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What is Plastic Surgery?
 
Plastic surgery is a surgical sub-specialty that deals with the healing and restoration of patients with injury, disfigurement or scarring resulting from trauma, disease or congenital defects. It includes aesthetic, or cosmetic surgery to correct or rejuvenate facial and bodily features not pleasing to the patient. Derived from Greek, the word plastic means molding or giving form and does not refer to the use of plastic materials.

How does a physician become a plastic surgeon?

Training to become a plastic surgeon is a difficult task. To become board certified by Medical Council, a doctor must complete a specialized post-graduate training course of five to six years. Background training usually includes a thorough grounding in general surgery however; a background in ENT or orthopedics may be acceptable. The final two to three years of training must be in an approved plastic surgery training center.

What questions should I ask before choosing a plastic surgeon to make sure he/she is qualified to operate on me?

Bringing a checklist of questions can help ensure the safety and quality of your procedure. Questions to ask are:

• Are you certified by the Medical Council of India
• When the doctor claims to be board-certified, ask by which board.

Do you have hospital privileges to perform this surgery?

Some surgical procedures can be performed in the doctor's office or other outpatient facility but it is important to find out if the doctor has operating privileges in an accredited hospital for the same procedure you are having. Before granting operating privileges, hospital review committees evaluate a surgeons training and competency for specific procedures.

Where will you perform my surgery?

If it's in an office-based facility, ask if it's accredited. It is best if it is a Hospital setting.

How many procedures of this type have you performed?

Also ask what training has been completed, especially in new techniques. Ask to see certificates of training.

What are the risks involved with the procedure?

       There are risks with any surgical procedure. Find out what they are, how often they occur, and how they will be handled if they do occur.

What is the expected recovery time?

       Be sure to discuss postoperative restrictions on activity and typical time periods for resuming work.

What is your policy on surgical revisions?

Some cases may require revisions to achieve the desired results. Find out about any costs for which you may be responsible.

How much will the surgery cost?

       Cosmetic surgery is not covered by insurance, and payment usually is required in advance. Costs include the surgeon's fee and fees for the surgical facility and anesthesia. Other possible costs are the preoperative physical and blood work, medications, surgical garments and private-duty nursing.

What procedures do plastic surgeons perform?

Aesthetic (also called cosmetic) problems with the face, neck and trunk, including forehead, eyes, nose, ears, lips, chin, neck, breasts, abdomen, hips, buttocks, thighs, calves, arms, and skin.

Congenital deformities of the hands and face, including clefts of the lip and palate.

Benign (non-cancer) and malignant (cancerous) tumors of the head and neck, skin and soft tissues.

Traumatic injuries of the bony facial skeleton and hand as well as soft tissue injuries of any part of the body.

Surgery of the hand.

Surgery of the jaw and facial skeleton.

Any type of skin cover and replacement problems.

All types of reconstruction following removal of cancer resulting in disfigurement of any part of the body including the face, breasts, trunk.

What is aesthetic (cosmetic) surgery?

Aesthetic surgery, also known as cosmetic surgery, seeks to improve an individuals appearance. These type of operations most often involve the nose, ears, face, forehead, eyelids, breasts, abdomen, hips and thighs.

Is a plastic surgeon a skin specialist?

Dermatologists specialize in skin, but the plastic surgeon has an equally important role of the treatment of benign and malignant tumors of the skin. The skills of a plastic surgeon are especially needed when large areas of the skin must be removed and replaced especially where disfigurement may result or when these areas are in conspicuous areas such as the face. Plastic surgeons also perform skin resurfacing techniques, for cosmetic purposes, in order to achieve healthier looking skin by reducing facial wrinkling and pigmentary changes of the skin.

Will I have a scar after plastic surgery?

Scarring is inevitable of healing, however a very fine lined scar placed in the correct orientation may be virtually invisible. A plastic surgeon spends years trying to master techniques to place scars in the most desirable location. Plastic surgeons will try to make incisions in areas that will not show, like under undergarments or along natural creases. Scars will normally fade over time, but certain areas of the body such as the back and chest, produce more severe scarring regardless of the technique used for reconstruction and closure. The severity of the scarring varies from person to person.

Does plastic surgery always involve skin grafting?

Skin grafting is only used when it is the best way of closing a wound or defect. A qualified plastic surgeon uses judgment to decide the best way of reconstructing a defect. A skin graft may appear to have poor color match and texture compared to the native skin, but with careful selection of a skin graft donor site these problems may be minimized.

What is a pedicle graft or flap?

