Trapianto di Capelli
Hair Transplant, FUE commonalities between the technical and STRIP EXTRACTION.
On average, in the scalp hair it is about 100,000 (up to 150,000 in women) and their number is predetermined at birth.
The two methods Surgical Hair FUE and STRIP share some fundamental aspects:
Visit preliminary patient selection.
The preliminary visit to the intervention used to assess the patient wants to undergo hair transplantation, examined for general health, dermatology and psychology, consider the possibility that it may be subjected to surgery of baldness (choice of intervention and subsequent assessments).
Removed the specialist should explain to the patient all aspects of the action, understand its real expectations, show clinical cases, locate the surgical technique best suited to his case. In general the intervention of transplant candidate:
Who has androgenetic alopecia type male or female who has scar areas caused by trauma (including surgery, such as a facelift) or skin diseases, Who wants to thicken or restore lost hair on body parts such as eyebrows, eyelashes, pubic areas burned. In order to be considered a candidate for a patient approach rather than another course patients should be subjected to evaluation parameters required for each case. It 'should in fact compare the advantages and disadvantages of each method together with the general health and specific patient and results that you want to achieve.
Candidate for hair restoration can be defined as those, men or women, from eighteen years, has found a permanent loss of hair (other than surgery are insulin dependent diabetics and heart patients severe).
The thickening surgery is warranted if there is a 'sparse small area, especially if the person lives with the problem as an element of discomfort and contempt. Young patients are in fact always difficult to settle because the will to use the bself-transplant is charged with a series of expectations not always objective. Often request the correction of the normal frontoparietal alopecia (the hair loss).
The premature baldness can have heavy consequences for the psychological quality of life. In a young patient and especially to those not yet of age, the surgeon should take an attitude while reassuring and decisive. This will give him that, if baldness is not particularly advanced, it is better to wait and assess the further progression. If you decide later but not for early intervention is necessary to choose a little aggressive approach and provides the worst possible evolution dell'alopecia.
The woman may be subjected to hair transplantation has provided good quality and sufficient density in the donor region. She lives baldness as a handicap not only for its aesthetic aspects but especially for the reputational damage that affects this behavior is that, sometimes with extreme forms, in his love life, social and professional. In discussing the transplant with a woman should be a different approach than men. Of great importance is the food not too high and unrealistic expectations that can lead to heavy disappointments and deep bitterness. The surgeon, after evaluating what are the causes of hair loss, will assess whether the patient has a sufficient density of the occipital donor and if the hair is suitable diameter.
Preoperative evaluation.
Whether you decide on the sampling technique for STRIP or FUE technique will require some preliminary investigations requiring routine preoperative tests: CBC, ALT, markers of hepatitis B and C and HIV, coagulation tests, ECG, etc.
It 's important that your surgeon is aware of any medicines taken by the patient whose components can interact with bleeding or with medications used in the surgical session. The patient is asked to report any allergies (ex latex) or abnormal reactions to anesthesia and medications used during the learning session surgery.
The day of surgery we proceed to the next step of pre-operative photographs and is reviewed and possibly redesigned the operating table and custom compiled during the preliminary visit.
STRIP in the self-transplant technique than in the FUE, under the invasion caused the decrease surgical incision in the donor area, it is important that patients adhere to the following provisions:
Implantation of grafts or follicular unit.
While assistants prepare the graft, the surgeon prepares the receiving area, this is cleaned and anesthetized with the same anesthetic used for the donor area.
Using 2% lidocaine with 1/100.000 adrenaline starts from the back, less sensitive, and proceed to circle along the front line, in the same manner described for the sampling area, triggering an anesthetic block (ring block). During this phase it is good to talk with the patient explaining what is being done and preparing for those that can feel: a tingling and a slight burning sensation. Not necessary and should not proceed with haste.
Subsequently injected into the ring block 3 to 5 ml of 0.25% bupivacaine with adrenaline 1/200.000 e. in an extremely shallow, 1 to 2 vials of 1.8 ml of lidocaine 2% with epinephrine 1/50.000. This integration aims to achieve a better effect vasoconstrictive and anesthetic as some nerve endings, especially in the frontal region, the surface shall be payable. Everything is always working a number far below the maximum recommended dose.
After waiting for about 30 minutes so that the drug has reached its maximum vasoconstrictor effect, we proceed to create the receive sites, providing again a bit of swelling, injecting saline zone by zone, little before impact, thus preventing its spread and making the most of its compressive effect.
The sites are intended to accommodate the graft can be achieved with a variety of instruments: scalpel blades, punches of various diameters, microlame and needles of various sizes. The incision should be slightly smaller diameter graft, prepared so as to cause less trauma and less vascular damage and while allowing the greatest possible proximity of the grafts and consequently the best possible density. The incision that creates the site of reception must also be given respecting the natural angle of hair growth in that area and preserving the integrity of any hair present, if the transplant would serve to thicken sparse area.
Created receive sites, is to install the bulbs.
