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.

AHRS meet at Mt. Abu ON 11TH SEPTEMBER

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

Dilemma fue

View more presentations from DrBishanMahadevia.

Fue megasession

Video of FUE on Unshaven Head by Dr. Mahadevia

8 new genes found associated with Alopecia areata

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.

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

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 gray hairs 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 level exactly 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

New advances in Asian Hair Transplantation workshop at Bangkok

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.

Celebrity bald look real and created

curtesy funzug.com

Photos of our clinic

 Dr. Mahadevia' Hair Transplant Clinic

 

Operation Theater area with SS Platforms and Transparent Glass area look out and Specially designed procedure chair

Procedure in progress

Consulting area

Waiting area

Our well trained and experienced Team

Gray hair, White Hair, Silver Locks, Achromotrichia or Canitis: Treatment and solutions

Gray or White hair at young age can be a distressing and annoying at times for many but for older people, gray hair can symbolize wisdom and maturity. Graying may make one look older. Good news is recently, scientists have found that graying hair might be protecting you from getting cancer.

You will observe the first grey hairs usually near the temples, then to the crown and then at the back of your head. The common belief that for every graying hair they remove, two will grow back up in place of the lost  one is a myth.

Hair color comes from a protein and a pigment called melanin. The cells in the hair follicles that make and store melanin are called melanocytes. The melanocytes also present in the basal layer of the epidermis that produces melanin under the control of the melanocyte-stimulating hormone

 

 

 

 

 

 The stem cells at the base of hair follicles produce melanocytes. Melanocytes are also present in your hair follicles right next to the dermal sheath, an area below the hair bulge where you can also find keratinocyte cells.  Working synchronously, melanocytes and keratinocytes are the building blocks of your hair
Hair color is the pigmentation of hair follicles due to two types of melanin,eumelanin and pheomelanin. Generally, if more melanin is present, the color of the hair is darker; if less melanin is present, the hair is lighter. Levels of melanin can vary over time causing a person's hair color to change, and it is possible to have hair follicles of more than one color. Pheomelanin colors hair red. Eumelanin, which has two subtypes of black or brown, determines the darkness of the hair color. A low concentration of brown eumelanin results in blond hair, whereas a higher concentration of brown eumelanin will color the hair brown. High amounts of black eumelanin result in black hair, while low concentrations give gray hair. All humans have some pheomelanin in their hair.

Gray hair results from a reduction of pigment. White hair has no pigment. Changes in hair color typically occur naturally as people age, eventually turning the hair gray and then white. This is called achromotrichia.

There is a pocket that houses melanocyte stem cells halfway up the follicle, above the bulb. These stem cells turn into melanocytes when old melanocytes die off. The death or inactivity of the melanocyte stem cells causes the onset of graying.

 

Causes:

Aging: No available treatment – only solution is colour the hair.( white people will begin to gray in their mid-thirties and Asian people begin graying in their late thirties, but most black people can retain their original hair color until their mid-forties.) Your chance of going gray increases 10 to 20 percent every decade after 30 years. By age 50, most people can expect 50 percent of their hair to be gray. There are two theories of aging. The signs of aging are programmed in our genes or DNA. The second is that our cells and DNA wear out and get damaged over time eventually leading to aging and the end of life. If we can find damage to the DNA or cells dying as we get older, then maybe genes are not involved in aging. Some people believe as we get a little bit older we don't produce enough catalase and then the hydrogen peroxide cannot be broken down and that bleaches your hair from the inside out, turning it gray

Premature graying: This premature graying of hair is called canities in medical terminology How fast your hair turns grey really depends on the person's genetic predisposition and certain lifestyle factors that can directly influence the production of the pigment melanin. If you have a family history of premature grey hairs, the chances of your hair turning graying much earlier in life is far greater.

Genetic: No available treatment - only solution is colour the hair. Two genes appear to be responsible for the process of graying, Bcl2 and Bcl-w. Gene therapy may someday help us treat the signs of aging

Smoking: Smokers were found to be four times more likely to begin graying prematurely, compared to nonsmokers.

Lack of sleep and excess stress: Excessive stress is the principal creator of chronic free radical damage that can damage vulnerable cells like Melanocytes and influence melanin production.

Malnutrition:(certain Minerals cupper, zink  etc. and Vit B deficiency) is also known to cause hair to become lighter, thinner, and more brittle. The condition is reversible with proper nutrition.

Pernicious Anemia (Vitamin B12deficiency): Facing a deficiency in vitamin B especially B12 has been associated with less effective hair pigmentation

Thyroid deficiencies: Hyper or Hypo Thyroid status

Albinism: (a genetic abnormality in which little pigment is found in human hair, eyes or skin

Vitiligo (a patchy loss of hair and skin color that may occur as the result of an auto-immune disease.)

Werner Syndrome (premature aging disease that begins in adolescence or early adulthood and results in the appearance of old age by 30-40 years of age)

Apart from this spicy, oily, fast or junk foods, addictive foods like tea, coffee, alcohol and long illnesses, some medications etc are blamed to be the cause of premature graying.

