The Patient's Guide to Hair Restoration - New Hair Institute

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hair shafts, each hair, along with its muscle and sebaceous gland, must be working properly to maintain a healthy head of hair. Anatomy & Physiology of Hair Anatomically, hair is a part of the skin. As hair is physically distinct however, it is among the structures known as skin appendages. Other skin appendages include sweat glands, fingernails and toenails. Skin is composed of three main layers. The outer layer of skin is the epidermis. This layer is less than a millimeter in thickness and is composed of dead cells that are in a constant state of sloughing and replacement. As dead cells are lost, new ones from the growing layer below replace them. Beneath the epidermis is the dermis, a tough layer of connective tissue that is about 2 to 3 mm thick on the scalp. This layer gives the skin its strength, and contains both sebaceous glands and sweat glands. Beneath the dermis is a layer of subcutaneous fat and connective tissue. The larger sensory nerve branches and the blood vessels that nourish the skin run deep into this layer. In the scalp, the lower portions of the hair follicles (the bulbs) are found in the upper part of this fatty layer. The hair follicle measures about 3-4 mm in length and produces one to four hair shafts, each about 0.1 mm in width. It is a complex structure comprised of three main layers. The outer layer, called the outer root sheath or trichelemma, surrounds the follicle in the dermis and then blends into the epidermis on the surface of the skin, forming the structure commonly referred to as the pore (from which the hair emerges). The middle layer, the inner root sheath, is composed of three parts (Huxley layer, Henly layer, and cuticle), with the cuticle being the innermost portion that touches the hair shaft. Interestingly, the cuticle is formed by a layer of overlapping cells that interlock with the cuticle of the hair shafts shaft (matrix cells). This mechanism holds the hair shaft securely in place, but also allows it to grow in length. The hair shaft itself is also composed of three layers. The cuticle, the outer layer just described, forms the surface of the hair and is what we see as the hair shaft emerges from the follicle. The middle layer, the cortex comprises the bulk of the hair shaft and is what gives hair its strength. It is composed of an organic protein called keratin, the same material that comprises rhinoceros horn and deer antlers. The center, or core, of the hair shaft, is the medulla, and is only present in terminal hair follicles. The lower portion of each hair follicle widens into a region called the bulb, which contains the matrix cells. The size of the bulb and the number of matrix cells will determine the width of the fully-grown hair. Below each follicle is a small, collection of specialized cells, called the dermal papillae. The dermal papillae fit into a hollow in the widened base of the hair shaft. For many years, scientists thought that hair growth originated from the dermal papillae. Recent evidence has shown that the growth center extends from the dermal papillae all the way up to the region of the follicle where the sebaceous glands are attached. It is now believed that the primary function of the dermal papillae is to regulate follicular growth and differentiation. If the dermal papillae are removed (this sometimes happens during a hair transplant),
the hair follicle is able to regenerate a new one, although the growth of the new hair will be delayed. The normal human scalp contains about 100,000-150,000 follicles that produce thick terminal hair. For comparison, the human body has approximately 5 million follicles that produce the fine, vellus hair. At any given time, about 90% of terminal hairs on one’s head are actively growing. This phase, called anagen, can last from 2-7 years, though the average is about three. Scalp hair grows at a rate of about 0.44 mm/day (or 1/2 inch per month). The other remaining 10% of scalp hairs are in a resting state called telogen that, in a normal scalp, lasts about three months. When a hair enters its resting phase, growth stops, the bulb detaches from the papilla, and the shaft is either pulled out (as when combing one’s hair) or pushed out when the new shaft starts to grow. When a hair is pulled out, or falls out on its own, a small, white swelling is found at the bottom of the hair shaft. Most people assume that this is the growth center of the hair, but it is just the clubbed, detached lower end of the hair shaft. The dermal papillae remain in the scalp. Humans lose about 100 hairs per day; everyone has a few hairs stuck to the comb each time they comb their hair. The presence of a large number of hairs on the comb, in the sink, or in the tub can be the first sign of excessive hair loss. One of the most interesting things about hair is that, in contrast to the commonly held notion that it grows as individual strands, it actually emerges from the scalp in groups of one to four (and sometimes even five or six). The reason for this is that hair follicles are not solitary structures, but are arranged in the skin in naturally occurring groups called follicular units. Although skin pathologists recognized this fact in the early 1980's, its profound importance in hair transplantation surgery was not appreciated until the mid-1990’s. The use of naturally occurring, individual follicular units has revolutionized modern hair transplantation.
Page 1 and 2: The Patient’s Guide to Hair Resto
Page 3 and 4: egan this practice and may have ado
Page 5: vellus hair to the dense, thick hai
Page 9 and 10: visible in a particular individual,
Page 11 and 12: Clogged Pores This claim usually ac
Page 13 and 14: Chapter 4 How Bald Will I Be? For m
Page 15 and 16: Chapter 5 Drugs to Prevent Hair Los
Page 17 and 18: In January 1998, the FDA approved f
Page 19 and 20: Finasteride has now been in clinica
Page 21 and 22: of these physicians were published
Page 23 and 24: cells. If the graft is too large, t
Page 25 and 26: The donor grafts obtained by the pu
Page 27 and 28: In addition to the variation of siz
Page 29 and 30: Chapter 7 What is Follicular Unit T
Page 31 and 32: of the scalp is extensive, the dama
Page 33 and 34: Cost per procedure More Less Total
Page 35 and 36: short-term loss, but rarely affects
Page 37 and 38: of hair is less noticeable than goi
Page 39 and 40: lose 70% of the hair on the top of
Page 41 and 42: unit grafts into very small recipie
Page 43 and 44: egarding whether to add additional
Page 45 and 46: Hair bulk, or hair shaft diameter,
Page 47 and 48: 5A 2000-2400+ --- 6 2000-2400+ 2400
Page 49 and 50: emainder of the procedure. If you d
Page 51 and 52: The night of the surgery and for a
Page 53 and 54: The results of this study, recently
Page 55 and 56: 5-10 Months Some or all of the orig
Page 57 and 58:
Disadvantages: Necrosis The worst p
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entire strip (or portions of it) is
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Scalp Expansion and Scalp Extension
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them, simple, direct pressure will
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Chapter 13 Hair Systems In this cha
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Metal clips or snaps can be sewn to
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inflammation may destroy the scalp
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NHI often uses actual patients to e
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patient’s hair density is below a
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estoration process to this point wi
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Chapter 16 The Psychology of Hair R
Page 79 and 80:
Chapter 17 Determining Quality and
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more common than anyone is willing
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estrogen and progesterone. A portio
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Chapter 19 Repairing Bad Hair Trans
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left with the dilemma of choosing b
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damage is done to surrounding tissu
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attention to measuring hair density
Page 93 and 94:
There are two basic repair strategi
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eserves and centrally placed grafts
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the visible stubble may direct the
Page 99 and 100:
searching in other parts of the sca
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scalp while utilizing a minimal amo
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have had a chance to mature, the sc
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• Suturing with large bites • N
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A Final Word on Repair The physicia
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specialty certifications available,
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hairs in the larger grafts that sur
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as part of the informed consent pro
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Chapter 21 When to be Suspicious So
Page 117 and 118:
Chapter 22 Common Fallacies in Hair
Page 119 and 120:
the patient’s needs, as the hair
Page 121:
• Hair transplantation is moderat
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