Post Hair Loss Questions and Get Answers

This insightful information was posted on our hair restoration forum by Dr. Timothy Carman of La Jolla, CA, who is a highly esteemed member of the Coalition of Independent Hair Restoration Physicians.

Has anyone depleted their donor hair supply after 2 or 3 hair transplant surgeries? What options are available if you have done this and need further work? Is FUE an option if strip is not?

One of the issues to be addressed in the initial hair restoration consult, and, in my honest opinion, the most critical concept, is the surgical plan created by the physician in conjunction with the patients’ age, degree of hair loss, donor supply, scalp laxity, and genetic background (familial history); all in an effort to “predict” the future hair loss pattern for that individual. Ideally, then, knowing the limitations given the patients “lifetime supply-demand balance”, as I like to call it, the initial plan will be implemented so as not to ever get to such a distressing or “impossible” situation as described above.

This concept can be difficult to communicate, especially to younger patients, who may want a more aggressive (less receded) hairline than they will have supply for in the future.   In  my opinion, the successful hair transplant is just as much about creating the conservative, less “wow” result as it is the obvious large hair transplant megasession out of the ballpark results; probably even more so. 

The long term picture is a very important concept, thought I should just give it some thoughts here.

Many veteran hair transplant patients are familiar with the term “follicular unit grafting” and have come to know this as the today’s “Gold Standard” in surgical hair restoration.  What many don’t know however, is that a “follicular unit” falls under a particular category of “micrograft” – a term often wrongfully associated with a much less favorable and also misconstrued term “minigraft“.

Believe it or not even some of the leading hair loss doctors in the hair transplant profession today use some “minigrafts” when appropriate for the patient. But what exactly is a “minigraft”? Are they really as bad as some have perceived them to be?

Unfortunately, the terms for the various types of grafts have been misunderstood and misconstrued in our hair loss forum community for a long time.

Recently, Coalition member Dr. Ron Shapiro wrote an article to help hair loss sufferers understand the differences and appropriate use of various types of grafts.

I encourage you to read through Understanding Hair Transplant “Graft” Terminology to learn the various graft types and how they’re appropriately used. You are also encouraged to give your feedback on this hair loss forum topic discussing graft types.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair transplant, hair restoration, follicular unit, micrograft, minigraft, hair loss doctors, minigrafts, hair loss

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.

Many hair restoration doctors don’t perform hair transplant megasessions and they appear to be limited to do only 3500 grafts or maximum 4000 grafts.  The few doctors that do perform megasessions go up to 5000 grafts plus.  What’s the reason for this?  Are megasessions unsafe due to limited blood supply?  I know doctors recommended on the Hair Transplant Network do perform megasessions and their patients have great results, but why do other doctors limit themselves?

The answer to this question is quite complex. It would depend on what hair restoration physician was performing the surgery. Meaning does a particular surgeon and their staff have the actual capability of carrying out a procedure of greater than 4000 follicular unit graftss in a reasonable period of time?  As important, does the hair transplant patient have the donor hair density and scalp laxity?

If all of the above is true there are still many other factors that should be considered. How large is the balding area in which the grafts are to be transplanted into? Would the patient prefer to have 5000 grafts placed into a specific area and have 4000 grafts actually grow hairs. That is an 80% success rate. Or would they prefer to have 4000 grafts placed into that same area and 3800 grow successfully? Giving a 95% success rate. Saving those other 1000 follicular units for later if needed. Is the physician really giving that patient those large number of grafts? It is awfully hard to go back and count.

While many men would rather not experience hair loss at all; those that do, experience many degrees of baldness. While some hair loss sufferers lose hair only at the front, others lose it in the crown while others lose it all over the top.

While restoring a natural looking hairline and frontal core is standard in surgical hair restoration, the bald or thinning crown is often considered the “black hole” for grafts. Thus, patients need to decide how much hair (if any) they want to designate for the crown as they discuss their hair restoration goals with their physician.

Recently, forum member “Mike the Dane” who’s already had a couple of hair transplants posted a thread with photos asking for input from our community as to whether or not he should start to focus on his balding crown. To offer your advice and/or share your experience, visit “To Crown or Not To Crown”.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair loss, baldness, hair restoration, bald, hair transplants, balding

The goal of hair transplant surgery is to give patients more hair than they had prior to surgery. However, unlike other cosmetic procedures, sometimes patients look worse after surgical hair restoration before they look better.

Some patients are plagued by a temporary hair loss condition known as telogen effluvium or “shock loss” which can occur anytime hair is transplanted in between or around existing hair.  This is true whether the hair is natural or previously transplanted. This often causes great concern for those who don’t expect it, and even those that do; it can be a real brain buster causing mild anxiety.

View this hair loss discussion thread to learn and discuss why shock loss occurs and how to get through the doldrums while waiting for new hair regrowth.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair transplant, hair restoration, hair loss, telogen effluvium, shock loss, hair regrowth

Most balding men and women would love to restore their natural full head of hair by waving a magic wand and/or by popping a miracle pill. However, hair restoration involves careful and strategic planning with a skilled and experienced hair loss doctor. While Propecia (finasteride) and Rogaine (minoxidil) are typically good at slowing down or stopping the progression of male pattern baldness, hair transplant surgery is the only method of hair restoration proven to grow hair in completely bald areas.

