This 35 years old patient came for correction of an FUT scar done elsewhere.
The skin is tight and the scar is dense.
The patient was told that the treatment of such big scars is not a hair transplant.
Neither can it be closed using the trichophytic closure technique.
He would need to get a tissue expanded flap cover done by a reconstructive plastic surgeon.
This is a method that takes around 3 months before the flap is expanded enough to cover the large resultant area after excision of previous scar

‘Cherry picking’ is yet another agricultural term used for the description of anagen selective hair transplant. It denotes the harvesting of ‘golden follicles’ (those that are in full bloom) in the anagen phase of growth. The advantage of harvesting these healthy follicles is that it leads to better growth over a shorter span with seemingly higher density with increased survival during transfer.

The golden follicles are selected either by mechanical selection or visual selection. In the former, the donor area is shaved 3 days prior to the proecdure. Since follicles other than those in the anagen growth phase are slow to grow, only the best will be available to harvest. In visual selection, high magnification is used to weed out poor quality available grafts.

This technique is the most effective way to move the very best grafts with fuller body and high survivability to the recipient site for the best results.

This selection is not possible by the FUT technique.

A lot of my work entails repairing of FUT scars.
Most that come to me are very wide scars and the treatment in these cases mostly is scalp relaxation exercises followed by trichophytic reveion closure with z-plasty.
However every FUT scar today wants revision. Strip scars are not pleasing any more for contemporary hair styles that are very short at the back and sides.
Points to be noted while repairing are-
1. FUT scar revision entails camouflaging the scar by breaking the visual linearity. The scar remains the same. Only it is less visible. It is a mere trick for the eye!
2. I do not harvest above the scar so the hair above are not thinned and do not reveal the scar more.
3. Beard grafts are the best grafts to cover strip scars since they are thick and coarse and break the visual linearity better than thinner hair from the scalp or chest.
4. Grafts are placed vertically so the scar tissue can be bypassed and the root gets its nourishment from the near subdermal level.
5. SMP (scalp micropigmentation) should be considered as a valuable adjunct to graft camouflage.​

Hair loss evinces varied reactions from men and women alike. Since olden days magical hair loss cures, have been sold to gullible people.

When we talk of hair loss it is the genetic cause that is mostly implied. However there may be hair loss due to immunological disorders, skin disease or while on anticancer drugs.

It is increasingly becoming evident that hair loss as we see it today is evolutionary. This explains the early onset of hair loss in young males and females. Though genetic cause is the supreme underlying environmental factors like stress, lack of sleep, fast food diet and use of improper hair care products are responsible for early onset. Like man lost his tail rendering tail transplant surgeons obsolete, hair transplant surgeons may become extinct when more people become bald and possession of a thick mane of hair is not longer at a premium.

Already bald people, like their idols Bruce Willis and Vin Diesel are beginning to wear the shaven look. As per University of Pennsylvania Wharton School men with shaven heads are seen as more masculine, dominating and with leadership potential. This may explain the popularity of the “Power Buzz” amongst business leaders today.

If they are to be believed, the mane does not define a Man since some of the best looking men are comfortable with their personality, their body and their baldness. I would go on to add that if you shave off when your hair has begins to haunt, the focus shifts to your other attributes- your eyes (the windows to your soul), your smile and your fabulous body- provided you possess them. In these cases just a head shave is the best way forward if you do not live in India where due to social reasons it may be an anathema.

If the above does not hold true for your situation, and you have thinning and not yet baldness, you can bank upon a few modalities-

  • Medication- Propecia, Rogaine, Biotin, Saw Palmetto
  • Platelet Rich Plasma

However if the condition has progressed to baldness, hair transplant is the only answer. Hair transplant is a surgical procedure in which hair from the same person is skillfully redistributed using 2 different techniques- FUT or FUE.

Of late, minimally invasive FUE techniques are in vogue and have mostly superseded the former technique in more than 90% hair transplant clinics the world over. The technique is laborious and intense and needs a team of 5-6 staff to accomplish with the plastic surgeon as the team leader.

