What's the buzz around immediate hair transplantation?

For our uninitiated readers, I'll start with the basics of hair transplantation.

Hair transplantation is the process of taking from hair from one part of the body to replace hair lost from another part of the body. It started off with hair on the head, and people have gone on to transplant beard hair as well. There are basically two kinds of hair transplantation methodologies used by trichologists.

Follicular Unit Transplantation (FUT): In this method of hair transplant, the patient is put under local anaesthesia. Then a strip of skin is taken from the back of the head (donor area). This strip is then dissected into grafts which are implanted to the front of the head. The harvested area is then sutured closed. This leaves a scar on the back of the head but is easily covered with the hair around the scar.

Follicular unit Extraction (FUE): In Fue, the doctor takes individual grafts, from a high-density hair region, most cases, this is the back of the head. These grafts are then implanted to the areas with low hair, in most cases this is the front of the head. The advantage with this method, is that the holes made during graft extraction, heal easily without leaving scars.

Most doctors today use FUE, as it is a better method (read minimal scarring), the grafts are pulled out and counted to provide the patient with the number of hairs that will be transplanted. This number is usually in the thousands. Extracting these many grafts can take a lot of time. Hair grafts spent this time outside the head. Immediate hair transplantation aims to change that.

What exactly is immediate hair transplantation?

The grafts that are extracted to transplantation, need to be kept moist for the best results. When the grafts spend time outside the body, they may become dry and dehydrated. Doctors use proper solutions to keep them hydrated, as seen in this video.

This includes placing them in a moist environment & watering them with a spray can. Whatever procedure the doctor may do, the best way to improve the number of successful grafts is to reduce the time spent outside the head. Typical success rate with hair transplantation i.e. the number of clean successful hair grafts is around 60-90% depending on the time spent outside the body.

IHT aims to increase this significantly, allowing for better results. This can lead to great results in 3-4 months with successful cases. "We at the Venkat Center do this by a special coordinated process and because we have a unique team: two transplant surgeons, dermatologist and a plastic surgeon," says Dr. Venkataram.

This was undertaken by Dr. Pradeep & Dr. Arika Bansal. Per their findings, "the survival rates are improved." Their conclusion was, "DHT procedure significantly reduces the transit time as compared to the current procedure of FUE, and thus minimizes the physical handling, mechanical trauma, chances of desiccation, hypoxia, infection and grafts getting heated up. It is an efficacious surgical modality for hair restoration. Although it may appear slightly more difficult and longer procedure for the traditional FUE surgeon in the beginning, with more practice and after improvement of expertise, it may take lesser time and turn out to be easier."

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764754/

The hypothesis is a reasonable, but as Dr. Venkatarm pointed out some time back, "What is needed is a split scalp study to establish the efficacy of this method." He adds, "There certainly is a logic here, but it has not been proven beyond doubt." Lately, there have been several other studies on the topic and IHT is providing a better hair survival rate. In a split scalp study last year, IHT provided better results compared to conventional FUE transplantation.

What's next for IHT?

However, there are a lot of kinks to work out.

The patient position is a variable trichologists are working with. Depending on the area of transplantation (extraction & plantation), the patient is sitting, lying to the left, lying to the right, lying on their back, sitting with either cheek on a pillow.

Then the number of grafts in IHT is an important process as most trichologists bill the patient based on the number of transplanted grafts.

Also, as Dr. Venkataram pointed out in the earlier article, "There is the limitation of access to the operative area-the method causes operator stress as the authors have admitted themselves. This could affect both extraction and the implantation process, causing possible damage while handling the grafts."

Disclaimer: The author of this article is not a trichologist but talked to some during the drafting process. The views presented are his own (unless cited). The article is based on his understanding of the studies around the several cited articles.

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