"Recharging donor" area which is also known as "Donor sealing" even
called "Donor Farming" is not new by concept and some surgeons have even
practiced this in past. The typical indication would be
1. When
surgeon has by poor & aggressive planning over harvested a particular
area of donor scalp and that looks thin compared to other parts of donor
area. The best way to recharge is to take anagen BHT. When well
performed there is no reason why BHT would not grow.
2. When the shock loss has occurred in donor area where hair does not grow back
3.
when patient wants to keep the hair very short and want to avoid
visibility of dotted scars. The transplanted BHT will bring back the
pigments to the donor area and reduce the visibility
4. It may be
useful esp. if someone wants to intentionally over harvest good quality
scalp donor hair for better cosmetic result in the front and therefore
replace donor with BHT instead of using BHT at the front or top.
More over when donor recharging done in the fresh wound immediately after extraction would cause higher chances of BHT growth rather than recharging done in the previous FUE scar with reduced blood supply.
Toppik, Dermmatch or Nanogen are the Hair cosmetics or concealer which by static adhesion to the existing thin hair will thicken the hair and also by covering the skin reflect no light there by it can give the better cover and volume to the hair thinning area.
It may have some value in early thinning
and in post hair transplant early growth
phase.
They are very inert material and would not harm your skin and hairs even on long term use. You can get more info on www.toppik.com , www.dermmatch.com or www.nanogen.com. They can easily be removed on shampoo wash.
Because these products are directly available on their website located abroad when some people in India may want to buy this in India following is the contact details in India:
1. Toppik powder in
India: http://www.nutraskyncare.com/
Midas Chamber 301,
Opp. Laxmi Industrial Estate,
Off New Link Road, Andheri ,
Mumbai – 400053.
Tel: 0226740022/32428898E-mail:- sales@nutraskyncare.com
Iron deficiency is defined as having a ferritin level of under 40ng/ml or iron
saturation of Ferritin under 20%.
Iron deficiency is the most common cause of Chronic Telogen
Effluvium ( CTE) in premenopausal women ('During one period, a woman will
lose around 10-15 mg of iron, while throughout a pregnancy around 600-1000mg
will be lost) . 72% of women in the premenopausal group were found to have iron
deficiency as the cause of Chronic Telogen Effluvium (CTE).
In postmenopausal women; medications are the most common cause of
telogen effluvium.
The
loss of this ferritin from the follicle cells can affect the ability of the
hair to grow. This leads to the development of vellus (non pigmented fine
hairs), which can be an early indication of deficiency. The presence of vellus
hairs is easily mistaken for miniaturized hair seen in androgenic alopecia. We
should note here that Iron deficiency hair loss could therefore mimic the
pattern of androgenic alopecia hair loss.
When low ferritin
levels and female hair loss coexist, the patient is most likely diagnosed with
Chronic Telogen Effluvium, or CTE. This hair loss condition usually occurs in
women of childbearing age (18-50 years old), and results in evenly-distributed
hair loss. Women with low serum ferritin hair loss usually notice one of two
things:
Increased loss of hair during shampooing or brushing.
Less density of hair, as in a thinner feeling ponytail,
or less hair to clip back.
If iron levels
are insufficient to maintain blood health, the body "robs" iron from
other cells. Since hair is not as essential to the body as is blood, the body
often sacrifices the less important function of hair growth for the essential
function of blood maintenance.
It is
important to note that hemoglobin is the standard measure for iron in the
blood, and while hemoglobin levels can diagnose anemia, they do not always
correspond with low serum ferritin hair loss. A woman can have plenty of
hemoglobin, yet still suffer from low serum ferritin levels
Rushton suggests that serum
ferritin concentrations of 40 ng/mL or greater are required for maintaining
good hair while 70ng/ml is required for regrowth
Iron metabolism
Total body iron averages
approximately 3.8 g in men and 2.3 g in women.
Typically about 65% of the iron
is in hemoglobin (in red blood cells) and about 4% in myoglobin (in skeletal
muscle). About 30% of the iron in the body is stored (as ferritin or
hemosiderin) in liver, bone marrow, and the spleen other tissues cells. A small
percentage of the body's iron is in transport between various compartments of
the body (in association with transferrin) or is a component of enzymes in
cells throughout the body.
