The following response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “MrGio”, Online Representative for Coalition Hair Transplant Surgeon Dr. Patrick Mwamba:

stripscara_zps344439b9Far too many hair transplant patients come to us after being told that they will have a pencil-thin strip scar, if they were told of any chances of linear scarring at all. Many times a scar from follicular unit strip surgery (FUSS) will stretch over time and the patient can never wear their hair shaved short on the back and sides. Sometimes the orientation of the hair in the donor zone can be skewed because the hair above and below the scar can be misangled. This isn’t fair to the patient because they should be given full disclosure of all possible after effects of strip surgery.

Based their specific goals, some patients come to our hair restoration clinic to revise their strip scars and some come to us for treating complications with their strip scars. Even with performing trichophytic closure, we still effectively prefer follicular unit extraction (FUE) method over FUSS (strip).

To treat strip scars, we usually can achieve significant improvement with two small sessions of grafting by FIT. The approach to add lower density over more than one session has allowed us to conclude that the transplanted grafts have a much higher survival rate and better blood supply. Strip scars can usually be treated after six months.

The above image is a view of a strip scar in the donor region that displays hair growing in opposite directions.

This question, from a member of our hair loss social community and discussion forums, was answered by a staff physician from Coalition hair transplant clinic Feller Medical:

I had a question regarding pimples and folliculitis after hair transplant surgery. I am 5.5 weeks post op and noticed two pimples on my head today (on the opposite sides of my head). I have emailed my hair restoration surgeon and waiting to hear back from him since I want to make sure it’s not folliculitis. Therefore, my question is, is there any sure way to differentiate a normal pimple from folliculitis?

I have had a few transplanted hairs that have grown the size of my native hair post transplant and was wondering if it could be ingrown hair or is it too early for that? Any input would be appreciated. Thank you

questionIn the absence of any other symptoms and in line with the timing and different location of the two bumps, I would say that this is most likely more of an ingrown hair type of phenomenon.

I don’t think it’s new hair growth yet, but probably some of the hair that was trimmed up during surgery attempting to grow back through the scalp.

Let us know what the doctor says. And try not to touch them too much in the meantime. Good luck!

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

Only surgeons who’ve mastered today’s revolutionary hair transplant techniques and produce the best results are approved for recommendation on the Hair Transplant Network. Recently we’ve interviewed many of these leading physicians in order to share their experience and hair transplant philosophy with you. We encourage you to visit the Hair Transplant Network channel on YouTube to view all of our videos and follow along for updates.

Below, we feature some of the latest hair transplant videos  to help you get to know some of the world’s leading physicians and their philosophies on surgical hair restoration.

Get to know Coalition Member Dr. Alan Feller and His Views on FUE

Hair Transplant Video Interviews Featuring Dr. Bernardo Arocha

Interviewing Recommended Physician Dr. Ivan Cohen

Learn about Dr. John Gillespie’s Quality Hair Transplants

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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This comment, addressed by Coalition hair restoration surgeon Dr. William Lindsey, was shared by a member of our Hair Loss Social Community and Discussion Forums: 

It’s been 15 months since my hair transplant on both temples, and I’m unfortunately unhappy with my results. One of my temples turned out great, the other one is very thin, with the hair direction off with my normal hair, and, really weird, I still have some thick stubbly hairs there.

I’m interested on what’s everyone else’s take on this?

Dr_Lindsey_photoThree of our frontal cases a year have better hair growth density on one side or the other that I can see from close conversational distance. Why? No idea. Now I can tell you that when we have a staff review that the placer on the good side thinks it’s her skill that allowed for a better result. But the problem with that theory is that half the time it’s on the side of each placer and the other 100 frontal cases aren’t different. So if indeed you were shaved in that area and packed and the follicular unit grafts were handled gently, well you may never figure out why.

As to the orientation. Just like with trees, if I dig a hole in your yard aiming northeast and have your nextdoor neighbor plant the tree, well it’ll aim northeast. So the direction is the doctor’s job. But, in repair cases, I have to match the angle of the newly placed hair to the stuff that is already there, even if it’s too straight up or the multiple directions look even worse.

The following response, posted on our Hair Loss Social Community and Discussion Forums was written by recommended hair restoration surgeon Dr. Tejinder Bhatti:

Hey so both times after my hair transplants, I remember around day 7, I stroked the little hairs in the recipient area and they felt like bristles. After drinking pretty hard on the night of day 10, I noticed the next day that they softened. I assume this means that circulation has been established for the new follicles.

And then I wonder if binge drinking that night helped establish that, or was it just coincidence? Hmmmm… I had a massive headache the day after as a result of the drinking, and actually ended up throwing up later that day in a parking lot. Could this be the solution!? lol

Dr-Bhatti-photoWhen follicular units are placed into their respective recipient sites they are very short, usually 1mm to 3mm so of course they will feel coarse and stiff. However, there is another several millimeters of hair below the surface of your scalp that you do not see. After the grafts are placed, the hair shaft will break free of the follicle and begin to make it’s way out of the scalp. The hair appears to be growing but it is merely that more of the hair shaft is visible and the hair appears longer but it will fall out in a few days.

Because the length is increased it will not feel as stiff. You may also begin to notice how the hair or hairs will begin to point in difference directions. This too is because of the migration of the hair shaft out of the tissue right before they fall out completely before they slumber for the next couple of months.

