 |
| - |
the
anagen phase (85%) during which the hair grows (2
to 5 years) |
| - |
the
catagen phase (1%) during which the hair no longer
grows, but still remains in place (a few days) |
| - |
the
telogen phase (14%) during which the hair is detached
from the scalp and falls out (2 to 3 months) |
|
|
|
The
lifetime of some of a man's hair-roots (on the forehead
and the crown) is genetically shorter as a result
of shortened cycles, which in their turn result
from the influence of the male hormone (testosterone)
and from the number of receivers of this hormone
on the hair-roots. This causes hair-roots to die,
with no new hairs being added. This loss of hair
is called androgenetic alopecia. It causes a baldness
which is genetically determined and which is therefore
transmitted from one generation to the other.
|
|
The
hairs in the hippocratic area, i.e. the area between
the neck and the temples, have less testosterone-receivers
and are therefore less subject to this hormone.
As a result of this, they have a normal lifetime
and these hairs can last a whole life. It is therefore
in this area that future implants will be taken.
Since they take their genetic information with them,
they can be moved without any impact on their original
lifetime. |
|
|
There
is a period of inactivity between two consecutive cycles.
This lasts a few months.
|
|
| |
|
Women
and children have a higher proportion of their hairs in
the anagen phase than men.
|
|
|
As
commonly known, the hormonal situation of women has an
impact on their hair cycle: the phase of rest lasts longer
during pregnancy, as a result of which the number of hairs
will temporarily increase. After giving birth, however,
there is an increased loss of hair. |
|
|
Remark:
women, too, can suffer from androgenetic alopecia, but
in their case it will be spread over the entire skull.
|
|
The
classification of Hamilton distinguishes between seven
levels of baldness with men. |
|
| __________ |
The
diagnosis of loss of hair |
__________ |
|
1)
Differential diagnosis of the different causes of loss
of hair :
|
| |
Hereditary
baldness is the most frequent cause of loss of hair. If
this cause is excluded, all forms of excessive loss of hair
or of hair becoming thinner, must be taken seriously.
|
| |
| - |
Child-birth:
the loss of hair will decrease during pregnancy,
as a result of which there will be an increased
loss of hair during the first months after having
given birth .
|
| - |
A
period of increased body-temperature or serious infection,
as well as major surgery can be followed by a period
of three months with increased loss of hair . |
| - |
Illnesses
of the thyroid gland. |
| - |
Low-protein
diets and a lack of magnesium, calcium, potassium,
zinc, iron, vitamins or
mineral salts (watch out for unbalanced diets!) |
| - |
Certain
drugs and anti-cancer treatments. |
| - |
Contraceptives
when the woman has a hereditary predisposition to
baldness. |
| - |
Alopecia
areata: an illness of the scalp which makes the hairs
fall out in bundles. |
| - |
Mycosis
of the scalp: an infection of the scalp which is caused
by a fungus. |
| - |
Repeated
aggressive hair-treatments (colouring, decolorisation,
tight hair-knots, uncurling) can make the hairs fragile
and cause them to break . |
| - |
Grave
stress-factors (e.g. mourning, emotional shocks, surgery)
|
| - |
Trichotillomania
: a nervous twitch which makes people pull out their
hairs. |
|
| |
Most
of these affections can be treated. But when the hair has
been affected in an irreversible manner, then a hair-transplant
is the only natural solution. |
|
2)
Diagnosis of the loss of hair:
|
| |
-
The trichogram: |
| - |
The
photo-trichogram |
| |
An
area of the scalp, a square centimetre in size, is shaven
and macroscopic pictures are taken. A second set of pictures,
taken five days later, will allow to establish the percentage
of new hairs. In order to obtain an even more precise idea
of the rate at which new hairs grow, one can review the situation
again after one month.
|
| - |
Analysis
of the hair under a microscope |
| |
When
the hair is exceptionally fragile, which could indicate a
fungous, a bacterial or a viral infection.
|
| - |
Analysis
of the hair in a laboratory |
| |
This
serves to determine hereditary defects of the hair's protein
composition, as well as changes caused by drugs or by heavy-metal
contamination.
|
| - |
Biopsy
of the scalp |
| |
In
the case of exceptional loss of hair, a biopsy can give additional
information as to the reason why the hairs break off.
