Dr Aman Dua presented a lecture on Beard & Body hair transplant in #ascicon2015. This was 13th Annual Conference of Association of Cutaneous Surgeons (I) and held at Science City, KOLKATA.

Dr Aman Dua lecture on beard hair transplant

 


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Losing hair is never easy to handle, and for many people medications simply do not work, which is why they have to consider prospects of hair restoration. In order to conduct a successful hair transplant procedure, there has to be a clear recipient site and more importantly, a clear donor area. However, there are plenty of cases, where there is not enough hair in the donor area. With such people, the main option is body hair transplant, but there is much to understand about it, before jumping the wagon.

Firstly, it is crucial that you understand what body hair transplant is and what it entails:

An average human being has close to a hundred thousand hairs on their head and around a million hairs on the other parts of the body. If a person is suffering from major hair loss, say class 7, they would have lost close to 75000 hairs out of the total 100000. In such a situation, there would not be enough hair in the donor area to complete a proper transplant procedure. It is in such conditions that a body hair transplant becomes the only way out.

The process is reasonably easy to understand – the entire body is checked and a donor area is identified. This donor area could be from the beard, chest, arms, legs or even back. there is actual a dual purpose to body hair transplant – one, you can have hair where you want, that is, on your head; and two, you are losing hair from the places where you would not want hair, such as your arms or legs.

The basic principle of body hair transplant is based on the fact that hair taken from any donor area will take up the characteristics of the recipient area where they are placed. This is called recipient dominance.

However, for years, body hair transplant has kept on the back burner, because there is always a concern that hair transplanted from other parts of the body might not flourish as well as hair harvested from the head. In addition, there is the possibility that the texture might not match, making the transplant procedure obvious.

Next, we will look at the advantages of a body hair transplant:

  • This is perhaps the best option when the donor areas on the scalp are limited.
  • The donor hair that is harvested from other parts of the body are much more stable, because they are normally not susceptible to DHT or Dihydrotestosterone. This means, that once they are implanted on the scalp, there is a minimal chance that these hair will fall off with time.
  • There is most certainly a large pool of donor hair, because it can be harvested from several parts of the body.
  • Even if the intention is only to fine tune the hairline, it can be done with the body hair. Finer body hair can be used to create that perfect hairline, and then coarser hair can be used to fill in the gaps and create density and volume.
  • Body hair transplant can also be used to create a fuller looking eyebrow.

If there are advantages, there are bound to be a few disadvantages too and some of the most prominent ones are mentioned here:

  • When hair is harvested from the sides or the back of the head, there is a certainty that the texture and colour will be an exact match to the rest of the head. However, hair from other parts of the body need not necessarily match with those on your scalp. This means that the texture, thickness and even colour could vary.
  • One of the main reasons why a lot of doctors do not practice body hair transplants is because it requires very special equipment. In addition, body hair transplants are much more time consuming and worst of all, there is no guarantee that the results will be as expected.
  • Most often,unlike scalp, the follicular units harvested from other body parts have less number of hairs per graft(usually1-2 hairs/graft), and follicular units with three or more hair are rare. This means that more follicular units have to be harvested and transplanted, making the procedure more expensive.
  • The procedure is extremely difficult and time consuming for the doctors, because the direction and angle of the body hairs keep changing randomly. This is why the follicular transection rates are also higher for body hairs than scalp hairs.
  • Many a times, the hair extracted from other parts of the body grows much longer than the length they would normally grow to in their original location. However, there is no saying that it will match the length of your head hair. This could lead to a situation where the only option would be to have a short hair style.

While body hair transplant might sound like a suitable option to many, the fact remains that it should be kept as a last resort. Not only is the process much more elongated, but also one that does not guarantee perfect results.Hence it is usually done in combination with scalp donor so that the minor differences get masked. Also, in cases where there is not sufficient donor hair on the head, this is the only option left. And in the hands of a good surgeon, you should have a head that looks full and natural.


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A twitch of your eyebrow or how you raise it can say a lot about what is going on in your mind. But what about those people who have lost their eyebrows due to an illness, trauma or some medications? However, there is hope for even such people, because these days, restoring eyebrows has become truly easy. In the hands of an experienced surgeon, you can go back to having natural looking eyebrows that will last you a really long time too. We get many enquiries regarding eyebrow hair loss, eyebrow hair transplant, eyebrow hair growth serums and creams and even castor oil. So we though to share some information with the patients.
In order to rectify an eyebrow, there is firstly the need to identify the exact cause of the loss of hair. The following are the major reasons

  • regular and incessant plucking of brows
  • trauma, burns
  • thyroid disorders
  • alopeciaareata
  • infections
  • tattoos

While most cases of eyebrow hair loss can be rectified with ease, there are certain cases, where there is no scope for restoration at all, such as alopecia universalis.

