FUE Hair Transplant Method

The hair has an elongated structure and consists of keratin proteins. These proteins are also the main constituents of nails and are very resistant to mechanical influences. As all proteins in the body, they are composed of long chains of amino acids.

The diameter of the hair varies from person to person, but is usually between 0.05 in 0.1 mm.

The epidermis creates small sockets that we call hair follicles, which contain the root of the hair.

The follicle

The follicle is a structure, from which the hair grows. It is located about 5-10 mm under the skin surface, in the fat tissue. The bottom part of the follicle is called a hair bulb. It consists of cells that divide and grow and produce elongated hair fibres. Next to them pigment cells are located (melanocytes), which give colour to the hair. Cells in the hair bulb contain receptors for male sex hormones.

In the basis of every bulb there is a hair papilla, which contains vessels. It is necessary for the nourishment of the growing hair.

Other structures, located in the follicle, are the sebaceous glands, which produce natural oils for greasing the hair and skin.

The hair shaft

The part of the hair above the skin surface is called the hair shaft. It contains keratinized dead cells, binders and smaller amounts of water.

The hair constitutes of three layers. Inner layer (medulla) only exists in thick hair. Middle layer (cortex) constitutes of keratin fibres. They give the hair strength and colour. The outer layer is called the cuticle; its function is to protect the cortex.

The life cycle of every hair consists of a relatively long growth phase, which is followed by a short resting phase. During this phase the hair is still attached to the follicle, although it has already stopped growing. At the end of the cycle the hair falls out and a new one starts growing in its place.

Every hair has a genetically programmed duration of every phase. With age the phase of resting gradually becomes longer while the growth phase becomes shorter.

The life cycle of a hair consists of three phases:

1. Growth phase (Anagen phase)

The hair grows throughout this phase. It usually lasts from 3 to 5 years.

2. Transitional phase (Catagen phase)

In this phase the hair is preparing for the resting phase. The follicle structures start to decompose. It lasts up to two weeks.

3. Resting phase (Telogen phase)

This phase lasts from 3 to 4 months and at the end of it the hair falls out. A new hair starts to grow in its place.

Daily physiological hair loss (alopecia)

At the end of every life circle the hair falls out, which is why the loss of a few hairs per day is completely normal. In the resting phase the hair loosens up in the follicle and the hair bulb starts to move towards the skin surface. Eventually it pushes the hair very close to the surface and a smaller force (washing and combing your hair) pulls it out. We lose around 200 hairs per day this way.

Physiological alopecia

This kind of hair loss is usually temporary. We notice it during pregnancy and in newborns, which lose their hair in the first few days after birth.

This group of hair loss includes hair loss and reshaping of the scalp in the frontal area during puberty, however in this case it is permanent.

Androgenic alopecia

Androgenic alopecia is the most common type of hair loss in both men and women. We also call it male pattern baldness or androgenetic baldness.

Androgenic baldness exists in other primates as well and has therefore been present in people through the entire human evolution.

For centuries scientists have been noticing that the male pattern baldness does not develop until after puberty and is prevented by castration before puberty, but cannot be stopped later on. The reason for that is that the hair follicles become sensitive to androgen hormones after they are exposed to them.

For a long time people believed that the male pattern baldness is a hereditary systemic disease connected with sexual maturity. However, this belief was in contrary to the observations in the previous centuries, when it was said, that anyone can lose their hair after entering puberty. Today it is known, that the pathophysiological basis of androgenic alopecia is the effect of male hormones on genetically sensitive individuals.

Although we are talking about male pattern baldness, it is also the most common cause of hair loss in women.

Alopecia areata

Alopecia areata most commonly appears in young adults of both sexes. It is a condition that spontaneously balances out on its own and usually does not require special treatment. Exact causes are unknown; supposedly it is a case of an autoimmune process which affects follicles.

Alopecia areata is manifested as a round surface without hair of an approximately 3 cm diameter.

Self-inflicted hair loss

Patients can cause hair loss themselves, either consciously or subconsciously.

Trichotilomania

This type of hair loss usually occurs in childhood, mostly in girls. It is a compulsive repeating pulling or stroking of the hair which can lead to permanent hair loss.

Traction alopecia

This type of hair loss is a consequence of mechanical influences of certain hairstyling products and tools.

