Hair Restoration Blog

Innovation in Chronic Wound Healing

A new study on hair transplant in chronic wound healing brings new hope for many patients who suffer from non-healing or delayed healing wounds.  The study was conducted by my friend Dr. Francisco Jiménez in Spain. In this research, Dr. Jiménez and his colleague evaluate the effect of hair transplant grafts on improved healing of chronic wounds.

Area reduction in experimental group (black line) that received hair transplant into their ulcers vs. the control group (red line)

The study is based on the fact that epidermal sheets from the hair follicle may help in re-epithelialization of the wound bed.  The investigators reported that healing of chronic wounds progresses faster in skin where healthy hair follicles exist.

This may be explained by the fact that hair follicles are full of progenitor cells (cells that can transform to other types).  In this study 10 patients with chronic wounds (ulcers) of about 36 cm².  Most wounds were present without complete healing for about 10 years. The researchers implanted 20 hair grafts in an area of 2×2 centimeter.  They also used a similar square of non grafted area as control.

After evaluation of the wound in those two areas it was readily apparent that the area receiving hair implants healed much faster at the 18-week end point.  In this particular case the transplanted area of wound (ulcer) healed significantly better than non transplanted area (27.1% vs. 6.5% ulcer area reduction).  The maximum healing has been noted to be 33.5% vs. 9.7% (transplanted vs. control group) reduction at week four.  In further microscopic evaluation, the investigators noted an increase in several wound healing elements such as epithelialization, neovascularization, and dermal reorganization.

This study demonstrates the amazing role of hair follicle grafting into wound that do not heal normally due to a variety of different causes.  The process of transplanting the wound with hair grafts can be done as an outpatient procedure. This new procedure could improve the life style of many people while reducing the financial burden of treating chronic wounds for the society.

Reference:

Jiménez F et al. A pilot clinical study of hair grafting in chronic leg ulcers, Wound Repair Regen. 2012 Nov-Dec;20(6):806-14

Q:

I had a hair transplant in past and planning to have another one. Part of the scar from the first procedure is often visible on the right side of the back of my head even when my hair is pretty long. It’s just a small section, but during the second procedure would it be possible to minimize its visibility further by transplanting a small amount of hair into that area (not sure if this is safe or not if the grafts are being removed from a nearby area) or through other means?

Stretched Hair Transplant Scar

A:

In order to minimize the visibility, we will do a double-edge trichophytic closure on the donor scar. We generally have more flexibility with our trichophytic closure during the second procedure due to the fact that we now know how aggressive we should be in bringing hair into the scar. The second time around, we know how your body scars and can anticipate what kind of stretching will occur. Going further, in the future we can place hair into the scar if needed with filling the scar with FUE transplant or even use SMP (scalp micropigmentation), which will minimize the visibility of the scar by placing pigments in it. Everything discussed above will be addressed in the future if necessary.  Whether to use FUE or SMP to minimize the visibility of hair transplant scar is discussed in another blog post.

Q:

I started the hair medication finasteride. Will this help stop me losing more hair? I was concerned that if you restored my hairline would I need to do another surgery in years to come if my hair continues to thin and fade behind where the restoration was done? There are many stories on the internet of people that have had multiple surgeries (other doctors) and they are still not satisfied so I just wanted to take the opportunity to gather as much information and ask the appropriate corresponding questions so I can make the most educated decision.

A:

While reviewing your miniaturization study (the microscopic evaluation you had in our office), it indicated that you have some hair loss activity on the top areas of your scalp as well, but it is very minimal. If you continue using medication, your hair loss will range from none to very minimal in the next few years. One hair transplant procedure in combination with medical treatment with Propecia (finasteride) can maintain your look for many years to come.

Q:

Dr. Mohebi,

From some of the hair transplant before and after photos I have seen from various clinic sites it looks like scabbing lasts up to 14 days. I only state this because you and I discussed not needing more than 4 to 6 days max for preliminary recovery from hair transplant surgery. I just want to make sure that I am allowing enough time as I work in a very high profile visible atmosphere.

A:

In some instances, the scabbing after a hair transplantation may stay for periods of up to two weeks or more if left alone. However, US Hair Restoration provides thorough directions on how to wash and treat your hair the day after surgery. We also provide the utensils you will need to do so, such as the proper sponge and shampoo. If washed and maintained properly, you can expect all scabs to be gone in about five to seven days. After about day five or so, it is important to be a bit more aggressive while washing your hair in order to effectively remove the scabs. This will all be discussed further in your post-operative evaluation the day after the procedure.

