This question comes from a member of our Hair Loss Social Community and Discussion Forums:

Several years ago, I underwent a follicular unit transplantation (FUT) procedure that, unfortunately, resulted in a significant “strip scar.” Now, I’d like to undergo hair transplant scar revision and I’m wondering what options are available?

In my opinion, hair transplant scar restoration (currently) breaks down into three categories:

1. Undergoing a scar revision procedure

During a scar revision procedure, the previous “strip scar” is excised in the same manner as strip removal during a follicular unit transplantation (FUT) procedure. After the scar is removed, a secure closure, likely a trichophytic closure, is utilized and the new wound, presumably, heals with less scarring. The most significant “down side” associated with this procedure is the potential for another unacceptable scar if the patient is prone to scarring. However, most talented hair restoration surgeons should be able to create a better closure and greatly improve upon the original scar.

2. Filling in the scar with grafts via follicular unit extraction (FUE)

During this procedure, grafts are extracted (via the follicular unit extraction process) and implanted directly into the scar. Although this procedure does not result in a second FUT scar, implanting grafts into scar tissue (which is generally thick and plagued by poor blood supply) can result in a lower yield and inability to fully camouflage the scar.

3. Camouflaging the scar with scalp micropigmentation (SMP)

This hair restoration article was written by recommended hair loss physician Dr. Carlos Wesley, who is recommended on the Hair Transplant Network.

Factors Influencing Postoperative Hyperesthesia (Discomfort)
in Hair Restoration Surgery

Summary

Background While esthetic outcomes in hair restoration surgery (HRS) have improved markedly since the advent of follicular unit transplantation (FUT), various undesirable sequelae persist. We investigated the technical and demographic variables that may contribute to the frequency of postoperative hyperesthesia.

Methods A multicenter retrospective chart review involving 552 patients undergoing HRS from 1999 to 2009.

Results A total of 19 patients (3.4%) reported postoperative hyperesthesia in either the donor or recipient area of their scalp. Although many trends emerged, one variable significantly influenced the rate of this neurosensory symptom. While no patient who had all previous and current HRS sessions performed entirely within the same investigated surgical practice (n = 42) experienced postoperative hyperesthesia, 14% of our patients who underwent prior HRS by a physician outside of the investigated surgical group (n = 35) developed this complication (P = 0.0404). The amount of intraoperative electrocautery to maintain hemostasis (P = 0.0897), degree of tension upon donor wound closure (P = 0.3044), and extent of donor wound edge undermining (P = 0.4420) influenced the frequency of this sequela to a lesser degree.

Conclusion These results suggest that physicians planning repair sessions on patients who have undergone prior HRS by a physician at a different surgical center should include the specific caveat of increased incidences of postoperative hyperesthesia in their preoperative consultation.

Acclaimed hair restoration physician Dr. Alan Feller is a pioneer in the field of modern follicular unit hair transplantation and an esteemed member of the Coalition of Independent Hair Restoration Physicians. Dr. Feller is widely known as one of the world’s foremost experts in follicular unit extraction (FUE) and is the inventor of the “Feller Punch“, a tool that has been adopted by many leading hair transplant surgeons around the globe.

Recently, Feller Medical announced the launch of their new, state of the art multimedia website. The new site features a unique, interactive patient results gallery, a patient video gallery, testimonials and more. Balding men and women seeking a solution to hair loss are encouraged to visit their new and improved website at Feller Medical to learn more about their experience, technique and high standard of patient care.

To discuss Dr. Feller’s new website, visit the discussion forum topic, Feller Medical Debuts New and Improved Website.

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant 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 Restoration Social Network and Enhanced Discussion Forum

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Technorati Tags: hair restoration, Dr. Alan Feller, hair transplantation, Coalition of Independent Hair Restoration Physicians, follicular unit extraction, FUE, Feller Punch, hair transplant, Balding, hair loss

According to the American Society for Aesthetic Plastic Surgery, the facelift, (rhytidectomy), is the sixth most popular elective procedure performed today.

Although the procedure is very common and usually offers significant cosmetic benefit, it is associated with one infrequently discussed side effect: the post-operative loss of “sideburns” and hairline distortion in female patients.  Females who undergo this procedure often consider surgical hair restoration to correct this.

During the facelift procedure, an incision is made in front of the ear (in the temple/sideburn region) and extended into both the hairline region and the area further behind the ear itself. Afterward, the skin is separated from the deeper tissues, tightened, and pulled until taut. Although this maneuver pulls the skin tight and creates a more “youthful” appearance, it also results in an excess of tissue that must be excised.

Unfortunately, because the initial incision is made in the sideburn and hairline area, the last step of the procedure involves the removal of the excess, hair-bearing tissue from this region. In various cases, this results in a total removal of the sideburn hair and an unnatural appearance of the hairline (which can be caused by scarring or a distortion of hairline shape or height).

Fortunately, although this side effect often discourages post-operative facelift patients, the damage can be reversed and reconstructed with modern hair transplant surgery.

This 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’m undergoing a hair transplant procedure in the near future, and I’m wondering if I should get a haircut before surgery? Is it best to “shave” my head? How short should it be cut?

Blake – 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: Hair Loss, hair restoration, Dr. Ron Shapiro, Dr. Paul Shapiro, hair transplant, haircut, follicular unit transplantation, FUT

This article was submitted to us for publishing and was partially written by Dr. Carlos Wesley, who is recommended on the Hair Transplant Network. For a complete list of contributors to this article, scroll down to the bottom of this article.

