Sterilization methods used in Hair Transplantation

Sterilization methods used in Hair Transplantation

What we do at Nuleaf Skin & Hair Clinic, Pune

In recent years with the take-off of medical tourism in India, numerous hair transplant centres across India area offering specialized packages for the foreign nationals including transportation, hotel stay and the entire procedure of the hair transplant. The hair transplants which cost up to $10,000- $20,000(₹6, 40,000 to ₹12, 80,000) in the western countries like USA, UK and Australia, cost no more than $ 3000 (₹1, 92,000) in India. This is a huge difference and makes it attractive to the foreign nationals.

However with a difference this big, obvious question comes to a logical mind: will low cost mean poor or sub-standard medical care? After all, this is a surgical procedure and nobody wants inferior care when it comes to their health. Will we get in more trouble with choosing something which is cheaper?

With consumer industry booming all around the world, the prevalent thinking is higher cost usually will give you a higher quality of care. But this is not the same when it comes to medical costs around the world. When we were in medical school we used to make fun of our relatives in USA who spent a fortune on as trivial medications like an antacid. In India, most of the medications are subsidized by the government and made available at equivalent quality at about 4-5times cheaper rate than UK, USA etc (It’s a different matter that most Indians still can’t afford these). But to someone looking from outside it’s a medical heaven!

High prices for medical procedures in other westernized countries are mainly due to high labor cost, high medication cost, high liability and indemnity insurance costs and of course in case of hair transplantation lack of medical insurance cover. The lower cost in India is precisely due to the same reasons: low labor cost, low medication cost, low liability and indemnity insurance cost. So, lower cost of hair transplant is not because we omit necessary steps of the surgery.

Now the question of quality of care: A leading doubt many of the patients coming from abroad express is whether the facilities perform adequate sterilization procedures to ensure no infections occur to them. Sterilization is a process to neutralize all known pathogens from the medical devices. It is a norm for all hair transplant centers to have “Autoclave” which sterilizes all medical instruments like forceps, slit handles, punches etc with high pressures and heat. In our center an autoclave confirmation strip (paper indicator strip) is made with the name of each patient and record of it is kept in the register.

Apart from this, most of the needles and materials used are disposable and are not repeatedly used. I will summarize what we do at our clinic as a part of routine sterilizations methods:

Material Used	Sterilization Method
Bed Sheets, Linen, OT uniforms and Patient uniform	Washed with chlorhexidine after each use and autoclaved.
Gauzes and cotton	Autoclaves before use and discarded (single use only).
Forceps, handles,  titanium punches and other metal instruments	Manual cleaning with alcohol after each use then Sidex (Freshly made Gluteraldehyde solution) cleaning and autoclave before and after every use.
Needles and syringes for anesthesia, tumescence etc	Disposable and are EO (Ethylene Oxide) Sterilzed by manufacturers, discarded after each use.
OT Room, lights and table	Cleaning before and after every procedure with Sodium Hypochlorite solution and Fumigated with Formalin before and after every procedure

The chances of getting any sort of infection are equal with the western hospitals if above methods are followed.

 

For a better understanding and satisfaction of the patients (all patients Indian as well as the foreign nationals are concerned regarding the sterilization methods and risks involved), it should be a standard practice to inform regarding this aspect with, if possible, actual demo of sterilization procedure. This alleviates the patients from fear of a surgery performed abroad away from their home country.

Hair Line Correction: FUE Method

The Hair Line

Hair line is the line where the front boundary of the hairy scalp starts. This is the line if irregular will change the shape and appearance of entire face. IN males, the recession of the hair line starts as early as 16 years of age. Males typically have a hair line which is u-shaped or v-shaped. 

As the age progresses, this ‘V’ becomes even more acute, which is often referred to as a ‘receding hair line’. In males who are prone to develop baldness,  this receding hairline advances very fast  and causes ‘baldness’.  Receding hairline more than anything is a prominent sign of baldness.

In females, the usual shape of the hair line is inverted u-shape. There are some irregularities in the hair line of females which are important for it have a natural appearance. Females even in presence of ‘female pattern baldnedd never lose their frontal hair line. However in few women, because of variety of reasons, most common being traction, hair line can get asymmetrical or less dense 

The Solution

The solution to this problem is very simple. A mini-session of FUE hair transplantation corrects the hair line easily and will give a permanent solution. This correction typically requires 400 to 800 grafts. The hair growth is very similar to what occurs after routine hair transplantation. Since FUE or Follicular Unit extraction method is a type of hair transplantation which is very minimally invasive, this is an ideal procedure for correcting the hair line. For more information regarding hair transplantation click here.

