FUT (Follicular Unit Transplant)

This common question, from a member of our hair loss social community and discussion forums, was answered by “SL,” a representative for Coalition hair transplant surgeon Dr. Christian Bisanga:

After years of progressive thinning, I’ve decided to finally “do something” about my hair loss. I started researching hair transplant surgery online, but I don’t know if I’m actually a candidate for the procedure. How can I tell if I’m a good hair transplant candidate?

0_3785Before embarking upon any surgery it is important to consider many factors and ask many questions. Like any important decision in life, surgery is a decision that should not be taken lightly or in haste.

The way in which one approaches the subject will usually change depending on several criteria – age for example is an important factor. The younger the hair loss sufferer is, the more prone they could be to making rash decisions. There are the same decisions that could be more emotionally-based rather than logic-based in an attempt to regain what was lost as soon as possible, and this is also understandable.

Hair loss at an early age is devastating and the initial thoughts are often very emotional, indeed mine was. Little to no thought is often given with regards to any future loss and many fall into the trap of having surgery too young to only regret it at a later stage.  I and others have seen this time and time again in consultations with patients who have been too young and ill prepared for the next years of loss.

This below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by Janna, the lead medical technician for Coalition hair restoration surgeons Dr. Ron Shapiro and Dr. Paul Shapiro.

I’ve never used an antibiotic cream on the donor scar straight after follicular unit strip surgery (FUSS) but I think I’m gonna try it this time so I’m interested in everyone’s experience with it. Was it effective? How long did you use it for? Thanks.

0_11851We have all our strip hair transplant patients apply the antibiotic cream Bacitracin right after their daily shampoo for the first 5 days. We’ve been doing this technique for years as we feel it’s been beneficial in producing better scars.

Lead Medical Tech and Surgical Manager
Shapiro Medical Group
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

The following hair loss article was written by Coalition surgeon Dr. Alan Feller, and presented on our Hair Restoration Social Community and Discussion Forums:

There is no doubt that no hair restoration clinic bats a thousand. Mine included. That’s just a fact of any surgery, including cosmetic.

Dr_Feller_photoThe problem I’m noticing is that I’m seeing more and more patients coming to my office in need of repair work. They paid thousands of dollars for thousands of grafts but have very little hair growth to show for it. Sure, it may just be that they are not “good growers”. But these people are few and far between in my experience.

When I see a patient with a poor result, I wonder if it is smart to do a procedure on them. After all, they did poorly after their first hair transplant, right? What’s worse is, now that they’ve had a procedure, the chances of good growth on the second one should be even less due to the disruption of the skin from the prior surgery.

So what does a hair transplant surgeon do? Does he turn the patient away saying he is obviously a poor grower, or does he assume there was a problem with the surgery and perform a second procedure right on top of the first?

My thinking is simple: if the graft distribution looks poor and it looks like there were a large number of multi-hair grafts in the hairline, I determine that it was clinic error and not patient physiology. So I do the surgery as if he never had one in the past.

This question, asked by a member of our hair loss social community and discussion forums, was answered by “sl” – a clinic representative for recommended hair transplant surgeon Dr. Christian Bisanga,

0_3785Once you are at the stage of wishing to gain further information regarding surgical hair restoration, it is usually helpful to have some idea of the type of surgery you are considering, i.e. follicular unit strip surgery (FUSS), follicular unit extraction (FUE) or even body hair transplantation (BHT), then short listing and contacting the clinics that perform the desired surgery is the next step. The price and location of the clinic may also be factors and although important, should not be the overriding considerations when making your decision. The world is becoming increasingly smaller with travel and inexpensive also so making the effort to meet a hair transplant surgeon and visit a clinic/s is worth it.

Most clinics will have an online consultation form or email and can be easily contacted. Remember to send as much information as possible and don’t make the clinic feel as if they are “pulling teeth” in order to get the required information and photos from you. Minimally one should include age, medication, any previous surgery issues, previous or current illnesses, goals and time scales.

ATPATP (Adenosine triphosphate) is an energy molecule that catalyzes a variety of important cellular reactions in our bodies. The lack of ATP can cause cell damage and eventual cell and tissue death. Because the creation and regulation of ATP requires oxygen, tissues deprived of oxygen often experience ATP loss and become damaged. Because of this, ATP becomes crucial for patients healing from wounds; especially surgical wounds. This has created demand for the use of ATP in post-surgical patients and patients with delayed wound healing. One area where the addition of ATP has been investigated for its healing properties is in hair transplant surgery.

According to experts, the addition of ATP – in liposomal ATP form – to follicular unit grafts while they are stored outside of the body and to the recipient scalp after the grafts sites are made could allow for quicker healing and better hair transplant yields. One physician who has experimented with liposomal ATP and believes it offers a variety of benefits in hair transplantation is Coalition hair restoration surgeon Dr. Jerry Cooley.

According to Dr. Cooley:

Early on I began experimenting with ATP, but I didn’t know whether it was helping and usage was intermittent over the first 6 years. However, after reviewing my results I began to believe ATP usage was a significant factor explaining the positive difference in observed results. 

