Tag Archives: Hair Loss

Removing unwanted hair


Earlier it was only women who were concerned about excessive body hair and its removal. They visited the friendly neighbourhood parlour to get their eyebrows shaped and moustaches removed. Times have changed; now both men and women want to get rid of unwanted hair – from face, arms, legs, chest and back. A hairy torso (male or female) is no longer considered attractive!

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In men excessive body hair is often, paradoxically, paired with male pattern baldness. This excessive hair not only looks cosmetically unappealing but can result in excessive sweating, and infections in the hair follicles.
Excessive hair growth in women is usually familial or due to obesity. Such women may have hair in areas such as the face, chin and back.

Women produce both male and female hormones. If the balance is disturbed, and more male hormones are secreted then the woman can become very hairy. This can occur during the teens or in later life. It may be due to polycystic ovarian syndrome (PCOS), congenital adrenal hyperplasia, if excessive steroids are administered or produced in the body as in Cushing’s syndrome, with some anti depressants and medications like danazole. In rare cases, it may be due to male hormone secreting tumours. If the hirsuitism is accompanied by deepening of the voice, loss of scalp hair and acne, it is called virilisation.

Shaving is a time tested method to remove hair from the arms, legs, axilla [armpits] and face. Shaving facial hair does not make it grow back thicker, coarser or faster. Apply shaving gel or foam first to soften the hair. Poor technique can cause ingrown hair.

A few unwanted hairs can be plucked using tweezers but it is painful. Pulling in the direction opposite to hair growth can cause ingrown hair and scarring. Apply ice immediately to the tweezed area to reduce swelling and redness.

Hair removing creams are available OTC (over the counter). The chemicals dissolve the hair shaft. Allergy can develop to the chemicals so it needs to be tested on a small area first. It can burn the skin if it is left on for too long.

Hot or cold wax can be used to remove hair. This can be done professionally in a salon or at home. It is messy and painful. Infection and burns can occur. It should be avoided if acne creams are also being used.

Twisting thread and then pulling the hair out is called threading. It is a technique done in parlours. It can cause pain.

Laser treatments have become very popular in recent times. Beauty parlours and spas offer such treatments. Only a licensed pro-fessional should do it. A physician should be available on the premises to tackle any side effects. Lasers suitable for Indian skin need to be used. The sittings need to be scheduled at the correct intervals 8-10 weeks apart. It does not get rid of unwanted hair permanently. After repeated sittings, hair growth is reduced by upto 80 per cent. It can cause scarring, keloid formation and pigment changes. That is why it should be tried on a small area first.

Hair can be removed permanently with electrolysis. A professional uses a needle to apply an electric current in the hair follicle. There may be tingling and pain. The process is slow and time consuming but is permanent. It can cause pigment changes. Several sittings spaced out over a period of months are required.

Resources: The Telegraph (Kolkata, India)

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Eclipta alba

Botanical Name : Eclipta alba
Family: Asteraceae
Genus: Eclipta
Species: E. alba
Kingdom: Plantae
Order: Asterales
syn. : Eclipta prostrata L.
Common Names: False Daisy , yerba de tago, and bhringraj

Habitat :Eclipta alba grows in E. Asia – China, Japan and Korea to Australia.Wet places in the lowlands of Japan, especially by paddy fields.

It grows commonly in moist places as a weed all over the world. It is widely distributed throughout India, China, Thailand, and Brazil.

Description:
Eclipta alba is an Annual plant growing to 0.6m by 0.6m.  Root well developed, cylindrical, greyish. It is also named ‘kehraj’ in Assamese and karisalankanni in Tamil. Floral heads 6-8 mm in diameter, solitary, white, achene compressed and narrowly winged. .
Click to see the pictures..>....(01).....(1).……...(2)……...(3)..(4)
It is hardy to zone 9. It is in flower in August. The flowers are hermaphrodite (have both male and female organs)
The plant prefers light (sandy), medium (loamy) and heavy (clay) soils. The plant prefers acid, neutral and basic (alkaline) soils. It can grow in semi-shade (light woodland). It requires moist or wet soil.

Cultivation:
Requires a damp to wet soil and a position in some shade. This is a tropical species and it might need more summer heat and a longer growing season than is normally available in British summers.

