Treatment - Dermatology and aesthetics


Dermatology and aesthetics

Dermatology and aesthetics


When hair is lost: problems, pathologies, types Alopecia: classification according to the cause Diagnosis Treatment
  • When hair is lost: problems, pathologies, types
  • Alopecia: classification according to the cause
  • Diagnosis
  • Treatment
    • Medical therapy
    • Hair transplantation
    • Convalescence and regrowth


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Medical therapy

Before starting a surgical therapy, i.e. hair transplantation, other less invasive treatments can be undertaken to try to stop hair loss.

The first thing to do, in this sense, is to go to a dermatologist expert in trichology, who is able to make a diagnosis of the type of alopecia and possibly a trichogram, then to prescribe any medical treatments capable of stimulating the regrowth of the bulbs hair and slow down or stop hair loss.

The doctor can then prescribe anti-androgenic drugs, capable of reducing the transformation of excess testosterone into dihydrotestosterone: finasteride (the intake of which however involves the risk of disorders of the sexual and reproductive sphere), serenoa repens (also called saw palmetto or, in Italian, dwarf palmetto), and minoxidil. Other therapeutic tools useful in this phase are food supplements, which must be rich in amino acids, vitamins and minerals.

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Hair transplantation

The first hair transplants, carried out around 1950, consisted of putting 4 mm wide cylindrical grafts of 10-12 bulbs on the scalp; the defect was that the transplanted hair grew in tufts, with an evident "doll effect".

Currently, the FUSS (Follicular unit strip surgery) is used, which consists in transplanting the individual hair follicles, containing from one to four bulbs and also called micro-grafts, with a much more natural final effect . The cost and price of the transplant is influenced by various elements such as the structure in which one is working, the remuneration of the surgeon and his assistants, the number of hairs to be transplanted and the duration of the intervention, and can be assessed by the surgeon only after the preoperative visit; in general, however, each session has a cost that varies between € 3000 and € 10, 000.

Before resorting to the FUSS micro-transplant, the surgeon must evaluate the extent of the bald area to be covered and the density and quality of the remaining hair: this entails the exclusion from the autotransplant of the subjects who are in the sixth or seventh stage of classification Norwood, or with very severe and extensive baldness, as the relationship between the donor area and the bald surface is not adequate. It is preferable to perform this transplant after 24-25 years, when the evolution of the pathology appears stabilized. Under local anesthesia, the removal (completely painless) of a strip of scalp from the nape of the neck is performed, an area in which the hair units are insensitive to the effects of male hormones and therefore, even after their transplantation in the bald area, they continue to grow strong and vital for life; in the picking area no obvious signs remain, because it is immediately hidden by the hair. The strip taken is about 24 cm long and 1.5 cm wide and allows to obtain about 3000-3500 bulbs; the reserve of hair that can be removed from the nape is not inexhaustible, although it can reach the figure of 10-12, 000 bulbs.

After collection, the individual micro-grafts are cut out, which can contain 1 or 2 bulbs (mono or bi-bulbar) or 3-4 bulbs. Monobulbar grafts are effective in thickening the front line, but are not able to sufficiently thicken the central and wider part of the bald area, an area in which 3-4 bulb micro-grafts are most suitable. An average hair transplant session involves the use of about 400 mono-bibulbar grafts and 700/800 mini-grafts, for a total of about 3000-3500 bulbs.

The grafts are inserted on the scalp by means of micro-incisions made with a special needle (called Nokor needle), 4-5 mm deep and 2-3 mm apart. To rebuild the front line, the most important from an aesthetic point of view, single bulbs are transplanted. The thickening is gradual and progressive and may require several sessions, in each of which 3000-3500 bulbs are inserted (a smaller number of grafts would lead to an excessive continuation of the intervention); the minimum distance between one graft and another should not be less than 2 mm.

In hair transplantation, it is always necessary to consider the probable evolution of baldness, so at least 30% of the grafts must be positioned in the adjacent areas, the most sparse part.

In fact, the aesthetic effect must remain over time, even when the hair close to the grafted hair will fall due to the progression of baldness.

Another autotransplantation modality, different from the FUSS one, is the follicular unit extraction (FUE) follicular unit extraction. This type of transplant is carried out by means of a monobulbar micro aspirator which functions as a circular micro scalpel and is therefore capable of taking minimal segments of the scalp containing one or two bulbs. This system is effective in reducing receding hairs up to a maximum of 500-600 bulbs to be transplanted, but not for large areas as it involves a number of sessions, and therefore a higher cost, compared to the micrograft self-transplant.

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Convalescence and regrowth

The transplant intervention lasts from 3 to 5 hours, depending on the number of transplanted bulbs. The hair present in the grafting area is not affected by the procedure and you can wash your head from the next day. In the first weeks it is possible to observe a greater hair change, which can give the person who has undergone the transplant the sensation of a greater fall. The convalescence is short since the small crusts in the area where the bulbs were transplanted detach themselves in a few days. The stitches are reabsorbed spontaneously.

The new hair begins to grow after about 2-3 weeks, but sometimes even after a few months, strong and robust forever.

If necessary, a second operation can be carried out after 4 months to further thicken the transplanted area. It is important to safeguard the vitality of the hair both in the thickened and in the picking areas (the nape of the neck) since, as has been said, the reserve of hair available from the nape is not infinite.

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