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Several years ago, Coalition physicians Dr. Jerry Wong and Dr. Victor Hasson released an educational video detailing and explaining the process of scalp exercises. In theory, scalp exercises help a patient create additional scalp laxity (or looseness) in the universal donor area before a hair transplant procedure. This allows the surgeon to (potentially) remove and implant a greater number of follicular unit grafts.

Although this video was informative, educational, and comprehensive, Hasson and Wong received a myriad of scalp exercise questions and concerns over the past few years. In response to this feedback, the clinic decided to create a new video that answers these thoughtful questions, presents new information, and provides a wonderful overview of scalp exercising.

To view this new video, click here: Hasson & Wong: Scalp Laxity Exercises.

Enjoy!

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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: scalp exercise, scalp laxity, universal donor area, hair transplant, follicular unit grafts, scalp exercising

In an ongoing thread on the Hair Restoration Forums, community members are discussing miniaturization analysis and if it should be performed before a hair transplant procedure. Miniaturization analysis is the process where hair restoration physicians carefully inspect a hair loss patient’s donor region (with a magnification device) and determine whether or not miniaturization is occurring in the harvesting zone.

During the balding process, hairs miniaturize or grow thinner at each expansion (or anagen) phase of the follicular growth cycle. Because of this, hair transplant surgeons must ensure they are not harvesting and implanting follicular units that are miniaturizing and susceptible to future loss.  Granted, miniaturization can occur in any scalp hair, but donor hair analysis is extremely important in a successful hair restoration procedure.

In the discussion topic, two hair loss experts (Louise – a hair transplant technician and consultant for Coalition surgeon Dr. Cam Simmons and Coalition surgeon Dr. Glenn Charles) share their opinion of miniaturization analysis and it’s importance before a hair transplant procedure:

When inspecting/assessing your hair’s characteristics, physicians will look for miniaturized hairs in the recipient and donor regions. If the donor hair is miniaturizing, it will not last and should not be transplanted. Some clinics use magnifying loops or a Densitometer or a close-up camera. Dr Simmons inspects everyone’s scalp personally with magnifying loops and/or a Microvid camera. The Microvid camera is a hand-held device that can be moved around one’s scalp and the physician and patient can see the image on a computer monitor. The follicular groups can be easily seen as well as any miniaturization. If the hair is long enough to hide it, tiny patches can be trimmed to get a very close look at the donor hair.

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

What is the open donor harvest technique used in a follicular unit transplantation (FUT) hair transplant procedure? How does it differ from harvesting a normal strip from the universal donor zone?

Although the open donor harvest technique is described as a unique mechanism,  it’s actually quite similar to the normal strip extraction utilized in a follicular unit transplantation (FUT) procedure. In a standard FUT procedure, a strip of dihydrotestosterone/DHT (the hormone directly responsible for hair loss) resistant hair is removed from the back of the scalp (also know as the universal safe zone), dissected, and implanted into balding areas.

In an open donor harvest procedure, a strip is harvested from the DHT resistant zone, but instead of making a straight incision (and potentially cutting or transecting viable follicular units), the hair transplant surgeon carefully cuts around (not through) unused follicular unit grafts at the incision borders. In doing so, the transection rate is quite low (quoted as low as 2%), but strip harvesting takes considerably longer and creates the potential for a crooked or uneven scar. However, many hair transplant surgeons state that no matter how the follicular units are harvested, scalp trauma and excessive transection are always taken into consideration.

Whether using the open harvest technique or simply keeping excessive transection in mind, most excellent hair restoration physicians are able to efficiently remove strips while minimizing trauma in the donor area.

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

After consulting with several recommended hair transplant surgeons I’ve come to the conclusion that most surgeons implant follicular unit grafts at a density of around 40 – 60 grafts per square centimeter. I’m curious, if I only want to restore my frontal hairline, why can’t the surgeon restore my hairline to the density I had before experiencing hair loss (80 – 100 grafts per square centimeter)?

