LOSING YOUR HAIR: The Ailesbury Hair Implant method

24 July; Author: Hair Extensions Australia

LOSING YOUR HAIR: The Ailesbury Hair Implant method

First, why do we actually lose ourhair?

There are numerous factors that contribute to the cause of hair loss in both males and females but genetic pattern baldness accounts for nearly 95% of all hair loss in men, as well as affecting millions of women. This common form of progressive hair thinning relates to a condition called androgenic alopecia or “male pattern baldness” and it occurs in adult male humans and other species. Androgenetic alopecia in women rarely leads to total baldness and the pattern of hair loss differs from male-pattern baldness. In women, the hair becomes thinner all over the head, and the hairline does not recede.

Tell us more about androgenetic alopecia

There are a variety of genetic and environmental factors that are likely play a role in causing androgenetic alopecia. Although we know risk factors that may contribute to this condition, most of these factors remain unknown. Researchers have determined that this form of hair loss is related to hormones called androgens, particularly an androgen called dihydrotestosterone (DHT). Androgens are important for normal male sexual development before birth and during puberty. The resulting effect is seen as baldness. The amount and patterns of baldness can vary greatly as the incidence varies from population to population based on genetic background. Interestingly, environmental factors do not seem to affect this type of baldness greatly.

You mentioned genes. How do they play a role?

It was previously believed that baldness was inherited from the maternal grandfather. While there is some basis for this belief, it is now known that both parents contribute to their offspring’s likelihood of hair loss. Large studies in 2005 and 2007 showed the importance of the maternal line in the inheritance of male pattern baldness. German researchers called the main ‘balding’ gene, ‘ARG’ or the androgen receptor gene. The presence or absence of a specific variant in this gene is related to baldness. This gene is recessive and a female would need two X chromosomes with the defect to show typical male pattern alopecia. Other research in 2007 suggested another gene on the X chromosome, which lies close to the androgen receptor gene, is also important in male pattern baldness. We consider the X linked androgen receptor as the most important gene with a gene on chromosome 20 being the second most important determinant gene.

How common is Male Pattern Baldness?

This is a good question. Studies show nearly all men have some baldness by the time they are in their 60s. However, the age the hair loss starts is variable. One large Australian study showed the prevalence of mid-frontal hair loss increases with age and affects about three in ten 30 year old males and half of 50 year old males. It also showed approximately 25 percent of men begin balding by age 30; while two-thirds begin balding by age 60. Some women also develop a similar pattern of hair loss. Male pattern baldness affects roughly 40 million men in the United States alone.

Can we use this information to our advantage?

Certainly yes, the Ailesbury Hair Implant technique uses a genetic test for male pattern hair loss, which reports the presence or absence of a specific variation in the androgen receptor gene. A positive test result means that a man has the high risk genetic variation. Men who test positive have approximately a 70% chance of going bald. This means the H+ genetic test can predict a patients risk for hair loss or thinning. Because single follicular hair implants can be used multiple times and it is not limited as in methods like strip surgery this means a patient can theoretically never be allowed to go bald again. Patients should remember by the time hair loss or thinning is noticeable ? almost 50% of your hair could be gone and the genetic test will help predict a patients hair loss before you can see any visible hair loss

What are the present medical treatments available?

The most popular medical treatment is Minoxidil (Rogaine), which is available in 2% and 5% topical solutions. Unfortunately, cosmetically useful hair is obtained in only about one third of cases and Minoxidil must be used indefinitely to maintain a response. Another treatment involves taking Finasteride (Propecia) 1 mg tablets and given once daily. Hair loss drugs like Propecia work by inhibiting the creation of DHT in our bodies.

By reducing the amount of DHT that can affect a man’s hair follicles, hair loss can be slowed or even stopped. Propecia lowers the dihydrotestosterone on the scalp and also in the serum of treated patients. Clinical trials have shown it to be effective in preventing further hair loss and increasing hair counts to the point of cosmetically appreciable results. Interestingly, hair loss on the temples is not improved. Side effects are rare, less than 1%, and patients must remain on the drug indefinitely since the benefit may be lost after discontinuation.

