FUT (Follicular Unit Transplant)


“Shock loss” is a term both dreaded and feared by many undergoing hair transplant surgery. Despite its notoriety, however, shock loss is a complicated subject and may be confusing for many hair transplant patients. So what is shock loss and why does it occur? In order to answer these questions and help clarify the mystery behind shock loss, Coalition hair transplant surgeon Dr. William Lindsey created the following video explaining shock loss and why it occurs after hair restoration surgery:

[embedyt]http://www.youtube.com/watch?v=S4o7nwvd0xw&feature=youtu.be[/embedyt]

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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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Dr_Wesley_photoPatients are often pleasantly surprised to learn during their initial consultation that our practice does not require patients to shave their heads for a follicular unit strip surgery (FUSS) procedure. As Coalition hair restoration physician Dr. Carlos Wesley operates on only one patient per day, it is much easier to take the time to carefully navigate around the pre-existing hairs during recipient site creation.

The benefit to hair transplant patients occurs not only in the immediate short term, (7-10 days) post-operatively when the redness can be better camouflaged by the longer native hairs, but also during the first few months of early hair growth when the transplanted hairs are just beginning to grow and provide coverage and density.

Here is an example of one of our patients whose pre-existing hair helped camouflage the redness and the stubble for the short-term postoperative period after hair transplant surgery.

MA_Slide1

 

His intraoperative appearance can be seen in the video below:

For more of Dr. Carlos Wesley’s patient results view the discussion, “Why we don’t require shaving the recipient area: Dr. Carlos K. Wesley (NYC)” from our hair loss forum and social community.

Billena,
Media Assistant for Dr. Carlos Wesley

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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 comes from a member of our hair loss social community and discussion forums

I’m undergoing a hair transplant procedure soon, but I’m worried my body will reject the implanted grafts and the surgery will be a failure. I have read about several cases online where this occurred, but it seems like it had more to do with the surgery team than the patient’s physiology. Is there a possibility that the procedure could go perfectly but my body rejects the hair transplant?

LPPYes, there are instances where patient physiology is solely responsible for poor yield. However, this is a very rare occurrence and it is usually difficult to distinguish from human error. 

When it is not caused by an external error, a hair transplant that simply “won’t take” or is “rejected” by the body is usually caused by post-transplant Lichen Planopilaris (LPP). LPP is an inflammatory scalp disorder that normally results in patchy alopecia. According to the literature, however, there have been at least 17 cases of LPP that developed within 4-36 months after hair transplant surgery. The authors of these studies concluded that the LPP caused the poor yield and was “set off” by the hair transplant. However, 17 reported cases out of the thousands of hair transplant procedures performed each year is a very small percentage of alleged LPP caused failures.

This question, asked by a member of our hair loss social community and discussion forums, was answered by “Jotronic” – a clinic representative for Coalition hair transplant surgeons Dr. Victor Hasson and Jerry Wong,

For those that have done hair transplant scar revisions, did the revision strip also yield a few usable grafts (Assuming the only goal was to make the scar better but a few grafts happen to be in the strip taken out)?

0_6181A proper scar revision will require cutting out all of the scar so that only healthy skin tissue meets healthy skin tissue when the wound is closed for the best healing. How this is done depends on the doctor performing the revision. Some hair restoration physicians will follow the exact outline of the existing scar to purposely avoid getting viable grafts. However, this will always yield at least a few grafts.

Other doctors will instead remove all of the scar tissue based on the laxity in the immediate vicinity as the revision progresses along the scar line, which will always result in some grafts being removed as well. This can vary to just a handful of grafts being 20 to 30 or up to 400 or so depending on the size and variations of the scar shape and direction.

I hope this helps.

Jotronic
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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 comes from a member of our hair loss social community and discussion forums:

I’m 21 years old and considering hair transplant surgery. However, I’m wondering: What is the minimum age for the procedure? Can a hair transplant procedure at an early age create the need for a second surgery down the road? Is there anything else I should be using?

Barry post opI don’t believe there is a defined “minimum age” for hair transplant surgery. Most hair restoration surgeons will likely reject patients younger than 25 or 26, but each case is unique and exceptions can always be made.

There is also nothing to “guarantee” you will not need a second procedure. Preventive medications like finasteride (Propecia) and minoxidil (Rogaine) will help – as will undergoing a well conceived procedure at an appropriate age – but hair loss is still a progressive and unpredictable ailment. 
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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

Technorati Tags: hair loss, hair transplant, , hair restoration, , Propecia, , Rogaine

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. William Lindsey:

Why don’t people get Botox in and around the hair transplant strip scar in the first 1-2 months post-op? It relaxes the muscles around the scar, meaning less tension and also has an effect on fibroblasts to assist with the healing.

There is a lot of research going into the use of Botox around areas of potential scarring! Anyone heard of this or had this? Thoughts?

Dr_Lindsey_photoA standard follicular unit strip surgery (FUSS) scar would not involve any of the surrounding muscles. So, there is no point in putting in a couple of hundred dollars of Botox which could, of course, diffuse and cause your head to cant forward.

I do suggest that hair restoration patients do not try and stretch surgical scars for a while, meaning no bench press arching on my scars, no behind the neck lat pull downs, and limit neck flexion with abdominal crunches.

