PREOPERATIVE CARE

Well following preoperative cares you should take

1. Avoid tobacco in any form for a few days before and after the surgery. Tobacco can reduce blood flow to the skin and thereby can affect you healing process adversely.can increase the bleeding during surgery
2. certain medications few days in advance e.g. Blood thinning agents like Aspirin or Anticoagulants etc. ; pain killers like Ibuprofen; medications for depression and vitamins; Local Scalp application of Minoxidil etc. These medication can at times may increase your blood loss
3. Alcohol, Tea and coffee a day before to avoid more bleeding during the procedure
4. Scalp exercise:If your scalp is tight, you can put your hands double clasped holding your skin of the back of your head and slide the skin up and down. Most people have about 1/2 inch of skin movement, those with tight scalps have less than that. With this exercise done 3-6 times a day for a few minutes at a time, your scalp laxity will go up. This in turn will allow easy closure in donor site and you can expect better donor scar.
5. Give a good shampoo wash in the morning of the procedure
6. Keep a large size cap with you when coming to clinic
7. a shirt and avoid T shirt or thermal because later need putting on from the top of the head after the procedure and that may rub with the grafted site.
8. One very important thing is to have hearty breakfast in the morning before coming to the clinic because you need stamina for 4-6 hours of procedure
9. your vehicle only if you are not going to drive back home.
10. If you have gray or white hair and are regularly coloring your hair color your donor site day before the procedure taking care that the part of the hair near the skin of the scalp get coloured well. This makes the graft dissection easy.

FUE: ADVANTAGES OVER STRIP METHOD (FUT)

FUE has following main benefits over the conventional strip method

1. Donor healing is faster 3-5 days compared to 10-15 days in strip method.
2. Practically pain free recovery due to absence of stitches
3. No linear scar in the donor area so even very short hair style can easily be worn. Strip method leaves a linear donor scar which shows up if the donor hair is short and therefore one needs to keep the donor hair long
4. Strip method at times leads to anaesthetic area just above the line of stitch for a few months. This is not seen in the FUE
5. Other fringe benefits according to me are

• Less bleeding
• Entire procedure performed by doctor & not given to technician
• For athletes or people who must resume full activity right after the procedure.
• Minimally invasive, less-traumatic and patient friendly
• Body hair Transplant is possible only by this method - so larger donor site. This is not possible by Strip Method. Even advanced stage can be treated (NH6-7) with sufficient hair by additional use of Body hair.
• For people who have had a lot of prior transplant surgery that has left bothersome scars, follicular unit extraction allows the doctor to work around the scars and select individual follicular units.
• Provides an alternative when the scalp is too tight for a strip excision
• Ideal for repairing donor scars that cannot be excised
• One can choose one hair or multi-haired graft

ARTIFICIAL HAIR - BIOFIBRE

There are 2 brands of Artificial Fibres available. Biofibre from Italy (http://www.biofibre.com) and Nedo of Japan. These are Polymer Fibres and usually supposed to be inert. They give instant visual improvement because you do not have to wait for them to grow. They also require local anesthetic and the procedure is also a surgery The down sides are :

1. They do not grow
2. They are lost by about 15% a year so there life not more than 10 years.
3. They need regular (daily) cleaning care by special cleaning agents under their protocol.
4. Monthly cleaning of their base by the doctor with special instruments to remove the deposited debris is necessary
5. They may be occasionally rejected by the body due to foreign body reaction or allergic reaction and granuloma formation



Pus formation and granuloma at the site of Artificial fibers that needed surgical removal

6. Being a foreign body and partly exposed to the exterior they are vulnerable to the infection and abscess which may require repeated Antibiotic courses. If the Antibiotics do not take care of the infection they may require surgical cut to remove it. This would leave permanent ugly scarring of your scalp.
7. Because of the above reasons some countries like USA have banned its human use.
8. They are more expensive than the Hair Transplant

I have had bad experiences and I have stopped recommending it.

AMINEXIL OR MINOXIDIL?

