INTRODUCTION: 

• Hair loss represents a distressing issue affecting a large portion of the population, including upto 85% of males & 40% of females. 
• The most commom cause of hair loss is Androgenetic alopecia(AGA) 
• Non – surgical modalities help in halting the progression of patterned hair loss & even help grow new hairs. 

• Recent advances in surgical hair restoration have made hair transplantation an increasingly effective, safe and reliable way to regain  a more youthful and natural appearance of their hair. 
• The ability to provide very natural looking results has encouraged large number of balding  men & women to opt for hair transplantation. 
• Follicular unit  transplantation (FUT)  and follicular unit extraction(FUE) are two commonly used & accepted techniques. 
• FUT required excision of strip of tissue from occipital donor area leading to linear scar. 
• To overcome scarring & other complication of FUT , FUE technique has been attempted which involves harvesting of small individual follicular units. 

HISTORY: 

• The history of hair transplantation can be traced as early as 1822 when Dieffenbach experiment with hair transplanted in birds
• In early attempts , Japanese Dermatologists  Sasagarva , Okuda , Tamura and Fujita used small autografts containing hair follicles for the correction of scars & cicatricial alopecia. 
• In 2002, Rassman et al , described the FUE technique in detail & discussed various clinical and microscopic features of follicular grafts harvested from 1mm punch. 

RATIONALE OF HAIR TRANSPLANTATION: 

                 Hair transplantation is based on the ‘ theory of donor dominance in Androgenetic Alapecia’. 

                 If a graft is taken from an area destined to be permanently hair-bearing and transplanted to an area suffering from patterned baldness, it will, after an initial period of effluvium,  grow hair in its new site as long as it would have at its original site.  

                  This is the scientific basis of hair transplantation. Occipital area is unaffected by balding process and the hairs in this region last a life time. 

 FUE in Androgenetic Alopecia: 

• FUE  is an established technique for Androgenetic alopecia in males as well as females. 

THE FOLLICULAR UNIT GRAFT( FUG) as described by Headington includes 1-4 terminal hair follicles, one (or rarely  two) vellus follicles, associated sebaceous gland & duct, insertion of erector pili muscle, peri follicular neurovascular network. 

ADVANTAGES  OF  FUE OVER FUT: 

• Increased no.of  grafts are harvestable  
• Post operative pain is less 
• Less visible scar                                                                    
• Shorter post operative recovery  
• Body hair can be used 
• Can be done in tight scalp cases. 
• Minimal risk of nerve injury or excessive bleeding. 
• Surgeon can selectively pick grafts from donor.    
  

PROCEDURE:

• The donor site hair is trimmed to 2mm ; pre-op medications (antibiotics & anti- inflammatory drugs )are given. 
•  The paitent is placed in a prone position. 
• Local anaesthesia is given in the donor region. 
• Once desired anaesthesia is achieved, the follicular units are harvested using adequate size punch (0.7 to 1mm) and forceps 
• The grafts are preserved in cold saline  
•  The grafts that are fit are chosen for the transplant. 
•  Once the grafts are harvested the recipient slits are prepared using appropriate 18-20 gauge needles or blades. 
•  Each follicular graft is then carefully transplanted in the prepared  slits. 
• Utmost care is taken while handling the grafts. 
• Once the procedure is over the surgical area is thoroughly cleaned with saline. 
• An antibiotic dressing is done on the donor area. 
• Routine antibiotics, anti-inflammatory medicines including steroids are prescribed for post operative care. 

Post operative care: 

• The patient is discharged on the same day. 
• Some swelling is obvious after a hair transplantation 
• The patient is instructed to follow the post-op medications, antibiotic ointment for the donor site,  washing the donor area with  mild shampoo starting from the 2nd post -op day. 

HAIR TRANSPLANT CAN ALSO BE USED FOR

1. Eye lash 
2. Beard 
3. Moustache 
4. Eye brows 
5. Scars  

GROWTH OF TRANSPLANTED HAIR

• There  will be loss of the implanted hairs normally after several days. 
• It may take several months ( 6-12 months) for the grafted hair to grow.