Modified Hair Transplants

The Evolution of Hair Transplantation
Before we get into the most cutting-edge techniques, it helps to know a bit about the history of hair transplantation. The first hair transplantation procedures date to the 1950s. In New York, the dermatologist Norman Orentreich came to learn that hairs on the back of the scalp could be removed without much difficulty and then transplanted into bald spots. This surgical technique was made routine by way of the use of the hair in graft form cut into small tufts-nice nickname was inevitable: ‘punch grafting’, a descriptive term for a technique that gave anyone squeamish pause. The procedure entailed cutting out clumps of the hair from the back of the head and then punching and implanting the plugs into balding patches. It was but left the patient with an unnatural or ‘doll hair’ look because of the size of the grafts.

The other big step 1990s, was the surgical procedure that came to be called Follicular Unit Transplantation (FUT), the harvest of a linear donor strip from the donor strip, slicing of that linear strip into units – hair follicle clumps of 1-4 hairs – preparation and separation of those units, and implantation of those units into the recipient area. FUT has the benefit of looking a whole lot more natural than previous surgical procedures but, unsurprisingly, it was subject to shortcomings (notably, the potential for a linear donor scar, which is seen as crucial by some).

Less than two years later, another ‘less-invasive’ method was introduced: Follicular Unit Extraction (FUE), whereby the individual hair-bearing follicular units are excised from the scalp without the need for the longer, linear incision required for FUT: no cut, no stitch. That FUE can’t eliminate follicular transection during extraction, that it has been shown to cause follicular fibrosis in the donor area that creates fibrosis – scars between the hair follicles that may make donor hair harvest impossible – and that it would for one surgeon take several days to complete the work normally done at a clinic in a day – were irrelevant because it was ‘less invasive’ and ‘faster to recover’ than FUT. Who would choose to go through an ‘invasive’ technique versus less-invasive ones?

The Science of Hair Follicles and Hair Loss
To understand that, you need to learn something about the biology of both hair follicles and hair loss – how hairs grow, and why hair loss happens. So here goes. A hair follicle is an extraordinarily complex, living part of your body, constantly buzzing with coordinated, regulated activity, with a never-ending procession of cycles.

Just like the skin, the hair-generating portion of the skin, known as the hair follicle, has something also known as the hair cycle – composed of the anagen phase (growth), telogen phase (rest) and catagen phase (shedding). With respect to androgenetic alopecia (sometimes referred to as male or female pattern hair loss), gradual shrinkage or miniaturization of the hair follicle over time is associated with an eventual obliteration at the skin surface, resulting in scarring, gradual cessation of growth and hair loss. Other than the dire misfortune of really bad genetics (which, it must be said for self-reflection, I count two strikes against me), hair loss is commonly accompanied by the androgens (notably, a hormone called dihydrotestosterone or DHT, an androgen, derived from testosterone).

The hair is relatively insensitive to DHT at the back and sides of the scalp, which is why it doesn’t fall out – those hairs are the ones transferred to the bald part of the scalp.

The Challenges of Traditional Techniques
FUT and FUE greatly improved the techniques, but even they come with caveats, which has led researchers and surgeons to develop new approaches – some of which include:

• Donor areas – we don’t have an endless supply of donor hairs. This is especially true for men with more advanced hair loss.
• The key is the technology that will create the most follicles per graft – or those that survive to result in the most natural looking hair transplant. Graft Survival (cutting out and putting follicles back in the exact same form as it originally grew, avoiding any damage to the follicle they survive and we should not lose the density of the outcome of the end-product of hair transplant.)
• Density: the single best, most needed – and ‘tis true – often elusive results, especially in your hairline and crown. Remember that by definition, traditionally, it (density) cannot be done.
• Cost and times: is too waste of time and money. that is because transplant process, consume much time. it is even more true, with FUE technique, because it is too much work, to extract such smaller grafts, and especially planning…them after that…

And in reply to these dilemmas, novel hair transplant techniques have been refined that carry the promise of better results and greater patient satisfaction.

Cutting-Edge Modified Hair Transplant Techniques
DHI, or modified FUE, is implantation of the hair follicles with more precision Still, in standard FUE, after they have been extracted, the follicles are put into some kind of infusion bath before they are implanted in the recipient area. The extra time between extraction and the implantation process can allow the hairs to have more time to be harmed by dehydration or mishandling. In DHI (which means direct hair implantation), but also called the ‘no-touch hair transplant’, after transfer of the hairs into this special instrument is caught in what is known as the ‘Choi implanter pen’. The surgeon is then able to insert the hair follicles directly as they come out without any further writing on them.

Because the needle on the end of the pen is smaller, the surgeon can dip it in more inserts the follicle into the skin more accurately, thereby allowing the surgeon much more control over the angle, depth and direction of each hair – particularly relevant to a natural-looking hairline – than the punches of FUT/STRIP surgery. DHI reduces the time interval between removal of a hair from the donor site and insertion of a hair into the scalp. Because a surgeon no longer has to remove a needle on the end of a pen out of the skin of the scalp, fewer follicles break when transplanted, which translates into more yield.