Today’s state of the art hair transplants are very natural looking and undetectable by even the harshest critics. This explains its increase in popularity over the last several years. But while advancements in surgical hair restoration are indeed exciting, it’s crucial for men and women considering this procedure to develop realistic expectations. What can realistically be achieved with hair transplantation varies for each patient. Below, we’ve cited a few important tips in helping you learn what to expect from hair replacement surgery.

Supply Verses Demand: What can be realistically achieved depends on the supply of donor hair and the amount of baldness in demand of new hair. Most patients can typically only achieve an illusion of fullness even under the best circumstances. Thankfully, this is usually enough to provide patients with a cosmetically significant improvement. Those with advanced balding may have to make additional sacrifices and leave some balding areas untouched. To see what hair transplants can accomplish on patients of varying degrees of lost hair, view Hair Transplant Photos by Norwood scale.

In the past I have been told that hair density of 50 follicular unit grafts per square centimeter should not compromise graft survival.  However, I was wondering would transplanting hair at 55 FU/cm2 or 65 FU/cm2 compromise vascularity or hair growth yield? Also, is any graft survival compromised leading up to achieving natural density? Cheers.

This insightful information was posted on our hair restoration forum by Dr. Brad Limmer of San Antonio, TX who is a member of the Coalition of Independent Hair Restoration Physicians.

I agree with what has been on the hair loss forum discussion thread “Graft Survival and High Hair Densities” by various members regarding percentage yield.  As Coalition member Dr. Charles points out a very important point regarding this question, “there are countless variables that go into this equation.” Some are hair transplant patient dependant and some are hair restoration clinic/technique dependant.   Thus, the outcome can be different between patients even though they go to the same clinic.

We have typically approached the problem of yielding densities higher than 50 FU/cm2 by a 2 pass approach. While more conservative than some (who produce nice results), I feel it minimizes 3 important risks to the patient:

1. Less than optimal hair growth
2. The Potential for ridging (dermal fibrosis below the skin – which is basically scar tissue resulting from the multiple recipient sites create in such a small area)
3. Permanent neovascularization (redness that won’t go away – resulting from capillary proliferation during the healing process)

Balding men and women with hair loss who’ve decided to get a hair transplant are usually excited with dreams of getting their hair back. And though the end result of a hair transplant is a fuller head of hair, the expression, “the devil is in the details” is vital when learning how to fit surgical hair restoration into your life, especially during the first several months of healing and waiting for new hair growth. This includes returning to work, concealing your hair transplant from co-workers, friends and family, how long it takes to heal and look normal, etc.

Visit this discussion thread to discuss how to prepare for the first few awkward months after surgical hair replacement including when it’s ok to return to work. Your experience and input is welcome and encouraged.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: Balding, women with hair loss, hair transplant, hair restoration, hair growth, hair replacement

Do you have any idea as to what the average surface area is for level 5, 6, and 7 on the Norwood scale of hair loss?  I was measuring my scalp and found that even if I progress to a Norwood scale level 7, I will only have about 175 cm2 of bald area. That would only take 7,000 grafts to fill in the entire area with 40cm2, a density that I believe is more than adequate to give an illusion of fullness and hair density. I realize there are variables such as color, hair shaft diameter, texture, etc. that come into play, but shouldn’t any hair restoration physician that transplants 1,000 grafts per Norwood level fill in the entire area with good density?

This hair loss question was answered on our hair restoration forum by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

In my experience, the average patient’s head can be divided into two areas. 

The frontal 2/3 of the scalp on average measures 100 sq.cm. On average the crown loss is 80 to 100 sq.cm. The area of the crown will vary by how low and wide the crown loss is. On average I would say that to cover the total bald area in most men who are type 6 or 7 on the Norwood scale, I cover an area of 200 sq. cm. But there are men with very large balding scalps in which the area is more like 250 to 300 sq.cm and men with smaller areas. A total area of 170sq.cm.is in the realm of a normal area to cover.

Recently, we sought the advice of our online patient hair loss forum community regarding the potential Coalition membership of two impressive doctors recommended on the Hair Transplant Network for the last year. These physicians are Dr. Timothy Carman of La Jolla, California and Dr. Brandon Ross of La Jolla, California. To learn how we recommend hair transplant surgeons, click here.

View the Potential Coalition Membership for Dr. Timothy Carman

View the Potential Coalition Membership for Dr. Brandon Ross

In addition to garnering feedback from our patient community and highly respected hair restoration physicians, surgeons considered for Coalition membership are often visited and observed in live surgery by Patrick Hennessey, publisher of the Hair Transplant Network. Highlights of each visit along with surgical photos are prominently featured in the “Visits to Leading Hair Transplant Clinics” forum. To view the highlights of Pat’s visit to Dr. Ross’ clinic, click here. To view the highlights of Pat’s visit to Dr. Carman’s clinic, click here.

After extensive research and seeking input from our patient community and other leading surgeons, both Dr. Carman and Dr. Ross have been approved to join the ranks of the elite Coalition. Feel free to congratulate them by clicking on their featured potential Coalition membership threads above.

We encourage those local to these cities considering surgical hair restoration to consult with these excellent physicians to develop a long term hair restoration plan.

Bill Seemiller – aka Falceros
Associate Publisher/Editor