For correcting your hair line from the experts at Nuleaf Skin & Hair Clinic contact 9011-73-9011 or email on info@nuleafclinic.com

Density Matters: High Density hair transplantation from Nuleaf Hair Transplant Center, Pune, India (Nuleaf Skin & Hair Clinic, Pune, India)

What is High Density hair Transplantation?

“High density” hair transplantation is a latest hype in the hair transplant world.  Patients come to the doctor with a demand of high density after watching mind-blowing densities in YouTube videos. Density is the total number of hair follicular units in a square centimetre. Normal natural hair density in an average male is 90 to 110 follicular units in a cm².  When this is lost in the process of baldness, theoretically we should try to achieve this density by hair transplantation. However this has many implications on the outcome of the surgery. Following are some of the important ones.

Natural appearance of the transplanted hair: This is, without doubt, the best outcome of the high density hair transplant. Hairs appear more natural, fuller and give the patient best results after the transplant.

Consumption of the follicular units: We have limited number of follicular units in the back of the scalp which are permanent. These are the follicles which are available with us for the hair transplantation. In an average case of the hair transplant, (not a high density one), the follicles are planted in densities ranging from 45 to 60 follicular units per cm². By this density you will require 2500 follicular units to cover the frontal area with mid-scalp in grade IV baldness. If you increase this density to 100 or 110 FU/cm² then the total graft number will obviously be double i.e. 5000 follicular units. Now the question is whether you have 5000 follicular units available or not. We cannot deplete the number of available permanent follicular units for the name of high density hair transplant. A recent trend is where just for frontal hair line correction the number of follicular units used at 110/cm² exceeded 4000 follicular units. This will invariably deplete the follicular units from back of the scalp and hence future hair transplant (which is required because only frontal hair line of 3-4cm is corrected) becomes a very low density one or sometimes impossible.

Survival of the follicles: Whenever a follicular unit is implanted in the skin, it cuts the blood vessels below causing a relative lack of blood supply to the newly placed hair follicle. If this is severe the unit may not survive for long time. Imagine is a centimetre of instead of making 50 punctures to implant the follicle, 100 punctures are made. Theoretically the damage to blood vessels would be twice and hence twice the reduction in the blood supply which will ultimately result in poor survival of the units. The final outcome by this logic is sparse or poor hair growth. However in recent studies even the densities of >100 FU/cm²  have shown a survival of almost 100% of the units. In our experience too lack of blood supply has never been a problem and high density transplantation show hair growth pattern similar to regular hair transplantation albeit more dense growth. However this is a real worrisome problem in the patients with diabetes and atherosclerosis where blood circulation to the skin is already compromised. We don’t perform high density sessions in these patients.

So why do ‘high density’ hair transplantation? : High density hair transplant are done specifically for the patients who have ample donor follicular units in the permanent zone. It is also done for the patients who have a very small area of baldness with stabilized hair loss.

Cost of the surgery: The cost of the surgery will obviously increase as the number of follicular units is doubled, surgery time is doubled. 

Nuleaf’s Stand on High Density hair transplantation: We perform high density hair transplants of up to 110FUs/cm² in selected cases taking care that we don’t overuse and waste the donor supply of the follicular units required in the future. In cases of Grade IV and above with no/unusable body hair, we go for densities of 45FU/cm². Sometimes we may perform surgery in 2 stages of 45FU/cm² with a gap of 2-6 months in order to achieve densities equivalent to 90-110FU/cm² .

Eyebrow Shaping @ Nuleaf Hair Transplant Center-Pune

Problem of irregular eyebrows

Eyebrows are notoriously important for the appearance of a person. Even small deviation from normal is usually highly visible. Irregular eyebrows can result from variety of different causes. The most common cause is old trauma resulting in scarring and subsequently lack of hair in that region. Other causes include dermatological diseases causing irregularity in the eyebrows. Sometimes eyebrow hairs grow excessively and asymmetrically producing very thick eyebrows.

What can be done?

FUE Hair transplantation

This is especially useful for the cases where eyebrows are lost completely or partially as result of trauma or burns. FUE hair transplant is one of the best methods of eyebrow reconstruction. Similar to the hair transplant required for baldness, the hair are obtained from the scalp. But these hairs are smaller in size so that they match with the eyebrow hairs.  The hairs take about 15 days to grow back and another 1-2 months for regularization of the hair cycle. The results are excellent and permanent.