Ferritin is a protein complex
that contains about 23% iron. It's formed in the intestine when iron unites
with a special protein called apoferritin. It is then stored in the body's
tissues, especially the liver, spleen, and bone marrow.
Iron
Deficiency and Ferritin:
Iron is stored mainly in the
liver, within the iron storage proteins ferritin and hemosiderin. Iron
stimulates the liver to make ferritin, and serum ferritin provides a reliable
estimate of body iron stores. Ferritin is a
protein found inside cells that stores iron so your body can use it later. Some
Ferritin is released in the blood when the cell uses the iron. The amount of
ferritin in your blood (serum ferritin level) is directly related to the amount
of iron stored in your body.
The fall of iron stores normally
passes through several stages: lowered iron stores, iron depletion and iron
deficiency anemia.
1) Lowered iron stores: This is indicated when the iron stores are
reduced but not exhausted. No clinical effects are detected.
2) Iron depletion: Shows up in laboratory
tests. Hemoglobin concentration may be well below ‘normal’ for that
individual’s reference range. This can be detected by Ferittin Test.
3) Iron deficiency anemia: No iron
is left remaining in the bone marrow. Hemoglobin production falls to the point
where concentration is well below the reference range.
It
is important to note, therefore, that iron deficiency (low iron stores, i.e.
low ferritin) can occur even if the patient is not clinically anemic and has
normal haemoglobin levels
The deleterious effects of iron deficiency
are partly due to impaired delivery of oxygen to the tissues and to a
deficiency of iron-containing compounds. Clinical features include restlessness
and irritability lower IQ scores in adolescent girls fatigue in nonanaemic women,
and abnormalities in response to infection and impaired T-cell proliferation.
It is believed that as people
have reduced or do not have red meatintake
There may be a number of reasons why the
amount of iron absorbed is not sufficient. Firstly, only about 10% of ingested
iron is absorbed into the blood each day, and this is dependent on the type of
food in the diet. Certain foods may
inhibit the absorption of iron, such as tanins
found in tea and coffee, also bran
and egg albumin.
One can lose iron by: intestinal
bleeding, excessive menstrual bleeding, poor digestion, long-term illness,
ulcers, and heavy use of anti-acids. [Irritable bowel syndrome too]
Controlling
iron deficiency
You can maximize your iron absorption by
eating a combination of iron-rich foods such as red meat, green, leafy
vegetables, shellfish, egg yolk, nuts and cereals with food or drinks that are
high in vitamin C for example, a glass of freshly squeezed orange juice. Avoid tea until at least an hour after
eating as it contains tannin, which interferes with iron absorption.
One method of controlling iron deficiency in the body is to stimulate the liver
to synthesize ferritin, the protein that stores iron in order to maintain the
correct balance. Hair follicles are known to contain ferritin, and when the
circulating stores of ferritin decline then these stores are called upon to
ensure support for more essential cells, such as bone marrow.
Treatment:
1.Eat a balanced diet that includes plenty of iron. Sources include red meat,
spinach, broccoli, prune juice, kidney beans and chickpeas.
2.Add Vitamin
C-rich foods
to your diet to help boost absorption of iron: Vitamin C sources are citrus
fruits and juices, berries, green peppers, tomatoes, broccoli and spinach.
3.Iron supplementation. The use of an
iron supplement may help low ferritin hair loss by adding more iron to your
system. The rationale for iron supplementation is that once the serum level is
raised to the necessary threshold point, hair growth will resume. However, one of
the biggest drawbacks to this type of treatment is that it takes a long time,
because ferritin levels must be increased gradually. Allow 2-3 months for hair
to stop shedding, and 6 - 12 months for new hairs to become long
enough to make a visible impact.Woman
usually needs between 18 and 30 mg daily Excess iron can accumulate in the body. This increases the risk of
heart disease, cancer, and some other conditions that are worse than hair loss.
Many people find that eating red meat is a better option than pills when serum
ferritin levels are low. The iron in red meat is absorbed well.
"If you need to take iron
supplements, do not take them at the same time as vitamin E, Antacids, tea or coffee. And choose
an organic form of iron such as ferrous gluconate or ferrous fulmerate.
