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Recently, recommended hair transplant surgeon and follicular unit extraction (FUE) specialist Dr. Sanusi Umar shared a presentation about leg hair transplants (body hair transplant) at the 2011 American Society for Dermatological Surgery (ASDS) annual meeting.

As a hair restoration surgeon, Dr. Umar is well known for his ability to successfully extract and implant hair grafts from alternative (non-scalp) sources during extreme hair transplant repairs. Although he’s frequently utilized body hair grafts from the beard, chest, and armpit regions, the ASDS presentation focused on the use of leg hair grafts during hair transplant repairs.

To demonstrate the validity of these grafts, Dr. Umar presented a repair patient who underwent a 1,000 leg hair graft procedure. Utilizing hair solely from the patient’s legs, Dr. Umar repaired a harsh, unnatural hairline created during a previous hair transplant surgery.

Two years after the repair procedure, Dr. Umar showed the leg grafts recreated a soft, natural hairline and permanently transformed the patient’s appearance. According to Dr. Umar’s blog, the leg hair graft’s natural fine caliber and ability to create a “soft,” gradual appearance makes them an ideal choice for transplant repair procedures.

Congratulations Dr. Umar!
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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

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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.
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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

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Below we’ve compiled some of the most recent hot topic hair loss related questions and answers provided by physician experts and veteran hair transplant patients. You are encouraged to click on any of the links to topics you find interesting below.

Which Shampoo is Best to Use After Hair Transplant Surgery? View this article presented by Dr. Michael Beehner and learn whether or not the type of shampoo you use after hair transplant surgery really matters.

Impact of Abruptly Stopping Non-Surgical Hair Loss Treatments? Learn about the risks of stopping proven hair loss treatments and what it may mean for your hair.

When Creating a Second Hair Transplant Scar May Be Appropriate: This article discusses Coalition member Dr. Cam Simmons‘ thoughts on whether or not it’s appropriate to create a second hair transplant scar.

Can Swimming or Excessive Chlorine Exposure Cause Hair Loss? Learn whether or not your hair is in any danger from swimming regularly.

Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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Watch hair transplant videos  on YouTube  

Technorati Tags: hair loss, hair transplant, Dr. Michael Beehner, hair transplant, hair loss treatments, Dr. Cam Simmons, hair transplant scar, Bill Seemiller

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

I began investigating hair transplant surgery and the possibility of shaving the back and sides of my head to a “zero” (very close cut) after the operation. I’m wondering, will an ultra-refined follicular unit transplantation (FUT) scar be visible at this hair length? If so, is follicular unit extraction (FUE) a better option?

At a “zero,” even the best, most “pencil thin” follicular unit transplantation (FUT) scar will be visible.

However, keep in mind that while scarring is very, very minimal with follicular unit extraction (FUE), I wouldn’t be surprised if you could see some scarring in the donor region with a “zero buzz” post-follicular unit extraction as well.

Obviously the type and overall visibility of the scarring will be different, but at this point in time, both these techniques are surgical procedures and will leave “some” type of scarring.

However, if you are an acceptable candidate and do plan on wearing your hair very short, FUE may be a better option. Consulting with a talented hair transplant surgeon will help evaluate your FUE eligibility.
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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

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Technorati Tags: Hair Loss, hair transplant surgery, follicular unit transplantation, FUT, hair length, follicular unit extraction, FUE, hair transplant surgeon

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

Recently, I underwent hair transplant scar revision surgery after a disappointing follicular unit transplantation (FUT) procedure earlier this year. Unfortunately, the repair was unsuccessful, and now the strip scar is even more apparent. I know scarring and patient physiology are unique, but I’m wondering if this is common?

I feel for you in your plight. Unfortunately there are no guarantees with any type of surgery, and in particular, the best predictor of poor scarring is … previous poor scarring.

We do lots of follicular unit transplantation scar repair cases, and I post lots of scar pictures. Having performed a lot of facial plastic surgery, I feel that I can suture better than most, but this doesn’t always mean that I get great scars.

