Avoiding Pitfalls in Planning a Hair Transplant (part 1)

Although many technical advances have been made in surgical hair restoration in the last ten years, particularly with the widespread adoption of follicular transplantation, many problems remain. Most revolve around doctor recommends surgery for patients who are not good candidates. The most common reasons why patients do not have to proceed with surgery is that they are too young and that their hair loss pattern is too unpredictable. Young people also have expectations that are typical of high – often demanding density of hair and a teenager. Many people who are in the early stages of hair loss should be treated with drugs, instead of being rushed to go under the knife. And some patients are simply not ready for a realistic decision when their problems are so emotional. In general, the younger the patient, the operator should work more prudent, especially if the patient has a family history of Norwood Class VII hair loss, or a diffuse-patterned alopecia. Problems also occur in the physician fails to properly assess the patient? Donors provide the hair and then not have enough hair to reach the patient? S objectives. Accurate measurement of a patient? S density and other characteristics of the scalp allows the surgeon to know exactly how much hair is available for transplantation and allow him / her to design a model of recovery can be achieved within these constraints. In all these situations, spending some 'time to listen to the patient? Gold, examines the patient more carefully and then recommend a treatment plan that is consistent with what may actually happen, it will be a long way to have happy patients. Unfortunately, scientific progress will improve only the technical aspects of the restoration of hair and will not be certain that the procedure will be performed with the right planning, or at the appropriate patient. Five years ViewThe improved surgical techniques that have enabled an increasing number of transplants made in small recipient sites has almost reached its limits and limitations of the donor supply is still significant barriers for patients to return to full head of hair. Despite great initial enthusiasm follicular entity extraction, a technique in which hair can be collected directly from the donor scalp (or body) without linear scars, this procedure is relatively little to enhance the patient? Total supply for the transplantation of human hair. The big breakthrough will come when the donor can be increased, even if cloning. Despite some recent progress in this area (particularly in animal models) the ability to clone human hair is at least 5 to 10 years in the future. Key Questions 1. The biggest mistake a doctor can do to treat a patient with hair loss is to do a hair transplant on a person who is too young, in general, expectations are very high and the model of future unexpected hair loss. 2nd Chronic exposure to the sun on one? S's life is very significant negative impact on the outcome of transplantation of hair of peri-operative exposure to the sun. 3rd Bleeding diathesis, large enough to affect the operation can usually be recovered in the patient? S history, but OTC medicines are often unreported (like the non-steroidals) and asked to be specific. 4th Depression is probably the most common psychiatric disorder found in the patient? S looking hair transplant, but is also a common symptom in people exposed to hair loss. The physician must distinguish between a reasonable emotional reaction to baldness and depression requiring psychiatric counseling. 5th In performing a hair transplant, the physician must balance the patient? S current and future needs of the hair with the current and future availability of the donor supply. And 'know that one? The balding patterns evolve over time. What is less appreciated is that the donor area can be changed also. 6. The patient? Donors supply depends on a number of factors, including the physical dimensions of the area permanently, scalp laxity, the density of donor hair characteristics and, especially, the degree of miniaturization of donors in the sector – because it is a window to the future stability of the donor supply. 7th Patients with loose scalp often heal with widened donor scar. 8th You should never assume that a person? S hair loss is stable. Hair loss tend to evolve over time. Even patients who show a good response to finasteride will be losing their hair. 9th The position of hairs normal adult male is about 1. 5 cm above the upper face lift. Avoid placing the new hair transplant on the position of young people, rather than appropriate for an adult. 