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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 (Falceros) 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)

ADVANTAGES:

1) In most research studies performed on hair growth / survival in follicles within MFU grafts, the survival has been 100%. It is presumed that this is because of the fact that they are buffered and protected by the surrounding tissue around and thus are less susceptible to trauma and drying. Also, hidden “telogen” stage (hibernation) hairs are often present and grow out later, which with FU dissection might be stripped away.

This hair loss article was written by Dr. Ron Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians. 

When Hair Restoration Surgery (HRS) was first popularized by Orentreich, the primary graft used was the “standard” 4 mm round punch graft.  However, over the past 10 years we have seen the introduction of much more diversity with respect to the size and shape of grafts. Grafts used today vary significantly and can be described with respect to a number of different variables including:

• Number of hairs
• Number of follicular units (FU’s) per graft
• Graft shape (linear, rectangular, round, chubby, skinny)  
• Size and type of the recipient site used (i.e. slit, slot or punch incisions).  Although technically this last variable refers to the recipient site and not the graft, in clinical practice, grafts are often described in this manner. 
• Process of graft production (i.e. cut “to size” vs. deliberately cut to contain a specific “number of hairs (or FU’s)”.

The reality of the situation was that for a long time a great deal of inconsistency and lack of specificity existed  when grafts were  described in the literature or at conferences.   Often in the past all that was stated was  that “Micrografts” or “Minigrafts” were  used.  This lack of specificity contributed to much of the confusion that existed when trying to compare different techniques that have developed over the years. 

Men and women with hair loss are rightfully excited by the prospect of being able to restore a natural looking head of hair with surgical hair restoration. However, understanding the limitations and risks of hair transplant surgery is just as important as counting its benefits. One important but controversial topic worth discussing is hair transplant dense packing, which enables the appearance of a thicker, fuller head of hair.

Though most surgeons agree that a certain level of dense packing is appropriate in some patients, not everyone requires large quantities of hair packed in a single area. Whether or not a balding man or woman is eligible for and how much dense packing is appropriate largely depends on the patient’s current and risk of future hair loss, donor hair availability, long term hair restoration goals, and what can realistically be accomplished.

A few hair replacement clinics have made claims that they can pack up to 70, 80, and even 100 follicular unit grafts (hairs as they occur naturally in the scalp) per square centimeter (FU/cm2). And though men and women  suffering from baldness are often intrigued by a physician’s ability to pack hair closely together due to dreams of recovering a full head of hair, too much dense packing might inhibit healthy hair regrowth.

This insightful hair transplant article was written by Dr. Bernardino Arocha of Houston, TX - an elite member of the Coalition of Independent Hair Restoration Physicians.

Hair characteristics, caliber, presence of curl, color, angle of emergence, and sheen play a pivotal role in the outcome of hair restoration surgeries. If your hair genie offered one of two wishes:

1) To double the amount of your hair;
2) To increase the diameter of your hair from thin to coarse.

Which of the wishes would be your choice? Well wish number one is quite simple by doubling the amount of hair you increase the volume by two, but what about the other option? If we go from fine hair with a diameter of 40 microns to coarse hair with a diameter of 80 microns, the area covered increases TWELVE fold since hair shaft is a circle the area is ∏r2 hence  (3.14)(2)2= 3.14x 4≥12. 

The other characteristics have a significant influence on the cosmetic impact of the hair transplant result, but to a lesser degree. The presence of curl can have a great impact on the volume; hence very curly. African-American hair covers a greater volume and more than compensates for the lower hair density in this race. The color or rather the amount of contrast between the color of the hair and the complexion is also important. Black hair looks thinner on the fair skinned individuals, while fuller on a tanned or darker individual. Similarly, a fair skinned individual with black hair who is transplanted will appear to get thicker hair as he ages and his hair turns grey. It is all attributed to the decrease in contrast.

With proper preparation for future hair loss, men and women with minimal thinning hair can often achieve high levels of both fullness and hair density in a single hair transplant procedure. However, those with extensive baldness are often left dreaming of the long lustrous locks they wore proudly during their high school days.

But there is hope for those who are bald. Though there is a limited donor hair supply in all patients, many leading hair restoration physicians can help bald patients re-create a natural looking mature hairline and a portion of the hair on top of their head.

On this hair loss discussion forum thread, members discuss what can realistically be accomplished in patients with extensive baldness and whether or not it will satisfy them. You are encouraged to share your experience and offer your input on this thread.

Bill Seemiller - aka Falceros
Associate Publisher/Editor

Technorati Tags: hair loss, thinning hair, hair density, hair transplant, baldness, bald, hair restoration

A few hair restoration clinics have made claims they can densely pack up to 70, 80, and even 100 follicular units per square centimeter (FU/cm2). And though balding men and women are often intrigued by a physician’s ability to pack hair closely together, how many will actually grow requires further exploration. Which patients are candidates for dense packing? How many follicular units can be safely placed per square cm before hair growth yield is affected?