Dr. William Lindsey – McLean, VA

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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.

Technorati Tags: hair loss, , hair transplant, , ,

This question comes from a member of our hair loss social community and discussion forums

I recently underwent a hair transplant surgery consultation, and the doctor mentioned using different sized follicular unit grafts (FUG) in different areas of the scalp. However, I’m still confused and I don’t understand the concept of follicular unit graft sizes and how these would be used in hair transplant surgery?

follicular unit graftsScalp hair naturally grows in “bundles” of hair follicles called “follicular units.” These units either consist of a single follicle, two follicles, three follicles, four follicles, and rarely five follicles. In modern hair transplant surgery, only follicular units are extracted and implanted into balding areas. This is why the term “FUT” stands for “Follicular Unit Hair Transplant Surgery.” Follicular Unit Hair Transplant Surgery can be performed one of two ways: either via Follicular Unit Strip Surgery (FUSS) or via Follicular Unit Extraction (FUE). 

When these follicular units are extracted during an FUSS or FUE procedure, they become “follicular unit grafts” (FUG). The FUGs are defined by the size of the follicular unit, i.e. single follicle, double follicle, triple follicle, or quadruple follicle. This is where the term “single graft,” “double graft,” et cetera, comes from. 

Each of these grafts must be placed in a specific region of the scalp to create a natural appearance. The first few millimeters of the frontal hairline – also known as the microhairline – must be filled with single unit grafts. If anything larger is used, the feathered transition zone is ruined and the frontal hairline will have a “pluggy appearance.” Next comes the macro hairline, which is created by naturally transitioning from single follicular unit grafts to double and triple unit grafts. From this point onward, a series of double, triple, and quadruple grafts may be used to recreate natural density in the posterior frontal scalp, midscalp, and vertex. In these areas, larger follicular units (triple and quadruple grafts) are often used to cover a larger area of scalp and offer the greatest amount of coverage with the fewest number of grafts – the biggest “bang for your buck,” if you will. 
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Blake – aka Future_HT_Doc

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

Three months ago, I underwent Follicular Unit Strip Surgery (FUSS) and I need to return to work. I haven’t told anyone at work about the procedure and I would like to keep it to myself. Because of this, I’m looking for ways to camouflage my healing hair transplant scar. Any suggestions for hiding the scar? Also, is it safe to use concealers 3 months post-op?

hair loss concealersAt 3 months post-op there should not be any harm caused by using cover-up products (concealers) on the donor area. However, I do recommend cleaning area daily.

As far as actually camouflaging the scar is concerned, DermMatch – or another cream-based product like COUVRe- might work a little better because you can carefully place it directly on the scar.

If you are going to use a microfiber product - such as Toppik or Nanogen Fibres  - you will also need the holding spray (locking mist). However, either type of concealer will likely provide you with decent coverage and allow you to keep the procedure to yourself.

Dr. Glenn Charles
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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

This question comes from a member of our hair loss social community and discussion forums

It’s been around 12 months since I had my Follicular Unit Strip Surgery (FUSS) and I’m now ready to start cutting and styling my hair differently. Part of this new styling involves shaving (“buzzing”) my head in the donor region, and I’m afraid the strip scar is going to show. How short can I shave the back of my head with a hair transplant scar?

FUSS scar fixedAltogether, it will vary and depends on a number of factors. For example, individuals with a thinner scar, higher density in the donor region, coarser, curlier hair, and hair similar in color to the scar tissue will be able to shave to a closer guard.

However, in general, it seems like most hair transplant patients shave to somewhere between a “4″ and a “6″ guard (also known as a “number 4″ or “number 6″) without issue. Others may shave closer, but this seems to be where most strip scars are thoroughly camouflaged. What’s more, those concerned about visible scarring in the donor region or patients who desire a closely cropped haircut may want to consider Follicular Unit Extraction (FUE). Although there is still scarring with this procedure, many believe the small, circular extraction scars are less visible under shortly shaved hair.
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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

This question comes from a member of our hair loss social community and discussion forums:

I’m looking into hair transplant surgery, and wondering what type of density is achievable with the procedure? Can I achieve the density I had before experiencing androgenic alopecia (male pattern hair loss)? What is the maximum density achievable with hair transplant surgery?

chrisdavNormal hair density – in individuals not suffering from hair loss – is somewhere between 80-100 follicular units per square centimeter of scalp. Thinning is not visually obvious until approximately 50% of the native density has shed. This means transplanting between 45-55 follicular units per square centimeter during hair restoration procedures is normally sufficient.

Implanting at densities of 80-100 follicular unit per square centimeter (“normal” hair density) is usually never done. This happens for several reasons: 1. because it is not necessary and wastes finite grafts; 2. because implanting at this density may overwhelm the blood supply and cause shock loss in the surrounding native hairs; 3. because severe damage or diversion of the scalp blood supply can potentially cause necrosis or other serious issues.

Because of this, the maximum density achievable with hair transplant surgery is usually somewhere below natural hair density. While most surgeons will transplant somewhere between 45-65 grafts per square centimeter, some will implant at slightly higher densities. These surgeons will only do so when they are certain they will not overwhelm the scalp blood supply or cause excessive shock loss.
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Blake – aka Future_HT_Doc

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