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Topic Title: Educational topics for laymen loosing hair (by Dr. A)
Topic Summary: Hair Restoration Open Education
Created On: 07/05/2018 12:36 AM
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 11/13/2018 09:08 PM
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Dr. A's Clinic
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Quoting Dr. A
.........................................................................

2 effluviums - a must read

Dear forum readers,

There is Anagen effluvium and telogen effluvium.
Both of these are not classic male pattern baldness. However, its very important to understand about them.

A lot of hair loss happenings/coincidences can be explained if these 2 are understood.

First, we shall talk about telogen effluvium



Telogen effluvium (TE) In animals, hair/fur goes into synchronized telogen and are shed. This is called telogen effluvium. It occurs in humans during phases of extreme stress, malnutrition, post pregnancy or when under certain drug therapy. For telogen effluvium to occur a significant proportion of hair have to switch from anagen to telogen at the same time. The hair are shed 2 to 3 months later .
Telogen effluvium may be acute or chronic. When hair sheds persistently for more then 6 months, its termed chronic. Chronic telogen effluvium is more common in females.
Acute Telogen effluvium is seen in many infants as a band of hairloss around the occiput that occurs 2 to 3 months after birth.
In order for a large number of hair to simultaneously switch from the anagen phase into the telogen phase, the body has to undergo some systemic injury .
There is usually a lapse of 2 to 3 months between the inciting cause and the hair shed. Therefore, it is often difficult to identify the exact cause in many cases.
A telogen effluvium is not caused by topical medications . But because there is a required time lapse of several months between the inciting cause and the excessive shedding of hair, the exact cause of the telogen effluvium is often not positively identified.

Hair shed is known to occur 2 to 4 months after pregnancy. This can be considered a classic example of telogen effluvium.

Other suspected causes of telogen effluvium include menopause, severe illness, job change, crash diets, major surgery, severe bloodloss, heavy metal poisoning etc. Hyper and hypothyroidism, SLE, end stage renal disease are other reasons. Medications, including anticoagulants, anti inflammatory agents, retinoids, calcium channel blockers etc. are some known causative factors of TE.
In all cases, the common factor is some form of physiologic stress several months before the hair shed.

Diagnosis 1. Hair pull test : Hold a bunch of hair between the thumb and fingers and pull firmly. Unlike in normal conditions, where 2 to 4 hair may shed, one notices a high number of hair coming out. Usually between 20 to 30. This test will be positive even in the scalp areas resistant to pattern hairloss, like the occiput area. At the same time, note that there are no slick bald patches like in alopecia areata.
The hair that get pulled out in the test will be club hair.
An obvious history of an inciting cause and the time frame between the physiological insult and the actual hair shed is usually sufficient to clinch the diagnosis.
A biopsy is usually not required.

Treatment Telogen is actually a variation of a normal hair shedding process, which occurs prematurely and in a synchronized manner in TE. Therefore, there is little in way of treatment except reassurance.
One must eliminate or treat the inciting physiologic event. Assuming there is no repeat of the physiologic insult, the hair should get replaced in 6 to 12 months.
In certain cases, telogen effluvium can coincide with early stages of Male phair lossairloss. In such cases, the hair that replace the shed hair may be miniaturized, giving the impression that the inciting physiologic event gave rise to male pattern hair loss.
Hair transplant is not recommended treatment for Telogen Effluvium.

Regards,
Dr. A
www.fusehair.com

Facebook @DR.AClinic
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I work for Dr. A's Clinic. My opinions need not be shared by Dr. Arvind Poswal
Dr. A's Clinic (Location - India: Delhi, Mumbai)
Ph:-(011)- 26274367, 41315125
Mob:-0987100606, 9810178062
Free online consult email ,
www.fusehair.com
 11/26/2018 09:32 PM
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Dr. A's Clinic
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Quoting Dr. A
.........................................................................

Testing for local anesthetic sensitivity



Dear forum readers,

It is a vital small detail.
In case you have not had local anesthetic ever in your life (or in recent years), a test dose of local anesthetic should be performed before the start of your procedure.
While relatively rare, Xylocaine (local anesthetic) sensitivity is something your treating doctor should watch out for.

Regards,
Dr. A
www.fusehair.com

Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
YouTube @hairtransplantcentre
blogspot @hairrestorationeducation
Tumblr @drarvindposwal

-------------------------
I work for Dr. A's Clinic. My opinions need not be shared by Dr. Arvind Poswal
Dr. A's Clinic (Location - India: Delhi, Mumbai)
Ph:-(011)- 26274367, 41315125
Mob:-0987100606, 9810178062
Free online consult email ,
www.fusehair.com
 12/02/2018 09:09 PM
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Dr. A's Clinic
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Joined: 08/06/2013

Quoting Dr. A
.........................................................................

Recipient slits - pre prepared v/s stick and place

Dear forum readers,
This is a topic that is not discussed often. But I feel that it merits attention.



There are 2 basic ways of making the recipient slits.

