Post Hair Loss Questions and Get Answers

This hair loss question was answered by Dr. Glenn Charles of Florida who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

Many hair restoration doctors don’t perform hair transplant megasessions and they appear to be limited to do only 3500 grafts or maximum 4000 grafts.  The few doctors that do perform megasessions go up to 5000 grafts plus.  What’s the reason for this?  Are megasessions unsafe due to limited blood supply?  I know doctors recommended on the Hair Transplant Network do perform megasessions and their patients have great results, but why do other doctors limit themselves?

The answer to this question is quite complex. It would depend on what hair restoration physician was performing the surgery. Meaning does a particular surgeon and their staff have the actual capability of carrying out a procedure of greater than 4000 follicular unit graftss in a reasonable period of time?  As important, does the hair transplant patient have the donor hair density and scalp laxity?

If all of the above is true there are still many other factors that should be considered. How large is the balding area in which the grafts are to be transplanted into? Would the patient prefer to have 5000 grafts placed into a specific area and have 4000 grafts actually grow hairs. That is an 80% success rate. Or would they prefer to have 4000 grafts placed into that same area and 3800 grow successfully? Giving a 95% success rate. Saving those other 1000 follicular units for later if needed. Is the physician really giving that patient those large number of grafts? It is awfully hard to go back and count.

The goal of hair transplant surgery is to give patients more hair than they had prior to surgery. However, unlike other cosmetic procedures, sometimes patients look worse after surgical hair restoration before they look better.

Some patients are plagued by a temporary hair loss condition known as telogen effluvium or “shock loss” which can occur anytime hair is transplanted in between or around existing hair.  This is true whether the hair is natural or previously transplanted. This often causes great concern for those who don’t expect it, and even those that do; it can be a real brain buster causing mild anxiety.

View this hair loss discussion thread to learn and discuss why shock loss occurs and how to get through the doldrums while waiting for new hair regrowth.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair transplant, hair restoration, hair loss, telogen effluvium, shock loss, hair regrowth

In the past I have been told that hair density of 50 follicular unit grafts per square centimeter should not compromise graft survival.  However, I was wondering would transplanting hair at 55 FU/cm2 or 65 FU/cm2 compromise vascularity or hair growth yield? Also, is any graft survival compromised leading up to achieving natural density? Cheers.

This insightful information was posted on our hair restoration forum by Dr. Brad Limmer of San Antonio, TX who is a member of the Coalition of Independent Hair Restoration Physicians.

I agree with what has been on the hair loss forum discussion thread “Graft Survival and High Hair Densities” by various members regarding percentage yield.  As Coalition member Dr. Charles points out a very important point regarding this question, “there are countless variables that go into this equation.” Some are hair transplant patient dependant and some are hair restoration clinic/technique dependant.   Thus, the outcome can be different between patients even though they go to the same clinic.

We have typically approached the problem of yielding densities higher than 50 FU/cm2 by a 2 pass approach. While more conservative than some (who produce nice results), I feel it minimizes 3 important risks to the patient:

1. Less than optimal hair growth
2. The Potential for ridging (dermal fibrosis below the skin – which is basically scar tissue resulting from the multiple recipient sites create in such a small area)
3. Permanent neovascularization (redness that won’t go away – resulting from capillary proliferation during the healing process)

Balding men and women with hair loss who’ve decided to get a hair transplant are usually excited with dreams of getting their hair back. And though the end result of a hair transplant is a fuller head of hair, the expression, “the devil is in the details” is vital when learning how to fit surgical hair restoration into your life, especially during the first several months of healing and waiting for new hair growth. This includes returning to work, concealing your hair transplant from co-workers, friends and family, how long it takes to heal and look normal, etc.

Visit this discussion thread to discuss how to prepare for the first few awkward months after surgical hair replacement including when it’s ok to return to work. Your experience and input is welcome and encouraged.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: Balding, women with hair loss, hair transplant, hair restoration, hair growth, hair replacement

This is probably one of the weirder questions I’ve ever asked.  I had hair transplant surgery about 2 months ago.  But I noticed that my hair has had a very distinct, not so good smell the past few weeks. I take a shower every day, sometimes twice a day and scrub my scalp pretty generously to clean it.   At first, I thought it might be the shampoo I’m using but I’ve used about 3 others as well and it still has that same smell starting up a few hours after my shower. Has anyone else ever experienced this with an hair transplant? Any suggestions?

That’s an unusual issue. Is the smell coming from your hair or your scalp? I know that certain bacterial or fungal infections of the scalp can cause a distinct odor. You may want to check your scalp for signs of discoloration or anything unusual symptoms like itching, bumpiness, or pain.

