This article was submitted to us for publishing and was partially written by Dr. Carlos Wesley, who is recommended on the Hair Transplant Network. For a complete list of contributors to this article, scroll down to the bottom of this article.

Hair Transplantation Procedures

Overview

Background

Hair transplantation procedures are used to treat various forms and degrees of permanent alopecia in both men and women. Intact hair follicles may be harvested from within the safe donor area of a patient’s scalp by either strip method or follicular unit extraction (FUE); each harvesting method has unique advantages and disadvantages. The refinement of follicular unit transplanting over the last decade has led to markedly improved hair survival and natural-appearing results.

This article provides a broad overview of the techniques used by various hair transplant surgeons throughout the world. Founded on the principal of donor dominance (ie, hair follicles continue to grow in the new recipient area to which they are introduced as long as they would have in the donor area from which they are extracted), the field of hair restoration surgery (HRS) has evolved considerably since its inception in the 1950s. Natural-appearing results are consistently achievable and reflect a surgeon’s technical skill and artistic creativity.

Indications

Hair transplantation is a surgical procedure used for the correction of androgenic alopecia (AGA), cicatricial (scarring) alopecia, or any form of permanent hair loss in both men and women.^[1,2]

This insightful hair loss information was posted on our Hair Restoration Social Community and Discussion Forums: by Dr. Jerry Cooley of Charlotte, NC who is a member of the Coalition of Independent Hair Restoration Physicians.

I hair restoration doctors talk about transplanting the crown border (I am talking about sides and not the bottom of the crown) with less density than the middle of the crown. When I get my crown fixed eventually as it is not all that bad yet, I feel that the center crown would not be all that important to me but rather the outside/sides of the crown would need more density to properly frame the head when viewing from the side. I know the crown side border typically is less dense even in non-balding men so maybe this is the reason?

It is complicated because there are many factors for the hair transplant surgeon to consider including the patient’s age, hair characteristics, current baldness, rate of hair loss, whether they are on Propecia finasteride, donor supply, etc. The goal is to produce not only a look that satisfies the patient in the short term, but also one that will stand up over time. It is best to be evaluated in person to get an individualized recommendation for you.

Dr. Jerry Cooley

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

Hair restoration surgeon Dr. Michael Beehner is recommended by the Hair Transplant Network. To view this discussion and other hair loss topics, visit our Hair Loss Social Community and Discussion Forums,

I am 29 years old and have been using Propecia (finasteride) for 3 years, Rogaine (minoxidil) for 3 years and had one hair transplant in the corners of hairline (temples?) of 1800 grafts 1 year ago. (See photo below)

Based on my photo, how many grafts do you think it might take to fully restore my crown? Who is the best crown doctor in your opinion? My donor is dense, hair is wavy, and hair diameter in thick (Spanish ancestors). No one in my family is slick bald. The only person with thinner hair is my mom’s dad but his crown is better than mine and he’s 65. My dad and his dad have Elvis hair.

I think, at the age of 29, it would be a mistake to transplant your entire crown area, especially using maximal density, which I am sure is what you probably would want.

In looking at your “top-down” photo, I can see obvious thinning in a 9-10cm diameter circular area in back. At 29, you likely have 50 years of life ahead of you in which male pattern baldness is going to progress. And unfortunately, the square area of the crown/vertex does not increase in a linear fashion, but rather in a logarithmic way.

In this hair loss video interview, recommended hair restoration physician Dr. John Gillespie discusses the importance of producing dense natural looking hair transplant results that mimic nature.

Dr. Gillespie has specialized in hair transplantation since 1976, performing thousands of hair transplants. He and his clinic and the all-micro procedure they perform are absolutely first rate by international standards. Dr. Gillespie’s very experienced staff prepare all the 1,2,3, and 4 follicular unit grafts using microscopes.

To learn more about Dr. Gillespie, his experience, skill, philosophy and to see examples of his hair restoration results, visit his Hair Transplant Network recommendation profile here.

To see all of our hair transplant videos, visit our Hair Transplant Video Channel on YouTube.

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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.

Get Proven Hair Loss Treatments at the Best Prices by visiting our new Online Hair Loss Product Store

Technorati Tags: hair loss, hair restoration, Dr. John Gillespie, hair transplant, hair transplantation, hair transplants, follicular unit, hair transplant videos, YouTube

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: 

I’ve recently attended several hair transplant consultations and each surgeon recommended a different follicular unit graft density (number of follicular unit grafts transplanted per square centimeter of balding scalp). I’m wondering, what type of follicular unit graft density is safe and recommended?

If you asked 10 different hair transplant surgeons “what is the maximum safe follicular unit per square centimeter density” you would probably get 10 different answers.

I generally do not exceed 50-60 follicular units per square centimer. I would rather place 60 follicular units in a square centimeter and have 56 units grow than place 80 follicular units per square centimeter and only have 68 units grow. Less waisted follicles is better in the long run. Everyone has a limited supply.

