Presently , there are only two approved drugs; 
· a) Minoxidil lotions 2% and 5%-it has to be applied daily twice over the affected area for many years. 
· b) Finasteride 1mg tablets (propecia)- one tablet daily.

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2. What are the disadvantages of these drugs? 

They are very safe and free from serious side effects. However, these treatments need to be taken for long duration, and are quite expensive. The effect is temporary and may not be effective in extensive baldness. They are very useful in following situation:

a) early hair loss and thinning
b) After a hair transplant surgery to promote hair growth and to prevent further hair loss in the remaining scalp
c) In those who rule out hair transplantation as an option

3. Is there a nonsurgical method of transplantation?

There is no nonsurgical method of transplantation

4. What is trichogram and trichoscan?

Trichogram is a record of different phases of hair cycle. Trichoscan is an estimation of hair density, hair thickness and type of hair units, using a microscope. These facilities are available at our center.

Trichologist is a trained person who studies hair and hair problems. They are usually not doctors and hence are not allowed to prescribe drugs or perform surgery. 

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5. What is Hair weaving?

It is important to realize that there are a number of temporary cosmetic methods of treatment-weaving is one of them. These are heavily advertised and hence proper understanding is required about them. In this a wig is prepared and fixed on to the scalp with pins and clips. The weaving does not have to be removed. However, the hairs do not grow and the person who undergoes will have a fixed hairstyle. Also, frequently the pins and clips become loose and have to be tightened-thus leading to maintenance expenditure .

It is also important here to note that a variety of advertisements appear in the lay press about various treatments for hair loss and baldness. Hair loss as explained earlier can be due to a number of causes and may be temporary. As explained earlier, there are only two drugs for male pattern baldness and the only permanent method for treatment is hair transplantation. It is important for patients to seek full information about such advertised treatments and evaluate carefully.

6. Does hair transplantation really work?

Yes. The transplanted hair is removed from back of the scalp (donor site) and transferred to bald site (recipient site). The transferred tissue is not "rejected" as it is not foreign tissue. The transplanted hair maintains it's own characteristics; colour, texture, growth rate, and curl, after transplantation and re-growth. The vitality of the grafted follicle is maintained by the rich blood supply to the scalp. 

7. Can women undergo this procedure? 

Yes. Women are increasingly having hair transplant operations and can undergo the procedure. 

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8. Is the cosmetic result good? 

Originally, in 1970s, large circular grafts containing 15-20 hairs were transplanted resulting in noticeable and unnatural results. Over years, instruments and techniques have been developed that allow us to achieve truly natural results by transplanting small grafts very close together. It has been found that hair grows from the scalp in groups of one, two, and three hair follicles-called follicular or hair units. These hair units are transplanted resulting in a denser and more natural result. 

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9. Which doctor performs hair transplantation? Is special training necessary?

It is very important for the patient to make sure that the doctor who performs hair transplantation has had previous formal training. Dermatologists and Plastic surgeons with proper specific training in hair transplantation are best suited to perform the surgery. A number of doctors claim to perform the surgery with very little or no training in the field. This is particularly true of the old technique of punch transplantation which is easy, but yields disastrous results. 

10. Who is the best candidate for Hair Transplants ? 

The very best candidates for hair transplants are men in their late 20s-30s and 40s. Very young people- who are in their late teens or in their early 20s- need proper counseling since baldness and the future pattern of hair loss is not yet established. Also these young people are often obsessed about hair loss and end up getting operated early for very small patches, leading to many hair transplants. We have seen a young man who had 4 hair transplants before he was 22 years in age!! Remember: hair transplantation is a treatment for baldness, not for small areas of thinning of hair!! Such early baldness should be treated by drugs.

11. Is it a complicated procedure? Does it need admission? 

The procedure is simple and is an outpatient procedure. Patient can go home the same day-no admission is necessary.

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12. Are there any complications?

No surgery is with out any complications. You will be given a detailed consent sheet with a full list of complications which you will have to sign prior to the procedure. You are welcome to ask for any clarifications on any doubt you may have. However, the complications are extremely rare and the procedure very safe. Remember; this is an operation in skin only, reaching up to A DEPTH OF ONLY 5 MMS . You will be given analgesics to prevent pain and antibiotics to prevent infection. Mild swelling of forehead may be noticed after the surgery, which can be easily controlled with ice packs or anti-inflammatory drugs .Allergy to local anesthetic, infection of operated site, delayed healing, delayed hair growth can happen rarely.