Well this product based on Aminexil has a credibility due to backing of company like L’Oreal. But the product is not tested according to FDA standard so no body can say that which one is better. But it is supposed to be working in the similar way as Minoxidil by increasing the the period of Hair Cycle. As for the safety also minimal data of credibility is available about Aminexil. Minoxidil is a FDA approved medication for prevention Hair Loss and has been well studied and its effects are well documented.

HAIR WEAVING,WIG & HAIR TRANSPLANT

Hair Transplant is the surgical procedure by which hair are transferred from the back of the head to the front. It is a permanent method where hair permanently grows and that can be cut coloured and styled. The hair does not require any special maintenance.

Hair weaving is a method of fixing (anchoring) the wig to your own hair. They weave your own hair in a “U” shape and with the thread the wig is tied to your own hair. This is a temporary method with lot of maintenance. It is in the long run, more expensive than the other options like hair transplant. And the expenses don't stop there. First, you will always need two hairpieces -- one that you wear and one that is being re-styled. Soon (usually in about a year to 18 months), you will need to replace both. Although human hair is used, it is constantly being dyed, brushed and permed to match your hair. After a while, just like your own hair, each hair strand breaks or becomes over-processed and the material it is attached to starts breaking down from the constant reattachment. You will also have to visit the hair centre every four to six weeks to have your hair trimmed and have the piece reattached and blended. Sweating and local hygiene is at stake and the constant burden of wig is also cumbersome. Stress on your existing hair, can cause permanent damage to your remaining hair.

A wig is a non-surgical hair addition by external hair-bearing device or cap added to existing hair or scalp to give the appearance of a fuller head of hair. Wig is known by various names like hair weaves, hair extensions, hairpieces, toupees, Hair Integration, non-surgical hair replacements and partial hair prostheses. Devices may consist of human hair, synthetic fiber or a combination of both. The device may have various bases a textile net in which hair weft can be tied or specialized polymer silicone

in which hairs fibers can be injected etc. It may be ready made or custom made.

It can be hand tied or machine made. Custom-fitted, hand-tied, human-hair wig are the best but most expensive.

All techniques use either the existing hair or the skin as anchor sites

EXISTING HAIR: Weaves (use thread)fusion (Use clips)

bonding (use double sided tape or adhesive liquids),

cabling, micro links, beading are general terms of techniques all attached to the client’s existing hair. All these techniques use the existing hair structure. TO THE SKIN: Includes adhesives such as two-sided tapes and new improved waterproof liquids. Vacuum bases- held on by suction through an air tight fitting foundation. All are used to provide more security for the active lifestyle, and they are all dependent on the growing existing hair and therefore must be reattached or tightened as the existing hair grows. (Techniques that stress your existing hair, such as weaves, can cause permanent damage if done incorrectly or on an inappropriate candidate. Even temporary clips attached too tightly can cause permanent hair loss.)

HAIR LOSS DUE TO CHANGE OF PLACE

The change of place has no relations to your hair loss. Excess mental tension due to work load may be the reason for your hair loss iitiation at the early age. There are natives of Mumbai who are bald and there are migrants in Mumbai who have good hair at much older age than you have. Your hair on the top is affected but the air at the back and the side are OK ; had it been due to Mumbai weather or water your hair on the back and side would also get affected by the that. Well pattern hair loss is due to genes and the hormones and is proven beyond doubt. Although ill health, certain medications, acute mental stress, pregnancy in women etc. can initiate this pattern hair loss at a young age.

DUPA nad DPA

Diffuse Unpatterned Alopecia (DUPA) is a condition where the hair has miniaturization (over 30%) throughout the scalp without a particular pattern to it. It is a relatively stable condition that may appear at any age. Senile alopecia in old age has similar features. DUPA in women with pattern hair loss is relatively common esp. in post menopausal cases. DUPA is believed to be, genetic and hormonal. In 50 % case it responds to Finasteride 1mg by 12 months; in slowing down its progress and in about half of male patients it get better by reversal with Finasteride. Half of patients have no effect of the medications. Using minoxidil would require a massive application to the entire scalp, it is worth trying. I also prescribe some nutrients like vitamins, minerals and amino acids. Cosmetic products like Dermmatch or Toppik alone or in combination are very useful for both DUPA and DPA and they are safe to use for regular use. The significance of this condition is that Hair Transplant in this condition may not be very satisfactory and therefore are often refused.