Propagation:
Seed – sow spring in a greenhouse and only just cover the seed. When they are large enough to handle, prick the seedlings out into individual pots and plant them out into their permanent positions in early summer, after the last expected frosts. Give the plants some extra protection, such as a cloche, until they are established and growing away well.

Edible Uses: Tender leaves and young shoots – cooked and used as a vegetable

Medicinal Uses:
Antiseptic; Astringent; Depurative; Emetic; Febrifuge; Ophthalmic; Purgative; Styptic; Tonic.

This species is widely used in traditional Chinese herbal medicine, and in Ayurveda. It is considered to be the best remedy for the hair and is also used as a rejuvenative and liver tonic. The whole plant contains the alkaloids nicotine and ecliptine as well as coumarin. It is astringent, deobstruent, depurative, emetic, febrifuge, ophthalmic, purgative, styptic and tonic. It is used internally in the treatment of dropsy and liver complaints, anaemia, diphtheria etc, tinnitus, tooth loss and premature greying of the hair. Externally, it is used as an oil to treat hair loss and is also applied to athlete’s foot, eczema, dermatitis, wounds etc. The plant juice, mixed with an aromatic (essential oil?), is used in the treatment of catarrhal problems and jaundice. The leaves are used in the treatment of scorpion stings. They are used as an antidote for snake bites in Korea. The plant is harvested as it comes into flower and is dried for later use. The roots are emetic and purgative. They are applied externally as an antiseptic to ulcers and wounds, especially in cattle

In ayurvedic medicine, the leaf extract is considered a powerful liver tonic, rejuvenative, and especially good for the hair. A black dye obtained from Eclipta alba is used for dyeing hair and tattooing. Eclipta alba also has traditional external uses, like athlete foot, eczema and dermatitis, on the scalp to address hair loss and the leaves have been used in the treatment of scorpion stings. It is used as anti-venom against snakebite in China and Brazil (Mors, 1991). It is reported to improve hair growth and colour

The herb Eclipta alba contains mainly coumestans i.e. wedelolactone (I) and demethylwedelolactone (II), polypeptides, polyacetylenes, thiophene-derivatives, steroids, triterpenes and flavonoids. Coumestans are known to possess estrogenic activity (Bickoff et al. 1969) Wedelolactone possesses a wide range of biological activities and is used for the treatment of hepatitis and cirrhosis (Wagner et al. 1986), as an antibacterial, anti-hemorrhagic (Kosuge et al. 1985). and for direct inhibition of IKK complex resulting in suppression of LPS-induced caspase-11 expression (Kobori et al. 2004)

Folkloric:
Plant is bitter, hot, sharp, dry in taste and is used in ayurveda & “siddha” for the treatment of Kapha and Vata imbalances. In India, the plant is known as bhangra, “bhringaraj” or bhringraja. Another plant Widelia calendulacea is also known by the same name, but Eclipta has white flowers so called white bhangra and Widelia has yellow flower so it is called yellow Bhangra (Puri 2003).

The expressed leaf juice, applied along with honey, is a popular remedy for catarrh in infants. A preparation obtained from the leaf juice boiled with sesame or coconut oil is used for anointing the head to render the hair black and luxuriant. An oil prepared with amla, bhringraj and sometimes with brahmi is well known in India as Amla Bhringraj oil, which is said to blacken the hair. Plant is rubbed on the gums in toothache and applied with a little oil for relieving headache and with sesame oil in elephantiasis. Roots of Eclipta alba are emetic and purgative.

In Ayurveda the plant is considered a rasayana for longevity and rejuvenation. Recent studies have shown that it has a profound antihepatotoxic activity. A cardiodepressant activity was also observed in it when used for hepatic congestion. A complete symptomatic relief in epigastric pain, nausea and vomiting in ulcer patients has also been observed (Puri 2003). Also it is one among 10 flowers called as ‘Dasapushpam’ (Ten auspicious flowers) in Kerala, the southern state in India

In Taiwan, entire plant is used as a remedy for the treatment of bleeding, haemoptysis, haematuria and itching, hepatitis, diphtheria and diarrhoea; in China, as a cooling and restorative herb, which supports the mind, nerves, liver and eyes. The leaf extract is considered to be powerful liver tonic, rejuvenative, and especially good for the hair. A black dye obtained from Eclipta alba is also for dyeing hair and tattooing. Eclipta alba also has traditional external uses, like athlete foot, eczema and dermatitis, on the scalp to address hair loss and the leaves have been used in the treatment of scorpion strings. It is used as anti-venom against snakebite in China and Brazil (Mors, 1991).

