Dermatology | Hair Transplant

Best Hair Transplant in Nepal

Founded in 2004, the division of dermatology at Dhulikhel Hospital has evolved into the only one of its kind, offering care for the entire spectrum of skin disorders and venereal diseases. The department provides a highly specialized care for medical and surgical dermatology problems and is fully facilitated with highly advanced equipment's, qualified doctors and staffs. The prime goal of the department is to offer each patient a precise diagnosis and customized treatment plan employing the latest advancements in knowledge and technology to minimize the recovery period. Apart from the quality for patient care, the department is actively dedicated in a spectrum of academic and research activities to perpetuate advances in the prevention and treatment of skin diseases.
We have extended and updated our services and possibilities as per the time call. Department of Dermatology has been a pivotal part of Dhulikhel hospital with plans for extension in the near future.

Successful Result

Our progress and advancing milestones:

1. Best Hair Transplant in Nepal
2. Outpatient clinic for general skin diseases
3. Sexually Transmitted Infections (STI), HIV/AIDS clinic and Voluntary Counseling and Testing (VCT) program
4. Leprosy clinic
5. Academic activities for MBBS and different allied streams.
6. Basic dermatology training for paramedics.
7. Community dermatology program.
8. Research activities
9. Cosmological procedures

Procedures done in Department of Dermatology

Different dermatological procedures are performed to test for wide variety of diseases or to treat dermatological diseases or conditions. Listed below are the procedures performed in Department of Dermatology, for which a brief overview has also been provided:

• Biopsy
• Electrosurgery
• Radiofrequency
• Intralesional injection
• Derma-abrasion
• Derma-roller
• LASERS
• Vitiligo Surgery
• Cryotherapy
• Chemical peeling
• Scar Revision
• Mole Excision

Biopsy

A biopsy is a procedure that involves taking a small sample of tissue so it can be examined under a microscope. It is a usually done in case of diagnostic confusion to confirm the clinical diagnosis. Different types of skin biopsy done in Dhulikhel Hospital:

• Excision biopsy
• Incision biopsy
• Punch biopsy
• Curettage
• Shave biopsy
• Snip biopsy

Nail Avulsion

Nail avulsion, the separation of the nail plate from the surrounding structures, is the most frequently performed surgical or nonsurgical, chemical procedure on the nail unit. It may either be useful to explore the nail unit for diagnostic purposes or as a therapeutic tool in particular nail pathologies. Nail avulsion may be done by using either a distal or a proximal anatomical approach. The former is the most frequently used technique, in which the nail plate is released from its attachment from the nail bed at the hyponychium, while in the latter; the nail plate is separated from the Proximal Nail fold (PNF) followed by a complete separation moving distally

Indications:

• Exploration of nail bed and nail matrix. Eg. Inflammatory dermatoses, infections, connective tissue disease and tumors.
• Exploration of proximal and lateral nail folds
• Performing biopsy on nail bed and nail matrix

Therapeutic:

• Before a chemical or surgical matricectomy
• Ingrown toe nail/onychocryptosis
• Chronic onychomycosis
• Traumatic nail injuries
• Chronic paronychia
• Pincer nails
• Warts
• Tumors

Electrosurgery
It is used in dermatological procedures to stop bleeding or to destroy tissue growths.
It includes the following:

• Electrofulgaration
• Electrodessication
• Electrocoagulation
• Electrosection
• Thermocautery
• Radiofrequency devices

The uses for the aforementioned procedure are as follows:

• Viral warts
• Seborrheic keratosis
• Skin tags
• Xanthelasma
• Syringoma
• Milia
• Comedones
• Molluscumcontagiosum
• Sebaceous hyperplasia
• Pyogenic granuloma
• Benign dermal nevus
• Telangiectasia

Radiofrequency

It induces thermal destruction of targeted tissue by an electrical current at a frequency of 0.5MHz
It is effective in treating various skin conditions, as explained below:

Intralesional injection
Intralesion steroid injection involves a corticosteroid, such as triamcinolone acetonide or betamethasone suspension, which is injected directly into a lesion or immediately below the skin. It may be indicated in following skin conditions:

• Alopecia areata
• Keloids
• Hypertrophic scar
• Hypertrophic Lichen planus
• Lichen simplex chronicus
• Discoid lupus erythematosus
• Granuloma annulare
• Nodulocystic acne
• Small infantile hemangiomas
• Localised psoriasis
• Necrobiosislipoidica

Intralesional 5-fluorouracil:
It is a chemotherapeutic agent reserved for recalcitrant Hypertrophic scars and keloids. 