Is hardly used at all. |
| __________ |
TREATMENT |
__________ |
|
Treatment with drugs:
food-supplements, lotions and vitamins (Biotine, Bépanthène,
vitamin B,…) can overcome most affections of the scalp.
|
|
|
Finasteride
(Propecia):
this drug, which has been used for many years in the treatment
of hypertrophy of the prostate, halts the progress of
baldness with more than 80% of the patients. In 66% of
all cases, there is even renewed hair-growth !
|
|
Dermography
(tattoos) can sometimes offer an interesting alternative.
The scalp is coloured to create the impression that it
is covered with hairs… |
|
|
Minoxidil-lotion
(Regaine):
this is the only local treatment, effective in 60% of cases.
When applied twice daily over a long period, it can slow down
the loss of hair. It is recommended to young men only. As
soon as the treatment is halted, the loss of hair will continue
as before.
|
|
| |
| 2)
Hair prosthesis (wigs) |
|
Their
advantages and disadvantages are well known. It is up to everyone
to judge... |
|
The
patch method (patches of the scalp are moved across the
surface of the scull). As this technique results in scars, it
is hardly used anymore.
|
|
|
Reducing
the bald crown (the bald central spot is resected). This
technique can be appropriate in the case of extensive baldness,
prior to a transplant. |
|
The
skin-expansion technique (subcutaneous elastics or small
balloons expand the hairy skin, allowing for the bald skin to
be cut away). This technique is quite effective, but it is painful
and results in scars. |
|
|
|
|
Artificial
: in the past, different kinds of synthetic hairs were implanted.
However, the risks of rejection, allergic reactions and infections
were very big.
|
|
|
Own
hairs : this methode makes it possible to spread the 'hair
capital' in a well-balanced manner. One avoids bald spots
and one can gradually move from dense to less dense hair,
which still covers the entire skull.
|
This technique has been perfected a lot over the recent years. |
| __________ |
History
and evolution |
__________ |
|
The
capillary auto-transplant was carried out for the first time
in 1938. It was further developed and systematized by professor
Orentreich.
|
|
|
The
next step was that analysis under a magnifying glass showed
that hairs are not implanted in the skin one by one, but
in groups of 1 to 4 hairs, the so-called follicular unit.
|
|
Nowadays,
these follicular units are kept as mother nature has given
them to us. They are transplanted in their natural state,
the only difference being that micro-transplants are used
for the frontal hair-line, whereas micro-transplants with
2 to 4 hairs are used on the rest of the head. This way
of working contributes to a well-balanced hair-density.
The technique to remove the hair has been improved as
well, the strip-method having replaced the punch-method.
It is now possible to perform several sessions. All that
is left is a narrow scar at the back of the skull, which
is covered by hair anyway. |
|
|
Until
the late nineteen-eighties, big grafts (with a diameter of
4 to 6 millimetres) were used. These were implanted in rows
next to one another, which resulted in a doll's head appearance.
|
|
| |
|
In
order to avoid this, the technique started to use mini-transplants
(small parts of the scalp, each with only a few hairs). This
was a substantial improvement compared to the previously used
technique.
|
|
|
As
the technique was developed further still, doctors logically
ended up in the other extreme of micro-transplants whereby individual
hairs were transplanted one by one, in an effort to reach the
aesthetically ideal image. Individual transplants do indeed
have a very natural look, but the result also looked very thin. |
|
|
The
hairs are removed in narrow strips at the back of the skull.
These strips are then meticulously cut into tiny transplants.
This allows for the follicular units to be split and to be sorted
by number of hairs per unit. The area where the strips have
been removed is closed which leaves only a very fine skar, which
will be covered by hair anyway.
|
|
The
follicular units are then implanted one by one in micro-incisions
which are made in the scalp by means of a micro-bistouri. The
pattern and the angle of these incisions is identical to those
of the original implant. Since only micro-incisions in the scalp
are made, the blood-circulation is not affected. This gives
the micro-transplants an optimal chance to survive and allows
for a maximum hair-density to be obtained. It goes without saying
that this density can only be obtained if the operating team
is extremely skilled in this kind of operation.
|
|
During an intervention which respects the necessary safety margins for any
kind of aesthetic operation, up to 5000 transplants can be implanted per
session. This corresponds to between 10.000 and 12.500 hairs.
|
|
Because
this implant-technique is so remarkably precise, it even allows
for hairs to be added on parts of the head where there are still
hairs.
|
|
The
operation can be repeated several times. This depends on the
area which needs to be covered with hair, and on the hair-density
which is wished.
|
|
Because
of the optical effect, larger bald areas than before can be
covered. The patient's hair capital can thus be optimally exploited.