Other Uses: A black dye is obtained from the plant. It is used as a hair dye and for tattooing.

Disclaimer:
The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider

Resources:
http://digedibles.com/database/plants.php?Eclipta+prostrata
http://en.wikipedia.org/wiki/Eclipta_alba

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Hair-Raising Tale

Scientists have discovered that activating a gene can trigger hair growth.
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This must be music to the ears of the millions of men and women who fret day in and day out about hair loss. The findings of a team of researchers from Sweden’s Umeå University that appeared recently in the journal PLoS Genetics offers a strand of hope for balding people in the not-so-distant future. The team found that activating a gene called Lhx2 can lead to increased hair growth.

“I think that our study can have practical implications in the future since we know a way of inducing hair growth,” Leif Carlsson, the Umeå molecular medicine scientist who led the study,  .

Hair is formed in hair follicles — complex mini organs in the skin that specialise in the task of hair formation. The follicles normally form when the child is in the mother’s womb. To ensure the continuous generation of hair, each hair follicle goes through three cyclical phases: recession, rest and growth. The length of the growth phase determines the length of the hair. For instance, the growth phase for scalp hair lasts for a number of years, while that for eyebrows lasts for only a few months.

Hair formation ceases after the growth phase. This is the recession phase when the rate of growth of hair reduces, finally entering a period of rest. After the rest period, a new growth period begins and the old hair is ejected from the body and lost. The reason for this complex system has still not been understood, but it has also been seen that hair growth adjusts itself to seasons.

In the present study, Carlsson’s team found that protein expressed by the gene Lhx2 plays an important role in regulating hair formation. The Lhx2 gene is active only during the growth phase and is turned off during the rest period. The studies, conducted on mice, showed that when the Lhx2 gene was switched off, the hair follicles could not produce hair. They also demonstrated that once the gene was switched on, the growth phase was activated and this, in turn, triggered the formation of hair.

Another significant, and perhaps more useful, finding from the studies was that the expression of the Lhx2 gene can be manipulated even after birth, and that it is sufficient to activate the growth phase and stimulate hair growth.

To be sure, this is not the first time that scientists have busted the myth that hair follicles can be formed only during the development of an embryo. Scientists led by dermatologist George Cotsarelis, at the Pennsylvania University School of Medicine in the US, had put to rest that half-a-century-old belief by making mice, with deep cuts in the their skin, grow hair. Their study, which was reported in the journal Nature in 2007, showed that new hair follicles are formed in a mouse when it is wounded deep enough (nearly five millimetres).

But, importantly, the new follicles were slightly different from the ones that develop during the embryo stage. In embryos, follicles are produced by skin stem cells, which had very little to do with follicular development in the wounded mouse. Instead, the epidermal cells — that give rise to the outermost layer of the skin — were reprogrammed to make hair follicles. The instructions for this, they found, came from a class of proteins called “wnts”. The wnts proteins are known to play a role in hair follicle development in an embryo.

Regarding the latest study Carlsson said, “We have to find clinically acceptable ways to turn this gene on. But finding such drugs may take many years. Our next goal is to systematically screen for compounds that will do this trick.”

That trick will be a blessing for the estimated half the world population which experiences hair thinning by the age of 50.

Source: The Telegraph (Kolkata, India)

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Calculator Tells the Bald Future

A pioneering new computer programme that predicts if and when men will go bald is being offered to British men.

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The “baldness calculator” — said to be the world’s first reliable tool for predicting hair loss — has been a huge hit with men.

The programme calculates the exact age at which someone will go bald or have lost most of their hair or provides reassurance by predicting that they will still have a full head of hair in old age.

More than half a million German men used it within ten days of it being unveiled there and three million men have tried it out globally so far.

Sixty per cent of users of the calculator to date have been young men aged between 15 and 30. Two thirds of all British men will eventually suffer hair loss, according to recent research.

The programme asks users about their age, marital status, occupation, where they live, what their current hairline is, hair loss in their family and their stress levels.

German scientists devised the programme because half of men in their country suffer from hereditary hair loss.

Adolf Klenk, head of research and development at hair care firm Dr Kurt Wolff, said: “More and more men value full hair but especially younger men.

