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Medical Treatment offered at Noble Vitiligo and Aesthetic Clinic (South India)

Noble Clinic is now equipped with Narrow Band UV Therapy Daavlin – USA and Excimer laser, the latest laser machine to medically treat vitiligo patients.

Narrow Band UV Therapy
Daavlin products solve the problems of over-exposure to ultraviolet light by maximizing the delivery of narrow-band UVB radiation (in the 311-312nm range, the most beneficial component of natural sunlight) while minimizing exposure to superfluous UV. This allows patients to receive photo therapy treatments with less risk of severe burning or pathogenic exposure to more harmful wide band radiation ranges. UVB narrow-band also avoids the adverse side effects of the psoralen drugs used in conventional PUVA therapy, since UVB treatment requires no supplemental drugs.

Narrow Band UVB light is at a wavelength of 311nm, most other products emit the older, more dangerous radiation in the wide band spectrum. Narrow band UVB is much safer than full spectrum UVB, and the output is reduced by well over 97%. Narrow band UVB is the exact wavelength that vitiligo responds to best. Why bombard your skin with unneeded light radiation? If you imagine sun exposure to natural sunlight is equal to 100% UV radiation exposure, using a narrow band UV light is roughly 1% UV radiation exposure (powerful and targeted treatment).

Melanocyte Transplantation
Melanocyte transplantation done at NOBLE CLINIC follows the same guidelines laid out by ( SWEDISH PROCEDURE ). Initially the melanocytes were harvested from a small part of normal skin, grown in laboratory & was then transplanted on to the depigmented patch after dermabrasion. But now a modified procedure is being done where-in the harvested melanocytes are immediately transplanted on to the depigmented patch

Methods:
Noble clinic's surgical technique requires no hospitalisation & is done on an out patient basis at his surgical center. It requires only local anesthesia, & patient is sent home immediately after the procedure.

After anaesthetising the normal skin (usually from thigh/buttocks) a 4cm by 2cm skin is removed, using Silver skin grafting knife which gives excellent thin grafts containing only the epidermis. This skin is then incubated in trypsin for one hour & at the end of one hour, dermis if found is separated form epidermis.

The epidermis is then divided into small pieces and mixed with minimum essential media, which keeps the cells alive till it is transplanted onto the body, centrifuged repeatedly till a melanocyte pellet is obtained. From a 4x2cm piece of skin, upto 100square-centimeters of depigmented patches can be treated.

The depigmented patch is anaesthetized (Xylocaine 2% or Emla ointment) & dermabrasion is done using either a laser or micromotor to remove epidermis, taking care not to injure the dermis, which can result in scarring.

Once the epidermis has been removed, the melanocyte suspension is applied over the patch, & wound covered with a Collagen dressing. This dressing is then removed after 7 days

Results:
» Treated areas remain pink after removal of dressing.
» Earliest pigmentation is seen with in 3-6 weeks.
» Entire area covers up in 3 to 4 months.
» Excellent cosmetic results are seen in 5-6 months.
» There were no cosmetic side-effects after the procedure. Some patients may
require more than one sitting for 100% pigmentation

Advantages of Melanocyte transplantation over other surgical procedures

- Day care procedure (no admission is required irrespective of site of patch)
- Very large areas can be treated.
- Pigmentation appears rapidly within 3-6 weeks.
- Cosmetic results are excellent.
- Difficult areas like fingers, lips can also be treated (some patients may require
two sittings for complete pigmentation)
- No scarring seen after surgery.

Results: Success Rates in
Generalised Vitiligo(Multiple Patches) 82%
(82 out every 100 patients treated developed excellent pigmentation)
Segmental Vitiligo (Usually One Patch) 96%
(96 out every 100 patients treated developed excellent pigmentation)

Aesthetic Treatments offered by Noble Vitiligo and Aesthetic Clinic are as follows;

Noble Aesthetic Clinic is the first clinic in South India that performs Laser Lipolysis for body sculpturing and is performed by Dr. Vivekanand, a Cosmetic Surgeon who has undergone extensive training in Milan-Italy & Singapore to perform this procedure.

Mesotherapy / chemical Lipolysis
The medications that are used in Mesotherapy melt the fat beneath the skin and shrink the fat cells in the scarpa's fascia layer. The fat dissolves and, as occurs when fat is broken down during typical weight loss, is carried through the bloodstream and excreted by kidneys and bowel.

