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This hair loss question  was answered by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  

The following question, asked by a member of our Hair Restoration Forum and Social Network, is related to patient results posted by Dr. Shapiro in the discussion thread, Dr. Paul Shapiro: 4400 FUT Grafts, 14 Days Post Op:

Can you tell me why you opted to go back into the crown? I ask because I hear of some hair restoration surgeons not wanting to touch the crown until a patient is much older and more progressed. This patient is a class 4 on the Norwood Scale at 28 but, theoretically, his crown could open up much further.

There is no set rule whether or not to put hair in the crown. What is important is that we take future balding into consideration so that, if the patient progresses, there is enough donor to make the hair transplant look natural.

In this case, the patient did not want his hairline very low and was happy with a mature frontal-temporal angle. I kept the front of his hairline high at 9 cm above the glabella and his frontal temporal angles mature. In these patients I will shrink the crown, but not completely cover it. It is usually safe to put hair at the top of the crown. Also the hair in the top of the crown is at a lesser density of around 25 to 30 FU/sq.cm to give it some coverage, but not very dense.

Recently, Dr. Jim Harris, who is recommended on the Hair Transplant Network became amongst the first hair restoration physicians to purchase the ARTAS Hair Restoration System, a hair transplant machine innovated by Restoration Robotics in an attempt to automate the follicular unit extraction (FUE) procedure.  But can ARTAS live up to its promise of increased extraction speeds, lower transection rates, increased session sizes, and optimal hair growth yield?

Like previous FUE extraction machines, the ARTAS Hair Restoration System attempts to increase the speed of extraction (allowing for larger single sessions) while automating the surgical process.  Claims that very little skill is needed to use automated devices has  led some marketing giants to mass market their machine to the neophyte hair transplant surgeon and untrained medical professionals.  Since no automated device or machine can adapt or make critical decisions during an FUE procedure, many hair loss practitioners and veteran patients have expressed concerns that many who undergo surgery with a neophyte surgeon using the ARTAS or any automated hair transplant equipment will eventually come forward with less than satisfactory results.

While the concept of automating the FUE hair transplant procedure is impressive, putting such advanced equipment in novice hands may be disastrous.  However, innovative machines like the ARTAS Hair Restoration System in skilled and experienced hands could significantly aid quality physicians and their staff in providing patients with the best results.

According to Dr. Harris:

I acquired the system because it produces great follicular unit grafts at an efficient rate and it will help leverage my resources.

Although hair transplantation is not an exact science (in fact, most physicians state that medicine, in general, is as much an art as a science), when it comes to hair transplant surgery many patients desire an accurate, objective outline of the procedure.

One of the areas hair restoration patients desire precise data is in graft count verification. Specifically, patients desire a way to verify that they receive (roughly) the number of follicular unit grafts estimated during the hair transplant consultation and paid for during the time of the operation.

However, in various cases, hair transplant procedures can range from 3,000 – 5,000 grafts, and it’s difficult to keep track of each follicular unit as it’s harvested, prepared, and implanted. So, how are hair loss patients supposed to “keep track” of the number of implanted grafts, and ensure that they receive the correct, quoted number of follicular units?

In a recent thread on our Hair Loss Discussion Forums, a group of patients asked themselves the exact same question and came to some innovative and creative conclusions.

Several patients stated that a final count was provided at the end of the procedure, and since they visited a trusted hair transplant surgeon, they safely assumed the graft count was accurate. Another member explained how he used a “clicker” to keep track of the incisions made in the scalp; a different member used a similar method, but simply counted the number of incisions instead of keeping track with a clicker device.

This hair loss question was posted directly to Dr. Raymond Konior of Chicago, IL,  who is a member of the Coalition of Independent Hair Restoration Physicians.   See his professional answer below.

At what age and degree of hair loss is it appropriate to transplant a patient’s crown?

The crown has been described as the “black hole” of the scalp. Based on that, I believe a very large percentage of patients seeking hair restoration should avoid grafting into the crown region, especially young men in whom it is often impossible to determine how far the pattern will progress. This recommendation is based on the finite nature of donor supply and on the progressive nature of male pattern balding, i.e. there is an imbalance between supply and demand. The fact of the matter, however, is that despite prolonged and detailed consultative discussion relating to the risks and limitations of grafting the crown, many men are still adamant about obtaining some crown coverage. Although it is difficult to predict with absolute certainty everyone who is a rock solid candidate, it is possible to weed out the majority of poor candidates and to institute a safe grafting strategy which will avoid future problems for most patients

While today’s state of the art ultra refined hair transplant procedures can provide many hair loss sufferers with a full and natural looking head of hair, each patient is unique and what can be realistically achieved with hair restoration surgery will vary. All balding men and women want to restore a full head of hair. But is this realistically achievable for everyone?

The discussion of large megasessions exceeding 3000 grafts and dense packing on our popular hair restoration forum has many hair loss sufferers hopeful and rightfully so. But while this ultra refined follicular unit grafting procedure is coveted by the vast majority of patients, not everyone is a candidate for it. Thus, working with a quality hair restoration physician to determine what you need to meet your goals is critical, even if it doesn’t evenly align with what you want. So how can you determine whether or not what you want matches what you need?

In the discussion topic, “Hair Restoration Needs Verses Wants – Buyer Beware“, forum member “Spex” cautions prospective hair transplant patients and helps them align their desire for a full head of hair with what can be realistically achieved for them. View this discussion topic to read what our members are saying and to contribute your own experience.
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David – aka TakingThePlunge
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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

I’m looking to undergo a moderately sized follicular unit extraction (FUE) procedure, but I’m having trouble finding information on the actual growth rate/yield I can expect from FUE. What kind of growth rate can I expect from a follicular unit extraction (FUE) procedure?

