The Perils of Direct Hair Transplant (DHT)

Hair Transplant
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The Perils of Direct Hair Transplant (DHT)

It has come to our notice that many patients have undergone substandard procedures in name of hair transplant.
In addition, their doctor or clinic told them that only 50 to 60% of the transplanted hair are expected to grow (something that is totally misleading and a lie).
Such procedures are sold with a the USP of Direct hair transplant (DHT) viz., that the grafts are extracted and then inserted into the recipient slits without examination under microscope and dissection of unnecessary skin (dermal, epidermal and subdermal) tissue.

In reality, DHT is of no benefit to the patient.
The only person to benefit maybe the doctor/clinic who does not wish to spend the extra effort and time required to perform all the steps of transplanting hair grafts.

The following pictures show some examples.

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The correct method involves

  • Extraction of grafts,
  • Examination of grafts & trimming of excess skin tissue under magnification, followed by,
  • Implantation of the graft in recipient slits.

Important

  1. The graft should fit entirely and snugly in the recipient slit (not recipient hole).
    A needle slit is a 2-D structure which will best accept a well trimmed graft.

The pictures show that a part of the grafts in the so called DHT method stay outside the recipient slit (see picture below).

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This often leads to poor growth as a part of graft that includes the stem cells (bulge area) is not inserted into the skin.

Even in the best of conditions, placing a 1mm cylindrical graft in a 2 – dimensional recipient slit creates cobble stoning as shown in the picture.

Cobblestone Repair Case

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Conclusion: Examining and trimming of the grafts under magnification is an important, non removable step in hair transplant.

  • It is being skipped in some establishments.
  • This is a wrong precedent (and active disinformation to outright lying) on part of such clinics.
  • The hair grafts have the capability to stay outside body for a few hours before implantation.
  • Proper trimming of excess tissue and placing the graft entirely and snugly into the recipient slit ensures better yield/growth without any ugly cobblestoning.

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So, my request to patients is to beware of 2 things:

  1. Do NOT fall for the marketing gimmick behind DHT (direct hair transplant). Its, at best, of no benefit to the patient.
  2. Look at ONLINE pictures (immediate post operative pictures) of the patients of the clinic.
    Also ask to be shown your own recipient area pictures immediately after procedure and on subsequent days.
    Take daily pictures post hair transplant.
    If all goes well you should not notice the telltale grafts extruding from the recipient slits.
    If you take all precautions (and tell the doctor you want correctly trimmed grafts to be placed snugly), AND PICTURES THEREOF, you shall not fall prey to this lie.

Please let me know if you have any queries.
Regards,
Dr. (ex-Capt) Arvind Poswal

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Thank you for the detailed explanation on the DHI, this explains why post op graft implantation pictures vary so much in terms of how implanted grafts appear.

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Dr Arvind,
I also come across the counter argument of “more native tissue around the graft leads to better survivability” and they can be placed in 3D holes rather than 2 D slits.
What are your thoughts on that?

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P.S. - The above pictures are not our surgeries . These are pictures available online in public domain and shared with us by concerned people and authorities.

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Dear Hairlove,
Putting untrimmed grafts (I refer to the extra dermis and epidermis around the hair follicles of the graft) into 3 D holes instead of fine 2 D slits is a method reminscent of the last decade of the previous century.
In simple words, its an outdated method and certainly one where dense packing is not possible and cobblestone appearance is a common outcome.

Moreover, the size of the upper part of the graft gives a good idea of the punch size used in extraction… in these pictures it looks to me to be larger than 1mm.

I will post a picture of what the scalp recipient should look like immediately after hair transplant.
Regards,
Dr. A

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Is DHT the same as DHI? Never heard of DHT before.