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Several years ago, Coalition physicians Dr. Jerry Wong and Dr. Victor Hasson released an educational video detailing and explaining the process of scalp exercises. In theory, scalp exercises help a patient create additional scalp laxity (or looseness) in the universal donor area before a hair transplant procedure. This allows the surgeon to (potentially) remove and implant a greater number of follicular unit grafts.

Although this video was informative, educational, and comprehensive, Hasson and Wong received a myriad of scalp exercise questions and concerns over the past few years. In response to this feedback, the clinic decided to create a new video that answers these thoughtful questions, presents new information, and provides a wonderful overview of scalp exercising.

To view this new video, click here: Hasson & Wong: Scalp Laxity Exercises.

Enjoy!

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Blake Bloxham – aka 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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Technorati Tags: scalp exercise, scalp laxity, universal donor area, hair transplant, follicular unit grafts, scalp exercising

This question, from a member of the Hair Restoration Social Community and Discussion Forums, was answered by recommended hair restoration physician Dr. William Lindsey:

I previously underwent an unsuccessful follicular unit transplantation (FUT) procedure and now have a large strip scar on the back of my scalp. I’m investigating scar revision surgery, but I’m wondering if the follicular unit grafts that surround the scar (and will be removed in the repair) can be salvaged and implanted into balding scalp?

It really depends on how big and thick the hair transplant scar is. If the scar is like beef jerky, then its pretty tough to get any hair out without transecting it or having essentially an antiquated 1 haired minigraft. If the scar is soft, sure. We are doing a scar repair from elsewhere next week and after the pre-operative exam,  we noticed that part of his scar is soft, and part is “jerky”; so I am not sure how many we can save, but we’ll try to get all we can.

Dr. William Lindsey

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Blake Bloxham – aka 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 Restoration, hair restoration physician, follicular unit transplantation, FUT, strip scar, follicular unit grafts, balding, hair transplant

This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY.  Dr. Beehner is one of our recommended hair restoration physicians. His professional answer is below.

I was looking closely at the hair transplant I had 15+ years ago and noticed many of the individual follicles appear to have several hairs per follicle in them. What is up with this? The hair on my sides is too thick to really tell if it is the follicles themselves doing this or if it’s a byproduct of something unusual that happened during the hair restoration surgery or healing. I counted at least 12 individual grafts that contained a follicle like this. Has anyone else experienced this?

By definition, a single hair follicle can only have one hair growing out from it. It is impossible for two hairs to come off of the same follicle. Obviously, it is hard to know the number of follicles under any given group of hairs since the follicle resides completely under the skin.

What you are seeing may have resulted from “pairing” of the follicular unit grafts. In other words, your hair transplant surgeon may have inserted a two-hair FU into a small slit opening and then later on had some extra 1-hair or 2-hair grafts and slipped one of them in along side the previously placed 2-hair graft in the same slit. Many doctors do this in the front-central area to increase density somewhat. However, when you look at one of these, it can look like an awful lot of hairs coming from a tiny opening all together.

In an ongoing thread on the Hair Restoration Forums, community members are discussing miniaturization analysis and if it should be performed before a hair transplant procedure. Miniaturization analysis is the process where hair restoration physicians carefully inspect a hair loss patient’s donor region (with a magnification device) and determine whether or not miniaturization is occurring in the harvesting zone.

During the balding process, hairs miniaturize or grow thinner at each expansion (or anagen) phase of the follicular growth cycle. Because of this, hair transplant surgeons must ensure they are not harvesting and implanting follicular units that are miniaturizing and susceptible to future loss.  Granted, miniaturization can occur in any scalp hair, but donor hair analysis is extremely important in a successful hair restoration procedure.