Inorganic forms of iron, such as ferrous sulfate, can oxidize vitamin E. Only about 10% of ingested
iron is absorbed into the blood each day, and this is dependent on the type of
food in the diet. Take after food to reduce GI side effects. Continue treatment for 3 months after the hemoglobin reruns to normal so as to ensure replenish the storage.
The
Pattern loss is genetic hair loss where the hairs at the top central
and horse shoe shaped are is where the hairs gradually miniaturize and
die because these hairs are Genetically Hormone (5DHT) sensitive. This
is the reason this hair loss is also called Andro Gentic Alopecia (AGA).The hairs at the back and side of the head are permanent and are resistant to this effect of 5 DHT hormone.
When
the head is developed from embryo the frontal and parietal bone area of
the head has migrated Neural crest tissue but the occipital and
temporal bone area ( back and side of the head ) does not have this
tissue of origin. It is believed that certain genes responsible for AGA
affect only these hairs which are having Neural crest origin and the
area at the back and sides escape the effect of these genes. As a result even if this hairs transplanted in the front they keep growing because they remain unaffected by 5 DHT.
The analogy is it is not the problem of the land but the seeds are bad in the front and when the good seeds from the back of the head are planted in the front they grow normally because the land is fertile.
It has been shown recently that some
hair loss is related to higher Serum Prolactin level.
An abnormally high level of prolactin (hyperprolactinemia) is a
condition characterized by elevated serum levels of the hormone prolactin in
non-pregnant individuals. Hyperprolactinemia may cause progressive pattern hair
loss due to an indirect effect on increasing free testosterone level. Prolactin also enhances LH (Luteinizing Hormone) receptors in
Leydig Cells, resulting in testosterone secretion, which leads to
spermatogenesis.
Prolactin delays hair regrowth in mice. It has been shown in research that Treatment of
organ-cultured human scalp HFs with high-dose PRL (400 ng/ml) results in a
significant inhibition of hair shaft elongation and premature catagen
development, along with reduced proliferation and increased apoptosis of hair
bulb keratinocytes. Human scalp hair follicles are both a target and a source
of prolactin, which serves as an autocrine and/or paracrine promoter of
apoptosis-driven hair follicle regression.
Conditions associated with
elevated prolactin secretion
Hyperprolactinaemia is the term given to having too-high
levels of prolactin in the blood, which can result from:
Excess thyrotropin-releasing
hormone (TRH), usually in primary hypothyroidism stimulates prolactin
secretion
Many antipsychoticAnti depressant medications
Increased
Emotional stress
Pregnancy
and lactation- Oxytocin sectreion by nipple stimulation releases Prolactin. Estrogens
provide a well-studied positive control over prolactin synthesis and
secretion, and increasing blood
concentrations of estrogen during late pregnancy appear responsible for
the elevated levels of prolactin that are necessary to prepare the mammary
gland for lactation at the end of gestation.
Some sexual
disorders
PCOS (
POLY CYSTIC OVARIAN SYNDROME)
It has also been shown that
prolactin levels after sex are 4x higher than prolactin levels after
masturbation but these hormonal changes are very short term and does not
affect hair loss
daylight
exposure significantly alters prolactin levels. This temporary increase in
the number of telogen hair follicles
Dopamine released by
Hypothelamus in turn inhibits
Prolactin.
Treatment:
In one of the studies at Argentina Prolactin Inhibitor like
Bromocriptine (dopamine receptor agonists),
Quinagolide, Pergolide, Cabergolidehave been
shown to help those with Hyperprolactinemia and have not been benefited
otherwise.
Well there is religious reasons why many people tonsure there head ( in Hindus at times it a sacrifice of symbol of aeasthetics esp. in females). But it is a common belief esp. in some parts of India that if you are losing hair and have thin baby hairs and if you repeatedly shave your head you may grow new hairs or better hairs.
Well shaving or tonsure is only external to skin and does not directly affect the roots which are responsible for the hair growth. The hairs outside the skin does not get the blood supply or nutrition and does not even have any repair capacity and may even be affected by environment.
By removing the outside hairs you are not actually stimulating hair follicle to grow hair. As in case after of shaving of the beard hair the initial stubble feels thorny strong and sharp the initial hair growth after shaving of the head feels thorny sharp and that has perhaps given this belief. But within few days again when the hairs grow little longer that feeling disappears.