And the effect lasts a lifetime ! The aim is obviously not to
regain the same quantity of hair as when one was young, but
to have the same volume of hair as a man of the same age who
has no exceptional hair-loss.
|
|
This
technique has seen an enormous boom in the past few years, for
it uses our own hairs and thus creates hair that can be cut
and modelled in the same manner as the original hair.
|
|
The
ideal recipe therefore is: natural (micro-transplants with one
hair, at the front), concentrated (micro-transplants with 2
to 4 hairs, behind) and manifold (lots of transplants can be
made during a session).
|
| __________ |
The
pre-operative consultation |
__________ |
|
The
first consultation is absolutely necessary.
|
|
|
Since
no one has an unlimited hair capital, one has to use
it parsimoniously. It is therefore important to anticipate
future loss of hair and not to behave in a reactive
manner, which would always stay one step behind the
progressing baldness. The operation will only be a
success if the result lasts for many years, making
the first operation at the same time the last one...
|
|
The
doctor will explain the result that can reasonably
be expected. He will also discuss the advantages,
the disadvantages and the costs. His explanation must
be clear, complete and fair. It should also give an
answer to the patient's questions, and it must take
into account the patient's specific situation.
|
|
This
discussion will build the trust between the doctor
and his patient, an absolute prerequisite before any
aesthetic surgery is undertaken.
|
|
Ample
time to reflect must be given before the intervention
is actually carried out. |
|
|
It
gives the patient the opportunity to talk about his problem
and to explain which result he wants to have.
|
|
| |
|
During
this consultation, the patient's medical and capillary antecedents
(personally and in the family) are examined.
|
|
|
The
patient's scalp is examined at the donor zones and at the
recipient sites. Diagnostic examinations (trichogram etc.)
may be carried out as well. They enable the doctor to assess
the future evolution of baldness and to analyse possible
treatments.
|
|
|
Once
this has been done, the doctor and his patient can discuss
which treatment strategy to use, based on the collected
information. |
|
| __________ |
Pre-operative
instructions |
__________ |
| __________ |
After
the operation |
__________ |
|
It
is recommended that someone should accompany the patient
to his home. Also, in view of the - minimal - risk of a
drop in the blood-pressure, someone should be near the patient
during the first night after the surgery.
|
|
|
The
patient may already shampoo his hair from the day
after the operation onwards. However, he has to do
it softly, staying clear from the zones that have
been treated. These can be rinsed but should not be
touched.
|
|
After
3 days, which is after 10 to 15 days, one is again
allowed to shampoo the entire scalp.
|
|
Around
the fourth week, some of the hairs that have been
implanted will fall out. This will do no harm, since
the root of these hairs remains intact. This means
that new hairs will grow from these roots between
the second and the fifth month. The hairs that do
not fall out, will immediately start to grow again,
at the normal rate of one centimetre per month. During
the period in which the hairs will again begin to
grow, epidermal cysts may occur. These result from
an irritation of the skin which is caused by new hairs
not immediately getting through the scalp. Another
possible issue is when the donor zone temporarily
becomes over-sensitive.
|
|
The
change takes place very gradually over a period covering
several months. This makes it go unnoticed by the
people around you. It makes the intervention a very
discreet one indeed.
|
|
The
final result can be assessed after 6 to 12 months. |
|
|
A
bandage is usually not needed. This means that the patient
can continue his professional life and his social life
without any interruption. The only visible sign of the
operation can be tiny scabs in the recipient site. These
scabs will fall out by themselves after 2 to 4 weeks.
If the patient wishes so, they can even be removed much
quicker.
|
|
| |
|
The
doctor will prescribe a disinfecting lotion for the patient
to use during the first few days.
|
|
|
It
is possible that there is some minimal bleeding in the donor
zone or in the recipient site during the first two nights.
|
|
|
There
is no post-operative pain as such. The only thing that may
occur is a sensation of a tensed scalp during the first
24 hours.
|
|
|
From
the third day onwards, the forehead sometimes swells. This
can also occur at the eyelids. However, this swelling disappears
on the fifth day. And, anyway, it can be avoided if preventive
medicine is taken. |
|
|
remark:
in case there has been a treatment with Regaine and/or with
Propecia before, this can be continued during this entire
period. |
| __________ |
Questions
and answers |
__________ |
|
Does
this intervention really bear fruits ? |
| |
Yes.
