The following hair loss article was written by Coalition hair transplant surgeon Dr. Michael Beehner:

Dr_Beehner_photoIt’s important that a hair transplant surgeon approach a 21 year old male a lot different than a 31 year old. There are two major reasons for being conservative and going slow, which includes for most of us – being a little reluctant to perform surgery on men under 23.

Reason #1: Male pattern baldness MPB is progressive throughout a male’s life. You can never look at a man in his 20’s and say you know how far his hair loss will extend. Virtually all Norwood IV’s and V’s go on to become Norwood VI’s, and a sizable percentage of young men with Norwood VI pattern go on to become a Norwood VII with the side fringe located somewhere down the side of the head.

There is a large risk for turning that young man into a freak later in life. This can lead to a reclusive lifestyle, depression, and rarely even to suicidal states. The decision to transplant a young man in his late teens or early 20’s should be taken very seriously. The hair transplant surgeon is making permanent marks on that person’s head that he will have to live with the rest of his life.

I wish to touch on this topic as it seems to be coming up a lot in articles and the like and I often get told by people (without them putting in some thought) that age should be considered when considering getting a hair transplant.

In my opinion your age is irrelevant when considering hair transplantation. At the end of the day it comes down to your hair loss to date. If all men lost hair at the same rate, then I would say yes wait until you get to a certain age to consider hair transplantation, but obviously that is not the case.

We all have a different genetic predisposition for hair loss. Due to genetics I lost a great deal of hair at a very early age, and by the age of 23 I was a IV on the Norwood Scale. This means I didn’t have much more hair to lose, so why would I wait until I am 30 or 35 and lose all those years being unhappy and down on myself? I have work colleagues who are in their 50’s and have a fuller head of hair then I did at 23.

The below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by Janna, the lead medical technician for Coalition hair restoration surgeons Dr. Ron Shapiro and Dr. Paul Shapiro.

I’ve had 3 strip procedures totaling 3,000 grafts with poor results. My goals are to add density in front and revise the scar. If I got another follicular unit strip surgery (FUSS) by a much better hair transplant surgeon this time, would that doctor be able to take the strip from the same area, remove the scar and then close up the area nice and tight? Seems that I could accomplish both goals that way.

scarThis would depend much on the size of your current scar and how much donor you need to thicken the frontal area you want addressed. Remember that the size of the donor strip+scar can only be a certain width or else there is great risk of the scar stretching.

There are different approaches to achieving your hair restoration goals and I’d consider you a repair case. Sometimes the repair cases aren’t done over just one procedure so it’s important that the clinic is able to work with you and get you to where you want to be.

Janna
Lead Medical Tech and Surgical Manager
Shapiro Medical Group

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David (TakingThePlunge)
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 have had recession and thinning hair for years. Am on 1.5mg daily of Finasteride and have been for 15 years. It has helped but lately (last three years), I feel like the battle is being lost. Therefore, I think “hair transplant”.

My decision to do a transplant is still worrisome because I fear having it done, all the hair behind my transplanted space falling out, and having the need to ultimately shave my head and lo and behold I have this massive scar there for people to look at (especially in church!). How do people who have had a transplant rationalize this last step before they take the plunge and if you do go fut should you expect that you will never be able to shave your head without someone completely noticing what has been done?

6a00d83452e47a69e2012876af43d4970c-800wiI’m sorry to hear that finasteride is no longer as effective for you as it once was. Medical hair loss treatments like Propecia (finasteride) and Rogaine (minoxidil) can help prolong the inevitable but, as we all know, there is no hair loss cure.

You haven’t stated your age and, of course, that will play a role in evaluating your candidacy for hair transplant surgery. However, given that you’ve been on finasteride for many years and have recently begun to see increased hair loss, you have a valid concern. Depending upon your age, current degree of hair loss, eventual Norwood Scale class and individual hair restoration goals, it may be possible to find a balance that will look natural over your lifetime and that you’ll be happy with aesthetically. Photos would help provide you with more realistic advice.

The following response was posted to our Hair Loss Social Community and Discussion Forums by Ailene Russell, Clinical Supervisor for Dr. Jerry Cooley who is a member of the Coalition of Independent Hair Restoration Physicians:

Is it fair to say the more you dense pack a hair transplant in a certain area there is a greater chance of shock loss? What I’m trying to say is, the more grafts you insert & also take out will there be more trauma to the scalp hence shock loss?

shockedWhen you discuss shock loss there are a lot of variables. You have to also understand that if the patient has a large amount of native hair that is, in fact, miniaturized by male pattern hair loss and they are not using medical hair loss treatments, this increases the “chance” of shock.

It also depends on the hair restoration physician’s technique. Dr. Jerry Cooley uses very small custom blades or needles to make the recipient incisions. He also makes his incisions very shallow and they are not all the same size.

In our post-op care, we have the patient spray with Dr. Cooley’s own post-op spray continuously for the first three days. This helps to restore that loss of oxygen which is the issue with “nicking” the small capillaries. The more densely packed the follicular unit grafts are, the more trauma and loss of blood flow to the new grafts there can be.

