WHAT CAN GO WRONG IN HT?

Hair transplantation does not penetrate any body cavities like skull, chest or abdomen. Hair Transplant is a skin surgery & is like taking off moles or warts. In over 550 procedures I have not seen any serious complications happening. The procedure is done under Local Anaesthesia and not general anaesthesia and therefore you are awake all the time and the any serious side effects are practically by passed.

Although the risks are very minimal and serious or long term side effects are exceedingly rare , for the consumers knowledge I have tried to collect extensive list as under:

A: Easily avoidable by a good doctor and patient:

1. Infection of the donor and transplant sites: I have never seen any serious infections as the scalp has a wonderful blood supply which prevents and protects against these infections. This occurs if the sterile techniques are not used ( e.g. disposable needles, sterilized instrumentations etc.) if poor post operative hygiene is kept.
2. Swelling in the operated site: The head may look swollen at the end of the procedure due to the anesthetic fluid in the tissue for a few hours. This gets alright by the next morning. The swelling due to the surgery is a natural reaction after 24 hours but this is usually minimal and lasts for 2-5 days. Mild Swelling after surgery is common. The swelling may work its way down to the eyes three or four days after the surgery this may frightening although it eventually goes away. Sleeping with the face down for first 3-4 days could swell your face by dependent edema- so avoid that position for 3-4 days. Sit with the head bent backwards to bypass the swelling to the back side of head instead of coming to the front. Sleeping on side would make your side swell up due due dependent edema your ear may change the position for a day or two until the swelling subsides. but the use of post-operative steroids may be helpful at reducing or eliminating swelling. Rarely delayed swelling could be due to allergic reaction to the Minoxidil application started post operatively.
3. Itching if the operated site: Seen usually during healing phase so in a way good indicator of healing. This could be due to dryness or allergy to Minoxidil application. This is also temporary symptom for a few days but can easily be taken care of by proper scalp cleaning and supplementing with hair oil or other skin emollient e.g. conditioner for the dry hair, for few days.
4. Flaking: If you do not wash your hair vigorously after 10 days of hair transplant, you will have crusting that may last for a month or more. Dry skin that may follow a hair transplant requires good skin care in terms of shampooing not just hair but also the skin underneath. For people with dry skin and hair may supplement some hair conditioner or hair oil.
5. Reaction.s to the local anesthetic: This occurs if you are sensitive/ allergic to it or if you are given over dose. Even this is exceedingly rare because the medications used like Lignocaine and Sensorcaine are intensively studied local anesthetic agents and have very high safety margin and their safe dosage are well defined. Local anesthetic toxicity can result in seizures, respiratory depression or arrest, hypotension, cardiovascular collapse or cardiac arrest. Paracetamol, aspirin, vitamins, alcohol and other such substances should be absolutely safe, but on very rare occasions, each of these can kill. When used in ‘overdose’ and untreated, these medications (including Lidocaine) can be lethal. This can although very rarely occur esp. in patients who had pre existing conditions, such as gross obesity, known cardiac disease, epilepsy, chronic obstructive pulmonary disease, and liver disease that can significantly affect anesthesia dosage and care. In all such cases most of the adverse events can be avoidable with skilled medical care
6. Mild pitting or tenting around the transplanted hair: this can be avoided by making appropriate size holes and making the appropriate size grafts. Easily avoidable by a good hair transplant surgeon.

