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Hair Restoration
Hair loss affects millions of men and women and can be a difficult and emotional problem for many. Fortunately, there are effective preventive measures that one can take. If your progressing hair loss is diagnosed early then there are successful treatments.

YOU SHOULD KNOW?
In last few years there is a tremendous increase in awareness about hair transplant, at the same time news papers, magazines; web sites hoardings are full of advertisement about the growing number of hair transplant units and various hair growth medicines, oils etc. All make lots of claims about their success. Consumer is very much confused about what to follow. Internet is biphasic it gives lots of information but at the same time it is difficult to trust that abundant information. We need to analyse them intelligently and formulate our views on the basis of some criteria.
One most important thing which you should know is the academic qualification of hair transplant surgeon. His degree should be recognised by medical council of India. You should also inquire about his experience in hair transplant and what technique he follows.
Then comes the details about his transplant unit. If he uses Follicle dissection technique, then does he use magnification for follicle dissection? Is follicle dissecting team experienced enough? Who is implanting follicles? Use of magnification loupe is recommended while implanting follicles. Now it is gold standard to dissect follicles under magnification to prevent micro damage to follicles. Does his unit have air conditioners to maintain low room temperature? Does his unit have power back up in case of electricity failure? Cool temperatures are mandatory for hair follicles otherwise damage to precious follicles takes place. Is his unit equipped to manage any unwanted emergency situations? Then you ask about charges. His charges are per hair, per hair follicle units or per square inches. Also enquire about the density of transplanted hair. What treatment is to be taken after hair transplant? Does he treat your hair loss by medicines? Enquire about any or all side effects of medicines. What is the rational of his medicines? YOU SHALL KNOW NAME OF MEDICINES HE IS GIVING. (By law, the physician has to tell you the name of medicine and its side effect etc)
Hair Growth and the Hair Cycle
The normal human scalp contains between 100,000 to 150,000 follicles that produce thick terminal hair.

CAUSES OF HAIR LOSS
Most people who are losing their hair are losing it simply because they have inherited a genetic design that predisposes them for baldness. Hair loss can also be caused by underlying medical problems, drugs, infections and a variety of other factors. Medical problems that can cause diffuse hair loss include: Stress, prolonged disease, anaemia, thyroid disease, connective tissue diseases (such as Lupus), severe nutritional deficiencies; mainly iron, calcium and vitamins deficiencies, crash dieting, surgical procedures, and severe emotional problems. So if you think you are losing your hair, what should you do? Don’t panic! Consult qualified doctor (plastic surgeon/dermatologist) Particularly when androgenetic hair loss is in its early stages, medications are the treatment of choice. Not only can prescription drugs, like finasteride , slow or prevent further hair loss, they can actually grow hair back if started when the process is just beginning. Other medical treatments include improved intake of multivitamins, mineral, iron, calcium and minoxidil. Results of medical treatment come after 2 to 6 months of regular sincere treatment.

RATIONALE OF MEDICAL TREATMENT FOR HAIR LOSS Hair loss or growth is affected by many factors. Till date few of them are known as effects of androgen, genetic factor, stress, crash diet, long standing malnutrition, ferretin deficiency. In male front hair follicles are genetically predispose to fall with the effect of testosterone. We can not correct genetic factor but we can treat dietary deficiency and effect of hormone. A proper diet of vitamins, minerals, protein, amino acids play a major role in healthy hair growth. Any deficiency in these natural diet supplements can lead to gradual thinning of hair.

Nutrition value of the diet which we are taking needs to be evaluated. Freezing food products reduces nutritive value of food. Fresh fruits and vegetables have high value of anti oxidants. They should be consumed fresh. Pesticides, water and air pollution affect nutritive efficiency. Our body is very selective in supply of nutrients to our body parts. Priority is given to vital organs. Hairs are given least preference as far as supply of nutrients is concerned because we can be alive without hair .therefore in order to nourish our hair our diet should be supplemented by enough amounts of essential nutrients so they are available for hair follicles.

Some minerals and vitamins can influence the activity levels of another vitamin and minerals. For example, intake of lysine, vitamin B12, vitamin C help in absorption of other factors like iron. So the nutrient may not affect hair growth itself but may influence another nutrient that does. It is worth bearing in mind that due to complexity of the body there can be many potential interactions for even the simplest of nutrient.


