FUT or Strip technique video

BHT ( Body Hair Transplant)

Body hair transplant (BHT):

For common baldness usually the hair roots from the back of the head is preferred but in some situations hairs roots from other part of the body are used which is called BHT

Body hair transplant (BHT): Procedure: Essentially it is FUE (Follicular Unit Extraction) but often bulky soft tissue underneath without strong bony support makes it difficult than that from the scalp. Usual sites are Beard, Pubic, Chest and Back.

Advantages:

• Esp. valuable when scalp donor is exhausted or limited Minimal evidence of scaring due to FUE technique used
• Large Donor area
• May be a better choice for eyebrow reconstruction where one can have better matching hairs then the fast growing thick scalp hair
• Some believe unlike scalp hair which is weakened by the male hormone DHT, body hair thrives and grows thicker and longer as time goes on
• BHT can be used to feather out the hair line by cherry picked fine BHT in patients with coarse donor hairs in the occipital area.

Disadvantages:

• Slow procedure and very taxing for surgeon not only due to awkward positioning but also this is due to acute angulations of more superficially placed follicles. The follicles are often in the more bulky soft tissue with less bony support. Some of the Body Hairs are not strong shafted to facilitate easy extraction.
• Not all Body Hairs are of good quality some may take long time to grow, and may not even grow long & thick enough (We believe Beard, armpit and Pubic hairs are of better quality hair for head hair replacement) This May leave pigmented or Hypo pigmented marks in donor site esp. in dark skin
• Most FU have one and very few have 2 hairs. 3 and 4 hair FU in BHT are practically non existent. So we are transferring less number of hairs and therefore turns out more expensive to patients.
• There is cyclical variation in the amount of coverage that the body hairs provided (due to natural body hair growth/resting cycles). Body hairs did grow longer than in their original location, but not as long as scalp donor hair.
• Persons with Fitzpatrick type 3-6 skins are prone to healing with initial hyperpigmentation (much like the dark marks that you get temporarily subsequent to an acne attack) Sometimes, instead of dark pigments, you could get lighter pigmentation (hypopigmentation) in the initial phase as well. The improvement of hyperpigmentation (dark spots) can be hastened by the use of fading creams. Wounds that heal initially by hyperpigmentation can end up finally with a much shrunken spot that is either normal in color relative to the surrounding skin or may assume a relatively faintly hyper or hypo pigmented hue.

Precaution:

For avoiding the telogen hair from extracting you need to shave the area about 4-5 days in advance of the procedure because the telogen hair are likely to be damaged during extraction due to the nature of their structure.

Body hair varies in calibre, texture and color. It is recommended to mix body hairs with scalp hair to achieve a uniform look and feel.

Body Hair Transplant (BHT)

There are about one hundred thousand hairs on the normal human head and about 1 million hairs of the body. Person having major loss of class 7 (almost 75000 hair out of 100000 are lost) may not have enough donor hairs at the back and side of the head (only 12500 out of remaining 25000 may be transplanted). Often donor hair may be even less. This situation made some surgeons to look for other Body hairs. Dr. Woods , Dr. Cole, Dr. Poswal and Dr Umar may be the torchbearers. Body Hair Transplant (BHT) as a major plus point may become donor hair because they are not genetically DHT susceptible hairs as some of the scalp hairs in MPB. But there are many issues with the effective use of BHT as routine. The conventionally used donor hairs from the back and sides of the scalp are very much similar to the hairs to be replaced in MPB but the characters of the BH has many variations such as thickness, length, colour, texture, the growth period etc. As a result for many years BHT was given the back seat. But some studies have shown that BHT hairs may change some of the character if not fully but partially when transplanted to the scalp (recipient "co-dominance" - or partial donor dominance) and this generated more interest and BHT is now being seen more seriously. . BHT is not widely practiced because, it requires special instruments, is very time consuming and the results can be somewhat unpredictable. Results are typically not at par with scalp hair yields Many patients consider body hair unnecessary and try to remove it. A body hair transplant serves a dual purpose by moving unwanted body hairs to the scalp, where they are more productive.

Body hairs from various areas have been used:

Dry zone: Beard, chest, back, limbs, abdomen

Wet zone or Apocrine zone : armpits and pubic hairs (so called because of Apocrine nature of sweat glands- In the case of sweat produced by the apocrine glands, which are located near hair follicles on the scalp, underarms, and groin area, the sweat contains fatty compounds. Bacteria feed on this sweat when it is secreted to the skin´s surface, and the resulting waste products, fatty acids, ammonia, and chemical reactions form a palpable odor which is unique for every individual.

