The capillary transplantation is at present the most spread surgical techniques for the treatment of the alopecia of male shape, and this since it associates the advantages of a local treatment with the absence of vast surgical manipulations.
The combination of mini and of microtransplants allows to obtain esthetic results of an exceptional quality. The distribution of these mini and of microtransplants obeys concepts used according to the evolution and to the area of the alopecia to obtain a natural cosmetic appearance.
Easily recognizable generally in their clinical aspect, so in man as at the woman, the alopecias androgenogenetics have for substratum physiopathological common that to be caused by a hyperandrogenical, at the level of the genetically scheduled hairy follicles, of certain zones of the scalp.
Indeed, androgens affect only the vertical and temporal portions of the scalp, while the occipital zones are respected. The cycle pilaire becomes shorter by shortening of the anagen phase.
There is thus a faster consumption of the capital, where from the fast appearance of a terminal down at the end of 10 - 15 years. According to the importance of the loss, Hamilton in 1949 classified the alopecia in 5 types relieved by Norwood who improved this classification having led its own study on 1000 men.
The scale of the hair loss can change dramatically from one year to an other one; and unfortunately, this change occurs only in a single sense that is towards more bald scalp and less scalp covered with hair.
The progress of the alopecia of male form is a statistical fact. The patients, between 35 and 40 years, are not all intended to reach an advanced alopecia, but several will be.
This merciless progress is variable, and the practitioner has to choose the appropriate treatment by taking into account the final appearance of the patient.
The patients often have some knowledge and variable objectives. Their expectations must be realistic and their objectives reached with a surgical protocol clearly defined, understood well and accepted well by them.
Most of the patients are anxious in the first consultation. They do not manage to explain their hair loss which seems to deteriorate over the years. Besides, their skepticism results from diverse attempts to counter in the phenomenon of the baldness (potions of the scalp, the supernatural surgical procedures)..
The hair transplant does not create new hair, but it re-arranges those who are already existing. The young patients always demand a complete restoration, forgetting the fact that the evolution of the alopecia may reduce the potential of later restoration.
The patient has to know the truth concerning his condition and his treatment, after which a plan of honest and logical treatment can be developed. A patient realist facilitates the consultation.
The easy consultations concern the middle-aged men who want to have a density raised by hair in the frontal region and are capable of tolerating certain degree of alopecia particularly in the region crown vertex. The most difficult interview is the one with young patients.
Generally, these latter refuse any idea of hair loss and require a complete return with the same density as the adolescence.
All of the scalp is examined. The number of available transplants in the zone donor and the way with which they will be the best used in the receptor site will be estimated.
Varied factors play a role in the decision and require to be appreciated in the consultation: the color contrast of hair / skin, the density, the texture and the age. The age of the patient merit a particular consideration.
During the evaluation, the alopecic state of the patient is not only appreciated at this moment, but what it will become later in life. The forms stabilized are not also safe even for the subjects which began the fall in about forty and more.
The hair loss can progress at more advanced ages, for longer periods of time and with a bigger greediness than we could never conceive; in the planning of the ideal line (particularly in the case of young patients), a low setting-up of hair would be ungraceful.
A low and wide hairy line can be for what wishes the patient young person, but it is necessary to measure the cosmetic consequences when he will be 40 or 50 years old, by continuing to lose more hair.
The progressive alopecia, at a man who receives a transplant at a young age, is going to require most probably in the future the additional sessions of transplant, to maintain a cover of the new alopecic regions, so limiting the potential of an additional cover.
The inverse relation which exists between the size of regions donors and that of the receiving regions prevents a dense cover and completes wide bald zones.
The young patients tolerate no degree of hair loss and ask yet that their hairy lines of adolescence are restored. However it is this group which has the biggest potential of advanced loss of hair and a material limited donor.
A conservative approach warns any cosmetic dilemma (example: a line hairy incompletely transplanted and absence of a material remaining donor). As the men advance in age, the hair loss becomes more frequent making consequently certain degree of alopecia more socially acceptable.
