Baldness

The term hair loss, is now established specifically to indicate a condition of severe and irreversible lack of hair.

One of the most common clichés identifies baldness as the hair loss but this is incorrect.

The term hair loss, is now established specifically indicate a condition of severe and irreversible lack of hair.

The main mechanism of baldness is the miniaturization of the hair, the hair processing terminal hair 'vellus': the hair becomes, always shorter and thinner. More specifically this transformation depends on the reduction of the bulb to work by inhibiting enzymatic reactions, which avoid the cycle of hair growth itself, in terms of genetic predisposition of the person.

The bulb is the vital part of the hair, so the problem of baldness is a problem of the bulb, not of the trunk!

Male pattern baldness is as all we know, a progressive thinning of scalp from areas that, the thunderstorms, proceed in the rear, until its merger with the thinning or bald summit. Others are visible only in the hair of the occipital and temporal areas.

Baldness also exists in women, however, it is rarely serious for the reduced presence of the male (one of the fundamental causes of baldness). It stands out because it does not exist, or it is very rare, the bi-temporal thinning, the hair loss.

We have seen that the phenomenon proceeds with different speed from subject to subject and, in this, male is conditioned by heredity rather than by the amount of male hormone in time.

During medical consultations it is showed that today more than the past, for some people, hair loss has become a rather significant and limiting life. The lack of hair can have an impact not only on aesthetics but also on psycho-emotional and social relationships with the others.

When hair loss occurs at a young age become a real frustration because this occurs between a handsome young body, with the height of its potential and an event associated with old age and loss of energy and life force.

Hence the search, sometimes frantic, and the availability of a remedy to undergo treatment of undoubted efficacy or side effects sometimes heavy to find a satisfactory solution that can restore its image.

Care and dermatological treatments for baldness with minoxidil and finasteride are attempt to slow hair loss that may still be subject to an unpredictable and irreversible evolution.

When the person reaches the awareness that the remedies used in the first phase of the fall do not achieve the desired effect, the desire to radically thickening its image often comes.

This desire leds him to an intervention that is aesthetic correction surgery.

Approach hair restoration

When the psychological distress becomes so deep, aesthetic correction is certainly not a frivolity, but a way to have a psycho-emotional improvement and strengthening self-esteem.

The hair restoration is the only way forward in a serious manner if there are ineffective or insufficient number of medical therapies.

In the surgical treatment of baldness, the hair transplant follicular units of hair follicles, is the intervention of first choice because scientifically it provens safe and still the best solution.

The operation, performed under local anesthesia, is painless and minimally invasive: it is the transfer of individual follicles containing from 1 to 5 hair from the neck to the bald or thinned. Its biological basis is the 'genetic memory' hair nuchal not fall wherever they are transplanted, a principle that guarantees the growth 'to life' without any hair transplant treatment.

To optimize the transplant and get the current high levels of quality has been developed in recent years, a surgical instruments that facilitate specific stages of sampling, creation of sites for receiving and positioning of the follicular units. The simplicity of operation and almost not visible made total area have made these micrografting increasingly accepted with enthusiasm by patients.

Indeed the result is very close to the natural desired situation although it depends very much on the surface area to be covered and the amount of scalp still present.

Hair Transplant

The microfollicular follicular unit (from Follicular Unit micrografting) has overcome the limitations of previous techniques, including unsightly 'doll effect' (pluggy look), and increasing the number of candidates for hair restoration. This procedure, with great flexibility, allows more than any other to recreate or redefine the line that was frontal and temporal in nature so as to render impossible the perception that the subject has undergone surgery to repair.

VISIT THE PRELIMINARY

The first contact between surgeon and patient is always very important. And it is here that it will determine whether the hair loss has reached a stage where other therapies cannot give satisfactory results and is corrected using surgery.

The fourth stage of the Hamilton scale surgery is often the best solution, although it should be noted that the ratings scales dell'alopecia are just indicative and that each patient should be individually evaluated.

