Post Hair Loss Questions and Get Answers

This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Ricardo Mejia of Jupiter, FL who is one of our recommended hair restoration physicians. His professional answer is below.

Scarring is risk factor with any surgery even in the best hands and even when we try to minimize the risks, it happens. I can guarantee you every hair transplant surgeon has had a similar result in one patient or another. Trichophytic closures help minimize the appearance of scars, yet they can stretch. This can be a result of the genetic variation in collagen and independent of tension factors. Hair restoration surgeons have gone back and rexcised the small 3- 5 mm wide scars with hardly any tension on the wound site. This can be an option for you if you are concerned. Keep in mind, you can still get a stretched scar even after a minimal revision without any tension. These are sometimes the uncontrollable factors in medicine and surgery.

Dr. Ricardo Mejia

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Technorati Tags: hair loss, hair loss help, hair transplant, Hair restoration

Is there any evidence that suggests waiting a full two weeks for suture removal, as opposed to nine or ten days after hair transplant surgery will produce a thinner donor scar? 

This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

For many years we took the sutures out at around 7 days after hair restoration surgery. Around 6 years ago we switched to taking most patients sutures out at 10 days after a first hair replacement session, 12 days after a second session, and if a patient had a third procedure, 14 days for that surgery.

The more important point is that for any hair replacement patient with a slightly tight closure or who had “hyper-elastic” scalp tissue, we have the sutures taken out at 14 days, even for the first session. On rare occasions I have gone to 16 days, but the trouble with going past 14 is that the stitch material (or staples) start to become imbedded with skin tissue creeping over it, which makes the removal more difficult and more painful.

What is actually happening when a hair loss patient goes those extra 4-6 days with the sutures in place, you give time for the hair-bearing scalp above and below the suture line to start to relax and stretch out. In this process the remaining hairs become infinitesimally further apart, which the human eye can’t detect. Keeping the sutures in keeps the wound scar from being pulled apart on from above and below during those early days when the tension is the greatest.

Technorati Tags: hair transplant, donor scar, hair loss, hair loss help, hair restoration, hair replacement

I was wondering if someone can briefly explain what donor closure technique is the best and can produce the finest scar in hair transplant surgery?  Based on the discussions that I read on this hair loss forum, it seems like the trichophytic closure is by far the best technique to cover the donor area and reduce the scar but this is only true if you don’t need to have additional hair transplants.  Also, what is the difference between a single and double layer closure technique?  What about staples verses sutures?  Is this a personal preference or is there a specific reason to perform such techniques?

Excellent Question.

Having observed surgery at dozens of leading hair restoration clinics, it is surprising that there is not one predominant school of thought on the optimal donor closure technique.

Some physicians argue that using internal sutures below the surface of the skin in the subcutaneous tissue will reduce the tension on the skin that is sutured by an external skin layer suture. This technique is typically referred to as a “double layer closure” and can be used with or without the trichophytic closure.

Typically the internal sutures are dissolvable, while the external skin layer sutures need to be removed.

Other physicians argue that internal sutures should only be used when the donor area is particularly tight due to either low scalp laxity and/or a wide strip being removed. They claim that internal sutures, which can take over a month to dissolve, can potentially create reactions or irritations, although very rare, under the scalp.

Technorati Tags: hair transplant, hair loss, trichophytic closure, hair transplants, hair restoration, double layer closure

This insightful hair transplant article was written by Dr. Bernardino Arocha of Houston, TX who is one of our recommended hair restoration physicians.

A survey of this hair transplant patient’s bald head, shows that the lateral fringes and crown have completely been eroded. The lateral humps have been obliterated, and the hair on the temporal areas (sides) is quite low. This isa level 7 on the norwood scale of hair loss country, it is a follicular unit barren real estate , where there is more hair loss, then there is remaining hair!

As if, that is not enough, study of the permanent donor area reveals that the hair density is decreased and the total occipital hair remaining is very diminished by baldness on two advancing fronts. From above, Androgenic Alopecia is eroding the crown, while from below a Retrograde Alopecia is raising the neck hair line.

