Post Hair Loss Questions and Get Answers

This hair loss question was answered by Dr. Glenn Charles of Florida who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

One thing I never really understood is when people say that the hairline will soften during the period 6-18 months after a hair transplant.  I thought that hairs initially grew thin and thickened up during this same period.  If hairs are getting thicker how can the hairline get softer? What does softening of the hairline actually mean?

Creating a soft and natural hairline with surgical hair restoration should be addressed by the hair replacement surgeon during the procedure.

It is critical that the thinner/finer hairs be used in the hairline. Thick/coarse hairs will most likely have a similar look and feel no matter where it is placed.  It is true that sometimes transplanted hairs will be more brittle and kinky during its first hair growth cycle. After repeated hair growth cycles and hair cuts those same hairs might begin to look and feel softer, but are probably just finally returning to their original state.

 Dr. Glenn Charles, D.O.

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Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair loss, hair transplant, hair restoration, hair replacement, transplanted hairs, hair growth

One of the most important factors that make a hair transplant look natural is a hair restoration surgeon’s ability to create a soft and natural looking hairline that mimics nature. Creating a natural looking hairline involves great skill, placement, artistic design, and hair density.

During the first several months of hair regrowth, transplanted hair can grow in at different rates, thin, and can sometimes be hard to tame, making a hairline appear “hard” rather than soft and natural. At what point does a hairline actually soften, look natural, and mature?

In this hair loss forum discussion members discuss the stages of hair transplant maturation and how and at what point transplanted hair softens and blends with their natural hair. You are encouraged to join in the discussion and offer your experience and opinion.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair transplant, hair restoration, hair density, hair regrowth, transplanted hair, hair transplant, natural hair

Today’s top hair restoration surgeons will create tiny incisions with small tools to maximize dense packing and reduce trauma to the scalp during a hair transplant procedure. The cutting tools however, vary from surgeon to surgeon.

The discussion on whether custom cut flat blades or pre-fabricated needles is optimal for making incisions has come up from time to time on our hair loss forum. While some clinics believe custom cut blades reduces trauma to the scalp and allows for packing hair more closely together, other clinics believe that by pushing the hair apart, sharp point needles can actually reduce the risk of shock loss.

In this hair loss forum discussion thread, read views by leading hair restoration clinics like Coalition members Hasson and Wong, Dr. Jerry Cooley, and Shapiro Medical Group. Feel free to offer your own input on this important topic.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair restoration, dense packing, hair transplant, hair loss, shock loss, Hasson and Wong, Dr. Jerry Cooley, Shapiro Medical

Recently, the Publishers of the Hair Transplant Network attended the 2008 16th annual ISHRS scientific meeting held in Montreal from September 3rd to the 7th.  See the formal Press Release.

Though many topics were discussed, this report will highlight topics that may be of most interest to hair loss sufferers. Many of these topics have been discussed and debated by patients for years on our hair loss forum. Topics include optimal hairline design and density, minimizing the appearance of the donor scar, using all follicular units (FUs) verses some multi follicular units (MFUs), FUE Megasessions, and complications with perpendicular (coronal/lateral) incisions and dense packing difficulties. There was a brief presentation on advances in hair biology discussing the latest research on cellular and molecular controls of follicular development and growth. However, because the Publishers of this community were not able to attend this presentation, this report won’t contain any new information on this topic.

The attention to detail at these meetings is certainly very impressive and hair transplant surgeons who regularly attend deserve to be commended for their dedication to continuing education.

Background on the ISHRS and Meetings

The primary mission of the ISHRS (International Society of Hair Restoration Surgery) is to educate hair restoration physicians from the beginner to the master. It is by far the most prominent hair restoration professional organization in the world and the host of the five day annual scientific meeting. Their website (www.ISHRS.org) provides useful information about hair restoration and profiles and contact information for its 700 worldwide physician members.

I am a hair loss sufferer considering hair transplantation but I am confused.  I have been reading this hair restoration forum for some time and don’t understand what makes some hair transplant clinics better than others.  Hair replacement surgery seems like a simple process.  Why are some hair transplant surgeons better than others?

There are many ways to answer this question.

Firstly, I don’t think it’s fair to call hair transplantation a “simple” procedure.  It’s in fact a very delicate process and damaging the follicular unit grafts without the necessary and proper care is sadly more commonplace than not in the world of hair transplantation.

Keep in mind also that not all hair transplant doctors in the world utilize the latest techniques and technologies.  In fact, the majority of them are still using out of date techniques which is why only a handful of hair transplant clinics are recommended on the Hair Transplant Network.  Many hair restoration clinics, believe it or not, still refuse to use microscopes when slivering the follicular unit grafts from the strip.  Many clinics still use minigrafts.  Read more about the history of hair transplantation.  And even still, many hair replacement surgeons still use a triple + blade to harvest the strip, which significantly increases hair follicle transection rate.

Keep in mind also that there are variations in even the latest of techniques and technologies. 

Some hair transplant physicians prefer making recipient incisions with needles, some with precut flat blades, some with custom cut flat blades, etc.  I have personally heard of cases made for each of these hair transplant tools.

This insightful article was written by well respected hair restoration forum member “Janna” who is also the lead hair transplant technician for Shapiro Medical Group of who is a well respected member of the Coalition of Independent Hair Restoration Physicians.

Two types of incisions one great hair restoration result at nine months.