 

Possible Uses of BHT:

1.      Obviously the most common use of BHT is as a viable option for those whose traditional donor hair supply is depleted.

2.      To feather out hair line by cherry picked thin and soft body hairs esp. in the people with strong and coarse scalp hairs where taking the thin hairs from the nape of the neck or per auricular area may not be a good option because they do not belong to what is conventionally called safe donor zone of scalp.

3.      To camouflage the widened strip scars of already depleted donor area where taking further the hairs from the scalp either by strip or FUE is not a sensible option. Coarse Beard hairs and other BHT from Apocrine area which grow thick and long is a good option.

4.      Body hair is an excellent filler to increase the density for use in between naturally thinning hair

5.      Transplanted scalp hair for the eyebrow restoration may not be the best match and grow very fast and need to be trimmed often. Some body hair with better match ( lighter colour, thinner diameter and slow growth than that of scalp hairs).

6.      Body hairs may be used for restoration of the hairless scar etc which become more obvious in the exposed part of the body.

7.      Donor recharging or Donor sealing of the scalp donor area by BHT esp. when the scalp donor area is very thin.

Problems:

·        Tiny Hyper or hypopigmented marks may be visible in some

·        Follicluitis esp. in case of buried or transected follicles with ingrown hairs may sometimes need antibiotics or steroid to resolve.

·        Keloid esp. is possible in the chest and shoulder area- one may doe a small test grafting

·        Redness for few weeks may be possible avoid sun exposure and use steroid application

·        Unpredictable growth at times

·        Long time to grow at times after transplant

·        Synchronous cycles

·        Due to difficulty in extraction compared to scalp hair may be more expensive and time consuming ( slow extraction and less yield per day) due to difficult positioning of doctor and patient.

It is a general perception that the short hair style gives the less ugly feeling of baldness than when the side and back hairs are kept long. Also, keeping the hair shorter might cut down on the number of grafts needed to diminish the bald look. BH usually do not grow very long (1 to 2 inches or less because their hair cycle is short) since it will not grow as long as scalp hair, a shorter hair style should ultimately be preferred.


Technical issues for BHT:

1.      The acuity of direction makes it demanding to use the instruments with more precision

2.       Most BH do not have as close a Bony support to the skin as that to the scalp hair (except in case of sternum and shin of tibia etc.). Some firm background support makes it easier to extract the grafts and in case of pubic and abdominal area due to minimal firm support at the back ground may make extraction more challenging.

3.      Many body hairs are not robust and without the good bony background it may nor be easy to harvest such hairs in some areas esp. when they are acutely placed and every other hair grows in different direction. This makes the extraction process very slow.

4.      At a  given time 80 to 90% of scalp hair are in anagen ( growing phase) and only about 40 to 60% of Body hair  are in anagen phase Some studies show that body hair has a very short anagen phase and a very long telogen phase.

Their duration of anagen is much shorter (12 to 16 weeks) as compared to the scalp donor hair (2 to 5 years).This means that body hair grows in a period of about six months to about 2 inch long, and they then rest on this length for some years. In Body Hair Transplantation when hair is transferred from the body to the scalp, it may have considerable delay in growth due to their long telogen phase. That does not mean that 10% to 20% of head hair and 40 to 60% of body hair died. It means that those percentages should always be resting or in telogen. As one hair cycles out, another cycles in and begins to grow. since body hair growth cycles are faster and more hairs are resting at any given time, it takes more body hair ( and even more BH follicular unit grafts- because most grafts have only one hair unlike the scalp grafts which may have up to 4 hairs) than scalp hair to create the same illusion of density. In Body Hair Transplantation when hair is transferred from the body to the scalp, it may have considerable delay in growth due to their long telogen phase.

5.      The dermal components of the hair, secondary germ cell and the dermal papilla are attenuated in telogen hairs, and more prone to damage during individual follicular extraction. Transactions by shearing forces will be higher with a higher chance of leaving behind vital cells that are essential for the healthy regeneration of the hair follicle.

 Therefore, only body donor hair follicles in the active anagen phase (which are strong even at the dermis level) are preferred for transplant. The hairs are shaved flush with the skin, 4-5  days prior to extraction. At the end of three to four days, the actively growing hair is easy to identify due to their increased length. If telogen hair is successfully extracted it will be bulbless hair and if transplanted will grow villous or thin hair  if at all it ever grows.

