By Dr. Patrick Treacy
A large number of men will experience what is known as male pattern baldness at some stage in their lives. While there is no doubt that that some men will find it upsetting to lose their hair, at least the condition is quite common among men. For women, on the other hand, hair loss, especially when it is sudden, can often be very traumatising. Fortunately, newer methods of treatment such as 'single follicular transplant' and 'genetic predictability screening' have become available, which now means a patient can be treated many times and technically does not have to go bald. A lot of these newer techniques have been perfected in Dublin. Rejuvenate Magazine spoke with Dr. Patrick Treacy about the option of the new H+ method of hair transplantation.
First, why do we actually lose our hair?
There are numerous factors that contribute to the cause of hair loss in both males and females but genetic pattern baldness accounts for nearly 95% of all hair loss in men, as well as affecting millions of women. Androgenetic alopecia in women rarely leads to total baldness and the pattern of hair loss differs from male-pattern baldness. In women, the hair becomes thinner all over the head, and the hairline does not recede.
Tell us more about androgenetic alopecia?
There are a variety of genetic and environmental factors that are likely play a role in causing androgenetic alopecia. Although we know risk factors that may contribute to this condition, most of these factors remain unknown. Researchers have determined that this form of hair loss is related to hormones called androgens, particularly an androgen called dihydrotestosterone (DHT).
How do genes play a role in hair loss?
It was previously believed that baldness was inherited from the maternal grandfather. While there is some basis for this belief, it is now known that both parents contribute to their offspring's likelihood of hair loss. Large studies in 2005 and 2007 showed the importance of the maternal line in the inheritance of male pattern baldness. German researchers called the main 'balding' gene, 'ARG' or the androgen receptor gene. The presence or absence of a specific variant in this gene is related to baldness.
What is the H+ method?
This is a good question. Studies show nearly all men have some baldness by the time they are in their 60s. However, the age the hair loss starts is variable. One large Australian study showed the prevalence of mid-frontal hair loss increases with age and affects about three in ten 30 year old males and half of 50 year old males.
With evolving techniques like the newer single hair follicle extraction technique, follicles are extracted one by one from the donor area (back of the head) and re-implanted with the unique patented devices. The H+ method is based on the use of genetic testing as a means of screening, the use of growth factors, 633nm light for fibroblast stimulation and the use of quality control during the hair transplant procedures. The hair transplant doctor needs only a single surgical assistant to help him during the follicle hair transplants. The procedure also ensures maximum care to the grafts. The hair transplant doctor can decide upon the exact number of grafts to be removed while he is removing them one-by-one.
The H+ genetic test can predict a patients risk for hair loss or thinning. Because single follicular hair implants can be used multiple times and it is not limited as in methods like strip surgery this means a patient can theoretically never be allowed to go bald again. Patients should remember by the time hair loss or thinning is noticeable - almost 50% of your hair could be gone and the genetic test will help predict a patients hair loss before you can see any visible hair loss
The best thing about the H+ method is that the hair extraction is simple, painless, and the donor area heals within 2-4 days. Individual hair follicles are removed one by one using the H+ Extractor and Implanter by a surgeon who is wearing high magnification loupes. Patients can listen to music, watch tv and enjoy a light lunch during the procedure, which is completed in four to six hours. There is absolutely no risk of nerve damage because scalpels or stitches are not used.
The most popular medical treatment is Minoxidil (Rogaine), which is available in 2% and 5% topical solutions. Unfortunately, cosmetically useful hair is obtained in only about one third of cases and Minoxidil must be used indefinitely to maintain a response. Another treatment involves taking Finasteride (Propecia) 1 mg tablets and given once daily. Hair loss drugs like Propecia work by inhibiting the creation of DHT in our bodies. By reducing the amount of DHT that can affect a man's hair follicles, hair loss can be slowed or even stopped.
Body hair follicular grafts have shown growth patterns similar to head hair with no difference in texture but are usually used for enhancing the density in the posterior region of the scalp rather than the hair line. Hair regrowth will be seen after 16 weeks, depending in part on how quickly the capillaries form around the newly relocated follicular units. This newly transferred hair grows naturally in its new location for the rest of the patient's life.
Hair transplantation is a surgical technique that involves moving sections of skin containing hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to a bald scalp. However, it is also used to restore eye lashes, eye brows, beard hair and to fill in scars caused by accidents and surgery such as face lifts and previous hair transplants.
This is the interesting thing about this technique. We can do one session or ten sessions depending on the needs and requirements of the client. In the end it really depends on the size of the balding area, donor yield and the goal of the patient. In order to achieve a greater density, I would suggest starting treatment early and plan at least two or three sessions over the next six or seven years, so in effect you never really become bald.
Modern hair transplantation began in the 1950s based upon the pioneering work of New York dermatologist Dr. Norman Orentreich who demonstrated that such grafts were "donor dominant," - the idea that grafts continue to show the characteristics of the donor site after they have been transplanted to a new site. This principle provides the basis for all hair transplant surgery. Although "donor dominance" insured that transplanted hair will continue to grow, it did not insure that the results would look natural.
Why did transplants by 'punching' stop?
