Post Hair Loss Questions and Get Answers

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

I’m planning on going for a hair transplant and recently consulted two top hair restoration physicians: both highly recommended on this forum. One recommended follicular unit extraction (FUE) and the other a strip. Both recommended between 1500-2000 grafts.

I’m trying to consider worst case scenarios for both options and am wondering if the scar is poor with the strip, how well does FUE into donor scar work to cover it up if I want to keep a short hairstyle as an option in the future? Has anyone done it successfully?

Follicular unit hair transplantation via strip is much more consistent at providing good results and unless you are planning on really short hair, our office would strongly suggest strip. Plus, if you are likely to need more hair later on, strip limits the quantity of scar tissue in the donor area.

You can wind up with a bad strip scar from even the best of surgeons, but it’s not common. Just yesterday I saw another 30ish year old with Norwood Class 5 hair loss who’d had 600 FUE’s (more likely 2mm punches) to attempt to rebuild his frontal hairline.  Now he presents for repair of that plus addressing some of the “further back” loss he’s had since that procedure. Well his donor area is all full of scar and we’ll be lucky to get 2500 grafts out of him and more likely 2200 at one setting since there is so much scar tissue in his donor region.

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

What do you do when a hair transplant results in mismatched angles in your hairline that clump and point different directions? Can you take them out and replant or do you build around? Any ideas?

My general thoughts are, unless the hairs are really misaligned so that you can’t cover them with hairspray, mousse, etc., that we simply pack hair around the previously placed hairs in a second hair restoration surgery. You paid for them already and they are growing, so be very cautious before you dig up follicular unit grafts and replant them. Some won’t survive.

It’s all just like moving a little fragile tree (singles up front) or a bigger tree (doubles /triples behind). I’d think carefully before proceeding.

Good luck to you either way.

Dr. William Lindsey – McLean, VA

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

Get Proven Treatments at the Best Prices by visiting our new online hair loss treatment shop.

Technorati Tags: Hair Loss, hair transplant, hair restoration, follicular unit

Recommended hair restoration physician Dr. Sanusi Umar of Redondo Beach, CA was recently featured in a segment on ABC’s Good Morning America about eyebrow hair transplantation.

Dr. Umar is not only world-renowned for performing state of the art follicular unit extraction (FUE) hair transplant surgery, but is arguably the world’s leading expert in the field of body hair transplantation (BHT).

Body hair transplants allow for the harvesting of hair follicles from virtually anywhere on the body including the face, arms and legs for implantation into balding scalps, eyebrows, beards or other areas of hair loss.

Anyone seeking follicular unit extraction hair transplantation, repair work or body hair transplants in California and beyond are encouraged to consider Dr. Umar. To learn more about Dr. Umar and his technique, click on his recommendation profile above and view the below clip.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

Get Proven Treatments at the Best Prices by visiting our new online hair loss treatment shop.

Technorati Tags: hair restoration, hair transplantation, follicular unit extraction, FUE, hair transplant, body hair transplantation, BHT, balding, hair loss, hair transplants

Whether or not hair duplication (formerly known as “autocloning“) may become a true cure for hair loss in the near future has been a hot topic of discussion since the topic was introduced by Coalition member Dr. Jerry Cooley at the 2010 Annual Scientific International Society of Hair Restoration Surgery (ISHRS) Scientific Meeting.  Dr. Cooley recently presented a brief presentation at last year’s 2012 ISHRS Meeting.  To view the highlights of his findings, visit the 2012 Annual Scientific ISHRS Meeting.

Hair Duplication (autocloning) works on the principle that a hair, when plucked properly, will emerge with its epithelial cells and follicular stem cells intact.  According to Dr. Cooley, applying ACell (a natural agent regularly used in optimal wound healing) to the plucked hair and implanting it into the scalp stimulates the body’s natural regenerative potential to create new hair follicles.  Since plucked hairs also regrow in the original site, a potentially limitless donor supply is created, providing hair loss sufferers with the possibility of restoring a full head of hair.