Losing hair post hair transplant surgery – “Shock Loss”

Q:

Dr. Mohebi,

I am a woman and I had a hair transplant surgery about a month ago.  I noticed a thumb size hair loss on one side around the closed wound on the donor area.  That has been doubled in size over the last few weeks.  Is my hair loss permanent in that area?

A:

Shock loss around the donor area is not an uncommon complication after a hair transplant surgery particularly in hair transplants that require a large number of grafts or when the patient’s scalp is tight.  It is more common among women due to the overall higher strip width to head circumference ratio.

This phenomenon is a type of telogen effluvium that may last a few months, but usually resolves completely with no need to any treatment. Here is additional information on post surgical ‘Shock Loss.’ I really appreciate your question they often help other readers of this blog.

Take Care,

Parsa Mohebi, MD

Q:

Dear Dr Mohebi,

I had a couple of hair transplant surgeries (FUT) in the past (about 12 years ago), and would like to do another surgery now. I have a question regarding the scar line in the back of my head. I obviously have a line now, but what I need to know is if you can use my current scar line as a part of your transplanted hair area, or if you would create a new scar line if I do another surgery? In other words, does a patient like me (who had surgeries before) end up with a new scar line, or does the new line overlap and cover the old line?

A:

Thanks for your question. The old linear hair transplant donor scar should be included in the new strip. That means you should end up with only one scar after your repeat hair transplants. We also perform trichophytic closure whenever we can in strip hair transplant surgeries to help hair grow inside the donor scar. This method allows some hair appear inside the final scar and make the final donor scar blend in with the surrounding skin when the scars matures. If your previous hair transplants were done many years in the past, it is likely that you have not received trichophytic closure. That means the final scar could be even improved comparing to what you currently have. Obviously, there are more individual factors involved in the process of wound healing and scar formation and we cannot always predict the final outcome. However we attempt to minimize the visibility of the hair transplant scar in repeat hair restorations whenever possible.

Shock Loss after Hair Transplant Surgery

Q:

Dr. Mohebi, I am considering an additional hair transplant surgery. With my previous surgery elsewhere, I experienced a good deal of shock loss. This makes me a bit skeptical but I know I need an additional surgery to maintain the image I have now.

Why is shock loss such a problem?

-

A:

Shock loss, is the accelerated hair loss following any stressful event. That stress may be due to emotional or physical trauma. Hair Transplant procedure is not an exception.

Shock loss after a hair transplant surgery was not uncommon in the past. However, today with proper medical treatment, shock loss can be significantly reduced or even eliminated. Using finasteride or Propecia around the time of hair transplant can inhibit or minimize the risk of shock loss. That is why this treatment is being used by most hair transplant surgeons.

At US Hair Restoration centers, most of our patients start a regimen of finasteride several days before their hair transplant surgery and continue the intake six to eight months after their procedure. The combination of medication and surgical hair restoration provides our patients with natural, permanent and proven results.

Parsa Mohebi, MD 

Since the advent of hair transplant surgery, hair transplant surgeons have been challenged to address the scarring that is inevitable from the donor wound in strip hair transplants. Other types of scalp surgeries such as neurological surgeries can also leave linear type scars in the scalp.

In addition trauma to the head can leave a person with unwanted scar.  A patient’s natural hair coverage can obscure the visibility of a scar in most cases.  However, proximity to a patient’s hairline and or wearing the hair too short can make a scar more obvious.

A hair transplant surgeon can easily repair or camouflage most scalp scars.  The variations in a scar shape, location and size are key factors affecting the techniques that a surgeon will use in the revisioning of the scar. The singular and most important purpose of the scar revisioning is to obscure or minimize its appearance to the naked eye. Scar revisioning is not merely cosmetic. Disfigurement from scarring often affects a person’s sense of well being and self worth.  Do to the inherent nature of the work they do cosmetic surgeons are at the forefront of minimizing the appearance of scars. We have developed an algorithm utilized in hair restoration and other surgical cosmetic practices that effectively meets the challenge of scarring from these procedures. Many of the same techniques are also employed in addressing scalp scarring from trauma and scalp surgical procedures.

Medical excellence is predicated on examination. Physically examining the scar is essential in determining what proportion of scar visibility is due to stretching, hypertrophic reaction and or hair transaction.