Tell me something about hairtransplantation?

Hair transplantation is a surgical technique that involves moving sections of skin containing hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to a bald scalp. However, it is also used to restore eye lashes, eye brows, beard hair and to fill in scars caused by accidents and surgery such as face lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin. Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, most hair transplant techniques migrate 1 ? 4 hair “follicular units” in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This hair transplant procedure is called “Follicular Unit Transplantation”

When didhairtransplantation actually begin?

Modern hair transplantation began in the 1950s based upon the pioneering work of New York dermatologist Dr. Norman Orentreich. According to medical myth, he was doing a study on vitiligo, transferring 4 mm punch skin grafts in an attempt to determine whether vitiligo was “donor” or “recipient” area dominant. The patient noted that a punch graft that had been taken from a hair-bearing area, grew hair, after it was placed into a non-hair-bearing area. Previously it had been thought that transplanted hair would thrive no more than the original hair at the “recipient” site. Dr. Orentreich demonstrated that such grafts were “donor dominant,” ? the idea that grafts continue to show the characteristics of the donor site after they have been transplanted to a new site. This principle provides the basis for all hair transplant surgery. Although “donor dominance” insured that transplanted hair will continue to grow, it did not insure that the results would look natural.


Why did transplants by ‘punching’ stop?

The initial hair transplants used grafts that measured 6?8 mm in diameter, about the size of pencil erasers. These were obtained from the back of the scalp by literally punching out the hair bearing grafts with a sharp, round instrument and then placing them in holes made in the balding front-part of the scalp. The punch technique continued during the 1960’s, although the size of the punch was gradually reduced in order to improve the survival of the hairs in the central part of the graft. For the next twenty years, surgeons worked on transplanting smaller grafts, but results were only minimally successful, with 2-4 mm “plugs” leading to results that were often “pluggy” and unnatural and was referred to as a “doll’s head” or “corn-row” look. It is thought that these hairs were also subject to poor oxygenation by a “donuting” effect as the punch size was too big. We must remember that the follicles also take a curved path through the skin and there was an unacceptable rate of transection (about 30%) during the punching technique. In the 1980s, Uebel in Brazil popularized using large numbers of small grafts, while in the United States Rassman began using thousands of “micrografts” in a single session.

Can you explain the technique of ‘minigrafts’ and micrografts?

In the late 1980s, Limmer introduced the use of the stereo-microscope to dissect a single donor strip into small micrografts. Micrograftsusually consist of one or two hairs per graft and ‘minigrafts’ contain 3-8 hairs per graft. These smaller grafts, when properly placed, provided a more natural, less abrupt appearing hairline in contrast to other methods. However, they could also contain up to 12 hairs producing a bulky tufted appearance leading to a ‘doll’s head’, or ‘toothbrush’ effect. Patients also complained of a dimpling of the underlying scalp. Micrografts were frequently damaged during the removal process or were too fragile to survive. In ‘mini-micrografting’, the graft sizes were arbitrarily determined by the doctor who cut the donor tissue into different size pieces. This technique has now largely been surpassed.

What technique is presently popular?

During the past few years, follicular unit transplant grafts (FUT) have become popular due to a more natural effect. Follicular units were first described in the medical literature by Headington in 1984. Follicular Unit Transplantation has its roots in the single-strip harvesting method and microscopic graft dissection technique developed by Dr. Bobby Limmer in the late 1980s and published in 1994. In 1995, Bernstein and Rassman published the first paper on “Follicular Unit Transplantation”, where hair is transplanted exclusively in naturally occurring groups of 1-4 hairs. With microscopic dissection of donor pieces from an excised portion of scalp, individual follicular units containing but 1-4 hairs could be prepared and individually relocated into needle punctures in the recipient areas. Since the transplanted hair mimics the way hair grows in nature, close to natural results were attainable. By the year 2000, Follicular Unit Transplant (also referred to as FUT) by the strip technique was more firmly established and respected due to its ability to produce more natural results. However, because the procedure was more labour intensive and time consuming than mini-micrografting, it was adopted slowly by the medical community.

