Hair Loss Restoration Options

Hair restoration is a highly sophisticated subspecialty that offers significant relief for patients with hair loss. The results of hair restoration are natural in appearance and are provided with a very high level of patients’ satisfaction and safety. The hair restoration options available can be surgical and/or Non-surgical.

Non-Surgical Options

Medications: The goal of therapeutic intervention is to increase coverage of the scalp and to retard further hair thinning. In the United States, two medications: oral finasteride at a dose of 1mg per day and topical solution of 5% and 2% minoxidil are currently the only dugs approved by The United States  Food and Drugs Administration (FDA). Both of these drugs will help increase your hair density and therefore decrease further hair loss.

• Finasteride as a medication reduces hair loss and have about 90% potency promoting hair growth in the scalp by lowering DHT through blockades to the 5-α-Reductase type 2 pathways. However, there are a number of side effects associated with using finasteride as hair replacement medication including a decrease in libido, erectile dysfunction, testicular pain, and benign growth in the male breast. But the side effects generally disappear with discontinuation of finasteride.
• Minoxidil, a topical medication helps increase proliferation of dermal papillae cells, increase hair calibre, and diminished telogen phases during the hair growth cycle. The adverse effects of topical minoxidil are mainly dermatologic; irritation of the scalp, including dryness, itching and redness.

Surgical Options

Strip Surgery or Follicle Unit Transplant

Human hair grows from the scalp in groupings called follicular units. These units usually contain 1-4 terminal hairs, sebaceous unit, and supporting structures.

Strip surgery is an amazing option for patients who cannot tolerate a long procedure. It’s also the best option if you have an appropriate amount of occipital scalp skin.

How is Strip Surgery carried out?

The harvest process of this technique is performed under direct visualization of the follicular hair bulb, where few hairs are transacted and a high grafts survival rate results.

How there any side effects with this Strip Surgery?

Yes there is! The harvest process of this technique may leave patients with a noticeable linear scar on the occipital, and is not preferred in patients who wish to wear short hairstyle that might reveal the scar. In some cases, patients may experience neurological sequelae including postoperative hyperesthesia and hypoesthesia and the procedure requires a surgeon or a highly skilled technician to spend substantial amount of time at workbench performing manual harvest of individual follicular units from the excised scalp specimen.

Follicular Unit Extraction (FUE)

FUE is a minimally invasive surgical procedure that utilizes a punch device to harvest occipital follicular units that are later transported in areas of loss to restore hair growth.

The FUE method is ideal for patients who have little scalp laxity, and those who have undergone the strip method in the past or who are prone to hypertrophic scarring. This technique leaves little scar and creates a natural, aesthetically pleasing result. Additionally, no cases have been reported of neurological sequelae and patients experience minimal downtime before returning to normal activity. Other benefits of FUE are the ability to utilize body hair for transplantation to the scalp, beard, eyebrows, and even eyelashes and FUE can be utilize to harvest hair from chest, back beard, pubis, and labia; however beard grafts yield the most natural results.

What are the Procedures of FUE as Restoration Option?

The processes of FUE are as follow:

• The hair in the donor is shaved to 1-2mm in length; this would allow adequate visualization of the direction of hair entry into the scalp and direction of the hair bulb.
• Grafts are taken from the occipital scalp as these hair follicles have fewer androgen receptors and thus, experience less androgenic loss.
• The patient is placed in a prone position from effective occipital harvest or lateral decubitus position for temporal and parietal harvest.
• The donor is anesthetized with a lidocaine or bupivacaine solution diluted with saline, with or without epinephrine. However, the patient’s previous to epinephrine must be elucidated to avoid ischemia or necrosis of the scalp.
• Punch devices size is chosen based on follicular unit density, the more densely aligned, the smaller the punch required.
• The punch device is aligned over the scalp in the direction of the hair bulb and advanced to the level of the lower dermis.
• After removal of the punch, the follicular unit is manually extracted with forceps or needle.
• The extracted grafts are then stored in saline or located ringers until ready for transplants
• The first step in transplanting is to access the recipient area where the grafts will be placed; the recipient site is usually prepared with knives.
• Grafts are transplanted in the desired patterns by one of the three methods:
• Creations of single transplant site with immediate graft insertion
• Creation of all transplant sites followed by insertion of all grafts
• Use of an implanter
• Grafts are usually placed 35/square centimetre to 55/square centimetre dense, but maybe arranged up to 70/square centimetre if appropriate in patients with more dense hair growth.
• This process is repeated over multiple small 700 to 1500- graft sections.

What are the Benefits of opting for FUE as Hair Restoration Option?

Compared to other options, FUE is less invasive, more efficient as it combines excision and harvest steps, and avoid creation of a linear scar like strip surgery and FUE achieves more desirable outcome because of small transplant can be packed densely for a natural look.in addition, eyebrow, beard, moustache and eyelashes hair loss can be remedied through FUE technique, conversely manual FUE requires extensive training and it’s a laborious time-consuming and fatiguing procedure with cost on the high!

Other Adjuvant Treatment

Platelet Rich Plasma (PRP)

PRP is used in hair restoration as a way to improve graft survival, increase hair yield rate, increase hair density and diameter. PRP possesses growth factors that do not only help in hair restoration, but also in scar revision, skin rejuvenation and treatment of skin disease.

Low-level light Therapy (LLLT):

Although LLLT mechanism as a hair restoration option is still unclear and may lack substantial scientific backup, but it has been observed that LLLT can help increase your hair growth and can aid in wound healing, reduce inflammation and reduce the symptoms of stroke.

What are the Pre and Post-operative considerations of these Restoration Options in relation to FUE Method?

Pre-operatively

• Patients are advice to discontinue minoxidil medication to reduce the risk of bleeding.
• Patients are advise to abstain from alcohol, smoking, non-steroidal anti-inflammatory drugs (NSAIDs) for two to seven days before operation.
• Your physician may prescribe a sedative such as benzodiazepine or doxepin, to help calm your nerves before the procedure.
• In addition, pre-operative photographs are taken and mentioned for post-operative comparison.

Post-operative cares include:

• Placement of compression or a simple sterile bandage on the donor area.
• Antibiotics and ice compression on the recipient site may be used as needed for swelling expected for 3 days after procedure.
• New hair growth occurs in recipient tissue in about the 2^nd months post-operatively and can cause formation of sterile pustules.
• FUE complications are mild and include pain at the donor site, crusting at the recipient site, sub-dermal cysts and rarely necrosis at the donor site owing to maybe the exaggerated response to epinephrine in the lidocaine anaesthetic.

How can the laborious time-consuming and fatiguing procedure associated with FUE technique be circumvented?

The laborious time-consuming and highly skills required in FUE technique can be circumvented by adopting a more technically advanced technique called “SMARTGRAFT FUE”

SmartGraft is the most advanced minimally invasive hair restoration device for both men and women. This device is developed by physicians, medical scientists and engineers, to allow physicians harvest and preserves the donor hair more efficiently than any other system available, and it is done  in lesser time while delivering natural, permanent results compare to manually FUE technique.

What are the advantages of Non-Invasive Restoration Options?

• All the benefits of non-invasive procedures are:
• Minimally invasive office procedure
• No scalpel, no suture
• No linear scar
• Little discomfort
• Significantly reduced treatment times
• Reduced fatigue
• Quick recovery time( low downtime)
• Patients do not have to shave their whole head