Post Hair Loss Questions and Get Answers

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeons Dr. Ron Shapiro and Dr. Glenn Charles:

During a recent hair transplantation consult, the physician told me that he will create an “irregular hairline” during my hair restoration procedure. However, I’m wondering why he would chose to do that? Wouldn’t a straight hairline look better? Why create an irregular hairline during hair transplant surgery?

The goal of any hair transplant procedure is creating natural, realistic results. A very important aspect of achieving subtle, realistic results is recreating a natural hairline. Though many individuals assume that hairlines unaffected by hair loss are straight and regularly shaped, this is not the case. In fact, in order to create a realistic hairline, hair restoration surgeons must utilize an irregular, “zig zag” design.

In fact, according to Dr. Glenn Charles:

The term we often use to describe the hairline approach is creating a “regular irregularity.” Meaning there has to be a certain degree of randomness to give a natural appearance. However, there also has to be some method to the madness. You could also call this “Zig Zag” hairline design.

Dr. Ron Shapiro agrees, and said the following:

This comment, from a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. William Lindsey:

I’m planning on going for a hair transplant and recently consulted two top hair restoration physicians: both highly recommended on this forum. One recommended follicular unit extraction (FUE) and the other a strip. Both recommended between 1500-2000 grafts.

I’m trying to consider worst case scenarios for both options and am wondering if the scar is poor with the strip, how well does FUE into donor scar work to cover it up if I want to keep a short hairstyle as an option in the future? Has anyone done it successfully?

Follicular unit hair transplantation via strip is much more consistent at providing good results and unless you are planning on really short hair, our office would strongly suggest strip. Plus, if you are likely to need more hair later on, strip limits the quantity of scar tissue in the donor area.

You can wind up with a bad strip scar from even the best of surgeons, but it’s not common. Just yesterday I saw another 30ish year old with Norwood Class 5 hair loss who’d had 600 FUE’s (more likely 2mm punches) to attempt to rebuild his frontal hairline.  Now he presents for repair of that plus addressing some of the “further back” loss he’s had since that procedure. Well his donor area is all full of scar and we’ll be lucky to get 2500 grafts out of him and more likely 2200 at one setting since there is so much scar tissue in his donor region.

This comment, from a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. William Lindsey:

I know that this will sound funny, and it is not a complaint, but it seems like the hair on top is much thicker than my hair on the side. I have been told I have good hair transplant donor hair, but the area that I see scalp when I part my donor region is much larger than, say, if I were to part my hair down the middle. Does this make sense?

My donor part may look like it is a half an inch wide or more, and my hair parted down the center may only be a quarter on an inch. I will see my hair restoration physician sometime this summer and talk to him about it but, until then, I was wondering if this is normal at all. It just seems like my donor is thinner than my non donor, or I could be OCD and over analyzing things? Any thoughts?

I’d guess that in 40% of the follicular unit transplant (FUT) strip cases we do that the hair is noticeably thinner on one or both of the sides than in the middle or up higher on the head. Then throw in a guy with salt and pepper hair and it can really get dicey as to how many grafts you’ll get from a typical strip.

Several months ago, we started a new feature at our hair loss community: the Hair Transplant Patient of the Week.

Each week, we review hair transplant cases posted by patients on our Hair Restoration Discussion Forums and select one particularly excellent result as our Hair Transplant Patient of the Week.

In April, we selected three community members as our patients of the week:

First, was Hypox, who received 2,500 grafts via Follicular Unit Transplantation (FUT) from Dr. Victor Hasson. After years of trying hair loss medications, traditional Chinese treatments, and Low Level Laser Therapy (LLLT), Hypox underwent surgical hair restoration in 2009 with a different physician. Ultimately, Hypox decided he required additional grafts, and sought a second procedure with Dr. Hasson in 2011. Recently, Hypox shared a 6 month update with our community, and the results are excellent! To see Hypox’s restored hairline, frontal scalp, and (partial) midscalp, please review the following: 6 Month Update – 2,500 Grafts from Dr. Victor Hasson.

Next was Levrais, who received 5,700 grafts via Follicular Unit Extraction (FUE) from Dr. Christian Bisanga.  During a total of 3 procedures, Dr. Bisanga used an impressive 5,700 grafts to restore Levrais’ hairline, frontal scalp, temple points, and part of his vertex. Recently, Levrais shared a 5 month update of his 5,700 graft FUE procedure with Dr. Bisanga, and the results are impressive! To review the procedure, please see the following: Levrais – 5,700 Graft FUE with Dr. Bisanga.

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

One week ago, I underwent hair transplant surgery via the follicular unit transplantation (FUT) method. After the strip extraction, the physician decided to close the wound with staples. Since then, I’ve been healing well, but I’m eager to get the staples removed. So, I’m wondering: how long after hair transplant surgery are the staples normally removed?

Follicular Unit Transplantation (FUT) via strip surgery incisions can be closed two different ways: with sutures (“stitches”) or with staples. While both methods have advantages and disadvantages, the decision to use one over the other usually comes down to the preference of the operating hair restoration physician. However, despite the method of closure, patients are usually eager to have the sutures or staples removed and continue with their daily lives. So, this leads to the question: how long after hair transplant surgery should staples be removed?

