Post Hair Loss Questions and Get Answers

This question, from a member of the Hair Restoration Social Community and Discussion Forums, was answered by recommended hair restoration physician Dr. William Lindsey:

I previously underwent an unsuccessful follicular unit transplantation (FUT) procedure and now have a large strip scar on the back of my scalp. I’m investigating scar revision surgery, but I’m wondering if the follicular unit grafts that surround the scar (and will be removed in the repair) can be salvaged and implanted into balding scalp?

It really depends on how big and thick the hair transplant scar is. If the scar is like beef jerky, then its pretty tough to get any hair out without transecting it or having essentially an antiquated 1 haired minigraft. If the scar is soft, sure. We are doing a scar repair from elsewhere next week and after the pre-operative exam,  we noticed that part of his scar is soft, and part is “jerky”; so I am not sure how many we can save, but we’ll try to get all we can.

Dr. William Lindsey

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Blake Bloxham – 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

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Technorati Tags: Hair Restoration, hair restoration physician, follicular unit transplantation, FUT, strip scar, follicular unit grafts, balding, hair transplant

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

A past follicular unit transplantation procedure left me with a less than desirable hair transplant scar. I’m now investigating a scar revision procedure and I’m wondering the potential pitfalls and risks of this operation?

Although revising a follicular unit transplantation (FUT) scar is usually considered less invasive than a hair transplant procedure, there are still certain risks and issues involved. In most cases, the undesirable strip scar is removed in the same fashion as the donor portion in a FUT procedure – by removing a portion of scalp (varying in width and length) from the universal donor zone and closing the wound with sutures or staples. Because of this, some issues associated with traditional hair transplant operations – scar stretching, laxity (“looseness”)  in the donor region, and closure tension, are still relevant in a revision procedure.

However, one of the most significant complications from a scar revision procedure comes from many patient’s desire to obtain and implant additional follicular unit grafts from the excised scar region. During many revision operations, excess scalp (containing implantable grafts) is removed from around the scar region and the additional follicular grafts are transplanted into balding areas. However taking excess scalp (around the excised scar tissue) simply for the intent of obtaining extra grafts can often create another sub-optimal scar. In various cases, it may be advantageous to simply remove the scar tissue and close a smaller area instead of trying to revise the scar and obtain additional grafts.

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.

If follicular unit grafts from FUE are transplanted into the scar from a strip procedure, how short can the hair be cut without exposing the strip scar?

This insightful answer was provided by Dr. William Lindsey of Reston, VA who is one of our recommended hair restoration physicians.

It all depends on the FUT scar. An excellent follicular unit transplantation scar may be undetectable, but they are rare. A very good strip scar can be camouflaged with just a small buzz of overlying hair and, if needed, a follicular unit extraction procedure may help but probably not.

While a good scar may need FUE for a buzz cut to conceal it, a poor scar may require a lot more work. How much work depends on both the doctor and the patient as both have a role in the healing process.

Lastly, one patient’s idea of a bad scar may not be the same for all others. Recently I had a patient see me about a scar that really concerned him. While I think that I can improve it, I did tell him that I’d personally grade his scar as a “B” or “B+”. Improving a B scar to an A scar may not be worth as much to him as perhaps improving a D to an A, which would result in a dramatic change.

Dr. Lindsey McLean VA

Can scalp stretching exercises add enough laxity to the scalp to aid in hair transplant scar revision surgery?

This insightful information was posted on our hair restoration forum by Dr. James E. Vogel of Owings Mills, MD who is a member of the Coalition of Independent Hair Restoration Physicians.

Yes! Scalp stretching exercises help loosen tight scalps and I recommend this maneuver to many hair transplant and repair patients. However, in the case of an individual who has undergone one or more follicular unit harvests from the same site there is considerable scalp tissue already missing and scalp exercises in this situation are unlikely to produce enough added laxity to make a real difference.

Dr. James E. Vogel

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David – aka TakingThePlunge
Assistant Publisher 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
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Technorati Tags: scalp stretching, scar revision surgery, hair transplant, follicular unit

Today, balding men and women have several viable options to treat their hair loss. Below, we share the latest and greatest information about the causes of hair loss and the benefits, limitations, and risks associated with today’s hair restoration solutions.

You can also ask your own questions and get answers on our hair restoration forum or privately by using the “contact us” form.