Following the success of pioneering clinics all over the world including India, FUE clinics have become extremely commonplace. It is estimated that in India alone, there are over 5000 FUE clinics operational. FUE clinics have a pecking order too like most health care delivery systems-

  • The doctor-centric doctor-administered Clinic
  • The technician- centric doctor-administered Clinic
  • The technician centric-entrepreneur administered clinic
  • The technician-centric technician-administered Clinic

The potential hair transplant candidate should do adequate research to determine the involvement of the doctor since the first hair transplant if improperly done can ruin his future chances of a successful hair transplant since the available donor gets depleted every time a procedure is done.

30th Sep 2016

Hair loss evinces varied reactions from men and women alike. Since olden days magical hair loss cures, have been sold to gullible people like horse uri

When we talk of hair loss it is the genetic cause that is mostly implied. However there may be hair loss due to immunological disorders, skin disease or while on anticancer drugs.

It is increasingly becoming evident that hair loss as we see it today is evolutionary. This explains the early onset of hair loss in young males and females. Though genetic cause is the supreme underlying environmental factors like stress, lack of sleep, fast food diet and use of improper hair care products are responsible for early onset. Like man lost his tail rendering tail transplant surgeons obsolete, hair transplant surgeons may become extinct when more people become bald and possession of a thick mane of hair is not longer at a premium.

Already bald people, like their idols Bruce Willis and Vin Diesel and are beginning to wear the shaven look. As per University of Pennsylvania Wharton School men with shaven heads are seen as more masculine, dominating and with leadership potential. This may explain the popularity of the “Power Buzz” amongst business leaders today.

Older silver back gorillas are the ones in charge in their pack and are considered powerful and more aggressive as compared to those gorillas without signs of aging. The body speaks a language in subtle ways across all animal species. This is the reason a shaven head in the human workplace looks daunting and competitive and is a sign of dominance.

If they are to be believed, the mane does not define a Man since some of the best looking men are comfortable with their personality, their body and their baldness. I would go on to add that if you shave off when your hair has begins to haunt, the focus shifts to your other attributes- your eyes (the windows to your soul), your smile and your fabulous body- provided you possess them. In these cases just a head shave is the best way forward if you do not live in India where due to social reasons it may be an anathema.

If the above does not hold true for your situation, and you have thinning and not yet baldness, you can bank upon a few modalities-

  • Medication- Propecia, Rogaine, Biotin, Saw Palmetto
  • Platelet Rich Plasma

However if the condition has progressed to baldness, hair transplant is the only answer. Hair transplant is a surgical procedure in which hair from the same person is skillfully redistributed using 2 different techniques- FUT or FUE.

Of late, minimally invasive FUE techniques are in vogue and have mostly superseded the former technique in more than 90% hair transplant clinics the world over. The technique is laborious and intense and needs a team of 5-6 staff to accomplish with the plastic surgeon as the team leader.

Following the success of pioneering clinics all over the world including India, FUE clinics have become extremely commonplace. It is estimated that in India alone, there are over 5000 FUE clinics operational. FUE clinics have a pecking order too like most health care delivery systems-

  • The doctor-centric doctor-administered Clinic (Hair transplant Clinic)
  • The technician- centric doctor-administered Clinic (Hair transplant center)
  • The technician centric-entrepreneur administered clinic (Hair transplant studio)
  • The technician-centric technician-administered Clinic (Hair transplant shop)

The potential hair transplant candidate should do adequate research to determine the involvement of the doctor since the first hair transplant if improperly done can ruin his future chances of a successful hair transplant since the available donor gets depleted every time a procedure is done.

A properly done hair transplant is costly. This is since the clinic cannot do many cases if a hair transplant clinic does a limited number of cases giving due care and time to each patient rather than a factory line as in hair transplant shops and studios. However clinics do give handsome discounts upto 50% during lean periods. People from the middle income group should avail these discounts by planning ahead.

A majority of balding people disregard motherly advice rather cynically when they are told that what counts is what they have within them – the qualities o character, intelligence and hard work and not what people see. However, most feel that the reality is that the work place, the peer group and relations in general can be harsh and unforgiving if balding belies a person’s age.