10th One way to avoid a hair transplant with a look that is too thin, is to limit the scope of coverage on the front and mid-scalp until a donor supply and a limited pattern baldness can be reasonably sure – a statement that can come only after the patient's age. Until then, it is better not to add the crown. Introduction to hair transplantation has been around as a treatment for hair loss in over 40 years. [1] With a majority of the time, hair transplantation has been characterized by the use of candles, slot-shaped grafts, flaps and micro mini-grafts. Although these were the best tools available to doctors when they have not been able to deliver consistently natural. With the advent of follicular unit transplantation (FUT) in 1995, finally, doctors are able to produce these results natural. [2] But the mere possibility of producing them does not necessarily mean that these natural result actually be achieved. Il fut procedure presented new challenges for the hair restoration surgeon, and only when it was really planned and implemented, the patient would really benefit from the power of this new technology. [3] The ability of follicular unit grafts to imitate nature soon gave results that were not completely. This unit features Follicular Hair Transplantation. [4] Equally important, however, has preserved – an exchange of correspondence between what is collected from donors and grow into what ultimately the recipient of the scalp. Since a finite donor supply is the main obstacle in the transplantation of human hair, hair Conservation is a fundamental aspect of any technology. But unlike the old methods used large grafts, follicular unit sensitive easily traumatized and very susceptible to dehydration, which makes the procedures of follicular unit transplantation, where thousands of grafts, particularly challenging. [5] of this writing, the vast majority of hair transplants in the United States using follicular unit transplantation techniques. Due to limited space, this review will focus exclusively on this technology and not the old procedure. Nor will focus on the follicular unit extraction, because this technology is still in development and how to avoid the major pitfalls of this procedure has not yet been implemented and an object in itself. As the title suggests, this paper will focus on the prevention of various problems in the fut, rather than its treatment – an equally important but one that is already covered by a comprehensive review. [6, 7] For those not familiar with follicular unit transplantation, there is a brief overview of the subject text in dermatology skin surgery [8]. For more detailed information on various hair transplant textbooks have sections devoted to this technology. [9, 10] The most common types of problems that arise in the fut procedures can be divided into two main categories, those involving defects in the design of transplantation of hair and those caused by errors in surgical technique. Of the two, the lack of planning often leads to very serious consequences for the patient and will be the subject of this document. Selection of patients AgeThe single biggest mistake a doctor can do to treat a patient with alopecia perform a hair transplant on a person who is too young. Although there is no specific age that can serve as a cut (such as this can vary from person to person), to understand the problems associated with the procedures for restoration of hair in young people can help to determine when the doctor may be appropriate surgery. A
few mistakes can literally destroy a young person? Life. When someone starts to lose hair in their teens or early 20s, there is a good chance that he (or she) can be substantial bald later in life and that the donor may become thin and see-through over time. While miniaturization (reduced diameter of the hair) in the donor is a first sign that this might happen, and can be recovered by densitometry, these changes may not be evident when a person is still young. If a person would be very bald (becoming Norwood Class 6 or Class 7), he often is not enough hair to cover his crown. A graft of the scalp with a thin or balding crown is a model acceptable to an adult, but totally inappropriate for a person in his twenties. [11] Furthermore, if the donor area thin with time, the donor scar can be visible if the hair was worn short – a style that is much more common in people who are young. ExpectationsThis is closely linked to age. For surgical hair restoration is to succeed, it must correspond to the expectations that things can happen in reality. Expectations of a couple is usually to return to their appearance was like a teenager, to have a large apartment and have all the hair density had only a few years earlier. The problem is that a hair transplant does not create more hair (and therefore can not increase the density) or to prevent the further loss of hair (so that the design must be suitable for persons ages). But then, the temple and a thin crown is not acceptable to find a young, surgery should be postponed for one person where this is not acceptable. As a person ages, which often becomes more realistic and are satisfied with what a hair transplant can actually achieve. And with the passage of time, if a person? S donor is found to be stable, and his loss of hair limited, more ambitious targets. Sunday chronic ExposureAlthough the common wisdom to avoid burns after a hair transplant, in fact, significant chronic exposure to the sun on one? S's life is very significant negative impact on the outcome of transplantation of hair in which peri-operative exposure to the sun. Actinic damage alters collagen and elastic fibers so that the transplants do not understand it safely and modification of the vascular system reduces the ability of the recipient of the transplant tissue for support of a large number of transplants. Even with the very small recipient sites in follicular unit transplantation, making the sites too close may be affected in a system of blood supply and result in poor