Although I’m sure each hair restoration physician has specific opinions on implanting grafts at this density (and that final density is unique to each patient’s physiology), there are several reasons why I believe experts do not restore hairlines to an unaffected density:

First, I’m uncertain that the blood supply to the balding areas is sufficient to accept and properly nurture grafts at this density (80 – 100 grafts per square centimeter). Because of this, the graft survival rate and scalp trauma could both be greatly affected. Second, transplanting at this density could negatively affect surrounding native hairs (causing unnecessary damage).

Third, transplanting at this density would require a large strip (in a follicular unit transplantation -FUT case) or various extractions (in a follicular unit extraction -FUE case) for a small transplant area, which could lead to unnecessary scarring. Fourth, transplanting at this density does not take progressive loss into consideration. It seems like a great idea to densely pack or lower a hairline at a young age, but the results can be very unsatisfactory when and if future hair loss occurs. Furthermore, this also depletes precious donor follicular units.

This frequently asked question comes from a member of our Hair Restoration Forum and Social Community:

I recently underwent a follicular unit transplantation (FUT) procedure and was wondering how long I needed to wait before resuming my normal weight lifting routine? Are there certain exercises I need to avoid? Is there anyway to protect the hair transplant scar from stretching while working out?

Although this issue is frequently discussed on the Hair Restoration forums, many people have differing opinions on weight lifting after a hair transplant procedure. Of all the available explanations and suggestions, one of the clearest and informative replies comes from Coalition physician Dr. Robert M. Bernstein of New York:

You may perform normal daily activities for the next three days and moderate exercise for the next 14 days. After two weeks, you may resume your normal daily activities. Avoid direct trauma to the head for two weeks after the hair transplant procedure. Abstain from sexual intercourse and alcohol for THREE days following the procedure.

Exercise

Follicular Unit Transplantation (WOUND CLOSED WITH SUTURES OR STAPLES).

Although hundreds of questions are asked and answered on the Hair Restoration Discussion Forums daily, the most common is likely hair loss patients asking how many follicular unit grafts are necessary to fill their balding scalp. Despite the fact that this question is quite common, it’s difficult to answer and unique to nearly every patient.

Various physiological and personalized factors determine the number of grafts required to cover balding scalp. Factors such as the size of the transplanted area, characteristics of the donor hair (circumference of the hair shafts – fine versus coarse and texture of the donor hair -wavy versus straight), desired density in the transplanted region, color difference between the scalp and follicular unit grafts, laxity (“looseness”) in the universal donor region, age, and hairline design all affect the number of grafts required for an aesthetically significant result.

However, despite the numerous variables associated with graft counts, there is a way to estimate the required number of follicular unit grafts in any given hair transplant surgery. The hair loss learning center graft calculator is a tool that allows patients to input their personalized information and calculate the number of grafts required for the desired amount of coverage.

The calculator takes variables such as current level of hair loss, the area of the balding scalp, and desired density in the transplanted area into consideration, and creates a helpful estimate of the required graft count. Although the tool is not a replacement for a consultation with an experienced hair restoration physician it’s a useful tool that can help many patients answer the infamous question: how many follicular unit grafts will it take to fill my balding area?
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Blake Bloxham – aka Future_HT_Doc

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).

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

I’m investigating a hair transplant procedure and I’m wondering if it is possible to figure out how many follicular unit grafts my case requires? Should I post pictures on my hair loss weblog, or rely solely on my hair restoration physician‘s recommendation?

Estimating the appropriate number of follicular unit grafts for a hair transplant procedure is not an easy or standardized task. Several variables – such as donor region laxity, desired density in the transplanted region, and donor hair characteristics, make it difficult to offer static values.  Posting pictures, asking advice from seasoned members of the Hair Transplant Network, and consulting with several recommended hair transplant surgeons are all wise ideas, but do not paint the entire picture.

A comprehensive approach, where a hair loss patient defines realistic goals, keeps the aging process and natural hairline design in mind, consults with several knowledgeable sources, and creates a plan with their physician, gives the best chance at accurate estimation. Additionally, using a program like the hair loss learning center graft calculator helps create rough graft estimates and allows patients to efficiently move forward on their hair restoration journey.

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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

Follow our community on Twitter

Watch hair transplant videos on YouTube