Can Low Iron Levels Cause Hair Loss? (Dr. Steven Gabel)

Why Pimples Form on the Scalp After Hair Transplant Surgery (Dr. Robert True)

Why Going Bald Today Isn’t the Only Choice

Is it Ok to Use Propecia While Trying to Conceive?

How to Fix an Old Stretched Hair Transplant Scar

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: balding, hair loss, hair restoration

Is it possible to harvest donor hair between scars and then suture the two scars together to make one scar with another hair replacement procedure?

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.

It’s all well and good to talk about taking out both scars and the hair in between and ending up with one scar, but in reality it’s almost never possible. When hair transplant patients have had old “stacked scars,” they are spaced apart just enough and with enough hair in the space between the two scars that that overall vertical width cannot be bridged by simply cutting everything out. It will look like one very wide four-lane highway along the side of your head.

A far better way to approach this situation is to leave every one of those hairs between the scars, because you will need them desperately to shingle down over the scar.  Instead, use follicular unit extraction (FUE) in whatever areas you want, including the hair between the scars, and plant FUE grafts into the scar.  Another approach is to add tattoo dots along with the FUE follicular units to further help camouflage these scars.

Mike Beehner, M.D.

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Bill – aka Falceros
Associate Publisher/Editor

Technorati Tags: donor hair, hair replacement, hair transplant, FUE, follicular units

This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Ricardo Mejia of Jupiter, FL who is one of our recommended hair restoration physicians. His professional answer is below.

Scarring is risk factor with any surgery even in the best hands and even when we try to minimize the risks, it happens. I can guarantee you every hair transplant surgeon has had a similar result in one patient or another. Trichophytic closures help minimize the appearance of scars, yet they can stretch. This can be a result of the genetic variation in collagen and independent of tension factors. Hair restoration surgeons have gone back and rexcised the small 3- 5 mm wide scars with hardly any tension on the wound site. This can be an option for you if you are concerned. Keep in mind, you can still get a stretched scar even after a minimal revision without any tension. These are sometimes the uncontrollable factors in medicine and surgery.

Dr. Ricardo Mejia

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Bill – aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Technorati Tags: hair loss, hair loss help, hair transplant, Hair restoration

I am considering hair transplant repair surgery.  What does this entail and what risks are there?  Will I be left multiple scars?

Hair transplantation has come a long way in the last few decades since it began.  Because of the vast improvements in this surgical procedure via ultra refined follicular unit grafting, many previous hair transplant patients who received plugs or mini-grafts are coming back for repair work. 

Hair tranplant repair surgery can be done a few ways.  Which one is better is debatable however, a huge determining factor depends upon the specific case of the individual hair transplant patient.

Two methods of repair using strip surgery:

Both surgical methods include removal of a strip which includes the old scar.  This will leave you with a single scar rather than two distinct scars.  With the new trichophytic closure technique, most likely, you will end up with a better looking scar than after the first surgery.

1.  Camoflauge: this is where new follicular unit grafts are transplanted around the old mini-grafts or plugs in order to camoflauge it.  Many hair transplant physicians have used this method succesfully creating a more natural look.

2.  Removal of Old grafts:  this is where a this is where the old grafts are excised from the scalp and follicular unit grafts are transplanted in it’s place which will create a more natural look.  Scarring, however, is inevitable in the locations where the old grafts were removed.

Follicular Unit Extraction  (FUE) and Follicular Isolation Technique (FIT):

Many people ask about hair transplantation on our hair restoration discussion forum and the best way to go about it.   Before anyone can advise them, however, it’s important that they consider the answers to the following standard questions:

1. Age: How old are you? Age can be a determining factor as to whether or not you are a good candidate for a hair transplant. Typically, the younger one is, the riskier it is to jump into surgery. Hair loss is unpredictable and donor supply is limited. Young people should proceed with caution when considering a hair transplant. I recommend that the younger folks read “Am I too young for a hair transplant”.

2.  Norwood Scale and Graft Calculation: What level are you on the Norwood scale of hair loss? The Norwood scale will give a person a good idea as to how many grafts they would need in the event that they are a good candidate for an HT. Take your calculated Norwood level and multiple it by 1000 (conservative) to 1500 (liberal) grafts and that will determine approximately how many grafts are needed to achieve “decent” coverage and density of your balding regions. You might want to consider using our animated graft calculator .  Additional animations can be found here.