The practice of treating hair loss is actually the art of treating hair loss. You don’t simply lose your hair and go out and get a wig or a transplant. The options are varied and all should be considered when treating each individual patient. We feel medications now play an important role and will discuss them later. We also have found at our clinic that lasers play an important role in the treatment of hair loss.
The initial use of lasers in hair transplantation took place in 1992. Results were variable and lead to lots of skepticism. We know that the prior use of continuous beam lasers were traumatic and caused large zones of thermal injury and necrosis. Any transplant done with this type of continuous beam laser was destined for failure. Newer technology was developed, especially with regard to pulsating lasers. Simply put, the laser’s light beam is rapidly pulsed up to hundreds of times per second. This avoids buildup of heat, resulting in preservation of the vasculature components. Any histological changes in the skin and structure occurred up to only fifty microns away from the lasers light. Of course, success with regard to hair transplantation or any surgical procedure depends largely on the skill of the surgeon and the tools that he uses. Whether a scalpel or a laser, competence must be exhibited to achieve desired results.
At our practice, we perform laser hair transplantation using a super pulsed laser. Our laser recipient sites are holes and range from .3mm to .8mm. The laser is set to cause ablation of the epidermis and part of the dermis. Small amounts of bald tissue are actually removed with each pulse of the laser; therefore we actually decrease the total bald area on a patients scalp. Care is taken not to disturb the vascular layer of the scalp. After all recipient sites are made, a small probe is used to enter the vascular layer. These two steps achieve what we consider the best of both worlds. The laser ablation helps to prevent any compression of the newly placed grafts and using a probe to enter the vascular layer prevents any damage to the underlying vascular components.
Another important step in our procedure is the way in which the grafts are prepared. All grafts are placed in an iced saline solution and the dissecting microscope is used when preparing the grafts. This insures the best dissection available from the donor strip. An additional 10% of grafts can routinely be obtained utilizing the dissecting microscope. Care is also taken to preserve each graft as a pilosebaceous unit. We feel if grafts are trimmed too closely survival rate of the grafts is diminished.
Hair density is also an important factor when it comes to selecting the size of grafts to be prepared. The donor area presents potential grafts as either individual hairs (single grafts) or naturally occurring groups of two, three, or four hairs. All grafts are preserved as Mother Nature intended and are not disrupted from their naturally occurring follicular components. We feel this results in a more natural appearance.
As with conventional transplant surgery, local anesthetic is all that is used for anesthesia. Initially we use EMLA cream applied to the scalp. This aids in reducing the sting of the injection. By doing this we obtain a much more favorable patient acceptance of the anesthesia process.
The donor area is then harvested using simple scalpel techniques. We have found that the laser does not offer any advantage in this area. We also feel that multiple bald knives can cause transection of the donor strip hair follicles and we elect not to use them. After the donor strip has been removed, we seal the area with an infrared coagulation device. The area is then closed using a two layer closure technique when necessary. Sutures are removed in 10 days in most instances.
All patients are requested to return to the office the next day for recheck and to again review our post-operative instructions. We strongly feel that the patient’s complete involvement in their post-operative care is very important. The newly transplanted hair needs to be treated gently for the first week and all patients are encouraged to call if any questions arise. By keeping in contact with patients we feel we can obtain the best results available and sustain a good doctor-patient relationship.
Aside from offering surgery for hair loss, we feel all options should be considered. Non-surgical options we most commonly deal with are the use of oral and topical medications to halt the progression or renew actual hair growth. We have been very pleased with the use of such medications as finasteride, minoxidil, and retinoic acid. We have actually been able to keep some patients from needing hair transplantation through the use of these medications.
As you can see, the practice of treating hair loss is not just a matter of hair transplantation but a field that involves looking at the whole patient, describing the nature of their hair loss and then presenting a treatment plan that best suits that individual patient’s needs.
Dr. Paul Riggs
Hair and Scalp Clinic, Clearwater, FL
