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 know that this will sound funny, and it is not a complaint, but it seems like the hair on top is much thicker than my hair on the side. I have been told I have good hair transplant donor hair, but the area that I see scalp when I part my donor region is much larger than, say, if I were to part my hair down the middle. Does this make sense?

My donor part may look like it is a half an inch wide or more, and my hair parted down the center may only be a quarter on an inch. I will see my hair restoration physician sometime this summer and talk to him about it but, until then, I was wondering if this is normal at all. It just seems like my donor is thinner than my non donor, or I could be OCD and over analyzing things? Any thoughts?

I’d guess that in 40% of the follicular unit transplant (FUT) strip cases we do that the hair is noticeably thinner on one or both of the sides than in the middle or up higher on the head. Then throw in a guy with salt and pepper hair and it can really get dicey as to how many grafts you’ll get from a typical strip.

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

Has anyone found scalp exercises helpful to increase donor laxity prior to hair transplant surgery?

One area frequently affected by male pattern baldness (androgenic alopecia) is the “temple points” or “temple triangles” region. The temporal points – the triangular region of hair located above and in front of the ears – may be commonly affected by hair loss, but opinions differ on whether this region should be addressed with hair transplant surgery.

Most patients balding in the temporal triangles also suffer from hair loss in the hairline, frontal scalp, and mid-scalp regions. Because follicular unit grafts are limited, many question whether these grafts should be allocated to the temporal regions, or whether it’s better to create a more comprehensive result by using all available grafts in other scalp regions. This leads many patients with scalp and temple recession to ask whether they should utilize precious grafts to restore the temples during hair restoration surgery?

Altogether, the decision to restore temple points during hair transplant surgery boils down to physician preference and the patient’s goals. In many instances, temple restoration helps frame a patient’s face and allows for a comprehensive post-operative appearance. Some hair transplant surgeons subscribe to this philosophy, and frequently restore temple hair during surgery. However, other surgeons believe patients are best served by allocating all available grafts to the more predominant scalp regions. Of course, if patients have an adequate amount of grafts for both, this becomes less of an issue.

However, patients should discuss temple restoration preference and hair restoration goals during consultations, and create a hair transplant plan with their physician. By creating a unified plan, patients are able to proceed confidently with surgery and hopefully meet their expectations.

This question, asked by a member of the Hair Loss Discussion Forums, was answered by Coalition physician Dr. Bernardino Arocha

Restoring crown hair loss can use a lot of grafts. How do hair transplant surgeons design crown restorations while planning for future balding?

Crowns are said to be the “black hole of hair restoration“. They can put great demand on precious hair transplant donor hair so it is usually advisable to consider future hair loss progression, donor/demand ratio and contemplating the quandary of “robbing from Peter to pay Paul”. In other words, weather there will be enough available donor to complete the restoration completely as the Norwood pattern is fully expressed. Propecia (finasteride) use can help conserve donor by maintaining the crown.

In restoring crowns, it is important to anchor the transplant into the thinning areas that are furthest out: that is, to work from the outside in so the first area of hair loss is the last to be restored. This is to prevent hair islands from developing or the “halo effect”.

Dr. Bernardino Arocha

—-

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: balding, hair restoration, hair transplant, hair loss, Norwood, Propecia, finasteride

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

Recently, I started researching hair transplant surgery, and I’ve become nervous about the possibility of scalp necrosis from the procedure. Is this a common problem? What exactly is necrosis? What causes scalp necrosis from hair transplantation?

Necrosis simply refers to tissue death caused by insufficient blood supply to an area of tissue.

In hair transplant surgery, I can think of several different scenarios where scalp necrosis specifically (and not necrosis or death of the newly implanted grafts) could occur:

The most prevalent causes are likely an infection due to a subpar donor closure during  Follicular Unit Transplantation (FUT), graft removal during the Follicular Unit Extraction (FUE) procedure, and “over packing” of follicular units in the recipient area.

Each of the above scenarios would require very specific situations that actually lead to scalp necrosis.

In the FUT example, the strip excision site would need to be closed tightly enough to actually “clamp off” blood vessels and suffocate certain areas of the donor region. This excessive strangulation of the critical blood supply would cause progressive damage and eventual tissue death (necrosis). In the FUE scenario, excessive graft extraction would need to damage enough superficial blood vessels to destroy blood supply to the non-extracted donor tissue. In the “over packing” example, follicular unit grafts would need to be implanted at such a high density that they overwhelm the blood supply and suffocate the rest of the scalp.

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

What is the advancement in hair restoration technology if one can’t get enough hair on head? What about taking hair from the body? I heard it has helped many people like me.