“They are looking for a partner and are at the peak of their social lives. They are very conscious about their looks and being accepted within their social groups. They get concerned that if they lose their hair, they will cease to be attractive to others whereas older men don’t care so much.”

Klenk said that men with a history of hair loss on either their mother or father’s side of the family are most at risk of going bald.

Source:The Daily Telegraph

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Hair Transplantation

 

Definition:
Hair transplantation is a surgical technique that involves moving skin containing hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. However, it is also used to restore eye lashes, eye brows, beard hair, and to fill in scars caused by accidents and surgery such as face lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.

Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques transplant these naturally occurring 1 – 4 hair “follicular units” in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This recent hair transplant procedure is called “Follicular Unit Transplantation.”..

 

History:
The use of both scalp flaps, in which a band of tissue with its original blood supply is shifted to the bald area, and free grafts dates back to the 19th century. Modern transplant techniques began in Japan in the 1930s, where surgeons used small grafts, and even “follicular unit grafts” to replace damaged areas of eyebrows or lashes. They did not attempt to treat baldness per se. Their efforts did not receive worldwide attention at the time, and the traumas of World War II kept their advances isolated for another two decades.

The modern era of hair transplantation in the western world was ushered in the late 1950s, when New York dermatologist Norman Orentreich began to experiment with free donor grafts to balding areas in patients with male pattern baldness. Previously it had been thought that transplanted hair would thrive no more than the original hair at the “recipient” site. Dr. Orentreich demonstrated that such grafts were “donor dominant,” as the new hairs grew and lasted just as they would have at their original home. Today Dr. Orentreich’s practice still performs hair transplants.

For the next twenty years, surgeons worked on transplanting smaller grafts, but results were only minimally successful, with 2-4 mm “plugs” leading to a doll’s head-like appearance. In the 1980s, Uebel in Brazil popularized using large numbers of small grafts, while in the United States Rassman began using thousands of “micrografts” in a single session.

In the late 1980s, Limmer introduced the use of the stereo-microscope to dissect a single donor strip into small micrografts. In 1995, Bernstein and Rassman published the first paper on “Follicular Unit Transplantation,” where hair is transplanted exclusively in naturally occurring groups of 1-4 hairs. With microscopic dissection of donor pieces from an excised portion of scalp, individual follicular units containing but 1-4 hairs could be prepared and individually relocated into needle punctures in the recipient areas. Since the transplanted hair mimics the way hair grows in nature, close to natural results were attainable.

The follicular unit hair transplant procedure has continued to evolve, becoming more refined and minimally invasive as the size of the graft incisions have become smaller. These smaller and less invasive incisions enable surgeons to place a larger number of follicular unit grafts into a given area. With the new “gold standard” of ultra refined follicular unit hair transplantation, over 50 grafts can be placed per square centimeter, when appropriate for the patient.

Surgeons have also devoted more attention to the angle and orientation of the transplanted grafts. The adoption of the “lateral slit” technique in the early 2000s, enabled hair transplant surgeons to orient 2 to 4 hair follicular unit grafts so that they splay out across the scalp’s surface. This enabled the transplanted hair to lie better on the scalp and provide better coverage to the bald areas. One disadvantage however, is that lateral incisions also tend to disrupt the scalp’s vascularity more than sagitals. Thus sagital incisions transect less hairs and blood vessels assuming the cutting instruments are of the same size. One of the big advantages of sagitals is that they do a much better job of sliding in and around existing hairs to avoid follicle transection. This certainly makes a strong case for physicians who do not require shaving of the recipient area. The lateral incisions bisect existing hairs perpendicular (horizontal) like a T while sagital incisions run parallel (vertical) along side and in between existing hairs. The use of perpendicular (lateral/coronal) slits verses parallel (sagital) slits however, has been heavily debated on patient based hair transplant communities. Many elite hair transplant surgeons typically adopt a combination of both methods depending on what is best for the patient.

The procedure:
At an initial consultation, the surgeon analyzes the patient’s scalp, discusses his preferences and expectations, and advises him/her on the best approach (e.g.,single vs. multiple sessions) and what results might reasonably be expected.