The plant is by means of anatomical tweezers curved or straight depending on individual preference. The follicular units to be taken lightly at the base, not at the level of adipose tissue, easily friable, but at present collagen fibers (which appear white) making sure not to tighten too much not to cause injuries (one must advise the feeling of keeping without touching).
The insertion depth of the receiving site must be done with a gentle flick of the wrist and without forcing. The follicular unit, once inserted, is positioned in harmony with the direction of the hair this short.
Transplanting very small grafts in large quantities at minimal incisions and requires skill and experience by the surgeon, the duration of that surgical procedure varies according to number of grafts to be inserted. A typical megasession with 2000 to 2500 follicular units required for a patient who has none of the problems described below, about 3 to 4 hours with four assistants to simultaneously begin the integration of follicular units.
Around the patient is positioned laterally two assistants began to insert the graft along the front while the other two are located behind to complete the remaining area. As the operating field narrows, off to work before an assistant and then a second, leaving the others to finish the operation. Usually half of the insertion phase, and before the patient begins to feel discomfort, it provides an integration of anesthesia and in the levy along the edges of the reception.
Problems can arise when inserting the follicular units are essentially the bleeding sites of reception and the phenomenon of popping out. As for the bleeding, a decision to infiltrate the area with lidocaine 2% with epinephrine 1/50.000, exercising for a few seconds a firm pressure with gauze and homogeneous. This maneuver is repeated several times, allows you to continue entering it, even more must be done with the utmost delicacy. The popping out is the wish to escape graft already included when you proceed to the insertion of a graft to close them. It is a little problem with the elasticity of the reception or excessive bleeding the patient, inserting the graft solved "patchy", ie skipping the insertion of 3-4 sites and then come back later and taking appropriate spot those already included applying a slight, uniform pressure with a cotton swab or gauze.
After the insertion of follicular units, the operative field is cleaned of any blood clots from spraying and dabbing pure saline gauze.
The surgeon then proceeds to carefully monitor the work, checking that everything appears to be perfect, even spraying on the saline and finally drying with warm air of a hair dryer: begins at this precise moment the process of rooting of the bulbs and formation of microscopic crusts, just as many grafts are inserted.
Familiarity on the anesthesia.
The hair transplantation surgery is limited to that invasiveness can and should always be performed under local anesthesia.
This, besides allowing the discharge of the patient almost immediately after surgery, leads him to interact and cooperate actively in all the surgical steps. Anesthesia also poses problems that must be known. First of all the duration of the intervention, which usually requires several hours of work and also the most cooperative patient often has a need for pharmacological support that enables them to bear its length.
Be advised that the modern techniques of hair transplantation now require longer sessions than before (4-6 hours), mainly due to the number of transplants for each session and to the smaller of them. All this requires adequate anesthesia, which maintains its constant action and better hemostasis limiting bleeding.
The choice and the anesthetic are therefore a key element.
The importance of pain control at all stages and reduce the anxiety of the patient should not be underestimated. For this reason it is necessary that the surgeon is aware of the action, dosage, duration and possible toxic reactions to anesthetic that will be used.
Among the local anesthetics are now preferred to lidocaine hydrochloride 1% with adrenaline 1/100.000 and 0.25% bupivacaine with epinephrine 1/20.000 which has a duration of action of 2 to 3 times longer than lidocaine but is more toxic. Allergic reactions to these anesthetics are very rare and mostly due to a preservative and methylparaben, which is added in multidose preparations for its bacteriostatic and fungistatic. The systemic toxicity is due to two reasons: to accidental intravascular injection, even in small quantities, or giving excessive dose.
The Company does not exceed the recommended dose of 50 ml of 1% lidocaine with epinephrine 1/100.000 for single dose, the maximum recommended dose for bupivacaine 0.25% with adrenaline 1/200.000 instead of 225 mg.
The administration of benzodiazepines reduces the effects on the nervous system Central or increases the seizure threshold. Are sufficient according to most surgeons hair specialists diazepam 10 mg orally, but some prefer a deeper sedation for venous here for medico-legal reasons it is advisable the presence of an anesthesiologist.
If you want to sedate the patient the choice of sedative hypnotic drugs falls on the last generation molecules are characterized by favorable pharmacokinetic profile with rapid action and equally rapid fall of plasma concentration below the therapeutic window, such that the risk of prolonged sedation and side effects at a distance is practically annulled. These properties allow, during surgery, a patient's sedation effective and highly adaptable, keeping intact the possibility of dismissal to end procedure.
Midazolam (Ipnovel), ultrashort-acting benzodiazepine, administered in boluses retracted until they reach desired clinical effect, can be used with confidence and remains today the most widely used molecule.
Propofol (Diprivan), is valuable if you prefer continuous infusion to achieve a stable level of sedation, which can vary from simple anxiolysis to a true hypnotic state. The characteristics of the drug, its high volume of distribution and rapid fall of plasma concentration at the end of infusion is related to degradation of that redistribution, to guarantee its complete cessation of clinical effects after infusions of long duration.
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