Download - Hair transplant
HAIR TRANSPLANT
Dr Junaid Ahmad
PG3 Plastic Srugery Dept
Jinnah Hospital Lahore
ALOPECIA
ALOPECIA
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lopecia is a loss of hair from the head or body. • Androgenic alopecia• Alopecia areata
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erminology• Alopecia totalis• Alopecia universalis
ALOPECIA
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t has adverse effect on• Appearance of a person• Social Life• Self Esteem• Psychological state
HAIR FOLLICLES
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air are the appendages of skin
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eated deep in dermis
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row in single or groups of two three or four
surrounded by collagen
HAIR ANATOMY
PHASES OF HAIR GROWTH
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nagen (Growth phase)
C
atagen (Shedding phase)
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elogen (Resting phase)
NORMAL HAIR LOSS
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he number of strands normally lost in a day
varies, but on average is 100
PATTERNS OF HAIR LOSS
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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
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ormone
N
utrition
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nfections
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rugs
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rauma
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regnancy
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thers
HORMONES
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ihydrotestosterone causes hair loss in genetically
suseptible patients
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strogen increases the hair thickness so after
pregnancy females notice hair thining
H
yperandrognemia in both sexes can cause
alopecia
MALE PATTERN BALDNESS
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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
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pproximately 25 percent of men begin balding by age 30; two-
thirds begin balding by age 60.
MALE PATTERN BALDNESS
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here is a great chance of receiving the baldness gene from
any of parents
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here are muliple genes for baldness
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he trigger for this type of baldness is dihydrotestosterone
MALE PATTERN BALDNESS
M
ale pattern baldness is diagnosed primarily on the basis of history
and physical examination.
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/D• Diffuse alopecia areata• Acute and chronic telogen effluvium• Early cicatricial alopecia
NUTRITION
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igh animal protein diet (fast foods) and hypervitaminosis
with vitamin A causes more hair loss
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eficencies of diet zinc and iron causes hair loss
INFECTIONS
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inea Capitis
F
olliculitis
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econdary syphillis
DRUGS
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hemotherapy causes severe hair loss
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ometimes even eyebrows are lost with
chemotherapy
TRAUMA AND BURN
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cid and flame burn are common in our country
C
auses permanent hair loss
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any times complete skin loss during trauma or burn is
replaced with skin grafts which lack hair follicles
OTHERS
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adiation exposures
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uto imune alopecia areata
H
yper/Hypothyroidism
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ongenital alopecia patches
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upus erythmatosis
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elogen effluvium
SIGN AND SYMPTOMS
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eceding hair line in males
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or L shaped prominent hair lines in females
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ncreased daily hair loss
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lopecia associated with other diseases or factors should be
evaluated according to associated sypmtoms
TESTS
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he pull test
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he pluck test
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calp Biospy
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aily Hair Counts
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richoscopy with hitech camera and software
OPTIONS FOR BALDNESS
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edicines
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have the rest of head
W
igs
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urgery
MEDICINES
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nly stop further loss and rarely regrow any hair with
medicines
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ven if a stable growth is achieved it terminates with
discontinuing medicines
MEDICINES
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inoxidil (Rogaine) is a nonprescription medication approved for male
pattern baldness and alopecia areata.
H
air regrowth can take eight to 12 months.
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reatment is continued indefinitely because, if the treatment is
stopped, hair loss resumes again.
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ost frequent side effects are mild scalp irritation, allergic contact
dermatitis, and increased facial hair.
MEDICINES
F
inasteride (5 alpha reductase inhibitor) is used in male-pattern hair
loss in a pill form taken on a daily basis.
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t is not indicated for women
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reatment is effective within six to eight months of treatment.
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ide effects include decreased sex drive, erectile dysfunction,
ejaculatory dysfunction, gynecomastia, and myopathy.
O
nce treatment is stopped, hair loss resumes again.
MEDICINES
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orticosteroids injections of into the scalp can be
used to treat alopecia areata.
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onthly basis oral pills
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esults may take up to a month to be seen.
MEDICINES
H
ormonal modulators (oral contraceptives or
antiandrogens such as spironolactone and
flutamide) can be used for female-pattern hair
loss associated with hyperandrogenemia.
WIGS
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ale or female patients with trauma and burn
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ost complete scalp hair
L
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
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xpanders to increase hairy areas
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calp reduction of bald areas
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air transplants
HAIR TRANSPLANT
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hoice of Procedure for• Androgenic alopecia• Female patchy baldness• Eyebrow reconstruction
HAIR TRANSPLANT
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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
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afe Donor Area
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ethods• Strip Excision• Follicle Unit Extraction
HAIR TRANSPLANT
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trip Method
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tart with• Trim donor area• Oral Antibiotic• Anxiolytic Diazepam• Markings on the recipient site• Position the patient
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osition the patient• Prone during strip taking• Sitting in a hair transplant chair in rest of
procedure
HAIR TRANSPLANT
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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
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teps• Take the strip• Silvering•Dissection to individual hair
HAIR TRANSPLANT
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aking the strip• Povidone-iodine application• Local Anesthesia • Epinephrine injections infiltration• Start incision in safe donor area
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t is a team approach
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good team will start with strip
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bad team will result in loss of most of grafts and
bad results.
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ilvering is separating one layer of hair from the strip
HAIR TRANSPLANT
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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
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good graft has pear shaped has protective
dermis and no epidermis
HAIR TRANSPLANT
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In the mean while wound is closed by triecophytic closure.
HAIR TRANSPLANT
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ollicular Unit Extraction • It is extraction of follicular units one by one
rather than taking whole stip
HAIR TRANSPLANT
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ollicular Unit Extraction • Benefits include• Rapid• No linear scar• Less post operative pain
HAIR TRANSPLANT
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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 cutterHave hollow needleInserted around a hair follicleAngle to minimize transection
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ypes of Punch includes• Manual or Mechanical• Blunt or Sharpe
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lunt mechanical are better• Less transection• Rapid
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ngles and Depth of hair follicles varies depend upon
patient and location of hair follicle
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enerally 30 degree to 45 degrees
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epth 4mm to 5mm
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irection of hair must be kept in mind
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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
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ombination of Strip and Follicles
Unit Extraction gives best results
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ultiple sessions can be done
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o apply the grafts steps are• Marking• Incisions• Placing/Transplant the graft
HAIR TRANSPLANT
• Supra orbital block is given
• Marking is done before draping
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• Inclined incision are given• According to natural hair • Direction according to areas• All incisions made
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• Final look after all incision
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• Grafts are placed• Single in frontal area• Then multiples hair grafts• In the directions of incision• According to markings• Randomized for natural
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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
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omplications at Donor area• Necrosis• Wound dehiscence• Parasthesias• Hypertrophied scar• AV fistula
HAIR TRANSPLANT
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omplications of recipient area• Necrosis• Folliculitis• Ingrowing hair
HAIR TRANSPLANT
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djuvant therapies• Topical Minoxidil• Finasteride oral
HAIR TRANSPLANT
HAIR TRANSPLANT
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ecent advances• Robotics• Stem cells
THANK YOU