Hair Restoration Surgery: The State of the Art

Hair restoration is a complex subspecialty that provides great relief to people suffering from hair loss. Since the original description, the approach to surgical hair restoration has been transformed by greater understanding of the aesthetics of hair loss and cosmetic hair restoration, hair anatomy and physiology, and the advent of micro vascular surgical instruments according to the best hair transplant clinic in India. Graft size, site construction, packing density, and medical control of hair loss are all factors that contribute to the present state of the art in hair restoration.

 

Hair restoration produces natural-looking outcomes that are backed by a high level of patient satisfaction and safety. This part of cosmetic surgery is a fantastic source of internal cross-referral and is a welcome addition to a typical aesthetic practise. Hair restoration surgery in the future will be focussed on minimal-incision surgery and cell-based therapies.

 

 Alopecia is a general term for hair loss that involves a loss of visible hair. Alopecia comes in a variety of forms. Androgenic alopecia is the most frequent type of surgically curable alopecia (AGA). The existence of scalp hair has long been associated with traits of health, energy, vitality, and strength. As a result, hair loss in males (MAGA, or male pattern androgenic alopecia) and women (FPHL, or female pattern hair loss) can have serious psychosocial consequences.

 

Hair transplants account for the vast majority of hair restoration treatments, and the introduction of microvascular surgical instruments, as well as a better understanding of the anatomy and physiology of hair loss, has transformed the art of surgical hair restoration since its inception.

 

Anatomy, Genetics, and Physiology of Hair Loss:

In genetically predisposed males and some women, androgenic alopecia is characterised by increasing noticeable thinning of scalp hair. The latest scientific evidence suggests that AGA is a polygenic characteristic. Variants of the androgen receptor gene, which is found on the X chromosome, have been linked to significant outcomes.

 

Caucasians have the highest incidence of AGA, followed by Asians, Africans, and Native Americans, with Native Americans having the lowest rate.The frontal, midscalp, vertex, and temporal portions of the scalp can be split for hair transplantation purposes. Hair thinning and shedding are caused by the gradual shrinking of genetically marked hair follicles, which is characterised by a reduction in the anagen (growth) phase of the hair follicle and an increase in the telogen/anagen ratio of the affected scalp suggested by the best hair transplant clinic in Kolkata. The physiology of hair loss is inextricably tied to an understanding of the typical hair follicle life cycle.

 

Although testosterone is the most common androgen that causes hair loss, it must first be transformed to dihydrotestosterone (DHT) by the enzyme 5-reductase in order to be most effective. The absence of AGA in men with congenital impairment of type II 5-reductase and varied amounts of hair regrowth in men with MAGA treated with finasteride, a selective type II 5-reductase inhibitor, demonstrate the relevance of DHT as an etiologic factor in male pattern hair loss. Excessive amounts of 5-reductase, DHT, and the DHT androgen receptor are found in the balding scalp. DHT's activity is mediated by nuclear androgen receptors found within cells.

 

There is no consensus among women on whether or not hair loss is actually androgen dependent. The majority of FPHL patients do not have biochemical hyperandrogenism. In fact, some women with no detectable circulating androgens may acquire FPHL, implying that non-androgen-dependent processes may play a role. Based on this information, it is reasonable to replace the term androgenic alopecia in women with the more recent and scientifically descriptive term female pattern hair loss (FPHL), which encompasses this known variation.

 

The bulk of human hair shafts come from the scalp in single-, two-, and three-hair clusters on a macro level. The groups are the apparent surface of the follicular unit, which is a separate histologic structure (FU). Follicular units are almost solely used as the transferred element of tissue in today's hair transplants, hence this operation is now known as a follicular unit hair transplant (FUT).

 

Nonsurgical Options for Treating Hair Loss:

Only two drugs have been licenced by the US Food and Drug Administration (FDA) to enhance scalp hair growth. Finasteride and minoxidil are the drugs in question. Other drugs that claim to treat hair loss are many, but their effectiveness is debatable.

 

Finasteride (Propecia; Merck & Co, Inc, Whitehouse Station, New Jersey) is a medicine that inhibits the 5-reductase type 2 pathways, lowering DHT levels. Finasteride was proven to prevent hair loss or have favourable benefits related to hair growth in 90% of patients in a prospective randomised study conducted by the company, and independent research has also confirmed the drug's safety and efficacy.

 

Propecia is solely approved by the FDA for men. The FDA only authorises the company to make claims about hair development in the vertex area of the scalp, although many doctors have noticed that this medication has a broad effect on the hair on the scalp.

 

 Minoxidil (Rogaine; McNeil-PPC, Inc, Morris Plains, New Jersey) has been available since 1988 as a topical medication indicated to treat hair loss. It has been used in men and women. The mechanism of action is unclear, but it is recognized that the vasodilatory effects of minoxidil do not fully explain its positive action on hair growth. Observed benefits include increased proliferation of dermal papillae cells, increased hair caliber, and diminished telogen phase during the hair growth cycle.

 

Evaluation and Planning:

The main metric by which results are objectively documented is photography of the hair restoration surgery (HRS) result. Hair photography has been defined in terms of lighting and typical positions. To avoid the upper borders of black hair blending into the backdrop, a light grey or blue-colored background is recommended. This background is also suitable for people with white or blond hair.

 

General Evaluation:

The indicators of hair loss have been particularly distressing. Because of their low self-esteem and vulnerability to an imagined outcome, this group of patients is more prone to rash decisions and excessive expectations. For patients with hair loss, managing these expectations and developing a realistic surgical plan is important to the procedure's long-term success.

 

The fact that hair loss is progressive is a critical idea that physicians and patients should keep in mind when evaluating and preparing for HRS. Hair loss that appears in the office during a consultation is only a snapshot in a long-term process that began years ago and will continue till death.

 

Communication on the quality of the patient's donor hair is also an important part of managing expectations.Curl, hair shaft diameter, colour, texture, follicular unit density, and the telogen/anogen ratio of in situ donor hair are all traits that should be examined. These characteristics of the donor hair should be examined and documented in order to anticipate how well the transplanted hair would conceal scalp baldness according to the best hair transplant surgeon in India.