Perhaps the benefit of shaving head is the ease of using or applying Minoxidil. Other thing is the illusion of less hair fall because the small hair are not visible when they fall but the long hairs are apparently visible. So person with shaved head or short hair may be psychologically benefited.
In some religion young babies are tonsured with the belief that it will grow new or better hairs. This is not true. In many religions they do not tonsure/shave off their child's hair. At 1 year, the babies usually get mature hair with baby hair falling off. On the other hand, it is know of kids who still have baby hair even
after a few tonsures. Shaving does not help hair growth is controlled by genes and hormones.
In the Strip Surgery (FUT /FUSS) after removal of the hair bearing strip of skin from the back side the gap is closed by stitches or by staplers. Well the suture mark or linear scar due to this remains permanently in the donor area and very often remains visible if the hairs are kept short or the scar becomes wide.
This linear scar does not grow the hair and therefore the scar visibility of this hair less line is more with wet hair, oiled hair or short hair.
Trichophytic closure is a special technique of closure of the gap. The advantage of this closure is the linear scar of stitches will grow the hairs though it and therefore the line has a better concealing capacity even when hairs are short or wet. This is because the technique brings the hair roots ( Follicular Units) under the stitch line; as a result the hairs grow through the linear mark.If done properly, and the outcome successful, the hair growing through the scar will camouflage the typical straight linear appearance of the scar. What this means is that the scar will still be present but less visible. The quality of the scar may also improve with this closer.Generally, after the fourth post-operative month, trichophytic closure yielded better cosmetic results than subcutaneous closure.
There are 4 methods which involves trimming off the upper edge of the incision and then closing the wound in such a way the hair near the edge can grow through the scar.
The skin is de epithelized to less than 0.5 mm so as not to damage the sebaceous glands and stem cells close to bulge and remove the burial of epithelium ( Best executed by Dae-young Kim technique) 1. Upper edge (Marzola)
2. Lower Edge
( Fretchet) 3.
Lower edge ledge ( step) shaped trimming ( Paul Rose) 4. Both upper and lower edge trimmimng (Kazuhito Yamamoto)
Well some times because of partially cut Follicular Units at the edge of the wound cyst formation may be a problem in this closure. If due to fibrous skin or tension on the wound the scar line become wide the Trichophytic closure becomes ineffective in its purpose.when the hair is growing through the scar during the healing phase, there may be more inflammation and discomfort, ingrown hair, itching, scabs, numbness, pain, peri-lesional redness and edema as compared to the standard closure.It is a good policy to prefer not to use a trichophytic closure when it is anticipated that you will need several strips harvested over the long term, preferring to use the trichophytic closure on the “final” procedure.
It is not likely that the person will be able to shave their head without any apparent difference between the strip site and the non-scarred skin in the area. The reason for this is that the scar tissue is still somewhat different in appearance from non-scarred skin and there is a subtle but definite change in the direction the hair that grows through the scar making the scar line stand out from the surrounding scalp.It becomes very difficult sometimes to use this technique when the pt. has had previous work and we are struggling to obtain enough grafts and still be able to close the incision without excessive tension. Since you have to overlap the incision by 1-2 rows of follicles, there has to be enough elasticity to safely close the incision. If there isn't, the patient must decide what is more important too him, more grafts or a trichophytic closure. the trichophytic closure transects hair follicles this results in no better than a 60% survival rate in the donor area scar. It kills hair. It has been also claimed that the trichophytic closure is a sales tool for strip surgery for those who do not want to offer FUE.
At the 2nd Annual scientific meet of Association Hair Restoration Surgeons (AHRS) of at Mt. Abu ON 11TH SEPTEMBER DR. Mahadevia presented his 2 PAPERS 1. various techniques and instrumentation of FUE ( FOLLICULAR UNIT EXTRACTION) and 2. Can FUE megasession replace Strip method in Future?
Both papers were highly appreciated by eminent faculties from India and Abroad and Dr.Mahadevia was personally congratulated by many about the high quality of the papers.
