Hair Restoration Blog

Q:

I have heard of FUE transplants with relatively high-quality hair coming from the neck area, and from the beard. It seems like this could dramatically increase the number of grafts available for patients, at least for the hairline and front.  Then, body-hair (chest, back…), which I think are lower quality (but very abundant on me!), could possibly be used for the crown area. I would like to take as few hair from the back of the head as possible, and as much as possible from other areas.
Doctor, what do you think of this plan? Would it be a good strategy to pull from other sources rather then the scalp for donor hairs? What would be the costs involved?

A:

Follicular Unit Extraction (FUE) can remove hair from anywhere in the body as long as you are tested positive for FOX for those areas.  Neck hair is not the best option for hair transplantation because those hairs may fall out at higher ages of some patients. We can use body hair for hairline, and front or even the crown, but you may need multiple surgeries to obtain adequate density from those areas with body hair.  As we discussed before, body hair has a long resting phase in relation to its growth phase.  So you will have more follicles in resting phase (telogen phase) that do not have any visible hair in comparison to the ones in growth phase (anagen phase) that provide you with actual hair and give you coverage. We do FUE transplants in our California hair transplant centers on a regular basis.  FUE procedures are more labor intense and more time consuming so the cost of them are almost double in comparison to regular strip hair transplant procedures.

Yes, I am  back from Amsterdam.  I spent one week there and I was mostly involved with the meetings of the International Society of Hair Restoration Surgery.  The city of Amsterdam was beautiful and I still cannot believe in this day and age people still bike to work on a regular basis in a capital city in Europe.

As always of every year, we had a large number of hair transplant surgeons come from all over the world. My lecture this year was on a new application for the Laxometer and the title was Laxometer and Sequential Strip Removal for Increasing the Safety of Strip Removal in Mega-session Hair Transplants.  We will be placing a summary of the lecture in the hair loss library on our website US Hair Restoration soon.

The research results that was presented by the consultant of Intercytex for hair multiplication was disappointing and basically despite the fact that they announced they started Phase III of the study, this year they said they have not even finished the II yet.  They claimed financial problems to be the cause of that.  We will look closely as we were before to see what is going to be out in the horizon for hair multiplication or as it is often called “hair cloning”.

Several new automated techniques were also introduced for FUE harvesting but I was not impressed by any of those.  It seems like no one could come up with an ideal technique for the automated FUE that does not have significant problems.  We will continue with the manual methods for FUE hair transplant graft removal and placement at this time.

There were many nice discussions on new techniques in making sites, closing the donor wound and preparation of the hair transplant grafts.  The aesthetic aspects of hair restoration surgery was also discussed in many sessions and nice new concepts were introduced by several doctors.  Hairline design and temple points were again discussed and it seems that more doctors are realizing the importance of restoration on hair in the temple areas.  We at US Hair Restoration are very big in restoration of the temple points in the patients that need it and temple hairline is a necessary part of our hair restoration and hairline designs.

The comparison of the maintaining solutions is always part of the discussions.  This year there were a few nice comparative researches on densely packed hair and also the comparison of the grouping of the hair grafts in follicular unit form or isolate single hair groups.

Hair Restoration is one of the young fields of cosmetic surgery.  It has been revolutionized in the last 10 years with development of the idea of follicular unit transplantation and stereotactic microscopy that gave us the capability of producing such great results that are undetectable from the natural hair.  Presence of hair transplant doctors in scientific meetings of this kind help the hair transplant surgeon to be able to deliver the highest standard of hair transplant to his patient that can eventually guarantee both the doctor and the patient satisfaction.  I recommend the meeting of ISHRS to every doctor who performs hair transplant surgery as a big part of his practice.  In fact I do not understand how some doctors can afford not to be there while new findings are changing the face of hair restoration medicine on a regular basis.

This article was just published last month in Dermatologic Surgery Journal.  I thought the results should be interesting for the readers of this blog.  The article title is Survival of densely packed follicular unit hair grafts using the lateral slit technique.

The authors, Nakatsui, Wong and Groot, describe their experiment on densely packed follicular hair units and follow up on the rate of survival of the transplanted hair.  They use a density of 75 hairs per square centimeter which is even higher than the regular hair transplantation methods currently in use. The authors explain that the use of densely packed follicular unit grafts (>30 grafts/sq cm) is a highly debated issue with some claiming decreased survival rates.

Those who perform dense packing routinely do not believe they have seen any impaired survival. However, no prior study has rigorously analyzed densely packed areas to assess survival rates.

This is true and some hair transplant surgeons still advocate the use of lower densities which make the patient commit to multiple surgeries. These hair transplant surgeons convince their patients that dense packing can negatively affect the circulation of the skin and jeopardize the rate of growth for implanted hair follicles.

The study was only done on one patient and needs to be experimented on a larger number of patients but this at least clarifies the mechanism of hair restoration with new methods of highly dense packing. The authors concluded that 98.6% of transplanted hair follicles survived and were able to re-grow a normal hair.  Obviously, this is the first study that demonstrates high growth rates in densely packed follicular units using the lateral slit technique, even at densities of 72 grafts/sq cm.

We do perform densepacking hair transplant surgery at the US Hair Restoration clinics in Los Angeles, Beverly Hills and Orange County in California on a regular basis.

Q:

Hi, I have a few thousand grafts already and I am interested in getting more as well as trying to revise my scar. My donor area is still quite dense.

A:

Scar revision could be done through several different methods depends upon the location, size and orientation of the scalp scars. The scalp scars that are not aligned with the Resting Skin Tension Lines (RSTLs) generally do not respond well to the revision through simple excision of the scars. For these scars hair follicular unit transplantation is a better solution. Filling the scalp scar with follicular unit transplant can be a successful method for the scars that do not respond to the regular excision. We have treated the scars that have been previously operated with multiple simple excisions by other plastic surgeons with no significant improvement in the final size and appearance of the scar. For more on scalp scar management with hair transplantation, you can read on one of my presentations in the fifteenth annual meeting of the international society of hair restoration surgery (ISHRS) which was titled: Hair Transplant and Neurosurgical Scars. You can also check our website at www.ushairrestoration.com to get more information on the modern hair restoration procedures and possible options for repair of old surgeries or scar revision procedures. You can also browse the Hair Restoration blog at www.ushairrestoration.com/blog to familiarize yourself with the available hair transplantation methods and techniques for revision of the hair transplant scar.

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.