4th Jun 2016

DOs:

  1. Take your medication at specific time of the day as advised on the schedule.
  2. Keep upright and sleep in semi setting position for minimum first three nights after the procedure so that head is higher than the heart.
  3. Water the roots minimum every 20 minutes on the evening after the procedure till you sleep and every 2 hours the next morning onwards.
  4. Spray antiseptic three times in a day (once in the morning after the shampoo after drying, second in the afternoon after lunch and 3rd time in the evening after shampoo and drying). This should be done from arm’s length away- 2 feet.
  5. Restart your other medications at your routine time as you were taking them prior to the procedure.
  6. Keep your eyes closed & covered with towel during antiseptic spray.
  7. Take shower and tap water bath below shoulders only.
  8. Do continue your routine work or even brisk walk.
  9. You may have normal sex life after 3 nights.
  10. Do keep the procedure area covered with cap for all outdoor activities up to 3 weeks to avoid direct exposure of dust, heat and sunlight.
  11. Keep pressing the forehead skin from midline outwards to prevent the swelling going into your eyes & shifting it to the side of the face.
  12. While drying the planted area with swab after shampoo, dab dry backward to forward only and if your temple triangles have been worked upon, do this to top to bottom.
  13. Do use a travel pillow if you have got a previous strip scar repaired lest it touches the pillow. In such cases you shall have to lie upright for 5 days.
  14. Do not hesitate to call helpline in case of any query (8 AM- 6 PM) or in an emergency 24×7. For routine queries, e-mail is recommended for a comprehensive reply.
  15. Use sterile medical water provided in the kit for 5-days & then use potable mineral water. However since usually the medical normal saline water is left over, you can continue to use this till it finishes, after which you can start using mineral/ bottled water.

DONTs:

  1. Do not sleep flat for the first 3 days.
  2. Do not consume alcohol on the night after
  3. Do not pour tap water over the procedure site.
  4. Do not do heavy exercise, gym, aerobics, heavy weight lifting or yoga for one week.
  5. Do not bend down or forward to tie your shoe lace or to pick up objects from the ground for the first 3 days.
  6. Do not use hair dryer.
  7. Do not scratch the procedure area with you finger-nail.
  8. Do not allow teeth of your comb to touch the procedure area while combing.
  9. Do not apply any ice or cold pack over the procedure area, forehead or any part of the face.
  10. Do not stroke the planted area with gauze from forward to backward.
  11. Do not use any shampoo, washing solution or antiseptic other than what is supplied/ recommended.
  12. Do not take steam or sauna bath for 2 weeks.
  13. You can use your own loose cap/ hat after 5 days of the procedure or you can wear a bandana. We request you to wear only our cap as it is designed specially for your care. Use it only for out door activity. Do not wear any woolen cap. No turban for 2 months after the procedure. No helmet for 6 weeks after the procedure. Cap should not touch any procedure area. Wear it loose and do not press it tight across your head. Remove it by lifting it from back to front.
  14. Do not go to the barber for 6 weeks after the procedure.
  15. Do not color your hair before 6 weeks of the procedure.
  16. After the first 2 weeks do not unnecessarily keep the hair covered with a cap. Give them air for a healthy growth.
  17. If you develop dandruff, you may use Ketoconazole shampoo 2 days a week.
  18. If the beard is the donor site, do not shave it for 7 days after the procedure. Till 7 days you can shave your beard and use a trimmer for the shadow area from where grafts have been take.
  19. Do not use shampoo more than 2-3 times a week.
  20. Do not wear the cap when on a long haul flight out of India since it will be uncomfortable. Tie a loose bandana over the scalp.
  21. Do not swim in a pool or in the sea for 3 weeks after the procedure.

1. OOZING: This normally occurs during first few hours or at the most on first day.

(a) From Plantation Area:

As the roots are planted in the normal skin either on bald area or between hair with very fine blades, small amount of blood and serum oozes out- a drop from each site. For this we need to spray saline every 20 minutes on the evening after the procedure and every 2 hours the next day onwards till morning of 4th day post procedure.

(b) From the donor area:

A dressing is applied. This dressing is removed on the first/second day after the procedure. The night after the procedure you can expect some blood staining of the applied dressing. This is normal. You have been provided a sterile towel in your kit to spread over the 2 pillows used to lift up your head while you sleep. This towel shall prevent contamination of the donor area and will also prevent your donor area from staining the hotel pillows for which you may have to pay!