This comment, addressed by Coalition hair restoration surgeon Dr. Michael Beehner was shared by a member of our Hair LossSocial Community and Discussion Forums:

I noticed a point about how quickly the hair transplant surgeon removed a strip in this recent write up from a fellow who had follicular unit transplantation (FUT): Dr. Rahal- 4737 grafts FUT- My Experience.

I recall Joe from Hasson & Wong talking about how slowly H&W remove their strips and that it can affect future yield–that is he said that he felt at their clinic their deliberate strip removal methods could actually help get more yield in future sessions, and generally they took more time/care than most other clinics.

First, it is important, when cutting out the underside of the strip (after the upper and lower skin incision have been made) to leave at least a thin layer of fat there, so that none of the follicle bulbs are “naked” and hanging in the breeze. This is important because the ideal graft created by the assistants doing the cutting under the microscope is one in which there is a small amount of fat left just under the bulb. This then is the ideal spot to place the forceps when placing the graft, so that the bulb itself is not traumatized. Also, this fat at the base of the bulb protects the dermal papilla, an important germinal center which is present just beneath the bulb.

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles and recommended hair transplant surgeon Dr. Carlos Wesley:

I notice in a lot of these post hair transplant pics people are posting, they have a lot of hair in the recipient site prior to shedding. It kind of seems like a preview of what their hair should look like after the grafts shed and regrow.

I never had a bunch of hair in my recipient sites. Sure, I could feel some stubble but visually could hardly see anything. I actually have less hair in my hairline now than I did before the procedure. I am almost six weeks along and it seems I have shed a lot. I also started Propecia (finasteride) three days pre-op. I had 1000 grafts to the hairline.

What I was wondering was, since I didn’t see any hair after the scabs healed which took about three weeks, does this mean I won’t have much density? I didn’t need to cover a large area but I do have fine straight hair.

What you see immediate post-op does not correlate with the final results. Hair restoration physicians use different hair lengths to work with during the procedure depending on what their staff is comfortable working with. Hang in there and try to remain positive and confident that you will have an improvement in the end.

Dr. Glenn Charles

In this article, recommended hair restoration surgeon Dr. Parsa Mohebi shares his expert knowledge comparing follicular unit extraction (FUE) to strip hair transplants:

Modern hair transplants have come a long way from the plugs and mini-grafts that rendered a very artificial look to the fine results we have today. Follicular unit transplantation has two surgical procedures. These procedures differ in the manner in which the donor hair or better said the donor hair follicles are extracted. These follicular units or micro grafts are removed in their natural unit arrangement and allow the hair restoration surgeon to artfully transplant hair to the bald recipient areas of a patient. The two methods are called Strip Hair Transplant Surgery and Follicular Unit Extraction (FUE) Procedure.

FUE hair transplant surgery is performed by removing individual follicular units one at a time. This can be performed through manual extraction, automated methods or programmed robotic devices. FUE hair transplantation is a solution that many hair loss sufferers choose. When there is minimum baldness or scar revision, this type of hair transplant makes a lot of sense. When patients absolutely cannot accept the scarring that is necessary with a strip hair transplant surgery, then FUE is again the best option of FUT hair restoration. FUE is a good alternative for individuals that suffer from significant pain; or patients that experienced discomfort or other donor complications with a previous strip hair transplant surgery.  FUE is also advantageous for those patients with a depleted donor area for which removing more hair through strip method is impossible.

This question, from a member of our hair loss social community and discussion forums, was answered by recommended hair transplant surgeon Dr. Carlos Wesley:

I have always wondered how you know the number of grafts they are telling you that they have transferred is the true/correct number. You just have to trust your hair restoration surgeon?

I especially became suspicious since I just recently went for two different consults on the same day (it was with the doctors themselves in their offices). One of the surgeons said that he could probably get 3000-4000 grafts from my donor area (I already had a surgery using 4200 a year ago). The second one said the he didn’t see it being possible to get more than 2000 grafts and that was the maximum. He said it was impossible mathematically to reach anywhere close to 3000-4000.

As a hair transplant patient, it’s important to know what to look for when viewing your very own follicular unit grafts. There’s a big difference between “healthy” versus “denuded grafts”. Ideally, each graft should possess a healthy amount of subcutaneous and dermal tissue that protects the stem cell-containing portions of the follicle: the bulb and bulge, respectively (as seen on the right side of the first image as well as the second image below). Denuded grafts do not have that tissue and are more susceptible to dehydration and traumatic handling (both of these hazards decrease hair survival when transplanted).