Pustules ( small boils or pimples may occur in the second month and represent reaction to hair; they do not represent infection. They are self limiting and subside with in 2-4 weeks
 

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13. What is the cause for swelling after surgery?

During surgery, diluted anesthetic solution is injected in to the donor site for anesthesia and to minimize bleeding-the water in the solution may descend down due to gravity and result in swelling on 2/3rd postoperative day. However, this mild, temporary (lasting -2 days) and can be prevented by using a tight plaster on forehead. It is easily treated by use of ice compresses or steroids orally.

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14. Can the entire bald area be grafted in one session?

The number of the sessions will depend on the 

• area of scalp treated 
• the number and size of grafts used and
• the density which the patient desires 4) the individual characteristics of the patient, e.g. coarse hair will provide a more dense look than fine hair.

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15. What will happen to my remaining hair? Will I continue to lose them?

It should be clearly understood that hair transplantation gives you new hair in a bald area-but it can not prevent future loss of existing hair. Hence, if patient has significant hair remaining at the time of surgery, he will need to use drugs to prevent further hair loss. Alternatively, he may undergo a second hair transplantation if he loses further hair.

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16. When can I undergo a second hair transplantation?

It can be done any time after about 6 months-1 year-the time required for the door scar to heal and the results of the first surgery to be seen.

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17. How long does it take for the transplanted hair to grow?

Typically the grafted hair will shed in the initial 2-4 weeks. New growth will begin in 3-4 months and length will increase approximately 1/2 inch per month. A full cosmetic result can be expected in 9-10 months.

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18. Is Hair Transplantation painful?

Little pain is experienced during the procedure. Some discomfort is to be expected as the anesthetic is injected into the scalp. Once the skin is anesthetized, there is no pain. We also minimize the pain of injection by using sodium bicarbonate, vibrators, EMLA cream etc.

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19. How long does the operation take?

It depends on the area of baldness and the number of grafts required. Hair transplantations are classified as:

• Small session: up to 1300 grafts. These take about 3 1/2 hours
• Medium sessions: 1300-2000 grafts .These last about 4 to 5 hours
• Large or mega sessions: more than 2000 grafts per session. These last longer; from 5-6 hours

Our team is capable of grafting up to 3000 grafts in one session


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20. Wont I get bored during this long surgery?

Yes, hence we have a TV-VCD player and cable television to make it enjoyable for you. You are welcome to bring VCD of your choice to see!!

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21. What is Laser Hair Transplantation?

The use of laser became a fancy a few years back-It was claimed that lasers create micro-incisions of uniform size and depth in the scalp for the insertion of hair, which are bloodless. However, it has now been shown that the main disadvantage of using lasers presently available is the skin trauma produced by the thermal effects at the recipient site. This trauma can lead to poor survival of grafts. Also, development of specialized instruments to produce hairs of uniform size and follicular units which need very small holes which cause little bleeding has made the use of lasers un-necessary, costly. Hence, the use of laser has fallen in to disuse in most centers. 

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22. Is hair transplantation expensive?

It must be remembered that all modalities for treatment for hair loss including drugs and hair pieces come at a cost. These are temporary solutions and thus need recurrent expenditure. Hair transplantation is the only permanent method of hair restoration. The cost of any hair transplantation depends on the area of baldness and the number of grafts required. 

The other factors that determine the cost are:

• The technique used( follicular unit transplantation costs more when compared to mini-micro grafts: follicular unit extraction costs more than follicular unit transplantation).
• The use of microscope
• Number of grafts put in a session. We ,at our center use the latest methods and assure a large number of grafts in one session.

World wide the cost varies from 2 dollars-10 dollars per graft. The cost includes the expenses of the team, the anesthetist, operation theatre, nursing and drugs used during surgery. However, Hair transplantation in our clinic is affordable and is much cheaper than clinics in other countries which follow similar state of the art technique. It should be understood by prospective patients that a number of centers claim to charge very less and might appear cheap. In such cases, we urge you to get full information as per the checklist enclosed below and assure that proper technique is used and results are assured.

