The following case was presented on the Hair Restoration Forum and Social Network by Coalition hair transplant surgeon Dr. Jean Devroye of Belgium:

Dr_Devroye_photoTranssexual transformation is the kind ofhair transplant work I love to do. There are many reasons why. First of all, because it is challenging. You have to move from a male appearance to a female appearance. The anterior line has to be traced very carefully. It is very important to obtain a very natural result, very thin. Also, most of time you have to graft completely bald areas and obtain in only one session a high density with a dense packing.

The big advantage in cases like these is that, generally, when a transsexual patient uses female hormones it completely stops the hair loss.

This patient came with a typical female hair loss pattern. The sequences of images show the patient from zero months to more than two years post-op.

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Surgery Details – Total number of grafts : 3643

  • Single hair grafts – 596
  • 2 hair grafts – 1555
  • 3 hair grafts – 1182
  • 4 hair grafts – 310

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

To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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 Shapiro Medical:

I’m close to committing to a 2nd follicular unit strip surgery (FUSS) in order to put as much hair in my vertex area as possible, but it likely wont be enough for a nice illusion of density unless I get scalp micropigmentation (SMP) or beard filler added later. But, those options are icing on the cake and I have to get the hair transplanted first.

I know some hair transplant surgeons will combine scalp donor with beard donor during their follicular unit extraction (FUE) procedure, but since I can yield more grafts from strip and it’s less expensive, I’m really tempted to do that in order to maximize my harvest from the scalp. But I want to make sure that if this strip leaves no more donor hair available on my scalp (which cannot be predicted for sure), that an FUE surgeon would be able to do a “beard filler only” FUE session.

Does anyone know the answer to this question? Can any surgeon here comment?

British_Beard_Mous_2340817kBeard hair can be an excellent source of “filler” hair once you have exhausted all of your available donor hair but you will never want to use it in a highly visible area such as the hairline. Beard hair is still very unpredictable in its yield and in its overall “value” in the final result.

logoThe Hair Restoration Forum and Social Network regularly advises prospective hair transplant patients about the dangers of choosing unskilled and inexperienced surgeons. In recent years, an increasing number of clinics have popped up across the Unites States offering machine assisted follicular unit extraction (FUE) performed by traveling teams of technicians. In fact, the manufacturers of such machines are known to actively market them to neophyte hair restoration physicians with the promise of becoming an instant hair transplant clinic.

It has recently come to our attention that the producers of the TV news program Inside Edition are seeking men and women who received hair transplant surgery with a poor outcome at the hands of unlicensed technicians, with or without the assistance of an automated hair transplant system. We have no further information about the developing story or when it might air. However, those interested in potentially sharing their experience on national TV can email us at service@hairtransplantnetwork.com for more information.

We encourage hair loss sufferers considering surgical hair restoration to perform careful and thorough research. Don’t be swayed by slick advertising. Choose a skilled and experienced hair transplant surgeon like those recommended by the Hair Transplant Network.

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

To share ideas with other hair loss sufferers visit the hair loss forum and social communi

I know its kind of a useless question since you can’t extract the grafts on the areas that are not considered the donor area, but how many grafts in total does your average person have on their entire scalp if they were not balding?

hairstyles-for-thick-hair-menI suppose this question could be answered by considering two averages. First, the average human head has about 100,000 hairs. It’s also said that the average number of hairs per follicular unit is about 2.2.

If these numbers are correct, that would put the average number of follicular units on a healthy head with no hair loss at around 45,455 with only about 8,000 hair transplant donor grafts available in the “permanent zone”.

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

To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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I have had two hair transplants in 3 years. I always ask my hair transplant doctor about my hair loss. Actually, whenever I wash my hair I always see lots of hair (more than 50 or 60) or when I scratch my hair it always breaks. So is it normal or do I need to use any product to stop hair loss? My doctor tells me that this is normal. If this is normal then why does my hair break whenever I scratch my head? Could you please tell me what to do? Do I need to go to a dermatologist or am I fine?

Propecia and RogaineIt’s normal to lose approximately 100 hairs throughout the day. Losing 50 to 60 hairs in the shower does seem excessive.

For most men with androgenic alopecia, hair loss is progressive. Hair transplant surgery can address a patient’s current degree of balding but, in most cases, the thinning hair will continue to progress. For this reason, most hair restoration physicians recommend that their patients medically stabilize hair loss with Propecia (finasteride) and Rogaine (minoxidil).

I recommend consulting with a dermatologist or recommended hair restoration physician in your area for more information on these medical hair loss treatments.

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

To share ideas with other hair loss sufferers visit the hair loss forum and social community.

This question comes from a member of our hair loss social community and discussion forums: 

I’m looking into hair transplant surgery. However, I hear hair transplant patients talking about “shock loss,” and it’s making me nervous. What is shock loss? How can a surgery to give me more hair cause hair loss? Is this hair loss permanent?