What do you mean by the ‘strip’ technique?

The strip method is really an invasive surgical procedure requiring the attendance of a plastic surgeon and general anaesthesia. During the procedure, a long strip of scalp, approximately 20- 25 cm in length and 1 cm to 2.5 cm in width of hair-bearing skin is removed from the donor area using a scalpel, cutting through nerves and major blood vessels of the scalp. The donor area is then sutured (stitched) closed and approximately 30 days are required for full healing. In order to avoid stretching of the donor scar, two layers of donor stitches must be used and left in the skin for at least two weeks. The doctor can harvest to a maximum of 3,000 hairs during one procedure. Body hair follicles and hairs cannot be extracted using the ‘strip’ method, depriving the patient of a tremendous area of donor hair. Post-operative care requires that the patient not play sports or weight train for at least 30 days. Many patients complain of scalp numbness for many months and sometimes permanently.

Are there any problems with the strip technique?

This is invasive surgery and the patient may sometimes develop scarring or neurological problems of sensation in the back of the head post procedure. Another primary disadvantage of strip extraction is that the patient must wait nine months for the area to heal fully before considering or being able to undergo a second procedure and the patient must have sufficient elasticity in the donor site before the surgeon can safely harvest another strip. Besides the long donor area permanent scar, there is also a possibility to be left with permanent suture scars, stretch back tension scars, keloid scars, or staple scars, even if the procedure goes perfectly. Should a patient shave their hair short in the donor area, a line or scar will always be visible. A patient forever gives up the option to shave their head or have a short haircut after a strip procedure. Although there are many good proceduralists of this technique, I personally would consider ‘strip surgery’ an out-dated procedure.

What is the best hair transplant treatment now?

Over the past few years unit follicular hair transplant has emerged as the most reliable hair transplant procedure of hair transplantation surgery. As the name suggests, the graft in this case consists of a single follicular unit as it exists in nature. The follicular unit contains sebaceous glands as well as nerve and blood tissue. It is for this reason that it needs to be extracted as an intact unit and transplanted as an intact unit, to be able to grow into a hair. There are basically two types of technique.

1 Follicular Unit Transplantation (FUT) is a hair restoration procedure where hair is transplanted exclusively in its naturally occurring groups of 1-4 hairs. These groups, or follicular units, are obtained through the microscopic dissection of tissue taken from a single donor strip or extracted directly from the donor area.

2. Follicular unit extraction (FUE) does not require a donor strip to be excised from the donor area and therefore does not involve any dissection of follicular units. The follicular units are instead directly extracted one-by-one using custom-made, precise micro-surgical tools less than a millimetre in diameter. Follicular unit extraction is simple and painless, with the donor area healing within 2-4 days as compared to 7-8 days required for follicular hair transplants using the graft extraction technique. There is also no risk of nerve damage being caused by the hair transplant procedure.

Which is the best method?

This is a difficult question to answer as there are proponents of both techniques. Although, FUT is considered an advance over the ‘mini-micrografting’ hair transplant procedure, many transplant doctors do not consider it as advanced as FUE because the technique still requires larger areas of the scalp to be removed than single follicle extraction. Proponents of the FUT technique say that there are also problems inherent in removing individual follicular units with small punches. First, any significant variation between the incident angle of the punch and the exiting hair can result in graft transection. It is known that it is difficult to keep the punch parallel to the follicles throughout the entire length of the graft as the visual cues used to guide one’s hand are lost once the punch passes into the depths of the tissue. Another disadvantage of both follicular techniques is the requirement of long hours of time and skilled teams of assistants for the preparation of 3,000 odd follicular hair transplants through dissection. My feeling is that the final result is very operator related.

