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Crowning glory
By ALLAN KOAY
allan@thestar.com.my

A good hair transplant can help boost confidence and self-esteem.

MOST people have the common perception that hair transplant is purely a cosmetic procedure, that those who go through it just want to look good or hide a bald patch. But consider people who have burns or scars, and need to hide them with hair. Hair transplant does not only involve the hair on one’s head; it can also be eyebrows, a moustache or body hair.

American hair transplant surgeon Dr Marc Dauer, who was recently in Kuala Lumpur to perform a hair transplant at Health Pathway, a holistic healthcare provider, explained that there’s more to hair transplant than vanity.

“There are many different reasons for undergoing a hair transplant procedure,” said Dr Dauer. “Aesthetic considerations are but one component of hair restoration. Hair is youthfulness, confidence. For men and women, the loss of hair, whether it’s on the head or eyebrows, it can be distressing.”
More than deft hands: Hair transplant is an art, and the surgeon needs to have an innate artistic eye.

By having his or her hair restored in a natural way, the person’s confidence and self-esteem are also restored. It has a major impact, not only on the individual’s perception of himself or herself, but also on people’s perception of them as well, said Dr Dauer.

“Hair restoration is not purely cosmetic,” he added. “There are corrective reasons for doing it – surgical scars or burns. Conditions of that nature that can be corrected with hair transplant are very common.”

Although the hair on the head is certainly the most common reason for hair transplant, eyebrows have also become very common recently. The more people find out about the ability to conceal a scar with hair, the more people are seeking out hair transplantation for those purposes.

Dr Dauer, who is based in Los Angeles, has performed hair transplants on Hollywood celebrities and is a graduate of New York Medical College, trained in the Department of Head and Neck Surgery at UCLA Medical Centre. He is also a teacher and author, a Diplomate of the American Board of Hair Restoration Surgery and a member of the International Society of Hair Restoration Surgery.

He uses follicular unit transplantation, which is considered the gold standard of hair transplant techniques. The traditional hair transplant procedure involves transferring hair from a permanent area of the scalp to an area where hair has been lost. The permanent hair on the sides and back of the head is harvested as a narrow strip of hair.

“That little strip is approximated with sutures, and the patient is left with a tiny 1mm to 2mm scar that’s completely concealed by the patient’s hair,” explained Dr Dauer. “Then there’s follicular unit extraction. That is where we extract a single follicle at a time.”
‘For men and women, the loss of hair, whether it’s hair on the head or eyebrow hair, it can be a distressing thing,’ says Dr Marc Dauer.

There are benefits and disadvantages to both procedures. “The benefit of the follicular unit extraction is that the patient doesn’t need sutures,” said Dr Dauer. “The disadvantage is that instead of forming a tiny scar, it forms hundreds to thousands of tiny scars. Every time you extract a follicle, you form a tiny scar.”

Follicular unit extraction is also more time-consuming as a surgeon is limited by the number of follicles that can be transferred on any given day. So, for patients who wish to have two or three thousand follicles transplanted in a single day – which could be 6,000 to 7,000 hairs, because each follicle averages 2.2 to 2.3 hairs – follicular unit extraction is not an option, said Dr Dauer.

“Personally I would recommend follicular unit extraction to patients who are doing smaller cases,” he added. “But if a patient desires a large case done in one day, then I’d recommend the strip method.”

The biggest misconception about hair transplant, he said, is that it provides an unnatural appearance.

“This is because you only notice the bad hair transplants, and you don’t notice the good hair transplants, which is the whole point,” he said.

In reality, the newly transplanted hair that grows can be washed, cut, styled, permed and even coloured. The look also depends on the artistry of the surgeon.

“Creating the hairline is really an artistic-based procedure as you are creating an individual’s hairline at a time when it does not exist,” said Dr Dauer. “So it’s important that you create something that doesn’t appear linear. It has to be ‘irregularly irregular’ and suit the individual’s face.”

And how long does it take for a surgeon to learn and master this art?

“It’s different for every individual,” Dr Dauer replied. “You must possess an innate artistic eye. Parts of it cannot be taught, they must just be innate in an individual. But as far as how many cases does it take to become comfortable and confident for a hair-transplant surgeon, I think it could take hundreds of cases.”
(Pic top) The biggest misconception about hair transplant is that it provides an unnatural appearance.

According to Dr Dauer, the procedure is completely safe, with no bleeding or risk of infection. There could be minimal bleeding in the donor area on the first night but there is none in the recipient area.

“The scalp has an incredible blood supply which nourishes the follicles, which is why this procedure is so effective,” he explained. “The same concept that provides blood supply and nourishment to the follicles is the same reason why the risk of infection is very low.”

And other than preventing direct sunlight on the healing areas, for example by wearing a hat, there is no other precautions to take after a procedure. In fact, Dr Dauer said he has had patients who go back to work the very next day.

Anyone can undergo a hair transplant procedure. The only thing is that patients under the age of 25 who have severe balding should not have transplants until they are into their 30s. This is to assess the patient’s future degree of baldness in order to assess how many donor grafts they will have to donate to the areas that need it.

