In recent years, there has been an increase in the number of patients who undergo hair transplantation by a plastic surgeon. This phenomenon is due to the fact that the possession of thick hair on the head is difficult to overestimate. The presence of baldness zones causes a certain aesthetic and psychological discomfort, emphasizes age-related changes. Therefore, effective methods for restoring hair on the head are of great interest to trichologists.
Since historical times, mankind has been searching for means and methods for restoring lost hair on the head. According to modern researchers, in order to hide a bald spot, in the United States, citizens annually spend 1 billion 360 million dollars on hair transplants, the purchase of wigs and overlays. About a third of this amount is spent on drugs that enhance hair growth.
For the most part, men from 27 to 52 years old apply for help. What is it connected with? Trends in society are aimed at the formation of a healthy lifestyle and related behavioral habits, at improving the quality of life, and preserving youth. In contrast to this trend, the presence of baldness zones causes a certain aesthetic and psychological discomfort, emphasizes age-related changes.
When determining the approach to the diagnosis and choice of treatment for alopecia, such possible causes as traumatic or post-burn cicatricial alopecia, or partial baldness associated with surgical interventions on the scalp are taken into account.
Classification of alopecia
Scarring alopecia and their causes:
- post-traumatic alopecia (surgical interventions, burns, injuries);
- systemic diseases (lupus erythematosus, Broccus pseudopella, traction alopecia, scleroderma, follicular mucinosis, dermatomyositis, microsporia).
Non-scarring alopecia and their causes:
- androgenetic alopecia;
- Alopecia areata (focal, subtotal, total, universal forms);
- diffuse alopecia;
- seborrheic alopecia;
- syphilitic alopecia.
Androgenetic alopecia
Androgenetic alopecia is the most common form of alopecia. The occurrence of the latter is due to a genetic predisposition. In men, it is polygenic and autosomal dominant; in women, – autosomal recessive. The process of baldness is localized in the androgen-dependent (fronto-parietal-crown) region and is characterized by gradual atrophy of the hair papilla.
The degree of baldness is determined by the Norwood-Hamilton scale (1-7 degrees), which allows you to identify the onset of baldness from the front hairline in the form of bald patches. The progressive process spreads to the top of the head, and subsequently these zones merge with each other, forming a characteristic type of baldness.
Causes of androgenetic alopecia:
- decrease in the level of sex hormone-binding globulin;
- increased production of the enzyme 5-alpha-reductase, which increases the amount of the active form of testosterone – dihydrotestosterone;
- increased production of androgens by the ovaries and adrenal glands;
- Increased sensitivity of hair papilla cells to androgens.
Treatment and alternative treatments for baldness
Applying camouflages
Various camouflage techniques are used to hide baldness areas from others. These are wigs of various modifications, camouflage products based on the use of various microfibers, which are applied daily to areas of hair thinning. Fixing on the thinning hair shafts, they give the appearance of density, but are easily removed when washing the head.
Therapeutic treatment
Patients with androgenetic alopecia are given daily topical lotions containing minoxidil, aminexil, azelaic acid, etc. These drugs can support hair growth and stop the development of baldness. But all of them are temporary. And many patients decide to have a hair transplant.
Surgical treatment
Surgical treatments:
- autologous hair transplantation;
- patchwork;
- excision of the area of baldness, plastic surgery with local tissues;
- Dermotension;
- artificial hair implantation.
Autologous hair transplantation (transplantation) is the most effective method of restoring hair growth in androgenetic and cicatricial alopecia. The essence of this method is to move the complexes of hair follicles (micrografts) from the zone resistant to the action of dihydrotestosterone (DHT) to the zone of baldness. The donor area is the back of the head. Even a 100-year-old man always has hair and preserved hair follicles in the occipital region. Once relocated, the newly growing hairs are hormone-resistant and do not die under the influence of DHT.
Hair transplantation is performed using two methods:
- strip method;
- seamless method (FUE-follicular unit extraction).