What is the Ailesbury Hair Implant method?

The Ailesbury Hair Implant technique has been perfected in Dublin. It essentially is a minimally invasive method of hair restoration which avoids the need for any scalpels or stitching to be required at any point during the procedure. Single hair follicles are extracted one by one from the donor area (back of the head) and re-implanted with the unique patented device; therefore a strip of donor skin is not required to be removed from the back of the head. Many doctors, including myself, consider this to be the most advanced method of transplanting hair. to techniques like the newer single hair follicle extraction technique. In this method follicles are extracted one by one from the donor area (back of the head) and re-implanted with the unique patented devices. The Ailesbury Hair Implant method is based on the use of genetic testing, the use of growth factors, 633nm light for fibroblast stimulation and the use of quality control during the hair transplant procedures. The hair transplant doctor needs only a single surgical assistant to help him during the follicle hair transplants. The procedure also ensures maximum care to the grafts. The hair transplant doctor can decide upon the exact number of grafts to be removed while he is removing them one-by-one.

Any other advantages with the Ailesbury Hair Implant method?

The best thing about the Ailesbury Hair Implant method is that the hair extraction is simple, painless, and the donor area heals within 2-4 days. Individual hair follicles are removed one by one using the H+ Extractor and Implanter by a surgeon who is wearing high magnification loupes. Patients can listen to music, watch tv and enjoy a light lunch during the procedure, which is completed in four to six hours. There is absolutely no risk of nerve damage because scalpels or stitches are not used. Another advantage of the Ailesbury Hair Implant transplant procedure is that it allows the hair transplant surgeon to extract as many grafts as is actually needed and on average, we usually extract and place 3,000-5,000 hairs per day. Bandaging is not necessary following the procedure, allowing the patient to leave the clinic looking just as they did on entering. Unlike the ‘strip’ technique, there is no scarring with the Ailesbury Hair Implant method and a patient can shave his head or wear all the current cuts and styles. In addition, there is also no waiting period between Ailesbury Hair Implant procedures and hair from all over the body can be used. Body hair follicular grafts have shown growth patterns similar to head hair with no difference in texture but are usually used for enhancing the density in the posterior region of the scalp rather than the hair line. Hair regrowth will be seen after 16 weeks, depending in part on how quickly the capillaries form around the newly relocated follicular units. This newly transferred hair grows naturally in its new location for the rest of the patient’s life.

How many sessions will be necessary before hair restoration is complete after the Ailesbury Hair Implant method?

That really depends on the size of the balding area, donor yield and the goal of the patient. In order to achieve a greater density, I would suggest starting early and plan at least two sessions, so that you never really become bald. The numbers of sessions being one or more is aided by the use of genetic programming and special camera densitometry equipment to see under the skin and fully inform the patient of his or her total available donor hair. In each session, the follicles are inserted between existing hairs or previously placed hairs and generally placed up to 1mm apart.

Dr. Patrick Treacy is on the Specialist Register in Ireland and holds a H.Dip in Dermatology and a BTEC in Laser technology and skin resurfacing. He is Irish Regional Representative of the British Association of Cosmetic Doctors and practices cosmetic medicine in his clinics in Dublin, Cork, London and the Middle East. He was amongst the first doctors worldwide to use the permanent facial endoprosthesis BioAlcamid for HIV Lipodystrophy patients. He was also the first person to introduce many techniques such as Radiofrequency assisted lasers, Fibroblast transplant and Contour Threads to Irish patients. Dr. Treacy is an advanced Botox, Dysport and Dermal filler trainer and regularly holds courses for doctors and nurses from around the world. He is also a renowned international guest speaker and features regularly on national television and radio programmes. Despite his busy global commitment (See his lecture schedule on the home page) he finds time to personally see patients at his Dublin clinic.

Ailesbury Clinics Ltd Suite 6 Merrion Road Ailesbury Road Dublin 4 Ireland Phone +35312690933 Fax +35312692250 http://www.ailesburyclinic.ie

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