ROLE OF VITAMINS, MINERALS, AMINOACIDS FOR HAIR GROWTH
Vitamins
Vitamin B12 (cobalamin).
Stress is one of the common causes of hair loss. Vitamin B12 is an anti-stress vitamin, which improves the condition of the immune system and it is also a potent hair growth stimulator. It is available in food sources like fish, dairy products, organ meats (the meat found in liver and kidney), eggs, beef, and pork. PANTOTHENIC ACID (Vitamin B5) ---Prevents graying and hair loss.present in whole grain cereals,breawer’s yeast, organ meat,egg yolk.Daily dose 4 to 7 mg.
Vitamin B6---Prevents hair loss,and helps in melanin formation.Daily dose 1.6 mg.
Niacin ( Vit B3)---Promotes scalp circulation.Present inwheat germs,fish,chicken,Daily dose 15 mg.
Biotin—helps in keratinin production.prevents graying and hair loss.Found in whole grains,egg yolk,liver,rice,milk.Daily dose 150 -300 mcg.
INOSITOL—Keeps hair follicle healthy at cellular level.present in whole grains,brewer’s yeast,liver,citrus fruits. Daily dose upto 600mg.
Vitamin E. the deficiency of this causes serious health hazards apart for major hair loss. Vitamin E is necessary to provide good blood circulation to the scalp by increasing the uptake of oxygen
Vitamin C- required for the healthy growth of hair and skin. It is commonly found in food sources like citrus fruits.

Proteins and Amino acid
Main constituent of hair is protein, so protein is an essential nutrient for hair production. Following are important aminoacids play important role in hair growth.
L-CYSTINE--For hair growth, the most important amino acid is cysteine. It contains sulfur molecules which cross link with each other to produce disulfide bonds. These chemical bonds gives strength to hair. This facilitate longer hair growth beyond what is genetically programmed.
L- LYSINE—This amino acid inhibit 5-alpha-reductase.This amino acid play important role in androgenic alopecia.
L-ARGININE-Hair follicle use nitric oxide to mentain and promote new hair growth.L-arginie is required to produce nitric oxide.

MSM---METHY-SULFA METHONATE--
Sulfur has been called nature's "beauty mineral" because it is needed to keep the hair glossy and smooth and keeps the complexion clear and youthful. It is needed for synthesis of collagen and is prevalent in keratin, a tough protein substance necessary for health and maintenance of the skin, nails and hair
Minerals
Minerals are one of the important diet supplements required for healthy hair growth. Without adequate quantity of minerals, our body is not able to absorb the benefits of other nutrients like vitamins, proteins, carbohydrates and fats.
Silicon
It builds the connective tissues, like ligaments and tendons. It leads to the growth of hair, skin and fingernails. Silicon is largely available in foods like whole grain, breads, cereals, alfalfa, beet, black pepper, bean and pea.
Zinc
is required for the normal growth of the hair, teeth, bones, nails and skin. It builds the connective tissue like ligaments and tendons. Zinc is largely available in food sources like whole wheat bread, seafood and other animal meats.

The FDA approval of oral finasteride and minoxidil for treatment of androgenic alopecia.

MINOXIDIL
The exact mechanism by which minoxidil works is not known, but the drug is felt to increase the duration of the hair follicle growth cycle (called anagen). This improves the quality of the hair by increasing the diameter and length of fine, miniaturized hair. Minoxidil is most effective if applied to the scalp twice a day. The medication only works if it is in direct contact with the scalp (not the hair) and only works in areas where it is applied. Therefore, it is important to use the medication in the front part of the scalp if this is an area of thinning. When using minoxidil, it may take 6-12 months before any results are seen. The majority of patients who see an effect from minoxidil experience a decrease, in the rate of hair loss. The drug also serves to thicken already existing hair, but most patients who do have results, grow only short, thin fuzz hair. It will not grow any new hair on a bald scalp. If minoxidil is discontinued, the effects of the drug wear off within three months and the previous pattern of hair loss resumes. When minoxidil is restarted, one generally does not regain the hair that was lost, so it is best not to stop and start the mediation, but to use it regularly. It is sold in concentrations of 5% for men and 2% for women. Only the 2% concentration of minoxidil has been approved for use in women. Female patients are generally more sensitive to the side effects of minoxidil in decreasing blood pressure (hypotension) and may get light headache from the medication. Women also have an increased risk of developing allergic skin reactions (contact dermatitis).


