Hair Restoration Blog

I have performed a hair transplant surgery on this 42 year old man who had another hair transplant last year with micor- and minigraft with another office last year. I would like to assume that the era of mini and micro-grafts are over, but still every now and then I see patients who are recently operated with micrograft or minigraft techniques. This 42 year old patient had small number of grafts for a large area with less than adequate coverage.

The patient’s old hair line is lower than where it should be on the corners for his age and race. He had some pluggy hair growth on the corners and on his hairline. We restored his hairline with 400 single hair FUT grafts, removed some of the pluggy hairs on the hairline using a 1mm punch biopsy device. We increased the density of hair on the front are with total of 2293 follicular unit grafts.

The frontal area was densely packed and the some of the frontal grafts with pluggy appearance were removed. I expect great result in a few months for this patient at our 10 month follow up.

Patient immediately after hair transplant surgery with 2293 FUT grafts including 400 single hair grafts on hairline.

Q:

Dear doctor Parsa Mohebi

I have got some questions that I request you to answer them, so that I can have a better decision.

1- Is it possible to use the hair of other members of the family as donor?

2-May the transplanted hair at the fore part of the head recede again? If yes, how long does it take to begin?

3-If the hair recedes to the back of the head, the scar of the surgery appears and it is so ugly. What should we do in this case? And in the case of FIT after receding in the back, that area looks very sparse and with little hair? These make a bad appearance. What should we do in this case?

I appreciate you before and I wish more successes in life for you.

Truly yours
Patient name

A:

I will answer your questions in the order you asked them:

1- Is it possible to use the hair of other members of the family as donor?

No

2-May the transplanted hair at the fore part of the head recede again? If yes, how long does it take to begin?

No it will not. Transplanted hair is considered permanent and there is no chance that you lose it in regular male pattern baldness. However you may continue to lose your own hair if you have any left in and around your transplanted hair. Here at US Hair Restoration we recommend finasteride to most patients around the time of surgery to prevent shock loss that could be seen after surgery.

3-If the hair recedes to the back of the head, the scar of the surgery appears and it is so ugly. What should we do in this case? And in the case of FIT after receding in the back, that area looks very sparse and with little hair? These make a bad appearance. What should we do in this case?

Scar or the surgery should never be seen if placed properly. The only way you can see the scar is if you decide to shave your head. If you plan to shave your head for any reason scar of the strip technique hair restoration surgery will be seen and you may want to choose FUE (Follicular Unit Extraction) or as some people call it FIT (Follicular Isolation Technique). FUE transplant or FIT are the same and if done properly should remove hair follicular units evenly throughout your donor area and it should not look thinned out in any particular area. Of course the donor area will be thinner than before the hair transplant surgery, but density of the hair on the back of our head is not what makes you look bald. Not having a solid frame around your face is responsible to give you the appearance of baldness and can make you look older.

After hair transplant care: This is something that I have to go over for my patients who undergo a hair transplant procedure almost every day. So let’s go over it once and for all.

Here, I will go over the post-op instruction of our patients at US Hair Restoration. Different hair restoration clinics may have different post-op care and instructions because of their different surgical methods.

Our patients who have a hair transplant surgery using a strip technique usually leave our hair transplant center with a bandage around their head. The bandage is used only to support the newly closed donor wound on the back of scalp. Patients are given prescription for pain and anti-inflammatory medications for first few days after surgery. The first night after hair transplant surgery, patient needs to be cautious not to rub or scratch the transplanted area. We recommend that all patients take it easy for the first days and avoid heavy physical exercises.

We would like to bring all patients back for physician evaluation and hair wash the day after surgery. During this first visit, we remove the bandage and assess the transplanted follicular unit grafts and the donor wound. We wash the donor and recipient areas with our meticulous methods while teaching the patient how to wash it at home during day two to four after hair transplantation. Hair wash after hair transplant surgery needs to be performed twice a day with a special method to minimize the probability of dislodging the grafts. Patients ask if they can skip washing hair within the first few days to avoid damaging the grafts. The answer is “No”. Hair wash is a key step in hair transplant care that guaranties the normal growth of the transplanted hair follicular grafts.

I don’t believe in strict limitations in patient’s physical activities after hair transplants as I hear is recommended by some hair transplant clinics. I generally prefer that patient keeps his normal daily activities with some minor limitations. I discourage any activities that may add to the tension of the wound edges at donor area for the first four weeks after surgery. Those activities are: extreme bending of neck and heavy weight lifting. I also ask patients to avoid immersing their head into water and avoid any exercises that cause excessive sweating for the first four days as part of their after hair transplant care.