6.       Pre shaving pinpoints body donor hair whose growth cycles are more closely synchronized. Transplanting these hair results in a closer synchronization of the growth and synchronized shedding phase of these hairs at least, in the initial growth cycles. However, over couple of years, as the hair go through repeated growth cycles, the growth phase of these transplanted body hair lose their synchronicity. Without preshaving and selection of only non growing hair, a certain proportion (perhaps 10-30%) of the early anagen hairs could be mistaken for telogen hair because of factors like clear bulbs that are yet to get pigmented.

7.      Positioning of surgeon and also that of patient varies greatly from one area of body to that of other and even in the same area due to variable direction of hairs the angling and direction of instrument keeps changing unlike in case of scalp hair extraction.

8.      It has been said that the rate of growth: Body hair grows about 0.2 mm per day while scalp hair grows about .44 mm per day. The same body hair transferred to the scalp grows about .34 mm per day.

9.      predictability of growth- somewhat less than the scalp hairs

10.  Mix the various body as well as scalp donor hair in any particular area of scalp to achieve a uniform look and feel

Masturbation does it cause Hair loss or baldness?

well research has shown that it is not masturbation or sex that increases the testosterone level but it is the abstinence ( staying away from sex)  that may raise the level of testosterone ( check this link:   http://www.ncbi.nlm.nih.gov/pubmed/11760788?ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

On the contrary it is the raises Testosterone level that may induce Masturbation or sexual urge.


On the link that you have sent if you read in the website on this page ( http://www.herballoveshop.com/product.asp?PID=1007) you find this:

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"The essential ingredients in MoodMax help the liver excrete the excessive hormones which are very harmful to cells. Binding of excessive testosterone, DHT or estrogen to hair roots or hormone receptor cells causes hair loss or alternates genes for the malicious development"

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They want to sell their product by taking advantage of your ignorance and your psychological fear about sexual myths and and they do not do this by spreading actual facts.You should be aware that Masturbation or sex may stabilize or perhaps temporarily reduce the testosterone level and would not increase the level. DHT perhaps have similar effects. Regular Masturbation or sex ( a biological response) may therefore  stabilize or reduce Testosterone or DHT level and this means that regular masturbation oor sex may  stabilize your hair loss! (Although this is never been studied or researched).

Mesotherapy for Hair Loss and Baldness

Mesotherapy (from Greek mesos, "middle", and therapy from Greek therapeia, "to treat medically") is a non-surgical cosmetic medicine treatment. Mesotherapy employs multiple injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients into the subcutaneous fat. Dr. Michel Pistor (1924-2003) performed clinical research and founded the field of mesotherapy. There is no conclusive research proof that these chemical compounds work to target adipose (fat cells) specifically. Some physicians[have expressed concern over the efficacy of mesotherapy, arguing that the treatment hasn't been studied enough to make a determination. It is expressed by Rod Rohrich, M.D., Chairman, Dept. of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas: "There is simply no data, no science and no information, to my knowledge, that mesotherapy works," For experiences of Mesotherapy one can refer to this link as well: http://www.realself.com/Mesotherapy/reviews

Besides ineffectiveness the possible allergy and long term side effects of the drugs are never studied well. More over it is advised to be taken and continued at few weeks interval for maintenance


Usually by a thin needle of 30 number gauge either manually or by a mesotherapy computerized mesogun aided injection (or as some people use dermaroller which makes tiny tunnel to channel the drug in the skin) of liquid containing vitamins, minerals and hormones or in case of hair loss treatment Finasteride or Minoxidil area injected in subdermal layer in a very small quantity at say every 1 cm distance of the bald area of scalp Skin. It is said that Vit. B 6 or pyridoxine, Azailic acid and Zinc are found to be 5 alfa reductase enzyme inhibitors (and in turn DHT inhibitors) in some research and some people inject these molecules as well. There is although always a concern of Hypotension ( drop in blood pressure) if Minoxidil is directly injected as it is the Hypotensive medication when given systematically. Finsteride has not been found to be effective locally any ways. These appear to be just claims rather than good science in this treatment, so one should be cautioned about this. In case od Dermaroller the needles penetrate the stratum corneum, the hard outer surface of the epidermal layer of the scalp.It is claimed that hundreds of tiny channels are created through the stratum corneum, which facilitate the passage and absorption of Minoxidil into the dermis to maximize it’s absorption by the hair follicles. The Derma Roller also stimulates blood flow to the hair follicles via direct scalp massage. The dermal damage induces the release of growth factors that stimulate the production of new collagen and elastin and stimulates the miniaturized hairs to grow stronger.

Why male pattern hair loss occurs on the top horse shoe area of scalp?

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).

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.