Coalition member Dr. Ray Konior recently presented a case where a patient originally had 3000 grafts densely packed in the frontal third up to 100 FU/cm2. Considering natural hair density is typically around 80 FU/cm2, this hair transplant patient’s hair should have been so dense that nobody could see his scalp through his hair after his first surgery. Unfortunately, though 100 follicular units were packed per square cm, hair regrowth yield was significantly less leaving the appearance of hair loss and thinning hair.

View this photo album on our hair loss forumto learn the risks of placing hairs too closely together and how too much dense packing might impact hair growth. Learn why less is sometimes more.

Bill - aka Falceros
Associate Publisher/Editor

Technorati Tags: hair restoration, densely pack, follicular units, balding, dense packing, hair growth, hair density, hair transplant, hair regrowth, hair loss, thinning hair, hair loss forum

Our community was created by and for hair loss patients to share experiences, evaluate hair restoration physicians, and offer input on hair loss treatments that really work. For over 10 years, our discussion forum has enabled balding men and women to share the good, the bad and the ugly.

Today, over 350 patients have authored weblogs to share their hair restoration experiences and hair transplant photos with you. Below we introduce you to just a few of the patients whose hair restoration dreams became reality and the doctors who made it happen.

Join the ranks of these hair restoration super stars and create your own free hair loss weblog to share your experience and photos.

• Blogger “Wantego” came to us with a receding hairline looking for real ways to restore his hair. His research on our discussion forum led him to surgical hair restoration with Coalition member Dr. Rahal. Receiving 4374 follicular unit grafts, he’s been able to restore his “true” hair density and no longer shows any signs of balding. View his blog for a detailed account of his experience with photos.

• After receiving two previous hair transplants, “Phoneguy” found Coalition member Dr. Cooley by researching our community. Bothered by hair loss in the frontal half of his scalp, Dr. Cooley placed 1947 follicular unit grafts into the areas of thinning hair, eliminating signs of baldness. “Phoneguy” has quickly learned why other Dr. Cooley patients refer to themselves as “Cooleyfied”. You can read his experience and view his photos on his blog.

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

I was asked to update my comments from what I said before about hair growth and follicle survival in high densities, but for the most part would pretty much say the same thing now in late 2008.

There was a nice study published in the journal, Dermatologic Surgery, by Coalition members Dr. Tom Nakatsui and Dr. Jerry Wong about a year ago or so, in which they used small lateral slits and created study boxes of between 23 and 72 slits per square cm of surface area, and obtained a 95.6% survival in the 23/cm2 box and 98.6% in the 72/cm2 box. These results are outstanding, although we have to keep in mind that the study was done on only one hair transplant patient and the same results may or may not occur with another person.  Also, as I recall, these boxes were around the periphery of the area transplanted and I don’t believe any were actually in the center, which I think would be the area most at risk for possible less-than-optimal hair regrowth. I have noticed in past studies I have conducted that, even though I did everything exactly the same, I often would see marked variation in hair follicle survival a year out. Every hair surgeon that I have spoken with acknowledges that there is an individual patient “X factor” that we can’t totally put our finger on, but does in fact exist.

Some men and women look better with their hair combed forward while hair styled back or to the side may be more flattering on others. For balding individuals, many would be happy with any hairstyle that doesn’t involve showing off a bald scalp.

But how often is hairstyling considered when creating a long term hair restoration plan? How does hair density promote or limit certain desirable hairstyles?

In this discussion thread, forum member “celeb hair vet” shares his opinion on our hair loss forum about the importance of considering hairstyling when creating a hair restoration plan. You are invited to join in the discussion and offer your feedback.

Bill - aka Falceros
Associate Publisher/Editor

Technorati Tags: balding, bald, hairstyling, hair restoration, hair density, hairstyles

I’ve noticed that some hair transplant surgeons use .7mm custom blades while others use .9mm to 1mm custom blades. Is it logical to follow the intuition of “the smaller the better”?

A doctor’s skill always reigns paramount when discussing something like this, or loupes verses microscopes. But assuming the hair restoration physicians are of equal ability, is there any reason why smaller blades/incisions are not optimal? Are there actual attributes for using the larger blades I referenced, other than that it’s easier for a doctor?

This hair loss question was answered on our hair restoration forum by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

The answer to your question is that sometimes smaller blades are more optimal, and sometimes not. It depends on many factors. What is more important then the size of the blade is how the follicular unit (FU) fits in the incision. The graft should fit snugly, but not too tight to cause compression. Also, the incision size should be such that the follicular unit grafts can be planted into the skin with as little trauma as possible. The texture and thickness of ones skin and the size of the graft determine what size blade should be used to make the incisions. Some patients have tough, non-forgiving skin that does not have much stretch to it.  In these hair transplant patients I would usually cut my blades a bit larger. Some patients have follicular units which splay at the bottom. I find they get squashed a bit if the incision size is too small and I have to use larger incisions for this type of follicular unit. A person who has thin blond hair will have much smaller follicular units then a person who has thick, black hair. Persons with very curly or kinky hair will have a curve to the follicular unit and will need larger incisions. Also, a FU with 4 hairs will be larger then a one hair FU and will need a larger incision to fit properly.