Avoiding Pitfalls in Planning a Hair Transplant (part 2)

Assessment of donor SupplyIn patient performs 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.  E 'know that one? The balding patterns evolve over time. What is less appreciated is that the donor area can be changed also.    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 in the future stability of the donor supply. The size of the donor is determined both by its width (height) and its length.  In the assessment of the potential breadth of the donor area, usually the doctors to assess the lowest point that balding achieved, ie the upper part of the area permanently. A, but it is equally important to pay attention to the bottom as well.  It is common for the hair thin considerably in the neck of the neck of a person ages, the production of a "growing hair."  As can significantly reduce the width of the donor area, no evidence that this process can occur should be taken into account in planning. A loss of points in time is another process that has a significant impact on the supply of donors. Not only Horten term potential donor band, but often ends up port significant baldness.    laxity of the scalp is another variable that affects the amount of hair available to donors. A very tight scalp significantly limit the amount of donor hair that can be removed from strip harvesting.  The restrictions imposed by a tight scalp is not always in the first session, but can affect the hair restoration in progress, and therefore should be carefully evaluated in the initial assessment of the patient. A very loose scalp can present its own set of problems that patients with loose scalp often heal with widened donor scar. [18]    The average density of a Caucasian donor is about 225 hairs/cm2. This can be easily measured with a hand tool called a densitometer. (2) When the density of a Caucasian is less than 180, a hair transplant should be done with great caution. In this author? You see, when the maximum density of donors is lower 150/hair mm2, a person generally should not be transplanted because there will be enough donor hair to do that on the surface meaning and the risk of a visible donor scar is too big. (3) Exceptions would be an elderly person with very limited expectations and where the normal density is lower (ie, Asians and Africans). A property of hair, especially hair diameter, are as important as the absolute number of hairs to determine the outcome of a proceeding.  The amount of trans plan table of the hair is tied to both the number of loose hair (depending on the size of the donor area, scalp laxity and donor density) multiplied by the hair section. Each hair on a person with coarse hair may be no more than 5 times the volume as a person with fine hair, the estimated (or actual measurement) of the diameter of the hair is important for the determination of the total donor supply.   miniaturization, a phased reduction of hair diameter and length (as a result of the action of DHT on the hair follicle) produces thinning on the front, top and crown of the scalp and characterizes the androgenetic alopecia. A, but the back and sides of the scalp can miniaturize so well and when a large part of a patient? The sensors are miniaturized, their hair in this area may be useless for a hair transplant. (Figure 1 and 2) This condition, called diffuse unpatterned alopecia (Dupa o) is the most common type of hair loss in women and is rare in men.  It is obvious that every patient, male or female, where a transplant treatment should be evaluated for sensor miniaturization using densitometry to ensure that the donor transplantation of human hair is stable. A receiver DemandOne must 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 lose their hair.  It's always better to consider the reasonable worst-case scenario when assessing the patient's bald as can be that the limited donor hair can be allocated properly. Although Norwood classification is useful for the implementation of the loss of hair, which is? Not take into account the real size of the scalp. Just as the donor site is the beneficiary must be measured.  even within a single class Norwood, there is a big difference between a patient with a narrow face and one with a very large head in relation to the actual area to be covered, and thus the number of grafts needed for recovery .  build Hairline hair POSITIONIN young, your hair is sitting just above the top face formed by folds of the upper limit of Frontalis muscle directly below it.  position normal adult male hairline is approximately 1. 5 cm in most of this week the midline). A common mistake is to place the new hair transplant on the position of young people, rather than appropriate for an adult. While the young patient, before hair loss occurs, can be considerable pressure on doctors to put their hair in the lower position, the physician must not yield to this demand.  In normal circumstances, such as a patient ages, the density decreases and the natural hair back slightly.  But a hair transplant is immutable. Therefore, when the transplanted patient continues to thin or bald (he will always be) the low drive before the hair begins to appear, because it is natural for a person with a reduction of the total volume of the hair were a little 'hair is gone, rather than a which is still capable of Youth.  