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

What do you do when a hair transplant results in mismatched angles in your hairline that clump and point different directions? Can you take them out and replant or do you build around? Any ideas?

My general thoughts are, unless the hairs are really misaligned so that you can’t cover them with hairspray, mousse, etc., that we simply pack hair around the previously placed hairs in a second hair restoration surgery. You paid for them already and they are growing, so be very cautious before you dig up follicular unit grafts and replant them. Some won’t survive.

It’s all just like moving a little fragile tree (singles up front) or a bigger tree (doubles /triples behind). I’d think carefully before proceeding.

Good luck to you either way.

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

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Technorati Tags: Hair Loss, hair transplant, hair restoration, follicular unit

This question, asked by a member of the Hair Loss Discussion Forums, was answered by Coalition physician Dr. Bernardino Arocha

Restoring crown hair loss can use a lot of grafts. How do hair transplant surgeons design crown restorations while planning for future balding?

Crowns are said to be the “black hole of hair restoration“. They can put great demand on precious hair transplant donor hair so it is usually advisable to consider future hair loss progression, donor/demand ratio and contemplating the quandary of “robbing from Peter to pay Paul”. In other words, weather there will be enough available donor to complete the restoration completely as the Norwood pattern is fully expressed. Propecia (finasteride) use can help conserve donor by maintaining the crown.

In restoring crowns, it is important to anchor the transplant into the thinning areas that are furthest out: that is, to work from the outside in so the first area of hair loss is the last to be restored. This is to prevent hair islands from developing or the “halo effect”.

Dr. Bernardino Arocha

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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

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Technorati Tags: balding, hair restoration, hair transplant, hair loss, Norwood, Propecia, finasteride

Can you tell the difference between a natural graft and a transplanted graft? I have very fine hair.

To a large degree, this is dependent upon the skill and artistry of the physician. When performed by a skilled and experienced hair transplant surgeon, ultra refined follicular unit hair transplantation is capable of producing undetectable results. The hair restoration physician must create the recipient sites to match the angle and direction of native hair growth. Placing them incorrectly can cause the transplanted hair to stand out like a sore thumb. When placed correctly and with adequate density as to create an illusion of density, then the grafts will look just like native hair, even upon close inspection. This is the beauty of follicular unit grafting.

Follicular units (see image below) are naturally occurring clusters of 1 to 4 hair follicles surrounded by small glands, blood vessels, nerves, and a connective tissue sac making it a tiny self-contained unit. They can be harvested via the “strip” method or individually via follicular unit extraction (FUE).

Below is a close-up image of a hairline restoration performed by Coalition hair transplant surgeon Dr. Victor Hasson of Hasson & Wong.

And this is how the patient looked before and after surgical hair restoration:

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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,

Are ultra refined FUT and “regular” FUT the same techniques, just different marketing from different hair restoration clinics?

FUT stands for “follicular unit hair transplantation“. In order to be classified as follicular unit transplantation one must be using stereoscopic microscopes at all dissecting stations to separate the naturally occurring follicular bundles out of the donor tissue. This was the defining difference between the older mini-micro grafting where, at best, jeweler’s loupes were used to dissect the grafts. The move to stereoscopic dissecting microscopes improved overall yield by 30%.

URFUT or “ultra refined follicular unit transplantation” is not a “technique” per se. Dr. Victor Hasson was the first to use this term when describing hair restoration surgery when he was giving a presentation on the merits of the lateral slit technique, which we invented and perfected. The phrase describes surgery where all the details are addressed to the highest degree: Angle, direction, custom sized incisions matched to the size of the corresponding graft, etc. When compared to the mess that was coming out most clinics at the time you could easily see, and in a lot of cases still see, how our hair transplants are so refined even right out of surgery.

Jotronic
Patient Educator for Hasson & Wong

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This question, from a member of our hair loss social community and discussion forums, was answered by recommended hair transplant surgeon Dr. Carlos Wesley:

I’m a 3 on the Norwood Scale for hair loss and considering hair transplant surgery. My doctor suggested I need 2500 grafts but he didn’t intend on going into my widow’s peak, which still has hair but is awfully thin (you can easily see the scalp). His reason is the possibility of shock loss, which is certainly something to be fearful of.

I’m happy to know he’s considerate of it and not just ready to jump in. But when I said I don’t think I should bother having hair restoration surgery done until I lose more hair, as I specifically want more hair in the peak, he said he’d be comfortable doing it after re-reviewing my photos. Kind of a flip, so not sure how to take that.

Is shock loss from hair transplants permanent or does it grow back? Is shock loss a handful of hairs here and there or whole areas? Any idea how likely?

This question, from a member of the Hair Restoration Discussion Forum, was answered by Jotronic – a senior member and consultant to Coalition physicians Dr. Victor Hasson and Dr. Jerry Wong:

I have read online that hair transplant surgeons often leave the placing of grafts to the technicians, perhaps checking every fifteen minutes or so. I guess my question is what is the most important part of the procedure? Is it taking the grafts in the first place, the splitting of grafts or indeed the placement?