Dermabrasion

It is an exfoliating technique that uses a rotating instrument to remove the outer layers of skin, usually on face. This treatment is popular with people who wish to improve the appearance of their skin. This is an outpatient procedure. Dermabrasion removes damaged outer layers of skin. This exposes new skin that appears younger and smoother. In addition to providing more youthful appearance, it can also help treat the following conditions:

• Acne scars
• Age spots
• Fine wrinkles
• Precancerous skin patches
• Rhinophyma, or redness and thick skin on nose
• Scars from surgery or injury
• Sundamage
• Uneven skin tone

Cryotherapy

It is a minimally invasive procedure in which surface of skin lesions are frozen. It is also referred to as cryosurgery or cryoablation. We use liquid nitrogen (-196°F) as a cryogen which is applied to skin lesion via cryospray, cyoprobe or cotton tipped applicator. These methods are relatively inexpensive, safe, and reliable.
It is used to treat variety of skin condition:-

• Viral warts
• Actinic keratosis
• Callus/Corn
• Pigmented lesions
• Pre-malignant and malignant tumors 

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Dermaroller

A derma roller is a handheld roller-device covered in microneedles – needles ranging in length from 0.25 mm to 1.5m – which is rolled over the skin. This is done in order to create tiny punctures on the skin which triggers skin repair, leading to the creation of new collagen. A bodily protein made up of amino-acids, collagen is the part of the connective tissue that helps in firmness, strength, suppleness, and elasticity in skin.
The uses of dermaroller are as follows:

• Antiageing effect
• Can diminish hyperpigmentation
• Derma rolling can help to reduce the size of enlarged pores by producing collagen, as well as by thickening the epidermis.
• For acne scars
• For stretch marks

Vitiligo Surgery

This is a commonly performed surgery at Dhulikhel Hospital for stable localized vitiligo. Apart from skin grafting technique whereskin from normal site is kept at vitiligo area, we also perform other technique like non-cultured melanocyte transfer or suction blister graft.
Scar Revision

Scars are troublesome and unappealing. Scar Revision via various techniques is performed at the department of dermatology, Dhulikhel Hospital. A fractional carbon dioxide laser following scar revision often brings back aesthetic results.

Chemical Peeling

Microscopic skin peeling is produced via different but safe chemical agents for any skin pigmentation especially at face produced by acne (Pimples), melasma, freckles etc. Similarly such procedure also helps for skin rejuvenation or scars. This is absolutely safe and quick procedures if performed by trained and skill personnel.

Hair Restoration/Transplant

Although females are only supposed to be concerned with beauty but nowadays even males are. Among males, most common concerning factor is baldness. Premature baldness or baldness even at very young age of around 20s to 30s has played a vital role in one's confidence and self-esteem. "But does all baldness require hair transplant?"This seems to be easy question but very hard to answer. So requires adequate knowledge regarding different causes and overlapping hair fall disorders. A person may not require hair transplant whereas other may only require single session or multiple. Thus, Trichoscopy is a must before hair transplant that gives clues to other concomitant hair conditions and idea of response to the person. Hair transplant is a procedure where one takes a normal hair from donor site (especially back of the head, beard or chest hair) and implants to bald area. So, good donor site always produce a good result. Hair transplant is a procedure of patience and requires a team of 4 to 6 to perform complete procedure. Result following hair transplant is another burning question and person often expects results as soon as hair transplant. A complete result is always expected and requires of 6 -12 months. So, the clients are always asked about their expectations and counseled regarding duration after transplant to result.

Immunotherapy in warts:

Warts are one of the common presentations in Dermatology OPD. Despite the availability of various treatment modalities, warts may be troublesome. Intralesional immunotherapy has evolved as newer treatment option. We have been providing various intralesional agents like Purified protein derivative, Vitamin D3, and Candida antigen in our department. The advantages of it being better therapeutic response, needs fewer sessions and are capable of treating distant warts.

Skin prick test:

A skin prick test, also called a puncture test checks for immediate allergic reactions to as many as 20 different substances at once. This test is usually done on the forearmto identify allergies to pollen, mold, pet dander, dust mites and foods. Common indications of it being rhinoconjunctivitis, asthma, urticaria, anaphylaxis, atopic eczema and food and drug allergy. It is minimally invasive, inexpensive, results are immediately available.

Skin patch test:

It is a test generally done to see whether a particular substance is causing allergic skin irritation (contact dermatitis). It can detect delayed allergic reactions, which can take several days to develop. In this test allergens are applied to patches, which are then placed on your skin. About 20 to 30 extracts of substances (e.g. latex, medications, fragrances, preservatives, hair dyes, metals and resins) that can cause contact dermatitis are tested and result is usually given after 48 hours. A treatment option that includes drug therapy, environmental and dietary changes depends on test results.

Radiofrequency

It is a versatile dermatosurgical procedure used for surgical management of benign and malignant skin conditions using various forms of alternating current at an ultra highfrequency(500-4000 kHz. The major modalities in radiofrequency are electrosection, electrocoagulation, electrodessication and fulguration.It can be used to treat most of the skin lesions with ease in less time with clean surgical field due to adequate hemostasis and with minimal side effects and complications. Some uses of RF are mole removal, scar revision, ear-lobe repair, skin tags, cherry angiomas, SK, Verrucae, molluscumcontagiosum, excision of cysts and abscesses and many more diseases. It should be avoided in unstable cardiac patients and in the treatment of the lesions of the skin overlying a pacemaker.Common side effects that occur with radiofrequency are pain, tissue edema, bleeding, infection, post inflammatory hypo/hyper or depigmentation, scarring and keloid formation.