Cellulite is caused by connective tissue bands that hold down the skin, trapping the fat and thereby causing the "dimpling" effect. The medications used in Mesotherapy destroy the connective tissue bands and melt the trapped fat, creating a smooth, dimple-free appearance

In Mesotherapy, very small doses of different medications are administered in specific areas, depending on the condition being treated. The medicines and plant extracts that we use are obtained from approved pharmaceutical companies in Europe. For cellulite, weight loss, and spot weight reduction, the medications are injected directly to the areas being treated. Treatments are administered weekly, and patients usually begin seeing results by the fourth treatment. After 10 treatments, patients see a significant decrease in size, improved skin tone,fat reduction, and smoothing of cellulite.

Mesotherapy is combined with radiofrequency for better results.

Laser Lipolysis (aka Laser Lipolysis aka Interstitial laserlipolysis (LASERLIPOLISI(r))

Lipolysis : is a new revolutionary concept for removing excess body fat & sculpt the body. Fat is stored in cells called adipocytes, the conventional technique to remove body fat popularly known as liposuction, is a procedure where in the fat cells were sucked out.

The problems associated with Liposuction

With Lipolysis it is now possible to sculpt any part of the body like, double chin, arms, breast enlargements in males, abdomen, love handles, buttocks, thighs.

Lipolysis is performed medically or surgically. Medical Lipolysis also known as mesotherapy or Chemical Lipolysis. Customized formulas injected in a specific area blocks the cells from storing fat & helps break the existing fat cell down. The broken down fat is flushed out naturally & spot reduction can be used for double chin, love handles & any other area where the body stores fat.

Surgical Lipolysis
Surgical Lipolysis, also called, as Laser Lipolysis is the new standard in Liposculpture. Its technique uses high peak power of laser emission to rupture the membrane of adipocytes. This creates an opening in the membrane & spilling out of cellular contents. Thus fat gets converted into an oily, low viscosity aggregate which facilitates body modeling.The laser is conveyed by 300 micron fiber through a 1 milli meter cannula. The laser vapourises not only the fat cells but the blood vessels as well, hence ensuring minimal blood loss, & reduced constrictive bandages.

Lipolysis with laser needs more than one sitting if the fat deposition is more, far better results

Suction Of Melted Fats
We prefer to suck out the lasered material called "lysate." which markedly accelerates the recovery time. In some areas like the chin and male pseudo-breasts we prefer not suck out the lysate. In these areas, the body is able to clear it naturally. The lysate is sucked out with a low intensity suction pump so that there is no damage to blood vessels and nerves.

Results following smart lipo. The best results are seen in the areas that are normally resistant to dieting and physical exercise. We can remove between 500 ml to 2 liters of fat in one sitting depending on the area .The subcutaneous fat is replaced by healing tissues, and initially the area looks the same or sometimes even larger, it takes three months for the healing tissue to organize, and contract to give the final appearance of reduction in shape along with contraction of overlying skin. In this period one can make out the reduction by pinching the affected area, between two fingers to appreciate the reduction in fat. If subsequent reduction is desired then further sittings can be done after 4 months, as there will be hardened tissues which take time to heal .

Hair Transplantation

For most men who are losing their hair before they'd like to, the answer is genetic. Hair loss, like eye color, is an inherited trait. While you were still forming in the womb, your hair follicles were being genetically coded. If genes responsible for hair loss were present, they made the hair follicles on top of your head sensitive to the hormone dihydrotestosterone, or DHT. These follicles were then predisposed to begin shrinking. When you reached adulthood. Unfortunately, once this genetic process begins, it will continue throughout your lifetime. As the hairs produced by your ever-shrinking follicles become finer and finer, they will begin failing to grow to normal length. And what is first noticed as "thinning hair" or a "receding hairline" progresses to baldness when the shrinking follicles finally stop producing any hair at all.

Popular Misconceptions : For many years our schools have taught quite erroneously that hair loss is always inherited from the mother's father. Medical science now knows that baldness genes are passed down from both sides of the family. They also can skip generations, and are utterly random in terms of which siblings they will affect; it is quite common for a man keep a full head of hair while his brother goes bald in his twenties.

Women Hair Transplant
Patterns Of Female Hair Loss : In Women as in men, the most likely cause of scalp hair loss in androgeneticalopecia-an inherited sensitivity to the effects of androgens (male hormones) on scalp hair follicles. However, with hair loss due to this cause usually do not develop true baldness in the patient that occur in man-For example, women rarely develop the "cue-ball" appearance often seen in male-pattern androgenetic alopecia .(See Ludewig - Classification). Patterns of female androgenetic alopecia can vary considerably in appearance. Patterns that may occur includes.

Grade1: Diffuse thinning of hair over the entire scalp, often with more noticeable thinning toward the back of the scalp.

Grade2: Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp but not involving the frontal hairline.

Grade3: Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp, involving and sometimes breaching the frontal hairline. It is important note that female pattern hair loss can begin as early as the late teens to early 20s in women who have experienced early puberty. If left untreated, this hair loss associated with early puberty can progress to more advanced hair loss if it is left untreated.

