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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.

This question comes from an interesting thread started on the Hair Restoration Discussion Forums:

Which member has received the most follicular unit grafts throughout their series of hair transplant surgeries? How many grafts were available in your donor area? How many hair restoration procedures did it take?

Although this topic is discussed quite frequently, it’s difficult to provide a universal, generalized answer. Since each patient is unique, the maximum number of grafts available in the universal donor area, the number of hair transplant procedures necessary to harvest these units, and the number of follicular units that can be safely harvested vary. Variables, such as donor laxity (the “looseness” of the scalp), hair characteristics, level of baldness, type of procedure (follicular unit transplantation -FUT versus follicular unit extraction – FUE) performed, and density in the donor region all contribute to the number of available grafts, the number of procedures necessary to extract the grafts, and the number of grafts that can be safely transplanted.

Despite these numerous variables, members at the Hair Restoration Discussion Forums are discussing the issue and trying to discover which hair loss patient has received the largest number of grafts, how many procedures it took, and if there are units left in the donor area. Very large numbers, ranging from 10,000 to 13,000 grafts, 4 to 5 procedures, and different methods of extraction are being reviewed. Do you think you’ve received the greatest number of follicular units, or know the maximum number of units available in your donor area? If so, feel free to participate in the ongoing thread – Who has had the most work done?

This question, asked by a member of the Hair Restoration Social Community and Discussion Forums, was answered by Spex – a senior member and consultant to Coalition physician Dr. Alan Feller:

I’m wondering, if a hair loss patient was only going to undergo one type of hair transplant surgery, either follicular unit extraction (FUE) or follicular unit transplantation (FUT), which procedure would yield the greatest number of grafts in the long-term (meaning multiple procedures over the entire duration of a hair restoration journey)? Which procedure (if given the option) should I choose?

Every patient is so very different that the answer to the question varies and there is no definitive solution for every hair transplant patient. Unfortunately, hair transplantation is not an exact science.

For example, I know some patients who have received 3000-4000 follicular unit grafts via FUE over multiple sessions very successfully because they possessed the donor supply, surface area, and the appropriate physiology to enable safe extractions over a large enough area without visible scaring. On the other hand, something like 7000+ grafts (over multiple sessions) via FUE is certainly a very rare and individual case, but has been accomplished many times through FUT operations. Also, this would definitely be the exception and not the rule, and basing hypothetical FUE grafts numbers on this one case along is highly inaccurate and misleading (in my honest opinion).

Because of the progressive nature of hair loss and the evolving nature of hair restoration treatments, patients often wonder if follicular unit grafting procedures stand the test of time. Although various articles are written on this very subject, many times a picture is truly worth a thousand words.

Recommended hair transplant surgeon Dr. Mike Meshkin of Newport Beach, California recently presented a case on the Hair Restoration Discussion Forums that demonstrates how appropriate planning and refined surgical techniques create a lasting result. Dr. Meshkin performed a 3,000 graft, follicular unit transplantation (FUT) procedure on the patient over 18 years ago and took follow-up photographs during a recent office visit. Needless to say, the results are impressive and still look ultra refined (even by today’s standards). View the presentation here:

Dr. Mike Meshkin – 3,000 graft case

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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: hair loss, hair restoration, follicular unit graft, hair transplant surgeon, follicular unit transplantation, FUT

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

I’m a male, late 30s, with a salt and pepper mixture of gray and dark hair investigating a hair transplant procedure. My question involves my gray hairs and transplanting gray hairs from the universal donor zone. Should my hair transplant surgeon try to remove a strip with as little gray hair as possible? Will the gray hairs be difficult to properly prepare under a microscope? Should the hair technicians try to blend black and gray hairs when preparing the follicular unit grafts?

First, it’s important to realize that many hair restoration patients possess gray or graying hair, and this issue is handled by experienced hair transplant surgeons on a daily basis. Meaning that transplanting gray hairs during a follicular unit transplantation (FUT) or follicular unit extraction (FUE) procedure should not be an issue.

Removing a follicular unit transplant strip to purposely avoid gray hairs is not an optimal strategy and would most likely not be done by a reputable transplant surgeon. The universal safe zone (where follicular unit grafts can be safely extracted because these follicles are resistant to the hormone that causes hair loss) is limited, and the surgeon will likely want to safely extract a significant amount of grafts during the procedure. Because of this, strategically ignoring pieces of the donor area because of gray hairs would not be a good idea. Especially because, under normal circumstances, gray hairs are just as viable as ones that still retain a natural hair coloring.

This question, asked by a concerned member of the Hair Restoration Social Community and Discussion Forums, was answered by Coalition physician Dr. Glenn Charles:

Around ten days after my hair transplant surgery I made the mistake of spending excessive time in the sun and ended up with a sunburn on my scalp. Since this occurred shortly after my follicular unit transplantation (FUT) procedure, I’m wondering if this could affect the final result? Did I damage any newly implanted grafts?