(c)  From single root in the planted area:

Accidentally either due to scratching or increased blood pressure within the skin or by accidental injury while getting in/ out of the car, one or more planted roots may pop out. This may cause slight amount of oozing of blood from that particular hole & a streak of blood may come forward up to the forehead like water runs down the hill. Do not panic- go near the bathroom mirror & try to locate the oozing spot  and then with the tip of your clean forefinger exert gentle pressure right over the bleeding hole & hold the pressure for up to 5 minutes. Oozing will stop in natural course. Do not keep taking finger onto the hole every few seconds or minutes to check whether bleeding has stopped or not. Due to frequent checking at shorter intervals oozing may not stop & continue for longer time- so just press on the spot & wait patiently. Do not put too much pressure so that surrounding roots start popping out & create further bleeding. Once the bleeding has stopped, spray antiseptic over the oozing spot from 2 feet away. Do not make any attempt to replace out root on your own.
On getting up the next morning, you may notice some blood stain over the dressing pad and over the pillow cover if you have not placed the towel properly. This will usually happen but is not alarming. The open pores of harvest (donor area) close completely in 12 hours time.

2. PAIN:

Because of our advanced technology using cooling, acupressure, vibration & local anesthetic during the procedure, there is minimal discomfort. Our clients have claimed the procedure to be almost “Pain Free”. Pain or discomfort at the site of operation after any procedure would be felt even when client comes out from general anesthesia. A little bit of discomfort is inevitable when you come out from the operation theatre but can easily be controlled with tablets taken as recommended by Dr Bhatti. Post procedure discomfort is maximally felt at the back of head after strip surgery and not after FUE. You will be very fresh the next morning when you come to the clinic at 9 AM/ or as advised by the staff.

3. SWELLING:

After any type of trauma, normally body reacts and produces swelling of that particular area- this is a normal bodily response and it continues up to 3 days from the time of injury. In hair transplantation this area is on the top of the head. So some swelling of the scalp skin is bound to occur. The amount of swelling would greatly depend on number of roots planted, site of area, (Front or Back), size of area (large or small) skin laxity & individual body tendency to react against trauma. With lesser swelling there will be less tension leading to lesser pain and better healing. If the swelling is less in the initial phase it will resolve quickly. We recommend that at least first three days & nights the head should be higher than the level of your heart and to achieve this we request you to sleep in semi upright position for 3 nights after transplantation. You can use 2 large pillows which shall lift up your head to this position. If you have had grafts implanted into your earlier strip scar, you will need to use a travel pillow (not the hotel pillow) so that the head does not touch the pillow or bed.

The swelling is more when more number of roots are transplanted in the front area in clients with lax skin. They notice a bump like swelling on the forehead usually appearing on the 2nd/3rd day after the procedure. This swelling is more bothersome to people who look at the client rather than to the client.

PLEASE DO NOT APPLY ICE OR ICE PACK ANY WHERE (Front, Top & Back of Hair).

We teach you how to shift the fluid side ways from the front of the forehead and prevent it from coming lower down below the eyebrows into the eyelids and between nose and the eyes. You are advised to press over the swelling against the forehead bone gently starting from midline going out wards (Not upwards towards the root) maintaining uniform pressure taking time- up to 15 to 30 seconds each time. You may have to repeat this 20 times every 2 hours while awake.

If  gravity wins and the fluid is collected around and between the eyes, you are advised to leave the swollen skin alone and DO NOT PRESS OVER THE EYE LIDS ANY MORE. Any facial swellings below the eyebrows have to be left alone. This may result in giving you a ‘Chinese-eye’ look for two more days till water runs down the cheek. First it will disappear from upper eyelids and then from lower eyelids. You may not have to restrict your reading, watching TV or other working activities due to swelling of eye lids.