Botox®

Irregularity of eyebrows can also be produced by the scar in the vicinity producing a pull on the eyebrows. This becomes even more prominent on raising the eyebrows during facial expressions. The excessive muscular action on the eyebrows can be successfully reduced with the help of a simple Botox® injection.

Laser Hair removal

Excessive hair growth of the eyebrows is another problem faced at times. Usually patients resort to methods like cutting with scissors, threading in parlours or bleaching the hairs. But these often produce dreadful results and also are to be done very frequently. Laser hair removal with a Diode laser (810nm) or Long Pulse Nd YAG laser helps to design the eyebrows effectively.

For shaping your eyebrows from experts at Nuleaf Skin & Hair Clinic, contact 9011-73-9011 or Email at info@nuleafclinic.com

Going Bald? Solution: Hair Transplantation (Explained Simply)

Hair transplantation in Pune

What if I tell you that the solution to your problem of baldness is a procedure which is stitch-less, routine, affordable and best of all will give you permanent hair! Sounds too good to be true? Of course it does. Everyone knows of hair transplantation. But many individuals suffering from baldness think of it as an expensive and a very surgical procedure which is mostly done by celebrities and we certainly won’t be affording a hair transplant. But hair transplantation has become much simpler and cheaper than before. It is not associated with the same kind of downtime it was once before. You don’t have to take a month off or even a week off. 2-3 days relaxation time after the hair transplantation is fine. This is mainly because of shift of the techniques from relatively invasive technique called the “strip extraction” to a much conservative “FUE extraction”. 

Most of the patients who come to visit our clinic are aware of the fact that there are two different methods of hair transplantation; one of them involves removing part of the skin from the back with putting of sutures that last for 15 days and another method where no such a thing is done i.e. the FUE method. 90% of the patients choose the FUE method. And there is a reason why. I don’t condemn the strip method neither do I condone the FUE method. What I do in my practice is to provide information regarding both the methods and whenever possible, I let the patients choose on their own. As I said earlier that 90% of the patients choose FUE method. This has led to gradual discontinuation of the strip method from our practice. For the patients who have extensive baldness I also discuss other possible options like wigs, hair bonding, hair weaving etc. But patients want real hair on them, who wouldn’t?

Male pattern baldness or androgenetic alopecia affects 70% of the males at some point in their lives. Not all the people require hair transplantation. I our setup we don’t usually go for the hair transplantation in a patient below the age of 24 years. Broad forehead and to an extent, baldness, is considered a sign of wisdom in our society. But has anyone taken opinion of the young men who suffer from untimely appearance of baldness as early as 24 years of age? The truth is baldness affects confidence. Whether a person is keen on his or her appearance, disappearing hair on his is a sign that is devastating. It is often associated with aging and then consequently associated with ‘loss of strength’ (As few of my patients have claimed). Of course there is no loss of actual strength, but that can be understood.  Most of the patients often try the non-surgical methods first. Some of these methods help some of them don’t; in any case all methods apart from hair transplantation are temporary methods of hair restoration. Many patients waste thousands, if not lakhs, of rupees on these methods. These methods are good for the early stages of the baldness but not in the later stages of baldness where the hairs are shed to a point of no return. However people who suggest the patients to do these procedures don’t always tell them this. That is the main reason why if you want to go for any hair treatment you should go forward after doing a thorough research. Lot of crooks out there!

Male pattern baldness or androgenetic alopecia is primarily a genetic condition, a lot of times, familial. On the hair roots an enzyme called 5α Reductase is situated which converts the male hormone testosterone into even more potent male hormone called dihydrotestosterone Or DHT. This conversion leads to gradual shortening of the hair and reduction in the growth phase of the hair follicles. This conversion is most active in the baldness prone areas of scalp such as the frontal hairline and vertex areas. The hairs from the back of the scalp are very resistant to this type of hair loss and they tend to persist for a very long time and generally do not get involved with the process of androgenetic hair loss. Hair loss can be categorized in a standardized scale called the Hamilton Norway Scale (Figure 1). These are the hair which we can take for transplantation.

‘FUE’ stands for the extraction of the individual follicular units by a device called a motorized punch. After extraction, these are planted with the help of implanters in the affected areas. Where do we remove these follicles from?: From the back of the scalp, where the hair follicles are ‘permanent’.