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23. How does one judge a hair transplantation team?

Final results in hair transplantation depend on a number of factors:

• Type of hair transplantation-follicular/non-follicular (punch)
• Number of grafts
• Hair density achieved by the surgeon
• Transection rate (percentage of hairs damaged during dissection)
• Will microscopic dissection be used?
• Instruments used
• Training of surgeon
• Training of staff-this is very important-as the surgery is a team work.

A prospective candidate should seek details of the above factors from the hair transplant surgeon while choosing to undergo the surgery.

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24. If the patient is from outside Bangalore, When should the patient come to Bangalore before surgery and when can he leave Bangalore after surgery? Are frequent consultations needed after surgery?

It is enough if you come the day before surgery. Most investigations and preoperative instructions can be completed at your home place by proper communication on email. You may leave the very next day after surgery. Once you leave, no further personal consultations are needed. You may follow up on email or telephone. However, we urge you to send the photos of your hair growth for our records.

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25. What are the preoperative instructions?

Before the operation, for one week:

• Avoid exertion-relax
• Avoid smoking/alcohol, too much coffee/tea
• Use antidandruff shampoo such as Nizoral for three days before surgery
• The day of surgery be at our center on time-have food before coming. Do not come on empty stomach.
• Leave hair on donor site long (at least 1.5 cms-to cover the suture)

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26. What are the postoperative instructions?

On the day of surgery:

• Relax. Watch television/listen to music
• Have light easily digestible food. Avoid spicy food.
• Take the painkillers as prescribed.
• Avoid jerky movements of head
• Use a soft pillow to sleep. 

The next day-return to the center to remove the bandage. After removing the bandage, you may start shampooing the scalp .This will help remove the crust in 4-5 days

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27. Will I have a big turban like bandage? When can I return to work after surgery? Will the sutures be visible?

The dressing is a small piece of gauze which can be easily hidden with a baseball cap. Even this is removed the very next day and you may return to work the very next day!!! However, it is preferable to rest for 2 days if there is any pain or mild swelling of fore head. Sutures wont be visible-they will be covered by hair. For this reason, we ask you not take a haircut and leave them at least 1.5 cms long in the door area.

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28. When can you wash your hair?

The very next day!!!

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29. When are the sutures removed?

We use absorbable sutures-which do not need to be removed. However, sutures can be removed any time after 10 days, if patient wishes.

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30. Is it essential to use a cap?

A cap may be used for about a week till crusts fall of. If you do not wish to use a cap, you may use a special keratin powder to hide the graft.

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31. What you should do next?

• Make sure you have understood all the facts about the problem and the procedure. You may visit the website www.ishrs.org for an unbiased authentic information. If you have any doubts, do not hesitate to send an email (mysorevenkat@hotmail.com) or contact us on telephone(91-80-23392788 or 91-80-41148848).
• Do send your photos for precise evaluation and information about cost of surgery, as it depends on the number of grafts required.
• Once you decide to undergo the surgery, you may need to do some simple blood tests. These are tests done preoperatively for any minor surgery under local anesthesia-your local doctor and laboratory will be able to do them. These include: Hb%, DLC<,TLC, BT, CT, RBS, HbSAg, HIV ELISA, ECG

These include:

• Blood:Hb%, Total leucocyte count, differential leucocyte count, bleeding time, clotting time, blood group and type, Random blood sugar, antibodies for hepatitis B and HIV viruses.
• ECG with a physician’s report on fitness for surgery under local anesthesia. If it is not possible to do these tests , we can get them done after you visit us.

Go through our Power Point Presentation on Results of Hair Transplantation.

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32. What is a graft?

Graft is a unit of hairs containing 1/2/3/4 hairs.

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33. Which is the most preferred method of transplantation?

Follicular unit transplantation (FUT) is the most preferred method; punch graftins is not done these days; mini-micro-grafting is done in some centres , but is inferior to FUT.

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34. Who is a trichologist? What is his role?

A Trichologist is a person who studies hair problem; he is not necessarily a doctor or even a medical person. He is not authorized to prescribe medicines and can only suggest care of hair.

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Recent Advances in Hair Transplantation