Hair Restoration
Hair loss is a major concern now among young males & females. Though there are several treatments available for stopping hair loss. A combination of medicines injected into the scalp helps to stop hair loss. Surgery for hair Restoration : the answer lies in follicular unit hair transplantation. A strip of hair removed from the backside of the Scalp is then cut into follicles (group of two or 3 hairs) & single hair follicles. This combination is then transplanted onto the scalp to give you, hair restoration that is appropriate for your age.

What type of grafts do you create? Strips, plugs, micro grafts or mini grafts? How do you place the grafts? In rows or random placements?
We use follicle units. They are also called micro grafts and follicular group grafts.. The hair on all of our scalps is in natural groupings, one-hair, two-hairs, or three-hairs or very rarely four hairs together. These natural groupings are called follicular units four-hair, five-hair grouping called follicular group grafts for density. The use of combination of both is latest technique in the world which gives natural look vis a vis density. We use a feathering technique for follicular unit graft placement. The feathering technique with random placement creates a gradual natural transition by using fine single hairs in the hairline and 2 and 3 follicular units behind the single hairs. Since this is the way that our natural hair grows this technique avoids any detect ability

How many grafts can be placed in one procedure? How many grafts will I need?
The number of grafts depends on the person. Most of the patients need range from 675 to 2,000 grafts. If a patient needs more than 2,000 grafts in one procedure the surgeon will make the judgment by examining the scalp and its laxity. If the scalp is very tight, as in the African and Chinese races, then performing more than 2,000 grafts might put a stretch on the donor area that can lead to delay in healing and scarring. This should most likely be avoided. Caucasians, Asians, however, can receive up to 3,000 grafts without putting a strain on the donor area.

Is this procedure painful?
At Noble Vitiligo and Aesthetic Clinic, the hair transplant procedure is virtually painless. Due to use of Expansion Technique many of the discomforts associated with a hair transplant procedure of the past have been eliminated. The Expansion Technique involves injecting saline into the donor area resulting in a raised area. This keeps the surgery site away from the neurovascular plane underneath.

How long does it take before the hair starts to grow?
After the transplant procedure most of the transplanted hair goes through a healing phase of two months. After the initial two months the hair starts growing at the same rate as your non-transplanted hair. The average rate of growth is half an inch per month.

What kind of hair density will I have or can I expect?
With the use of Expansion Technique we are able to achieve 100 hairs per square centimeter, which provides a natural looking density in one procedure.

What percent of the grafts permanently root?
Almost every hair that is transplanted will grow. Scientific studies on our technique show that the Noble Vitiligo and Aesthetic Clinic. Grafts have more than a 97% survival rate

Will I lose any more of my hair?
As we grow older the balding process gradually slows down. If we start losing hair at a younger age the balding process is usually very fast. If we start losing hair after our fifties then the process is usually slow. Fortunately, the science and art of hair transplant procedures today is so advanced, that we can restore the bald area naturally, permanently and can avoid losing remaining hair with the help of medical therapies available today.

If I do lose more hair, will that affect my new transplanted hair?
The hair transplant procedure at Noble Vitiligo and Aesthetic Clinic has been designed anticipating your natural future hair loss. One of Noble Vitiligo and Aesthetic Clinic's guiding principles is that the first surgery should never leave a patient in need of additional surgeries. In other words, if you never get another hair transplant procedure you should have the appearance of natural thinning hair due to future hair loss but still look great for life. Of course, those with severe hair loss would benefit from additional surgeries by further filling in these areas, but it is not necessary.

Will I have any scarring?
There is no scarring involved in the transplanted area. The donor area where follicular units are harvested is left with a very fine hair line scar. This fine line is usually completely undetectable even by someone trying to find it by lifting the hairs in that area

Can people see the incisions? Can anyone see the donor scar after the stitches are removed?
Your own hair covers the incision in the donor area. It is not visible even right after surgery because your hair covers the area. Once the area is completely healed it is hard to find the incision line. Before harvesting the grafts from the selected donor area the hair above the selected area are lifted up. After removing the donor strip the lifted hair is released and naturally covers the area just after your surgery.

How do you create receptor sites?
Receptor sites are made by these different techniques : In the hairline area they are created using the titanium needles blades (by depth controlled technique). These receptor sites can accept only single hairs.

In the area behind the hairline, depth controlled titanium micro punches blades are used to create a receptor site that can accept two- or three-hair follicular units.

In the thinning area, special micro needles blades are used to avoid damage to the existing hair.

How long does the procedure take?
It depends upon how many grafts are required; usually a procedure for a thousand grafts takes 2-3 hours. 1,500 grafts take about 3-4 hours. If more than 2,000 are required the procedure would take about 5-6 hours.

