Dj Illusions
Planning for a hair transplant: What to Expect During the first session
In our experience, patient expectations are more often influenced by patient age, stage of hair loss, and its rapidity. Young patients (those 20) with the memory of his hairline and density of adolescents remains clear in their minds, are also the most susceptible to rapid loss, hair, and the magnitude of the patients who need the most of the time in education and the planning process. Other factors include the social situation of the person (for example, how it is perceived by significant others) and how it was dealing with his loss of hair (such as using a hair piece or continuous use of a hat). It is for physicians to educate the patient and correctly set your expectations or the patient can not be satisfied.
The patient should not be led to believe that hair restoration surgery recover loss. In an ideal situation, hair restoration surgery should maintain the appearance of the adult patient and give the same "look" as he would if he had simply "matured." Surgery should not attempt to restore the appearance of the adolescent patient. At a minimum, can prevent the patient perceives himself as being bald. In a patient who is distressed by the extensive hair loss, this alone can be a significant achievement.
The young, bald patient quickly raises perhaps the biggest challenge. Even an extensive procedure may not be able to compensate for the loss that may occur during the year it takes implants to grow fully. In this particular patient, understanding all aspects of the dynamic nature of hair loss is essential. Nature progressive alopecia, hairline placement realistic, preservation of the crown, and the possible acceleration of the loss of the surgery itself must be clearly explained. If the patient does not understand each and every one of these ideas, it is best to postpone surgery. Time is always on the side of the doctor, since the progression the patient's hair loss will make each of these issues more tangible for the patient, simplifying the learning process.
At the other end of the spectrum the patient who has been bald for many years is much easier to meet their expectations as they are usually reasonable, and small amounts of hair occurs a marked change in appearance. However, this same patient has worn a hair piece for many years identified with this aspect and is much harder to please. As the patient was young, his reference point is a full head of hair. If the only goal of this patient is going to destroy the hair system is essential to determine the required amount of coverage that they need to accomplish this. If this has not been set in advance, a transplant could be perfect in everything else, will be a total failure if the patient still feels compelled to use his hair piece.
Different problems are presented by patients with more limited hair loss. The person who presents with recent progression of an adolescent hairline (Norwood Class I) for a natural hairline recession mature in temples (Class II) should not be transplanted. Should be noted that this development is normal and a flat hairline are not natural as you get older. In this patient, no should try to "fill" the temples. You can also not be suitable for transplant to a young, early Class III patient. However, in a patient older than Class III with stable hair loss, above average density, and no family history of baldness, but would also be desirable to blunt angles produced by bitemporal recession, but not eliminate it.
One last question regarding expectations related to the time that the patient expects to see results your procedure. The normal cycle of follicular growth is quite variable. In most patients, the majority of the transplanted hair begins to grow at about 3 to 4 months after surgery, hair additions listed in the coming months. In a small percentage of patients, early growth of most hair can be seen from 4 to 8 months or more, with new hair appearing from time to time until 18 months after transplantation. Since newly transplanted hair will increase in diameter and length in this subgroup of patients can not continue the aesthetic improvement of up to two years.
Much has been speculated about this so called "stunted," and it seems that a number of factors may be contributory. Although still speculative, some of these are: 1) asynchronous nature of normal human follicular growth cycles, 2) restoration of the growth cycle as possible after the post surgical effluvium (shedding) a complete new cycle, 3) the timing of hair regrowth after surgical post-shedding, 4) stunted as a result of trauma graft, such as temperature change, desiccation and crush injury, 5) the amputation of the dermal papilla during graft dissection with a lag time for regeneration of the bulb, and 6) local factors that cause growth retardation, such as changes often asymmetrical elastotic skin caused by the sun reaches the bald scalp unequally protected.
Carefully controlled studies, some of which are already underway, will be needed to resolve the relative importance of each of these factors. Whatever the cause, it seems that a large individual variability is an integral part of the transplant process. This should be clearly explained in advance in order to keep our patients to become "impatient" after hair transplant surgery.
The critical meeting
Regardless of how many procedures are planned, we believe that we must always consider the first transplant in the critical procedure. The patient sees the first meeting, a statement future sessions. The first session builds confidence, so it is essential that expectations are met. The first session is the most important, as is usually down the hairline and face frames. The initial transplantation of hair in places also a position to camouflage the subsequent processes.