growth. Another problem is that a hair transplant to cover the damage and areas Sunday cancer detection more difficult. When actinic finally addressed the related parts of the growth of hair transplantation will be destroyed. The best way for a person with a significant injury Sunday, the first is to treat the entire scalp with aggressive 5-flurouracil remove all pre-cancerous changes before hair transplantation is planned. You must wait at least 6-12 months after treatment for the scalp to heal completely, because the tissue becomes brittle at this time. Although this treatment operations can set more than a year will translate into better graft survival and fewer problems with future detection of skin cancer. MedicationsAlthough medical conditions and not necessarily an absolute contraindication for surgery, a number of pathological conditions make the procedure of follicular unit hair transplant more difficult and must be considered. When significant medical conditions, you should always consult a medical clearance from the patient? A primary care physician or appropriate specialist. Since the scalp is very vascular fut procedures and require a large surgical team, patients who are known to have the blood of pathogens such as HIV and hepatitis B and C, have an increased risk for staff, even if the general precautions used. It 'a good thing if the team is aware of the medical history of patients undergoing hair transplant so they can continue with a higher degree of alarm in case of need. In an HIV-positive patient, it is important to ensure that patient? S immunity was sufficient, so that the patient does not have an increased risk of infection. When the patient? S with hepatitis, it is important to assess their liver function so that the dosage of medication is appropriate. Patients with diabetes mellitus may be at higher risk of having a peri-operative infection. In this case, the rule that most transplant aseptic conditions can be changed to run on a modified sterile technique (modified in the sense that it is difficult for the preparation of the scalp). This must also be seen in patients with valvular heart disease, and other facilities where the bacteria may have sown the most serious consequences. Treated with antibiotic coverage should be even in individuals at high risk, even if you do not need routine hair restoration procedures. [12] A bleeding diathesis, large enough to affect the operation can usually be recovered in the patient? S history, but the drugs are often under the radar and should be made for specifically. Patient? Often it is not that the relationship with aspirin and that must be restored, as well as other non-steroidal anti-inflammatory drugs. Plavix, in particular, can significantly increase bleeding during the procedure. Alcohol, of course, also increase the bleeding. [13] may make changes in a patient? The anti-coagulant in conjunction with their regular doctor or cardiologist. As a general rule, you should stop anti-platelet drugs one week before the transplantation of human hair, but the time may vary depending on the specific drugs, the size of the procedure, and the importance of the drug to the patient? Health. They may be taken three days after surgery. If anticoagulation can not be stopped, it may be reasonable to continue with a small meeting. Since epinephrine is used in most of the procedures for restoration of hair, if a person has a history of arrhythmias or other heart disease that may be aggravated by epinephrine, a doctor by the patient? A primary care physician or cardiologist should be obtained. Epinephrine may also interact with a wide beta-blocking agents such as propranolol, which causes a hypertensive crisis, so it is better to have the passage of the patient to a selective beta-blockers for the transaction. [14] A number of modifications can be used during the procedure to control bleeding and reduce the need for epinephrine. Among the most useful, is to disperse the recipient is in principle the sites in the area to be transplanted (allowing extrinsic coagulation pathway start) and then fill in areas with more seats when the bleeding has slowed. [15] If the patient has had seizures, it is important not to discontinue the drug for the approval procedure and that medical services. It should also be remembered that otherwise normal patients may have a vaso-vagal episode during the procedure, particularly under the administration of local anesthetic. This can be avoided by immediately placing the patient in Trend Elen Berg as soon as the patient complained of nausea or start to sweat or look pale. Patients should be monitored with a pulse oximiter if a large amount of sedatives and other respiratory sedation. Patients should be closely monitored to ensure that local anesthetic administered certain amount and that the warning signs of lidocaine overdose are well known to all members of the surgical team. [16] Finally, it is good to have a pre-printed with all the drugs and their doses commonly used during the procedure. This can be administered to the patient? S regular doctor when seeking medical attention. Psychological factor hair can take a psychological weight of a person? S self-esteem and cause great emotional distress. When a person has the basic psychological problems, the consequences can be severe and therefore the management of hair loss much more difficult. It 'important to identify these problems and other psychological factors may play a role in a patient? Ability to clearly understand is the hair restoration and its expected results. In some cases, counseling can be done in conjunction
