This below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by recommended hair restoration surgeon Dr. Tejinder Bhatti:

I was just curious to hear from a hair restoration physician on what their theory is on why a small number of people won’t ever shed the newly transplanted hairs. I figured it has to do with genetics and the way the hairs were handled after cut.

Dr-Bhatti-photoAn ideal hair transplant procedure involves relocation of follicular unit grafts from the donor area to the recipient area with minimal trauma, in the shortest time possible, while stored in an optimal storage solution while the grafts are out of the body. These are 3 variables to the technique. The 4th variable is the patient’s age and general health.

Due to so many variables at work, it cannot be predicted which patient will shed and which will not. Even the same clinic will not be able to produce non-shedders consistently.

In my practice I have clinically experienced that the average amount of hair shed after the procedure is 65%.
1% of patients do not shed hair at all.

Honestly, there is no scientific basis on why one patient will shed and another will not.

Dr. Tejinder Bhatti
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Alan Feller:

What are the side effects of follicular unit extraction (FUE) hair transplant surgery?

Dr_Feller_photoThe thing you are probably concerned about is the side effect of FUE that can be rightfully called FUE Donor Area Neuralgia. Also known simply as FUE Neuralgia as you almost never see it’s counterpart in follicular unit strip surgery (FUSS) surgery.

This is a condition that occurs after the donor area is harvested with a great number of FUE grafts. It’s symptoms are a persistent and deep burning sensation in parts of, or throughout, the donor scalp that is not relieved with pain tablets. This condition can last for weeks, months, or even years.

The other concerns you may have read about are:
1. Lower and inconsistent hair growth yields compared to FUSS
2. More damage to the donor area resulting in fewer harvestable grafts in the future if needed
3. Donor area shock loss which appears as a moth eaten look or patches of thinning hair.

FUE is a good procedure for smaller cases. If you need greater than 1000 grafts -now or in the future- you would be better served going with a strip procedure.

Dr. Alan Feller
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

The below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by “California”, patient advisor for recommended hair restoration surgeon Dr.Tejinder Bhatti:

Can body hair from the stomach area be transplanted to the scalp? What other sources have hair transplant surgeons had success with aside from beard and chest (both of which I have little of)?

LOGODr. Tejinder Bhatti believes that when it comes to body hair transplantation (BHT), “only ABC is GOOD!”. (A- Axillary, B- Beard, C-Chest). He is not fond of using any hair other than beard, chest and axilla (armpit) in this order of preference since leg, arm, belly hair, in his experience, take a long time to grow, if at all.

In darker racial groups he does not venture outside the ‘shadow area’ of the beard which lies on and behind the jawline and above the Adam’s apple due to the possible risk of visible scarring.

North America Representative and Patient Advisor for Dr. Tejinder Bhatti.
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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It’s been over 3 months since my follicular unit extraction (FUE) hair transplant. I’m now getting some red bumps in the recipient area. Is this some sort of infection? Will they go away on their own or do I need to treat them?

PimpleThis sounds perfectly normal. You have reached the stage when a lot of new hair growth is stirring below the surface of the scalp. These hairs sometimes fail to exit the skin initially and that results in ingrown hairs. It may also be due to folliculitis or inflammation of the hair follicles. These can become large and quite painful and may even burst and bleed.

Typically, it’s not necessary to treat them. You can simply leave them alone and allow them to resolve themselves. If you feel the need to relieve the pressure, you should follow the advice of your hair transplant surgeon. Some may suggest squeezing them while others recommend only lancing them with a sterilized needle

If the condition should worsen, contact your hair restoration physician or regular doctor immediately. You may require medication to treat the infection.

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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The following thorough response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “Gillenator”.

I’ve read that you should not overexpose a new hair transplant to the sun. I’ve also read that glass stops UVB but not UVA. Which is the most harmful to the grafts?

summertime-clipart-sun-wearing-sunglassesGraft survival is dependent on the transplanted follicles getting established to a new source of blood supply. Without that occurring, whether from damage from UVA or not, they will perish.

So the risk of UVA rays is the potential of sunburn and/or exposure beneath the outer layer of scalp tissue damaging both the graft tissue as well as the underlying follicles.

My understanding is that the healing process in the deeper layers of scalp (dermis) are slower than the epidermis outer layer.

This is why wearing a cap or hat that fully covers the hair transplant recipient area is recommended when exposed to the UVA rays for more than 10 minutes in duration. The higher the UVA rating implies a quicker burn ratio yet a full cover with a cap/hat prevents this potential damage from occurring.

Most hair restoration physicians will want their patients to avoid direct exposure to UVA rays for at least 3 months post-op, some feel 6 months and still others 9 months.

This question, from a member of our Hair Loss Social Community and Discussion Forums, was answered by recommended hair transplant surgeon Dr. Mike Vories:

What is the advantage of using implanter pens in follicular unit extraction (FUE) hair transplant surgery?

Dr_VorriesAtraumatic placing of FUE grafts is the most important topic, in my opinion, in all of surgical hair restoration. It is the reason I use implanter pens, and the reason I place all grafts myself.