Grey Hair Treatments

Given the currently available treatment options, it appears that the greying process cannot be effectively reversed. There is no scientific evidence at the moment that any existing medicine, diet, herb, supplement or natural product can prevent or reverse greying hair. The only current option that delivers satisfactory results is changing the colour of your existing hair. You can either use regular hair dyes or try progressive hair colorants. Unlike regular hair dyes, progressive hair colorants only affect your grey hair and not your non gray hair, changing its colour gradually and unnoticeably. It makes their hair look more natural, as they do not have to cover up all their grey. One interesting point about gray hair is that it is thicker and usually grows faster than normal, pigmented hair, which makes it more visible and difficult to cover with colour.
Gray hair may temporarily darken after inflammatory processes, after electron-beam-induced alopecia, and after some chemotherapy regimens. However, French scientists treating chronic myeloid leukaemia (CML).  patients with a new cancer drug Gleevec or Glivec noted an unexpected side effect: some of the patients' hair color was restored to their pre-gray color.
Nonetheless, there are some traditional and commercial products that claim to be effective in preventing and reversing graying hair.

Some of them are:

Topical liquid, cream or foam, foam, oil, lotion or spray

GRECIAN FORMULA

GREYBAN

 (POLY) RE-NATURE

RE:NUAL SERUM

RESTORIA

TOUCH OF GRAY

Oral Tabb or powder

MELANCOR-NH

REMINEX

SHEN MIN

SH SHOU WU PILL

OU WU PIA

Beggan's pills

Go Away Gray

YOUTHAIR

Active Substances Used in these products are:

 

 FO-TI or He Shou Wu (polygonum multiflorum)a Chinese herb also known as Chinese knotweed or flowery knotweed, There is no clinical research available supporting the claim of its efficacy

PABA (para-aminobenzoic acid)  is often referred to as vitamin BX or B10 and it is believed to be an anti-aging and anti-grey hair vitamin.

FOLIC ACID is another member from the group of vitamins B (B9)

An average healthy person is unlikely to register a change in the colour of their hair as a result of the extra intake of these two vitamins. Their administration can only be beneficial in rare, grey hair conditions caused by the deficiency of any of these two vitamins.

Amla or Indian Gooseberry
An Indain Fruit known as 'Amla'. You can make gooseberry oil and apply it to the scalp. To make the oil, you need to heat some amount of coconut oil with few pieces of the Indian gooseberries. After the berries turn dark, turn off the heat and let the solution cool down. Remove the berries and apply the oil to your hair.

Blackstrap Molasses
Molasses is made out of sugarcane or sugar beets juice. The juice is boiled at high temperatures which crystallizes the sugars. When the left over liquid is heated up two more times, blackstrap molasses is formed. Blackstrap molasses also contains such as calcium, iron, magnesium, copper, potassium etc.

APPLE CIDER VINEGAR - its water solution applied topically. It is an old wive’s tale assumed to work in a similar fashion to the metallic-based, hair colorants, gradually changing the colour of white hair. Its mechanism of action and potential efficacy are unknown.

 SAGE TEA is another traditional natural remedy Strong sage tea should be applied to the hair and left to dry, then rinsed with water and dried. This therapy should be repeated weekly until the desired shade is achieved. It is conceivable that the strong sage tea could stain and colour.

Wheat grass (contains all essential minerals the body needs)
Sea weeds (kelp, nori, dulse)

Catalase:  It is believed by some that as we get a little bit older we don't produce enough of enzyme called catalase and then the hydrogen peroxide cannot be broken down and that bleaches your hair from the inside out, turning it gray. Products like Go away gray and Beggan Pills have this as a main ingredient

Emu oil: supposed to moisturize and preserve the hair nutrients like Omega3 and Vit B12

Other Treatments:

RUBBING THE NAILS an old technique from India against each other is said to help circulation (as nerve endings are located under the finger nails

Henna (Mehdi) :Dried Henna powder from henna leaves of the plant has been used traditionally in India as temporary body decoration or tattoos.  It is also used to color the hair. It gives brownish red colour. Benefit is believed to be it is a natural product and there is no synthetic pigment. One of the ways to use is: Henna is okay if you don’t have clorinated water, or go into swimming pools as it will turn green or purple with the chemical reaction. It builds up and does exactly what i told you henna will when exposed to chlorine. A temporary hair color does a good job, and covers all the hair. The bonus is it will give shine, and make the other hair more lusterious conditioning also.

Usage of henna powder is also one the effective methods for gray hair treatment. Prepare a mix of henna powder (2 tbsp.), yogurt (1 tsp.), fenugreek seed powder (1 tsp.), coffee (3 tsp.), basil juice (2 tsp.) and mint juice (3 tsp.). Use this mix to massage the scalp and let it stay for about 3 hours. Thereafter, get your hair washed with a mild shampoo

Covering or colouring Gray Hair