 Dermoscopy:
Dermoscopy is simple, handy, noninvasive, and bedside diagnostic method which gives magnified image of skin and its appendageal structure. This is done using a dermoscopes. Dermoscopes have inbuiltmagnifying lens and illumination system in the form of light source (halogen lamp or light emitting diode) which helps in visualization of epidermis,dermoepidermal junction, and upper dermis. Dermoscopes are available in two forms: manual (handheld) dermoscopes and videodermoscopes.The hand held manual dermoscopes provides 10 fold magnification, whereas videodermoscope provides higher magnification, up to 1000 fold. Manual dermoscopes requires direct contact with the skin and may require the interface solution for better visualization. Videodermoscopes are non-contact devices with an advantage of visualizingvideographic images which can be saved for comparison during the follow up. Therefore, it has higher patient satisfaction over the manual devices. The scopes of dermoscopy are:
a. Evaluatingpigmentary lesions like melanoma and naevi
b. Trichoscopy: evaluation of scalp and hair disorders which may be non-scarring alopecia or scarring alopecia and shaft disorders.
c. Inflammoscopy: evaluation of inflammatory dermatosis like lichen planus, psoriasis, discoid lupus erythromatosis, dermatitis etc.
d. Onychoscopy: evaluation of nail disorders
e. Infections and infestations
f. Mucoscopy: evaluation of muscosal lesions like oral lichen planus, leukoplakia, erythroplakia etc.
g. Capillaroscopy: evaluation of nail bed capillaries in inflammatory and connective tissue disorders.

Lasers:
We offer various laser therapy options to achieve optimal results in treating a wide range of skin conditions at reasonable cost. Treatment usually takes only a few minutes and is performed during an outpatient visit. Lasers are used to treat wrinkles, scars, sun/age spots, blood vessel lesions, pigmented lesions, tattoos and unwanted hair and various other conditions.
Different lasers are available in our setup include:-
Pulse Dye Laser:
For the first time in Nepal, Pulse Dye Laser is now available at Dhulikhel Hospital. It is treatment of choice for variety of cutaneous vascular lesion and is commonly used to treat:-
-Port wine stain
-Hemangioma
-Rosacea
-Spider angioma
-Venous lakes
-Angiofibroma
-Hypertrophic scars or keloids

Carbon Dioxide Laser:
The CO2 laser is an excellent tool not only for rejuvenation but also for a variety of other dermatological conditions like:-
-Wrinkles
-Acne scars
-Milia
-Sebaceous hyperplasia
-Syringoma
-Warts
-Rhinophyma
-Epidermal Nevi
-Comedones and cysts

Neodymium YAG laser (Nd-YAG):
Many of theconventional treatment options give less satisfactory result in pigmented lesion. Q switched Nd-YAG is a safe and effective option in treatment of these conditions. This laser works better in cases of:-
-Tattoo removal
-Pigmented lesions (age spots, lentiges, freckles, naevus of Ito, naevus of Ota, melasma, PIH, etc.)
-Vascular lesion (Vascular birth marks, facial veins, varicose veins)
-Hair removal

Intense Pulse Light or IPL
These devices are non-laser high intensity light sources that often give results equal to those of laser treatments. Treatments are quick and effective with very little downtime. IPL may be used with different parameters for a variety of conditions such as port-wine stains, hemangiomas, brown spots, scars, rosacea, acne, hair removal and more. It also leads to some improvement in wrinkles, pore size and flushing. Most people can go back to work right away after the treatment.

The newest laser systems, which are available here, are remarkably precise and selective, allowing for better treatment results and safety levels.

a. Minimally Invasive

• Hair Transplant /Hair Restoration Surgery Info

• Axillary Lipectomy for excessive sweating

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• Fat Graft for Facial Rejuvenation/Scars/Burns
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• Vitiligo Surgery
• Liposuction
• Scar revision
• Keloid Surgery
• Derma roller
• Cryosurgery
• Electrodessication
• Radio frequency ablation

b. Non Invasive

• Dermabrasion
• Non Lasers : Intense Pulse Light (IPL)
• c. Lasers:

  Ablative – Erbium – YAG, Fractional Erbium YAG. Fractional CO2 laser
  Non Ablative: Q-switched Nd:YAG, Long pulsed Nd:YAG, Erb – Glass
11. ART (Antiretroviral Therapy) sub center for HIV /AIDS.
12. Dermatology telemedicine service.
13. Phototherapy UVA , UVB

 
Progress in 2014:

1. Started Post graduate Studies - MD (Doctor of Medicine) Dermatology
2. Started Narrow Band Phototherapy – UVA and UVB
3. Introduction of Fractional Carbon dioxide laser
4. Started Skin Prick and Patch test for allergic diseases – allergic rhinitis, Allergic asthma and allergic skin diseases.
5. Introduction of House dust mite proof Bedding encasings.

Doctors