I’m experiencing shock loss in the recipient area after my 2nd hair transplant. I’ve been through this before with my first one. IWhy do some people experience shock loss while others do not?    FYI, I’m only 2 months out from my procedure.

This hair loss question was answered by  Dr. Glenn Charles of Florida who is a member of the Coalition of Independent Hair Restoration Physicians. His professional answer is below.

I wish we had an answer to the question of why shock loss occurs in some patients but not others. That would be like having the answer to how the lions could be that bad every year and not get better like most other teams. Unfortunately, I am also from Detroit and actually still watch them every Sunday. Not sure why. Where has Barry gone?

Any previously transplanted hair will come back. If you still had some original hairs that were very weak and ready to fall out they may be lost, but you will be replacing them with permanent hairs. Good luck.

Dr. Glenn Charles

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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One of the most common questions regularly asked on our hair restoration forum is “Who is the best hair transplant surgeon?” Because selecting a quality hair restoration physician is vital to get the best  result, this question demands an answer.

However, determining “who is the best” is as much subjective as it is objective. Thus, awarding a single hair transplant surgeon the gold medal for being the best isn’t always scientifically possible. However, a small group of leading  physicians regularly demonstrates outstanding work and stand out from the pack. Below we’ll discuss how their skill level, experience, and ethics form the characteristics of an elite hair replacement surgeon and how they continue to revolutionize the hair transplant profession.

An elite hair surgeon continually adapts and refines their technique to achieve the densest and most natural looking results. Reputable surgeons will customize individual hair restoration plans for each patient and always do what’s in the patient’s best interest. This includes standing behind their work and guiding patients through any potential questions, concerns, or problems. Continued education, regularly consulting with other leading surgeons, and dedication to excellence are key ingredients to separating the best doctors from the rest.

The Hair Transplant Network specializes in educating patients on available hair loss treatments and recommending only the best hair restoration surgeons. An elite group of surgeons who perform large, densely packed sessions of ultra refined follicular unit hair transplantation when appropriate for the patient are invited to join the ranks of the Coalition of Independent Hair Restoration Physicians. To see our demanding standards for Coalition membership, click here.

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

You read all the time on the hair restoration forum to maximize the number of strip hair transplants and then go follicular unit extraction (FUE), in order to max out one’s available grafts. I often wonder how many patients actually go through with all that though. Or what % of patients is it even necessary for?

Dr_VorriesThis is an excellent point. I have always disagreed with the “FUSS first” concept. A follicular unit is a follicular unit, whether it was harvested by follicular unit strip surgery or FUE. One of the several advantages of FUE is that we can spread the extractions over the entire donor area, and so minimizing the impact on any one area. Also keep in mind that strip excision changes the scalp architecture, and harvesting grafts (especially below the donor scar) with FUE is made more difficult after strip excision.

The only questionable benefit I can see to performing FUE after strip excision is the chance to try to cover up the strip scar with FUE grafts. However, the results of this are variable, and in many cases the strip scar does not have the vascularity to support the grafts. For this reason it is much better to avoid the strip scar than to plan on covering it with FUE grafts.

Dr. Mike Vories
Editorial Assistant and Forum Co-Moderator

Did you see lots of variability in your past hair transplants as to when hairs popped vs when they matured? Some say only 50-60% of hairs have popped by month 6. Hair transplant surgeon Dr. Steven Gabel says 5-9 months is the key pop period, and 9-12+ is mostly maturation. Dr. Jerry Cooley says 50% of “overall result” by month 6/7. My doctor just emphasizes “variability and patience”.

I will hit month 7 in a week, and I’d say 70% of the hairs have popped (could use more) and maturation is not really there yet. I know it’s still early, but it’s challenging to know where I should be. I feel behind. .

hairlossThere’s really no perfect answer for this because when a percentage is given, it’s an average and furthermore, the percentage typically includes both the “popping” of the transplanted hair and maturation.  Hair that pops is virtually undetectable in most cases because most of these hairs are invisible and colorless.  You can feel them but you can’t see them.  So even if 60% of the hairs popped, only 30% of them may be making any significant cosmetic improvement.  Thus, if you put the two percentages together, one could say at that point you are at about 45% growth.  Although there are many hairs in between the popping and maturation stage so even that’s not 100% accurate.

Rogaine PropeciaToday’s revolutionary surgical hair restoration procedures allow a qualified physician to move individual follicular units (hair groupings as they occur naturally) from the sides and back of one’s scalp to balding areas. The end result is a natural looking head of hair, undetectable to even the harshest critics. And while this miracle hair transplant procedure can restore hair to completely bald areas, it does nothing to stop the progression of genetic baldness. What if hair loss continues? Will a second or even third hair transplant be required? Is there enough donor hair to keep up with the progression of baldness? Should proven medical hair loss treatments be used in conjunction with hair transplant surgery? Why or why not?

Forum member “Roy” is about to undergo surgical hair transplantation with Coalition member Dr. Ron Shapiro and wants to know what risks are involved in proceeding into surgery without taking Propecia (finasteride)  to attempt to slow down continued loss. Visit “Going into Hair Transplant Surgery without Medication” to discuss why non-surgical hair loss products complement a hair transplant and the risks included in not taking them.

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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