I use technicians, and I could easily delegate this part of the procedure to them. I choose to do this myself not because I do not trust them, but because I believe I owe this to my patients. When they sign up for surgery with me, I should perform this most critical part of the procedure myself. I do not think most patients understand how easy it is to crush FUE grafts with forceps. Even the most gentle placer can injure the bulb with forceps.

So while it is true that FUE grafts can be injured with implanter pens, they are much less likely to be injured than by forceps placement. To explain this with words is one thing, to see it is another. That is why I welcome any hair restoration physician to my clinic to observe the procedure at anytime, at no cost. (With patient approval).

Dr. Michael Vories

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

I’m 33 years old and I am thinking about hair transplantation, but I am confused in choosing between FUE and strip and also would like to know if there are any serious side effects in the future after hair transplant surgery.

questionFollicular unit extraction and follicular unit strip surgery (FUSS) are both excellent procedures the can produce natural and undetectable results. However, each procedure has its pros and cons. There is not one that is better than the other in all circumstances.

Volumes can and have been written regarding these two techniques. But, in a nutshell, Strip surgery can typically yield more grafts in a single session and offer a higher average success rate in terms of the number of grafts that survive and grow. The downside for some guys is that it results in a linear scar often stretching from ear to ear that requires hair to be a bit longer for concealment purposes.

With FUE, follicular unit grafts are harvested individually using a small punch. This is much more labor intensive. Depending upon the tools used and the expertise of the hair restoration physician and staff, maximum grafts per session may vary from as low as 1,000 grafts to as high as 3,500 with a very high rate of success.

Due to the method of harvesting, scarring from FUE is in the form of very tiny dots that may be virtually invisible even when the hair is buzzed very short. This appeals to many younger men who like to wear their hair short.

I’m 22 and currently a III or IV on the Norwood Scale for hair loss with deep temporal recession. My dad is a NW 6.5 . For a while I thought I might not go that deep down, but recently, I am seeing the beginning of thinning hair in the deep crown. I am fairly certain I am heading down the path to a NW VII.

I recently went to a respected hair transplant surgeon (recommended on this site), who told me that I have some strong factors in my favor. I have thick, coarse hair. He said he could probably pull 6000 grafts via follicular unit strip surgery (FUSS).

My question is whether 6000 grafts will be enough to fill in my head if I was NW VII. I have a fairly large forehead. I’m not bent up on having a low hairline. I just want to be able to have my face framed and also have full coverage.

One major thing for me is that I never want to take Propecia (finasteride). Even if that means I need multiple hair transplants.

NWVIIThe short answer is yes, sometimes 6000 grafts can be enough to fill your scalp if you were to become a level 7 on the Norwood Scale. However, the long answer to your question isn’t cut and dry.

The following hair loss article was written by Coalition hair transplant surgeon Dr. William Lindsey:

Dr_Lindsey_photoFor years now I’ve seen a few hair transplant patients a year who really did no cleaning at all after their hair restoration surgery. Now, we go through pretty detailed post-op cleaning instructions with patients and we offer every patient the opportunity to come in the next day…even on weekends…to be cleaned up…and we also offer to see patients a couple of times during the first 7 days to make sure they are cleaning correctly.

We also have about 1 case a year that really doesn’t grow well, but 2 or 3 where there ends up being a few “thin spots”.

Now on occasion, those thin spots or diffuse poor growing are in guys who followed every instruction and still had trouble. I saw one of these guys last week and have no idea why he didn’t turn out perfectly. But, fairly frequently, it seems to me that it’s in areas of extremely poor cleaning and crust buildup that this occurs.

I’ve had a theory that the attachment strength of the follicular unit grafts into the recipient scalp eventually is surpassed by the lateral contraction force/stress of really thick crust and then the hair is avulsed (forcibly detached) from the recipient slit.

I recently had my second follicular unit extraction (FUE) hair transplant in Istanbul with a total of 9000 hairs on two 1 day sessions. It went smooth except that I am experiencing extreme thinning in my donor area. I am wondering whether it’s shock loss or maybe they just extracted too much from my donor.
Is it possible that shock loss happened during the procedure? Especially that I found myself in this situation immediately after the procedure and I can’t see any falling hairs since then.

shockShock loss or “telogen effluvium” is a very real possibility in both the donor and recipient areas several days to several months after hair transplant surgery. This condition where the surrounding hair temporarily falls out occurs as a result of trauma to the scalp during surgery. That said, I know you expressed concern as to whether or not you are experiencing shock loss or just a general thinning appearance as a result of too many follicles being harvested. Typically, physicians will not harvest too many follicular units in order to preserve the thicker appearance of the donor area. However, 9000 hairs is a lot.

Ultimately, I think you have to determine whether or not your donor area looked as thin as it does now immediately after surgery or not. That said, the best thing you can do is be patient at this point and wait it out. Any “shocked” hairs will grow back 4 to 12 months after the procedure. Plus, as the hair grows in, it will become thicker looking and show less scalp. Buzzed hair always makes an area appear thinner than it really is.

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