several conditions to achieve good hair transplant results

There are several conditions to achieve good hair transplant results. There are three conditions that need to be met, and they are as follows

1. engraftment rate :

as much of the transplanted hair survives to achieve the intended result.

2. Density : 

Densely packed grafts that look fuller.

3. optimized placement :

properly distributing the hair so that the same amount of hair gives the best possible appearance.



In this article, we're going to talk about engraftment rate.

Hair transplantation can produce the best results when we transplant 10 grafts and all 10 grafts come out.

We often refer to this concept as engraftment or survival rate, which is a percentage of [the number of hairs actually grown / the number of hairs transplanted at the time of surgery].

If the engraftment rate is 100%, all of the grafts are grown, and if the engraftment rate is 50%, only half of the grafts are grown.

Not only the surgical technique, but also the system in the operating room plays a very important role in grafting.

No matter how good the surgery is, if there is a problem with the environment or flow, it will result in a lower engraftment rate.

For example, no matter how well the grafts are transplanted, if the follicles were dried out during storage, the temperature of the follicles was high, or there was damage during removal process, the engraftment rate will decrease.

Let's talk about the hair transplantation system to maximize this engraftment rate one by one.

1. Using high magnification digital microscope and high magnification loupe

 

Hair transplantation is a surgery that deals with very thin, tiny hair follicles and the hairs that attach to them.

The micrometer (㎛) unit used to describe the thickness of a hair is equivalent to 0.0001 centimeters when converted to the centimeters we are used to.

When dealing with such small tissues, it's obvious that it's much better to operate under high magnification than with the naked eye.

Hair transplantation can be categorized as microsurgery, a subspecialty of plastic surgery.

Since the hair follicles need to be manipulated with precision to achieve good results, using equipment with good magnification is a key factor in achieving good results.

Many experiments and papers have already shown that there is an improvement of more than 20% when using a microscope.

The red coloring indicates that 20% more hair can be acquired when using a binocular microscope.

Source : Seager D: Binocular Stereoscopic Dissecting Microscopes: Sholud We All Be Using Them? Hair Transplant Forum International. Vol 6 No 4:2-5, 1996.



2. Low temperature moisture retention device

 

Moisture

Since hair follicles begin to dry out as soon as they are removed from the body, they are placed in a storage solution to prevent them from drying out.

Depending on the experiments and papers published, exposure to air for as little as 30 seconds or as long as 3 minutes can kill the follicles.

This is why it's important for healthcare providers to pay attention to the moisture status of hair follicles, as they can be affected by even very short periods of air exposure.

 

Experiments and paper on hair follicle exposure to air and engraftment

1. 40% reduction in primary follicle engraftment and 18% reduction in secondary follicles at 16 minutes exposure (Beehner M. Comparison of survival of FU grafts trimmed chubby, medium, and skeletonized. Hair Transpl Forum Int 2010; 20(1): 1,6.).

 

Cold Temperature

Keeping the follicles at a cold temperature of 4-8 degrees Celsius is just as important as maintaining hydration.

This has the advantage of lowering the metabolism of the cells, allowing them to live longer without oxygen and nutrients, and reducing cell damage from oxygen toxicity.

(In actual organ transplantation, organs are stored in cold organ storage fluids.

 

 

The table above summarizes hair graft engraftment rates in relation to temperature, and shows that the engraftment rate did not decrease when stored at 4 degrees Celsius for extended periods of time.

Dr. Beehner also presented at the International Society for Hair Transplantation in 2007 and showed that the grafting rate of cold-stored follicles was significantly better.

Doctors should always pay attention to the moisture and temperature of the hair follicles, because no matter how well the surgeon performs the surgery, if the system for storing the hair follicles is not good, the results will be poor.

4 Types of Medical Chilling Devices (MCDs)

  

 

In hair transplantation, there is a process of dehydration and temperature increase due to exposure to air during the process of separating the hair follicles and transplantation.

Although many good hospitals have been making efforts to reduce this, we thought it would be good to create a method that eliminates the time from harvesting to transplantation and continuously maintains a low temperature, so we developed and applied four types of low-temperature moisture maintenance equipment that can be applied to each stage of hair transplantation with Professor Seo Jung-hwan of Hongik University's Mechanical Engineering Department.



3. Use of organ preserving solution

 

We mentioned earlier that you need to moisturize the harvested hair. The type of storage solution you use can affect the engraftment rate.

We can categorize them into extracellular solutions such as saline and Ringer's solution, plasmalite solution, etc. and intracellular solutions such as hypothermosol and HTK.

We often use saline because it is cheap, but saline is actually not suitable for storing hair follicles because it is an extracellular solution that is high in sodium (Na) and low in potassium (K).

If you observe a hair follicle in saline for a few hours, it will swell and turn cloudy.

Instead, it is physiologically beneficial to use an intracellular solution, which is the solution used to preserve harvested organs in organ transplants such as liver transplants and kidney transplants, to preserve hair follicles. In this case, the engraftment rate is often over 90% after 24 hours.

In an experimental paper published in 2011 by a New York doctor named Beehner, he transplanted hair follicles stored in saline and long-term storage solution at 2-24 hour intervals for 96 hours to compare how many of the transplanted hairs were engrafted.

 

At all-time points, hypothermosol solution with ATP added is superior to saline, with the survival gap widening as time progresses.

It is recommended to lower the temperature of the storage solution to minimize cellular metabolism of hair taken from the body, and since lowering the temperature with normal saline increases the chance of cold injury, long-term storage solutions optimized for low temperatures have better results.

They also reduce DNA damage by reducing the production of cell-attacking free radicals by 47% compared to saline.

In other words, the temperature of the storage solution needs to be lowered to minimize the cellular metabolism of hair follicles that have been removed from the body, and not normal saline, but organ preserving solution is optimal to lower the temperature without causing cold damage to the storage solution.

 

There are still very few hospitals in Korea that use organ preserving solution.

Saline solution costs about 1.5 dollar per liter, whereas organ storage solution is expensive at 250 dollar per liter, so not many hospitals use it.



4. Minimizing tissue damage

Hair transplantation involves taking hair follicles from an unaffected area and transplanting them to the balding area.

If you have experience transplanting plants, you will easily understand.

It's important to bring enough soil around the roots so that the roots don't dry out and the plant can thrive in the new environment.

The purpose of bringing enough soil like that is to conserve moisture, but it's also to keep the roots intact so that the plant can thrive.