Why the transplanted hair grow permanently?

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.

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Prolactin and Hair loss

High Prolactin level and Hair Loss:

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:

• Prolactinoma
• Excess thyrotropin-releasing hormone (TRH), usually in primary hypothyroidism stimulates prolactin secretion
• Many antipsychotic  Anti 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, Cabergolide have been shown to help those with Hyperprolactinemia and have not been benefited otherwise.

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Tonsure or head shave does it help hair growth?

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.

Trichophytic Closure

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.