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This concern comes from a member of our Hair Restoration Social Community and Discussion Forums:

I underwent follicular unit transplantation (FUT) several years ago and was not pleased with the results. After the procedure, I found out that the hair transplant surgeon and staff split, or cut, the follicular units down to a smaller size before implanting into the balding scalp. What does this mean? Should hair restoration surgeons practice “graft splitting ?” Could this have caused the sub-par results?

From what I can tell, many hair restoration clinics do participate in this practice. However, I don’t believe splitting grafts is inherently unethical, nor do I believe it creates a sub-par result if performed properly.

It seems as if practices split follicular unit grafts when they need smaller, 1-2 (or singular) hair units for refined areas of the scalp, like the hairline. The controversy surrounding graft splitting arises when clinics allegedly split grafts simply to charge patients more money (based upon a pay-per-graft type scale). However, most of the information regarding this practice seems to come from anecdotal evidence via the internet, and it does not appear overtly common. If ethical hair transplant teams (surgeons and technicians) are splitting a small number of grafts carefully (under microscopic visualization) to create a greater number of singular unit grafts for the hairline, there does not seem to be any issues involved with splitting follicular units.

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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:

Years ago, I underwent an antiquated hair transplant surgery where multi-unit, hair plug grafts were implanted in my hairline. After years of turmoil, I’ve decided to have these pluggy grafts removed, or punched-out, and seek a modern, state-of-the-art hair transplant procedure at a later date. However, I’m wondering how long it will take before the redness caused by the hair plug removal procedure fades away?

Because of the size of multi-unit, plug grafts, it’s reasonable to worry about redness and swealling from a removal procedure. Keep in mind that although hair plugs are removed much like follicular unit grafts in a follicular unit extraction (FUE) procedure, the trauma caused by the size of the punch grafts will result in some swelling and redness in the extraction area. For the sake of comparison, a typical follicular unit extraction tool will measure 0.7 – 0.9 mm in diameter, whereas the average plug graft measures (and will require an extraction tool) 3.5 – 4 mm in width.

On average, the redness created by hair plug removal will last anywhere from 2 – 3 weeks. However, keep in mind that the wider the graft, the more trauma caused during extraction, and the longer the area will remain red. For example, a micro or mini-graft (a plug graft dissected into smaller, but still unnecessarily large segments) extraction would remain red for less time than a punch or plug graft removal.

This insightful article was written by  Dr. Michael Meshkin  of Newport Beach, CA who is one of our recommended hair restoration physicians.

Some consider hair to be the most aesthetic part of the face. As such, baldness can dominate one’s appearance, drawing attention from a beautiful face. The hairline is where your scalp hair borders your forehead and frames your face, thereby bringing out the beauty and richness of one’s features. When the hairline starts to recede, one’s facial features also recede into the background. A primary reason for seeking hair restoration is to restore your appearance to the condition before hair loss. One of the more critical decisions in hair restoration is determining where your new hairline should be, which should carefully be discussed with your physician. The physician should follow several cosmetic rules to design the hairline.   The doctor should place the hairline in correct position. The doctor should use all of the cosmetic guidelines, rules and tools available for creating the hairline such as the following:

• Rule of thirds- dividing the face in three equal proportions(described by Leonardo De Vinci)
• Measuring more than 8 cm from the mid-glabellar point
• Hairline not lower than the original hairline before hair loss  began
• Customize the correct shape of hairline individually such as:   widows peak, and correct flaring
• Creating different shapes of forelock for people with limited donor area
• Irregular soft and subtle hairline

Reconstructing a natural looking hairline is one of the most important facets of surgical hair restoration. What good would a thick head of hair do with an unsightly and abnormal looking hairline?

World class hair transplant surgeons take special care to establish suitable hairline placement and position to assure a proper and natural framing of the face. Single haired follicular units (groups of hairs as they occur naturally in the scalp) are carefully placed and angled correctly into tiny incisions to most accurately mimic nature.

Determining a suitable hairline placement depends on a physician’s artistry and patient’s characteristics. Whereas most hair loss sufferers would love to re-obtain their youthful looking hairline, it’s not always in the patient’s best interest.

Recently, forum member “Pharma” shares his desire for a youthful looking hairline with our community. To learn when recreating a youthful looking hairline is and isn’t appropriate and to contribute your input, visit the discussion thread “Youthful Hairline“.

Bill Seemiller
Managing Publisher of 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: natural looking hairline, hair restoration, follicular units, hair loss, Bill Seemiller

This question was posed  by a hair loss sufferer seeking hair loss  help  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.

