For achieving an aesthetically pleasing, efficient and permanent hair restoration only one method is acceptable: transplantation of micro grafts of your own hair . The procedure is done under local anaesthesia as an outpatient. The principle is very simple : a strip of hair bearing skin is taken from the back of the head, where hair loss is extremely rare. This strip is cut under the microscope in fragments containing one to maximally three hairs. These fragments (=micro grafts) contain a hair and its hair bulb, which ensures the survival of the hair. The micro grafts are then implanted one by one in the bald or balding area, after making tiny slits in the skin, which is numbed with local anaesthetic. By implanting individual hairs the plastic surgeon can create a very natural hairline, in males as in females. In one treatment session a 1000 to 2000 grafts containing 1 to 3 hairs each can be transplanted. In most cases one treatment is sufficient for achieving a pleasing hair growth, but in some cases of severe baldness more treatments are necessary. After 3 to 4 months the hairs begin to grow, but it is only after a year that the definitive result is obtained. baldness or alopecia
There are se veral types of baldness: the most common is the typical male pattern of baldness, as seen in the figure on the left. It can also occur by surgery on the scalp, for instance after removal of a skin lesion (“ post-surgical baldness”), after a trauma like a b urn or a wound in the hair bearing skin (“post-traumatic baldness ”), or by some inborn or congenital forms of baldness. The temporary types of baldness occurring through curable skin disorders or through stress
are not taken into consideration for hair transplantation. In males the baldness progresses on the one hand by recession of the frontal hairline, first at the temple, later in the middle. Often hair loss at the top of the head (the vertex) occurs after some time. Later these two zones may join, ultimately leaving only a zone of hair in the neck, and above the ears. In fewer cases, the baldness occurs purely from the front to the back, without a bald spot on the vertex. Hair loss is an ongoing situation. Usually the rate of hair loss diminishes round the age of 40, but rarely it stops completely. In females hair loss is less common, and usually follows a more diffuse pattern, centred in the middle of the scalp, usually sparing the frontal hairline.
By implantation large numbers of micro-hair grafts usually one session (a “mega session”) is sufficient to give a satisfactory hair growth of the bald or balding area. Of course this depends on the size of the bald zone. In one megasesion 1000 to 2000 micro gr afts, each containing 1 to 3 hairs are being inserted in the bald skin, with a distance of 1 to 2 mm. If the bald zone is very large two, sometimes three mega sessions are needed to obtain a satisfactory hair density. The sessions can follow each other with 4-6 months interval. The only absolute condition is the presence of sufficient hair in the back of the head to serve as donor hair. The hairs present in the graft at the time of the surgery all shed in the first weeks after the intervention. It takes three to four months before hair growth becomes noticeable. It takes a year before the hair has obtained a satisfactory length and thickness ! Patience is very important when considering this type of treatment. Normally nearly all the transplanted hairs survive, and the result is permanent, because the hair from the back of the head very rarely sheds, and this quality is preserved after moving the hair to a new position . In the case that a balding area (with severely thinning, but still present hair) is treated a temporary shedding of the present hair can occur. By the “trauma” of the surgical intervention many hairs simultaneously move into the so-called “telogenic" or resting phase of the hair bulb. This can be very frustrating, but after 4 to 6 months this hair always grows back. instructions before the intervention also read “general instructions before plastic surgery” Give your surgeon complete information concerning your medications (also the ones you take only once in a while), allergies, your medical history. A limited blood examination will be asked, which can be arranged through your G.P. The day before and the day of the surgery you will need to wash your hair with a gentle shampoo. There is no need for a particular haircut. The hair in the back of the head should ideally be at least three centimetres long, to conceal the wound after the treatment. Wear comfortable clothes which you don’t need to pull over your head. Remind that the clothes might get spoiled. the intervention A mega session of hair transplantation is a very time consuming and labour -intensive intervention which takes 4 to 6 hours on the average. Nevertheless for you, the patient, it is quite comfortable, as you spend most of the time in a semi-reclined position , and you get plenty of opportunities to change your position. First your surgeon draws the zone to be treated, the exact position of the new hairline, and the zone on the back of the head where the hair will be taken (=the donor zone). Then the hair in the donor
zone is trimmed (to appox. 1.5 mm) ; the surrounding hair is left long. A mild sedative is injected in the thigh. The local anaesthesia is injected, like at the dentist’s. It will numb the complete hair-bearing skin during the whole interventi on. Your head is being cleaned with a desinfection solution, sterile drapes are
applied, and you lay down on your side to start with. The strip of donor hair is taken and the wound on the back of the head is immediately closed. In the meantime the team has started with cutting the strip in small grafts of one to three hairs per piece. This is the most labour-intensive part, as the technicians need to look through a loupe or microscope to cut the grafts
meticulously to keep the hair bulbs intact. The grafts are counted.
Once a sufficient number of grafts have been cut the bald area is prepared for transplantation ; some extra numbing solution is injected. You can sit now, with the back of the seat somewhat reclined. The surgeon makes tiny slits in the skin with a special scalpel, and inserts one graft in the slit. Gradually the bald zone becomes filled with hairs. When all hair grafts have been implanted your head is cleaned thoroughly, and a dressing is applied. Half an hour later you can leave the office. after the intervention Rest for the first 72 hours after surgery while keeping the head elevated at a 45 degree angle. From the first day after surgery it is important to get up and walk around, to reduce swelling. You will notice swelling of the eyelids and forehead on the second or third day, from the numbing solution injected into the scalp during the procedure. Swelling usually resolves by the seventh postoperative day. You may apply cold compresses to these areas. The bandage will be taken off in the office at the Coupure on the second day. Your head will be cleansed, and afterward you shoul wash your hair daily with a lukewarm or room -temperature water (avoid hot water), using a mild shampoo. Make shure that the shower head is set on low pressure or use a cup. After the bandage is taken off, wear a hat or cap for protection, especially when going out. Start applying 5% minoxidil twice daily for 2 to 6 months. This will help speed up the growth of the newly transplanted hair and may minimize the initial further thinning in patients who still have hair in the transplanted area. If scalp irritation occurs, stop for a few days and then begin using 2% minoxidil. If the irritation persists, discontinue its use. Avoid the following :
• driving until eyelid swelling (if present) has resolved
• strenuous exercise or sports activities in the first 2 weeks
• the sun or excessive heat exposure for at least 3 weeks
The stitches of the donor area will be removed after a pproximately one week. The small crusts around the micrograft will drop off naturally 10 days after surgery along with some of the transplanted hair. However, the hair root has become safely incorporated into the scalp by that time and is not at risk. Hair growth will become not will become noticeable 3 to 4 months after surgery, but the final result will take 1 year.
SPHYGMOMANOMETERS AS A RESERVOIR OF PATHOGENIC BACTERIA Authors: M.A. Beard, A. McIntyre, P.M. Roundtree OBJECTIVE: The purpose of this study was to identify the type and level of the bacterial contamination of sphygmomanometers in use week and sampled at 0, 24 and 48 hours after introduction. Three sites on the cuff were sampled each designated as high, medium, SUMMARY: The b