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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.

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

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

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.

This question, from a member of our Hair Loss Social Community and Discussion Forums, was answered by recommended hair transplant surgeon Dr. Kenneth Siporin:

Has anyone found scalp exercises helpful to increase donor laxity prior to hair transplant surgery?

Reading though different hair restoration forums and browsing through results, it appears that follicular unit transplantation (FUT) yields better results and is more consistent in comparison to follicular unit extraction (FUE). In theory if shouldn’t be the case as FUE allows you to extract any kind of graft you want whereas strip is limited and you only got what’s in a strip of skin that’s been cut off.

FUE results vary. Some results are on par with FUT and some are not so great. Many surgeons don’t do any testing. I think the only one who does it is Dr. Rassman (not sure if he still does). Many don’t even test body hair transplants (BHT) and move to the large sessions without knowing what % of grafts will grow and we all know how unpredictable BHT can be.

Disturbing part is a lot of FUE clinics advertise 100% growth or close to it. Truth is they can’t predict that even if they are the best in the field. Also, excuses such as hair color, scalp contrast and curl is the reason why some results look better than others. Yes, these are the factors but they are often used to cover up for poor yield.

This question, from a member of our Hair Restoration Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Michael Beehner:

My understanding is that, in general, an average maximum possible hair transplant donor strip width on a virgin scalp is around 1.25-1.75 cm for a person with good laxity. What would the maximum possible average donor strip width be for this same person in their second surgery? I realize that donor strip widths are not uniform across the entire strip but I am referring to the average width along the entire strip. My guess is that it would be about 1 cm – 1.3 cm in the second surgery.

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

Five months ago, I underwent a large Follicular Unit Transplantation (FUT) procedure. The surgery was successful, but one area of the strip scar remains raised and hard. I visited the surgeon who performed the procedure, and he said this part of the closure was now considered a hypertrophic scar. He said at this point I can undergo some steroid injections (with cortisone) to treat the area. Should I get the injections done? The operating surgeon is now in a different country, so should I travel to have him do the injections?

Dr. Charles: 

I generally wait at least 6-8 months before recommending any cortisone (steroid) injections. This is because hypertrophic scarring can continue to raise and thicken for up to 6 months after the operation.

The steroid injections can help flatten and sometimes shrink hypertrophic/keloid type scars. Additionally, because this procedure is routinely performed by primary care physicians and dermatologists, there is no need to travel to another country to get this done. Simply follow up with your hair transplant surgeon and make sure he knows about the procedure and how it affected the scar. 

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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

One area frequently affected by male pattern baldness (androgenic alopecia) is the “temple points” or “temple triangles” region. The temporal points – the triangular region of hair located above and in front of the ears – may be commonly affected by hair loss, but opinions differ on whether this region should be addressed with hair transplant surgery.

Most patients balding in the temporal triangles also suffer from hair loss in the hairline, frontal scalp, and mid-scalp regions. Because follicular unit grafts are limited, many question whether these grafts should be allocated to the temporal regions, or whether it’s better to create a more comprehensive result by using all available grafts in other scalp regions. This leads many patients with scalp and temple recession to ask whether they should utilize precious grafts to restore the temples during hair restoration surgery?

Altogether, the decision to restore temple points during hair transplant surgery boils down to physician preference and the patient’s goals. In many instances, temple restoration helps frame a patient’s face and allows for a comprehensive post-operative appearance. Some hair transplant surgeons subscribe to this philosophy, and frequently restore temple hair during surgery. However, other surgeons believe patients are best served by allocating all available grafts to the more predominant scalp regions. Of course, if patients have an adequate amount of grafts for both, this becomes less of an issue.

However, patients should discuss temple restoration preference and hair restoration goals during consultations, and create a hair transplant plan with their physician. By creating a unified plan, patients are able to proceed confidently with surgery and hopefully meet their expectations.

This insightful hair loss information was posted on our Hair Restoration Social Community and Discussion Forums: by Dr. Jerry Cooley of Charlotte, NC who is a member of the Coalition of Independent Hair Restoration Physicians.

How does ACell work? Are there any studies to show its effectiveness in hair restoration surgery?

Please see my recent update on ACell in the Hair Loss Q&A blog, “Updates on Hair Duplication (AutoCloning) and ACell: Hope For a Hair Loss Cure.

Performing full scale blinded, controlled studies on agents that might improve hair transplant results is exceedingly difficult if not impossible. To prove something is helping and that this result did not occur by chance, you need to study 50-100 patients with a split scalp design, and follow these patients carefully with good photographs and hair counts. Virtually no clinic could do this, and would you want to be one of these study patients where one half of your transplant came out looking different than the other half?

Nevertheless, we can adopt practices and techniques that are safe and scientifically sound and begin reporting our clinical observations. This is what I have done over the years with holding solutions like HypoThermosol, PRP, ACell, and liposomal ATP. Other hair restoration physicians who have also begun using these are reporting improvements similar to mine.