Smile clinic istanbul hair transplant
We have named the method of direct measurement
of hair density hair densitometry. Hair densitometry can also be used to diagnose and plot the hair loss associated with the thinning process in the early stages of male pattern baldness. Several measurements taken over a period of time can assist the doctor by helping to predict the extent and rate of hair loss.
Rational planning of the steps that may be necessary to correct hair loss, and the ability to accurately estimate the effectiveness of those steps, may have significant value to doctors and patients alike.
Densitometry also offers the physician and the patient a method for evaluating the effectiveness of medications that claim to increase the amount of hair growth.
Earlier methods of measuring hair density devised by Bouhanna
used camera attachments to create a “phototrichogram” and an “ultra close-up photograph” but these had the disadvantage that assessment could not be done until after the film had been developed.6
The information thus obtainable offered little assistance to the surgeon at the time that the hair transplantation was being done; however, a permanent record was created. The hair densitometer (patent pending) is a self-contained, portable, hand-held unit that houses a magnifying lens and openings of predetermined size.
The hair is clipped short and the unit is placed on the scalp. A density count is taken in a field of known size; the hair count can be incorporated into the plan for surgery at the moment that the information is needed.
In attempting to shift from standard grafts to minigrafts, physicians who believe that “a graft is a graft” and who fail to adjust predictions of the number of grafts needed to yield an acceptable result may underestimate the amount of work that will be needed, and this may result in a management problem, possibly a legal one.
A true, honest, and accurate informed consent should include a discussion of cost and technique. Appreciation of the patient’s hair character, color, and density and of the patient’s goals is critical.10
Techniques in common use today for determining the optimum number of minigrafts needed by a particular patient-which usually depend only on rough estimates of hair density, or which ignore the issue altogether-can add significantly to reported problems with minigrafts. Random hit and miss “guesstimation” of donor hair density should be relegated to the wastebasket of history.
A natural hairline is not a dense hairline. One criticism of some flap hairlines is that the appearance is unnaturally dense. Some surgeons partially depilate the frontal edge of the flap to overcome this problem.
Some doctors base their standard of quality on a densely packed hairline. Close examination of a natural hairline, however, shows that it does not consist of a dense, impenetrable wall of hair.
On the contrary, a natural hairline consists of a 1- to 2-cm wide band of graded increasing density from the outer “line” of a few sparse hairs to the impenetrable, dense barrier wall of thick hair.1,4,11 When one uses only 4-mm grafts and places them very close together, the hairline thus created can be very dense.
It can look like the thick wall of hair, described as unnatural looking, with a flap procedure. An unnaturally dense hairline is more apparent in patients with coarse, straight, black hair and pale, white skin.
In this situation, micrografts are often used to soften the “artificial” density, thereby increasing the total amount of required work. Another problem is the dysesthetic “corn-row” appearance seen when large, densely populated grafts are placed with large spaces between them, or when follicle loss occurs around the outer rim of many grafts (a fairly common problem).
These circumstances are all too familiar. Minigrafts can be placed in a pattern that simulates the natural, transitional hairline and, by sheer quantity, produces the required bulk of hair.12
Number of grafts; patterns; scheduling of treatment sessions
If one strictly follows the traditional spacing of grafts and places them 1 diameter apart, minigrafts will be placed with smaller distances between them than is possible with larger grafts. This means that more minigrafts can be performed in any one session.
Because of this and because the grafts can be placed in closer proximity to each other, it is often possible to complete a course of treatment in fewer than the four sessions usually required with standard grafts.
Hair density in the donor area, hair character and color, and hair distribution will influence the number of required sessions.4,8 The positive effect of placing more grafts in a patient in a single session will outweigh the negative effects on the patient.
Nevertheless extended sessions, in which the surgeon places 400 to 1200 minigrafts per session, can certainly strain a surgical team that is not trained or accustomed to such efforts.
The human eye is highly conditioned to regular patterns, and the appearance of such patterns is readily recognized. Random distribution of minigrafts is much less noticeable than the traditional, orderly, linear placement recommended with traditional grafting techniques, This less detectable random distribution is gaining in popularity.