FUE shock lossThere are two types of shock loss: permanent and temporary.

Temporary shock loss occurs when strong, permanent follicles are exposed to trauma. The follicles are “shocked” into a temporary resting state (“telogen”) and return to normal function after a slightly prolonged dormant period. Usually, around 3-5 months. This happens most commonly in the donor area during hair transplant surgery.

Permanent shock loss occurs when weakened, pseudo-miniaturized follicles are exposed to similar trauma. These follicles are already “on their last leg,” and the stress pushes them over the edge. This causes “permanent shock loss” that does not grow back. This happens almost exclusively in the recipient area during hair transplant surgery. The zones surrounding the transplanted area are filled with these weakened, androgenic alopecia-affected follicles. The strain from the surgery is too great and the follicles simply can’t bounce back. It’s important to know that these follicles were going to fall out regardless. However, the shock loss simply speeds the process up.

This question comes from a member of our hair loss social community and discussion forums: 

Will the follicles removed during a follicular unit extraction (FUE) procedure grow back or “regenerate”? Or are these follicles permanently lost once they are removed?

fue fixedThey are “permanently lost.”

Regeneration in the donor area requires splitting the follicle and leaving some portion of stem cells behind while transplanting another portion to the front. This leads to regeneration in the donor region and new growth in the transplanted region. Unfortunately, it is all theoretical at this point. We’ve yet to find a reliable and reproducible method of “donor doubling” – or splitting the follicle and creating two follicles from one.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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I am going to have a hair transplant soon, however I have a few questions. I have been told that follicular unit strip surgery (FUSS) with trichophytic donor closure leaves a very fine scar that would allow me to shave my head down to a 2 or 1 grade and follicular unit extraction (FUE) scaring is still noticeable when the hair is cut at low levels. Is this true? If I shave my head down, I don’t want a million small bump scars.

admin-ajax.phpShaving the head is off the table for all strip patients unless they don’t mind displaying the scar. Most FUE patients will not be able shave with a razor either as all surgery results in some scarring. The FUE scars won’t be bumps but tiny visible dots. FUE scars typically allow a much closer buzz cut but there are no guarantees. There are many factors at play including your skin type and healing characteristics.

I have a very good quality strip scar that was closed with a trichophytic closure. With a #3 guard my scar is mildly detectable. Anything lower and it’s obvious. I’ve heard some guys say that they can get away with a #2.

Many patients are opting for FUE these days because yield and session sizes have increased substantially over the last few years and they want the option of a closely buzzed haircut. Others prefer to maximize the number of strip procedures they can get before turning to FUE to exhaust all possible donor grafts. In many cases, the scar can be concealed with FUE using either scalp or body hairs or with scalp micropigmentation.

The following response to a question from a member of our Hair Loss Forum and Social Community, was written by forum member “hair there” who is a scalp micropigmentation practitioner:

I just got my scalp micropigmentation (SMP) last week. They are telling me it will take about a month before I see the final results. Not too happy so far in some parts. Does it take a month?

AfterIt should not take a month to see final results. SMP results and heal times will vary from clinic to clinic as most use their own equipment/products. For instance, I use Beauty Medical’s system exclusively which is a temporary SMP designed to naturally fade and disappear over time.

From my experience it generally takes a few days for redness to dissipate and for the true final product to shine through. After about a week the client should have a finalized product and fading should start around the 1 year mark. This depends on several factors including client’s physiology, as well as environmental factors (sun/chlorine exposure, etc.). Once the product begins to fade there should be no color change (blue/green) just a lessening in intensity.

Now, the reason our system is temporary has to do with the depth we deposit the pigment (our needle goes .05mm), and the small size of the particles that comprise our pigments (15 microns). This small particle size allows for the body to absorb and eliminate the pigment.

This hair loss question  was answered by Dr. Paul Shapiro who is a member of the Coalition of Independent Hair Restoration Physicians.  

Dr. Shapiro, are your graft survival rates for follicular unit extraction (FUE) hair transplants coming close to your strip results?

0_7188Your question about graft survival is a good one but the answer is complex. When we talk about the survival of our surgeries we are honestly going by gut feeling and what we know should look like 95% survival.

To truly know the survival of a transplanted area, the area needs to be tattooed and photographed prior to surgery. The pre-surgery photo gives us a count of the hairs present before surgery. Then the incisions made need to be photographed and counted. Lastly, the grafts need to be planted and can be re-photographed. Most studies done this way are done using 1 sq cm tattooed boxes. In a year we can then take a photo of the tattooed area and count the number of hairs. And, even using this method is not accurate because about 10 to 15 of a person’s hair is in the catagen stage and cannot be seen.The only way to really measure survival is to transplant onto a completely bald head and mark out sq cm areas with a tattoo.

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