B. Occur in spite of the best care by Doctor:

1. Wide scar: Scarring always happens when the skin is cut, but newer techniques of wound closure usually prevent that from occurring at socially detectable levels. With each successive procedure there is possibility of slightly wider scar 5% after 1st 10% after 2nd surgery and more after 3rd. More chances in dark or black people. Rarely do these scars become cosmetically significant unless one shaved his head and in that case, all such scars will be seen no matter how perfect the healing is. Wide scars can best be corrected by planting some FUE hair in the cosmetically visible area and some times hair colored tattoo in the scar helps. People with keloidal tendencies should avoid this surgery.
2. Bleeding: spotting of blood on the pillow the next morning due to some oozing from the stitch area is not uncommon for 2-4 days and is event less and one should keep the stitched area clean by twice daily shampooing for period of 10 days . Some oozing from the recipient site is usual and that requires twice daily gentle shampooing with spray bottle if possible to prevent crusting. Sudden late bleeding from the donor up to 2 weeks could be due to some strenuous activity or that from recipient area could be due to dislodged graft. This may require immediate pressure at the site of bleeding with the clean finger tip for 7 minutes by watch and once it stops you may consult your doctor.
3. Numbness or hypersensitivity above the donor area (This can happen only in strip method due to cut superficial nerves FUE does not have such a problem) or recipient site (usually temporary for 3-6 months – till the new nerve growth takes over). Massage or tapping of the hypersensitive scar help to retain the sensitivity.
4. Redness in recipient area: Generally, the redness goes away after about a week or two. This is due to what is known as "Histamine positive skin". It is the way how your body reacts to irritation with resultant vasodilitation (more blood flows through your skin). This is more common in white or fair skin and very rare in dark or black skin. The good thing is; redness will slowly fade away in few weeks. Use of steroids ointment for a few weeks will expedite this fading. Copper Peptide shampoo may help. A disguising light makeup (Couvre, Toppik or Nenogen) is also useful at times. avoid sun irritation.
5. Failure of the hair to survive the procedure or Poor hair Growth - this happens if there is improper technique or wrong case selection of Hair Transplant (alopecia areata or scarred area. Poor hair growth may be attributed to the smoking during the post operative period because out of those who had poor growth were smokers.
6. Shock loss occurs in the recipient area especially in young( below 30years and females) in first 3 months following surgery. The best way to reduce the risks for shock loss in males is the use of Finasteride 1mg to be taken orally 2-4 weeks prior to the surgery and for the subsequent few months and in females Minoxidil and Low Level Laser Therapy may help beside reassurance. Usually the miniaturized hairs of the recipient area shed and some may be lost permanently.
7. Pimples or Folliculitis or cysts: It is not uncommon to have a few pimples in the first few months as the new hairs grow in. Folliculitis or cysts in the scalp are most often caused by (1) remnants of the previous hairs that were not shed but put below the skin or (2) pieces of the sebaceous glands that are putting out sebum below the skin and collecting below the skin, or (3) grafts that were placed too deeply or piggybacked one on top of the other (4)Ingrown hairs. This is cared for by just keeping the scalp clean. Sometimes popping these pimples yourself works, or doctor can drain the cyst. Wet warm compresses will help. Steroid application may work in initial period of pimple. Sometimes these ingrown hairs have infectious which might require an antibiotic.
8. Wavy or rough transplanted hair: This although rare to see could be due to 1. poor support of sparse transplant 2. bent ir partly folded roots while transplant or 3. microscopic scars in graft is influencing the direction of hair growth and the character of the hair.This usually corrects after one hair cycle (about 3 years). As a temporary solution use of gels, mousses, and good conditioners will help to solve this problem.
9. Difference in color of transplanted hair and the native hair: Donor hair has thicker shaft and have heavier pigments due to lower exposure to sun compared to the hair on the top . As a result sometimes the native hairs may look lighter in color compared to the transplanted hair. This difference usually fade over a period due to bleaching effect of sun on the transplanted hair.
10. Delayed hair growth: On occasional cases the hairs started growing after 8 to even 12 months post operatively. The reasons for that are not accurately known. Minoxidil to increase the scalp blood supply and Laser comb may be of some help at least theoretically

So your biggest risk is in the choice of your surgeon.. Choose a surgeon with a good reputation with proper facilities, experienced staff. Lastly, choose someone with whom you feel comfortable. Do your homework, shop around, make visits to their offices for consultations and ask to see plenty of before and after photos of their previous work.

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.