FINASTRIDE
Male pattern baldness or androgenetic alopecia is caused by the effects of the male hormone dihydrotestosterone (DHT) on genetically susceptible hair follicles that are present mainly in the front, top, and crown of the scalp (rather than the back and sides). DHT causes hair loss by shortening the growth (anagen) phase of the hair cycle, causing a decreased size or miniaturization of the follicles. The effected hair becomes progressively shorter and finer until it eventually disappears. DHT is formed by the action of the enzyme 5-alpha reductase on testosterone. Finasteride is a drug that works by blocking the enzyme 5-alpha reductase Type II that converts testosterone to dihydrotestosterone (DHT) in the hair follicle. Finasteride decreases both scalp and blood levels of DHT and its effect is felt to be related to both of these factors. Finasteride 1-mg/day decreases serum DHT levels by almost 70%. (Finasteride 1 mg) can hold on to hair at any age, but works best to re grow hair in those who are younger. Occasionally we see patients in their 50s re-grow some hair with finastride, but this is the exception rather than the rule. The benefits of finasteride will stop if the medication is discontinued. Over the 2-6 months following discontinuation of treatment with finasteride, the hair loss pattern will generally return to the state that it would have been if the medication had never been used. Of course, if there is no hair in the area at all, the medication is not going to work. Since finasteride takes up to a year or more to exert its full effects, in either re-growing hair or preventing further hair loss, patients must take finasteride for one year, or longer, before its effects can be accurately assessed. During the first six months, one may note some thinning of ones existing hair as the new growing hair replaces the miniaturized hair, so it is important to be patient during this period.

SIDE EFFECTS
Side effects from finasteride at the 1-mg dose are uncommon, and fortunately reversible. Of men taking finasteride 1mg, 3.8% experienced some form of sexual dysfunction verses 2.1% in men treated with a placebo. Finasteride and minoxidil work synergistically since their mechanisms of action are different. Minoxidil stimulates the hair follicle directly, but finasteride permits hair growth by blocking the negative effects of DHT.

HAIR TRANSPLANT V/S MEDICATION
Men experiencing hair loss often think of either using medication or having a hair transplant; however, the two treatments are not mutually exclusive. Finasteride has shown to be useful in complementing a hair transplant for a number of reasons:
Finasteride works best in the younger patient who may not yet be a candidate for hair transplantation. Surgery can be used when the patient is older if the balding has progressed.
Finasteride can re grow, or stabilize hair loss in the crown, where a hair transplant may not have been performed.
Finasteride is less effective in the front part of the scalp, the area where surgical hair restoration can offer the greatest cosmetic improvement.
For those who choose not to take finasteride, or who cannot take it due to its side effects, surgical hair restoration is just as effective. The only difference is that medications can prevent further hair loss whereas surgery cannot. It is important to note that medications are not needed for a hair transplant to be successful or for the transplanted hair to grow and be permanent.


TIPS FOR HEALTHY HAIR GROWTH
Apart from natural products, a disciplined lifestyle combined with a balanced nutritious diet is the key for healthy hair. Here are some natural hair care tips…..
Avoid smoking and drinks containing caffeine and carbonated sodas. They may decrease the normal rate of hair growth and weaken the body.
Take a healthy diet that includes vitamins like B group vitaimns, vitamin C, E and K. Hair growth is stimulated by protein rich foods including meat, eggs, cheese, seeds and nuts, yogurt, milk and milk products.
Eat fish as it is rich in protein, essential fatty acids and natural oils ( ghee ) which are essential for hair growth.
Have a good night’s sleep and take plenty of rest to maintain healthy hair.
If you are a restless sleeper, it is better to use satin pillow covers. Cotton pillow cases tend to catch the hair easily and help break up the hair cuticle by the constant rubbing.
It is better for women to tie the hair on the top of the head instead of leaving it loose when going to sleep
It is better to use natural shampoo or soap to clean hair. Use natural oils like Mahabhringraj, Amla or Arnica oil, coconut oil to massage the roots of the hair gently.
Prefer Sprouted foods, honey, amla, yogurt, milk and milk products, nuts and avoid fast food and carbonated drink. Fresh vegetables and fruits are rich in antioxidants and have much more nutritive value then freezed one.
Visualise yourself with thick, black dense hair over your scalp, then bald scalp. You have immense power of attraction so think for dense hair then baldness. “Your thought becomes thing”