Click to see on pictures : CORRECTIVE HAIR TRANSPLANT PROCEDURE

For several days prior to surgery the patient refrains from using any medicines, or alcohol, which might result in intraoperative bleeding and resultant poor “take” of the grafts. Pre-operative antibiotics are commonly prescribed to prevent wound or graft infections.

Hair transplantation is a surgical technique in which a physician redistributes hairs from an area of thick growth to bald areas.

This Procedure is Performed because:
In patients who are concerned about their balding, hair transplantation can significantly improve their appearance and self confidence. Realistic expectations are important, however. It is important to remember that hair still cannot be created; it can only be redistributed from the back of the scalp to the front.

Most patients undergoing hair transplantation have traditional male or female pattern baldness, with hair loss on the front or top of the scalp. Patients must still have thick hair on the back or sides of the scalp, or there may not be enough hair follicles to move. In some cases, patients with hair loss from lupus, injuries, or other medical problems may be treated with hair transplantation.

Patients undergoing hair transplantation should be otherwise relatively healthy, or surgery is less likely to be safe and successful. Always discuss your risks and options with your physician before undergoing any elective surgery.

Surgery:
Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected topical anesthesia, and typically last about four hours. The scalp is shampooed and then treated with an antibacterial chemical prior to the donor scalp being harvested.

In the usual follicular unit procedure, the surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. The excised strip is about 1-1.5 x 15-30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts from the strip. Working with binocular microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting.

The surgeon then uses a fine needle to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The assistants generally do the final part of the procedure, inserting the individual grafts in place.

Risk Factor:As with any surgical procedure, risks exist. The most common complications of hair transplantation are bleeding, infection, and scarring.

Though less dangerous, it is also possible that the transplanted hair won’t look as good as you had desired. Older techniques often resulted in unnatural appearing tufts of new hair growth. With modern techniques, this complication is infrequent.

Post-operative care:
Advances in wound care allow for semi-permeable dressings, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have you shampoo the day after surgery. Shampooing is important to prevent scabs from occurring around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.

During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out (“shock loss”). After two to three months new hair will begin to grow from the moved follicles. The patient’s hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.

Modern techniques:
There are two main ways in which donor grafts are extracted today. These are the Strip Harvesting Technique and the Follicular Unit Extraction (FUE) Technique.

The Strip Harvesting Technique involves removing a strip containing a large group of follicular units from the donor area – almost always from the back and sides of the scalp. The strip is then divided into grafts (or follicular units) containing 1 to 4 follicles.

The Follicular Unit Extraction (FUE) Technique involves removing one follicular unit at a time directly from the donor area – usually the back and sides, but also sometimes from the chest, legs or face (beard hair) – using a small punch usually of between 0.5mm and 1mm in diameter.

Side effects:
Hair thinning, known as “shock loss”, is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day.

Other side effects include swelling of areas such as the scalp and forehead. If this becomes uncomfortable, medication may ease the swelling. Additionally, the patient must be careful if his scalp starts itching, as scratching will make it worse and cause scabs to form. A moisturizer or massage shampoo may be used in order to relieve the itching.

Relevant Anatomy
The scalp is divided into 5 layers, which are easily remembered by the mnemonic SCALP, which represents, in order from outermost to innermost layer, the skin, connective subcutaneous tissue, galea aponeurosis, loose connective tissue, and periosteum over the cranium.
The skin contains all the epidermal appendages, including hair follicles, which extend into the connective subcutaneous layer. In areas that have undergone hair loss, thinning of the outer 2 layers usually occurs. This situation can be appreciated when one compares the thickness of the scalp in recipient areas to that in donor areas.

The subcutaneous layer is well vascularized and contains the main penetrating branches of the named main arteries that travel primarily along the external surface of the galea. The importance of staying superficial along the connective subcutaneous tissue layer (when one makes slit recipient sites to avoid compromising circulation) has only recently become apparent. The scalp has an excellent blood supply. The supraorbital, supratrochlear, superficial temporal, postauricular, and occipital arteries are the primary vessels, and they typically travel with the veins.

The galea aponeurotica is a nonelastic layer that connects the frontalis muscles anteriorly with the occipitalis muscle at its posterior aspect. The temporoparietal fascia, in which the superficial temporal artery travels, is also connected to the galea. The galea sliding over the loose connective tissue layer allows for most scalp mobility. This loose connective tissue layer and the periosteum below have minimal sensory innervation.