After careful study, it is determined that a minimum of 2000 follicular unit grafts will be needed to commence the hair restoration process. That is, 500 follicular units to raise the lateral humps. Into which, we can anchored the hair line , which is estimated to need at least 1500 follicular units. We do not know at this juncture, whether, we can achieve the full 2000 hair grafts, much less, any extra to transplant into the area beyond the hair line.

Technorati Tags: hair transplant, norwood scale, hair loss, hair density, baldness, Androgenic Alopecia, Alopecia, follicular unit grafts, hair restoration, follicular units, hair grafts

This question was posed by a female hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

I saw a very reputable hair transplant surgeon yesterday. I have receding hair at my temples so I went in to inquire about a hair transplant to those areas. Upon inspection, he indicated that I have about 30% or so hair miniaturization in the donor area. I’m very scared and am now thinking “am I going to go completely bald“? I have more questions. Has anyone with similiar problem had hair restoration surgery that can offer me some insight?  He says he can do the hair transplant but can offer no guarantee on how long it would last.

Also, how long to miniaturized hairs last and how fast does it progress? Is it normal for a woman at age 46 to have hair miniaturization?

30% is a fairly high percentage of hair miniaturization to be present in the occipital donor area, usually the best hair on most women’s heads who have female pattern alopecia. Most of the time I wouldn’t give a woman a hair transplant with that high of a percentage, simply because it also portends that a lot of the other hairs will probably be following in the same footsteps of miniaturization a hair growth life-cycle or two away from now. The good news is that hereditary female pattern hair loss is a very SLOW process for most women, and almost never occurs as rapidly as its counterpart in males.

Technorati Tags: hair loss, hair loss help, hair transplant surgeon, hair transplant, hair miniaturization, bald, hair restoration, female pattern alopecia, hair growth, female pattern hair loss

I am 10 days after my hair transplant and went to get my sutures taken out, and the ends behind each ear seem to be difficult to remove. I’m not sure if the doctor I visited to have them removed (not my hair restoration physician) was new to this, but he said that I had scabs surrounding the knots on each end.

I soaked my head for 15 minutes before I went in, but this didn’t help much. Any ideas guys? He removed the middle section of the sutures along the back of my donor scar, but I still have to remove both ends behind my ears.

This hair loss question was answered by Dr. William Lindsey of Reston, VA who is one of our recommended hair restoration physicians.

In our hair replacement clinic, we usually remove all of the sutures by day ten.

However, we occasionally use coetaneous (skin) sutures which will dissolve in two weeks or so. More commonly, patients think that there are sutures still in place and its actually just dry skin/scabs along the suture line that needs more vigorous cleaning.

Finally, with our 2 layer donor closure technique, about one person in thirty has a deep suture extrude, usually around 3 months out. Thus, we often ask patients to come in for a checkup around that time and particularly to call if they are having any issues like this. You were smart to call your doctor and ask her thoughts.

William Lindsey, M.D.

Technorati Tags: hair transplant, hair restoration, hair loss, hair replacement

I emailed one inquiry about hair transplant costs.  I was told by a hair loss doctor in India that I require approximately 6000-8000 follicular unit grafts, which I think is too much.  They said if I want enough hair density, that I require 2000 grafts for the hairline and temples and another 2000 for the crown.  I don’t think I am that bald.  Please tell me what I need to do to lower and add density to my existing hairline, refine my temples, and the expenses involved in a full hair restoration plan.

This hair loss question was posted directly to Dr. Raymond Konior of Chicago, IL, who is a member of the Coalition of Independent Hair Restoration Physicians.  See his professional answer below.

Interpreting graft numbers can be confusing for patients.  It is understandable why you would think such large numbers are unnecessary.  You need to understand that density is one of the main factors that will influence your satisfaction or dissatisfaction with the end result. 