A pedicle graft also called a flap, consists of a segment of skin, underlying subcutaneous tissue and/or muscle which is shifted from one area to an open wound or defect for coverage of that wound. The word pedicle means that the blood supply to the flap is never divided. When the blood supply is completely divided and reattached this is called a free flap, and requires specialized skill in microvascular surgery.

What is rhinoplasty and nasal reconstruction?

Rhinoplasty, or nose reshaping, reshapes the nose to improve appearance, and it may also be used to alleviate breathing problems.

Pain from nose reshaping procedures are surprisingly mild. A splint is usually worn over the nose and sometimes inside the nose for five to seven days. There may be some bruising around the eyes, but this usually clears up in one to two weeks.

Can I receive a second nose reshaping if the first surgery does not produce the desired result?

Sometimes a touch-up is necessary after a nose reshaping, but it is generally better to wait a year before any additional surgery is performed. This also allows the maximum time to see the final results of the surgery.

What aesthetic surgical procedures are performed to improve the aging face?

There are various degrees and stages of facial aging that can be caused by the natural aging process, heredity, and lifestyle choices. Plastic surgeons have undergone training to address all areas of facial rejuvenation. A face lift tightens and lifts the redundant skin in the face and neck. Additional procedures are available to improve the aesthetics of the forehead, eyes, mouth, chin and neck. Minimally invasive endoscopic techniques are also available. Fine wrinkles of the face may be best treated by skin resurfacing techniques, like laser resurfacing, chemical peels or other skin care treatments.

How is a face lift done?

During a face lift incisions are made in the hair line, temple region extending down in front of the ear and then around the back of the ear into the hairline. These incisions vary depending on the technique used by your plastic surgeon. Many plastic surgeons are well trained in more than one face lift technique. The skin of the face and neck is dissected into the cheeks and neck allowing it to be mobilized upward producing a tightening and smoothing result. Many plastic surgeons can now also tighten the muscular layers underneath the skin as well during a face lift procedure. Years of specialized training are necessary to safely perform this procedure. The results can be subtle or drastic depending on the condition of the facial area prior to the surgery and the desired results.

Does a face lift leave scars?

Yes, but as with other scars plastic surgeons have been trained to place them in areas that are very inconspicuous. Your plastic surgeon will be able to show you exactly where your scars will be following your surgery. Normally your hair will cover up most of the scars and makeup can touch up any leftover marks.

How is excessive wrinkling and bagginess of the eyelids corrected?

Eyelid surgery can correct this condition. Excessive skin and fat may be removed from both upper and lower eyelid. Tightening of the lower lid may also be done in concurrence with this procedure. One to two weeks of bruising and swelling is expected from this procedure. Eyelid surgery may be done in combination with or separate from face lifts or other types of aesthetic surgeries of the face such as brow lifts to better proportion your facial features.

What surgery can improve the appearance of breasts?

Three common procedures are performed: breast augmentation, breast lift, breast reduction.

Augmentation mammaplasty is a procedure that can safely enlarge a small breast or increase an undesired size. Different techniques are used, but in general this is performed using a saline breast implant, after the FDA ruled silicone unsafe in 1992. Implants may be placed in different positions depending on the physical make-up of the patient and her breasts. The implant may be introduced through three different incisions: below the breast, around the nipple areolar complex, or in axilla (arm pit).

A breast lift is used when the patient is happy with the size of her breasts however due to aging and pregnancy the breast gland has begun to droop. Various techniques are employed to accomplish a breast lift and results are generally excellent.

Breast reduction is designed to make overly large breasts smaller. Patients seeking this type of surgery often have multiple severe physical symptoms secondary to their large breasts including neck, shoulder, back pain, paresthesia of the arms and bra strap grooving of the shoulders. The technique of breast reduction requires lengthy incisions; however, they may be placed in inconspicuous locations such as the fold underneath the breast. Typical symptoms of back pain, neck pain etc. are almost always improved after a breast reduction if not completely eliminated. This procedure is often covered by insurance.

Am I a good candidate for liposuction?

Liposuction is not used for weight loss, rather to correct problem areas or fat bulges. A candidate will be close to their ideal weight because a liposuction is typically performed in patients that have an area of fat they find hard to lose. The fat removed does not weight a lot, so patients should expect a shape change, not a weight change.

Do the results of liposuction last?

As long as the patient maintains a healthy life-style, including exercise and a sensible diet, liposuction results are long lasting. Once the fat cells have been removed from an area there is no longer a preferential fat storage area and any fat gain will be distributed more evenly over the rest of the body.

