Dr. Kapil Dua

A 36 years old female approached us with chief complaint of hair loss over scalp since 11 years in 2011. She noticed patchy hair loss on scalp right after first childbirth. It was associated with no other symptoms. The patient had taken multiple treatments outside but no relief. On examination, the scalp showed a big patch of hair loss over central scalp. The skin showed atrophy and wrinkling with shiny appearance. A provisional diagnosis of cicatricial alopecia was kept. A consultation was taken from the Dermatologist ( Dr. Aman Dua, my wife) who did biopsy to confirm the clinical diagnosis. It revealed cicatricial alopecia with possibility of lichen planopilaris.

The patient was put on oral deflazacort, hydroxychloroquine, biotin, omega 3 fatty acids, topical steroids, tacrolimus and benzyl nicotinate, vitamin k, salicylic acid tincturefor 4 months. The patient showed some improvement in terms of no further hair loss and some areas also showed hair regrowth in the periphery.

Then a second biopsy after 4 months to check the activity of the disease. It showed partially treated lichen planopilaris. She was given intralesional steroids in resistant areas with mild improvement in terms of vellus hair regrowth seen. After seeing that the disease had stabilized she started asking for a hair transplant. Then again, biopsy was done to study the activity of the disease which showed post inflammatory pigment alteration.This prompted us as well as the patient to think about hair transplant. The same treatment was continuedfor 5 more months, aim being disease inactivity before we jump to hair transplant. Five months later, the final biopsy showed dermal sclerosis with focal pigment incontinence and few terminal hair follicles.

Then after the insistence of the patient and the inactivity of the disease, we decided to do a test patch of 100 grafts with FUE in 2012.It was planned with FUEtechnique as the patient did not want to undergo surgery with stitches.

She showed excellent results with seen approx. 80% re-growth in 6 months.

Second time over we did 1000 grafts covering the most prominent area by FUE technique in 2013. Again the result was excellent and resulted in a robust regrowth in one year.

Again the result was excellent and satisfactory by patient. Encouraged by good result, 1 year later patient has come for full area coverage and need for more grafts. Fifteen hundred (1500 )grafts were given this time as donor did not seem to support more in 2014. Patient is very happy with the surgery and a lot satisfied.

Now, the patient had again come for a visit ( in 2015) and her picture is completely changed. She is very happy with result of 2600 grafts ( done over three sessions) and is ready to have more to increase the density on the back side.

A fifty year old gentleman came with the complaint of baldness ( NH Grd V). He wanted a permanent solution and was not interested in any type of medical treatment as he had already taken it somewhere outside. But he did not remember the names of the medicines. He consulted the doctors, his donor density was around 70 FU/cm2 and was advised Hair Transplant by Bio - FUE technique as he did not want any ' cut ' on the back side of his head. The patient underwent some routine blood tests and was after confirming the reports was taken up for procedure. The plan was to cover Frontal half of the head by Bio- FUE technique ( 2000 grafts).

The procedure: It was divided into two sessions of 1000 grafts each i.e. the 1000 grafts were taken out and then implanted. Then again 1000 grafts were extracted and taken out. The grafts were of good quality. The surgery was uneventful and the patient was discharged in the evening. Post operatively, after two weeks the patient was put on Finesteride 1 mg once a day and Minoxidil 5% twice a day.

During the follow up after one year, we were satisfied when the patient came and got his pictures done.

Hair Transplant Sessions: 1

Procedure= FUE

Grafts=2300 grafts

FUE technique performed on 32 years old Indian male. NW Grade V. Donor density of 70-80/sqcm.

Treatment Plan:

1) Procedure done in a single session.

2) Procedure done 2300 grafts given in one day by FUE technique.

Hair transplant surgery before, and 1 year after result photos

Yes Fisherman,

You are right. We have done three sittings in this patient. In the first sitting, we gave him 3100 grafts in which the hairline and the frontal half were covered. In the second sitting, 2900 grafts were given to cover the mid scalp, the pictures of which have been attached, and then we did the third sitting was done in which 2000 grafts were given ( the immediate post operative pictures have been attached earlier). The patient has not turned back after the third sitting as a result of which we have not got the pictures of results after third sitting.

See pictures.

Dr Kapil

I think crown shot is after 2nd session and 2nd session addressed the middle area (no operative pictures) We see now the full result after 2 sessions with 6000 grafts. Check the pictures again carefully.

 

Crown was addressed in 3rd Session -with operative crown shot pictures-. And the result after this session has been waiting to end.

 

Anyway I might be wrong (and I wish) due to positional differences in the pictures. Am I right Dr. Kapildua?

Hair Transplant Sessions: 1

Procedure=BIO FUE

Grafts=3100 grafts

BIO FUE technique performed on 28 years old Indian male. Baldness Class= 3Vertex. Donor density of 70-80/sqcm.

Treatment Plan:

1) Procedure done in a single session.

2) Procedure done 3100 grafts to fill the frontal area of the scalp.

3) Medical treatment with cyclical therapy to stabilize and prevent further hair loss.

showing patient results after 8 months.

Hair transplant surgery before, immediate post-op and after result images

Hair Transplant Sessions: 2

Patient: 34 years old indian male.

Grafts=5200 grafts(two sessions)

Surgical Procedure: FUE

Showing results After 1 year

Baldness Class= 5

Treatment Plan:

1) Hair transplant procedure done in two Sessions

2) Medical treatment after the procedure with cyclical therapy to stabilize and prevent further hair loss.