To plan the intervention it is important, with some exceptions, that the fall has somehow stabilized. It is important that you probe the expectations that bring the patient to the surgeon, which are realistic and not linked to or dismorfofobia unrealizable desires.

For younger patients, where hopes and anxieties are usually very urgent, it must be shownt the hair change that it may have in life and how this should be considered in the planning stage of self-transplant. Often this terrifies a boy who loses his hair but this is not the situation that he fears about what can happen later.

A transplant will give him the assurance that there won’t be baldness. A good surgeon will recommend the best strategy without promising miraculous results but looking for the right solution, taking into consideration the age, degree of hair loss, density, color and hair quality of the donor. Often, in conversation with the patient, stressing that baldness is not a disease but a psychological and aesthetic problem: the surgeon's task is to find the solution to this problem.

During the preliminary interview, the patient will receive all relevant information (proper technique, site preparation, the results obtained, precautions and possible complications of post-operative) approach to intervention that will help you with greater awareness of the benefits and limitations of the self-transplant.

To avoid disappointment, the patient must basically have a clear basic concept: the self-transplantation of hair plays well with the task of reallocating existing hair but cannot create new ones.

MARKING of self-transplantation.

The candidates for transplantation: who has type androgenetic alopecia or male and female, who has scar areas caused by trauma (including surgery, such as a facelift) or skin diseases, those who want to thicken or restore hair lost in body parts such as eyebrows, eyelashes, pubic areas burned.

The candidate for hair restoration can be defined as those, men or women, from eighteen years, that have found a permanent loss of hair (other than surgery are insulin-dependent diabetes and severe heart disease). The thickening surgery is justifiable in the presence of sparse small area, especially if the person lives with the problem as an element of discomfort and contempt.

Autografting in younger patients.

Young patients are always difficult to please because the will to use the self-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 as reassuring as decisive. This will give him that, if baldness is not particularly advanced, it is better to wait and assess the further progression.

Meanwhile, to keep the hair as possible these should be considered medical treatment: finasteride, minoxidil etc.. 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. To design the intervention must also rely on family anamnesis, considering the cases of baldness in the family, especially his father and maternal grandfather.

AUTOGRAFTING IN WOMEN

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. Please inform the patient that, with the perimenopausal and postmenopausal period, there will be further hair loss and therefore may have to be taken into account in future sessions of transplantation, provided that the donor area is able to enable it.

Redefining THE FRONT LINE

Until a few years ago there was a tendency to over-achieve perfection by drawing a line too symmetrical front with instant density. However, experience has shown that this approach produces results unnatural. Overcrowding is also not advisable, especially if the reserves are limited donor areas.

Although the transplant surgery always the same in its execution, the end result should be slightly different because of the way in which the surgeon faces the design front line staff.

There are various formulas that indicate the ideal position of the front row. It always advisable, however, a conservative approach (8-9 cm from the glabella) to fit the face shape, age, extent of baldness, the density of the donor patient. To obtain the naturalness of all proceed to the creation of sites receiving a second path irregular and random.

The surgeon must constantly put in front of the patient to have a front perspective also. During the first 2 cm of hairline incisions are performed sleepers, coronal, within which are inserted solely with individual follicle transplants from the lateral area of the head and particularly suitable for the greater subtlety of their hair.

The distance between plants is related to the density you want to reach the understanding that gradient that allows a more natural appearance. The rest of the cuts are radial, sagittal, and receive follicular units.

Thickening of the Summit and the tonsure

Transplant surgeries is rightly given considerable attention to the reconstruction of the front row while the summit is often overlooked.

And 'common conviction that the transplantation of young patients with apex tonsure should not be executed. Having said that, for patients aged between 20 and 30 years, collecting family history on hair loss and found that the donor area is sufficient for three interventions, we can start to fix the tonsure even if we assume that future baldness can evolve to the stage 6 or stage between 6 and 7 of Norwood classification.