A while ago Pat Hennessy, the Publisher of the Hair Transplant Network, the Hair Loss Learning Center, and the Hair Loss Q&A Blog inquired about hair transplant photos where Dr. Jerry Wong and Dr. Ron Shapiro were asked to perform a live hair transplant surgery demonstration at the 2006 ISHRS (International Society of Hair Restoration Surgeons) Live Surgery Workshop. Pat asked if I could aid in getting some postoperative hair transplant photos of this particular hair transplant patient. The main objective of the live hair transplant procedure was to showcase a side by side demonstration of sagital and coronal (lateral) incisions while dense packing the hairline. The demonstration went extremely well, so well in fact that both hair transplant surgeons were asked repeat this educational demonstration again at the 2007 European Conference in Paris last May.

Since Dr. Shapiro went through the trouble of putting the hair transplant pictures together for great side by side comparison, I thought there may be seeking hair loss sufferers interested in seeing if they can tell a difference between sides. Most of the hair restoration physicians that have seen the photo as well as Dr. Wong and Dr. Shapiro feel that both sides look very good. I think it demonstrates that as long as fine follicular unit grafts and tiny incision are used properly, the great majority of hair transplant clinical results are due to the skill of the hair transplant physicians rather than a specific incision type. All parties have consented to showing the pictures on the hair restoration forum.

How long after the first hair transplant should I wait to have another one?

Though there are varying answers on this, I have revervations about going for a second hair restoration procedure too early especially if hair is to be transplanted in the same area as previously transplanted hair.  This also depends on whether or not the hair transplant procedure is follicular unit hair transplantation / follicular unit strip surgery (FUT/FUSS) or follicular unit extraction / follicular isolation technique (FUE/FIT).

In my opinion, undergoing follicular unit hair transplantion too early does not give the scalp enough time to restore normal elasticity.  This means a lesser amount of follicular unit grafts can be excised from the donor area safe zone the second time around.  Scalp exercises are only encouraged 6 months after the first hair transplant procedure anyway which ultimately suggests that the donor area can be a bit sensitive before that point.  Personally, my donor laxity started to really increase dramatically after about 8 months from each hair replacement surgery.

Whether referring to follicular unit transplantation or follicular unit extraction, in the recipient area, new hair growth can occur up to 12-18 months after hair replacement surgery.  In the latter months however, new hair growth will be minimal.  Due to the projected new hair growth even in later months, it is possible that some may be transected and therefore damaged before they actually grow, preventing them from growing.  Additionally, it may be more difficult to determine the proper direction of a hair if that hair has only started to grow.

This question was posed by a hair loss sufferer on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

Most of the factors that we think have to do with “shock loss” of native hair following a hair transplant procedure all take place at the time of hair restoration surgery. The two most important things are: one, the VULNERABILITY of the hairs that exist on top, and two, the AGGRESSIVENESS with which the recipient sites are made. If a large percentage of those remaining native hairs are “miniaturized” (limited length and decreased diameter; ie: “wispy”) they are much more likely to be shocked than a strong terminal hair is. When recipient sites are aggressively made, whether it is the closeness with which they are made or the width, depth, or length of the individual sites, native hairs can be lost either by taking a “direct hit” by the instrument used or simply as a “shock” reaction to having all these cumulative injuries occurring so close to them.

The THICKNESS OF THE SCALP is another key factor. The plexus of key arterial vessels that network to supply blood supply to the scalp lay deep in the scalp over the “galea” layer (the thick gristle at the bottom) deep in the subcutaneous fatty layer. It this subcut layer is nonexistent, then it is hard for the doctor to avoid injuring those deeper vessels, even with tumescence.

I recently had the opportunity to visit Dr. Williams and his staff as they performed a truly ultra refined hair transplant procedure in their Henderson office in the Las Vegas area. I found the high quality and refinement of their work very reassuring. After speaking extensively with the clinical staff it was obvious that they had extensive experience and took great pride in the quality of their work and patient results.

All grafts are trimmed under microscopes. Graft quality that I observed was excellent. The staff does not sub divide the naturally occurring 1, 2, 3 and 4 hair follicular units when creating grafts. Dr. William and his staff focus on one patient a day and have the capability to do 3,000 graft sessions.

Dr. Williams has a strong surgical background and has been performing follicular unit hair transplantation exclusively for the past seven years. He has a very good bedside manner and is very candid with his patients.

Patients are also provided with free post op low light laser therapy (LLLT). Dr. Williams and his staff have no doubt that this post op treatment has accelerated both the healing and growth for their patients.

Like many other leading hair transplant physicians, Dr. Williams often uses both perpendicular (lateral) and parallel (sagital) graft incisions depending on the area he is transplanting and whether the area has pre-existing hair. He never requires his patients to shave their hair.

The question of shaving the recipient area (the balding area where hair is to be transplanted) for a hair transplant is a hot issue. Below you will find Dr. Hasson’s comments on why he feels shaving the recipient area is important for optimal results.

This insightful article was written by Dr. Hasson, a member of the Coalition of Independent Hair Restoration Surgeons.

There are multiple technical factors that come into play during the creation of recipient sites and the subsequent follicular unit graft placement. These include:

1. When thinning areas are shaved down the “thinning process” takes on a different meaning. With the use of magnification it will be seen that some follicular bundles are absent (and there are wider spaces between remaining bundles) and that some bundles are significantly miniaturized. It will then be possible to place new recipient sites in the place of absent bundles and alongside miniaturized bundles to recreate the density. This can also be done in a uniform manner so that if the pre-existing hair eventually disappears, due to progression of hair loss, the hair transplant can still look reasonably natural. If the recipient site is not shaved the hair restoration surgeon must part through the hair again and again looking for any empty spaces and trying to fill the spaces as best as possible. This is not really as exact a process but much more hit or miss.