What areas of the body can be treated with liposuction?

Most body areas can be treated with liposuction, though the most common areas in females are the abdomen, hips, and thighs. Men are often treated for liposuction in the breasts, hips, and abdomen. Liposuction is not limited to these areas, though other places may include the upper arms, under the chin and the buttocks.

Does liposuction leave scars?

Incisions made during liposuction are generally very small and put in areas that are more inconspicuous. Most cases of liposuction will heal well and it will be difficult to see where they were originally made.

What is the difference between cosmetic and reconstructive surgery?

Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem. Cosmetic surgery is usually not covered by health insurance because it is elective.

Reconstructive surgery is performed on abnormal structures of the body, caused by congential defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance. Reconstructive surgery is generally covered by most health insurance policies although coverage for specific procedures and levels of coverage may vary greatly.

There are a number of "gray areas" in coverage for plastic surgery that sometimes require special consideration by an insurance carrier. These areas usually involved surgical operations which may be reconstructive or cosmetic, depending on each patient's situation. For example, eyelid surgery (blepharoplasty) - a procedure normally performed to achieve cosmetic improvement may be covered if the eyelids are drooping severely and obscuring a patient's vision.

What is recovery from plastic surgery like? Will I be able to tolerate the pain post-operatively?

Each patient will tolerate pain post-operatively in a different way, and we consider this. While some patients may describe the pain as an ache, others experience greater discomfort. Appropriate pain medications are prescribed for the post-operative patients, and these help minimize discomfort. Most facial cosmetic operations have minimal discomfort post- operatively. Liposuction is slightly more uncomfortable, and operations that require elevation or tightening of the muscles-such as an abdominoplasty or breast augmentation have discomfort equal to that of a C-section.

How long is the recuperative period and when can I return to work?

The length of time it takes to recuperate after plastic surgery varies depending on the procedure performed and the person operated on. Most patients will require assistance for the first two days. Then most patients are able to care for themselves, but may still need assistance if they have small children to care for. The specific lengths of disability are outlined below by procedure. These are approximations, and do not include return to exercise. Eyelid Surgery - Usually can get around independently by the second day. With the use of sunglasses, may feel comfortable going to the store by day 3-4, and with makeup could return to work by 5-7 days. Facelift Surgery - Usually can get around independently by the second day. Usually do not feel comfortable going out in public for 5-7 days. Requires 10-14 days before returning to work if in the public eye. Breast Surgery - Usually can get around independently by the second day. May return to work at 5-7 days if not required to lift more than 15 pounds. Liposuction - Usually can get around independently by the second day, earlier if smaller number of areas treated. One can return to work and normal activities in 5-7 days. Abdominoplasty - Patients may take between 2-4 days before getting around independently. The recovery is almost identical to C-section. One can return to a desk job at 5-7 days, other jobs 10-14 days. When can I resume regular exercise? The time a patient resumes regular exercises varies based on the operation performed. All patients are encouraged to start a slow walking routine on the second postoperative day. Regular aerobic and more vigorous activities are not allowed during the first 2 weeks in order to decrease the risks of bleeding, swelling, and bruising. Weight lifting and contact sports are allowed at 1 month in most cases

What is the difference between reconstructive and cosmetic plastic surgery?

Reconstructive surgery corrects defects (as in breast reconstruction after cancery surgery) or restores function, while cosmetic surgery is meant to improve a person's normal appearance.

What is Male Pattern baldness?

Thick lustrous hair are the envy of all – particularly young people who suffer from premature hair loss. It is quite normal for even young adults to lose 100 strands of scalp hair daily; but this is because, in the normal course, new hair keeps appearing to replace them. This, however, does not happen in pattern baldness, which results in bald areas showing up on the scalp. And this continues till the person is totally bald. The only solution then is medical hair restoration through hair transplantation. 

What are the causes of pattern baldness?

Most people who lose scalp hair are genetically predisposed to pattern baldness. Such people have a male hormone in their hair follicles, called testosterone, which gets converted into dihydrotestosterone (DHT) by an enzyme called 5-alpha reductase. 

The effect of DHT on the hormone receptor in the hair follicle is to slow down hair production, thus resulting in weak hair. When that happens hair growth can cease completely. Baldness follows a certain set pattern. It’s usually the temples or the crown of the head that first start balding. Then it spreads to the other areas. 

Stress is another cause of baldness. People who lead stressful professional or personal lives, and do not exercise enough, are more prone to baldness than those who are carefree.

 Why men are the biggest sufferers?

