Post Hair Loss Questions and Get Answers

This insightful information was posted on our hair restoration forum by Dr. Timothy Carman of La Jolla, CA, who is a highly esteemed member of the Coalition of Independent Hair Restoration Physicians.

Has anyone depleted their donor hair supply after 2 or 3 hair transplant surgeries? What options are available if you have done this and need further work? Is FUE an option if strip is not?

One of the issues to be addressed in the initial hair restoration consult, and, in my honest opinion, the most critical concept, is the surgical plan created by the physician in conjunction with the patients’ age, degree of hair loss, donor supply, scalp laxity, and genetic background (familial history); all in an effort to “predict” the future hair loss pattern for that individual. Ideally, then, knowing the limitations given the patients “lifetime supply-demand balance”, as I like to call it, the initial plan will be implemented so as not to ever get to such a distressing or “impossible” situation as described above.

This concept can be difficult to communicate, especially to younger patients, who may want a more aggressive (less receded) hairline than they will have supply for in the future.   In  my opinion, the successful hair transplant is just as much about creating the conservative, less “wow” result as it is the obvious large hair transplant megasession out of the ballpark results; probably even more so. 

The long term picture is a very important concept, thought I should just give it some thoughts here.

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.

While many men would rather not experience hair loss at all; those that do, experience many degrees of baldness. While some hair loss sufferers lose hair only at the front, others lose it in the crown while others lose it all over the top.

While restoring a natural looking hairline and frontal core is standard in surgical hair restoration, the bald or thinning crown is often considered the “black hole” for grafts. Thus, patients need to decide how much hair (if any) they want to designate for the crown as they discuss their hair restoration goals with their physician.

Recently, forum member “Mike the Dane” who’s already had a couple of hair transplants posted a thread with photos asking for input from our community as to whether or not he should start to focus on his balding crown. To offer your advice and/or share your experience, visit “To Crown or Not To Crown”.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Technorati Tags: hair loss, baldness, hair restoration, bald, hair transplants, balding

Most balding men and women would love to restore their natural full head of hair by waving a magic wand and/or by popping a miracle pill. However, hair restoration involves careful and strategic planning with a skilled and experienced hair loss doctor. While Propecia (finasteride) and Rogaine (minoxidil) are typically good at slowing down or stopping the progression of male pattern baldness, hair transplant surgery is the only method of hair restoration proven to grow hair in completely bald areas.

Today’s state of the art hair transplants are very natural looking and undetectable by even the harshest critics. This explains its increase in popularity over the last several years. But while advancements in surgical hair restoration are indeed exciting, it’s crucial for men and women considering this procedure to develop realistic expectations. What can realistically be achieved with hair transplantation varies for each patient. Below, we’ve cited a few important tips in helping you learn what to expect from hair replacement surgery.

Supply Verses Demand: What can be realistically achieved depends on the supply of donor hair and the amount of baldness in demand of new hair. Most patients can typically only achieve an illusion of fullness even under the best circumstances. Thankfully, this is usually enough to provide patients with a cosmetically significant improvement. Those with advanced balding may have to make additional sacrifices and leave some balding areas untouched. To see what hair transplants can accomplish on patients of varying degrees of lost hair, view Hair Transplant Photos by Norwood scale.

Do you have any idea as to what the average surface area is for level 5, 6, and 7 on the Norwood scale of hair loss?  I was measuring my scalp and found that even if I progress to a Norwood scale level 7, I will only have about 175 cm2 of bald area. That would only take 7,000 grafts to fill in the entire area with 40cm2, a density that I believe is more than adequate to give an illusion of fullness and hair density. I realize there are variables such as color, hair shaft diameter, texture, etc. that come into play, but shouldn’t any hair restoration physician that transplants 1,000 grafts per Norwood level fill in the entire area with good density?

This hair loss question was answered on our hair restoration forum by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

In my experience, the average patient’s head can be divided into two areas. 

