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Dermatology. 2009;219(2):105-10. doi: 10.1159/000216832. Epub 2009 Apr 29.

Seasonality of hair shedding in healthy women complaining of hair loss.

Kunz M1, Seifert BTrüeb RM.
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A number of otherwise healthy women with or without clinical alopecia complain of recurrent hair loss, presumably reflecting seasonality in the growth and shedding of hair.

To test the hypothesis that periodicity in hair shedding reflects seasonal changes in human hair growth.

Retrospective case study over a period of 6 years of apparently healthy women with the complaint of hair loss. All underwent biochemical investigations, and trichograms were made.

After exclusion of patients with a disease or on drugs known to cause hair loss, 823 women remained. Analysis of trichograms demonstrated annual periodicity in the growth and shedding of hair, manifested by a maximal proportion of telogen hairs in summer. A second peak seems to exist, though it is less pronounced, in spring. The telogen rates were lowest in late winter.

These results confirm the findings of former authors who have indicated seasonal changes in human hair growth, though this is the first study performed systematically in a representative number of women.

1. Dr. venkataram attended ISHRS meeting at Montreal Canada, in septeber 2008. He presented An original research paper on "USE OF CLONIDINE AS PREANESTHETIC MEDICATION IN HAIR TRANSPLANTS." The paper documented the utility of the drug clonidine in rendering the process of transplantations stress free and pain free.

2. Dr. Venkataram has now been made a member of Fellowship training committee of ISHRS.

3. Dr. Venkataram attended meetings at Calicut, Indore where he delivered lectures

4. Dr. Venkataram was the workshop chair person of Dermacon 2009, the national conference of Indian association of dermatologists, venereologists an leprologists(IADVL).

5. Dr. Venkataram has authored and edited a CD on skin surgery and a book on skin surgery.

6. Dr. Venkataram has been asked to continue as the coordinator of Taskforce on dermatosurgery of IADVL, for the third year in a row.Dr Venkataram on the guest faculty at the International congress of dermatology at Prague

7. Dr. Venkataram is a founding member of the newly formed Association of hair restoration surgeons , India.He is also the chairman, ethical committee of the association and the scientific committee chairperson of the first national conference on hair restoration surgery in dec 2009.

8. Venkat Charmalaya has been recognized by Rajeev Gandhi University for F Superspeciality Fellowship- It is the first centre in dermatology to receive this recognition.

9. Dr. Venkataram was the scientific chairman for the 2nd conference of Association of hair restoration surgeons, Haircon 2010, Mt Abu from 10-12th sep 2010. He delivered the following lectures:
Logic of follicular unit transplantation
Role of biopsy in alopecias
Video on recipient site creation
Video on trichophytic closure
Logic of follicular unit Extraction

10. Dr. Venkataram was the course director or trichosurgery session at Hairindia , conference on trichology, with the theme Dermatologist- the true trichologist –from 04-06 sep 2010. He delivered the following lectures:
Logic of follicular unit transplantation
Role of biopsy in alopecias
Evidence based practice of aesthetic trichology

11. Dr. Venkataram and Jayashree will deliver the following lectures in European society of aesthetic dermatology(ESCAD) at EADV conference Gothenberg in oct 2010:
Tumesecent liposuction for Gynaecomastia
Basal cell suspension method for vitiligo surgery

12. Dr. Jayashree is attending the world congress of liposuction at Washington, from 1-3 oct 2010. She is speaking on: Tumesecent liposuction for Gynaecomastia in Indian patients

13. Dr. Venkataram attended ISHRS conference at Anchorage Alaska, USA and delivered the lecture "Evidence based hair restoration surgical practice".


Giga sessions:
As techniques improve, the no. of grafts that can be transplanted in one session has increased. IN 2001, when Dr Venkat first learnt hair transplantation , any thing above 1000 grafts was considered as megasession. Now, only those with grafts above 2500 is considered as megasession and any thing above 4000 is considered as Giga session.This has been made possible my refinement techniques, improvement in anesthesia, and skilled technicians.

However, it is important to understand that variations between different individuals and the no of grafts that can be done in one session depends on quality of donor area.  The no of grafts that can be obtained in one session depends on three factors:
1. Hair density( no of hairs and no of units per sq cm).Denisty varies from 70-95 per sq cm in Indian patients
2. Skin elasticity( which determines the maximum width of skin that can be removed). The width of skin varies from 1-1.7 cms depending on elasticity in Indian  patients
3. Size of head-width of head from one ear to other. This varies from 25-32 cms in most Indian patients.