The final density will depend on how many grafts are placed per square centimeter in the thinning hair zones.  Baseline density in a non-thinning zone has been reported to vary between 60-100 follicular units.  Variations in baseline density are influenced by age, area of scalp, race and other factors.  Your scalp would need to be examined under magnification to determine your exact baseline density in the donor site.  That inspection would also determine if you have any density fluctuations between the occipital donor site (back of your scalp) and the temporal donor site (side of your scalp).

Technorati Tags: hair transplant, hair loss, follicular unit grafts, hair density, bald, hair restoration, thinning hair

This insightful hair transplant article was written by Dr. Bernardino Arocha of Houston, TX who is one of our recommended hair restoration physicians.

Whenever hair replacement surgery is performed, there is always a scar. Scars are the body’s attempt to heal. However, scars respond with increased laying down of collagen (scar tissue), to tension vectors applied to the wound margins. In a two-layer closure, the first layer does most of the work to minimize tension forces on the superficial layer, thereby producing minimal scars. The other principle in making scars nearly invisible applied here, is the use of follicle sparing suturing techniques. These techniques avoid the strangulation of the hair follicle, interdigitating between the follicles and remaining very superficial. Note that I prefer to avoid the use of tricophytic closure, unless this will be the last surgery. The reason is that the tricophytic closure causes a distortion of the hair architecture along the scar area, which will decrease the donor yield.

Two-layer closure is well described surgical technique, trico-sparing techniques are not always employed. Also keep in mind that tension vectors, whatever the origin, applied to the scar that has not matured will stretch or augment the scar. I refer you to the article “Post-surgical scars in hair restoration surgery” , which can be found on my web site under articles. A scar can take between 6-12 months to mature.

Bernardino A. Arocha M.D.

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Technorati Tags: hair transplant, hair replacement, tricophytic closure, hair restoration

Would it not be better to do large follicular unit hair transplantation (FUT) sessions until there is no more available donor hair via strip due to reduced elasticity or other reasons, and then use follicular unit extraction (FUE) to extract the remaining possible donor hair grafts? Wouldn’t this provide the greatest overall graft yield?  Can the same donor area be used a second time for follicular unit extraction (FUE)?  Is it possible to get hair growth yields of 7000 grafts via FUE?  Is FUE less traumatic to the scalp than strip surgery?

This insightful response was posted on our hair restoration forum by Dr. Alan Feller of Great Neck, NY who is a member of the Coalition of Independent Hair Restoration Physicians.

Because there is no agreed upon terminology for follicular unit extraction (FUE) procedures it is difficult to have a conversation about it because key words mean different things to different people. Right now FUE is NOT a scientific discipline. It is art, and as art it is difficult to describe accurately.

Unfortunately it is the lack of agreed upon definitions that allows ten different clinics to SOUND like they are offering ten different forms of FUE, when in fact they are mostly the same. That said I will move on to your questions the way I read them:

No, it’s not impossible to get fantastic numbers of follicular unit extraction (FUE) on certain hair transplant patients. Dr. Jones and DHI were performing 2,000+ surgeries in a “day” as far back as 2003.

Technorati Tags: follicular unit hair transplantation, FUT, follicular unit extraction, FUE, hair transplant

I just recently had a hair transplant for my hair loss and was wondering if the pink area represents the eventual width of the donor scar?  The pink area where they took the strip is up to 7mm on both sides and seems to be getting wider and obviously there is no hair growing in it.

The pink area is not necessarily indicative of the width of the final hair replacement donor scar. Anytime a wound is healing, a halo of color will surround the wound as blood is rushing to the area to heal it. Most likely, your donor scar will be much thinner than the entire pink area. Over time, it will fade and the halo will lessen and eventually fade away leaving you with the final scar.

If you follow my hair restoration journey and click on my hair transplant photos, I post a number of donor scar pictures in that helps show this progression of healing.

However, if the donor scar appears to be getting wider, be sure to express your concern to your hair loss doctor.

Bill Seemiller - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Technorati Tags: hair transplant, hair loss, donor scar, hair transplant photos, hair loss doctor