ShapeA hair similar logic applies when you select a type of hair. A as a boy passes from childhood to adult, its wide and flat hair grows in a more streamlined temples without recession. AA persistently low hair widely enjoyed those too young to maintain their density. This situation is not in those who suffer from androgenetic alop, why a pot of hair transplants do not "of age and over time, and it seems unnatural as the patient? S decreases the total density, especially when the crown begins to thin.  If a person is older, has maintained a high density of donors, and has a low risk of extensive hair loss, hair is as wide as possible. A but is not the case for the person who starts bald at a young age, because it has a significant risk of extensive baldness and, more importantly, the scope of its future, hair loss may not be known at the time of surgery is planned.  Graft Distribution nuances transplant distribution and quantity of problems that arise due to the distribution of grafts in error is written outside of this, but there are two main issues, but that the hair transplant surgeon must be aware of the moment to decide whether to add slips. The first is that an area of coverage, taking into account the patient? Future balding patterns, as well as its total supply of hair donors.  The second is the weight of grafts, rather than distribute evenly the top of the scalp. The extent of problems CoverageThe to determine the amount of bald scalp a hair transplant should include can be illustrated as follows.  For example, take a patient whose total number of follicular unit grafts available for the collection is about 5500.  The front of the scalp has an area of approximately 50 cm2. At the beginning or middle of the scalp has an area of about 150 cm2 and the vertex or crown about 175 cm2. But the size of the bald crown can vary greatly depending on the extent of hair loss, which reaches more than 200cm2 Norwood Class VII patient.  If the front and top of the scalp was transplanted with the help of all patients donor hair density transplanted grafts/200cm2 only 5500 or 27. 5 grafts/cm2 (less than 1 / 3 the density of the patient? Initial hair). If the crown were also the subject, it would be 5500 grafts/400cm2 or 12. 5 grafts/cm2 (only 15% of the density of the patient? Initial hair).  Using various
manipulations, how to create different densities in different parts of the scalp, a good surgeon can do 1 / 3 of the total density similar to a lot of hair. But to work with only 15% of the initial density, it can do the job of creating a natural appearance far more difficult if not impossible. Â Â Â Â The way to avoid a hair transplant with a look that is too thin or see through, is to limit the scope of coverage on the front and mid-scalp until a donor supply and a limited balding patterns may be somewhat 'Lunda-a sure guarantee that only the age of the patient. Â Until then, it is better not to add the crown. Â Â Another problem with the crown at the top transplant is that the crown expands further hair will be required to comply with the expansion of baldness luck, just to maintain the first hair transplant seems natural. This may require a considerable amount of hair that will not be available to cover the front and center of the scalp, if it was too bald, too. On the other hand, if the hair transplant has been limited to the top of transition or VTP (see photo above), the restoration would naturally without surgery, no matter how much hair loss in the crown developed. The reason is that the front and top of the scalp represents a complete unit with cosmetic VTP as a natural boundary back – and it is therefore natural for the hair to cover this region of the scalp, but not thereafter. Â density GradientsAnother for surgeons to prevent a thin see through the look is to avoid the distribution of grafts transplanted on the surface evenly. It 'goes without saying that only 1-hair grafts should be used in hair, with larger grafts behind them, but there are other ways to produce gradations of density to mimic the way hair grows in nature. In particular, the maximum density should be the front of the scalp (in brown) and especially in the front MANE zone (dark brown). The increased density at the front of the scalp MANE zone can be created in two ways, placing the recipient sites closer together in this location and the use of larger follicular units in the area (ie 3-4 and – this device rather than 1s and 2s). Â These techniques can be used in combination to achieve greater density, but that will be discussed in the following sections, if done to excess, could threaten growth. Â Â SummaryFollicular unit hair transplantation is a powerful technology that allows the surgeon to restore natural hair to create designs and produces results that mimic nature. The success of the procedure depends greatly on the proper selection of patients, evaluate the patient accurate? Donors supply and distribution of grafts in a manner appropriate for a person who will continue to age and, finally, thin over time. With thoughtful planning, large errors can be avoided and our patients will be able to realize the full benefits of this extraordinary procedure. Â 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 microscopic analysis of controlled injury 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. Â Am J Psychiatry, 2006; 163:1280-82. A 18. Bernstein RM, Rassman WR. Paradox laxity of the scalp. Hair Transplant Forum International 2002, 12 (1): 9-10.