The strip method consists in excision of a skin flap with hair follicles in the occipital region and dividing it into hair connections (grafts) ready for implantation. The resulting linear wound is sutured with a cosmetic suture. This technique is highly effective, but there are also negative aspects. When the strip is excised, part of the grafts is crossed with a scalpel. When performing the division of the skin flap into grafts, a long time passes before implantation in the tissue. During this period, subject to all conditions of storage and preparation of grafts, the hair growth zone partially dies, and a linear scar always remains on the back of the head.
The most highly effective technique is seamless hair transplantation. A feature of this method is the complete absence of a linear scar in the occipital region. Each follicular connection (graft) is removed separately with a special round scalpel. Its outer diameter is from 0.7 to 0.9 mm. The graft is almost immediately ready to move to the area of baldness. The advantage of this technique is that the graft between removal and implantation is without food for a minimum amount of time, which accordingly increases its survival after transplantation. There are no visible scars in the donor area. Pinholes in the back of the head heal quickly, leaving no traces. After the procedure, even the hairdresser will not determine whether the surgeon worked there or not.
Before the procedure, each patient is diagnosed with the scalp using an ARAMO SG microvideo camera in order to determine the density of growth, thickness, and the number of healthy hairs in the hair junction. The area of the recipient site and the density of the implanted follicular junctions are determined. An electronic patient record is generated using the HairXPPro software.
Discussion about hair transplant methods
In world practice, certain approaches to the treatment of androgenetic and cicatricial alopecia have been formed. Regarding androgenetic alopecia with Norwood-Hamilton grades 1 and 2 and Ludwig grade 1, it is absolutely justified to apply topical lotions, including 5-alpha-reductase enzyme blockers, constant use and the use of specialized shampoos containing ketoconazole, which allows you to maintain the viability of hair grafts in within 3-4 years.
This therapy is temporary, takes time and does not give a lasting result. With the aggravation of the disease and the progression of alopecia to 3-7 tbsp. according to Norwood-Hamilton in men and 2-3 tbsp. According to Ludwig, the use of topical preparations in women is ineffective. In recent years, various methods of stimulating hair growth have been actively introduced: microcurrent therapy, laser therapy, mesotherapy, the use of platelet-rich plasma, cryomassage, Darsonval currents, myostimulation. But many authors note that although these methods are used for a long time, they do not give lasting results, and the process of alopecia resumes when treatment is stopped. For this reason, surgical methods for the treatment of alopecia occupy a leading position.
In terms of effectiveness, there are no clear differences between the strip method and seamless hair transplantation.
When performing hair transplantation using the strip method, after excision of the skin flap, a scar remains in the occipital region, 20 to 35 cm long. Since it is located in the tension zone, there are prerequisites for its expansion. It depends on the properties of tissues, the activity of healing and the strength of collagen fibers, and with age, the quality of tissues deteriorates. After the procedure, the patient is forced to wear long hair that camouflages the scar. In some situations, it becomes necessary to perform hair transplantation in the scar. There are no problems with this seamless method.
Regarding the percentage of engraftment of follicular connections, the authors of the studies do not note a big difference between these methods. According to some observations, the percentage of engraftment of grafts is higher by 1-2% when performing FUE. The difference is not significant, but it is additional evidence that FUE is a safer, more predictable procedure with a minimal downtime compared to the strip method. If it is necessary to obtain a large number of grafts and donor resources are limited, the techniques can be combined in one session to achieve the best result.
Thus, when choosing a technique for correcting baldness in men with straight hair, the seamless method of hair transplantation is a priority compared to the classic strip method. This technique makes it possible to more accurately plan the scope of intervention by reducing the traumatization of grafts at the preparation stage and increasing their survival after transplantation. An important aspect of the effectiveness of the FUE method is the absence of linear scars in the occipital region, which allows you to wear short haircuts.
Based on materials from the site http://blog.best-hair.in.ua/
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