Understanding the physiology and anatomy are crucial to a proper restoration process:

The eyebrow is perhaps one of the more complicated areas of hair restoration, because the direction of the hair changes in every part of the brow. If you have ever noticed, the hair that is closest to the nose always stands upright, while the other hair can point either upwards or downwards. Also the arch is very important in females, the absence of which gives the masculine look in males. The density of eyebrow hairs vary, with very fine, sparse hairs at either ends to thicker and increased density in the middle part. This is why not all hair restoration specialists will promise you an eyebrow restoration process, because not only is it complicated, but also very hard to perfect.
There is one other distinctive feature of the hair in the eyebrows – the hair that emerges from the follicles is normally at a very acute angle. This means that the hair that does grow is flat against the surface of the skin. Then there is also the fact that eyebrows grow in the form of individual strands, as opposed to follicular units founds on the head, which have from 1 to four hairs.
Finally, the growth cycle of each hair on the eyebrows is very short; this means that the movement from the anagen stage to telogen and catagen happens much faster, as compared to hair on the scalp. This is one of the main reasons why, hair on the eyebrows never grow really long.

Eyebrow transplant After one week

Eyebrow transplant After one week

Now, let’s take a look at the actual transplant method used for eyebrows:

The eyebrows are divided into 3 parts, head, body and tail and in each part, the direction of hair is different. The holes or slits are made accordingly in each part, parallel to the direction of the patient’s existing hair. They are also made at a very acute angle almost parallel to the skin so that the hair that emerges out is flat, as is the case with normal eyebrows. If this goes wrong, the eyebrow hairs can stand out forwards, giving a bizarre look. Very fine hairs are placed along the eyebrow borders and at its tail, while thicker hairs can be placed in the centre. The arch in females should also be made right. All these steps are very crucial in order to ensure that an eyebrow transplant looks totally natural.
Single-haired grafts are mainly preferred for eyebrows to match with the normal eyebrow hairs, while two haired grafts can be placed in the middle to increase the thickness. The donor hair can be taken by FUE or Strip technique from the scalp.

Here is a look at the points that need to be considered while completing an eyebrow restoration:

  • The hair that is being transplanted has to be placed in a manner that it lies flat against the skin.
  • The hair should follow the proper direction of the eyebrow hairs.
  • Transplanted hair, once it grows might need to be trimmed at regular intervals as, being taken from the scalp, they will grow longer than the normal eyebrow hairs.

Let’s take a quick look at how a follicular unit extraction on the scalp and the brow differ:

  • Donor area: For the restoration of the scalp, hair has to be taken from the part of the scalp, where the hair growth is the densest. This includes the back of the head or the sides. However, for an eyebrow, hair has to be extracted from an area where the hair matches the eyebrow the most. This is why, most surgeons prefer to harvest hair from behind the ear or from the mid donor region.
  • Recipient site creation: The hair has to be placed at a 30 or 45 degree angle in a scalp restoration process, while in the brows the hair has to be placed acutely, flat against the skin.
  • Graft placement: The placement for scalp restoration is simple enough – straight in, but for the brows, there is the need for rotation to match the curve of the existing hair.
  • Type of grafts preferred: For a scalp restoration, multi-haired grafts are more preferred as they give good density with less number of grafts. In case of eyebrow restoration, fine single-haired grafts are essential to give a natural look.

 


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So you know what a hair transplant refers to and what the basic tenets of the procedures are. However, you might not know much about BHT or body hair transplant. This article intends to look into the increasingly popular world of body hair transplant. Gone are the days, when transplants could be done only the head; but today, transplants are being successfully completed on other parts of the body too, including eyebrows, beard and even moustaches.
The most innovative facet of body hair transplant is when hair from other parts of the body are used to recreate a full head of hair. There are many cases, wherein the donor area on the head is not sufficient to complete a procedure on the head. In such a case, hair has to be harvested from other parts of the body. Many a times, hair is taken from beard, chest, back, arms, legs, and even the abdomen.
The reason why body hair is considered for transplant is because it might prove to be home to thousands of grafts. Since the hair is from your own body, it will take root and you will most certainly have a healthy head of hair, in a matter of months. These body hair are found to take up the characteristics of the scalp hair by a property called recipient influence after being transplanted to the scalp. With the larger donor area, it becomes easier for the doctor to provide greater density on the head and even fill in larger areas with ease.
In most cases, the hair from other parts of the body is removed using the follicular unit extraction method, because with strip removal, there will be obvious scars. The follicles that are harvested are normally implanted in the same manner as a regular transplant procedure.