The frontal 2/3 of the scalp on average measures 100 sq.cm. On average the crown loss is 80 to 100 sq.cm. The area of the crown will vary by how low and wide the crown loss is. On average I would say that to cover the total bald area in most men who are type 6 or 7 on the Norwood scale, I cover an area of 200 sq. cm. But there are men with very large balding scalps in which the area is more like 250 to 300 sq.cm and men with smaller areas. A total area of 170sq.cm.is in the realm of a normal area to cover.

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.

Given the number of impressive hair transplant results presented in the “Results Posted by Leading Hair Transplant Clinics” forum, Coalition member Dr. Jean Devroye has quickly become recognized as a leading hair transplant surgeon in Europe.

In an attempt to improve the quality of results patients can achieve with follicular unit extraction (FUE), Dr. Devroye designed and has been using for 6 months a unique powered instrument (prototype) for FUE hair replacement procedures. This prototype was designed to improve the speed of the follicular unit extraction procedure while maintaining the same effectiveness as when performed manually by a skilled surgeon.

This new powered FUE device works by spinning alternatively with a low angular motion.  This allows for fast and effective penetration of the scalp and extraction of the follicle while keeping the risks of damage to the follicles virtually nonexistant.  It’s speed is controlled by a foot treadle allowing for better hand control of the device.

While Dr. Devroye believes his FUE tool prototype helps to increase the speed of the hair restoration procedure, he admits it doesn’t reduce the already very low transection rates he achieves while performing follicular unit extraction with a manual tool. Dr. Devroye’s powered FUE instrument has allowed him to increase the number of follicular unit grafts he can transplant daily via FUE from approximately 1200 to 1500 per day.

This insightful article was written by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians. 

Here are few examples of hair transplant patients in which I believe dense packing in the hairline area is appropriate. I consider planting at densities between 40- 60 follicular units per square centimeter (FU/cm2) as dense packing. There are hair restoration patients in whom I will plant at densities from 60-80 FU/cm2, but they are the rare exceptions and need to be perfect candidates for what I would call super dense packing. In order for me to feel comfortable dense packing the hairline I think the following criteria need to be met:

1) The patient must be at least 30 years of age
2) The patent should have a family history that suggest his hair loss will not progress further than a class IV on the Norwood Scale of hair loss.
3) The donor area has to have at least an average density of 80 FU/cm2
4) The donor area has to have good laxity
5) The hair behind the hairline should have no or little evidence of miniaturization.
6) The crown should have no or little evidence of hair loss or miniaturization.

This insightful article was written by Dr. Shelly Friedman of Scottsdale, Arizona who is one of our recommended hair restoration physicians.

To appreciate today’s hair transplant, one must realize how far we have travelled over the past 50 years:

When Dr. Norman Orentreich first introduced hair transplantation in the 1950s he was more interested in getting hair to grow in its new site rather than concerned with the cosmetic appearance.  The first hair transplants utilized a 4mm round punch which removed the hair and the surrounding tissue.  The “hair plugs” were removed with a cylindrical punch either manually or with an electric drill, and allowed to heal secondarily with a white scar.

This small piece of skin called a “plug” was then placed back into the scalp after a 3.5mm punch removed the bald skin.  The bald skin was discarded and the “plug” was inserted in the new recipient site.  The typical “hair plug” measured 4mm in diameter and had approximately 15-25 permanent or terminal hairs.  To accommodate the blood supply in the recipient region, the “plugs” needed to be spaced one “plug” apart.  This created the checkerboard effect which required 4 surgeries to fill in the entire transplanted area.

In 1984, Dr. Wayne Bradshaw, a hair transplant surgeon from Australia described a new approach to hair restoration whereby a 4mm “plug” is either bisected or quadrisected.  Instead of removing balding tissue in the recipient region, a blade is used to incise or create a paper cut within the tissue.  This new type of “plug” is called a minigraft.  The term “plug” was then abandoned in hair transplant circles.