We would like to bring patients back at day ten after hair transplant surgery to remove the staples (for patients who had strip surgery and donor is closed with metal staples) and to reevaluate the donor and recipient area. For the patients who have their donor closed with absorbable sutures, we would still like to see then in ten days to assess the healthiness of recipient and donor area, which includes patient’s who had FUE (follicular unit extraction) surgery.

Patients need to avoid direct sun exposure to the recipient area for about six months after hair transplant surgery. Direct sun exposure may harm the growing grafts. Sun exposure can also cause skin hyper- or hypo-pigmentation (changing the skin color).

The last follow up appointment for their after hair transplant care is between months nine to twelve after their hair transplant surgery, when transplanted hair grows to its final thickness and length. At this session we can evaluate the transplanted hair grafts and assess the finial size and condition of donor scar. This visit is a good time for patients who want to consider a repeat surgery to increase the density of hair or cover the areas that has not been completely covered with first hair transplant surgery due to the limited scalp laxity or extended balding area. Having said that, patients who are planning for a repeat surgery do not have to wait that long and a repeat surgery could be done any time after month 5 after the initial hair transplant procedure.

What I explained above what a general rule for the follow up visits and after hair transplant care in most hair transplant surgeries. We may add or remove some instructions for some patients who have complex procedures or special conditions.

Q:

I am 65 with 2 hair transplant surgery in the past. I ran out of donor hair and I was told I don’t have much more hair for my crown area. Is it possible to use armpit hair and pubic hair for hair transplant on to my crown? Is it going to be a high rate of transection for hair from those areas because of the curly hair there?

A:

The best option is always transplanting hair from scalp to scalp. Scalp hair is the most economical in terms of the number of hair that can stay and grow at any given time. Because of efficiency of hair on the back of the scalp (donor hair), we hardly ever use body hair transplant including armpit (axillary) or pubic hair, but hair from those areas could be used in some conditions such as violated donor areas from old technique surgeries leaving not much donor hair to work with, in presence of large balding area. Body hair transplant, as we discussed before is not a good substitute for scalp hair transplant, because of of the difference in hair growth cycle in those areas as long sleep phase (telogen) and short growth phase (anagen). There are some new studies indicating that body hair may change its trait in favor of recipient area (grow for a longer period of time thus become longer), but it cannot completely become scalp hair.

Body hair transplant with pubic and armpit hair in particular has its own problems. Body hairs have different characteristics from scalp hair. They are limited in numbers and should be reserved for the cases that no other alternatives are available. As we mentioned before, in cases of severely diminished donor hair, body hair could be an alternative to scalp hair. Body hair could be conveniently obtained with FUE techniques. Patient needs to be tested before the procedures with FOX test. If patient is FOX positive, it means that the hair could be harvested for the actual procedure with no trouble.

It is about 8:00 Pm and we just finished performing a big FUE procedure and I thought I write this post on “who is a candidate for FUE procedure” before going home.

Recipient and donor area right after a FUE (Follicular Unit Extraction) procedure.

Follicular Unit Extraction or FUE hair transplants is one of the methods of hair transplantation with Follicular Unit Transplant (FUT) technique. The biggest advantage of FUE is that, the linear scar in the donor area on the back is eliminated.

FUE has been around for a few years now. Many people ask about the advantages and disadvantages of FUE when they are considering doing a hair transplant surgery. People always ask; whether or not FUE hair transplant is the right procedure for them. There are many articles on hair transplant techniques including FUE and its different methods that compared FUE with regular techniques of strip hair transplant. Hair transplant surgeon has to consider patient‚Äôs needs when planning for a hair restoration procedure. Many surgeons don‚Äôt do FUE on a regular basis. This needs to be explained to the patient. Unfortunately some doctors talk patients out of this procedure simply due to their inability to perform one. That is the same for mega session surgeries that many people are told that grafts won’t survive if place too densely only because they can not perform one. This might be due to not having enough skilled personnel or any other limitations.

Donor area with small wounds of FUE punches right after FUE procedure

The most important factor that people consider when they consider doing a FUE is elimination of linear scar on the back with FUE hair transplant surgery. It might be because they want to wear their hair short on the back or shave it at some point. FUE by far is the only method that can completely eliminate the linear scar on the donor area. Have more comfortable post-op period is the other reason for choosing FUE.

All patients need to be tested before performing an FUE procedure for their candidacy. At the Los Angeles office of US Hair Restoration, Dr. Mohebi tests all patients who are considering this method for their hair restoration. FUE test (FOX) is easily done in the office with to extra charge to the patients. We perform a mini FUE procedure under local ansthesia to test feasibility of removing intact follicular unit grafts with different FUE technique and see which method is the right one for each patient. If patients are FOX negative then other options should be discussed with them. Even if patient’s are FOX positive, they have to understand that they may have a much better yield and superior final outcome with regular strip technique. For some patients, not having scar on the donor area is more important than having higher density in recipient area and they can live with thinner hair in the recipient area, but they don’t want any line of scar at all. These patients are the best candidates for FUE if they are tested positive for that.