Scar results generally are related to part patient physiology, part doctor skill, and probably part luck.

Patients with a family history of poor scarring, or who are in demographic groups more likely to have wide scars (black and asian patients), are at increased risk for poor scars – whether presenting with a virgin head or a scar revision.

Doctor skill and limiting skin edge tension by a variety of techniques definitely plays a role too. Entire books are written on this subject, but in summary, if you can limit the pull on the skin edges in the universal donor region, either by a skinny strip or by deep sutures, or both, you’ll decrease the risk, but not eliminate it, of getting wide scars.

In a recent article, recommended hair transplant surgeon Dr. Parsa Mohebi shared his expert opinion regarding follicular unit transplantation (FUT) scar revision.

According to Dr. Mohebi:

Hair transplant surgeons have been dealing with scalp scars in “strip” hair transplantation since the introduction of the follicular unit transplantation procedure. There are also other ways patients may end up having a linear scar after other scalp procedures such as neurosurgical operations or trauma to the head. Although most scars are hidden in patient’s native hair, some may become exposed due to their proximity to the hairline or when a patient keeps his hair short.

Depending on the size, type and location of scars, hair restoration surgeons may have to use different techniques to minimize their appearance. We have created an algorithm that hair transplant or other cosmetic surgeons can use toward the most effective methods to address follicular unit transplantation scars and the proper surgical or medical approach to them.

Among the factors that are being taken into account for scalp scar revision are: the prior history of scar occurrence and the patient’s reaction to injuries in other parts of the body. A proper physical examination can reveal what proportion of the visibility of scar is due to stretching or hypertrophic reaction and what portion has to do with hair transection. 

The scars that are wider than what is expected might have some components of stretching. To improve the visibility of stretched scars the surgeon needs to use a technique to minimize the contrast between the hairless scar and neighboring areas of the scalp by bringing hair inside the scar.

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

Is the skepticism regarding the efficacy of follicular unit extraction FUE into hair transplant donor scars simply due to the dearth of examples and case studies we have available to us? These aren’t the things that hair restoration physicians typically focus on in their before and after photos.

As I’ve posted a bunch of times before, I’m very comfortable excising scars and trying to improve them that way first, and using follicular unit extraction (FUE) or even a separate follicular unit transplantation (FUT) to get hair to plant as a refinement of a scar revision.

This fellow (see images below) has already tried that and I think it didn’t really work well due to the really low position of the strip. It’s way down on the neck and it stretches with even mild neck motion. Plus, from talking with the patient, I’m not sure deep layer sutures were placed during his scar repair but that may not have changed anything given the location of the scar as I mentioned above.

So I think this was really his only viable option and I make it clear that there is no guarantee with planting grafts in a scar but this was a nice soft scar with good vascularity. I think it will work and he’ll get 50% improvement if the grafts don’t get dislodged before “taking root” over the first week.

Recommended hair transplant surgeon Dr. Carlos Wesley is currently recruiting participants for a clinical study investigating follicular unit transplantation (FUT) scar reduction and follicular unit graft survival enhancement.

The “Hair Restoration Surgery Enhancement” study, which is approved by the Investigational Review Board, addresses both donor region scarring and graft survival rates, and hopes to significantly improve implanted growth yields and, according to Dr. Wesley, reduce donor scarring to levels below traditional Follicular Unit Extraction (FUE).

Interested parties must be available for travel to Dr. Wesley’s New York practice and will receive a number of follicular unit grafts free of charge.

Although the details of the investigation have not yet been disclosed, promising updates will be provided as the clinical results unfold.

Are you interested in participating in the Hair Restoration Surgery Enhancement Study? If so, feel free to visit the discussion topic and contact Dr. Wesley directly: Invitation to Participate in HRS Enhancement Investigation.
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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

Follow our community on Twitter

Watch hair transplant videos on YouTube

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Technorati Tags: hair transplant, follicular unit transplantation, FUT, follicular unit graft, Hair Restoration, Follicular Unit Extraction, FUE, Hair Restoration Surgery

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