The origins of hair transplant surgery can be traced back as far back as the early nineteenth century. First performed on animals in the 1800s, hair transplants (or hair-bearing autografts as they were known) have been carried out to treat alopecia with varying degrees of success since 1893.

Early research and studies either failed or produced contradictory results. Further confusion was caused by transplants that had failed to “take” or had been only partially successful. An example of a study carried out in 1959 follows:

“After administration of local anaesthesia and appropriate surgical preparation of the skin, which included washing, trimming, and cleansing with alcohol, four full-thickness punch excisions below the level of the hair papilla were made (with punches of 6, 8 and 12 mm). Each graft was trimmed of excess fat. Of the punch grafts, two were excised from a site of persistent disease, and two were excised from a healthy, normal skin site. The grafts were then transplanted in clockwise rotation in the following manner: (1) a normal graft was transplanted to an affected site; (2) a normal graft was transplanted to an affected site; (3) an affected graft was transplanted to a normal site; and (4) an affected graft was transplanted to an affected site.” (Stough, 1996 p. 60)

Results were as follows:

“Donor dominance was observed in all 52 cases of androgenic alopecia: normal graft to normal site grew hair; normal site to bald site grew hair; affected graft to affected site remained bald; and affected graft to normal site remained bald.”

The study concluded:

“The results…corroborated the statement that “the capacity for development of baldness appears to be controlled by factors resident in localised areas of the scalp”; that is, that the pathogenesis of common baldness is inherent in each individual hair follicle. This phenomenon thus would explain the common clinical finding of isolated, normally growing, terminal hairs in a sea of male pattern baldness.” (Stough, 1996 p. 60)

The first hair transplant in the United States was performed by Dr. Norman Orentreich in the late 1950s. He proposed the concept of “donor dominance” – 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” ensured that transplanted hair will continue to grow, it did not ensure that the results would look natural. Punch grafting could successfully transplant hair but could not produce a natural-looking result.

Since the 1960s the field has expanded, resulting in improvements in instrumentation and technique. Physicians from different specialties and backgrounds have entered the field which has resulted in the development of new innovations and alternative techniques of transplantation in addition to punch grafting.

The original concept for Follicular Unit Transplantation was introduced by Drs. Robert M. Bernstein and William Rassman in their 1995 paper “Follicular Transplantation”. The procedure was further detailed in articles, “Follicular Transplantation: Patient Evaluation and Surgical Planning” and “The Aesthetics of Follicular Transplantation” (1997). The concept was further elaborated upon in the 1999 publication “The Logic of Follicular Transplantation.”
By the year 2000, Follicular Unit Transplant (also referred to as FUT) was firmly established as the state-of-the-art due to its ability to produce natural-looking results. However, because the procedure was more labour intensive, time consuming and therefore more expensive than mini-micrografting, it was adopted slowly by the medical community.

In the last few years, an elite group of hair restoration physicians have, and continue to, revolutionise standard follicular unit transplantation, called “Ultra Refined follicular unit hair transplantation”. Trimming smaller “skinny” grafts and making smaller incisions with ultra refined tools allows a hair transplant surgeon to dense pack follicular unit grafts even closer together, almost twice as much as standard follicular unit transplantation. Benefits therefore of ultra refined follicular unit hair transplantation include:
1.dense packing follicular unit grafts closer together when appropriate for the patient;
2.larger single hair transplant sessions requiring fewer sessions for the patient;
3.minimising scalp trauma and lessening the risk of “shock loss” of existing “native” hair.

In the past, hair transplant patients with minimal hair loss would still need multiple sessions to achieve their desired hair density. But surgeons who trim skinnier follicular unit grafts and make smaller incisions with ultra refined follicular unit hair transplantation gives the surgeon the ability to “dense pack” or place follicular unit grafts closer together. Patients therefore can achieve their desired hair density within a single session. But high levels of dense packing are not always advantageous to the patient. Patients with higher levels of balding must often choose between adequate hair coverage or hair density. One often must be sacrificed to achieve the other. Keeping in mind the potential for future hair loss is also important as a surgeon and patient plan how to make use of the finite donor hair supply.

There are several reasons to transplant large numbers of grafts in each session. Large sessions: 1) allow the hair restoration to be completed quickly so that the patient has minimal interference with his/her lifestyle; 2) can compensate for Telogen effluvium or “shock loss”, the shedding that frequently accompanies a hair transplant; 3) preserve the donor supply by reducing the number of times incisions are made in the donor area; 4) provide sufficient 1- and 2 hair grafts to create a soft frontal hairline and enough 3- and hair grafts to give the patient the fullest possible look.

Follicular units are relatively compact structures, but are surrounded by substantial amounts of non-hair bearing skin. In stereo-microscopic dissection using ultra refined follicular unit hair transplantation, this extra tissue can be removed without injuring the follicles, thus making the grafts smaller. Small grafts can then be placed into small incisions; minimising damage to the scalp’s connective tissue and blood supply.

The larger wounds produced by mini-micrografting and plug transplants cause cosmetic problems that include: dimpling and pigment changes in the skin, depression or elevation of the grafts, and a thinned, shiny look on the scalp. The key to a natural appearing hair transplant is to have the hair emerge from perfectly normal skin. The only way to ensure this is to keep the recipient wounds very small.

