Transplanting in
crown with early hair loss has following drawback in your case at this stage and age of hair
loss;
1. The miniaturized weak existing hairs in this area may not be able to sustain
the surgery and some of them may be lost sometime after this procedure ( shock
loss)
2. The Transplant may be possible between the existing hairs so we can only put
small number of hairs without damaging the existing hairs
3. If you lose more hair in future around the area of transplant you will have
central are of transplanted hair with surrounding halo of no hairs ; this will
not look natural.
4. You can certainly improve the area by use of medications then why you need
surgery?
According to an article published in on line journal Plosone.org Million
Mulugeta, D.V.M., Ph.D., co-director of UCLA’s preclinical stress biology research
program at the University of California, Los Angeles, claim that they have
uncovered a promising hair-loss treatment & may have the potential to
affect hair color, including gray hair..
The experiment wasn’t focused on hair loss. Instead, it was
designed to study a chemical compound that blocks the effects of stress on the
gut.
The research team, during a study of the effect of a compound
called Astressin-B while conducting
stress-hormone experiments on mice that typically develop head-to-tail baldness
as a result of being genetically altered
to overproduce a stress hormone (The mice used in the experiments had been
genetically altered to overproduce a stress hormone called
corticotrophin-releasing factor, or CRF. Corticotropin-releasing factor
over-expressing (CRF -OE)-mice that display phenotypes of Cushing's syndrome
and chronic stress, including alopecia. CRF-OE mice develop bilateral symmetric
hair loss in adulthood). The goal of the experiments was to study the effect of
Astressin-B ((5 µg/mouse) injected
peripherally once a day for 5 days) to determine whether it would block the effects
of stress on the colon but accidental finding was the mice treated with Astressin –B had recovered the full
cover of fur on the back in few weeks compared to the placebo ( injected with
saline) given mice which did not recover. A
sterssin-B induced pigmentation and hair re-growth that was largely
retained for over 4 months (a significant period for average 2 years life of
mouse) when mice were killed Histological examination indicated that alopecic
CRF-OE mice had hair follicle atrophy and that Astressin-B revived the hair follicle from the telogen to anagen phase.
The team repeated the experiment several times and got the same
results — bald mice grew new hair in a few weeks. The researchers also injected
the compound into young mice before they went bald. Those mice never lost their
fur.
The researcher said the compound appears to have affected the
mice skin pigment as well as
spurred hair growth. This could mean
Astressin-B has the potential to
affect hair color and gray hairs. Majority of Pigments were regained by about 1
week and the hair was regained by about 2 weeks
Temporary blockade of the CRF receptors could thus be a
breakthrough therapy for alopecia particularly for patients in acute
(chemotherapy, traumatic stressful events) or chronic stress setting.
Findings of a mouse study may not be applicable to humans, but results
may spur more study of the role stress might play in human hair loss. Hair
growth cycles are very different in mice and humans, so one could draw only
limited conclusions from the research
The research would probably be useful only for hair loss related
to stress, likes that caused by one-time events, rather than as a treatment for
genetic baldness.
Your thought is ingenious but the
scalp transplant would involve very major surgery under general anesthesia with
higher risks. More over it will have circumferential scarring, which may not
look natural.
Well The reason they write not to use on shaved head is if you are
having sensitivity to minoxidil and if you are exposing your shaves head
to sun for long time there may be irritation. Although this is not very
common but if you are having sensitive skin and if you have more sun
exposure you may not apply Minoxidil with shaved head. Shaved head infact makes the application easy and with direct application on long hairs can make your hair stiff and the crusting on the scalp under the hair may not be easy for you to remove.
Same way hair
loss can be due to many reasons some skin conditions with hair loss may
have more skin irritation if Minoxidil is applied and therefore it is
best suited for hair loss such as Androgenetic alopecia ( male pattern
baldness or common baldness) . Because this common baldness has some
link to father or mother side genetically it is written on the information leaflet given with minoxidil that those with no
family history of hair loss may not use it. Since you certainly have a
pattern hair loss it is Ok for you to use it without any problem. In
fact it is the right indication for minoxidil
"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.
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