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Androgenetic alopecia or common baldness is that common disorder of the
scalp that, causing an alteration of the aesthetic profile, determines
a series of psychological and relational problems which interfere negatively
on the quality of these individuals' lives.
Moreover, medical research laboratories have been working for many years
in order to find an effective and durable remedy to contrast falling hair
and to restore them in those areas that have prematurely become bald.
Recently, such studies have produced interesting results and, this time
rational, such as the ones obtained with finasteride, often used in association
with surgical treatment. But when therapy is adopted too late or produces
only partial results, surgery intervenes more and more frequently.
In the last ten years, interesting advances have been achieved by means
of surgical approaches: the new autografting techniques, the reduction
of the bald area with expanders and extenders, flap rotation of hair-bearing
scalp used singularly or in association, can guarantee definitive and
cosmetically satisfying results. The autograft technique is certainly
the most widely used especially for its latest results with only one-
or two-bulb grafts (micrografts) along with follicular units for the first
frontal lines and three- or four hair grafts (minigrafts) to thicken the
density of hair further back.
In order to obtain a result that satisfies the patients requests, it is
of fundamental importance to have a preliminary interview to understand
what the patient really expects and to explain what results to expect
at a short and long term, thus gaining reciprocal confidence. Mutual understanding
between the patient and the surgeon is fundamental, in fact, if this is
not possible, it is better to dismiss the patient before starting any
therapeutic treatment that could turn out to be too time-consuming and
unsatisfactory for both. With regard to this, a written description of
the various steps of the surgery could be helpful, especially if accompanied
by photographs and schemes of the possible, even if rare, intra- and post-operative
complications in order to come up with an informed consent.
It is important to evaluate the colour and the thickness of the hair,
the density of the donor area and to suggest and decide with the patient
where the new frontal line should be. The frontal line must never be too
advanced, but varies according to the patient's age, appearance and to
the degree of baldness. When the frontal line is too advanced, other than
appearing unnatural, it requires a great number of grafts that are not
always available.
At this stage, you give the patient the pre-operative instructions along
with the list of blood and cardiology examinations necessary to perform
the surgery in perfect safety. The surgery is performed in local anaesthesia
with the assistance of an anaesthetist who watches and monitors the patient.
The other members of our team are a physician, three nurses who prepare
the grafts and, of course, the surgeon. Before starting the surgery, it
is a good rule to have a briefing with all the members of the team to
highlight and plan the various technical steps of the surgery and, what
certainly never does any harm, give the final recommendations.
You start by administering the patient a pre-medication (a tranquillizer)
and after about twenty minutes you go ahead with the anaesthesia of the
donor area and harvest the strip of hair-bearing scalp that the nurses
divide into micrografts, follicular units and minigrafts. You then suture
the donor area and proceed with the anaesthesia of the receiving area
using local anaesthesia mixed with a vasoconstrictor to reduce bleeding
to the minimum. Now starts the real autografting stage that lasts about
four hours for the large sessions (megasessions). The receiving sites
should be accurately prepared using microblades of various forms or punches
of 0.75 mm and then you proceed with the distribution of the grafts being
particularly careful not to damage the bulbs.
At the end of the operation, the patient is bandaged for 12-24 hours after
which our staff washes the head for the first time and during this stage
the patient receives precise instructions on how to behave in the first
15 days. For the post-operative stage, antibiotics and analgesics are
prescribed when needed and an appointment is set after 12-15 days to remove
the stitches and provide clear post-operative instructions. The post-operative
course is excellent, with no pain in the receiving area, whereas in the
donor area an uneasy feeling of contusion is perceived when resting the
head on a cushion, but this only lasts for two or three days. In absence
of complications, that are very rare when the operation has been performed
correctly, you can check the results six months after the surgery.
Even though autografting is the most widespread technique, we must not
forget about other hair restoration surgical techniques. For instance,
it is possible to reduce the bald area by means of the extensor, the technique
that expands hair-bearing regions and the rotation of hair-bearing flaps.
The reduction of the hairless region is advisable for patients with baldness
at an advanced stage along the median line and on the vertex, but with
a good scalp mobility and looseness. This type of surgery, although apparently
invasive, if correctly performed, does not imply great uneasiness and
only takes about two hours, always in local anaesthesia. It allows a conspicuous
reduction of the bald area especially if the scalp reduction is integrated
with the intra-operative application of a silicon extensor that allows
the extension of the hair-bearing area. In this way, in two or three sessions
at a distance of 40 days, it is possible to obtain outstanding results,
completed with modest autografting to obtain a natural frontal line.
However, autografting is the procedure most surgeons prefer, but it is
absolutely necessary that those who start surgical techniques for the
correction of androgenetic alopecia should know and be able to perform
all these operations, both singularly and in association with autografting.
Otherwise, you run the risk, which is quite common, of inducing the patient
to chose the latter technique even in those cases when there are precise
indications that require other surgical therapies, either on their own
or in association. In other words, it would be as if "having only
a hammer all problems seem to have the shape of a nail!"
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