Anagenic effluvium

Anagenic effluvium is a sudden hair loss following an exposure to radiation or certain chemical substances. It is commonly seen after chemotherapy or radiation treatment in patients with cancer.

Telogenic effluvium

Telogenic effluvium occurs after exposure to certain stress factors. Factors representing stress on the body can be anything from birth, a miscarriage, switching birth control pills, hormonal imbalance, emotional stress, surgical procedures, starvation etc.

This causes a lot of hair to enter the telogen phase all at once, which makes them fall out simultaneously. New hair usually grows in their place. The delay between stress and the hair loss corresponds with the telogen phase, which lasts 1-6 months.

Alopecia due to a scar

Hair loss can also occur in the area of physical or chemical skin injury. The inflammation causes the destruction of follicles, which do not regenerate again. This type of condition can also be caused by some skin diseases (skin carcinoma, lupus erythematosus, and scleroderma, severe bacterial or fungal inflammation).

Genetic factors

The impact of male hormones or androgens on genetically sensitive follicles causes androgenic baldness.

Certain conditions must be met for this type of baldness.

Hair loss in androgenic alopecia only occurs with people that have a specific genetic code. This is transferred as an independent gene or within a group of genes, and can be inherited from the father or the mother. The gene is expressed dominantly. It can be expressed both in men and women, which means the androgenic baldness can transfer to both sons and daughters.

Everyone that carries the baldness gene will not also express it. The gene must first be expressed for androgenic baldness to occur. Whether the gene is expressed depends on different factors – hormones, age, stress and other. If somebody does not have androgenic baldness he either does not have the gene or the gene has not expressed.

The specific gene or group of genes, responsible for androgenic baldness, has not yet been identified. Scientists believe that the gene is a part of a synthesis of male hormones, enzymes (5-alpha reductase) and hormonal receptors in the follicles. These are the three main factors contributing to the male pattern baldness.

5-alpha reductase is an enzyme that converts the male hormone testosterone into its more potent form dihydrotestosterone (DHT). The latter connects to the androgen receptors in the follicles.

With the continuous development of genetic medicine it is likely that scientists will soon identify the gene responsible for male pattern baldness and consequently enable its genetic treatment or prevention.

Hormones

Hormones that take part in the mechanism of androgenic hair loss are male hormones or androgens.  They work through a number of biological mechanisms. Their functioning is based on the interaction with receptors on the membrane or within the cell. Different androgen hormones affect the same type of cells in different ways. Most body hair under the influence of androgens accelerates growth, while fine hair on the head falls out.

The occurrence of male pattern baldness is influenced by testosterone in dihydrotestosterone (DHT). Testosterone is a relatively inactive form and converts into DHT with the help of the 5-alpha reductase enzyme. This enzyme is therefore crucial to the development of androgenic baldness. We can find it around follicles. DHT has the capability of connecting with androgen receptors in hair follicles, while the potency of testosterone is significantly weaker.

The interaction of hormones with follicles causes changes that manifest themselves as shortening or the growth (anagen) phase. The lengths of catagen and telogen phase stay the same, but this means their share increases from 10 to 20 %. This means that more hair is at the resting phase at the same time. Besides this the size of the affected follicles also changes, which means that the new hair is thinner, shorter and more fragile.

Why some people develop androgenic baldness and others do not, despite having all the necessary androgen hormones and receptors, is not yet completely clear. There are a few possible explanations:

• The number of androgen receptors on individual follicles is bigger in people prone to baldness, which is why the effect of the same amount of androgen hormones is bigger.
• The sensitivity of receptors is bigger in people suffering from hair loss and therefore the same amount of receptors causes a bigger effect of androgens.
• The activity of the 5- alpha reductose enzyme in bald areas is bigger and causes a higher concentration of DHT in comparison to testosterone.

Aging

The presence of genes and hormones is not enough for androgenic baldness to develop. The process also takes a certain amount of exposure to hormonal influences. The necessary time of exposure to reach the consequence of hair loss differs among people and depends on the expression of the gene and the amount of androgen hormones in the blood.

Even in people who are not predisposed to androgenic hair loss, the length and thickness of the hair reduces with age, which also leads to reduction of number of hair.

Stress

There are several ways for the hair to fall out. Some of them are extensive and require medical assistance, other are limited and transitional. The most common is telogen effluvium, which is a consequence of stress. The hair stops growing, stays in the resting phase for a few months and then falls out. It then regenerates within 6-9 months and starts growing again.

