Dr. Haren Jayasinghe painstakingly sows row after row of hair in their tidy little follicular units. Patiently, he builds a new hairline. The technique he uses is known as Follicular Unit Extraction or FUE. Having recently returned from an extended stay in Britain, Dr. Jayasinghe now runs Sri Lanka’s only FUE hair transplant clinic – the Prosper Clinic in Battaramulla. For his patients, the process is a transformative one. “Being bald is not a disease,” Dr. Jayasinghe says. “It is a hereditary process in most cases.” Still he concedes that “it is, of course, a soul destroying experience for many people.” He believes a full head of hair is actually empowering, a confidence booster in a country where bald is seldom equated with beautiful.
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| Placing the graft in the affected site |
Androgenic or pattern hair loss is the most common cause of hair loss in men and women. “Due to hormonal influences (DHT) the head hairs on top have their growth cycle shortened from the usual five years to a short growth phase (weeks to months),” explains Dr. Jayasinghe, “This leads to small vellus hairs forming instead of healthy mature terminal hairs and then leading to complete hair loss.” Pattern hair loss is a hereditary form that affects both men and women alike.
Typically bi modal, it is characterised by rapid hair loss that occurs either early on, when individuals are in their twenties or later, in their forties and fifties. “It is estimated that by the age of 50 about 50% of men and 40% of women suffer from some degree of hair loss that causes them some degree of mental anguish. So it is a very common problem.”
Hair loss follows its own patterns. In the Norwood pattern which is most often found in men, hair is lost in the back, front, or both these areas leading to a wide bald circle on top. In contrast, the Ludwig Pattern, found primarily in women, is identified by a hair loss occurring “diffusely on the top of the head.” The hair that sprouts on the side of the scalp is permanent and does not usually fall. It is from this abundance that Dr. Jayasinghe selects hair to transplant which can then be re-grown in the bald patch.
“Before hair transplants you had to stay bald or wear a wig,” says Dr. Jayasinghe. A wig might have seemed preferable though when the only option was ‘strip surgery’ also known by the more formal Follicular Unit Transplants. Here a strip of skin would be removed from the permanent hair regions, sectioned into follicular units and transplanted.
There were multiple disadvantages: it required a theatre, was accompanied by bleeding and required sutures to close the strip scar wound. Recovery was painful and unsightly scars remained. For these reasons, the new minimally invasive FUE procedure has become more popular although it is more expensive, explains Dr. Jayasinghe.
This approach was born when doctors realised that hair grows in natural clusters of hairs or follicular units and that simply transplanting these would produce a more natural look. “The hair itself is a protein structure which grows for an average of 5 years and then sheds. Inside the scalp there is a factory consisting of stems cells (dermal papillae) that produce hair. It is this which you can consider the living hair root and continuously produces hair. It is this root that we extract and transplant...”
“The process has now been refined to the point where it is both painless and produces natural, growing, hair on a bald or thinning scalp,” he says, revealing that the process does not involve scalpels or sutures. “Extensive research evidence shows that hair transplants are the only way to re-grow a dense natural head of hair on bald scalp.” Dr. Jayasinghe’s daily maximum is 2500 FUE grafts per day – which takes an 8 hour marathon to accomplish. Though smaller grafts will take less time, the process is time consuming, Still, Dr. Jayasinghe explains that he does only manual extractions. (Though attempts have been made to mechanise the process, the use of extraction machines has been associated with damaged hair grafts and very poor results.) However, clients seem to feel it’s well worth it. “The beauty of FUE is that it is minimally invasive and can be camouflaged. So the client can even return to work immediately after the procedure and no one will know.”
Before the process is attempted though, Dr. Jayasinghe emphasises that the cause of the initial hair loss must be well understood. Hair loss has been linked to many conditions, including after pregnancy, hormonal changes in women, physical stress such as accidents and high fevers. But this hair loss (tellogen effluviam) usually recovers spontaneously, he says. “Hair loss also occurs due to disease such as thyroid disease, autoimmune diseases leading to alopecia (scarring alopecia, areata, totalis and univesalis), and infections such as tinea captis fungal infections, viral shingles of the scalp.”
“Hair loss due to disease is best treated with medication to treat the underlying illness then the hair will re-grow naturally in most cases,” he explains. “Our only other exclusion criterion is poorly controlled diabetes. If a client is diabetic we advise the client to show evidence of good glycaemic control prior to accepting them for a hair transplant.”
Braiding (traction alopecia) and misuse of hair products that scar the scalp and damage hair can also trigger permanent hair loss. Unsurprisingly, so can severe nutritional deficiencies. “FUE hair transplants are advisable only for pattern hair loss,” he explains, adding that “it has to be a person’s own hair otherwise the body will reject it.” If the hair on the scalp itself if sparse, hair can taken from the body and beard. Hair transplants are possible for other parts of the body as well. Dr. Jayasinghe has reconstructed eyebrows, eyelashes (using false lashes is a major cause of permanent eye lash loss) and facial hair (beards/moustaches) and says hair can be used to camouflage facial scars.
His is actually the voice of experience. At just 23, Dr. Jayasinghe was appalled to find he was losing hair. “After much research I realised that the only way to regain my hair was through a hair transplant. This is what made me learn more about the procedure and acquire the skill to perform it to international standards,” he says. He studied medicine at the University of Bristol School of Medicine and received his Fellowship from the Royal College of Surgeons in Edinburgh UK. As a surgeon, he says he has extensive experience in ENT head and neck surgery including hair transplants in the U.K. He sees what he does as having a profound impact on his patients.”Beautiful hair is a big part of Asian culture. In many ways we don’t just give people hair we give them back their identity.” |
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