The technical advantage that makes this "chance" is the transplantation of a single follicle.

A strip of skin with a thousand follicles, which once yielded 300 to 350 transplants, now makes all its 1000 grafts, ensuring the possibility of wider coverage even more sparse. The goal is a "crown" often natural-looking, plausible.

With the patient must also be discussed the benefits and risks of medical treatments available today. Is important to treat all the tonsure at once, but leave enough donor area for two interventions: the frontal area and the summit. If the patient has 40 or more years instead of objective examination and family history indicate that hair loss is limited to one area of the summit, you can operate with greater density.

The thickening of the tonsure requires technical skill and artistic sense equal if not superior to that required for the front line in this area because the hair changes direction and the spiral vortices appear with many variations.

To facilitate access to the underside of the summit, the patient is placed in the prone position, as the sampling procedure. This position makes it more ergonomic and physically easier for the surgeon to create sites and reception for the staff, the insertion of implants. Follicles are put down, changing direction in a second time in a curve of 360 °, in order to create the vortex. Once you reach the center of the summit, the patient is sitting in the back seat.

It should consider the center of the summit, where the hair grows forward, an extension of the frontal region, so care should be taken here with a higher density.

CONSIDERATIONS

It 'a far better transplant conservative too aggressive.

The goal is not thickening as possible glabrous or sparse area, but the gradual density maximum in the central and lower as you approach the four peripheral sides.

Experience makes every surgeon adopts its own modus operandi with his patients. It 'hard to stay on its exhaustive convictions and skeptical of new approaches. If you instead open to new perspectives will have a greater chance of finding a case the best surgical approach that responds to individual needs.

Even the autograft has its limitations. The surgeon must adapt to what you have available to achieve a result as complete as possible. When the follicle cloning will be a reality, you can obtain the full restoration of hair in all cases of baldness.

A successful transplant is that once a hair restorer, is not recognizable, even more critical eye, for the naturalness of the results achieved.

THE POSTOPERATIVE

After surgery, the patient leaves the medical facility and can resume normal activities within a few hours. And 'possible in 24 to 48 hours, notify the donor in an unpleasant sensation of stretching the skin, solved with a mild analgesic. For the first few days, the patient is advised to sleep in a half-sitting, to prevent or minimize swelling and bruising.

The incision donor area heals with a scar thin and aesthetically negligible, because covered by surrounding hair. The external sutures applied here should be removed around the tenth day.

The scabs that form on the site of reception, a normal consequence of the healing process, leaving no visible signs of fall in a relatively short time: 4 - 6 days those related to individual follicular units within 10 days of those multifolliculars grafts.

RESULTS AND CONTROLS

The transplanted hair will begin to grow after 4-6 months after surgery. Usually requires monitoring at 3 to 6 and 12 months later the self-transplant.

EVOLUTION OF TECHNOLOGY IN THE FUE SELF-TRANSPLANT

The continued demand by patients to use less invasive interventions, is shifting many surgeons using the technique of Follicle - Extraction or in combination or as an alternative to the traditional one. This fact avoids the presence of scars in the occipital region, which can sometimes be cause for resistance to psychological intervention for transplant.

The F.U.E. Indeed as is well known for taking the individual follicular units from the donor region and then insert them in the same way the traditional technique in the receiving areas.

Need a good training because training removal from the individual UF requires speed 'manual and precision to avoid damage to the bulb when it proceeds from its surrounding all'ipoderm posting.

This technique is particularly useful in taking bulbs placed in areas other than occipital region as pubic, and thus is indispensable for patients with very sparse donor area.

There is also greater in younger patients request for their look, that look a haircut almost razed to the scalp.

CONCLUSIONS

The new revolutionary technique F.U.E. has joined our panel and our therapeutic practices of high quality hair transplant thanks to the experience in recent years and the constant and continuous updates at International level and world that this field requires.