The front hairline forms the top of the frame. When the front line returns, the top of the frame disappears and a relatively old look appears.
The most important factor in determining hair loss is a genetic predisposition. Although environmental factors contribute, the main cause of hair loss is the sensitivity of the androgen receptor to this hormone. Sensitivity to androgen or testosterone, especially in the front and top of the scalp. Although there is no tendency to shed, some openings can be considered normal with age. The starting amount accepted as normal varies by age, for example, 30% normal shedding in the 30s. If the opening amount is higher than this rate, it is considered abnormal. It is also normal to lose 100 hairs per day. However, fresh graduates rather than spills. The hair cycle on the scalp takes an average of two years and consists of the anagen, telogen and regressive phases. Each hair is at a different time in the cycle. 85% of the hair on the scalp is in the anagen phase, that is, in the phase of active growth. 15% is in the resting or telogen phase, while a very small part is in the regression or telogen phase. Hair follicle regeneration is due to the abundance of stem cells in this area.
It is the structure of the hair that determines the style of the hair. It is important that the hair is curly or straight, black or light, thin or thick. The features that increase the quality in hair transplantation are that the hair is black, thick and straight.
Hair density means the follicular unit per square centimeter and the number in the occipital region where the grafts are made varies between 50 and 160. The ideal rate of transplantation is 25-35 follicles per square centimeter. It is technically difficult to obtain a density above 25 and the success of graft retention may be decreased.
The most common seeding methods:
- FUT (Follicular Unit Transplant)
- FUE (Follicular Unit Extraction)
In FUT (Follicular Unit Implantation), the occipital area, that is, the strip above the nape of the neck, is removed and divided into grafts on the table. Accidental leaves a scar between the ears and is rarely preferred in our country.
In the FUE (Follicular Unit Extraction) method, the grafts are taken as units with a hole. In this method, although the scar is more gross, it is easier to hide it with the remaining hair as it is distributed over the area. This method is mainly used in our country, and we prefer this method.
The method of transplantation is the same in both methods.
It is possible to use an average of 3000 micrografts (part of the skin with an average of 1-3 hairs) at a time. Although this number can be increased to higher numbers, the total time to the procedure is prolonged and the patient’s tolerance may be reduced. If there are sufficient resources, it will be appropriate to offer a second session the next day.
FUE can also be performed on gray hair. First of all, the hair is dyed with black paint immediately before the procedure and wait for a while. Hair turning black prevents its intake and loss during this time.
In the FUE method, a manually processed pen-shaped perforator or low-speed micro-motors with a perforator (0.7-1 mm in diameter) can be used. Both tools have plus and minus sides. We prefer getting tinted with a precision motor.
Before transplantation, the scalp structure is extracted by examining the hair. What is the level of hair loss according to Hamilton Norwood classification, what is the condition of the hair in the recipient area, what is the hair density, thickness and color of the donor area (the occipital area between the ears).
Ludwig’s classification is used for women and its disposal pattern is different from that of men. Blood thinners such as aspirin and vitamin E are stopped one week before the operation and it is recommended not to drink alcohol during this period. Otherwise, the bleeding that occurs during the procedure makes it difficult to obtain the grafts.
The procedure begins with gentle sedation, lying on a table specially designed for hair transplantation, and applying local anesthesia to the receiving area. The graft is removed at a rate of 2 hours for 3000 grafts. This period may increase or decrease depending on the structure of the skin. The follicles taken for culture are prepared in Petri dishes and on ice batteries. Upon completion of the intake, the treated area is wrapped with gauze and the patient rests for a while.
Local anesthesia is applied to the previously planned area in the head of the patient who is brought into a sitting position. Holes for graft placement are drilled using the slit or slit technique, and fine grafts are placed in these holes with special tools, single in front and double and triple while reversing.
After planting is completed, this area is not closed. Only the donor site is closed. After painkillers are recommended, the patient is called for observation and lavage after 3 days. A lot of cream is applied to the planting area and the crusts are expected to soften for half an hour. The cream is removed only by pressing the shower nozzle. This procedure is taught to the patient and asked to be performed until the tenth day.
On the tenth day, the crusts are poured around the entire hair follicle. After an early growth of 2-3 mm, about a month after the operation, the hair stages return to the resting phase (telogen) and begin to fall out. This shedding is normal. 3-4. It begins to grow again from the ninth month and takes its final form around the ninth month. A new session is appropriate after this stage.
The donor area is left open after the third day. As the hair grows, the hair is covered and looks as if it hasn’t been removed. The removed hair does not grow back. The process here is thinning and up to 60% of the dilution can be taken depending on the structure of the hair. Since the direction of the hair is downward, the effects of the intake disappear in a short time.
In the case of severe hair loss (such as the Hamilton 7), transplantation may not be appropriate or may not meet expectations. In such cases, alternative methods are recommended. Sometimes the receiving area may be insufficient for transplantation in terms of skin or hair features.
If excessive hair loss occurs at a young age, it can be stopped by methods such as PRP and hair mesotherapy. However, the disadvantage of these methods is that the effect of treatment is seen as long as it is applied. After a few months of treatment, the spill continues where it left off. Oral finasteride and locally applied minoxidil are the main medicines used for this purpose. Mesotherapy can be applied to the scalp by making a mixture of vitamin B compounds and dexpanthenol ampoules.