4. CRUSTING:

In hair transplantation hundreds of hair roots are planted in a very small area within close proximity. From each planted side a drop of blood and serum oozes through. So on day one the planted side looks like an area covered with red spots. As time passes by, the dried drop of blood & serum starts looking black & the whole area of planted hair is covered with a thin crust. Every day the whole area is soaked & cleaned with shampoo and antiseptic is sprayed over. As the planted area starts healing, the new hair continues to grow and lift the crust away from the normal skin. Between 5 to 10 days after the procedure the crust starts cracking & is gradually washed out with the shampoo. One can move the tip of the finger slowly to remove the crust which is loose and hanging on the hair latest by the end of second week. Most of the crust falls off and small stiff bristle (brush) like new planted hair is felt & seen growing through the normal looking skin. If one wishes to remove the dry black crust it can be safely removed mechanically by a special medical technique at the clinic by an expert or by gently moving the fine teeth comb through the planted area by yourself but this only after 2 weeks. Do not use Gillette foam, etc. after 2 weeks. Start the normal routine advised- Johnson Baby shampoo twice a week with daily washing of the hair with tap water.

5. ITCHING:

Itching is considered as a sign of healing. This starts any time after 5 days. Use of spray and aloe vera water over the planted area; and aloe vera lotion over donor area gives an extra healing touch and reduces itching. Irresistible ‘sweet’ itching can be tackled during the day time by gentle touch of pointed end of folded sterile gauze or hand-kerchief, but should not be tackled with finger nails.

6. NUMBNESS:

On the day of the procedure, numbness over the plantation and harvested areas is produced by cooling, acupressure, vibration and local anesthetic. During the post procedure phase, numbness of the scalp on the plantation area remains because of internal swelling (edema).  As days pass by, the numbness is reduced and the feeling of touch comes back gradually. Sometimes it takes around 12 weeks before it becomes almost normal. During this time you may feel that during combing or touching someone is touching the skin over a thick plastic sheet. Gradually as the internal swelling reduces, it will feel as if this plastic sheet is getting thinner & thinner with return of sensation. Even if the return of sensation takes place a couple of weeks later it is not a matter of concern. The sensation at times may take 3 months to return fully.

7. TIGHTNESS:

As soon as the effect of local anesthetic wears off one begins to feel tightness. One describes this feeling as if skin is pinched tightly all the time- more of a discomfort than pain but this shall soon respond to medication.

8. BLACK SCAB WITH PLANTED HAIR:

Quite often between 5th & 10th post procedure days, one notices black scab falling out from the hair. Sometimes this is accompanied by a small planted hair adherent to the scab. You will naturally worry and feel the planted hair has come out and have lost one root. In reality one can compare hair root with ice candy where the stick of candy is hair & ice-cream attached to the stick can be compared with soft tissue of hair root with stem cells attached to hair. Hair in the hair root acts only as a stand to keep the soft tissue in position during plantation. When the planted hair falls off the ice-cream like soft tissue remains buried inside the skin from which new hair will grow. Any hair falling off after 6 days of the procedure does not carry the root with it – so be reassured that the root shall grow a new hair. During the course of recovery between 8 & 10 weeks,  most of the planted hair fall out and the new spurt of fine soft hair is seen coming through the skin 12 weeks after plantation and that hair continues to grow at the rate of 1cm per month. The first result can be expected only at 22 weeks and no earlier than this timeline. 60-85% of the result in our practice is obtained at 6 months after the procedure and the remaining growth is mostly completed between 6-12 months depending on your age and other factors.
9. IRRITATION OVER RECIPIENT & DONOR AREAS:
During the first 3 days one feels little tightness at the back because of the swelling of skin. After that period the tension (pulling sensation) disappears and the spots begin to heal. One feels itching around 5th day onwards. Immediately after the shampoo in the morning and evening one feels the comfort of softness for a while. To maintain this softness we recommend application of provided aloe vera water (purple top small plastic jar) for the planted area and aloe vera lotion for the donor area after the blue antiseptic spray.

10. ACIDITY AND HEAVINESS IN STOMACH:
Most of the medications used to control pain, swelling & infection after hair transplantation procedure can produce a feeling of acidity & heaviness in the stomach.  Those, who commonly suffer from hyper acidity will be affected more. To prevent this we recommend you to take tablets at the exact time as shown in the time-table. Keep minimum interval of two hours between different tablets. We also request you not to take these tablets on empty stomach. Please have something to eat before taking medication. However in spite of all the measures if one develops acidity one is advised to take chewable tablet REFLUX FORTE from your local chemist as & when required. With each passing day, pain/discomfort is much reduced- after 3rd day you are advised to reduce the dose of 3 tablets per day to 2 tablets & lastly once at night. In case of uncontrollable hyper acidity please stop all pain medications without worrying.
11. SWEATING:
Sweat gland & hair root are two different structures of the skin.
Sweating from and around the planted areas is normal occurrence after hair transplantation procedure, because of external high temperature or following walking. If one notices excessive sweating, that is not harmful. Sweat will evaporate or will be washed away during the shampoo procedure. After all sweat is sterile and it only keeps the area wet. It is not harmful at all.