Below, world renowned hair transplant surgeon Dr. Cooley  presents his ongoing research on the use of ACell MatriStem for wound healing and the promising hair duplication technique.   While the below, preliminary data gives hope to hair loss sufferers waiting for hair multiplication technology to provide a cure for baldness, much more research and testing is required.

To view the entire power point presentation, click here.

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What is ACell?

This question comes from a member of our hair loss social community and discussion forums: 

Several years ago, I underwent Follicular Unit Transplantation (FUT), and the post-operative scar did not heal well. I’m now left with a very large hair transplant scar, and I’m wondering what options I have for strip scar revision? What are the advantages and disadvantages associated with each option?

In my opinion, there are three options available for those seeking Follicular Unit Transplantation (FUT) scar revision:

Option 1: Undergo traditional scar revision with a second strip excision and a better closure.

During this procedure, the scar will be excised like a strip in a traditional FUT procedure, and a second closure (likely a two layered, trichophytic closure) will hopefully heal “better” and create an improved post-operative scar. The advantages of this procedure include: the possibility of extracting extra tissue and performing a second hair transplant procedure; the disadvantages include: the possibility of a second unacceptable post-operative scar (if the patient truly scars poorly).

Option 2: Follicular Unit Extraction (FUE) into the strip scar.

During this procedure, follicular unit grafts are extracted from the donor tissue surrounding the scar and implanted into the inappropriate scar tissue. The advantages of this type of scar revision include: lack of a second linear scar and minimal trauma in donor tissue; disadvantages include: the possibility of poor growth in the scar because of the nature of the thick, avascular scar tissue, and the potential for FUE scarring in the donor region (though this should be minimal).

Recently, we started a new case-based series on our Hair Restoration Discussion Forums called the “The Hair Transplant Patient of the Week.”

Each week, we review cases from the hair loss weblogs, patient photo albums, and “Results Posted by Patients” sub-forum, and select an excellent hair transplant case to present as our “Hair Transplant Patient of the Week.”

This week, we selected “Chrisdav” – a member who underwent a 1,900 graft Follicular Unit Transplantation (FUT) repair with Coalition hair transplant surgeon Dr. Alan Feller.

After two unsatisfactory FUT procedures in the UK, Chrisdav began researching the possibility of a third surgery to repair the previous work. This research led him to our discussion forums, and after reviewing online examples of previous repair procedures, he scheduled surgery with Dr. Feller. It’s now been 12 months since his 1,9000 graft FUT repair with Dr. Feller, and the results are excellent.

To review Chrisdav’s 12 month post-operative results, please see the following: Chrisdav’s 12 Month Update – 1,900 Graft FUT Repair with Dr. Feller.

Additionally, if you’d like to see any of our past Hair Transplant of the Week cases, feel free to review the following: Barry1108′s 3,000 graft FUT with Dr. Path, England’s 2,548 FUE with Dr. Feriduni,  BonkerStonker’s 7,460 FUT with Dr. Hasson, and Spreadlock’s 2,400 FUT Procedure with Dr. Feller.

Please join me in congratulating Chrisdav!

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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

Background

Recommended hair transplant surgeon Dr. Carlos Wesley of New York recently authored a manuscript to be published by the “Journal of Dermatological Treatment“. The article entitled, “The Influence of Peri-Incisional Triamcinolone Acetonide Injection on Wound Edge Apposition in Hair Restoration Surgery” aims to answer the surgical question, “Do steroid injections help or hurt the wound healing process?”

The practice of injecting steroids into follicular unit hair transplant (FUT) strip scars in order to reduce excessive scarring was recently addressed by Dr. Alan Feller in the article, “Injecting Steroids into the Hair Transplant “Strip” Scar to Reducing Excessive Scarring?” In the article, Dr. Feller asserts that the benefits are, “minimal and not well-proven”. Dr. Wesley’s study was designed to measure and document these effects in order to help answer this vital question.