Hair transplant surgery before, immediate post-op and after result images

Hair Transplant Sessions: 1

Procedure=Strip

Grafts=2800

Patient: 32 years old, Indian male

Hair loss: Type 5 pattern

Dr. Dua transplanted 2800 grafts using by FUT hair transplant surgery technique. Procedure was completed in a single session.

Medical treatment after the procedure with Finasteride and Minoxidil to stabilize and prevent further hair loss.

Hair transplant surgery before, immediate post-op and after result images

Hair Transplant Sessions: 1

Procedure= FUE

Grafts=1500

Baldness Class= 3V

This patient is 27 years old, was presented to Dr. Dua for his hair transplant options and had a procedure of FUE an year ago.

showing patient results After 1 year.

Hair transplant surgery before, immediate post-op and after result images

fisher4man

2 - Now see second session patient's pictures album

pictures are only of before & immediate post-op after first session.

Dr Kapil Dua

AK Clinics

Thanks BUSA, KO & fisher4man for the reply.

Busa,

it is 6000 grafts by FUE technique.

KO & fisher4man

1 - time period between sessions:

first session = 3100 grafts done on 21-Jan-2013

and second session = 2900 grafts done on 14-Sep-2013

2 - Do you use manual or motorized technique for graft extraction?

We use Harris Safe Scribe Motorized Technique.

2 - Please see first session patient's pictures album.

Dr. Dua,

 

Welcome to the community! Thank you for sharing this introduction to your FUE process.

 

A few questions:

 

1) I see you use a motorized extraction device. Which one? Also, do you use sharp or dull punches? What size punches do you use?

 

2) It looks like all the extracted grafts above are singles. Do you split follicular units to make singles post extraction, or is this a picture of just the single grafts?

 

Look forward to seeing more of your work!

Thanks again Blake for here to reply,

We use 0.8 - 0.9mm dull punches. We initially used to work with Harris Safe Scribe, but now we have started getting punches made for ourselves.

The picture you are referring to has both single as well as double hair follicular units. However, the position of grafts at the time of clicking pictures have got misaligned, which is giving the appearance of single hair follicular units. We have never split any grafts ever in our experience of around 8 years of FUE Hair Transplant Surgery.

Dr Kapil Dua

AK Clinics

Hi Dr. Dua,

 

Thank you for sharing this introduction to your strip technique.

 

Quick question:

 

1) I see part of the dissection process is occurring under loop magnification and another part with microscopic magnification. What portion of the graft dissection occurs under a microscope? Is there a reason why part of the dissection process is aided by loop magnification instead of microscopic magnification?

 

Thanks. Look forward to your reply.

Thanks Blake for the reply,

We use microscopic dissection(mantis) for doing the slivering part because this is the most important part of dissection. If the slivers are made properly under higher magnification, then we can easily do dissection under less magnification as well. (most of our sugeries are FUE, therefore our purposes are solved with this type of set up only.)

Dr Kapil Dua

AK Clinics

Please find the following thumbnails pictures of FUE technique is being performed by Dr. Dua & his staff from AK Clinics, India.

Photos include

close-ups of several extracted follicular units

Dr. Dua's extraction tool

creating recipient sites

insertion of the grafts into recipient sites

pictures of the donor and recipient areas immediately after surgery.

Please find the following thumbnails pictures of Strip FUT technique is being performed by Dr. Dua & his staff from AK Clinics, India.

Photos include of the

sutured donor area

the graft trimming process with all technicians trimming grafts under microscopes as we discussed

the grafts, close ups of the graft incisions and the recipient area after the grafts.

This patient came from Amritsar, 26 years young male. Worried about his hair loss problem, Dr. Dua suggested him to go through Hair Transplant Surgery, then he was undergone with the procedure of FUT for 2300 Grafts on the frontal area.

Hair Transplant Sessions: 1

Grafts Implanted: 2300

Baldness Class: 3 VERTEX

Surgical Procedure: Follicular Unit Transplant (FUT/Strip)

Hair transplant surgery before and 10 months after results pictures.

Patient: 47 years old Indian male.

Hair Transplant Sessions: 1st and 2nd

Grafts Implanted: 5500

Baldness Class: 6

Surgical Procedure: Follicular Unit Transplant (FUT/Strip) and Follicular Unit Extraction (FUE)

Treatment Plan:

1. Hair transplant procedure done in two Sessions
   
2. Procedure performed for filling the front and middle scalp 70%.
   
3. Medical treatment after the procedure with cyclical therapy to stabilize and prevent further hair loss.
   

Hair transplant surgery before, immediate post-op and after result images

This hair restoration patient is in his late 50's and really upset with his baldness.

Dr. Dua implanted 2200 grafts using the FUT/strip technique. Procedure was completed in a single session.

Hair Transplant Sessions: 1

Grafts Implanted: 2200

Baldness Class: 4

Surgical Procedure: Follicular Unit Transplant (FUT/Strip)

Hair restoration surgery procedure before, immediate post-op and after results.

Hair transplant procedure performed on 38 years old Indian male. NW class 4. Donor density of 80-90/sq cm.

Hair Transplant Sessions: 1

Grafts Implanted: 2500

Surgical Procedure: Follicular Unit Extraction (FUE)

And showing patient results are after 9 months.

Hair transplant surgery before, immediate post-op and after result images.

This patient is from Afghanistan, 40 years old. Dr. Kapil Dua implanted 3100 grafts using the FUE hair transplant technique in a single day session.

Showing patient results are after 12 months post-op.

Hair Transplant Sessions: 2

Grafts Implanted: 6000

Baldness Class: 6

Surgical Procedure: Follicular Unit Extraction (FUE)

Donor Desnsity: 85-90grafts/sqcm;

Slits = 0.9mm blades