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.

Cost of Hair Transplantation: What we Charge at Nuleaf Skin & Hair Clinic, Pune

Hair transplantation has come a long way from being the procedure available only to the celebrities to a much more common and everyday procedure. Easy modification in the procedure techniques and much less downtime in terms of dressings and hospital stay has reduced overall costs to the patients. Today the cost of hair transplantation is measured on ‘per follicle’ basis. In India the range of the cost is somewhere between 40 to up to 100 INR per follicle with average hair transplant requiring roughly 1500 follicle. This rate may vary from clinic to clinic and country to country. Also the rates will rise when advanced technology is used to perform hair transplantation. It is up to the patients to choose the best service available.

The cost of hair transplantation all over the internet is a bit foggy. It involves lots of calculations, something to do with the 'follicle' or the 'grafts' or 'number of hair' even 'effective hair number'. This is very confusing to patients who really have to know how much it will be on their pockets. I will clear out a few things first:

What is a Follicle?

Follicle or Hair follicle or simply the hair, is a entire hair up to the hair root with surrounding coverings  and glands.

A Hair follicle in cross section

What is a Follicular Unit?

Research has shown that neighbouring hair follicles especially over the scalp grow in together in groups. In Follicular Unit transplantation, rather than removing individual follicles, follicular units are removed. This approach not only ensures better survival of hair but also produces naturally appearing hair.

Follicular Units containing 2 follicles (or 2 Hair) (Courtesy newhair.com)

Follicular Units extracted: You can see follicular units containing 2 or 3 follicles (or 2 or 3 hair) (Courtesy hairforlife.com)

What are "grafts"?

In hair transplantation the word "graft" is synonymous with "follicular unit".

What do you mean when the site say how many hairs are transplanted?

Sometimes the hair transplant surgeons explain the patients how much hair they are really going to get. This is just to increase the numerical figure. For example, instead of saying 2000 'grafts' transplanted, it feels prestigious to say 6000 'hair' transplanted (if one follicular unit or a graft contains 3 follicles or hair then 2000 X 3=6000 hair). This approach is purely a marketing approach and a game of numbers. Also not all the follicular units or grafts contain similar number of follicles. Some may contain 2, others may contain 3 and at times there can be  only 1 follicle per follicular unit. These number vary from person to person.

So dont get confused, dont follow wrong figures. Get all the information before committing yourself to this procedure. For more information regarding hair transplantation at Nuleaf Skin & Hair Clinic, Pune visit: http://nuleafclinic.com/services/hair-transplantation/

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

Hair Growth After Hair Transplant

Hair Growth Stages: After the Hair Transplant

By Nuleaf Hair Transplant Centre, Pune

If you are thinking of going for a hair transplant, then the knowledge about the hair growth pattern after the hair transplant is absolute essential for you. Hair transplant will give you excellent hair growth. But hairs do not grow immediately after the transplant. Rather the hair growth occurs in stages.

Once the follicles area removed from the body, because of the changes in the surrounding environment they go in a phase called dormancy similar to hibernation. This is what results in a growth pattern we see after the hair transplant.

Immediately after the transplant:

Immediately after the hair transplant, the grafts appear whitish in colour as they have a bit of epidermis attached to them. From 2^nd day onwards this epidermis shrivels off and scabs form on the grafts.

Immediately After Hair Transplant

2^nd Day to 10^th day after the hair transplant:

2nd Day After Hair Transplant

In a high density transplant, the scab may take up to 10 days to come off. We do not recommend hasty removal of the scabs by washing or scrubbing of the area. Picking of the scabs in this period may results in accidental removal of the grafts. But not to worry, the scabs usually fall off causing no trouble in majority of the patients. Some people do get swelling over the forehead from 2^nd day which may last for 4-5 days ahead. But use of sharp instruments has reduced the incidence of swelling in the patients. We at Nuleaf Hair Transplant Centre, Pune do not give patients oral corticosteroids to reduce or prevent swelling are patient become more vulnerable to infections. A harmless swelling even if it looks bizarre is much better than an infection which is a dangerous scenario.

7-10 days to 1 month after the transplant:

15 Days after Hair Transplant

After the scabs fall off, the planted hairs stay in the place till 15 days to 1 month. After 15 days, the hair shafts (and not roots) start to shed off. The expanded portion at the bottom of the hair is a bulb and not the root. Roots don’t fall off during this time. Although the situation is alarming to the patients, there is nothing to worry. The upper portion of the hairs which is called ‘shaft’ falls off. The root goes in hibernation or a dormancy mode.

1 month to 4-5 months after the hair transplant:

1 Month After Hair Transplant

After the hair shafts shed off, the root goes in dormancy. During this time there is hardly any growth of the hair. It looks as if nothing has been done on the scalp. No growth can be visualized in this period. In stage of dormancy, the metabolism of the hair roots is slowed down. It’s like a reboot mechanism which takes about 4-5 months’ time.

4-5 months to 9 months after the hair transplant:

5 Months After hair Transplant

7 Months after the Hair Transplant

9 months After Hair Transplant

After the roots come out of the dormancy, hairs start appearing as fine growth over the transplanted area. Once hairs appear they start growing at the rate of 1cm per month. During this period they grow synchronously. This mean all of the hair enter in a growth phase together. This is unlike the normal hair where every hair is in a different stage of growth (that’s why we don’t get intermittent periods of baldness/shedding like other animals). This is however not very noticeable by the patients. The normalization of the growth cycles may take up to 2 years some times.

1 year after the hair transplant: Final Growth:

Assessment of the hair transplant is done at 1 year duration. This is a time where your transplanted hair would have grown up to 6 cm in length (if you have not cut them).

Simple Explanation of Hair Transplantation

Everything About Hair Transplant Simplified! (Nul…: http://youtu.be/vkmBZ7lO09M

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

Hair Transplant India Details

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’.