SURGERY FOR HAIR RESTORATION
There are various procedures for hair restoration.
FOLLICULAR UNIT TRANSPLANT---FUT
FOLLICULAR UNIT EXTRACTION---FUE ( FOX )
ALOPECIA SCALP REDUCTION
USE OF EXPENDER.
SCALP FLAP


FUT….FOLLICULAR UNIT TRANSPLANT---
SURGICAL TREATMENT OF HAIR LOSS—FOLLICULAR UNIT TRANSPLANT—FUT In this a strip of hair is taken from occipital region, then individual follicle units are dissected out using STEREOMICROSCOPE. These follicle units are transplanted individually in bald area of scalp. These follicle taken from occipital region are not genetically predisposed to fall.
HAIR TRANSPLANT PROCEDURE
Hair transplantation surgery is considered to be “out-patient surgery.” Hair transplant procedures can take from 3–8 hours and are usually performed using local anaesthesia on an out-patient basis, often with some supplemental oral or IV medication for sedation. Patients are often awake, but feel very relaxed because of the effect of the sedative. There is typically little discomfort during the surgical procedure. The donor areas, where the grafts have been harvested, are usually closed with sutures or surgical staples, except in the Follicular Unit Extraction technique, which does not require surgical closure. These are usually removed in 7–14 days. Dissolvable sutures may occasionally be used in order to eliminate the need for you to return for suture removal. The recipient sites, where the grafts are placed on top, are essentially small, Superficial needle holes or slits in the skin of the scalp. At the end of procedure usually no dressing is applied.
FUE /FOX---FOLLICULAR UNIT EXTRACTION---
In FUE, using micro punch single follicle unit is extracted from donor area and this unit is transplanted. So there is no scar at donor site. Limitation of this technique is that it is very time consuming and in one sitting very limited number of graft can be implanted. In FUT strip technique large number of follicles can be transplanted. Experience of surgeon is very important pre requisite for success of this FUE. There is very high risk of damage to nearby follicles while harvesting follicle by micro punch. Consumer is not aware that how many nearby follicles and extracted follicles have been damaged. In FUT chances of damage to follicles are very less. FUE is good technique in experienced hand for limited number of hair transplant. Many surgeons are combining FUT with FUE to do large numbers of hair transplant in one sitting.
ALOPECIA SCALP REDUCTION
This is surgical excision of non hair bearing area of scalp in order to reduce overall size of bald area. Follicular unit transplanted is needed to cover remaining bald area of scalp.
SCALP EXPENSION Hair bearing area of scalp is expended using tissue expender. Then this expended hair bearing area is used to cover bald area of scalp.
SCALP FLAPS
Various scalp flaps has been designed to cover non hair bearing area of scalp. Based on vascular supply, various scalp flaps has been designed. These flaps are used to cover bald area of scalp.
The alopecia scalp reduction, scalp expansion and scalp flaps are major surgical procedures usually requires general anaesthesia. While choosing these procedures one should discuss all technical details with surgeon.

FEATURES OF REJUVENATE HAIR TRANSPLANT UNIT
Our unit is unique in many senses…
We have well trained senior hair transplant surgeon, trained Tricologist, trained operation theatre technician and well trained hair follicle splitters.
Our centre is as per norms, is certified by Government health department.

