The best doctor for hair transplant in turkey
Graft injury from drill rotation
The speed of a mechanical punch produces undirected energy that must be absorbed by the surrounding tissue (both inside and outside the punch).
The excess energy takes two forms: heat energy and kinetic energy (as torque). In theory, the excess energy could easily damage the delicate structures of the hair follicles in the graft.
The amount of damage will reflect the sharpness of the punch, the speed of rotation, and the turgor of the donor tissue. Excess heat energy outside the punch is probably rapidly dissipated into the surrounding tissue.
But heat energy within a small punch cannot be dissipated and may become significant. The effects of excess kinetic energy would be expected to have an equal impact inside and outside the punch.
The distortion and injury that can be caused by dull punches, excess compression, too rapid advancement of the punch, and failure to properly position
and immobilize the head have been clearly demonstrated in Alt’s superb photographs.5
For those surgeons who use a mechanical punch for harvesting minigrafts smaller than 2.5 mm in size, we suggest that they closely inspect the bulbs of all the harvested grafts for visible damage.
Microscopic damage to the hair follicles and the other delicate structures of the pilosebaceous unit immediately adjacent to the whirling punch may occur.
These may be torn apart or suffer significant injury. Such damage may not be observable even under magnification, yet could substantially reduce the number of hairs that survive. The problem can be substantially mitigated by harvesting larger grafts and subdividing them.
If a very small punch is used to create minigrafts, slight deviations of the incident angle of the punch with the skin may cause amputation of parts of some follicles. We believe that this is unavoidable when small grafts are cropped directly.
Such damage will injure hair follicles on the periphery of the graft often on only one side; therefore, inspection must be done on all sides.
The surgeon who uses this method of harvesting without personally closely inspecting at least a large sample of the grafts may be deluding himself.
The use of mechanical punches for direct harvesting of very small grafts should be minimized if the surgeon is unwilling to meticulously inspect results.
Halving or quartering larger grafts or dissecting small grafts from a larger bloc of tissue under direct, magnified vision obviates this problem.
Frechet in 1989 advocated direct harvesting of individual small minigrafts; however,
those who follow his suggestion should include his precautions of fixing the position of the patient’s head and of supporting the doctor’s forearm.
Frechet uses carbon steel punches, which are sharper than the stainless steel punches most surgeons use. He harvests his grafts under high-power microscopy.
Surgeons who are unwilling to take these special precautions and to use the additional equipment should not expect the high quality results Frechet is able to achieve.3
Minimizing graft shock
Normal saline solution is used to stiffen the donor area when mechanical punches are used. Most of this intercellular fluid separates the individual hair follicles and distends the supporting structures of the pilosebaceous unit.
This trauma may have little significance if it is isolated (not associated with transplantation). However, when combined with the shock due to transplanting the hair, its significance may be increased.
Because the multibladed scalpel can be used without injecting saline solution, this potential source of trauma can be avoided.
The loss of hair follicles from the outer rim of the grafts may contribute much to a “pluggy” appearance. Most practitioners believe that their superior techniques adequately address this issue,
but we question such statements in the absence of objective evidence.
It is very difficult to address this issue properly when the techniques themselves may be based on defective scientific assumptions and principles. We further believe that highly experienced surgeons,
although they may not have recognized the “science” associated with graft survival in planning their techniques, may over the years have altered their techniques to minimize the “pluggy” appearance.
There is no substitute for experience provided re-assessment is ongoing and consistent.
The number of hairs that survive in a minigraft can be influenced by actions of the transplant team.
Small distinctions in technique can make the difference between passable or adequate and excellent results.
For example, the sharpness of punches can be ensured only by developing punch sharpening expertise in house. Such attention to seemingly minor details is absolutely critical to minigrafting.
Minimizing follicle shock
The normal saline solution medium in the Petri dish holding the prepared minigrafts should be iced; the value of low temperature to reduce tissue injury in major organ transplantation is well proven.
Hair transplantation is not a life-threatening procedure, and hair is more resilient than most large organ systems, yet the same basic treatment principles apply. Subtle differences in follicle survival may be at stake.
Because of their smaller mass and larger surface area, minigrafts are more susceptible to the harmful effects of drying; they will dry out more rapidly than standard grafts. At room temperature, injury from anoxemia will be substantially greater than when the graft temperature is reduced.
In addition, because more grafts are often done in minigrafting than in a traditional procedure, the interval when each graft is maintained outside the body is lengthened.
An efficient, experienced transplant team is absolutely essential for the proper and expeditious placement of minigrafts. Failure to heed such small but critical details in minigraft transplantation may affect the overall surviving follicle count.
Visibility of work in process and transplant scars
Traditional hair transplantation was devised for the person with complete hair loss in some or all of the scalp. Most patients had to manage a process that was visible to all the world.
Replacing “hair for hair” and taking into account the receding hairline is relatively recent. In traditional grafting, the hairline was recreated, moving backward.
The patient was required to wear a hat, to cover the grafted area with a hair piece, or to comb the existing frontal hair in conv