The capillary micro-transplant technique makes it possible
to implant hairs across the bald parts of the head in such
a way that an optical impression of a full head of hair
is created. Since the patient's own hairs are used, there
is no rejection. The obtained result is therefore lasting.
And, finally, the transplanted hairs retain their shape,
colour and texture.
|
|
Why
should I consider a capillary micro-transplant ? |
| |
| - |
JI
do not want to look like my bald father (or mother). |
| - |
I
have lost a lot of hair and therefore I look older
than my age. |
| - |
It
bothers me that people notice that I am becoming bald. |
| - |
My
reflection in the mirror is different from the way
I feel. |
| - |
I
want to have an ideal head of hair, in order to please
better. |
|
|
Can
it correct a previous hair transplant that has gone wrong
? |
| |
The
solution is likely to consist of placing follicular microtransplants
in between the old transplants, in order to make the latter
disappear in the mass of transplanted hairs.
In some cases, it may be necessary to remove the old and
coarse transplants. But then at least the hairs can be recovered
from them.
|
|
Is
the intervention painful ? |
| |
Only
the local anaesthesia hurts a little, similar as the one
used by your dentist. There is hardly any pain after the
surgery. The only feeling is that of a tense scalp. Although
the doctor will prescribe a painkiller, it will usually
not even be necessary to take it.
|
|
Are
there any scars ? |
| |
The
scar in the donor zone is narrow as such, and it will be
hidden by the hairs anyway. In the recipient site, no scars
are visible at all thanks to the micro-incision technique.
|
|
When
can one wash one's hairs again ? |
| |
This
can already be done from the day after the operation onwards.
It is even recommended to do it on a daily basis. This will
make the scabs disappear quicker.
|
|
How
many micro-transplants and how many sessions are needed
? |
| |
This depends on the size of the bald spots. Also, one must keep in mind that zones which still have hairs in them now, but which may loose these hairs in the next few years, must receive implants as well.
On average:
-400 to 600 transplants are needed for the crown or for the temples
-1.000 transplants are needed for a partial baldness across the frontal and the upper part
-and from 1.500 transplants for widespread baldness
Thanks to the follicular micro-transplants, the result looks very natural from the first session onwards.
The number of sessions depends solely on the density of hair which the patient wants.
|
|
Does
rejection sometimes occur ? |
| |
No,
since the patient's own hairs are transplanted.
|
|
How
long does one have to interrupt one's professional life
? |
| |
Most
patients resume their professional activities already on
the day after the intervention.
An oedema can sometimes occur on the forehead. However,
it is only very small. If one wants to be totally discrete
about the intervention, it may be necessary to interrupt
one's activities for a few days. Anyway, taking appropriate
medicine prior to the intervention will avoid most of this
swelling.
|
|
Are
there any risks related to a session of capillary micro-transplants
? |
| |
Although
there is no such thing as zero risk, it is clear that the
risks are kept as low as possible by having an experienced
and competent team, which uses the equipment which is required
to guarantee optimal sterility (autoclave, sterile fields,
etc.) and optimal safety (cardioscope, oxymeter, etc.). |
| __________ |
Alopecia
with women |
__________ |
| Alopecia
with women is different from alopecia with men. It exists
in three forms : |
|
1)
Alopecia with women after their menopause : this
alopecia is spread across the head, but is most obvious
at the top of the head.
|
|
|
3)
Androgenetic alopecia of the female type : this is
the most frequent form. The hair on the crown of the head
becomes thinner, the hairs as such become thinner too and
the scalp becomes visible through the hair. The frontal
hairline remains quite normal. |
|
2)
Androgenetic alopecia of the male type : the frontal
hairline is driven back. This kind of alopecia is quite
rare and it fortunately hardly ever evolves into complete
baldness. |
|
|
| Three
levels of baldness are usually distinguished, according
to the classification of Ludwig. |
| The
extent to which these pathologies can be remedied, depends
on the quality and the concentration of the hairs in the
donor zone. These must be assessed during the first consultation. |
| __________ |
PICTURES |
__________ |
|
Even if lots of pictures showing results can been seen on lots of websites, the medical association in Belgium does not allow us anymore to show them, reason why you won't find any here.
On the other hand, you will, during the consultation, have access to all those pictures to show you the quality of our work.
|
If
you wish to have specific information relating to your case,
please come and see us.
|