Alopecia areata occurs due to the autoimmune attack of the white blood cells on the hair follicles, which causes hair loss. It usually affects a few centimetres of the skin surface, only in rare cases all hair falls out. This kind of condition requires medical intervention.

Stress is often the basic cause of hair loss, but only since recently have we been discovering its true influence on people. The modern way of life connected with everyday stress can be the basic cause of hair loss which is why it makes sense, that you examine your way of life in case of hair loss and search for ways to reduce stress.

The Norwood classification

The Ludwig classification

Graft calculator

http://www.hshairclinic.co.uk/hair-loss/graft-calculator/

Treating hair loss with follicle transplants 

This is a surgical, minimally invasive method, which in comparison to other classical methods reduces the recovery time and the possibility of complications. It is becoming a standard of hair loss treatment. However, due to its technical complexity, its introduction has been relatively slow.

What is follicle transplant?

Follicle transplant is a modern technique of baldness treatment. Unlike some of the old methods, individual follicles are transplanted, each of which contains between 1 and 4 individual hairs. Older methods transferred larger groups of hair, which caused an unnatural appearance. In this method, however, the result looks completely natural, because the sample of transplanted hair looks the same as a natural one.

The surgical procedure of follicle transplant consists of two steps. The first step, called FUE (Follicullar Unit Extraction), consists of the use of a special device to take out individual follicles from the donor area. The device contains a special spinning needle with a diameter of 0.8 – 1.0 mm, with which we cut out the follicle from the donor area. What remains at the donor site is a small hole (a round wound), which heals in a few days without leaving any visible scars. We perform the procedure under local anaesthesia so it is completely painless. This way we avoid a classic elongated scar in the back of the head. The method enables us to choose the strongest and healthiest follicles.

In step two we implant the transplants (grafts) into the recipient area. To do that we use special micro pencils that enable a precise implantation of the grafts. When choosing the pattern, density and the direction of implanted hair, we follow the natural appearance of the scalp. This way we achieve a natural look without any unnatural clumps of hair.

Suitable candidates

The purpose of a hair transplant is to improve your look and increase your self-confidence, which means that it is necessary to talk to our surgeon about your precise wishes and goals for the procedure.

In order for us to prepare hair implants the candidate must have hair on the side and the back of the head. This area is where the follicles are extracted and then moved to the areas where there is shortage of hair. What also affects the result is the texture of the hair, direction of growth and waviness (curliness) of the hair.

There are also limitations to the hair transplant and we advise persons with a very low amount of hair against the procedure.

Before the procedure we must assess the cause of hair loss, the process of it and the genetic impact.

For the FUE procedure the scalp must be shaved to a hair length of about 3-4 mm. That can be done very precisely at the hairdresser’s. You will receive instructions regarding potential examinations and limitations to using certain types of medicine before the procedure. We perform the procedure under local anaesthesia, which means you do not have to be fasting. We advise you not to drink coffee or smoke. Wash your hair in the morning using normal shampoo and dry it with a clean towel and hairdryer. Wear light clothes for the procedure – preferably the kind that you do not have to pull over your head.

We perform the hair transplantation under local anaesthesia. We inject the local anaesthetic into the scalp using a thin needle. It starts working almost immediately. You are awake during the procedure and are able to talk to your surgeon or watch movies with the help of special video glasses. If you wish we can also give you some sleep medicine so that you sleep through the procedure.

Extraction of the follicles is equal around a large surface on the back of your head and above the ears, which means the appearance of the scalp there will not change. After the extraction we anesthetise the recipient area, where we insert individual follicles.

The procedure lasts several hours, in case of larger amount of implants even the whole day.

After the Procedure the donor and recipient spots are slightly bleeding and covered with small scabs. We protect it with special gauze which does not stick to the surface, and wrap your head in a bandage.

Pain after the procedure is minimal and it is enough to take paracetamol to relieve it. The swelling is also minimal and disappears within a few days, in rare cases it can last up to three weeks.

The head bandage can be changed after two days. A lot of caution is necessary when removing it, so the bandage does not pull out the transplanted hair. It can help to wash your hair with a gentle stream. You are allowed to use shampoo in small dosage.

The patients receive written instructions regarding care after the hair transplant procedure.

The transplanted hair falls out within a few days, which is perfectly normal. New hair should start growing within a few months. The end result is reviewed after 12 months.