Follicular Unit Extraction (FUE) - Advantages or disadvantages

My patients always ask about advantages and disadvantages of Follicular Unit Extraction so I thought this topic makes a good post for the blog. Before going over these points I have to say, although we at US Hair Restoration offer the most advanced techniques of FUE nationwide, most of our patients are still being transplanted by strip technique and I don’t recommend FUE to everyone and select my FUE patients very meticulously. Here are the main reasons why we do recommend FUE to some people and not to everyone.

Advantages

• FUE does not leave a linear scar, which is great for those who want to wear their hair very short on the back or the ones who may need to shave their head in the future (like actors).
• FUE has a more comfortable healing process with decreased healing time.
• No restrictions in physical activities for those who want to do strenuous exercise right after FUE procedure.
• FUE is a viable alternative for those who have tight scalp that makes strip surgery risky or impossible.
• Follicular unit extraction makes it possible to harvest hair from body, beard or almost everywhere else.
• FUE is very useful when we need limited number of grafts like for restoration of eyebrow hair.

Disadvantages

• The biggest disadvantage of follicular unit extraction is that the maximum follicular unit graft yield is lower than when it is done with strip technique due to higher rate of follicular transection compared to the strip technique.
• Although linear scar is not present after FUE, small punctuate scars will be there that may make future FUE hair transplant surgeries more difficult or impossible.
• Not everyone is a candidate for FUE and patients need to be tested with FOX before proceeding with the surgery.
• FUE procedure takes much longer to perform compared with strip FUT procedure.
• FUE is more laborious thus it cost more compared with strip technique hair transplants.
• In FUE, we have more chance of burying grafts that increases the risk of having folliculitis (tiny inflamed cysts under the skin) on the donor area.

Q:
Our 2 year old son has very fine hair and his hair growth has been very limited around his scalp. Is he going to lose his hair or you think his hair may grow as he gets older? Is there anything we can do that his hair gets better.

A:
Hair loss in children is generally not associated with their pattern when they become adults. In fact, most hair loss cases or limited growth patterns during the first two years is hereditary and if you search child’s family hair growth pattern, you should be able to find similar pattern in other family members when they were that age.

Children’s hair loss usually resolves spontaneously in vast majority of children. Other than congenital hair loss of children, they may lose hair due to a variety of other causes including: Alopecia Areata, Traction alopecia, Tinea Capitis, Trichotillomania, or Telogen Effluvium due to different disorders. Although most types of hair loss is self limited and resolves without treatment, any child with a hair loss should be evaluated by a dermatologist to rule out treatable causes of hair loss.

Hi Doctor,

My son has had a hair transplant years ago with old techniques and he has bad hair transplant scar now. He now wants to shave his head, but the scar of hair transplant on the back of his head may become exposed. Do you perform hair transplant scar repair or do you recommend any procedure that can help with hair transplant donor scar coverage?

Answer:

Hair transplant with strip technique can cause a linear scar that could be visible on the back of head if the patient wants to shave his/her head. A hair transplant scar is not limited to a bad hair transplant technique and it might have to do with one’s personal healing process too (some people are generally better healers compared to the others).

The good news is that we have methods to minimize the size of the scars nowadays and if you have bad hair transplant scars from bad transplants in the past, there are several new methods that can help improving the appearance of the donor scar. A hair transplant scar could be improved by repair of linear widened scars with different methods that we perform at our Los Angeles office of US Hair Restoration. Dr. Mohebi is the inventor of the axometer, a device that measure the laxity of the scalp precisely before hair transplant surgeries. Good measurement of the scalp laxity is one of the best ways to minimize development of donor wound complications and widening of donor scar and the Laxometer is the device to do these measurements.

One method is through simply excising the scar. Excision of the donor scar may be helpful for some donor scars. After removing the scar, hair transplant surgeon can close the skin with the trichophytic closure method in which a small wedge on one or both sides of the skin edge is removed and the skin is closed primarily. Trichophytic closure allows some hair follicles to grow new hair into the final scar. Presence of hair helps making the hair transplant scar become invisible.

Hair transplant donor scar coverage could also be performed by transplanting hair into the scar. Hair could be harvested from other areas using FUE or mini-strip techniques. Again, presence of the hair inside scarred area could trick the discriminating eye and the scar would become less detectable. Patients may need more than one hair transplant procedure into the donor scar for minimizing the difference between the densities of hair in scar and surrounding areas.

The last method that could be used to camouflage the linear scar is by tattooing the scar. People who plan to keep the hair very short can easily tattoo the scar with the figures of short hairs so it seems that there are some hairs present in the scar area, which can help minimizing the visibility of the scar.