Hair Transplantation Procedures

Overview

Background

Hair transplantation procedures are used to treat various forms and degrees of permanent alopecia in both men and women. Intact hair follicles may be harvested from within the safe donor area of a patient’s scalp by either strip method or follicular unit extraction (FUE); each harvesting method has unique advantages and disadvantages. The refinement of follicular unit transplanting over the last decade has led to markedly improved hair survival and natural-appearing results.

This article provides a broad overview of the techniques used by various hair transplant surgeons throughout the world. Founded on the principal of donor dominance (ie, hair follicles continue to grow in the new recipient area to which they are introduced as long as they would have in the donor area from which they are extracted), the field of hair restoration surgery (HRS) has evolved considerably since its inception in the 1950s. Natural-appearing results are consistently achievable and reflect a surgeon’s technical skill and artistic creativity.

Indications

Hair transplantation is a surgical procedure used for the correction of androgenic alopecia (AGA), cicatricial (scarring) alopecia, or any form of permanent hair loss in both men and women.^[1,2]

This question comes from a member of our Hair Loss Social Community and Discussion Forums: 

I recently underwent hair transplant surgery (follicular unit transplantation) and I’m wondering if I’ll experience any sort of additional hair loss from the procedure? Additionally, how soon, after the hair transplant procedure, can I shave my head?

Technorati Tags: Hair Loss, hair transplant surgery, follicular unit transplantation, hair transplant, hair restoration

This question, asked by a member of our Hair LossSocial Community and Discussion Forums, was answered by recommended hair transplant surgeon Dr. Sanusi Umar:

I have noticed more and more cases recently of surgeons like Dr. Umar showing some impressive hair transplants using nape hair in addition to hair from the “safe zone”. I am curious as to what people’s views are regarding the use of nape hair in hair restoration surgery.

For most individuals, nape hair* is more DHT (dihydrotestosterone) resistant than the hair in the area of baldness. In other words, nape hair is not necessarily lost in all cases of male pattern baldness (MPB) and what’s more, the safe donor area (SDA) is functionally the area bordering the fringe of hair that would be left in a terminally bald person such as a Norwood 7 or higher. Yet, we know that the majority of individuals do not experience this degree of hair loss.

The role of nape hair has hitherto been defined by:

1. The notion that it is generally DHT susceptible.
2. It is not typically an area subject to harvest given the limitations of the strip harvesting methods available.

The second factor has been cancelled by the advent of follicular unit extraction (FUE). Since then, nape and temple hair (donor areas outside the SDA) have been widely used in successful repairs of strip-donor-depleted patients: Those would-be patients whose capacity for further follicular unit transplant (FUT) surgeries has been exhausted. It is the extension of these experiences with repairs that opened the prospect of using nape hair as the vanguard hair of transplanted hairlines. Obviously, patient selection is key. Using criteria such as the degree of balding relative to age, visual evidence etc. nape hair can play an important role in hair transplantation.

This question comes from a member of our Hair Loss Social Community and Discussion Forums: 

I recently underwent follicular unit transplantation (FUT) and I’m worried about post-operative scar stretching. I’m curious, could Botox injections help prevent the potential hair transplant scar stretching?

In my opinion, this wouldn’t work. Botox is a purified form of Botulinum toxin, which is a well studied muscle paralytic. Botox, when used for cosmetic purposes in the face, “relaxes” facial muscles and decreases the wrinkled, furrowed, aged appearance associated with excessive muscle contraction.

During follicular unit transplanation (FUT) the depth of the “strip” removed from the donor region goes to the dermis and (likely) slightly into the deeper subcutaneous fatty tissue, but stays superficial to any muscle tissue (which in that region of the scalp is likely to only be the occipital region of the occipitofrontalis muscle).

Because scar tissue forms from the more superficial layers and not the muscle tissue, providing an agent that would decrease potential contraction from the muscle, but not necessarily the overlying tissues, really would not prevent excessive stretching. Furthermore, injecting botox into muscles in the back of the scalp would result in unwanted muscle paralysis with no cosmetic or anti-spastic benefit to the patient.
___________________

Blake – 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

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

I am over a year post-op from a disastrous facelift by a ‘top’ UK surgeon who surgically removed my sideburns without my consent and elevated my hairline above my ears. It’s difficult to find anyone with significant experience of female sideburn reconstruction. There are just a few pics on the Internet and it’s the same few pics constantly circulating.

Some hair restoration surgeons appear to have fantastic results with female sideburn reconstruction using follicular unit transplantation (FUT) but I am a bad candidate for strip surgery as I already have a .8 x 7cm bald strip on my head courtesy the facelift surgeon where he pulled too tight and the scar stretched. My hair fell out and I now have this bald strip. Coupled with the loss of sideburns, I have lost a lot of volume and my hair was thin and fine to begin with so I cannot risk a stretched scar from strip.

I recently had revision surgery to try and minimize the elevated hairline (flap rotation and temple redraping) and to excise the bald strip but this, unfortunately, failed. The bald strip simply stretched again resulting in yet more hair loss and the rotation had no impact on the elevated hairline. My only option now is limited to follicular unit extraction (FUE) and I really need to get it right as the emotional and financial impact continues to devastate me.