1. Patient with poor donor( small head, tight skin, and low density):25cm length*70/sq cm density *1cm width=1750 grafts--- this is very rare
2. Patients with very good donor( Large head, loose skin, high density): 32cm*95*1.7cm=5,168 grafts—this is very rare too in Indian patients. However this is possible in many Caucasian( western) patients.
3. Average patients( most common):29cm*1.3cm*85=3200 grafts.So in most Indian patients , around 3000 grafts

So how do we perform Giga sessions in Indian patients?
This is done by  combining different methods. Over 4000-6000 grafts can be done in most Indain patients  as follows:

Day 1 morning FUE about 600-800 grafts. This loosens the skin and helps us to take wider strip for FUT

Day 2 afternoon FUT 2500-3500 grafts depending on quality of donor hair on back of scalp,as explained above

Day 3 FUE scalp 600-1000 grafts from scalp

Day 4 body hair 500-1000 grafts

However this needs stamina,  and a big budget and therefore is applicable for select patients only.

We have now added follicular unit extraction (suture less hair transplantation).

This makes the method faster with less transection of hairs .As explained in FAQ section, FUT is a method of extracting individual units with a small 0-8-1mm instrument. The advantages claimed are that this does not need suture on the back of the head and the scars are minute. It is thus suitable for those who are scared of a suture such as women. This method also is suitable for body hair transplantation, for those without sufficient donor area.

However, there are major limitations with this method:
a) It is suitable only for certain patients who have easily extractable units
b) It is much slower and the number of grafts transplanted in each session is much less.
Many hair follicles are damaged during the process of extraction d) Because it is slower, the cost of transplantation per graft is more and the technique is hence more expensive.

Dr. Venkataram underwent a workshop in the international conference at Sydney (see below). The consensus of opinion on this issue is that while the new techniques and instruments for FUT address some of these limitations partially and have taken the technique forward, the method still has limitations and at present can be offered only to a selected category of patients and for people with small areas of hair loss. There is much internet hype about this technique, with many unsubstantiated claims. Hence patients are advised to seek proper information and understand the limitations while seeking this treatment.

New method of donor closure:

One of the main concerns with the strip method has been that many patients are worried about the donor scar. A new method called trichophytic closure was discussed in 2005 Sydney Conference of International Society for Hair Restoration. This method consists of a special way of strip closure, in such a way that the hairs grow through the scar and hence the scar is not apparent. This method has been adopted in our centre successfully. We now use it in all our patients.

New method for making hairline more natural by using laser for hair line

Body hair transplantation:

Body hair transplantation is a new technique for people without sufficient donor area. The body hair follicles are extracted individually by a special technique and then transplanted in to the donor area. This technique has opened up a new area for those patients in advanced hair loss, who were previously denied of any treatment.

However, we would like to clarify here that body hair behaves differently from scalp hair and has a different growth cycle. One obvious question is whether body hair would grow long and thick when transplanted. Preliminary results available show that they do grow much longer than they do on the body, possible because of the influence of scalp skin. However, the technique is new and long term results of the technique are not yet known. Hence these facts need to be understood before undertaking this surgery. Also body hair transplantation is more expensive than conventional transplantation

Our International clientele:

We are happy to announce that we have had many patients from USA and UK. This reflects our lower costs and excellent results.

Conference news:

Dr Venkataram is on the faculty for world congress in dermatology at Buenos Airies October 2007 ;he is also chairperson for a session.

July 2007: Dr Venkataram spoke as a guest speaker at IMCAS ASIA at Bangkok( International masters course on ageing skin) , on follicular unit transplantation and targeted phototherapy for leucoderma.

January 2007: Dr Venkataram was awarded the prestigious Glaxo oration at Dermacon 2007 at Chennai; the national dermatology of conference of Indian dermatology association, and spoke on hair restoration; changing trends

December 2006: Dr Venkatarm was invited to speak at the International congress of cosmetic dermatology, Melbourne to speak on Indian experience of hair transplantation

November 2006: DR Venkataram spoke at the annual conference of cutaneus surgeons association of India at Delhi on hair transplantation.

August 2007: Dr Venkataram was invited to speak at Cairoderma; Afrcian dermatology conference Cairo .

Dr. Venkataram attended the international conference of International society for hair restoration at Sydney in august 2005. This is the premier annual event in hair restoration. Dr. Venkataram gave a lecture on his experience in Indian patients, as a member of the Asian faculty.

Our publications and presentations:

Dr Venkataram has co-authored a book: Dermatological diseases; step by step approach for general practioners. His book Fundamentals in Pathology of skin is being published as its third edition.

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