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Hair transplantation. Where are we at? Dr. Chiara Insalaco answers all your questions.
We asked Dr. Insalaco whether hair transplantation really works and what she thinks about low-cost hair transplantation procedures in Istanbul and hair loss drugs.

How effective is hair transplantation?
To date hair transplantation represents the only permanent solution to restore hair in case of androgenic alopecia.
Hair transplantation is a surgical technique that consists of harvesting follicular units from the occipital area, where they are not affected by the action of androgens, and grafting them into the hairless areas of the scalp.

Where can I undergo a hair transplantation procedure? Here is a list of cities where you can find the best clinics offering this technique
Hair transplantation consists of many steps and the outcome of the procedure depends on the attention the surgeon places on all of them.
Following are the steps of the procedure: careful manipulation of Follicular Units both during the harvesting phase and the grafting phase in order to avoid any irreversible damage to the hair bulb; shortest time possible outside the body so as not to reduce hair survival; preservation of the grafts inside advanced solutions at low temperatures to avoid any heat stress and the consequent liberation of free radicals.
If the procedure is carried out by a skilled surgeon, who personally performs all steps, a positive outcome is guaranteed.

Is hair transplantation dangerous?
Although carried out under local anaesthesia, hair transplantation is an actual surgical procedure. That is why the surgeon has to be perfectly aware of the action, the duration, the dosage and the potential toxic reactions of the anaesthetic. Patients have to be carefully evaluated and selected before the procedure.
Bleeding risk is minimal or non-existent for most patients.
Tobacco smoke, alcohol, anticoagulation therapies, drugs and vitamin E are among the factors that can increase bleeding.
This is the reason why an accurate evaluation of the patient’s medical history is essential to avoid risks.

According to you, do Propecia and Minoxidil have any negative side effects? Many people are interested in this.
Finasteride (Propecia®) and Minoxidil are seen as the cornerstones of medical therapy against Androgenic Alopecia. Their beneficial impact on hair growth was discovered accidentally.
MINOXIDIL is a topical solution prescribed in its 2% and 5% concentration.
Thanks to its vasodilatory effect and other unknown effects it is able to turn miniaturized hair into terminal hair.
Side effects are rare and include Telogen Effluvium, that is a temporary self-correcting hair loss.
Only a very small percentage of patients report a form of Dermatitis that can be treated by reducing the frequency or the concentration of the therapy (from 5% to 2%).
PROPECIA® (FINASTERIDE) inhibits the action of 5-alpha reductase, thus reducing the levels of DIHYDROTESTOSTERONE in the hair follicle.
The FDA states that 3.5% of men taking Finasteride report one or more of the following sexual side effects:
Decreased libido
Erectile Dysfunction
Ejaculation disorders
Further less common side effects can be:
Gynaecomastia (increase in the size of male breast tissue)
Depression

The percentages are low and side effects are reversible, which means that once the patient suspends the therapy they disappear.

I always recommend that patients contact a trichologist, who’s able to select the right therapy, listing all pros and cons of it, even considering the rarest ones.

According to you, are there any natural remedies to stop hair loss? (Food or lotions)
In order to treat hair loss it is necessary to identify its causes.
If you spot any vitamin or microelements deficiencies, thanks to blood tests, of course the first step will be to reintegrate these elements through food or supplements.
We don’t know any food that can stop androgenic alopecia.
The combination between the medical therapies we talked about (Finasteride, Minoxidil, etc.) and hair transplantation represents the main solution against hair loss.
Of course following a healthy and balanced diet, rich in fruit, vegetables, Omega-3 fatty acids and first class proteins is fundamental to keep our hair and our skin strong and in good condition.

Does the positive outcome of hair transplantation depend on the experience of the surgeon?
The experience of the surgeon is everything. The outcome of the procedure depends 100% on that!
Unfortunately many surgeons, due to lack of experience or laziness, very often delegate all the phases of the procedure to unauthorized paramedical staff, who should only help the doctor and on the other hand carries out the most important and critical steps of the procedure. According to law, only a specialized doctor can do this.

Read our article about the mistakes that could jeopardize the outcome of hair transplantation.

What do you think about low cost hair transplantations in Istanbul?
In my opinion those packages offering flight, hotel, transfers, city tours and finally surgery do not comply with the ethical and scientific rules we were taught during medical school.
The problem with this new phenomenon is that the patient is seen as a number.
It is the patient who makes a self-diagnosis. He is then sold a package of follicular units according to an evaluation based on the photos he sent by email.
Once he gets to the clinic he finds out that the surgeon the centre is named after is just a businessman who takes a quick look at the patient and then delegates the work to young underpaid nurses. These people work like robots, cranking out hair transplantations from dawn to dusk without having any medical nor scientific knowledge and being unable to evaluate the most complicated cases that require technical changes in the procedure.
We know the hygiene rules of such places don’t comply with the national and European law. Dozens of people undergo surgery every day on close beds, thus running the risk of being infected with diseases.
I work both in Italy and in the US and I receive every day more and more requests of repair cases.
Those patients who undergo a low cost procedure (But how much does hair transplantation cost?) will have to spend even more money to fix all damages, such as infections, necrosis, donor destruction, doll’s hair effect, cysts all over the scalp caused by the fact that hair was grafted too deep, in a few words aesthetically unacceptable results.

Furthermore, the current political situation in Turkey makes it risky to spend even a few days there. Just yesterday, Dec. 10, 2016, a terrible attack took place in Istanbul.
Unfortunately the Turkish government isn’t releasing any information and foreign travellers are not adequately informed about the risks they may face.
What I suggest is that patients should look for quality and safety.
A well-performed hair transplant lasts forever and patients will benefit from it for the rest of their lives. On the other hand a bad-performed hair transplant is a burden patients have live with every day and it is often very hard to fix it.

We know that just one hair transplantation is often not enough and the patient has to be taken care of also after the procedure. How is it possible to do this if the clinic is based in another country?
This is a good point many of our patients don’t take into account when they decide to travel to another country to undergo a hair transplant procedure in order to save some money.
In case of complication, who can they refer to? Who will take care of them?
Will they have to catch a plane every time they need to talk to someone after the procedure?
Of course costs will double, more time will be wasted, more days off will be necessary and it will never been as comfortable as being followed by a surgeon who speaks our language and who is based where we live.
Therefore I suggest that patients do research trying to gather as much information as possible about local experts before travelling to foreign countries (maybe located in the third world), without knowing who their technician will be and what hygienic conditions they will find.

How can I decide whether hair transplantation is the best option for me, or if it is better to accept my hair loss?
Not all hair loss types are the same. They can be divided into many groups, ranging from the very common Androgenic Alopecia to scarring forms.
A skilled trichologist has to be able to evaluate every case, thanks to specific tests, and to make a diagnosis, according to which it will be possible to define the best therapy and to decide if the patient is a good candidate for hair transplantation.
In case of Androgenic Alopecia the main factors we have to focus on are the age of the patient and the degree of hair loss.
For example a very young patient is not the best candidate and nor is a Norwood 7 patient.
Losing hope is not an option for me!
Therefore, also in such cases there are several non-surgical solutions. In young patients hair loss can be treated or slowed down. They will then have the opportunity to undergo the procedure on a later stage. In case of advanced hair loss cases, besides surgery, there are several paramedical solutions that can offer great results.

Dr. Chiara Insalaco
Specialist in Plastic, Reconstructive and Aesthetic Surgery
Specialist in Trichology and Hair Restoration Surgery
PhD at the University Tor Vergata in Rome.

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