About the Study

The study was a single-center, prospective, randomized, controlled, single-blind study of 57 patients that were undergoing hair restoration surgery in Dr. Wesley’s clinic.  The objective was to determine if injecting a corticosteroid called triamcinolone acetonide (TMC) would affect the early stages of wound healing in the donor area.

A Folliscope (magnified focused camera used for detailed follicle analysis) was used to precisely measure the distance between the donor wound edges both at the time of surgery (once the donor had been closed) and again at the time of suture removal (8-10 days later).

Conclusion

While no statistically-significant effect on the donor wound edge apposition was revealed, Dr. Wesley states,

This question comes from a member of our hair loss social community and discussion forums: 

Recently, I heard an individual discussing “hair plugs,” and I was wondering if these are still used in modern hair transplant surgery? Does this term refer to a recent technique? What are hair plugs?

“Hair plugs” is term used to describe the mini and multi-unit grafts used in hair restoration procedures from the 1950s until the late 1980s.

During these outdated procedures, hair transplant surgeons utilized large punch tools to remove pieces of hair-bearing scalp from the universal donor region. Although these grafts were removed in a manner similar to modern Follicular Unit Extraction, the 2-4 mm grafts were excessively large and contained multiple follicular units.

After removal, the mini/multi-unit grafts were placed into large incision sites made in the recipient region. However, because of the graft size and nutrient requirements, physicians feared that placing the implants too close together or in too great of numbers would compromise scalp blood supply and cause graft necrosis. To avoid this issue, the hair restoration physicians would place a small number of grafts at a noticeable distance apart, allow time for a certain level of blood supply regrowth, and then ask the patient to return for another round of graft placement between the existing grafts. In theory, repeating this process would eventually allow for a natural, aesthetically pleasing hair transplant result.

This patient had undergone multiple hair transplants (including an unsuccessful repair attempt) prior to consulting with recommended hair transplant surgeon, Dr. Carlos K. Wesley.  Below, Dr. Wesley describes his approach for this patient.

Our focus was to reduce the donor scar and soften the “pluggy” looking hairline from his prior transplants. Because of his concern from his prior surgeries, we took this case with a “stepwise” approach. On the first session, the left donor was harvested for the right hairline. On the second, the right donor for the left hairline. The donor received a double-layered closure, then reinforcement sutures once the initial set was removed at 14 days, as well as frequent follow-up direct corticosteroid administration into the donor scar to ensure that the scar would not spread once the sutures were removed. Needless to say, we got to know each other very well during this process!

With a unique emphasis on the ways in which hair restoration surgery can serve as a useful adjunct to their practice, Dr. Carlos K. Wesley has been invited to deliver a Grand Rounds lecture to the University of Colorado Department of Dermatology.  In addition to sharing with his colleagues current approaches to achieving the most natural appearance, Dr. Wesley’s lecture is to highlight corrective strategies in both male and female patients who have undergone facelifts, wide-margin excisions of skin cancers, and notable skin trauma to hair-bearing areas of the body.

Corrective strategies can be viewed in the slides below and include: transplanting at low density in areas of compromised blood supply (e.g. scar tissue, skin flaps, and skin grafts).  Strategies also include covering a large defect with either a skin graft or flap and transplanting hair follicles using a design to re-established a normal pattern of hair loss (as seen in the brief video clip here).

The lecture will provide a foundation for physicians who are not otherwise familiar with the field of hair transplant surgery.  In addition, it will provide insights and anecdotes regarding the use of hair transplantation coupled with full-thickness skin grafts and pedicled flaps.  Pedicled flaps are skin flaps that have an edge left attached to the donor site so that they retain their own blood supply when transposed (moved) to cover a new area (this is commonly used in breast reconstructive surgery).  In these scenarios, blood supply is often the limiting factor related to the ultimate success of the surgery.  Therefore, Dr. Wesley will describe methods to maximize hair follicle survival after transplantation.  In addition to minimizing trauma by lowering the density and the depth of incisions during transplantation, use of platelet-rich plasma (PRP) has shown some promise in retaining good survival of transplanted hair follicles.