In the discussion topic, two hair loss experts (Louise – a hair transplant technician and consultant for Coalition surgeon Dr. Cam Simmons and Coalition surgeon Dr. Glenn Charles) share their opinion of miniaturization analysis and it’s importance before a hair transplant procedure:

When inspecting/assessing your hair’s characteristics, physicians will look for miniaturized hairs in the recipient and donor regions. If the donor hair is miniaturizing, it will not last and should not be transplanted. Some clinics use magnifying loops or a Densitometer or a close-up camera. Dr Simmons inspects everyone’s scalp personally with magnifying loops and/or a Microvid camera. The Microvid camera is a hand-held device that can be moved around one’s scalp and the physician and patient can see the image on a computer monitor. The follicular groups can be easily seen as well as any miniaturization. If the hair is long enough to hide it, tiny patches can be trimmed to get a very close look at the donor hair.

This question comes from a member of the Hair Restoration Discussion Forums and Social Community:

What is the open donor harvest technique used in a follicular unit transplantation (FUT) hair transplant procedure? How does it differ from harvesting a normal strip from the universal donor zone?

Although the open donor harvest technique is described as a unique mechanism,  it’s actually quite similar to the normal strip extraction utilized in a follicular unit transplantation (FUT) procedure. In a standard FUT procedure, a strip of dihydrotestosterone/DHT (the hormone directly responsible for hair loss) resistant hair is removed from the back of the scalp (also know as the universal safe zone), dissected, and implanted into balding areas.

In an open donor harvest procedure, a strip is harvested from the DHT resistant zone, but instead of making a straight incision (and potentially cutting or transecting viable follicular units), the hair transplant surgeon carefully cuts around (not through) unused follicular unit grafts at the incision borders. In doing so, the transection rate is quite low (quoted as low as 2%), but strip harvesting takes considerably longer and creates the potential for a crooked or uneven scar. However, many hair transplant surgeons state that no matter how the follicular units are harvested, scalp trauma and excessive transection are always taken into consideration.

Whether using the open harvest technique or simply keeping excessive transection in mind, most excellent hair restoration physicians are able to efficiently remove strips while minimizing trauma in the donor area.

This question comes from a member of the Hair Restoration Discussion Forums and Social Community:

After consulting with several recommended hair transplant surgeons I’ve come to the conclusion that most surgeons implant follicular unit grafts at a density of around 40 – 60 grafts per square centimeter. I’m curious, if I only want to restore my frontal hairline, why can’t the surgeon restore my hairline to the density I had before experiencing hair loss (80 – 100 grafts per square centimeter)?

Although I’m sure each hair restoration physician has specific opinions on implanting grafts at this density (and that final density is unique to each patient’s physiology), there are several reasons why I believe experts do not restore hairlines to an unaffected density:

First, I’m uncertain that the blood supply to the balding areas is sufficient to accept and properly nurture grafts at this density (80 – 100 grafts per square centimeter). Because of this, the graft survival rate and scalp trauma could both be greatly affected. Second, transplanting at this density could negatively affect surrounding native hairs (causing unnecessary damage).

Third, transplanting at this density would require a large strip (in a follicular unit transplantation -FUT case) or various extractions (in a follicular unit extraction -FUE case) for a small transplant area, which could lead to unnecessary scarring. Fourth, transplanting at this density does not take progressive loss into consideration. It seems like a great idea to densely pack or lower a hairline at a young age, but the results can be very unsatisfactory when and if future hair loss occurs. Furthermore, this also depletes precious donor follicular units.

This insightful information was posted on our hair restoration forum by Dr. Alan Feller of Great Neck, NY who is a member of the Coalition of Independent Hair Restoration Physicians.

Are there any negatives to FUE that you don’t have with FUT such as survival rate? I know it takes longer and is more expensive. Anything else people should know?

When it comes to hair transplant surgery, there can be no question that growth from follicular unit extraction (FUE) cases is not as consistent as that of strip procedures. The reason is obvious: the amount of trauma the follicular unit grafts must endure during FUE surgery, even the very best and meticulous FUE surgery, is far greater than the amount of trauma experienced by the equivalent FUT grafts. It’s a simple matter of physics.