HAIR TRANSPLANT SURGEON----DR.ANIL GARG MS., MCh. plastic surgeon
He has done MS in General Surgery and MCh in Plastic surgery in 1993 From SMS Medical College, hospital Jaipur. He is well trained micro surgeon and done his fellowships in microsurgery from Taiwan and USA has extensive experience of plastic, cosmetic and micro surgery.
We have a state of art hair transplant unit with following features... Large operation room with good air conditioning and excellent ambience, Modified operation table giving comfort, with Silicone neck pads giving extra comfort.
Operation room having all monitoring equipments to have close watch on your vital parameters. Like continuous BP, pulse and blood oxygen monitoring.
Operation room is also equipped with gazettes to deal with very rare life threatening situation. Boyle’s apparatus with oxygen cylinder, endotracheal incubation equipments, Defibrillator etc are also there. Our unit has good power back up (high grade power generator) in case of any power failure so as to maintain operation room temperature which is very important for precious hair follicles.

STRIP HARVESTING
As in FUT technique we take a skin strip from back side of scalp. While harvesting strip due care should be taken to avoid damage to nearby follicles, this will give narrow scar. We use magnification loupe to avoid damage to follicles, as well as while suturing also care is taken to avoid damage to donor site follicles.
     
  Immediately after strip harvesting   Fine scar after taking skin strip  

FOLLICLE DISSECTION
We have STEREO MICROSCOPE (From England) for follicle dissection. These microscopes are specially designed for follicle dissection with patented technology which gives virtual 3Dimensional picture of follicle, so damage to follicles is nil. At the same time there is no extra tissue around follicles and all follicles are de-epithilised. This improves faster revascularisation of follicles. Assistants are given proper training for working with these microscopes. Our follicle damage incidents are negligible.

     
  STEROMICROSCOPES   Practice going on for follicle dissection  
         
   
  HAIR FOLLICLE UNITS DISSECTED UNDER MAGNIFICATION
(Some follicles may have one hair/ two hairs / three hairs / four hairs)
 
     
  Hair transplant is done in very friendly atmosphere with good music
around etc.
 
   
  Hair transplant going on in most comfortable condition  
     
   
  While transplant is going on patient can go to wash room, can have tea/ coffee etc. patient usually takes lunch / snacks with our team. At the end of day he is our friend.  
     
IMPLANTATION OF FOLLICLES
Implantation of follicles is another very important step. It is very important to prevent damage to delicate follicles while handling them during implantation. It should be absolutely traumatic. Stability of hand and delicate griping is necessary. We use Magnification loupe (from Zeiss) to full fill all above requirements. Dr. Anil Garg is basically Micro- neuro- vascular surgeon who has 20 years experience of microsurgery and done many replants, and other micro surgical procedures. His handling to follicles is unmatched. At our unit we implant using needles. For one hair follicle unit we use 20G needle, for two hair follicle unit 19G needle and for three and four hair follicle unit 18G needles are used.
   
  Hair implantation using magnification  
   
  Use of different size needle for different hair follicles.  

RESULTS OF HAIR TRANSPLANTS
Hair transplant is done for area where there is no hair at all or to increase the exiting hair density. As these hair follicles are taken from occipital area so they remains unaffected by the effect of harmone. So we can say transplanted hair is your own natural growing long lasting hair and to preserve them there is no need to take medical treatment. But if we want to control existing frontal hair loss medical treatment is advocated.
Before   After
CASE 1    
 
     
CASE 2    
 
     
CASE 3    
 
     
RESULTS OF MEDICAL TREATMENT AT OUR CENTRE
Medical treatment improves thickness of hair, control miniaturization of hair, convert baby hair (villus) into adult (terminal) hair. Medical treatment does not affect where there is no active follicle.
     
CASE IThis young man at 28 yrs, had thinning of hair with frontal and crown hair loss. Took medical treatment. Result after two months
     
CASE II—This man of age 41 yrs has severe hair loss with thinning of hair. His back area shows improvement just after one month treatment.
     
CASE III—One month treatment result.
     
     
CASE IV—This leady had hair loss, Results after two months treatment.
     
     
CASE V —Severe hair loss. No steroid given in our medical treatment. This is result after two months treatment only.
 
     
     
     
     
     
     
HOW TO CONTACT US
You can call on phone 91 8120300300, 91 731 2544351
E mail anilgarg61@yahoo.com
You can E mail your pictures. Take picture---front full face view, one head top view, each side view, and one back view. FRONT TOP RT.SIDE Lt.SIDE BACK





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