ultimately determine the final shape of the scalp line and surgical plan.