The sensory innervation of the scalp closely follows the vascular supply. At the anterior aspect, the supraorbital and supratrochlear nerves provide sensation to the anterior half of the scalp. On occasion, sensation to the frontal scalp can diminish for several weeks when a large number of graft recipient sites are made along the hairline. The occipital nerve serves the posterior half of the scalp, whereas the supraauricular and superficial temporal nerves contribute innervation from the sides.

Perhaps no anatomic feature of the scalp is more important with regard to hair transplantation than the microscopic distribution of hair. Scalp hairs usually do not grow individually; they most often grow in tiny follicular-unit bundles, which usually contain 2-3 hairs and occasionally 1 or 4 hairs. A follicular-unit contains these 1-4 terminal hairs, a sebaceous gland element, and insertions of the arrector pili muscles, all wrapped in an adventitial tissue sheath. These follicular units are dispersed throughout the scalp, where non–hair-bearing skin constitutes up to 50% of the total tissue. By transplanting only these follicular units and dissecting away the 50% of unnecessary non–hair-bearing tissue, the most natural-appearing results can be attained.
Prognosis
Most modern hair transplants result in excellent hair growth within several months after the procedure. Often, however, more than one treatment session is needed to create the best-looking results. The replaced hairs are usually permanent, and no long-term care is necessary.

Recovery
During the recovery period after surgery, the scalp is often very tender. Strong pain medications taken by mouth may be necessary for several days. A bulky surgical dressing, or sometimes a smaller dressing protected by a baseball cap, must be worn for at least a day or two. Some surgeons may also recommend several days of antibiotics or anti-inflammatory drugs following surgery. After this very brief recovery period, no special treatment is needed.

Cost
In recent years hair transplants have become less expensive. Prices typically range from $3.00 to $7.00 per graft, with $4 to $5 per graft being about average. Normally the price per graft also drops as the size of the surgical session increases. Depending on the needs of the patient a typical surgical session can range from 1,500 to over 4,000 grafts, resulting in a total cost of approximately $6000 to $15,000. A few clinics offer larger sessions of up to 6000 grafts in one sitting.

Contraindications:
Perhaps the most difficult part of being a surgeon is knowing when not to operate. In elective cosmetic surgery, sound judgment must certainly be exercised.

Individuals must be motivated to undergo hair transplantation. Although the author does not conduct a formal psychological evaluation by means of lengthy questionnaires and examinations, some surgeons use this method. During the consultation, the present author generally reads to the individual to ensure that he or she is mature enough to decide to undergo the planned procedure. A prospective patient who has realistic motivations and expectations before the procedure is likely to be happy after the procedure. Honest and thorough preprocedural consultation is perhaps the most important part of the process.

Poor medical health is a potential contraindication for elective surgery of any kind. Individuals cannot be taking anticoagulants (eg, Coumadin, aspirin) before the procedure. Good surgical judgment must be exercised when one considers surgery in individuals with potentially complicating medical conditions. Age is not a medical contraindication. The author has performed procedures on men in their late 70s. Ensure that such patients provide medical clearance from their internist.

Perhaps no single hair-loss condition calls for more conservatism in judgment than premature MPB. Teenagers and men in their early 20s are particularly self-conscious about hair loss because most of their peers still have full heads of hair. These young men often hold unrealistic expectations, desiring a youthful hairline that will not be appropriate as they age. Worse, early surgical correction uses a large number of donor hairs, which will be sparse in the future, potentially resulting in an unnatural look and a disappointed patient.

In general, attempt to delay the procedure in individuals in their 20s or younger, though the author has performed procedures in select individuals as young as 20 years. When counseling young men about hair loss, the author advises a conservative approach to give patients time to consider hair transplantation. If the patient and surgeon agree on transplantation, restore a relatively high hairline and instruct the patient to use minoxidil for the crown region. Perhaps in the future, as effective medical therapies that end or substantially slow MPB progression become available, a less conservative approach can be taken.

For a number of medical conditions that are associated with or that can cause hair loss, treatment with hair transplantation is not appropriate. Examples are the active phases of alopecia areata, lupus, and infections. Scalp conditions, such as vitiligo and psoriasis, must be evaluated because hair transplantation can aggravate them.

Resources:
http://en.wikipedia.org/wiki/Hair_transplantation
http://www.nlm.nih.gov/medlineplus/ency/article/007205.htm

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