Hair transplant, which started in the 50s, has become highly refined and gone through many subtle improvements.

There is now a solution to prevent post-operative swelling, and blades that are used to make the receptive sites for the transplanted hair are now custom-made to match the individual’s hair characteristics and size.

“I think the next big step on the horizon is the ability to clone an individual’s hair,” said Dr Dauer. “I still think we’re years away from that, but when it occurs, it will completely change the whole field.”

Credits to and source taken from: http://thestar.com.my/lifestyle/

Kidney matters
THE DOCTOR SAYS
By Dr MILTON LUM

The kidneys play a pivotal role in maintaining blood pressure, and blood pressure, in turn, affects the health of the kidneys.

THE leading cause of death in Malaysia is coronary heart disease. According to the Statistics Department, it constituted 12.9% of medically certified deaths in 2008, with pneumonia second at 7.0%, and strokes (cerebrovascular disease) third at 6.6%.

Data from the Health Ministry reveal that heart diseases and diseases of the pulmonary circulation were the most common causes of death in its hospitals at 16.09% in 2009, with septicaemia second at 13.82%, and cerebrovascular disease fifth at 8.43%.

High blood pressure (hypertension) is a common medical condition in Malaysia. According to the National Health and Morbidity Survey (NHMS) 2006, the prevalence was 32.2% of the population aged 18 years and above.

The disturbing finding was that only 35.8% of those with hypertension were aware of their condition, and of these, 87.7% were then currently on treatment. Of those who were aware of their hypertension and were receiving treatment, only 26.3% were found to have their hypertension controlled. The overall control of hypertension was a shocking 8.2%.

Hypertension is the most important modifiable risk factor for coronary heart disease, cerebrovascular disease, kidney failure (end-stage renal disease) and peripheral vascular disease. As such, the identification and treatment of patients with hypertension, together with the promotion of a healthy lifestyle, will assist in decreasing the prevalence of the condition.

Hypertension is either primary (essential) or secondary. The former comprises 90% or more of all cases whilst the latter comprises the rest. The majority of the secondary causes of hypertension are due to conditions in the kidneys (renal).

The kidneys play a pivotal role in maintaining blood pressure within a healthy range, and blood pressure, in turn, also affects the state of health of the kidneys.

Regulation of blood pressure

The regulation of blood pressure is complex. Although blood pressure is a product of heart (cardiac) output and peripheral vascular resistance, both are affected by multiple factors. The factors that affect cardiac output include sodium intake, renal function, and hormones.

The factors that affect peripheral vascular resistance include the sympathetic nervous system, humoral factors, and local autoregulation. The humoral factors are mediated by compounds that constrict or dilate the blood vessels, e.g. angiotensin, prostaglandins, etc.

Autoregulation is mediated by contraction and expansion of the volume in the blood vessels, which is regulated by the kidneys, and transfer of fluids across the blood capillaries.

The interactions between cardiac output and peripheral vascular resistance maintain a set blood pressure for a person. Changes in the various factors that affect cardiac output and peripheral vascular resistance would lead to the development of hypertension. Changes in blood viscosity, blood velocity, vascular wall thickness and circulating blood volume can all lead to the development of hypertension.

Hypertension

When blood pressure remains high over a period of time, it is called hypertension. Many people consider that a blood pressure below 140/90 mm Hg is normal. However, experts recommend that normal blood pressure with respect to cardiovascular risk be set at 120/80 mm Hg or less. Blood pressure of 120-139/80-99 mm Hg is considered as pre-hypertension, a category of individuals who are at risk of progressing to hypertension and in whom lifestyle modifications are essential preventive measures.

Hypertension and kidney disease

Hypertension results in the heart having to work hard, and also causes damage to blood vessels all over the body. Should the blood vessels in the kidney be damaged, its function of removal of waste materials and excess fluid from the body will be affected.

The extra fluid in the blood vessels would then increase the blood pressure further, with the vicious cycle continuing if untreated or inadequately treated.

Although hypertension is treated when it is diagnosed, the incidence of end-stage renal disease has not decreased. There are several reasons for this and they include the nature of hypertensive disease, failure to reduce the blood pressure to a level that provides protection, poor compliance with treatment prescribed, and the concomitant presence of diabetes.

Pressure in the glomeruli in the kidneys in hypertension leads to the development of sclerosis and impairment of renal function.

The likelihood of developing end-stage renal disease is increased in patients with diabetic nephropathy and hypertension. The increased glomerular pressure results in the presence of albumin in the urine in microscopic amounts (microalbuminuria).

The renin angiotensin system in the kidneys is involved in the development of hypertension. The consumption of angiotensin converting enzyme (ACE) inhibitors, which reduces glomerular pressure, has been shown to slow down the progression to end-stage renal disease in diabetic nephropathy, even if there is no hypertension. However, this beneficial impact of the ACE inhibitors is less clear in patients who are not diabetic.