To find out whether men are more likely to suffer from pattern baldness than women you don’t need to consult an expert. Just look around you and you’ll have the answer. Yet why does this happen? The reason is biological. Women’s bodies do not produce the male hormone testosterone that causes male pattern baldness. 

The production of testosterone in the male body continues throughout a person’s lifetime. A new supply of this hormone produced by the testicles is always on the way. To make space for these new supplies the older lot gets converted into di-hydro-testosterone (DHT). As the body ejects the DHT, a waste material, the hair follicles in the scalp get clogged and become incapable of holding on to the hair. This is what causes baldness. 

 People in the 20-45 age group are particularly vulnerable to male pattern baldness. To repeat, both hormonal and lifestyle factors can be the cause of male pattern baldness. Of all the methods of medical hair restoration it is hair transplantation that such people need to go in for. 

What is the hair structure like?

There are several reasons why people lose their hair and require medical hair restoration. The hereditary factor predominates in cases of male pattern baldness, though stress too can play a role. That is when hair transplantation, a highly effective method of medical hair restoration, becomes necessary. 

 Hair consists of two parts – the hair follicle and the hair shaft – and is composed of a protein called keratin. Each hair strand has three layers. The innermost layer, or modula, is found in large thick hair. The cortex – or the middle layer – gives the hair its strength, color and texture. The outermost layer, called cuticle, protects the cortex.

· Structure of hair root

The hair root is enclosed within the hair follicle, and the dermal papilla lie at its base. The root is nourished by the bloodstream, which is how new hair sprout up. Here-in lie also the receptors for the male hormones and the androgens that are crucial for hair growth. The androgens, which regulate hair growth, can cause the hair follicle to progressively shrink, causing the hair to thin down in people who are genetically predisposed to hair loss.

· Hair follicle

The hair follicle is a sac-like structure. Hair grows out of the follicle, into which the sebaceous glands also open. The hair follicle grows by packing old cells together. The sebaceous gland, a sebum-producing gland, is attached to the hair follicle. Having thick hair implies an abundance of sebaceous glands that are absent from the palms, lips and soles. 

A tiny bundle of muscle fiber called arrector pili is also attached to the hair follicles. The arrector pili causes the follicle and hair to rise perpendicularly to the skin surface. Hair follicles grow at the rate of .04 cm per day.

· What is dermal papilla?

The dermal papilla, a small structure based at the root of the hair follicle, is made up of connective tissue and a capillary loop. There is no cell division in the papilla, around which is the hair matrix – a collection of epithelial cells that are often interspersed with melanocytes. The cell division in the hair matrix enables formation of the hair fiber and the inner root sheath. The hair matrix epithelium is a fast-growing cell population in the human body, and the papilla is normally pear-shaped with the matrix wrapped completely around it.

· Hair bulb

The hair follicle consists of two parts. The hair bulb inside it produces the long fine cylinder of hair. New cells are continuously being produced in the lower part of the hair bulb. As it develops it steadily pushes the previously formed cells upwards. Once a cell reaches the upper part of the bulb it gets transformed into six cylindrical layers – the three layers in its inner side becoming the actual hair.

 Special cells in the hair bulb, called melanocytes, produce the pigment called melanin, which gives the hair its color.

 Hair growth

 Hair performs various functions for the human body, besides adding to a person’s personality. How good you look depends in large measure on the kind of hair you have. Hair loss can be traced to heredity, disease or stress. In medical hair restoration the surgeon employs the hair transplantation route, which is a permanent and safe solution for treating the malady. 

 Hair is composed of a protein called keratin. Each hair strand comprises a hair follicle and hair shaft, and has three layers. The innermost layer, or modula, is found in large thick hair. The middle layer, called cortex, provides the hair its color and texture. The cuticle, or outer layer, protects the cortex. 

In healthy people hair growth is a constant process. This is because new hair cells are being constantly formed at the base of the follicle. The growth occurs after the male sex hormone androgen activates specific areas of the body.

 Hair growth is individual specific: some have more and some less, depending on a host of factors led by heredity. Besides, the hair on the scalp grows faster than on the leg. In genetically determined hair loss no new hair follicles get formed.

· Cycles of hair growth

Hair grows in three cycles. The first, called anagen, is the growth phase. Catagen is the involuting or regressing phase and telogen, the third, the resting phase.The anagen phase is the reawakening of the follicle's growth stage where a newly formed hair begins to grow. This phase can last from weeks to years. The rate of growth depends on factors such as the body part, gender and a person’s hormonal constitution.