Another advantage of small wounds is creating a “snug fit.” Unlike the punch and some mini-grafting techniques, which remove a small bit of tissue to make room for the new grafts, the small grafts used in follicular unit transplantation fit into a small, needle-made incision without the need for removing tissue. This preserves the elasticity of the scalp and holds the tiny follicular unit graft snugly in place. After surgery, the snug fit facilitates wound healing and helps to ensure that the graft will get enough oxygen from the surrounding tissue to maximise their survival.

The origins of hair transplant surgery can be traced back as far back as the early nineteenth century. First performed on animals in the 1800s, hair transplants (or hair-bearing autografts as they were known) have been carried out to treat alopecia with varying degrees of success since 1893.

Bibliography
Bernstein, Robert M., Rassman, William R., Szaniawski, W., Halperin, Alan J. Follicular Transplantation, International Journal of Aesthetic and Restorative Surgery 1995; 3(2):119-132.

Bernstein, R.M., Rassman, W.R., Follicular transplantation: patient evaluation and surgical planning, Dermatol Surg 1997; 23:771-784.

Bernstein, R.M., Rassman, W.R., The aesthetics of follicular transplantation, Dermatol Surg 1997; 23:785-799

Bernstein, R.M., Rassman, W.R., The logic of follicular unit transplantation, Dermatologic Clinics 1999; 17(2):277-295

There are several products on the market that can help treat your acne. The different kinds are hormonal therapy, topical antimicrobials, topical retinoids, and oral antibiotics.

Hormonal therapy is typically given in an oral contraceptive to women. This helps level out the amount of sebum being produced; which in turns helps acne less severe.

Topical Antimicrobials are used to treat the mild to moderate inflammation of acne. Topical antimicrobials can come in four different solutions: cream, lotion, gel or foam. Choosing the right form needs to be done by your dermatologist as this decision is made on your skin type.

There are also different kinds of topical antimicrobials available on the market right now; they are azelaic acid, benzoyl peroxide, clindamycin, erythromycin, and sodium sulfacetamide.

Azelaic acid is prescribed for mild to moderate inflammatory acne, and can create peeling of the skin. Benzoyl Peroxide is available over the counter and in many over the counter acne treatments and will kill the acne bacteria in your pore.

Clindamycin is an antibiotic that can be administered as a pill or a topical cream, it can cause dry skin. Erthromycin helps to reduce inflammation and acts as an anti microbial. Sodium sulfacetamide is a topical ointment that helps treat inflammation and open the pores.

Topical retinoids are used for mild to moderate severe acne. It works by unclogging pores, and allows the antibiotics to enter the hair follicle and kill the bacteria. There are three types of topical retinoids, they are as follow: adapalene, tazarotene, and tretinoin. Adapalene is a gel or cream that unclogs pores to allow the medication to kill the acne bacteria. Tazarotene is available in a gel or cream and is used to keep pores to clean.

Tretinoin is used to gradually unclog pores and keep them unclogged.

Oral antibiotics are prescribed for moderate to severe recurring cases of acne. They reduce redness and inflammation by killing the responsible bacteria. There are three types of oral antibiotics, they are as follows: erythromycin, tetracycline, tetracycline derivatives.

Erythromycin in the oral form is used to kill and prevent many different types of acne causing bacteria.

Tetracycline is used to treat papules, and pustules. This is typically prescribed when you are the victim of pus filled lesions. Tetracycline derivatives are doxycycline, and minocycline. Doxycycline is used to treat inflammatory acne, and minocycline is used to fight acne.

Alternatives to Medicine:

If you do not like the options listed above there are also several alternative routes that you can take to treat your acne. They are as follows: nutritional therapy, herbal medicine, aromatherapy, detoxification, fasting, and colon therapy, homeopathy, hydrotherapy, and meditation.

Nutritional therapy involves taking supplements of vitamins that are known to strengthen your skin and help fight acne. The vitamins are as follows: zinc, selenium, vitamin A, vitamin B6, vitamin E. Some foods that contain zinc are dried beans, wheat germ, oysters and clams.

Herbal medicines that help with acne can be derived from different types of plants. These herbal remedies can help eliminate the bacteria that cause the acne and inflammation. Some different herbs that can do this are as follows: tea tree oil, calendula, burdock and cleaver, and vitex.

Tea tree oil is made from a shrub that grows in Australia, and is well known for the antibacterial properties it possesses.

Calendula is also known as marigold. The marigold can be used as an anti-inflammatory and antibacterial after the dried flowers have been placed in hot water and steeped. After the flowers have been steeped and cooled they are applied to the skin like a face wash.

Burdock and cleaver are used in an alcohol and water solution that can be used as a cleanser. Vitex is also know as chasteberry. The chasteberry has been used to level out hormone levels in women. Aromotherapy products can be placed in water and used a face wash. The following herbs have proved to work: bergamot, chamomile, juniper, and lavender.

Detoxification, fasting and colon therapy can help with acne because some view acne as the body saying it can not get rid of the waste.
Homeotherapy can be used with the following prescriptions: kali bromatum, hepar sulphuris calcareum, and sulphur. But the prescription needs to be chosen specifically for each person.

Hydrotherapy works by placing ice on inflamed areas, soaking your skin in ocean water, or quickly rubbing your body with a cold wet washcloth.

Meditation can help lower yoru stress level and then help prevent acne caused by stress.