Nakledilmiş saçlar da kalıtımsal (genetik) yapıdan etkileneceğinden zamanla döküleceği bilinmelidir. Son yıllarda saç nakline artan talep nedeniyle çok fazla reklamı yapılıp yaygınlaşmıştır ve rant kapısı olarak görülmektedir. Saç naklinde 1-4 saç hücresini barındıran saç köklerinin naklinin uzmanlar tarafından yapılması gerekmektedir.
Bugün, 1-4 hücre içeren doğal saç köklerinin ileri tekniklerle alınıp grup olarak transfer edilmesine FUT"Follicular Unit Transplantation." denilmekte ve saç kaybı/kellik problemi olan kişiler tarafından bu yöntem hızla artan şekilde tercih edilmektedir.
Tarihçe
19 yüzyılda kafa derisinin operasyonla yüzülerek başka yere cerrahi aşılama yöntemi kullanılmaktaydı. Modern nakil tekniği 1930`larda Japonya`da kaş ve kirpik naklinde kullanılmıştır. Yalnız bu yöntemi saç naklinde denememişlerdir. 2.Dünya Savaşı`dan sonra izole olmuş Japonya`nın bu çalışmalarından onlarca yıl dünyanın haberi olmamıştır.Modern çağın ilk saç nakli haberi, 1950`lerde Newyork`ta Dermatolog Orentreich`in erkek deneyler üzerinde saç nakli yapmaya başlaması ile duyuldu. Öncesinde saçın nakil yapılması durumunda orjinali gibi gelişemeyeceği fikri yaygında. Oysa Orentreich saçın geliştiğini ve kalıcı olduğunu denekler üzerinde gösterdi.
Yirmi yıl boyunca cerrahlar saç aşılama konusunda çalıştı ancak bunların çok başarılı olduğu söylenemezdi. 1980`lerde Brezilya`lı Uebel saç naklini küçük çaplı da olsa kullanmaya başladı ve yöntem duyulmaya başladı. Esas popüler olması ise ABD`den Rassman`ın mikro cerrahi yöntemiyle bir seferde binlerce saç kökü nakli yapması ile başlamıştır.
In the late 1980s, Limmer introduced the use of the stereo-microscope to dissect a single donor strip into small micrografts. In 1995, Bernstein and Rassman published the first paper on "Follicular Unit Transplantation." where hair is transplanted exclusively in naturally occurring groups of 1-4 hairs. With microscopic dissection of donor pieces from an excised portion of scalp, individual follicular units containing but 1-4 hairs could be prepared and individually relocated into needle punctures in the recipient areas. Since the transplanted hair mimics the way hair grows in nature, completely natural results were attainable.
The follicular unit hair transplant procedure has continued to evolve, becoming more refined and minimally invasive as the size of the graft incisions have become smaller. These smaller and less invasive incisions enable surgeons to place a larger number of follicular unit grafts into a given area. With current techniques, over 50 grafts can be placed per square centimeter, when appropriate for the patient.
Surgeons have also devoted more attention to the angle and orientation of the transplanted grafts. The adoption of the “lateral slit” technique in the early 2000s, enabled hair transplant surgeons to orient 2 to 4 hair follicular unit grafts so that they splay out across the scalp`s surface . This enabled the transplanted hair to lie better on the scalp and provide better coverage to the bald areas.
Saç Nakli Preosedürü
At an initial consultation, the surgeon analyzes the patient`s scalp, discusses his preferences and expectations, and advises him/her on the best approach (e.g.,single vs. multiple sessions) and what results might reasonably be expected.
For several days prior to surgery the patient refrains from using any medicines, or alcohol, which might result in intraoperative bleeding and resultant poor "take" of the grafts. Pre-operative antibiotics are commonly prescribed to prevent wound or graft infections.
Fiyat
In recent years hair transplants have become less expensive. Prices typically range from $3.00 to $7.00 per graft, with $4 to $5 per graft being about average. Normally the price per graft also drops as the size of the surgical session increases. Depending on the needs of the patient a typical surgical session can range from 1,500 to over 4,000 grafts, resulting in a total cost of approximately $6000 to $15,000. A few clinics offer larger sessions of up to 6000 grafts in one sitting.