Dr. Glenn M. Charles
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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

Follow our community on Twitter

Watch hair transplant videos on YouTube

Get Proven Hair Loss Treatments at the Best Prices by visiting our new Online Hair Loss Product Store

Technorati Tags: Hair Loss, hair transplant surgeon, hair transplant, follicular unit graft

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
_______________
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

Follow our community on Twitter

Watch hair transplant videos on YouTube

Get Proven Hair Loss Treatments at the Best Prices by visiting our new Online Hair Loss Product Store

Technorati Tags: hair restoration, hair transplant surgery, hairline, single grafts, hair transplantation, hair loss, hairline restoration

This insightful hair loss information was posted on our Hair Restoration Social Community and Discussion Forums: by Dr. Jerry Cooley of Charlotte, NC who is a member of the Coalition of Independent Hair Restoration Physicians.

Grafting into and around existing, native hair will be a requirement for my next hair transplant and I am interested in any such cases (i.e. shock loss/damage to existing hair etc).

We graft areas with existing hair all the time. Shaving is a nice technique, but fewer than 5% of our hair transplant patients are willing to do this. People are willing to take a week off to recover from hair restoration surgery but expect to be almost undetectable at that point so they can go back to work.

Grafting into existing hair requires special techniques including:

1) Taking time to make incisions using high magnification.
2) Tumescent anesthesia.
3) Control over size and depth of incisions..

We still see some thinning hair post-procedure from time to time but it is usually very mild in most cases. Using the ACell may trigger anagen growth in existing hair, so we actually see a little more shedding 3-4 months after the procedure but this is well worth it considering the robust hair growth and thickening of existing hair.

Dr. Jerry Cooley

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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.

This hair loss question  was answered by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  

The following question, asked by a member of our Hair Restoration Forum and Social Network, is related to patient results posted by Dr. Shapiro in the discussion thread, Dr. Paul Shapiro: 4400 FUT Grafts, 14 Days Post Op:

Can you tell me why you opted to go back into the crown? I ask because I hear of some hair restoration surgeons not wanting to touch the crown until a patient is much older and more progressed. This patient is a class 4 on the Norwood Scale at 28 but, theoretically, his crown could open up much further.

There is no set rule whether or not to put hair in the crown. What is important is that we take future balding into consideration so that, if the patient progresses, there is enough donor to make the hair transplant look natural.

In this case, the patient did not want his hairline very low and was happy with a mature frontal-temporal angle. I kept the front of his hairline high at 9 cm above the glabella and his frontal temporal angles mature. In these patients I will shrink the crown, but not completely cover it. It is usually safe to put hair at the top of the crown. Also the hair in the top of the crown is at a lesser density of around 25 to 30 FU/sq.cm to give it some coverage, but not very dense.

This question, asked by a member of our Hair Restoration Social Community and Discussion Forums, was answered by recommended hair transplant surgeon Dr. Michael Beehner:

Is Follicular Unit Transplantation permanent? Is there concrete evidence (anywhere!) that hair transplants last a lifetime, or at least last for a fair amount of years?

The question you pose is the million dollar question. I’m not sure anyone knows the exact answer, but I’ll give you my attempt at honestly answering it.

For starters, I think the permanency of the transplanted hair varies some from one patient to another. There are patients I have seen over a 20 year period (including looking in the mirror every day at my own hair, which was transplanted 29 years ago) and it seems the transplanted hair has thinned more than the remaining donor hair has. There are also a great many patients I have observed over those 20 years from my early days of doing hair transplants who are still very full.

There are a few facts that have been proven and are general knowledge: First of all, to some degree, almost all men and women develop what is inappropriately named “senile alopecia“. This refers to gradually thinning hair everywhere on the head in people as they age. This hair loss varies tremendously among individuals, but I do believe everyone does thin from their 40′s up and through their 70′s and 80′s – some to such a small degree that it may not seem noticeable. Another fact that has been proven with research is that the diameter of the resultant transplanted hair in most studies has been measured to be slightly less than when it was originally in the donor area. Thus there is probably less “hair mass” right from the get-go.

Although hair transplantation is not an exact science (in fact, most physicians state that medicine, in general, is as much an art as a science), when it comes to hair transplant surgery many patients desire an accurate, objective outline of the procedure.

One of the areas hair restoration patients desire precise data is in graft count verification. Specifically, patients desire a way to verify that they receive (roughly) the number of follicular unit grafts estimated during the hair transplant consultation and paid for during the time of the operation.

However, in various cases, hair transplant procedures can range from 3,000 – 5,000 grafts, and it’s difficult to keep track of each follicular unit as it’s harvested, prepared, and implanted. So, how are hair loss patients supposed to “keep track” of the number of implanted grafts, and ensure that they receive the correct, quoted number of follicular units?

In a recent thread on our Hair Loss Discussion Forums, a group of patients asked themselves the exact same question and came to some innovative and creative conclusions.

Several patients stated that a final count was provided at the end of the procedure, and since they visited a trusted hair transplant surgeon, they safely assumed the graft count was accurate. Another member explained how he used a “clicker” to keep track of the incisions made in the scalp; a different member used a similar method, but simply counted the number of incisions instead of keeping track with a clicker device.