Because the H+ technique may continue to place hair over a longer period we have decided to allow patients to join a 'Samson' club. This means they can contribute about 25 per week for six months and we will provide interest free financing to cover the rest of the cost. Plans usually this run over a 3-5 year period making it very easy for the patient to finally achieve his aesthetic goals
Tell me about punch transplants?
The punch technique continued during the 1960's, although the size of the punch was reduced in order to improve the survival of the hairs in the central part of the graft. For the next pedriod, surgeons worked on transplanting smaller grafts, but results were only minimally successful, with 2-4 mm "plugs" leading to results that were often "pluggy" and unnatural and was referred to as a "doll's head" or "corn-row" look.
What are the 'minigrafts' and micrografts technique?
With microscopic dissection of donor pieces from an excised portion of scalp, individual follicular units containing but 1-4 hairs could be prepared and individually relocated into needle punctures in the recipient areas. Since the transplanted hair mimics the way hair grows in nature, close to natural results were attainable. By the year 2000, Follicular Unit Transplant (also referred to as FUT) by the strip technique was more firmly established and respected due to its ability to produce more natural results. However, because the procedure was more labour intensive and time consuming than mini-micrografting, it was adopted slowly by the medical community.
What transplant technique is the best in your opinion?
The strip method is really an invasive surgical procedure requiring the attendance of a plastic surgeon and general anaesthesia. During the procedure, a long strip of scalp, approximately 20- 25 cm in length and 1 cm to 2.5 cm in width of hair-bearing skin is removed from the donor area using a scalpel, cutting through nerves and major blood vessels of the scalp. The donor area is then sutured (stitched) closed and approximately 30 days are required for full healing. In order to avoid stretching of the donor scar, two layers of donor stitches must be used and left in the skin for at least two weeks.
What is the 'strip' method of hair transplant?
. Should a patient shave their hair short in the donor area, a line or scar will always be visible. A patient forever gives up the option to shave their head or have a short haircut after a strip procedure. Although there are many good proceduralists of this technique, I personally would consider 'strip surgery' an out-dated procedure.
What is the best hair transplant treatment now?
Over the past few years unit follicular hair transplant has emerged as the most reliable hair transplant procedure of hair transplantation surgery. As the name suggests, the graft in this case consists of a single follicular unit as it exists in nature. The follicular unit contains sebaceous glands as well as nerve and blood tissue. It is for this reason that it needs to be extracted as an intact unit and transplanted as an intact unit, to be able to grow into a hair. There are basically two types of technique.
1 Follicular Unit Transplantation (FUT) is a hair restoration procedure where hair is taken from a single donor strip or extracted directly from the donor area.
Follicular unit extraction is simple and painless, with the donor area healing within 2-4 days as compared to 7-8 days required for follicular hair transplants using the graft extraction technique. There is also no risk of nerve damage being caused by the hair transplant procedure.
1 Follicular Unit Transplantation (FUT) is a hair restoration procedure where hair is transplanted exclusively in its naturally occurring groups of 1-4 hairs.
This is a difficult question to answer as there are proponents of both techniques. Although, FUT is considered an advance over the 'mini-micrografting' hair transplant procedure, many transplant doctors do not consider it as advanced as FUE because the technique still requires larger areas of the scalp to be removed than single follicle extraction. Proponents of the FUT technique say that there are also problems inherent in removing individual follicular units with small punches. First, any significant variation between the incident angle of the punch and the exiting hair can result in graft transection. It is known that it is difficult to keep the punch parallel to the follicles throughout the entire length of the graft as the visual cues used to guide one's hand are lost once the punch passes into the depths of the tissue. Another disadvantage of both follicular techniques is the requirement of long hours of time and skilled teams of assistants for the preparation of 3,000 odd follicular hair transplants through dissection. My feeling is that the final result is very operator related.
What is the H+ method?
There are proponents of both techniques. Although, FUT is considered an advance over the 'mini-micrografting' hair transplant procedure, many transplant doctors do not consider it as advanced as FUE because the technique still requires larger areas of the scalp to be removed than single follicle extraction.
What is the H+ transplant method?
One advantage of the H- transplant procedure is that it allows the hair transplant surgeon to extract as many grafts as is actually needed and on average, we usually extract and place 3,000-5,000 hairs per day.
How many sessions will be necessary before hair restoration is complete after the H+ method?
This is the interesting thing about this technique. We can do one session or ten sessions depending on the needs and requirements of the client. In the end it really depends on the size of the balding area, donor yield and the goal of the patient. In order to achieve a greater density, I would suggest starting treatment early and plan at least two or three sessions over the next six or seven years, so in effect you never really become bald. The numbers of sessions being one or more is aided by the use of genetic programming and special camera densitometry equipment to see under the skin and fully inform the patient of his or her total available donor hair. In each session, the follicles are inserted between existing hairs or previously placed hairs and generally placed up to 1mm apart.
How many sessions are required for the H+ method?
How many sessions are needed before hair restoration is complete after the H+ method?
What price is the H+ technique?
About 3 per follicle
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Hair loss a problem. Before you decide on hair transplant, make sure you check cosmetic expert Dr. Patrick Treacy's excellent free report on the H+ hair restoration technique