Seeing as you are paying thousands of dollars, one would expect the doctor to perform all of the procedure from start to finish or at least 90%. As I say, I’ve read lots of posts where the doctors in question (some top class Coalition) delegate parts of the procedure out to others. I feel lucky that my doctor did all of my procedure from start to finish and only left for ten minutes or so. I would feel terribly let down if my hair restoration physician seemed to be away more than he was present during the procedure considering the large amount of cash handed over.

Graft placement is very important. But, when it comes to high quality hair restoration with a decent number of grafts, no single doctor should do the whole procedure. If you’re talking about a few hundred grafts then sure, I can see this being possible. But, when you’re dealing with a few thousand or more grafts then it just does not make sense. The procedure would take far too long and the grafts would stand a larger chance of dying due to desiccation (drying). Fatigue is another factor to consider.

This question, asked by a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

In my research, I have noticed that the hair restoration physicians who perform sagittal incisions do sessions averaging about 2500 grafts and then want you to come in later for further surgeries. Those who do lateral slit incisions average about 4,500 grafts in only one hair transplant surgery. What is everybody’s preference? Has anyone done both?

Both the sagittal and coronal slit have their place in hair transplantation. I often use combinations and have done very large cases using both methods. It should really depend on the individual factors of the case including, but not limited to, the type of hair the patient has, existing hair that the doctor needs to avoid damaging and the number of grafts per sq cm being placed.

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David (TakingThePlunge) Forum Co-Moderator and Editorial Assistant for the Hair Restoration Forum and Social Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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Technorati Tags: Hair Loss, hair restoration, hair transplant, hair transplantation

Coalition hair restoration surgeon Dr. William Lindsey recently discussed the importance of utilizing single hair follicular unit grafts (grafts comprised of one, singular hair) in hairlines during hair transplant surgery. According to Dr. Lindsey:

We try to pack the hairline with single grafts, back about 1/4 to 3/8 of an inch and then we move to double follicular unit grafts (comprised of two haired units). Only much further into the midscalp do we use three hair grafts.

Remember, hair transplantation does not cure patients of baldness, it provides hair loss sufferers coverage of bald scalp. The key in hairline restoration, specifically, is creating a look that is dense and yet natural. The best way to create this natural, appropriate appearance is to utilize single grafts exclusively.

When seeking “bulk” in the midscalp and vertex, using two and three hair units spread slightly further apart is appropriate and creates a natural appearance.

Dr. William Lindsey
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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 restoration, hair transplant surgery, hairline, single grafts, hair transplantation, hair loss, hairline restoration

In the hands of a skilled and experienced hair restoration physician, today’s ultra-refined follicular unit hair transplants can produce thick, natural looking results. However, many factors can affect the appearance of fullness. Among these factors include scalp and hair characteristics. In fact, the relationship between the hair and scalp are a key element in hair transplant surgery.

While a hair transplant surgeon’s artful placement of follicular unit grafts can enhance the look of transplanted hair leading to a thicker and fuller appearance, the following characteristics play an important role in creating a desirable result:

• The Number of Grafts: This number depends on the hair transplant patient’s available donor hair density and scalp elasticity.   The larger the numbers, the fuller and thicker the result will appear.

• Hair Shaft Diameter: Thicker hairs can lead to an aided appearance of fullness.

• Hair/Scalp Color Ratio: Patients with a lower hair to scalp contrast ratio typically experience a thicker looking appearing result than those with a high hair to scalp contrast ratio, even if all other variables are the same.   However, this additional appearance of fullness is just an illusion.

• Degree of Hair Loss:  The more hair loss a patient has, a greater number of grafts will be necessary to achieve the same results as someone with lesser degrees of balding.

To read more about this topic and contribute your thoughts and experience, join the discussion thread, What is the Best Type of Hair for Hair Transplant Surgery started by Hair Restoration Forum member “Newhairplease”.

The following article, written by Coalition hair transplant surgeon Dr. Victor Hasson, was posted on our Hair Restoration Social Community and Discussion Forums.

Frequently, patients ask us about styling options after the hair grows in from their hair transplant. Will they be able to style their hair in any fashion or will they be forced to style it in a particular way to maintain coverage and naturalness?

In general, if the transplanted hair is directed correctly, the styling options will increase with higher transplant densities. At low density it is important to comb the hair in a particular direction to maintain the hair shingling effect to bridge over balding scalp until the hairs reach the next follicular unit (FU) at which point the hairs from that next FU will take over the coverage function. In addition, lower densities will require longer length hair for coverage. However, there is a point where the hair can be too long, thus making the hair appear to give less coverage. Each patient is different so it is up to the individual to find the best length to maximize coverage given their degree of hair loss and coverage..

If an individual intends to part their hair through a transplanted area that was previously bald the transplanted hair density required rises dramatically. The shingling effect is largely negated here and what becomes impacted is the distance between transplanted FU’s. Generally, for a part to look natural, transplanted densities of 50 FU per cm2 and up are necessary. Obviously the hair characteristics such as shaft diameter, color and curl will come into play as well.