The PowerPoint presentations can be viewed here
According to the study published in
the July issue of Nature the professor of dermatology and genetics at
Columbia, Angela Christiano et al have found
a connection between the gene called ULBP3 on Chromosome 3 and the
Alopecia Areata recently. This gene is normally not found in the hair follicles
but it was observed that ULBP3 proteins were found in high concentrations in
hair follicles affected by alopecia areata. ULBP3 attracts immune cells (called
cytotoxic cells, Natural Killer or NK Cells)
receptors called NKG2D . If an infection is present in the body, cytotoxic
cells can help fight the infection or
destroy damaged cells, but if there is no infection or damage, these immune
cells end up attacking healthy tissue. These genes ULBP3 are already associated
with a number of autoimmune disorders, including type 1 Diabetes & Rhematoid Arthritis.
Two other genes were also expressed
in hair follicles, while the remaining five genes were involved in immune
system response.
The researchers discovered that the number of
alopecia-associated genes a person had correlated with the severity of the
condition. Those who carried 16 or more genes (the genes are in pairs) were
more likely to progress to alopecia universalis, or total hair loss.
In people with alopecia, immune
system T cells are present in large numbers in the hair follicle. Microscopic look
is like the hair follicle is being attacked
by bees, which are the T cells. Among
the eight genes, one in particular -- ULBP3 -- has been shown to attract toxic
cells that can invade and destroy an organ. In a person without alopecia, ULBP3
is turned off. But in people with
alopecia, ULBP3 proteins are plentiful in the follicle.
In people with alopecia areata, a
huge expression of the ULBP3 gene in the outermost layer of the follicle is
seen as per Christiano. ULBP3 is a
danger signal that signals to T cells to come in and attack the follicle. It's
like putting nectar on the hair follicle, and then the 'bees' come in and do
their damage.
When the follicle is attacked, the
hair falls out. If the T cells remain, which they do in alopecia areata, the
follicle goes dormant.
The mechanism of genes pathway in
Alopecia areata has opened a new vista of developing the new drug for this
disease that affects over 5 million people only in America the disease is life-altering - sufferers,
especially children, experience social stigma. It affects their quality of life
and can lead to long-term psychosocial impact.
More over ULBP3 genes might work as
a biomarker for Alopecia areata.
Saturday, July 3, 2010
We perform procedures from Monday to Thursdays only and on Friday we have only consultations. Saturday and Sundays the clinic remains closed.
As for the appointment I think it is best if you could let us know around which period or week you want to have the procedure done so that; we can offer you the available dates during that period.
The usual policy FOR booking a date is:
You need to deposit $ 500 or 20000 Rupees in advance by one of the following:
Following are the safe methods for sending advance deposit:
1. If you are in India you can deposit the amount to the Savings bank account of BISHAN MAHADEVIA at ICICI bank account No. 029501515482, ICICI bank SG Road Branch, Ahmedabad, Gujarat, India. You may deposit by cash or cheque by going to nearest ICICI bank or by sitting at home through Internet Transfer (NEFT) (Postal address: ICICI Bank Sarthik II, Ground Floor, S.G.Road,
Bodakdev, Ahmedabad 380054 )
IFSC (Indian Financial System Code)code: ICIC0000295
MICR (Magnetic Ink Character Recognition) Code: 380229009
International wire transfer to this ICICI bank account in India is routed through one Correspondent Bank depending upon the currency that you are paying in (e.g. JP MORGAN CHASE, NEW YORK for payment in $ --- the comprehensive list is given at this link http://www.icicibank.com/pfsuser/icicibank/ibank-nri/nrinewversion/money_transfer/common/wire_transfer/wiretransfer_list.htm) You need to tell your bank the Name of Correspondent Bank, Account Number ,Swift code / BIC or IBAN or
Bank Clearing Code of that branch of Correspondent bank to your local bank for the wire transfer form as mentioned in the "For a sample wire transfer form please select currency below" at this link
http://www.icicibank.com/pfsuser/icicibank/ibank-nri/nrinewversion/money_transfer/money_transfer_others/wire_transfer.htm
IBAN(International Bank Account Number
Swift (Society for Worldwide Interbank Financial Telecommunication) code: or BIC ( Bank Identifier Code )
2. Bank Draft in favour " Dr. Bishan Mahadevia" payable at Ahmedabad
3. If you are out of India You can deposit the amount to my ICICI account 029501511589 by going to the nearest ICICI bank or by Bank to Bank Internet Transfer
4.Western Union:
Deposit the amount at the nearest "Western Union" office payable to "DR. Bishan Mahadevia" at Ahmedabad, India. You will be given a 10 digit "MTCN number" that you have to pass on to me so that money can be encashed at my end of Western Union.