Turban Alopecia in Sikhs

Although Sikh men are as susceptible to other forms of hair loss as anyone else, they commonly suffer from what is known as traction alopecia. This occurs when the knotting of long hair pulls on the hair over time so that its roots are damaged. It is different from pulling hair out accidentally when taking the turban on or off. It is a

slow process but it can be irreversible.

Sikhs males have religious reasons not to cut their hairs throughout the life. The long hairs are kept hidden under their turban after winding them in a ‘Rishi knot’. It is an irony that this long hairs due to constant traction on the root due to this knot result in premature hair loss over the years. This especially happens in the frontal and temple area where the traction stress is maximum. This is common to all those Sikhs round the world may be in millions. It's a subject rarely discussed because it's relatively easily hidden, but hair loss is a big problem among Sikh men and covering it up doesn't take away the associated distress.

Traction alopecia can be exacerbated by the ritual combing of the hair. This can be alleviated by straightening out the hair and working through tangles with the fingers before combing, thereby reducing the pull of the comb. It's important to keep the hair soft and in good condition even if you're not worried about other people seeing it.

To prevent this problem, I would advise avoiding unnecessary stress on the hair by winding the

‘Rishi’ knot less tightly. The problem is not with wearing the turban, but with improper hair care.  Hair must be combed down at night and then joora retied in the morning. Keeping joora tied all the time does not allow hairs to relax properly.

Use a light fabric and only use as much fabric as is absolutely necessary to contain the hair. The weight of extra fabric will put added strain on your hair. Be careful not to bind the turban too tightly - it's better to secure it with grips further back on the scalp if necessary, as hair is most vulnerable toward the front of the head. With Be careful to position your hair directly on top of your head before you bind it. This will enable your head to support most of the weight of your hair directly when you are upright. If you tend to lean backwards when sitting, be careful to keep your head upright.

Some Sikhs who suffer from traction alopecia choose to give up on wearing turbans altogether and to keep their hair in pony tails instead. If you do this, make sure that you don't draw it back too tightly from your head and that you secure it loosely.

It is interesting to note that traction alopecia often occurs as a result of various headwear and hair styles, including hair extensions, wearing tight ponytails and wearing tight fitting-hats.

But if you take care to look after your hair and bind it appropriately, you are likely to be able to keep much of the length of it at the back for most of your life.

As a permanent solution to restore hair, hair Transplant is recommended as it is not possible to medically restore lost hair as shown in one of my patients.

Turban Alopecia in Sikhs

Although Sikh men are as susceptible to other forms of hair loss as anyone else, they commonly suffer from what is known as traction alopecia. This occurs when the knotting of long hair pulls on the hair over time so that its roots are damaged. It is different from pulling hair out accidentally when taking the turban on or off. It is a slow process but it can be irreversible.

Sikhs males have religious reasons not to cut their hairs throughout the life. The long hairs are kept hidden under their turban after winding them in a ‘Rishi knot’. It is an irony that this long hairs due to constant traction on the root due to this knot result in premature hair loss over the years. This especially happens in the frontal and temple area where the traction stress is maximum. This is common to all those Sikhs round the world may be in millions. It's a subject rarely discussed because it's relatively easily hidden, but hair loss is a big problem among Sikh men and covering it up doesn't take away the associated distress.

Traction alopecia can be exacerbated by the ritual combing of the hair. This can be alleviated by straightening out the hair and working through tangles with the fingers before combing, thereby reducing the pull of the comb. It's important to keep the hair soft and in good condition even if you're not worried about other people seeing it.

To prevent this problem, I would advise avoiding unnecessary stress on the hair by winding the

‘Rishi’ knot less tightly. The problem is not with wearing the turban, but with improper hair care.  Hair must be combed down at night and then joora retied in the morning. Keeping joora tied all the time does not allow hairs to relax properly.

Use a light fabric and only use as much fabric as is absolutely necessary to contain the hair. The weight of extra fabric will put added strain on your hair. Be careful not to bind the turban too tightly - it's better to secure it with grips further back on the scalp if necessary, as hair is most vulnerable toward the front of the head. With Be careful to position your hair directly on top of your head before you bind it. This will enable your head to support most of the weight of your hair directly when you are upright. If you tend to lean backwards when sitting, be careful to keep your head upright.

Some Sikhs who suffer from traction alopecia choose to give up on wearing turbans altogether and to keep their hair in pony tails instead. If you do this, make sure that you don't draw it back too tightly from your head and that you secure it loosely.

It is interesting to note that traction alopecia often occurs as a result of various headwear and hair styles, including hair extensions, wearing tight ponytails and wearing tight fitting-hats.

But if you take care to look after your hair and bind it appropriately, you are likely to be able to keep much of the length of it at the back for most of your life.

