Post Hair Loss Questions and Get Answers

In a recent article, recommended hair transplant surgeon Dr. Parsa Mohebi shared his expert opinion regarding follicular unit transplantation (FUT) scar revision.

According to Dr. Mohebi:

Hair transplant surgeons have been dealing with scalp scars in “strip” hair transplantation since the introduction of the follicular unit transplantation procedure. There are also other ways patients may end up having a linear scar after other scalp procedures such as neurosurgical operations or trauma to the head. Although most scars are hidden in patient’s native hair, some may become exposed due to their proximity to the hairline or when a patient keeps his hair short.

Depending on the size, type and location of scars, hair restoration surgeons may have to use different techniques to minimize their appearance. We have created an algorithm that hair transplant or other cosmetic surgeons can use toward the most effective methods to address follicular unit transplantation scars and the proper surgical or medical approach to them.

Among the factors that are being taken into account for scalp scar revision are: the prior history of scar occurrence and the patient’s reaction to injuries in other parts of the body. A proper physical examination can reveal what proportion of the visibility of scar is due to stretching or hypertrophic reaction and what portion has to do with hair transection. 

The scars that are wider than what is expected might have some components of stretching. To improve the visibility of stretched scars the surgeon needs to use a technique to minimize the contrast between the hairless scar and neighboring areas of the scalp by bringing hair inside the scar.

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

I understand that during a hair transplant procedure, donor hair is taken from the back of my own scalp and transplanted to the balding areas in the front. However, I was wondering if it would be possible to take donor hair from another individual (a relative perhaps) and transplant it to the front of my scalp? If my donor region was depleted, would this be an option? Would it work?

Definitely an interesting concept, and one I’ve pondered myself from time to time. I think the most unique aspect of this type of true hair “transplant” would be the ability to select a donor with different donor characteristics and blend the new hairs into the native, implanted patient to create different, potentially “fuller” results.

For example, if you have a patient with fine, straight hairs and found a suitable donor with coarse, wavy hairs, the hair restoration surgeon could focus the majority of the patients own donor hair on the hairline (to create a natural, dense appearance) and integrate the “other” donor hair in the scalp to create additional texture and fullness without creating a big distinction between the native and transplanted hairs. I think other surgeons have tried something similar with body hair transplants (BHT).

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

I was recently thinking about forehead lifts and the reverse procedure known as hairline lowering. Couldn’t small FUE procedures be used to hide the scars? Perhaps in the case of males who want their hairline lowered in this way, a follicular unit extraction hair transplant could be used to improve the shape of the hairline which, from what I’ve seen, doesn’t always look good in males who undergo hairline lowering.

Yes, a forehead reduction procedure is cheaper and, if done correctly, gives a great result quickly. However, this procedure does come with the the added risk of potentially permanent numbness behind the incision.

Lowering the hairline with hair transplants avoids that risk but uses up valuable   and irreplaceable follicular unit grafts that may eventually be needed elsewhere if hair loss progresses.

I recently removed the sutures of a patient who had a brow lift by a doctor down the street a few years ago. He had a really bad scarline. We transplanted 16oo to 1700 grafts via FUE in front of, in, and behind the scar and I think he’ll look great.

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

The following thorough response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “Gillenator”.

My beard line dips down a bit on one side and I’m considering hair transplant surgery to fix it. I probably only need about 100 grafts. I’m worried about scarring on my face with the transplant since I don’t always have my beard grown out. Will I see any sort of scar or mark where the follicle was transplanted? I assume that between the two methods of extraction FUT vs FUE, it will make no difference for what I’m trying to accomplish in terms of end result?

I think the method of extraction does make a difference in a small case such as yours. Since the recipient area you want filled in is relatively small, requiring the 100 grafts you mentioned, you may want to consider follicular unit extraction (FUE) versus follicular unit transplantation (FUT) to harvest the grafts you will need. Providing you have thick facial growth, you may also want to consider having the donor extracted from under your chin for several reasons.

First, the recipient area will potentially look the most natural grown out if the donor grafts also come from the face. It’s the same hair. A smaller punch (.50mm) would potentially be used so there should not be much visibility of scarring under your chin after the extractions completely heal.

When most hair loss sufferers think about hair transplantation, the idea of removing follicular unit grafts from the back of the head (universal donor region) and implanting it into balding regions of the scalp immediately comes to mind. However, it’s worth nothing that hair transplant surgery is a fairly broad term, and simply refers to the idea of taking hair from one region of the body and “moving” it to another.

Because of this,  hair restoration surgeons are able to successfully transplant hair from the back of the scalp to areas such as the eyebrows, eyelashes, and facial hair areas when safe and appropriate for the patient. Additionally, certain hair transplant surgeons even utilize body hair transplant units (hair taken from body regions like the chest, legs, and pubic regions) when the traditional donor supply is depleted.

It’s clear that hair restoration surgeons are able to augment areas of the scalp and facial regions with transplanted hair, but is it possible, or common, to take hair from the traditional donor region and actually implant it into different regions of the body, like the chest? Recently, Coalition surgeon Dr. Edmond Griffin answered this question by sharing a very unique chest hair transplantation case with our hair restoration community.

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.

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

Although eyelash transplantation is performed much like a modern hair transplant procedure (and is often practiced by the same hair restoration physicians), finding information on the technique is not an easy task. Because of this, coalition surgeon Dr. Bijan Feriduni wrote a descriptive article on eyelash transplantation. According to Dr. Feriduni:

1. Indications :

Basically, there are two groups, for whom eyelash transplantation is  eligible :

A. Women and men – independent of age, skin color, hair color or skin type, because this aesthetic operation is eligible for everybody who would like to have longer or fuller eyelashes;

B. The second group comprises those people for whom the method is used as a reconstructive measure. After an accident or burnings, the eyelash transplant procedure is the only possibility to have ones own eyelashes.

2. Techniques for eyelash transplantation in my clinic :

Harvesting technique – (Follicular unit strip harvesting)

A small strip with long donor hair (I always try to use  thick, strong, double hair units ) is harvested from the back of the scalp, the long donor hairs are stereo-microscopically dissected (trimmed as closely as possible  with a minimum of surrounding tissue) from the strip and prepared for transplantation.

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.