1. Make all of them at one go, before transplanting the grafts (pre prepared)
2. Make one slit at a time and simultaneously place the graft into the slit. Then proceed to make the next slit and so on... (stick and place method)

- - - - - - - - - - - - - - -
I personally prefer the first.

Reasons
3. All the slits are made at one go keeping in mind the angulations and densities, by the doctor (in pre prepared method).

In stick and place method, there is a wide time interval between making the complete slits during which the directions, angles etc. could vary

1. In stick and place method, (unless the procedure is a very small one), the recipient slits would be made by more then one person. That could lead to a difference in aesthetics in the final result.

2. In stick and place method, there is a very real possibility of graft popping out from the previous slit when a new slit is made adjacent to it.
Leading to avoidable graft trauma.

3. To avoid this popping out the graft placer may make the recipient slits further apart, leading to a low density transplant
- - - - - - - - - - - - - -
In view of the above, I prefer that all the recipient slits be made at one go and do not advise the stick and place method.

Regards,
Dr. A

www.fusehair.com

Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
YouTube @hairtransplantcentre
blogspot @hairrestorationeducation
Tumblr @drarvindposwal

-------------------------
I work for Dr. A's Clinic. My opinions need not be shared by Dr. Arvind Poswal
Dr. A's Clinic (Location - India: Delhi, Mumbai)
Ph:-(011)- 26274367, 41315125
Mob:-0987100606, 9810178062
Free online consult email ,
www.fusehair.com
 12/05/2018 11:14 PM
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Dr. A's Clinic
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Posts: 367
Joined: 08/06/2013

Quoting Dr. A
.........................................................................

Trimming of grafts v/s placing them direct

Dear forum readers,

This is another interesting topic.

Once the grafts are extracted, should they be implanted as such or should the excess tissue be trimmed. This is even more important for the grafts extracted by the fue method.

In my opinion, and experience, it would be very bad if the grafts were not trimmed of excess tissue.

The reason is very simple. In older times, recipient holes were made. Nowadays we make recipient slits . There is a crucial difference between the two. When making a hole, tissue is taken out (much like digging a pit in ground). When making a slit, no tissue is taken out (somewhat like an injection needle going in and coming out).

So, when a recipient slit is made and filled with an untrimmed graft, one is putting in excess tissue which may likely lead to cobblestone appearance (you are stuffing up a hole that does not exist).
One needs to put in the bare necessary minimum to acheive the most aesthetic result.

So, in my personal opinion, if someone says that their USP is that they are just extracting the grafts and placing them into recipient slits without touching or trimming them under magnification, they are not only doing less work, they are making a virtue of their lethargy.

Remember, we are not transplanting skin .
When transplanting follicular unit grafts into slits, its our duty to transplant the follicular unit alone, with bare minimum excess baggage.

Regards,
Dr. A
www.fusehair.com

Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
YouTube @hairtransplantcentre
blogspot @hairrestorationeducation
Tumblr @drarvindposwal

-------------------------
I work for Dr. A's Clinic. My opinions need not be shared by Dr. Arvind Poswal
Dr. A's Clinic (Location - India: Delhi, Mumbai)
Ph:-(011)- 26274367, 41315125
Mob:-0987100606, 9810178062
Free online consult email ,
www.fusehair.com
 12/16/2018 09:31 PM
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Dr. A's Clinic
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Posts: 367
Joined: 08/06/2013

Quoting Dr. A
.........................................................................

Hair transplant training for doctors

Dear forum readers,

Who are the doctors that get formal and comprehensive training in hair transplant?
None.
When we need surgery for eye, we search for eye surgeons. Doctors that are formally trained in the field of eye surgery. It is taken for granted that only trained eye surgeons would perform eye surgery.

Similarly, it is assumed, mistakenly, that only doctors formally trained in hair transplant would offer hair transplant.

Any doctor, from any field of medicine, can offer hair transplants.
- - - - - - - - - - - - - - - - - - - - - - - - -
Where can doctors get formal and comprehensive training in Hair transplant?

In no medical college. In no medical speciality.

If modern hair transplant methods were routinely practiced and training offered in medical colleges and the hospitals affiliated to them, we would see patients going to those institutions for their hair transplants.

- - - - - - - - - - - - - - - - - - - - - - - - -
Combination of the above two factors is partly responsible for the majority of bad hair transplants we continue to see today.
It is a sad but true state of affair that we hope to rectify. But for now, it is important for the prospective patient to be aware of these facts and understand the true reason why it is so important to do their research prior to getting a hair transplant done.

Regards,
Dr. A
www.fusehair.com

Facebook @DR.AClinic
Instagram @drasclinic
Twitter @DrAsClinic1
YouTube @hairtransplantcentre
blogspot @hairrestorationeducation
Tumblr @drarvindposwal

-------------------------
I work for Dr. A's Clinic. My opinions need not be shared by Dr. Arvind Poswal
Dr. A's Clinic (Location - India: Delhi, Mumbai)
Ph:-(011)- 26274367, 41315125
Mob:-0987100606, 9810178062
Free online consult email ,
www.fusehair.com
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