Growth slows down in the second phase – the catagen – and continues into the last phase, the telogen. This last is a phase of inactivity or rest. In it the hair separates from the dermal papilla and becomes incapable of receiving nourishment. No new hair cell gets formed and the inactive hair is kept in place by a thin strand of epidermal cell. At the end of the last stage the hair shaft is held in place only mechanically. 

· Why hair growth stops

There are three stages of human hair growth – anagen, catagen and telogen. After the last stage of hair growth, telogen, there is no new growth.

Several factors contribute to pattern baldness . The main reason for male pattern baldness is hereditary. Other factors include medication, radiation, chemotherapy, exposure to chemicals, thyroid dysfuntion, generalized or local skin diseases and stress. Hair thinning is caused by a short anagen phase and an inordinately long telogen phase. This eventually leads to the hair follicles drying up completely, spelling the end of the growth cycle. The only way of countering hair loss is to go in for medical hair restoration through hair transplantation – a sure shot way of achieving permanent medical hair restoration. 

 · What is hair transplantation?

People suffer from pattern baldness for various reasons, heredity leading the list. Stress, disease and harmful medication too can result in male pattern baldness and hair transplantation is the most effective solution for it. The process involves transplantation of the scalp’s hair-bearing portion onto the bald area. Thanks to recent technological advances hair transplantation is today considered one of the most convenient and affordable methods of medical hair restoration. No wonder it is so popular among the balding masses, though there are several alternatives to the hair transplantation method of medical hair restoration. Intake of Propecia is a prominent one. 

· History of hair transplantation

The first hair transplantation surgery was conducted in Japan around the 1930s, using small grafts to treat damaged eyebrows and lashes. But hair transplantation to treat pattern baldness drew scant attention during the War years. It was not till the American dermatologist Orentreich used free donor grafts on bald areas in the 1950s that it drew the attention of the world medical fraternity. Orentreich proved that donor grafts not only survived in the recipient areas, but actually thrived there, just as if they were natural hair. Initially surgeons transplanted only small grafts, measuring not more than 2 to 4 mm. But subsequently surgeons in Brazil came up with “micrografting” and “minigrafting” techniques, which are now familiar to us as follicular unit transplantation. 

· Pre-surgery precautions

Before hair transplantation can begin the patient gets to choose between single and multiple sessions. The surgeon also provides a list of dos and don’ts: s/he must stay off alcohol and medicines not prescribed by him.

· Post-operative care

The operated area must not be exposed to sunlight for some days after the surgery and shampoos and chemicals shunned. It sometimes happens that the displaced hair starts falling off from the recipient zone. This should not frighten you, it being part of the process of hair restoration. Regrowth resumes a few months later.

After hair transplantation the patient loses hair only in areas where no hair had been transplanted. Some people start with medication, and not finding it effective enough move on to the hair transplantation treatment. It is the only permanent method of hair restoration on the scalp.

· What is the Cost of hair transplant surgery?

The charges for each graft are Rs 40. All expenses except for the medicines are included.

The standby anaesthetist would be available if required.

· Why hair transplantation is favored

Hair transplantation is the most effective method of dealing with male pattern baldness. The surgery involves removal of the scalp’s hair-bearing portion and transplanting it onto the bald patch. Recent technological advances have made hair transplantation so convenient and affordable that it is today the most popular method of medical hair restoration.

Besides the hair transplantation method of medical hair restoration there are other options for surgical hair restoration, Propecia being a prominent one. 

· What is the procedure of hair transplantation

Hair transplantation surgery is a delicate affair calling for a series of precautions. In the surgery that takes about four-eight hours the scalp is treated with certain antibacterial chemicals and then shampooed.

The single strip (which is the gold standard in hair transplant) surgery involves harvesting a strip of hair from the scalp’s hairy area, or the donor strip, that measures 1-1.5 x 15-30 cm. Great care is taken while removing the excess fatty tissue to ensure that the vital follicular cells come to no harm. Using binocular microscopes for close inspection the surgeon punctures the graft-receiving sites with a fine needle. These are then arranged according to a predetermined density and pattern and the individual grafts placed on the problem patches. Normally 40-50 grafts per square centimeter are considered enough for providing acceptable hair density.

When done properly this method of medical hair restoration can yield breathtaking results. It becomes hard to tell whether the hair is natural or been transplanted. Surgery is also convenient because much less time is used up in separating the follicular units and their transplantation in the problem areas.

In hair transplantation surgery it is also possible to save the follicular units from iatrogenic injuries that bedevil the dissection phase and during placement of grafts. 