This question, asked by a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair restoration physician Dr. Timothy Carman:

I’ve been following protocol after my hair transplant and my staples are really feeling better daily. Day 4 and 5 I went back to work and stayed up late. I have not slept good the last 2 nights. Never took meds other than 2 Tylenol before bed. I’m sleeping on 2 pillows with travel pillow around the neck same as 1st night.

Feels like things are tighter and more sensitive. The hair hurts back there but does not feel hot to the touch. Going to take my first shower and wash my hair since surgery. Hope this is just healing. Can’t wait to get these out on Saturday. Any similar thoughts or issues?

0_1124Staples by far are the most uncomfortable type of closure for the follicular unit strip surgery (FUSS) patient. This should all become a non-issue once they are removed. And yes, things can feel “tighter” as healing progresses.

You should be fine once they are out. Grow well!!

Dr. Timothy Carman
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, from a member of our hair loss social community anddiscussion forums, was answered by Coalition hair transplant surgeon Dr. Michael Beehner:

I always hear hair transplant surgeons say that donor shock loss is very rare. I just don’t see it that way at all. If you look the Hair Loss Forum I would bet that better than 40% of the posters had at least some level of donor shock loss even if it was minor. You would know better than me of course but there just seems to be a disconnect here.

The patients I am referring to went to great docs so I am not talking about hacks here.

Dr_Beehner_photoI hadn’t noticed that many posts about that, but you could be right. However, in 24 years of transplanting, I have only had 2-3 cases of donor area shocking and, fortunately, hair growth returned in each of these patients. I think sites like the Hair Restoration Forum will get a lot of the negative comments congregating in one spot and that the overall incidence among all hair transplant surgeons is low. A very small percentage voicing their complaints in one place may make it seem more common.

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

I’ve used minoxidil (Rogaine) for a number of years. During this time, I was able to stabilize my progressive thinning and actually regrow some hair. However, roughly 7 months ago I underwent a hair transplant procedure and now I’m wondering if I can stop the medication? Can I stop minoxidil because of my hair transplant surgery?

Generic Minoxidil Foam better sizedMinoxidil (Rogaine) is known as a “preventive” hair loss medication. This means minoxidil is proven to halt progressive hair loss and restore some thinning, but it only works while taking the medication. If the treatment is stopped, any positive gains will be lost and the on-going hair loss process will continue.

While hair transplant surgery restores hair to thinning scalp, it does not stop progressive balding. If a patient stabilized and restored areas of the scalp with minoxidil and then stopped the medication after surgery, the native hair around the transplant would continue to thin and shed. This could result in an unnatural appearance if the surgery was designed with continual minoxidil use in mind. If patients experienced positive results from minoxidil, they should be aware that these will disappear after stopping the medication; even if they underwent hair transplant surgery as well.
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

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

I recently underwent hair transplant surgery, but I think I’ll require a second procedure to achieve my desired density. Because of this, I’m wondering how long I need to wait between procedures? Is there a standard time period? Are there any exceptions to this rule?

Dr. Lindsey: 

Barry post opFull healing and stretching of the scalp to allow another excision and limited tension closure takes a while. Especially in follicular unit strip surgery (FUSS) or “strip extraction.”12 months is better than 6 and easy to remember, and since some people are slower healers than others, most doctors probably wait 12 months to be on the safe side. I do as well.

Also, I prefer the patient to know that the first one “worked” before paying for a second procedure (which means waiting a full 12 months to see the matured results). They are more relaxed and it just goes more easily than a second “leap of faith”.

That said, we perform roughly 1 surgery on a patient at 6 months per year, and it is always someone who was leaving the country for an extended time frame and who wanted to have a second surgery with me rather than wait 4 or 5 years. Interestingly all of those have promised to send pics, but unfortunately only one has. Several send a thank you email or card but it would be nice to have a bit more followup from my selfish perspective.

ISHRSEvery year the International Society of Hair Restoration Surgery (ISHRS) holds its annual scientific meeting to discuss hair loss and advancements in medical and surgical hair restoration. This year, the ISHRS meeting was held in San Francisco, CA and the topics discussed were in stark contrast to those that were on the agenda at the first San Francisco meeting 14 years ago.

In 1999, hot topics included whether microscopes were necessary for graft dissection; scalp reduction, extension and flaps; and the evolution from mini-grafts to follicular unit transplantation. There was no mention of follicular unit extraction (FUE), a topic that dominated this year’s meeting.

Refinements in FUE tools and techniques have led to increasing patient demand for the procedure over the past few years. Accordingly, much of this year’s meeting was devoted to discussing the evolution and current techniques in FUE. This includes comparing advanced FUE to state of the art follicular unit strip surgery (FUSS) and automated FUE hair transplant surgery. Other hot topics included updates on Dr. Wesley’s new Pilofocus scarless hair transplantation, ACell, Platelet Rich Plasma (PRP), the safety and efficacy of Propecia (finasteride) and an update on low level laser therapy for hair loss.

The below highlights from this year’s conference come from presentations and interviews with Coalition members; Dr. Mike Beehner, Dr. Robert Bernstein, Dr. Jerry Cooley and Dr. Carlos Wesley and recommended hair restoration physicians; Dr. Shelly Friedman, Dr. James Harris and Dr. Parsa Mohebi.  A special thanks to these expert physicians for providing this community with their feedback on the latest innovations discussed at the 2013 ISHRS meeting.

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