My understanding is that it is normal to have shafts of transplanted hair fall out within weeks or a month, and that they will (hopefully) grow back after 3 to 4 months after the hair transplant procedure.   I realize that not all heads are created equal but, on average, if there is such a thing, what is the percent of transplanted grafts that will continue to grow after transplanting without falling out first?   Maybe it would better ask if it is common to have hair grow without falling out, or is it completely unheard of?

Your impression is correct, in that the great majority of the hairs that are transplanted (most of which are only 1/8th inch long) are shed during the first few months, before the “real” hairs appear 3-4 months post-operatively. They usually shed in one of two ways: some fall off with the scab at the 6-10 day point, while others just “sit in place” in the skin, even though down deep in the skin they are literally disconnected from the follicle (the living part of hair), which shrivels up and hibernates for that time period. These short stubs then can sit there for weeks or they can fall off at anytime. The best way to tell a “disconnected,” non-growing one from one that is going to grow is to simply look at it a couple of weeks later. If it is longer, then it is growing. It’s as simple as that.

Many veteran hair transplant patients are familiar with the term “follicular unit grafting” and have come to know this as the today’s “Gold Standard” in surgical hair restoration.  What many don’t know however, is that a “follicular unit” falls under a particular category of “micrograft” – a term often wrongfully associated with a much less favorable and also misconstrued term “minigraft“.

Believe it or not even some of the leading hair loss doctors in the hair transplant profession today use some “minigrafts” when appropriate for the patient. But what exactly is a “minigraft”? Are they really as bad as some have perceived them to be?

Unfortunately, the terms for the various types of grafts have been misunderstood and misconstrued in our hair loss forum community for a long time.

Recently, Coalition member Dr. Ron Shapiro wrote an article to help hair loss sufferers understand the differences and appropriate use of various types of grafts.

I encourage you to read through Understanding Hair Transplant “Graft” Terminology to learn the various graft types and how they’re appropriately used. You are also encouraged to give your feedback on this hair loss forum topic discussing graft types.

Bill Seemiller
Associate Publisher/Editor

Technorati Tags: hair transplant, hair restoration, follicular unit, micrograft, minigraft, hair loss doctors, minigrafts, hair loss

Given the number of impressive hair transplant results presented in the “Results Posted by Leading Hair Transplant Clinics” forum, Coalition member Dr. Jean Devroye has quickly become recognized as a leading hair transplant surgeon in Europe.

In an attempt to improve the quality of results patients can achieve with follicular unit extraction (FUE), Dr. Devroye designed and has been using for 6 months a unique powered instrument (prototype) for FUE hair replacement procedures. This prototype was designed to improve the speed of the follicular unit extraction procedure while maintaining the same effectiveness as when performed manually by a skilled surgeon.

This new powered FUE device works by spinning alternatively with a low angular motion.   This allows for fast and effective penetration of the scalp and extraction of the follicle while keeping the risks of damage to the follicles virtually nonexistant.   It’s  speed is controlled by a foot treadle allowing for better hand control of the device.

While Dr. Devroye believes his FUE tool prototype helps to increase the speed of the hair restoration procedure, he admits it doesn’t reduce the already very low transection rates he achieves while performing follicular unit extraction with a manual tool. Dr. Devroye’s powered FUE instrument has allowed him to increase the number of follicular unit grafts he can transplant daily via FUE from approximately 1200 to 1500 per day.

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
Associate Publisher/Editor

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

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
Associate Publisher/Editor

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

This insightful article was written by a  Dr. Michael Beehner  of Saratoga Springs, NY who is one of our recommended hair restoration physicians.

Over the past few years Bill Seemiller   and Pat Hennessey have asked me to share with the reading audience my rationale for using multi follicular unit grafts (MFU) grafts (multi-follicular grafts, 4-6 hairs each) in the hair transplant planning for some patients. I will try to do so here.

First of all, in order to get our terminology straight, the difference between a “minigraft” and a MFU Graft, is that the minigraft is cut with less magnification, usually with “loupes” and are “cut to size” and often have a little transection in the cutting process. A MFU graft is cut, at least in our practice, under a 10x stereoscopic microscope and the nurse in our practice who specializes in cutting them each case that we use them, under high magnification dissects out a graft that encompasses two (or sometimes three) follicular units (FUs) that are in close proximity to each other. Incidentally, MFU grafts can be placed into either a small slit (usually made in what we call a “parallel” orientation) or into a small, round hole (usually 1-1.3mm in diameter; about the size of pencil lead)

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