· FUE

This is the latest modification of the punch technique which was used for decades, but in this the punch size is made small so as to accommodate single hair follicle unit. In our OT we use special punches with latest hand held micro-motors to extract these hair follicles intact and implant them with equal care into the recipient site. All surgeries are done under binocular loupes( Carl Zeiss) and microscope is used where required.

· Precautions before and after surgery

Several precautions are taken while conducting hair transplantation surgery, of which the patient is informed in advance. S/he also decides whether to go in for single or multiple sessions. But it is important that no medicine other than the antibiotics prescribed by the surgeon is taken and the patient stays off alcohol for a designated period before surgery.

The operated area must not be shampooed or exposed to sunlight for some days after surgery. And don’t get scared if some of the hair falls off in the displaced area. This is part of the process of hair renewal and re-growth takes just a few months to resume. 

After the hair transplantation surgery the patient loses hair in only the areas where none was transplanted. Whether to go in for medication or hair transplantation treatment of the untreated areas is the patient’s prerogative. But if he s/he has opted for surgery in one portion it makes sense to repeat it in the newly balding areas as well. For remember that medication isn’t half as effective as transplantation in these extreme cases. 

Genetic factors predominate in cases of male pattern baldness.Those who are genetically predisposed to baldness have testosterone in their hair. The hormone gets converted into dihydrotestosterone (DHT) by the enzyme 5-apha reductase. DHT slows hair production, and the hair produced is weak. In many cases production of new hair ceases completely, resulting in hair loss, and ultimately total baldness. Another cause of male pattern baldness is stress.Among the several methods of medical hair restoration follicular unit transplantation is considered the most effective and therefore widely used. The surgery, which is performed by a professional surgeon, involves transplanting hair from the permanent zone in the back of the scalp onto the affected areas.

The donor tissue is removed in one piece so that the follicular units that are being relocated from the back of the scalp are not damaged. Single-strip harvesting, an essential component of follicular unit transplantation, not only preserves the follicular units but also ensures no damage is caused to the individual hair follicles. Follicular unit transplantation allows the surgeon to use small recipient sites. 

The technique of follicular unit transplantation follows a well laid out pattern. During surgery the follicular units that are removed from the donor tissue are carefully studied under a microscope/magnification. This microscopic dissection raises the yield of both the absolute number of follicular units and the total amount of hair. 

· Follicular unit transplantation and mini-micrografting

Minigrafting and micrografting techniques of hair transplantation are similar to follicular unit transplantation. However, follicular unit transplantation is different from minigrafting and micrografting, both of which use a multi-bladed knife to split the follicular units. This causes unacceptable levels of transection of hair follicles.

In follicular unit transplantation graft sizes are determined by nature. In mini-micrografting, on the other hand, the graft sizes are arbitrarily determined, and the donor tissue spliced to the size the surgeon deems fit.

Follicular unit transplantation differs from mini-micrografting in another respect as well. In the latter the hair follicles are not kept intact, and the follicular units are not preserved. Speed and economy are more important in mini-micrografting. The technique uses a multi-bladed knife to quickly generate thin strips of tissue, following which direct visualization comes into play, and the tissue severed. Mini-micrografting is the shorter and less expensive route of the two.

· How follicular unit transplantation is done

While the main cause of male pattern baldness is genetic predetermination, stress too is a factor. Yet whatever the cause of male pattern baldness follicular unit transplantation , the most widely used method of medical hair restoration, is the sole recourse in these extreme cases.

In follicular unit transplantation the surgeon scans the follicular units that are being removed from the donor tissue under a microscope. This stereomicroscopic dissection is essential for protecting the follicular units and ensuring a rich yield of both the follicular units and the total amount of hair that is restored.

Follicular unit transplantation is different from minigrafting and micrografting that use minimal or no magnification during graft removal. The follicular way thus ensures that the transplanted hair looks natural and the hair transplants use up the maximum hair from the donor site. 

· Donor strip

In follicular unit transplantation the donor strip is the strip of hair that is taken from one part of the body and transplanted to the scalp’s bald region. In this technique the donor tissue is removed in one piece to ensure that the follicular units being removed from the back of the scalp suffer no damage.

· Extraction of the donor strip

The donor strip is removed from the permanent zone in the back of the scalp and transplanted onto the problem areas. The single-strip harvesting in follicular unit transplantation helps in preserving the follicular units and protecting individual hair follicles from possible damage. The surgeon takes no chances and removes the follicular units from the donor tissue under close microscopic control. This stereomicroscopic dissection results in higher yields of follicular units and the total amount of hair. 