In our experience, for most patients, establishing the front hairline is the most important function of the first procedure. First, the frontal hairline should be placed in its normal position matures. Hairline in this location should frame the face and restore the balance of the patient's facial proportions in a way that is appropriate for a mature individual. In our opinion, common practice to create a hairline well above the position of mature hairline, with the aim of reducing subsequent proceedings must be avoided. If the intention is to keep the hair in anticipation of a very limited choice of donors, it could still maximize the aesthetic impact of surgery by the creation of bitemporal recession or not to extend as far back transplantation into the corona. However, the position of the front middle portion of Birth Hair must not be compromised, as this defines the "look" of the individual. Creating a hairline too high (in the hope of preserving donor hair) only heightens the patient's baldness by extending the front and the distortion of normal facial proportions.
The other objective important first meeting should be to ensure coverage in the remaining bald scalp with the exception of the crown. Since the Norwood Class A patients, by definition, no hair loss extends into the crown, if possible, the bald area should be treated in the first session. The amount of hair needed to cover the front and top of the scalp of the patient, of course, vary depending on the extent of baldness, but must always be an attempt to cover these areas in the first session, even if the coverage is light. In general, scalp areas that already have adequate cover should not be transplanted. Despite edges of the transplanted area should be mixed in the skin with hair, too aggressive invasion may accelerate hair loss and offers no additional cosmetic benefit. The objective should not be to restore the density of adolescents, as this is not necessary from an aesthetic point of view, nor (as we discussed) mathematically reasonable. Patients who want the density of adolescents should be treated equally with those who want an adolescent hairline. They should be more educated and led outside the surgery.
In general, the crown coverage should not be an objective of the first meeting, but would be the most important cosmetic face and above have been properly transplanted. From the front and top of the scalp are together a single cosmetic unit, the transplant may stop after this area has been treated. The patient himself can assess the adequacy of coverage in the first action, and if you want more fullness or greater density, a second session can be used to supplement the transplanted area in the first. If coverage of the crown is tried in the first session, the patient's options will be much more limited and the ability to produce a balanced aesthetic transplantation could be permanently eliminated. An exception would be patients of Norwood Class III and Class IV Vertex, which are usually over 30, are less likely to become widely bald, and has a good donor density and laxity of the scalp. In these situations, the transplant the crown at the first session can provide modest coverage in the area and serve to camouflage a limited number of bald crown more. What should be avoided in these practice patients is several times the risk of transplantation of hair on the crown to achieve a high degree of density, since the density can not be supported often as baldness progresses.
Besides the aesthetic considerations that make the first important meeting, there are many surgical advantages of working in a virgin scalp. In summary, the implants can be placed more easily, more securely, and closer together in a normal scalp, because the blood supply and elasticity intact tissue. In the donor, the maximum density and mobility of the scalp and the absence of scars provide a closure of Birth hair. To take advantage of these factors, one should seek in the first session, as many of the goals of the patient as possible. In our opinion, what can be done safely in a procedure is best done in a procedure, and should not be spread over two or more.
When should a single session Transplantation consider?
Much can be achieved in the first session. However, one must be realistic to anticipate what the targets can be achieved with a single procedure surgical patients in which these goals are possible.
As noted, we consider the main objectives for the first session should be: 1) provide a framework for the face, 2) to cover the front, and, where appropriate, the top and vertex of the scalp, 3) look completely natural.
In general, for the doctor to suggest to patients who might be satisfied with a single session, there should be relatively stable hair loss. This is especially important in the Norwood Class III, III, IV, V and patients whose own hair contributes to the aesthetic appearance of the front of the scalp. In patients with frontal balding, the first procedure can successfully frame the face and cover the anterior portion of scalp with hair loss so that even more a second procedure would not be needed immediately. For Norwood Class VI or VII patients in which the front and top of the scalp are transplanted properly in the first procedure, satisfaction can be achieved in a single session, due to further expansion of the crown of white hair is relatively inconsequential. However, if the coverage of the crown is tried, then, as bald crown expands, the central transplanted grafts became an isolated island of hair, and surgery would be followed.
A patient with hair color lighter also are more likely to achieve their goals in a session and that these colors reflect light and give the appearance of more hair. In addition, low contrast to the underlying skin gives the illusion of more hair and skin that serves as a "filler" for the space between the hair shafts. By contrast, the dark hair on light skin accentuates the spaces between the strands of hair. Salt and pepper hair works reflect both light and creating another visual detail to subtract the low-density areas. Certainly, any patient who has no genetic attributes of hair color you can change color to complement the surgical procedure.
wavy hair usually provide better coverage than straight hair and is beneficial in the transplant. As that hair color, this can be manipulated after the surgery to improve the aesthetic impact of the transplant. frizzy hair, the other party may, on occasion, the work of a disadvantage for the patient if complete coverage of the bald area is not expected. very curly hair may increase the fullness of the transplanted area to such a degree that contrasts with any remaining bald area can increase. Furthermore, very curly hair transplanted to the front and top of the scalp can not be easily brushed back to cover a bald spot.