You are most likely safe so long as you did not severly burn the scalp in the transplanted areas. Especially if the burned area returned to its normal color shortly after the exposure to the sun. Often, the negetive effects of the sun have more to do with skin color and permanant redness than the transplanted follicles not growing. As long as the burn was not too severe, the newly transplanted follicles should be unaffected, and your hair restoration should mature according to plan.

Glenn M. Charles, D.O.

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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: hair transplant surgery, follicular unit transplantation, FUT, transplanted follicles, hair restoration

On June 25th through the 27th, 2010, The International Society of Hair Restoration Surgeons (ISHRS) is hosting a conference in Bangkok, Thailand. The conference, which focuses on new advances in Asian hair transplantation, features two hair transplant surgeons recommended by the Hair Transplant Network - Dr. Damkerng Pathomvanich, and Coalition physician Dr. Jerry Wong.

Dr. Pathomvanich is presenting an introductory speech and giving presentations on hairline placement in Asian hair restoration patients, eyebrow transplantation in Asian patients, and stem cell and growth factor hair loss treatments. He’ll also be sitting on several question and answer panels and assisting in several follicular unit transplantation (FUT) cases.

Dr. Wong is giving presentations on the difference between pre-made follicular unit incision sites and stick-and-place incisions, mega sessions for Asian patients, facial hair transplantation, and temple hair transplantation. He too will be sitting on several panels and assisting in follicular unit transplantation cases.

Congratulations to both Dr. Pathomvanich and Dr. Wong!

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, Asian hair transplantation, hair transplant surgeons, hairline placement, Asian hair restoration, eyebrow transplantation, stem cell, growth factor, hair loss, follicular unit transplantation, FUT, follicular unit incision sites, mega sessions, facial hair transplantation, temple hair transplantation

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

I recently underwent a follicular unit transplantation (FUT) procedure where the donor area was closed using a trichophytic closure. I’m curious, how long will it take for hairs to grow through the hair transplant scar?

As you may very well know, the trichophytic donor closure technique during hair transplant surgery occurs when one side of the open donor area is slightly trimmed before the section (specifically the outer layer in a double, deep layer closure) is closed with sutures or staples. Only around 1 millimeter of the epidermis (outermost layer of skin) is removed, which trims the tips of the existing hairs without transecting the follicle (or its ability to produce new hairs). By removing this thin layer of epidermis and superficial hair shaft, the hairs will ideally grow through the scar and minimize its appearance.

Now, because the hair follicle is not damaged in a trichophytic closure, the trimmed hairs should continue to grow and cycle at a normal rate. According to cumulative averages, human hair grows around 13 millimeters (1/2 an inch) a month or approximately 0.44 millimeters a day. Unless something is stunting or blocking the hair shaft (which could be a possibility), it should grow through at a fairly normalized rate. However, due to trauma placed on the scalp during hair transplantation, there may be a delay in hair growth through the wound for approximately 3 to 5 months. Also, keep in mind that no two hair restoration patients are the same, and growth will most likely occur at differing rates.

For many balding men, there are several barriers to seeking surgical hair restoration. Among these are naturalness, successful growth, density, cost, and scarring.  The idea that a standard strip procedure – follicular unit transplantation (FUT) will leave you with a linear scar typically stretching from ear to ear across the back of your head can be a tough pill to swallow. However, in the skilled and experienced hands of a quality hair restoration physician, the scar should result in nothing more than a pencil thin line that is easily concealed. In fact, some FUT patients report that they can clip their hair as short as ¼” without revealing their scar. However, while reasons for this vary, on rare occasions, patients may be left with wider scars that are difficult to hide at all. Every man that decides to proceed with a strip procedure does so with the understanding that shaving his head bald in the future will no longer be a viable option for him.

But, what if you could have a hair transplant with no or minimally visible scarring? The myth of the no scar hair transplant has reached almost epic proportions.  However, despite the fact that follicular unit extraction (FUE) provides a different kind of scarring that is typically minimal, every surgical procedure leaves some kind of scarring. Rather than a linear scar, the extraction of follicular units via FUE produces small white dots in the donor area.  If too many follicles are taken in any given area of the scalp, the donor may result in a “moth-eaten” look. However, under the right conditions, patients can cut their hair to very short lengths without revealing any signs of scarring.

This question, from a curious member of our Hair Restoration Social Community and Discussion Forums, was answered by Mattj – A senior member and consultant to Coalition physician Dr. H. Rahal:

Hello, I’m a 31 year old Asian male who was born with a natural Norwood 3 – 4 level of hairline recession. Although I haven’t experienced any hair loss since, it’s always been a personal sore spot, and I’m finally ready to do something about it. I’m wondering, is it possible to undergo a hair transplant procedure and lower my matured hairline to the level it should have been in my early twenties?

It would certainly be possible to construct a new hairline somewhat lower than even your juvenile hairline. If you haven’t lost much during adulthood, I see no reason why you would be a poor hair transplantation candidate. Especially since Asian hair is usually wavy and coarse, so it should provide good coverage. It’s best to see what a hair restoration physician has to say regarding graft numbers, which will differ depending on just how much lower you want to go. Also, keep in mind that hair line lowering should be approached in a somewhat conservative manner to account for any future hair loss.

Mattj
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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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