Post Hair Loss Questions and Get Answers

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.

This hair loss question was posted directly to Dr. Raymond Konior of Chicago, IL,  who is a member of the Coalition of Independent Hair Restoration Physicians.   See his professional answer below.

At what age and degree of hair loss is it appropriate to transplant a patient’s crown?

The crown has been described as the “black hole” of the scalp. Based on that, I believe a very large percentage of patients seeking hair restoration should avoid grafting into the crown region, especially young men in whom it is often impossible to determine how far the pattern will progress. This recommendation is based on the finite nature of donor supply and on the progressive nature of male pattern balding, i.e. there is an imbalance between supply and demand. The fact of the matter, however, is that despite prolonged and detailed consultative discussion relating to the risks and limitations of grafting the crown, many men are still adamant about obtaining some crown coverage. Although it is difficult to predict with absolute certainty everyone who is a rock solid candidate, it is possible to weed out the majority of poor candidates and to institute a safe grafting strategy which will avoid future problems for most patients

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

How many hair transplant patients have growth that came in (or appeared) much thicker on one side vs. the other? I am almost at 8 months post-op and the right side of my head seems much thicker. I had just under 2300 grafts in my temple area and behind to compensate for the possibility of future loss. I had 2 techs working on each side and meeting in the middle. Is it possible the one on the right packed the grafts more densely? They appeared about the same right after.

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”.

How Today’s Hair Transplants Can Produce Natural, Dense Looking Results

Due to the advancements in surgical hair restoration, today’s hair transplants can produce thick natural looking results that mimic nature.   However, due to a limited donor supply, significantly bald men and women may not be able to achieve both full coverage and high degrees of density.   Covering a large balding area will result in fewer grafts available for transplantation per square centimeter and thus, may result in a slightly thinner appearance.   Other attributes such as hair texture and scalp quality also play a role in the patient’s final result. To get an idea of the kinds of results today’s hair transplant procedures can produce for men and women with varying degrees of thinning hair and baldness, visit our extensive hair transplant photo gallery.

A skilled hair transplant surgeon’s artful placement of the follicular unit grafts can enhance the look of transplanted hair leading to a thicker appearance. This is what’s referred to as an “illusion of density”. It takes a skilled and experienced hair transplant surgeon like those recommended on the Hair Transplant Network to design a hair restoration plan that takes into account all of these variables while still meeting their patient’s expectations.

So, what are realistic expectations? Is it reasonable to expect your hair transplant to appear full and natural under all lighting and weather conditions? Can your hair transplant give you back the kind of “wash and go” hairdo you had when you were younger or will you continue to rely on hair loss concealers like Toppik and DermMatch to provide the icing on the cake?

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.

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

I’m looking to undergo a moderately sized follicular unit extraction (FUE) procedure, but I’m having trouble finding information on the actual growth rate/yield I can expect from FUE. What kind of growth rate can I expect from a follicular unit extraction (FUE) procedure?

I think there are two things to consider with regard to follicular unit extraction (FUE) and yield/growth rate: 1. any damage to follicular unit grafts during the extraction phase (which would damage the follicle and result in a graft that didn’t grow) and 2. a graft extracted from outside the universal extraction zone, which would be susceptible to future hair loss (as the graft wouldn’t be as resistant to dihydrotestosterone – DHT).

The first variable is dependent on the skill of the hair restoration surgeon and, to a much lesser extent, the tool used. If you visit an experienced FUE surgeon, my guess is that the ’90 – 95%’ number often quoted (which is comparable to the 95% growth rate experienced with traditional follicular unit transplantation) would be accurate. If the practitioner has less experience with extracting follicular units, than issues with transection become apparent and the ‘yield rate’ will suffer as a result.

The second variable is really up to the hair transplant surgeon, how many grafts he/she is trying to extract, and whether or not they feel like the follicles in these extraction areas (outside of the universal safe zone) are susceptible to future loss or not.

Recently, the Publishers of the Hair Transplant Network  attended the 2010 18th annual ISHRS scientific meeting held in Boston from October 20 th through the 24th.

Each year hair restoration physician from around the world gather for several days to attend lectures, meetings, workshops and discussions focused on hair loss treatments. It’s practically impossible to cover all of the important topics discussed at the meeting. Thus, this report will feature the highlights that may be of most interest to hair loss sufferers and those wanting to restore their hair. A few of these topics have been discussed and debated by patients for years online using our hair loss forum, while other topics provide information on innovative techniques and treatments that may potentially revolutionize the hair restoration profession in the future. However, despite some exciting anecdotal evidence provided in various presentations, it’s important to remain cautiously optimistic while much needed research continues and investigation is underway. Some of these topics include the benefits, limitations, and refinements in follicular unit extraction (FUE), its tools and techniques; treating and minimizing the risks of scar stretching via follicular unit hair transplantation (FUT); Platelet Rich Plasma (PRP)  as a storage solution for grafts; Bioengineering of the hair follicle (hair multiplication) including exciting preliminary findings using the highly talked about formula ACell; the advantages and disadvantages of dense packing; studies on the causes and treatments for female hair loss and more.

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