· Follicular units

Follicular units are a bundle of hair that grow together. On an average one to four terminal hair follicles form a follicular unit. In the case of genetic balding the hair that is transplanted is of smaller diameter and length than the hair replaced. Each follicular unit is surrounded by one to two fine vellus hairs, oil glands, a small muscle and a fine band of collagen. The follicular unit is the skin’s hair-bearing structure that ensures maximum growth. Viewed under a microscope it looks like a well-formed structure in the skin.

Using individual follicular units has several advantages. For while this makes it possible to use very small units the amount of transplanted is proportionately much larger. Thus a surgeon can place up to four strands of hair in a tiny recipient site, something that has tremendous implications for cosmetic surgery in general. This makes follicular unit transplantation a considerable improvement over micrografting. Transplantation of individual follicular units also provides a natural look to the transplanted hair. So don’t make a bet on this score. You’re bound to lose it!

· Removal of follicular transplants

In follicular hair transplantation individual follicular units are removed directly from the donor area. In other words this method does away with linear incision. A 1-mm punch is used to make a small circular incision in the skin around the upper part of the follicular unit, which is then directly extracted from the scalp.

Follicular unit extraction (FUE) and follicular unit transplantation (FUT) are often treated as two different things. Not so! FUE is actually a type of FUT wherein the follicular units are extracted directly from the scalp, and not microscopically dissected from a strip that has already been removed. In follicular unit transplantation the individual follicular units can be obtained either through single-strip harvesting and stereomicroscopic dissection or through FUE.

· Preservation of follicular transplants

In follicular unit transplantation it is important to keep the individual follicular unit intact. The unit should neither be broken up into smaller units nor combined with larger ones. This is a path-breaking development in the history of cosmetic surgery. Many hair transplant surgeons combine several follicular units or split them up. But the practitioners of follicular unit transplantation, and those they have treated, know better.

· A delicate procedure

There are many reasons for male pattern baldness, including heredity and stress. Follicular unit transplantation is a method of medical hair restoration used in the case of male pattern baldness. In this technique hair is transplanted from the permanent zone in the back of the scalp onto the balding regions. Only naturally occurring follicular units are used. While removing follicular units the donor tissue is removed in one piece to avert damage. Single-strip harvesting is an important feature of follicular unit transplantation.

Great care is taken during hair transplants and thereafter. The follicular units are held in 0.9 saline chilled to 59°F and not allowed to stay out of the chilled solution for longer than five minutes. The surgeon places a few follicular units on the back of his hand, his gloves preventing heat transfer from the hand to the implants. The hair transplants are then placed on the scalp. The speed of the operation depends on both the quality of the hair and the surgeon’s skill. 

· Pre-transplant preparations

A month before hair transplant surgery the patient must grow his/her hair long enough to be combed and consult the surgeon about the medication to be taken. S/he must also be informed in case there is a skin infection in or around the problem area. The patient must stop drinking and smoking a couple of weeks before surgery and avoid using any chemical on the hair. It must also be washed with an antiseptic soap or shampoo and the use of skin creams avoided. In some cases the patient reports for surgery on an empty stomach, or he could be put on a surgery-specific diet. On surgery day the hair is washed with an antibacterial shampoo and the prescribed antibiotics administered.

Hair transplantation is a highly effective means of restoring hair on the scalp and performed by a qualified surgeon with a proven track record. The entire process takes around four hours.

The procedure of hair transplantation involves harvesting a strip of hair from an area of the scalp that is rich in hair and transplanting it onto the bald patch. The donor strip usually measures 1-1.5 x 15-30 cm.

· Risk factors in hair transplantation

Hair transplantation is a highly effective method of medical hair restoration. In it the hair-bearing portion of the scalp is removed and transplanted on to the hairless one. What results is natural hair where there was none. 

The risks involved in hair transplantation are minor and can include bleeding, infection and scarring. Pre-transplantation anxiety is less easy to quell due to the numerous misconceptions surrounding it. It is normal for patients to become jittery, especially while the hair transplantation surgery is in progress. The long time it takes tends to make the person undergoing surgery restless. Patients report varying degrees of discomfort at the donor site and of the forehead swelling up. The swelling, however, is temporary and recedes within days of surgery. A good surgeon prepares patients well in advance, so as to raise their comfort level and ensure speedy recovery. 