The NHMS 2006 reported that the overall control of hypertension was a shocking 8.2%. The survey also reported that overall prevalence of diabetes mellitus (known and newly diagnosed) was 11.6%, with the national prevalence of known and newly diagnosed diabetes among adults above 30 years having risen from 8.3% in NHMS in 1996 to 14.9% in NHMS 2006.

The 16th report of the Malaysian Dialysis and Transplant Registry 2008 reported that a total of 18,856 patients were reported to the registry as being on renal dialysis at the end of 2008, with a prevalence rate of 626 per million per year. These facts do not augur well for the nation’s health.

Hypertension is common in those with renal disease, with the majority of patients with end-stage renal disease having hypertension. This has been mainly attributed to volume expansion and the activation of the rennin angiotensin system in the kidneys.

Management

Damage to the kidneys may be without symptoms and is often detected through medical examinations and laboratory investigations, which would provide information about renal function. An elevation of the serum creatinine would indicate that the main function of the kidneys, i.e. glomerular filtration, is impaired.

The presence of protein in the urine (proteinuria) is another indicator of impaired renal function. However, proteinuria is also present in other conditions, e.g. heart disease, damaged blood vessels.

Microalbuminuria is an early indicator of diabetic nephropathy and those with increased risk of cardiovascular morbidity and mortality.

It is currently recommended that diabetics be screened for microalbuminuria. Such screening in hypertensives who do not have diabetes has not been established.

There are occasions when hypertension is due to renal artery stenosis. If the clinical features suggest this condition and if a corrective procedure is considered, imaging studies like computed tomography (CT) angiography and magnetic resonance angiography (MRA) would be performed. Both imaging studies are not without risk.

The risk of CT angiography is that of dye nephropathy, especially in diabetics with chronic renal disease. The risk of MRA is that of nephrogenic systemic fibrosis due to the gadolinium used in the MRA.

Additional tests may be done depending on the clinical situation.

Medicines would be required in most patients to control the hypertension. There are two groups of medicines that lower blood pressure and have a protective effect on the kidneys in diabetics, i.e. ACE inhibitors and angiotensin receptor blockers (ARBs). Both ACE inhibitors and the ARBs also reduce proteinuria and reduce the progression to end-stage renal disease in non-diabetics.

Controlling blood pressure

The recommendation of the National Heart, Lung, and Blood Institute (NHLBI) in the United States is that people with kidney disease should use whatever treatment necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.

It has been calculated that a blood pressure reduction of 2mm Hg reduces the risk of stroke by 15% and the risk of coronary artery disease by 6% in a given population.

The NHLBI recommends lifestyle changes to control the blood pressure:

> Maintenance of the body weight at a level close to normal. Choose fruits, vegetables, grains, and low-fat dairy foods.

> Limitation of the daily salt (sodium) intake to 2,000mg or lower if there is high blood pressure. Read nutrition labels on packaged foods to inform oneself of how much sodium there is in one serving. Keep a sodium diary.

> Getting plenty of exercise, i.e. at least 30 minutes of moderate activity on most days of the week.

> Avoidance of excessive alcohol consumption. The limit for men is two drinks (two 360ml servings of beer, two 150ml servings of wine or two 45ml servings of “hard” liquor) a day. The limit for women is no more than a single serving a day because metabolic differences make women more susceptible to the effects of alcohol.

> Limitation of caffeine intake.

> Cessation or reduction of smoking and avoidance of illicit drugs are also essential preventive measures.

Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Kidney matters

More on: http://thestar.com.my/health/

Credits to and source taken from: http://thestar.com.my/health/

Mum of runaway twins receives call from mystery man
By SYLVIA LOOI
sylvia@thestar.com.my

IPOH: The mother of a runaway pair of teenaged twin girls was contacted by a man who told her the two and another friend were with him in Bukit Bintang in Kuala Lumpur.

The three girls, twins Nurulashiqin and Nurulain Kamarazmi, 14, and Suhaily Abdul Razak, also 14, had run away from home on Saturday.

The twins’ mother, Harliza Samah said a man called her at noon yesterday and told her the three girls were with him.

”Before I could ask anything more, he hung up on me,” she said, adding that she had given the man’s number to the Kampar police.

Kampar OCPD Supt Abdul Aziz Salleh said police had yet to locate the girls.

“We are following up on some leads which we hope will lead us to them,” he said.

Asked whether the girls had run away or were being held against their will, Supt Abdul Aziz said:

”They ran away. No one forced them to do so.”

Suhaily’s mother Che Norliah Chet Hat, 47, is clinging on to the words of a bomoh who told her that her daughter was safe and in Malaysia.

“I have asked family and friends to help search for her. But, I can’t do much if she decides to hide from us,” she said yesterday.

It was reported yesterday that the three girls had failed to return home after visiting friends.

They had left their Taman Sentosa homes in Kampar at 11am.

Mum of runaway twins receives call from mystery man

Credits to and source taken from: http://thestar.com.my/