Operasyon
Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected topical anesthesia, and typically last about four hours. The scalp is shampooed and then treated with an antibacterial chemical prior to the donor scalp being harvested.In the usual follicular unit procedure, the surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. The excised strip is about 1-1.5 x 15-30 cm in size. While he is closing the resulting wound, assistants begin to dissect individual follicular unit grafts from the strip. Working with binocular microscopes, they take great care to remove excess fibrous and fatty tissue without damaging the vital follicular cells that will produce the patients` first crop of new hair.
The surgeon then uses a fine needle to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The assistants generally do the final part of the procedure, inserting the individual grafts in place.
The finest surgeons can place more than 70 grafts per square centimeter in order to get a good density and appearance. In a "megasession", they may perform more prolonged surgeries, placing more than 2500-3000 grafts, reportedly even 6000 grafts, in one sitting. There is a recently reported case of 7761 follicular units transplanted in a patient, performed by Dr. Victor Hasson in one 18 hour megasession.
İşlem
An example of this procedure from consultation through each stage of hair growth can be read, heard, and seen through a blog, Hair Loss Conqueror, created by NicNitro. (See link below)Yeni Teknolojiler
Newer procedures today allow for far less invasive surgery with optimal results. FUE (Follicular Unit Extraction), invented by Dr. Ray Woods of Sydney Australia, allows the surgeon to select individual follicular units from a donor region and transplant them to the recipient region. This method uses a small needle (0,50-0,75 mm diameter)to pluck out the follicular units, eliminating the need for the surgeon to excise skin from the back of the head. Benefits of FUE are quicker healing time, far less trauma, no strip scar, and the surgeon`s ability to individually select follicular units. Drawbacks are that the procedure is far more time intensive than traditional STRIP methods and thus is much more costly. A top STRIP doctor can transplant more than 5000 grafts in a day, while a top FUE surgeon is limited to 1000-2500 in a day. An FUE procedure can continue over consecutive days, allowing to harvest over 3000 grafts if required for larger sessions. If too many grafts are harvested, a patient may get a "moth eaten" appearance in the back of his head. Transplants using FUE, however, still have the same drawbacks as the strip method when it comes to the recipient site often leaving patients with poor density, pitted skin and unappealing results.An extension of the FUE procedure is BHT, body hair transplantation (BHT). A select group of surgeons are now successfully transplanting body hair to the head. In some cases, the body hair can take on many characteristics of head hair. However, the procedure is still in its infancy, and while there have been successful cases, more completed results are needed to give a better assessment. At this stage the hair transplant community sees body hair as a good "filler" between scalp hairs, and as an additional donor source when patients have run out of scalp hair to transplant.
Lately some of the initial results of mega session BHT have started coming in. Basically it seems that yield is directly related to the quality of the extracted hair and the trauma it has received. Initial results seem to show that the time frame of removing a body hair and re implanting it to the scalp is critical. The less the graft is out of the body the better the results. Thus it seems that the new extraction protocols should be modified to minimize this critical time frame. While scalp grafts can survive out of the body for many hours the time frame for Body Hair is dramatically less. BH grafts that are thin and fragile (eg. arm and thighs) have dramatically less yield than robust hairs (eg. chest). Another thing to note about BH is that if DHT inhibiting drugs are used (eg. Finasteride or Dutraside) these drugs could work against the success of BHT. The same drugs that are very successful in stopping or reversing MPB have a negative effect on body hair.
Operasyon Sonrası Bakım
Advances in wound care allow for semi-permeable dressings, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and is not shampooed for about a week.During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out ("shock loss"). After two to three months new hair will begin to erupt from the moved follicles. The patient`s hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.
Yan Etkileri
Birsaç kaybı tedavisinden sonra karşılaşılabilecek olası yan etkiler vardır. Hair thinning, known as "shock loss", is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day.Diğer yan etkiler alın kafa derisi gibi bölgelerde terlemeyi içerir. bu durum rahatsızlık verici olursa terlemeyi azaltmak amacıyla tıbbi tedavi uygulayacak bir doktora başvurulabilir. ek olarak hasta kafa derisi kaşınmaya başlarsa dikkatli olmalıdır. kaşımak durumu daha kötü yapacak ve yara kabuğu oluşmasına neden olacaktır. nemlendirici krem yada masaj şampuanı kaşıntıdan kurtulmak için kullanılabilir.
References
- Bernstein RM, Rassman WR, Seager D, Shapiro R, ``et al``. Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques. ``Dermatol Surg`` 1998; 24: 957-63.
- eMedicine|derm|559