Post Hair Loss Questions and Get Answers

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

Unfortunately, my most recent hair transplant surgery did not go according to plan, and I was left with a series of unsightly, small bumps or “cobblestones” in the implanted scalp area. These bumps are causing quite a bit of anxiety, and I’m looking into repair procedures to fix the problem. Because of this, I’m wondering if it would be possible to remove the bumps via follicular unit extraction (FUE) and replace them with transplanted tissue (either containing or not containing hair follicles)?

From what I gather,  in order to get rid or your excessive cobblestoning, you want to remove the “cobblestone tissue” via follicular unit extraction (FUE) and implant other (transplanted) tissue either containing or not containing follicles into the area?

Although this sounds interesting, I’m unsure it’s the best way to proceed. I definitely understand the idea of removing the cobblestone pattern, but the combination of removing that tissue, removing additional tissue from somewhere else, and then implanting the new tissue into the area seems excessive and has the potential to create unnecessary trauma to the scalp. Additionally, I feel like removing “grafts” (or the cobblestoning pattern in this case) has the potential to create excessive scarring due to the diameter of the graft requiring removal. Furthermore, the blood supply necessary to support all this new tissue could be a problem.

Balding men and women who underwent surgical hair restoration in the early years, prior to the advancement of follicular unit transplantation (FUT) and follicular unit extraction (FUE), were often left with unnatural and unsightly “hair plugs“. These larger grafts created an effect much like that of doll’s hair. Today, many of these patients are seeking to revise or even remove these older grafts completely.   Below, recommended hair transplant surgeon  Dr. Michael Beehner discusses the process of removing plugs:

One thing to bear in mind is that, regardless of what size punch you use in cutting these old hair transplant grafts out, with a single pass procedure there will always be some hairs that don’t get removed and still grow. Therefore, it always requires a second smaller pass, usually with a smaller punch, to get complete eradication of the hairs.

The patient below has very fair Irish/English scalp skin and the redness you see will most certainly be better at the one year point. However, I think, cosmetically, it will look best with some dermabrasion or laser resurfacing to give it an “even”, homogeneous look, which is what he is after.

Mike Beehner, M.D.

—-

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

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

A growing alternative in the field of cosmetic enhancements, Micropigmentation refers to aesthetic tattooing, usually performed on the face and scalp. Sometimes called “permanent makeup,” Micropigmentation is sought by patients for recreating lost or underdeveloped facial hair (such as beards, mustaches, and eyebrows), eyelid darkening (to create the appearance of permanent upper eye makeup), creating the appearance of hair in balding scalp, and also for reducing the appearance of a scar (in many cases, scars created by follicular unit transplantation/FUT surgeries).

Because this process has applications in creating the appearance of restored hair it’s often a subject of discussion on our Hair Restoration Social Community and Discussion Forums. However, despite numerous hair loss sufferers inquiring whether or not it’s a suitable alternative to preventive medications (such as minoxidil/Rogaine or finasteride/Propecia) or hair transplant surgery and asking who performs these procedures and where, it’s difficult to obtain substantial information regarding Micropigmentation.

Many cosmetic surgery organizations question the regulation of the practitioners and products used in Micropigmentation, but since this procedure is often requested and asked about by hair restoration patients, it’s important to garner the opinion of a hair loss expert. Fortunately, in a recent Micropigmentation discussion, Coalition hair transplant surgeon Dr. Cam Simmons offered his opinion on the procedure and whether or not he would recommend it to hair loss patients:

While I am no expert on micropigmentation or tattooing itself, I do believe that there are several issues concerning Micropigmentation on balding scalp and hair transplant scarring:

This hair loss question was answered by Dr. Timothy Carman of La Jolla, CA who is a member of the Coalition of Independent Hair Restoration Physicians. His professional answer is below.

Three years ago I received a bad hair transplant that resulted in cobblestoning or bumps in the recipient area as well as a bad scar. I have scheduled a consultation with a dermatologist about using a Fraxel laser to smooth the skin. Are there any other non-surgical options? Also, can I sue the hair restoration clinic?

The work that was done, although certainly not stellar, would appear to fall within the category of “standard of care”, so the “suing” issue I believe may be a waste of time. The overall result wherein the follicular unit grafts are placed sparsely more than likely would be the result of “filling in” as many patients request, without attention to the fact that this will be the result when further hair loss occurs. Following the previous “immature” hairline, results in a mismatch between the contour design of the hairline and the density.

As for the raised nature of the grafts as they sit on the scalp, while this is certainly less than ideal, hair that is worn at a “normal’ (i.e. not “buzzed”) length should hide this poorer result. However, I can understand that, as this has evolved the low density you have,   your hair probably doesn’t look too good in the “normal” longer style.

This following article was written by recommended hair restoration physician Dr. William Lindsey and posted on our Hair Restoration Social Community and Discussion Forums.

When revising an old “pluggy” hair transplant, is it harder to place the follicular unit grafts near the big plugs due to scar tissue?

No, not at all. We do a fair number of hair plug repairs in my hair restoration clinic and surrounding scar tissue is almost never an issue that requires making larger slits or causes concern that there is insufficient blood supply for hair growth. Now, if you consider placing grafts in thick keloidal tissue in donor scars, I’d say that it’s a problem 50% of the time, if not more.

Really, the only issue with older hair transplants is that the scar tissue around the sensory nerves makes it a bit harder to numb them up. About 25% of the time I need to do a supraorbital nerve block, which itself hurts a little bit.

