Hair Transplantation in Nepal

Hair Transplantation (Hair Restoration Surgery) at Dhulikhel Hospital, Nepal

I.    Introduction
Like good health and youth, hair is a very imperative part of one’s life. Hair style and length are distinctive features of an individual’s identity. The burden of hair fall is huge and so is its psychological impact. No one, given the choice, would want to lose their hair. Baldness is the most common cause of progressive hair loss globally. Interestingly baldness can affect both men and women and both young and old. It affects roughly 50% of men and the prevalence progressively increases with age. Similarly, 13-20% of ladies suffer from this problem and the incidence increases rapidly after menopause.
Common questions and feelings that people with increased hair fall express are as follows:

1. Is this the end of my youth and am I getting old?
2. I cannot style my hair anymore.
3. My hair is making my body image, personality and appearance look dull.
4. I am having less confidence, shame and self-esteem
5. That person in very good looking than me (Feeling of envy and jealousy)
6. I suffer social teasing and humiliation everywhere
7. I feel depressed and introvert
8. My partner is not be happy from me
9. I wish to wear caps or hats every time
10. I do not wish to take photographs or videos
11. I have decreased social life; people hate me. So, I don’t wish to meet friends or relatives.
12. I wish my hair grows back every day when I wake up

Discovery of hair loss is a stressful condition for both genders. However, our scalp hair may be shed according to the various stages of hair cycle. Daily 50 - 100 hair loss is considered to be normal for human. It can decrease self-respect, self-confidence, personal-image and limit the ability to enjoy life to the fullest. Lack of hair growth despite trying multiple hair growth treatments or shampoos is further frustrating for the patient.
Although stressful, balding isn’t the end of the world! Bald people are considered to be more intelligent. They are considered to have a more attractive masculine body shape and are found to be good at sports. Modern anti-androgenic medications and Permanent Hair transplant is a boon for patients with baldness.

• The medical term for baldness (तालुपना, गन्जापना) is “Androgenetic Alopecia”.  The term is composed of two terms: Andro: meaning androgens, a hormone namely testosterone and dihydrotestosterone; and genetic (बंग्शानुगत) meaning familial tendency. Hence, baldness is a process caused by genetics and hormonal changes that result in hair loss.
• We humans have a hormone called testosterone secreted from the testes in males and minimally by ovaries in ladies. The hormone is changed to a potent hormone called dihydrotestosterone (DHT) by an enzyme called “5-alpha reductase”. This enzyme 5-alpha reductase, is expressed more in the frontal hair of human (the area where people get bald). And under genetic influence people gradually get thinning of hairs and finally go bald.

III.    Treatment of Baldness
The treatment options can be divided as medical and surgical management. Regarding medical management, the Food and Drug Administration (FDA) of the US. has till date recommended only two medications for androgenetic alopecia. The first one is an oral medication called Finesteride. This drug in very lower dose inhibits the action of the enzyme 5-alpha reductase and helps regrowth of hair. The second drug is topical Minoxidil, helps stopping hair fall and stimulates new hair growth. But there are disdvantages of the medical therapy and are as follows:

1. Medical management of only helps in the early phase of the disease.
2. Medical management does not stimulate hair growth in areas that are already bald.
3. The duration of treatment is not fixed. Guidelines recommend the use of drugs for life long.
4. Once you discontinue the medical therapy, hair starts falling again.

Hence because of these disadvantages, the surgical option, Hair transplantation (कपाल प्रत्यारोपण) has become a boon for patients with baldness.
Hair transplant can help bring back what looks like a fuller head of hair. Hair transplantation (कपाल प्रत्यारोपण) is a type of minor surgery that moves hair we already have in our body to fill an area with thin or no hair. For example, generally we transplant normal hairs from the back of the scalp (the donor area) of a client to the front bald area (Recipient area). In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding, (like the back of the head) are transplanted to the bald scalp. Because of this reason, the transplanted hairs and natural, grows normally and do not fall for lifetime.
IV.    Types of hair transplant
There are basically two types of hair transplantation techniques:
1.    Follicular Unit Extraction (FUE):
This is a very new technique of hair transplant where individual hair follicular units are extracted from the back of scalp. These follicular units are then preserved in an optimal situation for 4-6 hours and then transplanted over the bald area.
2.    Follicular Unit Transfer / Transplantation (FUT)
Here the donor area is stripped off to extract a linear piece of skin, and individual follicles are then extracted under high magnification. Sutures are needed to close the skin defect from which grafts were extracted.
The following table enlists the differences between the two procedures (FUT versus FUE)