12. FALLING OF PLANTED HAIR AND AREA LOOKING BALD AGAIN:
You can compare the hair root structure with an ice-cream candy where the stick is hair & the ice-cream part is a mass of cells around hair from which new hair grows. When root is transplanted with hair the cells revive and get nutrition from the surrounding tissue. You would naturally be keen to know when your hair would start growing. Planted hair which is about I mm in length can be felt like stiff stubble. Up to 4- 8 weeks after the procedure hair continues to grow longer with each passing day & you will feel happy about it. This happens because from the very next day the new hair starts growing under the planted hair, while the old  hair is pushed up & up with time; this makes it look as if  it is growing! Anytime between 4-12 weeks planted hair is more out than in the skin- and because of lack of support it falls off. When you notice this you shall be unhappy about the situation and naturally would  start worrying. In reality new hair growth is occurring just under the skin and is not seen outside. After the 12th week, you will see the soft hair coming out through the skin and they continue to grow at the rate of 1cm per month. DO NOT EXPECT ANY VISIBLE RESULT TILL 22 WEEKS AFTER THE PROCEDURE IF YOU ARE BELOW 30 YEARS OF AGE AND 26 WEEKS IF YOU ARE OLDER.

11. COMBING
Most people opt to be trimmed before the procedure. However, if your hair has not been trimmed short, you may be allowed to comb your existing hair as there is no bandage or dressing. You are advised to keep the teeth of the comb (provided in the kit only for such cases) away from the skin during combing avoiding direct contact of teeth with the planted area and adherent hair stuck around and over it. If you already have long existing hair we may show you a suitable combing style so that planted area becomes almost invisible- covered by surrounding existing long hair and it may look as if nothing has been done.
FAQs
Question: What phone no. should I call in case of emergency or query?
Answer: Our help line contact number is 9814531111. However, in case there is no urgency, best is to e-mail at justfue@gmail.com. Mails are never missed. Phone calls may not get you to the doctor since he remains busy in the operation room the whole day.
Question: What things can I carry in hand baggage during my air travels? And how do I manage shampooing during air travel?
Answer: You may not be allowed to carry any liquid medication, shampoo or solution for hair wash in larger quantity than 90 ml. So please put them in your check in baggage. We advise you to carry 10 ml antiseptic  and saline spray and shampoo with you.. You will be allowed to carry tablets for medication in cabin baggage. The prescription has been provided to you.
Question: What do I do for immigration clearance at airport due to my changed look?
Answer: If you are traveling during 1st 3 days of procedure post operative swelling on the forehead near the nose around the eyes or face or other part of the face may alter your physical appearance which may be questioned by an alert immigration officer at the port of entry. We advise you to collect a certificate issued by Dr Bhatti  with seal & sign stating that you have undergone hair transplant procedure by him on the dates mentioned. Keep the certificate with passport henceforth till you get a new passport made after the present one expires.
Question: When do I start Finasteride (Propecia), Biotin and Minoxydil (Rogaine)?
You can start Tablets Finasteride & Biotin immediately or after the antibiotics and pain killers have stopped (3 days after the procedure).
2% Minoxydil is to be started after 14 days and is to be applied over the planted area at night after washing the hair with plain water and drying with a clean towel. Please read detailed instructions contained in the carton before using Minoxydil. After 6 weeks, you can switch to 5% Minoxydil. Minoxydil is available in solution or foam or spray forms. You can choose what suits you best.
The above medications shall continue till 6 months after the procedure.
If you are travelling abroad you are advised to buy these medicines in India since they are 10-15 times cheaper in India. However, please check expiry dates before you pay for the medicines. My office can help you in procuring these medications. The typical cost of all medicines for 6 months is INR 2700 (under USD 50). The cost of these medications is not included in the hair transplant fees charged.