That said, hair follicles are pretty hearty. Ask anyone who’s undergone multiple waxings, electrolysis, and laser hair removal. Those little guys will often endure all of that and still come back.

FUE is a great procedure, but it is very exhausting and time consuming even on the best hair restoration surgeons. Smaller cases usually do better because lack of fatigue can make the difference between hurting a graft and not hurting a graft. Also, if 10% of 300 grafts don’t grow, it’s not nearly as obvious compared to 10% of 1,500 grafts. That is, you probably won’t miss 30 grafts out of 300, but you most certainly will miss 150 grafts out of 1,500. The bigger the number of FUE gets, the more the equation works against the final result.

This question, asked by a member of the Hair Loss Discussion Forums, was answered by Coalition physician Dr. Cam Simmons:

I have heard of a process called LHFUE (Long Hair Follicular Unit Extraction) where individual long hair follicles are extracted and placed as short hairs between existing hairs in the natural direction of growth. This just sounds to me like a regular hair transplant. Is there a difference I’m missing?

The long-haired hair transplant was first presented by Dr. Marcelo Pitchon of Brazil. I believe this was done as a strip FUT procedure. My understanding is that the main purpose was to use it to simulate final density for planning purposes.

Patients could look in the mirror as the case progressed and could have input about whether they wanted more density or to cover more area. It was interesting to see videotaped patient’s reactions when they saw themselves in the mirror with a sudden improvement.

Dr. Pitchon explained clearly that the transplanted hairs would mostly shed then grow back like a typical hair transplant. It seemed to me that long-hair transplants would be more technically difficult and that the cosmetic recovery would be smoother with short-hair transplants but it was a very interesting presentation.

I, like many doctors, transplant slightly longer hairs where it is important to control the direction of the curl, such as in eyebrow transplants.

Cam Simmons MD

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This frequently asked question comes from a member of our Hair Restoration Forum and Social Community:

I recently underwent a follicular unit transplantation (FUT) procedure and was wondering how long I needed to wait before resuming my normal weight lifting routine? Are there certain exercises I need to avoid? Is there anyway to protect the hair transplant scar from stretching while working out?

Although this issue is frequently discussed on the Hair Restoration forums, many people have differing opinions on weight lifting after a hair transplant procedure. Of all the available explanations and suggestions, one of the clearest and informative replies comes from Coalition physician Dr. Robert M. Bernstein of New York:

You may perform normal daily activities for the next three days and moderate exercise for the next 14 days. After two weeks, you may resume your normal daily activities. Avoid direct trauma to the head for two weeks after the hair transplant procedure. Abstain from sexual intercourse and alcohol for THREE days following the procedure.

Exercise

Follicular Unit Transplantation (WOUND CLOSED WITH SUTURES OR STAPLES).

This question comes from a member of the Hair Restoration Social Community and Discussion Forums:

A past follicular unit transplantation procedure left me with a less than desirable hair transplant scar. I’m now investigating a scar revision procedure and I’m wondering the potential pitfalls and risks of this operation?

Although revising a follicular unit transplantation (FUT) scar is usually considered less invasive than a hair transplant procedure, there are still certain risks and issues involved. In most cases, the undesirable strip scar is removed in the same fashion as the donor portion in a FUT procedure – by removing a portion of scalp (varying in width and length) from the universal donor zone and closing the wound with sutures or staples. Because of this, some issues associated with traditional hair transplant operations – scar stretching, laxity (“looseness”)  in the donor region, and closure tension, are still relevant in a revision procedure.

However, one of the most significant complications from a scar revision procedure comes from many patient’s desire to obtain and implant additional follicular unit grafts from the excised scar region. During many revision operations, excess scalp (containing implantable grafts) is removed from around the scar region and the additional follicular grafts are transplanted into balding areas. However taking excess scalp (around the excised scar tissue) simply for the intent of obtaining extra grafts can often create another sub-optimal scar. In various cases, it may be advantageous to simply remove the scar tissue and close a smaller area instead of trying to revise the scar and obtain additional grafts.