So, 20 years ago we discussed shock as something that would probably occur. Now, we seldom see it even with dense packing. Remember, you will receive the best yield the first time transplanting into a given area.

Ailene Russell, NCMA
Clinical Supervisor for Dr. Jerry Cooley
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One of the most common questions patients ask after hair transplant surgery is: “did I lose a graft?” Patients are extra cautious after surgery, and any slight bump of the head or funny-looking graft causes anxiety. This is because the grafts are fragile during the first few days after surgery, and it is possible to “lose” one. Excessive pulling, rubbing, or bumping can dislodge grafts. These few grafts are truly “lost” and won’t grow. But how do you know if you’ve actually lost a graft?

When a graft truly dislodges, you’ll see two things: 1) bleeding, and 2) an intact follicular unit graft — usually laying flat on the scalp near the hole where it was originally placed. I’ve said this on the forums many times in the past, but it’s still a very frequently asked question. Well, they say a “picture is worth a thousand words,” so here is an image showing several truly “lost” grafts. If a patient sees something like this, they probably did lose a graft. If not, they’re probably okay:

lost graft

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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

Follow our community on Twitter

Watch hair transplant videos on YouTube

Technorati Tags: hair transplant

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

Which procedure has better growth, Follicular Unit Extraction (FUE) or strip (Follicular Unit Strip Surgery)?

implanted frontAltogether, this is a complicated question with many variables. On average, however, strip has higher and more consistent growth. Here’s why:

Long story short, FUE exposes the grafts to a greater level of stress and strain, and this affects growth and survival.

As to how much? The objective data — which is still lacking — tells us it’s anywhere between 10% – 30% less than strip. I personally think strip yield is 95%+ on average and FUE is probably 75-80% on average. The caveat with FUE is that it’s a lot more variable. You’ll get cases where it’s 90%; you’ll also get cases where the yield is clearly poor.

Now, does this mean it’s a bad procedure or patients shouldn’t chose FUE?

No, absolutely not. What it means is that patients need to know the above information and hair loss doctors need to recommend the right surgery to the right patient. If a patient is okay with variable yield and doesn’t want to hassle with the strip scar, then FUE is an appropriate choice. But, this info needs to be shared and discussed honestly so patients can make an informed decision.
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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

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

I think I have retrograde alopecia (hair loss). Can I undergo hair transplant surgery with retrograde hair loss?

dupa_sampleRetrograde hair loss — or alopecia — refers to thinning in what should be the permanent donor region (the hair on the sides and back of the scalp). These are the follicles we use in hair transplant surgery. Hair restoration physicians harvest follicles from this region because they are resistant to DHT — the “hair loss hormone” — and won’t shed after being implanted into the front of the scalp.

Patients with retrograde alopecia have thinning in the permanent donor region. This means follicles from this region can’t be used in hair transplant surgery. They may thin or shed in the future, so they should not be transplanted. These patients are generally not good surgical candidates. However, all patients who believe they suffer from retrograde alopecia or a diffuse thinning pattern should be evaluated by a hair loss expert in-person.
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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

Follow our community on Twitter

Watch hair transplant videos on YouTube

Technorati Tags: hair loss, , hair transplant, Hair restoration,

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

Dr_Lindsey_photoI frequently discuss hair transplantation as being similar to trees in a forest. I’m a tree hugging hair transplant surgeon. Here are some similarities between the human head and a forest:

  1. A forest has a random pattern at the border and not a straight line. The natural human hairline is random and not straight like so many of the old style hair transplants we see on TV here in the DC area.
  2. A forest has individual trees which you can see at the edge, but behind that all you see is “the forest”, not clumps or individual groups of trees. Same with a hairline, thus we put singles at the edge, followed by doubles and triples.
  3. Lastly a forest of thin trees conceals the ground less than a forest of bushy leaf filled oaks. Hair restoration patients similarly have hair which can be thin and less concealing no matter how densely packed, or thicker hairs with better coverage even with decreased hair count.

In order to better demonstrate, I made this video. Recall that I’m not a professional video maker but it should help explain how differences in donor hair quality and thickness can alter hair transplant results, and what the differences are between single and multiple haired follicular units.

Dr. William Lindsey – McLean, VA

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

Dr. Vories, It has been stated by a physician with some follicular unit extraction (FUE) experience that subcutaneous scarring resulting from the primary FUE procedure will compromise subsequent procedures by making extraction more difficult, with a significantly higher transection rate resulting in a lower yield and a graft of poorer quality. In your vast experience performing FUE do you agree with this observation and do you recognize this as a FUE barrier that will need to be addressed by further refinement of the current state of the art hair transplant techniques?

Dr_VorriesI have seen this stated before, but I do not agree with it. We have done many hair transplants on previous FUE patients, and we measure all transection rates. We have seen no difference in transection rates in subsequent FUE procedures.

What we do see, however, is increased transection in what we would expect in patients whom have had prior follicular unit strip surgery (FUSS) – especially below the strip scar,where exit angles get distorted due the tension in closing the wound.

Dr. Mike Vories, MD
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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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