The majority of the patients of about forty and more, accept voluntarily a plan of more preservative Clerk's Office (a narrow and high hairy line, an aspect at the end of the frontal region and the vertex, or even a bald place on the crown). Their purpose is often a natural and fine appearance.
THE TAKING : it is going to interest a horizontal occipital ellipse, inside the region donor. This occipital band will have 1,5 in 2,5 cms in width to be able to close the donor site without tension.
Its length varies between 7,5 and 15 cms according to the number of transplants to be used and the density of the donor site. The anesthesia is realized by local infiltration, of the band to be taken, with the xylocaïne in the adrenalin in 1 %. To have an anesthetic effect, 10 seconds are necessary and to have a vasoconstrictor effect 10 minutes are required.
The sections of the band donor are made by means of a blade of bistoury n°15, directed in a parallel to (at the same time as) the angle of exit of hair not to hurt the marginal hair bulbs.
Then, the band taken donor is put in a cupule filled with fresh physiological salt solution.
To avoid the scar alopecia, the electrocoagulation is disadvised. The closure of the donor site is realized without tension by means of an oversewing to the threads absorbable 3/0.
The receiving site: the first gesture concerning the receiving site is the marking of the proposed hairy line.
The previous central point of the frontal hairy line is usually placed more or less 8 in 9 cms above the line joining the previous edges of eyebrows.
The hairy line extends laterally and connects as possible the temporal fringe. The frontal zone is anesthetized by a local injection of xylocaïne in the adrenalin in 1 % diluted in the physiological salt solution to lead in more a turgescence of tissues making easier the realization of the receiving holes which precedes the insertion of transplants.
The receiving holes of mini-transplants , realized with 2 mm punch, are cut most of the time in an acute angle from 45 to 60 ° with regard to the scalp and managed in a radiaire way. Sections intended to receive microtransplants can be create with needles NO-KOR or with small blades of bistoury.
Failing that, the blades of bistoury N°11 can replace them. The transplant is inserted into the receiving site by taking at first with caution the fat under cutaneous, situated above the hairy follicle, with a pair of forceps.
The transplant is then slid in the hole of the site receiving and stabilized ready hanging a few seconds with an applicator cotton bud.
A bandage recovering all the scalp is preferred to warn the occurrence of a postoperative bleeding from the donor and\or receiving sites. The patients are kept one or two hours in a rest room, then they get back to their place of residence provided with a list of precautions to be taken in the immediate operating consequences.
A normal social and occupational activity will be resumed the day after the procedure, and the patients can take their shower 48 hours later, by rinsing slowly the transplanted zone. In the immediate consequences of the intervention, transplants cover themselves with brownish crusts, made of exsudats and with dried blood, with rather disagreeable aspect; we would be try to unstick them, but this operation is dangerous for the transplants which could be torn away.
We content with hiding them by the neighbouring hair. Usually crusts fall after approximately two weeks. The definitive growth of transplants occurs, 2 in 4 months after the fall of crusts, from their hair bulbs.
The survival of the transplant can thus be appreciated only 16 weeks after the intervention, dates in what the other sessions can be scheduled if need be.
In absence of follicular hurts and within the framework of mini and microtransplants, the growth of hair is considered 100%.
In most of the cases, a spontaneous resolution arises in two in three weeks.
Scars: the scar of the donor site is usually invisible. However, an ungraceful scar can become widely visible as the donor site clears up after multiple takings.
However an interrogation and a good clinical examination before the surgery have to minimize this risk. Scars can also become hypertrophic and seem to be more common in the lines of section which are placed close to the nape of the neck, in the region low lower donor.
Anesthesia of the donor site Hyperesthesie and: a passing hyperesthesie is usual at the level of the donor site after taking of transplants.
This situation can persist several weeks sometimes months, but it gives in invariably for the majority of the patients.