5. Ask your bank to Transfer the Fund Electronically in our current account in the name of Dr. Bishan Mahadevia of at HDFC Bank Navarangpura Branch, Ahmedabad:
A/C number: 00062020002040.
BIC: HDFCINBBAHM;
IFSC code: HDFC 0000006
International wire transfer to this HDFC bank account is routed through one intermediary international bank e.g. JP Morgan Chase Bank and that bank depends upon the currency in which you are paying. You need to tell your bank the swift or IBAN code of that intermediary bank to your local bank as follows:
Swift Code for $ : CHASUS33 JP Morgan Chase Manhattan Bank of NY
Swift code for Pound: CHASGB2L JP Morgan Chase Manhattan Bank of NY
Swift code for Euro: CHASDEFX Gen ac No. 6231602308 JP Morgan Chase Manhattan Bank, Frankfurt
6 . Paypal.com:
you should be the registered member of Paypal.com services or else go to www.paypal.com get registered. The Registration process takes 2-3 days for validation of your credit card and bank. After that you may send me the money directly to my e mail "info@goodbyehairloss.com" using "send money" option in www.paypal.com
N.B.: 1. In case of cancellation or changing the date you must inform us 1 week in advance if you want the refund. There will be no refund of advance in last week or on no show. 2. In case where deposit is not paid after taking a date the date will automatically canceled one week prior to the date and it can then be allocated to some one else.
We perform procedures from Monday to Thursdays only and on Friday we have only consultations. Saturday and Sundays the clinic remains closed.
ROUTINE PREOPERATIVE CARE: advised to our hair transplant patients
1. Avoid smoking few days before and after
2. Avoid blood thinning medications like aspirin for a few days before if
possible
3. Wear regular shirt at the time of procedure and avoid T shirt
or thermal under garment which you have to wear from the top
4. Keep a large size cap or hat that yu may wear for a few days after
the procedure when you go outdoors.
5. Shampoo your hair well before coming for the
procedure
6. Do not come on empty stomach have good breakfast
or lunch before the procedure.
7. Exercise of the scalp skin: slide your skin up
and down on the back and side of the head by holding it with the palms of the
hands. You may be 100 times a day. This will increase its blood supply and also
make it more lax and makes the stitches tension free and thereby improves the quality of linear scar.
8. The routine preoperative blood tests (they include CBC,
Blood Sugar Urea, Hbs Ag, HIV, PT and APTT). You can get them done from the
Laboratory from your Town/City before coming if you want to save that time and also make sure the fitness for the surgery.
9. If you do have grayhairs get your hair colored black if possible for
surgical convenience before 2 days of procedure if not then inform us and come
earlier so that we can colour the donor area hairs prior to the procedure.
10. If you are going to have Body hair Transplant (BHT) you
must shave
the possible body donor areas ( chest, pubic, armpit, back or thighs) hairs to
the skin levelexactly 4 days in advance of your procedure date.
10. Although rare there is a possibility of “shock loss” of
some of the currently existing weak hairs in first few months after the surgery
and If you are not already on Finasteride ( Tab. Finax 1mg or Propecia 1mg
to be taken once a day) start at earliest to protect your existing hairs.
10. I would appreciate if you can CALL ME A DAY BEFORE TO
MAKE SURE EVERYTHING IS OK ON MY MOBILE 9974113377
11. The black and white receipt you can receive when you
come for the procedure
ISHRS regional workshop was organized from 25th to 28th June 2010 at Bangkok, Thailand. It was a great learning event organized at Montien Riverside Hotel Bangkok under the leadership of Dr.Prthomvanich. The best part of learning was the FUE and BHT techniques and tons of debates related to strip vs. FUE as the method of hair transplant and clearly FUE was the winner. Well Dr.Jone Cole with his great analytical expressions, built out of his long and painstaking experience of performing FUE and BHT was certainly the center of the lime light.
Dr. Mario Marzola from Adelaid, Australia ; Dr. Dow Stough of Arkansas USA, Dr. Jerry Wong from Vancouver , Canada, Dr. Sungjoo Tommy Hwang from Soul Korea and Dr. Kenichiro Imagawa from Yokohama, Japan with their candid pearls of wisdom mad the workshop a worthwhile time spent.