Who is an ideal candidate for body hair transplant?
Normally, hair is harvested from donor areas on the head, especially the back and the sides of the head. However, if there is not enough hair in these areas, it means that the person does not have the physical conditions to have a healthy hair growth. Such a person would not be considered eligible for a hair transplant at all. There are rare cases though wherein hair harvested from other parts of the body can compensate for the hair in the scalp. This, however, is a decision that only a qualified doctor can make.
A doctor will utilise something known as the Torso Donor Index, in order to decide whether body hair transplant would be a food enough idea. There are five main criteria that need to be kept in mind:

  • The size of the actual donor area
  • Similarity between the body hair and that on the head
  • The actual length of the body hair
  • The number of follicular units available with 2 – 3 hair follicles
  • And most importantly, the hair density should ideally be above 40 FUs per cm²

Should the Torso Donor Index be less than 4, the person would be considered unfit for a body hair transplant. The ideal score should be eight or above, and such people would be considered the best candidates. However, in certain cases, people who score between 5 and 7 could also be considered.

Difference between traditional FUE and BHT FUE
Body hair transplant is based on the same concept as the follicular unit extraction; the main difference is that the donor area gets spread all over the body. The reason why other parts of the body are considered is because the donor area on the head has either been compromised due to previous extractions or is just not yielding enough follicles.
Body hair has a growth cycle that is slightly different from the head, which is why considering them for transplant has to be done with much deliberation. This is why, while the follicular units harvested from the head will vary from single to up to three hairs, in body hair extraction, only single hair is harvested.

A point wise dissection of the differences
The direction of growth of the follicular units is important as is the actual structure of the hair. It is important that the thickness of the hair be taken into account, as this will eventually lead to the natural look. While the structure of the hair is important, it is just as crucial to consider the skin and its nature. It is important to remember that the scalp and the skin on the rest of the body are different. Finally, the depth of the hair follicles is also important.

What the success depends on
The success of a body hair transplant depends on several factors and some of the most important ones include:

  • The actual experience of the doctor conducting the procedure
  • The creation of a natural looking hairline
  • The precise extraction of the donor hairs
  • Proper preparation and storage of the follicular units
  • Precise implantation of the grafts

There are a few limitations too
This is still an area where the amount of research being carried out is limited, which is why not a lot of doctors dabble in it. For even experienced doctors, this method is almost like a last resort. While the survival rate is high at 70 to 80 percent, there are still not a lot of people who prove to be ideal candidates. In addition, there is no absolute guarantee that the implants will all take root.

It is also important to note that after being transplanted, the structure of the hair might change, which means that your head might not look as natural as you would want it to.
So the more common custom is to mix body hair with scalp hair in patients who have a poor donor scalp or require more number of grafts so that the overall look is more natural.


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Each day, there are some new advancements being made in the world of hair transplant surgery and one of the technique on the block is called NeoGraft. This is actually partially automated hair transplantationsystem in which doctors can make the best use of the popular FUE or Follicular Unit Extraction technique.
Generally, in the FUE method, hair are taken out from the donor area by manual or electric punches which is controlled by doctors. Then the grafts are stored in the holding solution. After that, they are implanted in the bald area with the help of forceps and needle by the implanters in a couple of hours. If the process is done by someone who does not have enough expertise, things could go down south very quickly. Not only will the implant look unnatural, it might not even last as long as it should.

However, with NeoGraft things are slightly different !! This FDA-cleared device excecutes  the surgical removal, collection, and placement of individual hair follicles, one at a time. The machine works on the concept of pneumatic pressure, using which the hair follicles are extracted. Then with the help of the same forceps, the implantation is done by the implanter. One benefit of the pneumatic pressure is that it is so gentle that there is neither any damage to the hair follicle nor to the scalp where the hair is being implanted.

But the main disadvantage is the dehydration that may occur due to the following reasons:

1. The pneumatic pressure which strips the surrounding tissue from the lower portion of the grafts during their removal, making them fragile and exposing them to drying injury.

2. The vacuum creates a continuous flow of dry air around the harvested grafts causing dessication of grafts.

Both these things may lead to poor results.  A couple of doctors had started using this machine in India but later on gave up because of the poor results. The new machine is a modified version. And has slightly improved but it takes some time for the hand to be set on the machine.

The main advantages of neograft machine:

  • If the skill of the surgeon is low he will be able to  handle of grafts in a better way.
  • If the technicians handling the case are not experienced and permanent, neograft gives advantage.

But if the team is not experienced, then ultimately the results may be below par.

the latest in the attempt to make the Hair transplant surgery fully automated is the introduction of Robotic Surgery by ARTAS machine.

So, this is one of the options of undergoing hair transplant surgery. But, for us the danger of risking poor results is too high to try anything like this……

Is Neograft a Robotic Hair Transplant?

The Neograft is not a robotic hair transplant but all the surgical steps (scoring, extraction, implantation are manual. So there are many clinics in the country that are misleading patients saying that Neograft is Robotic Hair transplant.


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