with the restoration of hair, but often must precede the treatment, especially when there is a surgery. It is wise to get the green light for the operation of a psychiatrist or clinical psychologist, when there is a history of mental illness, or if you suspect at the time of consultation. A number of psychiatric conditions is particularly important for the success of a hair transplant. These include Trichotillomania, obsessive compulsive disorder (OCD), Body dysmorphic syndrome (BDS), and depression. Trichotillomania is a relatively common condition characterized by the constant need to pull out of one? The hair. The most commonly involves the scalp hair, but may involve the eyelashes, facial hair or other body hair. It often results in bald patches and can be identified by the short hairs in the affected area, which is not sufficient to grasp. Active trichitollomania on any part of the body is a clear counter-indication for a hair transplant, but if a person has a history of this condition, the physician should also be cautious and only surgery, if the therapist is convinced that the condition is unlikely to recur. Obsessive-compulsive disorder (OCD) is a condition characterized by recurrent, intrusive thoughts (obsessions) and related behaviors (compulsions), which attempt to neutralize the stress and anxiety caused by obsessions. The consultation OCD patients often ask a litany, and often ask the next question before you hear the answer to the previous year. OCD patients are very difficult to achieve, and even in a very successful hair transplantation can focus on a smaller gaps seem oblivious to the good overall result. Body dysmorphic disorder (BDD) is a mental disorder that involves a distorted picture of one? Body. The person who is very critical to their physical self, even though there may be actual errors. It should be obvious that patients with BDD are not satisfied with a hair transplant, or other forms of cosmetic procedures and the conditions are best treated by a psychiatrist rather than a surgeon. Another warning is that patients with BDD are much higher for suicide than the general population, even greater than patients with depression. [17] Depression is probably the most common psychiatric disorder found in the patient? S looking hair transplant, but is also a common symptom of those who have hair loss. The physician must distinguish between a reasonable emotional reaction to baldness and depression requiring psychiatric counseling. It 'important to realize that a hair transplant will be ineffective in treating depression in medical and unfulfilled expectations can lead to a deterioration of the situation. References 1. Reich pure N: Autografts in alopecia and other selected dermatological conditions. Annals of the New York Academy of Sciences 83:463-479, 1959. 2nd Bernstein RM, Rassman WR, Szaniawski W, Halperin S: follicular transplantation. Int J Aesthetic Restorative Surgery 1995, 3: 119-32. 3rd Bernstein RM, Rassman WR: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84. 4th Bernstein RM, Rassman WR: Follicular Transplantation aesthetics. Dermatol Surg 1997; 23: 785-99. 5th Gandelman M, et al: Light and electron microscopy analysis of injury control follicular unit grafts. Dermatol Surg 2000; 26 (1): 31. 6. Bernstein RM, Rassman WR, Rashid N, Shiell R: The art of repair in surgical hair restoration – Part I: the repair of the basic strategies. Dermatol Surg 2002; 28 (9): 783-94. 7th Bernstein RM, Rassman WR, Rashid N, Shiell R: The art of repair in surgical hair restoration – Part II: The tactics of repair. Dermatol Surg 2002; 28 (10): 873-93. 8th Bernstein RM, Follicular Unit Hair Transplantation. In: Robinson JK, Hanke CW, Siegel DM, Sengelmann RD, editors: Surgery of the skin, Elsevier Mosby, London United Kingdom. 2005. 9th WP Unger, R. Shapiro hair transplant. New York: Marcel Dekker, Inc. 2004. 10th Bernstein RM, Rassman, WR. Follicular unit transplantation. In: Haber RS, Stough DB, editors: Hair Transplantation, Chapter 12. Elsevier Saunders, 2006: 91-97. 11th Norwood OT. Male pattern baldness: classification and frequency. Così. Con. J 1975, 68:1359-1365. 12th Haas AF, Grekin RC: treated with prophylactic antibiotics in dermatologic surgery. J Am Acad Dermatol 1995; 32: 155-76. 13th Otley CC. Perioperative evaluation and management in dermatologic surgery. J Am Acad Dermatol 2006; 54: 119-27. 14th Gandelman M, R, Bellio, Barretto M: Beta-blockers and local anesthetics with vasoconstrictors: A dangerous combination. Int J Aesthetic Restorative Surgery 1995; 3 (2): 143-45. 15th Bernstein RM, Rassman WR: Limiting epinephrine in large sessions of hair transplantation. Hair Transplant Forum International 2000, 10 (2): 39-42. 16th More ski RA, Patterson JD, Tomsick, RS: Local anesthetics. Dermatol Surg 1996; 22:511-522. 17th Phillips KA, Menard W: Suicidality in body dysmorphic disorder: a prospective study. Am J Psychiatry, 2006; 163:1280-82. 18th Bernstein RM, Rassman WR. Paradox laxity of the scalp. Hair Transplant Forum International 2002, 12 (1): 9-10.