I think there are two things to consider with regard to follicular unit extraction (FUE) and yield/growth rate: 1. any damage to follicular unit grafts during the extraction phase (which would damage the follicle and result in a graft that didn’t grow) and 2. a graft extracted from outside the universal extraction zone, which would be susceptible to future hair loss (as the graft wouldn’t be as resistant to dihydrotestosterone – DHT).

The first variable is dependent on the skill of the hair restoration surgeon and, to a much lesser extent, the tool used. If you visit an experienced FUE surgeon, my guess is that the ’90 – 95%’ number often quoted (which is comparable to the 95% growth rate experienced with traditional follicular unit transplantation) would be accurate. If the practitioner has less experience with extracting follicular units, than issues with transection become apparent and the ‘yield rate’ will suffer as a result.

The second variable is really up to the hair transplant surgeon, how many grafts he/she is trying to extract, and whether or not they feel like the follicles in these extraction areas (outside of the universal safe zone) are susceptible to future loss or not.

It’s no secret that hair transplant surgery is a complex procedure requiring the skills of an experienced physician and the clockwork precision of a highly trained staff. Within the realm of surgical hair restoration, there lie many lingering debates regarding technique; FUE vs. FUT, sutures vs. staples, shaving the head vs. not shaving, just to name a few. But, perhaps one of the most misunderstood of these techniques is the method used to make the incisions for placing the follicular unit grafts.

The two most common slit-making techniques are parallel (sagital) and perpendicular (lateral/coronal).   By definition, sagital incisions run parallel (vertical) alongside and in-between existing hairs while the lateral incisions bisect existing hairs perpendicular (horizontal) like a T.   Learn more about parallel versus perpendicular incisions by visiting “Hair Transplant Photos – Parallel (Sagital) versus Perpendicular (Lateral/Coronal) Incisions“.

But, what does that mean to the prospective hair transplant patient? Is one technique always better than the other? Are both techniques ever used in the same procedure?

For the answers to these questions, visit the discussion topic, Does the Lateral Slit Technique Provide Better Yield than Sagital Technique?, started by Hair Loss Forum member “j1j9j85″. You are encouraged to provide your input to this important topic.

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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

With advancements in ultra-refined follicular unit hair transplantation over the past 15 years, patients have come to expect more from a single hair restoration procedure. Today’s mega-sessions have the potential to place 4,000+ follicular unit grafts in a single day when appropriate for the patient. However, one of the limitations a patient with significant balding faces when considering such a large session is scalp laxity. After all, as the size of the planned session grows, so does the size of the strip extracted from the donor site.

So, what do you do if your scalp is too tight? Introduced by mega-session pioneers Hasson & Wong, (and presented by forum member and H&W representative “Jotronic” in this discussion thread) scalp stretching exercises are now recommended by most hair transplant surgeons performing larger sessions. But, do they really work and to what degree?

In hopes of answering these and other questions, forum member “gmonasco” started the thread How effective are scalp laxity exercises? You are encouraged to share your experiences and opinions.

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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

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Technorati Tags: follicular unit, hair transplantation, hair restoration, balding, hair transplant, Hair Loss

This question, which was answered by Coalition surgeon Dr. Alan Feller, was asked by a member of our Hair Restoration Social Community and Discussion Forums:

I recently met with two hair transplant surgeons and was provided with two completely different estimates regarding the number of available follicular unit grafts. One doctor claimed I had 4,000 donor grafts available to remove and implant, while the other claimed I only had 2,000 available grafts. Is one surgeon correct and the other incorrect? What would account for such a large difference?

All hair restoration physicians have their own take on what donor resources are available. Their are many more variables than one might think. For example, someone who actually went to the trouble to find out the average density of their donor might think they know with accuracy how many grafts are available, but, when one figures in skin flexibility, existing scars, dimensions of the skull, positon of the ears, the diminesions of the donor area, etc – the final number is not so clear. Add to that the ability, confidence, and experience of the doctor and you may have quite a range of numbers.

Having 4,000 grafts in your donor area does not necessarily mean they are all available for harvesting in one session or even multiple sessions. Some areas of the donor area are unreachable (unless follicular unit extraction is then employed).

The following thorough response to this thread from the Hair Restoration Social Community and Discussion Forums, was written by forum member “weweregods.”

Several factors figure in to how dense a physician might pack an area receiving hair transplantation:

1) Hair characteristics – If the hair diameter is large, course, and of a wavy texture, the hair transplant physician won’t need to pack the area as densely because these characteristics help with the illusion of density.

2) Density of the donor – If the donor area is dense, then there will be more follicular unit grafts to use for transplanting, which may factor into the decision to pack denser. Not everyone has 90 grafts/sq cm. Some may have much more and some much less.

3) Density of natural, non-miniaturizing hair – If the doctor transplants denser than the surrounding hair then the transplant will look strange. Ideally, the physician wants to create an illusion that will blend the natural and the transplanted hair in a smooth way.

4) Scalp laxity – The laxity of the scalp also factors into how dense the transplanted area will be as it may limit how many grafts may be taken from the donor area.

5) Positioning of the hair – Some doctors can transplant the hairs so that they grow parallel to the scalp and may, for instance, design a hairline that appears denser because it grows very near the scalp.