Non invasive
hair transplantation
In medicine, non invasive means that the skin is not penetrated
or cut. Some clinics claim that they perform noninvasive hair
transplants. Other clinics claim that their procedure is scalpl
free. We feel that these statements are misleading. The term
“non invasive” is used to describe follicular unit
extraction or FUE. Follicular unit extraction is not performed
by excising a strip of scalp as in a standard hair restoration
procedure. Instead, small punches are inserted into the scalp
in order to individually remove hair follicles. This is definitely
invasive. Furthermore, exactly as in standard hair restoration,
small slits need to be created to place these follicles where
you need them. These slits can be made with special scalpl blades
or with needles. Again, this is definitely invasive. Instead
of one linear scar at the back of the head, there will be hundreds
to thousands of individual punch scars. All follicular unit
hair transplantation, whether follicular unit extraction or
follicular unit strip extraction is minimally invasive surgery.
FUE vs FUS
FUE is Follicular Unit Extraction; FUS is Follicular Unit Strip
excision. There are advantages and disadvantages to both procedures.
These terms are used to describe two techniques commonly utilized
to produce follicular unit grafts. Once the grafts are obtained,
the technique used to implant them is identical with both procedures.
Follicular unit extraction uses small 0.7 to 1.0 mm punches
in order to individually extract follicular units. Follicular
unit strip involves removing a strip of scalp. Both procedures
leave scars, hundreds of small circular scars for FUE; one linear
scar for FUS. Follicular unit extraction takes two to three
times longer and is usually twice more expensive than Follicular
unit strip excision. Follicular unit extraction sessions are
generally limited to less than 500 follicular unit grafts, while
FUS will routinely produce over 2000 follicular unit grafts.
There is substantially less growth after FUE than FUS. Follicular
unit extraction is appropriate for smaller cases, or when the
scalp is no longer sufficiently loose to allow for Follicular
unit strip excision. Dr Clas will discuss these options with
you during your evaluation.
Trichophytic
closure
Trichophytic closure is a special technique used to decrease
the width of the scar. In the trichophytic closure technique,
two millimetres of one edge of the strip excision site is removed
before closure of the donor site. The wound edges overlap a
small amount and hair follicles grow through the scar. While
ensuring minimal tension in the wound edges is probably the
most important element of narrow wounds, the trichophytic technique
can help improve the scar in some patients. There will be a
temporary increase in wound crusting, selling and redness. Some
patients will develop small cysts in the wound. The wound will
eventually heal with hairs growing through the scar.
Dense packing
Dense packing involves placing a very high density of follicular
unit grafts into a small area. Typically, densities over 40
follicular units per square centimetre are considered dense
packing. This technique is useful in recreating a frontal tuft
in men or recreating frontal mounds or filling temporal recessions
in women. There can be an issue with decreased growth when densities
over 50 follicular units per square centimetre are attempted.
Dense packing is useful in selected areas only, and should not
be attempted in large areas as this can lead to damage of the
nerves and blood vessels of the scalp.
Multiunit hair
transplantation
The only way to achieve density is with a large amount of hair.
For several years, there has been increasing interest in using
multiple follicular units in highly selected areas on the scalp
to achieve very high density of hair. This is especially useful
when transplanting hair into the top of the head, particularly
in the frontal tuft area. However, multiunit hair grafts can
be more visible, they can only be used in patients when they
will be hidden by individual follicular units. Multiunit hair
transplantation is particularly useful for patients with light
coloured and fine hair. Patients with thick, dark and wavy hair
do not need multiunit hair transplantation. Patients with a
good amount or remaining hair are not candidates for multiunit
hair grafting.
Dutasteride (Avodart®)
Dutasteride is not currently approved for use in hair loss.
Dutasteride is a pill that can block two types of five alpha
reductase, the enzyme that converts testosterone into dihydrotestosterone.
It was developed to treat prostatic hypertrophy, the excessive
growth of the prostate that occurs as men age. Five alpha reductase
is also the hormone responsible for hair loss in genetically
susceptible men. Dutasteride is five times more powerful than
finasteride in blocking type II five alpha reductase and 300
times more powerful than finasteride at inhibiting type I five
alpha reductase. This indicated a good potential for increasing
hair growth. A randomized placebo controlled study demonstrated
that dutasteride improved hair growth more rapidly and to a
greater extent than finasteride. Dutasteride had a considerably
higher incidence of side effects than finasteride. Apart from
a 13% incidence of decreased libido and gynecomastia, there
was an almost 30% incidence of decreased sperm counts. For this
reason it is only reasonable to recommend Dutasteride in patients
who have had no response to finasteride and who have already
had all their children.