William H. Lindsey, MD, FACS
McLean, VA

—-

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

Technorati Tags: hair transplant, follicular unit grafts, hair plug, hair restoration, hair growth, hair transplants

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

I’ve heard that because of issues with donor density and hair characteristics, African American hair loss sufferers can’t undergo hair transplant surgery. Is this true?

I’m not sure where this rumor came from, but it is untrue: African American hair loss sufferers can definitely undergo both follicular unit extraction (FUE) and follicular unit transplantation (FUT) procedures. However, as you pointed out, there are a few factors that make African American hair transplant cases a bit more unique and interesting.

First, it’s my understanding that the usual characteristics of African American hair makes dissecting follicular unit grafts or cleanly extracting units slightly more difficult. It seems like the hair characteristics can be a bit curly, thick, and “wirey,” which makes working with these follicular units more difficult. However, these same characteristics, in my opinion, often create excellent density and coverage when transplanted into thinning scalp.

Additionally, as you stated before, African American patients tend to have lower density in the universal extraction region when compared to Caucasian patients, for example. However, “lower density,” does not imply that hair transplantation is not possible; it simply means that session sizes may be a bit more conservative (which could again be countered by the excellent characteristics of the donor grafts).

Finally, it’s my understanding that African American patients tend to scar a bit easier than individuals from different racial backgrounds.

The following thorough response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member and lead medical tech and surgical manager for the Shapiro Medical Group, “Janna”.

My first hair transplant surgery was ten years ago and I’m considering doing another one with a reputable surgeon. One issue I’ve spoken to various top hair restoration physicians about is improving my hairline which, if you look at it very closely, looks pretty pluggy due to the mini-grafts used. What I’ve discussed with some of the surgeons is the idea of removing them and planting them further back to blend with newer transplanted hair, or to place grafts around them to minimize the look. Has anyone had luck with this? Also, when mini-grafts are simply removed is there a pinhole or scarring left in their place or can they be pretty cleanly removed?

Either removing the mini-grafts or transplanting around them are both viable options when revising an older procedure. Generally, there really isn’t much of a scar remaining after a punch out session if done correctly. Which course to take depends on several factors, such as, the size of the mini-grafts, how prominent they are in the hairline and how high or low the current hairline is. If your hairline is low, the recommendation will likely be to remove as many mini-grafts as possible and replant them further back. I would imagine you’ll still need some fine single hairs to make it look natural.

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

I have mini-grafts at my hairline from a hair transplant 10 years ago. You would probably not be able to tell unless you were staring at them from a few inches away. If there was one place they were visible, it’d be right at the root which is unnaturally thick. Natural hair at the hairline is typically very soft and light. So, I’m wondering if anyone has tried lightening the root of those hair shafts right at the hairline to lessen the appearance of transplants?

Since dying or lightening your hair isn’t permanent and doesn’t typically result in significant damage to the follicle, it is worth a try and may make the hairline a little less noticeable.

You may also want to consider hair restoration surgery to remove and redistribute part of the mini grafts. Another option is placing some additional follicular unit grafts around and in between the mini grafts to help camouflage them. These techniques have been used quite successfully to enhance the appearance of older, mini-graft procedures.

Dr. Glenn Charles

—-

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

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

This common question was asked by a member of our Hair Restoration Social Community and Discussion Forums:

Years ago, I underwent follicular unit transplantation (FUT) and was never pleased with the resulting scar. I’m now researching strip scar revision, and wondering if I should have additional grafts removed and implanted during the same procedure. I know this would most likely result in a larger strip removal, but is it worth it? What are the “pros and cons?”

In many cases, I completely understand the appeal of removing and implanting additional grafts during a scar revision procedure. The patient is already at the hair transplant clinic and a strip, whether still containing some viable follicular unit grafts or simply scar tissue, is being removed regardless, so why not add additional density? Because of this, the topic of obtaining and implanting additional grafts during scar revision is a popular topic on our discussion forums. In a recent thread, two hair restoration experts, recommended surgeon Dr. William Lindsey and Coalition surgeon Dr. Glenn Charles, were kind enough to add their opinions to the ongoing discussion:

It really depends on how wide the follicular unit transplantation scar is and how the tightness of the scalp in the surrounding area. Has this hypothetical, or actual, patient been practicing scalp stretching exercises to improve laxity? Is the next procedure going to have a two layer donor closure used to try and reduce the amount of tension at the wound margins? These are important questions to ask when weighing the pros and cons of harvesting and implanting additional follicular units during scar revision. Regardless, maybe the donor strip could be made a little longer than the original to obtain some additional grafts for the next procedure.

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

Six years ago I underwent a follicular unit transplantation (FUT) procedure which resulted in a stretched scar. I’m now investigating a scar repair operation and wondering what type of closure should be used on the new incision? Is a trichophytic closure ideal, or should I investigate other methods? What type of surgeon should I see?

First, I wanted to state that you should definitely share these questions and concerns with the consulting physician. He or she will be able to properly analyze the situation and recommend an efficient type of hair transplant scar revision

Having said that,  state-of-the-art hair transplant surgeons use the trichophythic closure technique for a reason: it minimizes scarring in the donor area. If other techniques worked more efficiently, these would probably be used instead. However, the idea behind the trichophytic closure is that it allows hairs to grow through the closure and better camouflage the scar. Because of this, I would assume that revising the original scar with a trichophytic closure is optimal.

Additionally, seeing a qualified hair transplant surgeon who performs follicular unit transplantation (FUT) procedures and scar revision procedures frequently would probably yield the best results.

_______________
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

Follow our community on Twitter