Direct Hair Transplant

Hair transplant is a very popular and rewarding surgery performed in millions of people every year globally. The techniques used for transplant have evolved beautifully in the last few decades, making it more comfortable, and the results more desirable.

Advent of FUE (Follicular Unit Extraction) metamorphosed the outlook on this touted procedure. FUE technique has three main steps:
– Creating slits
– Harvesting grafts (over few hours)
– Implanting the grafts (few hours)

Extraction of hair grafts with motorized micropunches significantly improved the pain involved and cosmetic outcome. The estimated grafts are taken out first for two-three hours. Then, they are placed in bald areas over the next few hours.
Holding the grafts (hairs) outside the body for certain hours has a potential threat of losing hair survival. Over the years, FUE technique saw many embellishments and improvisations, such as enhancement of results with PRP therapy, growth factors, stem cell-based treatments, and exosomes.
However, according to Dr. Limmer and his team of researchers, hair grafts die progressively, as they are kept outside the body for more than two hours. When hairs are placed into the scalp within two hours of extraction, hair survival percentage is almost 95 percent. But, this ratio declines progressively as we cross four-six hours, after which the survival reduces steeply. Longer the hairs stay outside the body, more is the cellular injury to hair cells, and lesser is the survival. Hence, in 2013, the method of Direct Hair Transplant (DHT) was introduced, where grafts are not kept outside the body for crucial period.

What is Direct Hair Transplant (DHT)?
Direct Hair Transplant is modified FUE hair restoration (transplant). Hair grafts are harvested and implanted simultaneously to minimize outside body time for hairs. It is different from traditional FUE, as grafts are not susceptible to more injury until hairs are safely lodged at their site of implant. It is quick, with shorter recovery time and better results.

Is DHT better than FUE?
In FUE, since hairs stay outside in room air or chilled solutions, the risk of cell death in hair roots is pertinent. As time increases, damage due to dessication, more mechanical handling, trauma, temperature changes, etc. increases. Hence, DHT is a better technique, as its graft survival is of around 99 percent.

How is DHT done?
Different areas are treated in different positions. A highly skilled team is required to extract and implant the grafts, alongside management of hair grafts in between extraction to implantation. Position of the patient and angles of extracting and implanting experts has an important role. It could be slightly uncomfortable, as patient positions and surgical team’s positions are tiring. The number of skilled staff required is higher in DHT compared to FUE.

Does donor zone hair re-grow after transplant?
This is a transfer of grafts from your donor area to your recipient area. The extracted grafts do not grow back on the donor area again once they have been removed, but hair transplant is an art, so the donor area will not be empty. Ideally, only 25% of the hair at the donor site should be extracted in one session. On average, 3500 to 4000 grafts can be harvested from the scalp in one session. Over-ambitious harvesting of donor area can lead to “see-through” effect in donor area, showing skin in between hairs. Harvesting too much hair can also risk the “non-permanent” hairs to be used from donor area, which may be eventually lost. However, encouraging studies from India show up to 12,000 hairs can be extracted over two-three sessions.

Is DHT permanent?
Yes, DHT is a permanent method of hair transplant.

Is everyone a candidate for DHT?
Patients with Grade III-IV hair loss are better candidates. However, we have done it in different grades of hair loss. Any candidate for hair transplant can be a candidate for DHT, too.

Who are NOT candidates for hair transplant?
People with advanced grade of hair loss, who also have thinning of donor area, are poor candidates. Mismatch between donor vs. recipient area in advanced hair loss poses challenge in providing good density. As grade of hair loss progresses, the permanent area in donor hairs also depletes. Hence, in advanced grade of hair loss, careful calculation of donor density should be done beforehand. In those with acceptable density, it is wise to treat one area of baldness at a time, i.e. covering frontal areas of baldness first, followed by central scalp and crown area.

What can be done if we are NOT candidates for transplant?
People who cannot go for hair transplant can choose camouflage techniques, such as Scalp Micropigmentation (SMP) or hair wig. Scalp Micropigmentation is a medical procedure of inserting pigment into the scalp skin, thus creating an illusion of having hairs. It can also be done in men and women with diffuse hair thinning without complete baldness, as these colors give an appearance of dense hairs.

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