· What are the alternatives to surgical hair restoration

Hair transplantation is the only permanent method of hair restoration. There are also some medicines that, when used regularly over an extended period, slow down and, in some cases, even reverse baldness.

 Among the medicines that assist medical hair restoration Minoxidil, marketed as Rogaine, is a popular one. It is applied on the scalp twice daily and acts variously on patients, depending on their constitution and the extent of baldness. Having applied the preparation the scalp should be massaged thoroughly, and the treatment pursued over an extended period.

 Finasteride, marketed as Propecia, is another medicine which is sold in pill form and taken once a day. The Propecia hair loss treatment is known to work well in cases of male pattern baldness, but only if it is used over a long period of time.

 There is also the camouflage solution. As the term implies these colored creams, sprays and powders camouflage the thinning hair areas on the scalp creating the illusion of hair in and about the area where it is thinning.

• Painless hair transplantation

Hair transplantation techniques have seen various advances in recent times. All these ensure painless hair transplantation.

 The Woods technique of follicular relocation offering painless hair transplantation is really quite different from traditional surgery, which is painful and can cause scarring. The Woods method involves transplanting of only hair and not the excess tissues, as is the case with the older techniques.

 This means that the transplant site needs only to nourish the follicles, resulting in a higher take rate and a much lower risk of a fallout caused by localized shock. The method has benefited over 2,000 people so far. 

• Propecia
  
  Propecia is a safe and reliable method of hair restoration. It prevents the conversion of the male hormone testosterone into di-hydro-testosterone (DHT). The production of testosterone in the testicles is unceasing during a man’s lifetime. As new supplies pour in the testosterone that was present earlier gets converted into DHT – a waste product. While it is getting ejected the DHT clogs the hair follicles of the scalp. As clogged air follicles are unable to hold hair it starts to fall.

 The Propecia hair loss treatment blocks the conversion of testosterone into DHT. This hair restoration method uses a steroid type II alpha reductase, which works on the testosterone and synthesizes it in 5-alpha DHT.

 Marketed as a pill, Propecia is taken once a day and the treatment continued for at least three months. The Propecia hair loss treatment, however, works only in the case of male pattern baldness. 

• Side effects of Propecia

The side effects of Propecia are minor, such as hypersensitivity, swelling of the lips and itching. Propecia side effects vary according to the patient’s constitution and disappear after the first few days of treatment, as the body gets adapted to its use. 

The surgeon uses a fine needle to puncture the sites for receiving the grafts and placing them in a predetermined density and pattern. Only then are the individual grafts placed in the appropriate places.

Myths vs. Reality

•      Myth : Tranplanted hair shed easily and never match original hair.
•     Reality : Transplanted hair are as strong and as permanent as the original hair on your head, and they need to be maintained as normal hair. They require cutting as they grow  as normal hair do, they need washing/ shampooing, combing and dying when needed. So they behave just like your natural normal hair.
• Myth: It is against nature / unnatural to be put under surgeon's knife, purely for cosmetic reasons!

Reality :
          o It is only that person who is comfortable with his body image  who can say like that.But what about those sensitive persons who are psychologically distressed by their inadequate or inapproriate contours/proportions or are suffering from body dysmorphic syndrome? A few simple procedures not entailing much discomfort can make such a person feel good about himself/herself. This has been my uniform experience over the years over all of my patients. The feel good factor disseminates into all other aspects of their personality.
          o Although it is a fact that plastic surgery gives maximal  benefit to those people in professions where looks matter most like models,,celebrities,front desk operators, public relation officers,air hostesses etc,it is by no means limited to these class of people alone.Statistics prove that maximum number of patients attending the plastic surgery opd and undergoing cosmetic surgery procedures belong to middle and upper middle class families and well might be your next door neighbor. Fact also remains that only the procedures done on celebrities are advertised and are publically noticed whereas the common person getting under the plastic surgeons knife prefers not to reveal about his/her surgery.

•     Myth: Plastic surgery procedures are very costly!
•     Realilty : This is not at all true and on the contrary , most of the cosmetic surgical procedures are very economical and within the reach of the common man. Most of the procedures can be done within your one month's pay if you are belonging to the middle or upper middle class population, and most of the procedures do not entail a long hospital stay and most of the times the patient is discharged on the day of the surgery itselves.
•     Myth : A scar is a scar for ever!
•     Reality : Unlike psychological scars which never heal, thanks to modern techniques of plastic surgery, bodily scars are amenable to significant modification. We have a lot of techniques in the modern era with which the scars on your body can be modified to almost invisible. Come over and you might be taken aback by the surprisingly good results!