In the event you suspect an infection, be sure to speak with your hair restoration physician or a dermatologist as soon as possible.

All the Best,

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair transplant, hair restoration

Recently, we published a well written summary of the follicular unit extraction (FUE) procedure, its advantages, and its disadvantages by Coalition member Dr. Ron Shapiro who recently started to experiment with FUE at his clinic.

Follicular unit extraction (FUE) has been notoriously overhyped online by some hair restoration clinics while other clinics underestimate its potential advantages in some circumstances. Reading this well balanced article was extremely refreshing. For those of you who are interested in considering the FUE procedure as a strip alternative, you are encouraged to read ” The Evolution, Advantages, and Disadvantages of Follicular Unit Extraction (FUE) Hair Transplant Surgery“.

Feel free to offer your input on this thread.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: FUE, Follicular unit extraction, hair restoration

Though the results from hair transplant surgery can be undetectable and give you back your hair, your scalp looks a bit like it’s been conditioned with a meat tenderizer for the first week. Thus, many hair restoration patients do anything they can to conceal the evidence of their hair transplant to the world for the first week or two.

Recently, hair loss forum member “Sparse” (pun most likely intended)  asked if it was safe to wear a hat or other concealers after their procedure. Are there any conditions that these may harm the grafts or impact hair regrowth? View this topic to see what other members are saying or offer your experience and input.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair transplant, hair restoration, hair loss, concealers, hair regrowth

This hair loss question was answered by Dr. Glenn Charles of Florida who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

Do all the good doctors require you shave your head before hair transplant surgery?

There are some great hair transplant doctors who require the patients shave the hair and other excellent hair restoration doctors who do not require shaving. One thing for sure is that the surgery is easier to perform if there is no hair to work around.

The question is what is more important? Making the surgery easy for the doctor and staff or keeping the patient happy even though the surgery may take a little longer. When a hair transplant megasession of densely packed grafts are placed into an area that has existing hair, there is often the development of postoperative shock loss and significant thinning hair. This can be very upsetting to the patient. Some physicians may choose to require shaving prior to surgery to avoid the potential patient complaints. Interestingly enough I have heard that some doctors actually charge more if the patient does not shave.

Dr. Glenn Charles, D.O.

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Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair loss, hair transplant, hair transplant doctors, hair restoration, hair transplant megasession, shock loss, thinning hair

This insightful information was posted on our hair restoration forum by Dr. Timothy Carman who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

Many hair restoration doctors don’t perform hair transplant megasessions and they appear to be limited to do only 3500 grafts or maximum 4000 grafts.  The few doctors that do perform megasessions go up to 5000 grafts plus.  What’s the reason for this?  Are megasessions unsafe due to limited blood supply?  I know doctors recommended on the Hair Transplant Network do perform megasessions and their patients have great results, but why do other doctors limit themselves?

 In general, the maximum amount of donor grafts available in any one hair transplant session is dependent upon three factors:

1) The patient’s hair density in the donor area;
2) The length of the strip removed; and
3) The width of the strip removed.

Number one, the patients density (average = 100 FU/cm2), is what it is- this factor is beyond the surgeons/clinics control. If this number is 110 or 120 FU/cm2, the total amount of potential grafts available can dramatically increase.

Number two, the length of the incision, is limited by the size of one’s head and the relative hair density of the hair on the sides of the head. How far the incision is extended up the sides is an area where one needs to not only observe a patient’s density at the time of surgery, but also (especially in the younger patient) the anticipated thinning hair that may be in the future based on the patients genetic (family) history and hair loss pattern to date. This is critical, as, a cavalier approach for the sake of “getting big numbers” may backfire in ten years if the patient thins on the sides, revealing the incision scar.

This hair loss question was answered by Dr. Glenn Charles of Florida who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

I was wondering if hair transplants are really undetectable.  The reason I ask is that I recently spoke to someone who had an FUE procedure and at the front of his hair line you could see small dots where the hair was coming out from. Does this fade with time?

With the technology available in the field of hair restoration, the results should be virtually undetectable.  Certainly some hair transplant cases depending on the patient’s hair characteristics are more difficult than others. Some patients may require more procedures to achieve the same degree of undetectability as other patients get with a single hair replacement surgery. Often the small dots you are describing do fade over time especially after the hairs start growing. In some patients additional grafting also helps that situation.

Dr. Glenn Charles, D.O.

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Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair loss, hair transplants, FUE, hair restoration, hair transplant, hair characteristics, hair replacement