According to most hair restoration experts, staples should be removed somewhere between 12 to 14 days after hair transplant surgery. Some clinics will allow as low as 10 days, especially in cases where travel is necessary, but many use 12 days as the cut-off for staple removal. What’s more, some physicians understand the urgency to remove the staples and will agree to remove every other staple on day 11 or 12, and remove the rest on day 14.

This question, from a member of our Hair Loss Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

I got a follicular unit hair transplant approximately two months ago by the strip method. I got a wound closure called trichophytic and self-dissolving stitches. The donor area felt pretty sore for a while at first and I found it somewhat difficult to sleep as one would expect. However, this subsided greatly after a month and it would have seemed to have healed up very well so far.

On a few occasions, including earlier this evening, I picked at some scabs in the donor area. A few times the scabs that came off in my finger had hairs in them. They were purely white flaky scabs with absolutely no blood. It would seem that the hairs were going through the scabs.

Could somebody please tell me if there is a possibility that I pulled hair follicles out from my head when picking at these scabs or are the hairs that I see interwoven in the scabs simply hairs only that will grow back again?

You cannot pull out the hair follicles at this point (1 month post-op). I do agree with gentle rubbing/messaging to get the scabs off.

Keep in mind that, for the first few months after the procedure, the original hair in the areas that were transplanted and close to donor wound are more fragile.

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I’m interested in the hair transplant surgery without a rear scar. Please tell me what the next step is. Is it possible to do the procedure with long hair? Please note that I am not completely bald and I use Toppik hair loss concealer.

It’s important to note that there is simply no such thing as completely scar-less surgery. However, it seems that you are referring to Follicular unit extraction (FUE) hair transplantation.  This procedure avoids the strip scar associated with Follicular unit transplantation (FUT) via strip excision and can, under the right conditions, result very minimal scarring, allowing the patient to wear a closely cropped hairstyle without detection.

Unfortunately, FUE will require you to shave your donor area and, in some cases, your entire head. To learn more about these techniques, click the links above and also research on our hair restoration forum.

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

Get Proven Treatments at the Best Prices by visiting our new online hair loss treatment shop.

Technorati Tags: hair transplant, bald, Toppik, hair loss, Follicular unit extraction, FUE, hair transplantation, Follicular unit transplantation, FUT, hair restoration

Several months ago, we started a new feature at our hair loss community: the Hair Transplant Patient of the Week.

Each week, we review hair transplant cases posted by patients on our Hair Restoration Discussion Forums and select one particularly excellent result as our Hair Transplant Patient of the Week.

In March, we selected three community members are our patients of the week:

First, was Djjr1, who received 2,500 grafts via Follicular Unit Transplantation (FUT) from Coalition hair restoration surgeon Dr. Alan Feller. Four years ago, Djjr1 grew tired of his hair loss and decided to seek surgical restoration with Dr. Feller. Recently, Djjr1 proved that quality hair transplantation truly “stands the test of time” by updating the community with his 4 year results. To review Djjr1′s excellent 4 year post-operative update, please see the following: Dr. Alan Feller – Four Years After 2,500 Grafts.  

Next, was Aj29, who received 1,301 grafts via Follicular Unit Extraction (FUE) from Dr. Christian Bisanga. Aj29 chose Dr. Bisanga to treat his temporal regions and hairline because of his experience with FUE and his expert use of a manual FUE punch tool. Recently, Aj29 shared a 9 month update on the community, and his decision to seek FUE with Dr. Bisanga clearly paid off! To view Aj29′s 9 month post-operative update, please see the following: Dr. Bisanga – 1,301 Grafts to Hairline.

Just wondering; if balding is a progressive condition, why would patients opt for surgery (be it strip/extraction)? Won’t we have to deal with it once the hair falls out?

You are correct. Androgenic alopecia is a progressive condition and there is no hair loss cure. This is the very reason why hair transplants are not recommended for very young balding men and also why most hair restoration surgeons highly recommend medically stabilizing hair loss with Propecia (finasteride) and Rogaine (minoxidil).

The older we become, the easier it is to more accurately judge just how far on the Norwood Scale our hair loss will progress. This helps doctors and patients agree on a long-term plan that will make the best use of grafts in order provide for adequate donor hair to address future balding. Medical treatments can prolong the life of existing hair and, in some cases, even regrow hair. The right patient with the right plan can achieve a natural and aesthetically pleasing result that will last a lifetime.

It’s important to remember that not everyone is a candidate for surgical hair restoration. Patients have to find a skilled and ethical hair transplant surgeon that they trust to give them the best advice.

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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.
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 Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

I just had my hair transplant a few days ago with Coalition hair restoration physician Dr. Damkerng Pathomvanich who said that my scalp was very loose. So loose that it might result in a large donor scar. He said I can take a drug called Enalapril to help reduce the appearance of the hair transplant scar. The only possible downsides are coughing and discolored urine. He said it’s inexpensive and I would only have to take it for about 3 months.

Does anybody have some more information on this? I am probably going to take it just to ensure that I have the smallest scar possible for when I want to cut my hair short.

Also if you guys know any other tips to keep my scar from widening I would be interested to hear them.

I have not heard of that drug being used for the purpose of reducing scar formation. However, Dr. Pathomvanich may have some insight that other doctors do not currently have. You really want to avoid excessive flexion of the neck (no chin to chest movements).

People have a tendency to want to test things out to see if there is any pain (like purposeful over flexion of neck to see if donor area is still painful). Don’t try it for several months.