Benefits of DHI:

• Higher graft survival rates.
• More precise implantation with improved control over hair direction.
• Faster recovery due to minimal trauma to the scalp.
• Ideal for smaller, localized areas, such as the hairline or eyebrows.

Stem Cell Hair Transplantation
The latest hair restoration technology is stem cell hair transplantation. All hair follicles contain genetically engineered ‘regenerative cells’ that can create new ‘cloned’ follicles that grow into hair. In order to perform this technique, a few millimeters of skin and hair follicles is taken through a tiny biopsy (puncture) from the donor area of the scalp of the patient. The follicles can be multiplied through cloning in the laboratory to create up to several thousands of new follicles from an individual sample, and then placed into recipient area.

The procedure would avoid one of the most serious drawbacks of the classic hair transplant, which relies on the presence of a limited number of donor follicles. In theory, a low number of donor follicles would be sufficient, for stem cells to produce an infinite number of new follicles that could ultimately replace the bald spots. For the most part, people would be denied the growth of new hair anyway; they would have lost every single follicle completely. For them, such a solution would be unbeatable.

Although stem cell hair transplantation currently is considered experimental, the early results are promising. Whenever it officially makes its way onto the stem-cell hair transplantation scene it is unlikely to be a silver bullet. But it could one day initiate a radical revolution to hair transplantation – an effective and true one for those unfortunate few with no donor reserve.

Benefits of Stem Cell Hair Transplantation:

• Unlimited supply of hair follicles.
• Potential to treat severe cases of hair loss.
• Minimally invasive with minimal scarring.

Platelet-Rich Plasma (PRP) Therapy with Hair Transplantation
As is often the case with modern medicine, an adjunct to hair transplant is PRP (platelet-rich-plasma) therapy, which heals and encourages hair follicle growth. PRP is simply taken from a person’s blood, with the platelets concentrated when spun in a centrifuge. The growth factors in platelets are those which lead to healing and tissue regeneration.

PRP can be injected into the scalp before and/or after the transplant to speed up the healing and the life of the transplanted follicles. PRP is said to put dormant hair follicles into action and into the active growing phase.

Hence, PRP is not a hair transplant but used as a complementary therapy to the FUT (Follicular Unit Transplant) or FUE (Follicular Unit Extraction) procedure, it’s just hitching a ride. For the patient with thinning hair and at the early stages of loss, I like PRP therapy as an option.

Benefits of PRP with Hair Transplantation:

• Accelerates healing and recovery.
• Improves graft survival and hair density.
• Can be used as a standalone treatment for early hair loss.

Synthetic Hair Transplantation (Biofiber)
Hair transplantation process will be done on the patient after completely removing patient from head including all hair. Patients who are not suitable candidate for hair transplantation can also be benefitted from biological hair transplantation with Biofiber or artificial hairs. Those biological hair transplantation means, easily just synthetic hairs of fiber will be placed on the patient who is unsuitable candidate for hair transplantation for two different reason. First one is the patient who has very low density of bald area, not suitable to do hair transplantation. Second one is, patient is unable for to donate required number of grafts or follicular unit on scalp because of some sort of depression which is observed on the scalp or patient is having some medical problem, described as medical reason. Artificial hairs somehow motivated the blood circulation through facial area by giving vasodilatation effect of silicon fiber. Since silicon has bi-compatible property have close bounding with blood, artificial hairs can allowed for nourishment can reach through veins and arteries. The hair extracted from the body is attached to the glass mentioned in above figure. Hair Transplant Surgeon is able to set the color and texture of his choice.

One their most important advantages is that synthetics are immediate and the patient already sees the aesthetic effect while does not need the physiological growing cycle of natural hair. The disadvantage is that it doesn’t grow, the patient need to refresh the synthetic fibers every so often to maintain somehow the density, if the patient prefers.

Benefits of Synthetic Hair Transplantation:

• Immediate results with no need to wait for hair growth.
• Suitable for patients with insufficient donor hair.
• Customizable to match the patient’s natural hair color and texture.

The Future of Hair Transplantation
Further advances in hair transplantation are facilitated by new directions from an ever larger group of researchers made possible in large part due to techniques that make it more affordable:

Gene Therapy: Since genetic factor is a major cause of androgenetic alopecia, gene therapy is being studied where empirically the main genes responsible for this miniaturization of the follicular unit that causes balding can be targeted and sure in some metabolic changes, prevention of hair loss and sometimes, re-growth of hair becomes possible without the need for hair transplant surgery.

3D-Printed Hair Follicles: High-end 3D printing of artificial hair follicles might be developed in the future that can be implanted into a bald site of the scalp. Transplanted hair follicles will grow and behave like natural follicles.

Hair cloning – the search for ways to multiply follicles in the laboratory in order to transplant them back to the head – is an excitingly active field of development, with a clinically tested method hopefully coming to fruition at some point in the future.

But today’s influx of options provides another opportunity for those with hair loss to regain the hair-fueled swagger.