As a permanent solution to restore hair, hair Transplant is recommended as it is not possible to medically restore lost hair as shown in one of my patients.

FUE and lateral damage

FUE Technique is sufficiently advanced now so that to avoid less trauma to not only the follicular unit to be extracted but also to the follicles around that. The strip method in fact while cutting out the strip and then while making the slivers and then cutting the individual grafts from the slivers can damage more number of grafts than done by individual follicular extraction.

1. When follicular units are extracted the cut is only made till the level of sebaceous glands and the part of the follicle below that level which is harboring stem cells and is important for the growth is not touched with knife by the techniques that we use so not only the follicle to be extracted but follicles around that are not damaged. 
2.The  lower part of the follicle is any way loosely attached  to the surrounding and easily come out without cutting.
3. More over we use tumescence ( inflate tissue with saline) this separates the follicular units from one another so that while extracting one the other does not come in the way.
4. We use smaller punches with 0.75 to 1mm diameter which which avoids the lateral trauma to the surrounding follicles check the attachment.

FUE or FUT which method is better?

There are 2 methods of Hair Transplant as per the latest evidences following are our views:

1. FUHT or Strip method ( a conventional method that requires stitches  at the back and leaves a permanent linear scar which at the back that does not make it possible to wear a short hair style and sometimes gives pain and numbness for a few weeks to few months. Healing time is longer due to a long cut at the back)

2. FUE (With recent advances this modern and stitch less method that does not leave a linear scar on the back of the head and heals faster and practically pain free post operatively. Final outcome is better). We use 0.75 to 1 mm micro punch with depth control and use Lorenzo technique for extraction.

The difference between the 2 methods is essentially in harvesting the roots from the back side of the head and the method of grafting and the final outcome of both methods in the area of hair loss (recipient area) is the same. We now strongly believe that FUE is except for the cost is superior method than the FUT (Strip method).

                                         Enlarge the picture below by double click to read

Shock loss or Reactive loss or Post surgery effluvium

Shock Loss , Reactive Loss or Telogen effluvium, Shock fall out:
It is reaction to the surgery esp. that on the scalp because the scalp is stressed by surgery and some of the hairs may fall out in 2 to 12 weeks some are permanent and some can be temporary. Most likely the miniaturized hairs are likely to fall out.  This can happen mostly in recipient area but can rarely also happen in the donor area esp. in the FUT or strip method and less commonly in FUE method due to its minimally invasive nature. The Shock loss is unpredictable although factors to be considered are:

Age: young ( <30) more with active inadequate stabilization of hair loss it is common but in Older age patients with stabilized hair loss has les chances of shock loss.
Sex: male more common than female but it is more significantly visible in females
            Male more likely to be permanent in female more likely to regrow
Miniaturized hairs (i.e. the hair that is at the end of its lifespan due to genetic balding): more likely to be permanently lost unless Finasteride supported
Terminal Hairs ( Healthy) : more likely to grow back in 4-6 months
Transplanted hairs: shock loss is less common but can grow back in 4-6 months
Temporary Loss: The terminal or healthy hair shock fall out is usually tempoaray and they grow back by 4-6 m9onths
Permanent loss: usually of the miniaturized hairs or of the terminal hairs that is damaged or transected while making the incision for grafting in between the hairs.
Protection: by starting Finassteride 1mg ( or Dutaseride 0.5mg) per day at least 2 weeks before until the at least 6 months post op in males. In females Finasteride is useless and Minoxidil may be useful to some extent.
How can one minimize Shock loss:

1         by using smaller incisions for recipient area ( using smaller grafts rather than using minigrafts)

2         Limiting the depth of incisions

1.       Minimizing the adrenaline use in recipient area

2.       Reducing the packing between the existing hairs

3.       Minimizing the tension of the donor area

4.       Using Finasteride from at least 2 weeks before the procedure and for 6 months after the procedure.

5.       Spacing the 2 sessions of transplant at least 1 year apart

6.       Avoid operating on the young patients who are in the actively losing state and have high miniaturization. Put them on Finasteride & or Minoxidil for a few months before contemplating transplant.

7.       Plan to use enough FU and transplant through the highly miniaturized hairs rather than avoiding that area so that in case of shock loss of highly miniaturized hairs the area is sufficiently compensated with the healthy transplanted hairs. In areas of extensive miniaturization, it may be appropriate to transplant follicular units in the same density as one would if the area was totally bald ass the miniaturized hair may be lost by the time transplants grow.

However, regardless of the “claims” of a particular surgeon, the process is a natural response of hair follicles and the risk cannot be eliminated completely.