The follicle density in the donor area will also affect the procedure. In patients with high density, no more hairs per follicular unit, and therefore each implant contains more hair. In patients with very high density, a significant proportion of implants containing 3 and 4 hair can be harvested each from the donor, giving a wonderfully complete, including a single procedure.
Patients with hair of average diameter or above average will the best chance of success with a procedure. The cylinder of the skin surrounding the follicular unit from a patient with thick hair is more or less similar to one unit of fine hair, however, the volume of hair is very different. The diameter or "weight" of patient's hair is a huge variable. Considering that the density can vary by a factor 3 times the weight of the hair can vary from patient to patient for many times. Although it is much easier to quantify the density (number of hairs/mm2) rather than the weight of an individual hair, it is probably more important to the outcome of the procedure. Patients with early baldness who have fine hair and dark high-density are very difficult to satisfy in a single session, as the transplanted hair is often seen in the context of the population of the patient terminal thick hair around the area bald. By contrast, in a patient with similar hair thicker, satisfaction is easier to achieve in a single session.
Contrary to what one might expected, the patient extensively bald, even with low donor density, it can often be very satisfied after one procedure. These patients often have expectations very reasonable, and after being bald for many years are delighted to have the hair making your face, covering the light at the top, and "something comb. "In order that the expectations are met in a session, the reality of supply and demand situation should be taken into account. It is obvious that individuals in Norwood Class VI or pattern seventh, only light to modest coverage can be achieved in one session, as the hair area of the accident exceed the total supply donor by a factor of at least 6:1, even under ideal circumstances.
Finally, grooming patterns also influence the success of a procedure unique. Patients who plan to comb the hair to the side instead of straight back will have the appearance of more fullness. Unfortunately, this style of hair will not provide crown coverage. Many patients achieve "the best of both worlds" with his hair combed back diagonally.
References:
1. RM Bernstein, Rassman WR, Szaniawski W, Halperin AJ. Follicular transplantation. Rest Aesthetica Int J Surg 1995; 3:119-132.
2. Norwood OT. Male pattern baldness: classification and advocacy. So. J Med 1975, 68:1359-1365.
3. Rassman WR, S. Carson micrografts in vast quantities, the ideal hair restoration procedure. Dermatol Surg 1995, 21:306-311.
4. Headington JT: Transverse microscopic anatomy of the scalp. Arch Dermatol 1984, 120:449-456.
5. Kim JC, Choi, YC. Regrowth of scalp hair grafted after removal of the bulb. Dermatol Surg 1995, 21:312-313.
6. Limmer BL. Link theory hair growth and experimental evidence of hair transplantation practice. Am J Cosmetic Surg 1994; 11:305-310.
7. D. Seager Stereoscopic binocular microscope dissection: should we use? Hair Transplant Forum Int 1996; Vol 6 No 5:2-5.
8. Limmer BL. Elliptical donor stereoscopically assisted micrografting as an approach to further refinement in hair transplantation. Dermatol Surg 1994, 20:789-793.
9. Kuster W, Happle R. The inheritance of common baldness: two B or not two B? J Am Acad Dermatol 1984, 11:921-926.
10. Rassman WR, Pomerantz, MA. The art and science of minigrafting. Rest Aesthetica Int J Surg 1993; 1:27-36.
11. Demis DJ. "Clinical Dermatology." Philadelphia, PA: JB Lippincott Co., 1994, (1) 2-35 p3.
12. Bernstein RM. Are scalp reductions still indicated? Int Hair Transplant Forum 1966, Vol 6 (3) :12-13.
13. Bernstein RM, Rassman WR. What is stunted? Hair Transplant Forum Int 1997; 7 no.2.
14. Cooley J, J. Vogel Loss of the dermal papilla during dissection and bone transplantation: another cause of x-factor? Transplant Forum Hair Int 1997; 7:20-21.
About the Author
Dr. Bernstein is Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York. He is recognized worldwide for pioneering Follicular Unit Hair Transplantation. Dr. Bernstein’s hair restoration center in Manhattan is devoted to the treatment of hair loss using his state-of-the-art hair transplant techniques. To read more publications on hair loss, visit http://www.bernsteinmedical.com/.
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