Will the back of my head look different after removing the strip?
The back of your head looks the same after removing the donor strip. We take advantage of the natural laxity of the scalp. The donor hair is usually selected from the center of the back of the head. In addition, we use densitometer that enables us to evaluate the quality and density of potential donor hair. If selected from the wrong place, the donor area will produce an unsightly scar. That is why we take such care to determine the optimal donor location on an individual basis.

Is there any special treatment I have to use after the procedure is done?
There is absolutely no requirement for any special product to help transplanted hair after the procedure. Unlike drug therapies, for the rest of your life your transplanted hair behaves naturally. That is the beauty of an Noble Vitiligo and Aesthetic Clinic procedure. Noble Vitiligo and Aesthetic Clinic gives unwavering attention to minor details through each step of the procedure. First, selecting the proper donor area with the Densitometer, is paramount. Second, we avoid damage to the hairs, nerves, and vessels by using Depth Control instruments. Third, we prepare follicular units used for transplanting under magnification. This allows us to save the tiny sebaceous glands required for healthy, shiny hair for the rest of your life. Last, we place the follicular units in the thinning or balding area using a depth control technique which assures maximum survival and healthy growth of hair. During the first ten days after the procedure, for faster recovery, a special heeling kit (spray, tube, wet guaze, shampoo and conditioner) that contains copper peptide can be used to promote healing.

Will ever lose the transplanted hair?
The transplanted hair is permanent. They will continue to grow for the rest of your life. The transplanted hairs are taken from the back or side of the scalp. They have a different genetic makeup than the already lost hair and are genetically permanent. Once they have moved to the thinning or balding area they will continue to grow for the rest of your life.

Will the grafted hair fall out?
No. The grafts never fall out. The grafts are trimmed before being transplanted. After being transplanted they look like the size of an unshaven face after a week. Within a few weeks most of the hair stubs fall out. The actual grafts, which are inside the scalp, go through a six-week process of a healing resting phase. After this dormant phase, hair starts growing from these grafts, and will grow for the rest of your life. The average growth is half an inch per month. In six months your hair can be styled the way you like.

Does the doctor perform all of the surgery?
Yes. The procedure is performed by the doctor and aided by medical assistants to help complete the procedure

Do you require a blood test?
Yes. This is important for your safety. We perform a blood test to identify any bleeding tendencies or active medical problems. This is to protect your health.

Do you perform scalp reductions?
Noble Vitiligo and Aesthetic Clinic does not believe in scalp reductions. There is extensive scientific research to indicate detrimental effects, such as the stretch back phenomenon. With this procedure there is an association of visible scarring. The procedure also loses its effectiveness within 12 weeks.

Should I have the procedure performed in the front or the back?
It's truly the patient's choice. What bothers you the most, the front or the back? We always recommend that you do the front and the crown together. However, we will still focus on your main area of concern. If you want to focus on only one area, we strongly recommend you to do the front first. The front hairline restoration brings out the best features of the face. It restores your individual symmetry, harmony, and resets your natural proportions.

Can I go back to work?
Yes. You should be able to resume your work schedule immediately after the surgery. Some patients go back to work the very same day. In fact, one patient, a child Specialist drove back to his practice and saw patients that very afternoon. For certain people with high stress occupations where physical exertion is common you may want to wait a few days or so.

Can I shower and wash my hair after the procedure?
The answer is yes; however, you must be very gentle with your transplanted hair for the first week after surgery. After the first week you will be able to resume your regular shampooing routine

Will I have to comb my hair differently?
An Noble Vitiligo and Aesthetic Clinic hair transplant provides freedom for you to style your hair the way you desire, because no graft is bigger than your natural follicular unit. The transplanted hairs are no different from your naturally lost hair. So, enjoy styling your hair as you did in the past.

Once the hair grows in will it follow the flow of my hair?
After the healing phase, once the transplanted hair starts growing, they grow exactly at the same rate as your other hair grows. Remember that these are your own hairs and they have the same genetic makeup.

Can I work out after my procedure?
Yes. Routine workouts can be resumed after one week. If your workout includes heavy weightlifting or swimming, we recommend that you wait longer and resume exercise after two weeks

How soon can I start the procedure?
Once you reached an informed decision to have surgery, we can set an appointment to have it performed within a few days.

How important is hair care?
Contrary to common belief, hair loss is not caused by a failure to take good care of your hair. Consumers waste millions of dollars on shampoos and phony, non- FDA approved treatments. (Only two medications, Rogaine and Propecia, have ever been approved by the FDA to treat hair loss.) We have counseled too many men who held themselves responsible for their hair loss. It is important to understand that with very few exceptions our hair follicles are going to live or die by their genetic coding and nothing else.