There is another condition called Diffuse Patterned Alopecia (DPA) is an androgenetic alopecia characterized by diffuse thinning in the front, top, and vertex of the scalp in conjunction with a stable permanent zone in male ( one can compare it with female pattern hair loss). Usual pattern loss in male is by beginning of loss in frontal or crown area and but in DPA the hair loss starts in the front, mid scalp and crown altogether. Diffuse Patterned Alopecia is usually associated with the persistence of the frontal hairline the hairline of the Norwood II or III type hair loss.

MSM (Methyl-sulfonyl-methane),

The herbal/nutritional supplements such as: MSM (Methyl-sulfonyl-methane), beta-sitosterol, pygeum, nettles sting root, green tea, biotin and fish oil (Omega-3)brewer’s yeast, wheat germ oil are popular products esp. on internet. The web site www.msm.com, states that MSM is found in milk, coffee, tea, vegetables, etc. It is sold as capsules, tablets, powders, as well as topical preparations. to help with pain, inflammation, increase blood flow, soften scar tissue and reduce muscle spasms, arthritis and also hair loss. The website suggests doses of 1,000 mg taken by mouth, three times a day with meals.The safety standard of such a high dose is not animal or human tested under FDA standards and they can be damaging your body in long run and even if it may not hurt you, but I doubt it will really help you correct this genetic condition. Due to its lack of credible data about effectiveness and safety I would not recommend this to you for hair loss. To my knowledge it is not available in Ahmedabad or Baroda in medical stores.

SODIUM VALPROATE AND HAIR LOSS

The excess hair fall and even hair loss may be noticed as a shock ( telogen effluvium) following her head injury. But 12 -28% patients who take sodium valproate experience increase hair fall in few weeks that follow and this hairs usually come back in few months after the medication is stopped. Minoxidil local appliction and the vitamine and minerals may help early recovery.

HAIR CUT AND TRANSPLANT

Having your hair long enough (more than an inch) will help to cover your donor stitch whereas having your hair cut before the transplant help to keep the operated area clean easily. Now that you had transplant it is best to wait for about 2 -3 weeks before the hair cut i.e. after your wounds heal completely. Although the remaining native hairs will start growing from the next day of hair cut but the grafted hair would not start growing before 3-4 months.

HAIR ANALYSIS

Very interesting question. The Hair analysis is the chemical analysis to measure mineral content etc. of a hair sample usually taken from the back of the neck.. Hair may be considered for retrospective purposes when blood and urine are no longer expected to contain a particular contaminant, typically for a year or less. Its most most widely accepted use in Forensic and environmental Toxicology e.g. detection of Alcohol or drug abuse or for monitoring of these patients treatment. But Hair analysis is worthless for assessing the body's nutritional status or serving as an aid for dietary or supplement recommendations. Some practitioners use this to diagnose wide variety of conditions or even predisposition to certain diseases and not just hair loss.This is on the basis of mineral deficiency heavy metal pollutants, mineral imbalance in the hair. Well the fundamental flaws in Hair Analysis are mineral content can be affected by shampoo, dye bleach etc.; the concentration of minerals do not correlate with that of the hair & it can be affected by the color, diameter and rate of growth of an individual's hair, the season of the year, the geographic location, and the age and gender of the individual. Following link is worth checking: http://www.quackwatch.org/01QuackeryRelatedTopics/hair.html For majority of hair conditions diagnosis is reached by History, clinical examination and by using dermascopy.

NIGHT SHIFT & HAIR LOSS

There is no scientific connection to the hard work or night shift and the pattern hair loss(MPB) ; although sometimes excess mental tension has resulted in the early initiation of pattern hair Loss.