A scar that is wider than expected gives evidence that some level of stretching has occurred. Skin that is stretched typically has a contrasting color to neighboring skin. Minimizing this contrast is one of the key approaches to reducing this type of scar. Hair transplant surgeon can reduce the contrast by bringing hair inside the scar by a variety of techniques to minimize the contrast between the hair bearing scalp and non-hair bearing scar. That is done through placing  follicular unit grafts with FUE procedure or by performing trichophytic closure on one or both edges of a scalp scar.  Many people may need more than one hair transplant into their scalp to improve the reduction in visibility of the scar.

Every cosmetic surgeon should be familiar and knowledgeable about the cosmetic products or non-medical methods that could be used to improve scars. When managing a scalp scar, we always consider and discuss with the patients the role of a variety of techniques that might be used solely or in conjunction with surgical procedures for further improving appearance of scars. Some of these are; microfibers, foundations, and coloring agents for skin and hair or tattooing of scalp.

If you are suffering from a scalp scar, you need to find a good hair transplant surgeon with plenty of experience with treatment of scalp scars.  A simple consultation would make the overall plan clear.  The plan may include a surgical procedure, using cosmetics for hair and scalp and hair style changes.

Q.

Dr Mohebi,

I hope you are well. As we get closer to my surgical date I have put together some questions for you.

I have been reading a lot on the hair restoration network and found this 1 individual called Megatron with a similar makeup to myself.

I have looked at his very detailed journal and find many similarities to myself. Because of this I have several concerns.

If you look through his journal you will notice that he has a similar hair type to myself. It appears he got acne throughout the donor and recipient area that looks horrible at about 2 months after hair transplant and continued for several months. I was very prone to acne as a child and as I mentioned in our consultation I have incredibly sensitive skin and very thin tissue. If I went to a spa and received a facial not only would my face become very red and inflamed but the benefit of the facial would not be realized for sometime due to the fact that I would most certainly get a breakout the following day. Seems like my skin does not like to be touched, squeezed etc. It also appears that he was treated for several infections around the 2 month mark as well which may have affected or increased his shock loss.

I am also concerned about the level of shock loss that he had. What are the common reasons for this and is there a way to minimize this other that the propecia you have already prescribed? It appears as if he lost a good portion of the density at about 2-3 months in the recipient area. I am not sure if I am ready to go through that even for the greater good. I understand that everyone is different and will react differently to the surgery. I have always been on the side of having the most and weirdest reactions to everything that messes with my bodies natural makeup!

When would you say that a return to normal sleeping patterns is likely?

I am not sure if this can be considered a random case of cold feet but I just wanted to get some additional reassurance from you prior to finalizing everything today

A:

It is great to hear from you. I will be answering your questions in the order you asked:

1.      What is generally seen a few months after a hair transplant procedure in some individuals is called folliculitis. This happens due to an accumulation of sebum, oily secretions, of the hair follicles.  They are not seen in every patient and do not generally have to do with having a history of acne in the past.

2.      Having sensitive skin may indicate more swelling and redness for the first few days after surgery, but this might be controllable with steroids that we already give to most patients.

3.      Shock loss is most often seen in the areas where you have significant miniaturization, which in your case we know exists based on our microscopic evaluation.  However, we recommend using finasteride after your hair transplant for a few months to minimize the shock loss.

4.      You may want to add minoxidil after hair transplant to the finasteride, to minimize the risk of shock loss even further.

5.      You can go back to your normal sleeping pattern after the 4th day after hair transplantation. Within the first four days you need to sleep in semi-sitting position, but there is no problem with putting pressure on the closed donor area.

In closing, be aware it is normal to have some level of anxiety before any type of procedure.  Please contact me if you have any other questions.

Q:

Hi Dr. Mohebi,
I saw on Channel 4 News a new type of hair restoration called the Fleming/Mayers flap method. What is your opinion on this procedure vs FUT?

A:

The Fleming/Mayer Flap method used to be one of the more solid options for treatment of frontal hair loss in patterned baldness, but with today’s more advanced methods of microscopic follicular unit transplantation, flap surgery does not have any place compared to hair restoration surgery. The result is unnatural, causing an awkward hair angle and unusually high density in the narrow strip at the front. There is an exposed linear scar on the front of your hairline.

There might be some occasions when the flap surgery might be beneficial, but for a routine patterned hair loss hair, restoration it is not recommended anymore. In fact, we do repair the scar of the patients who had a flap surgery in the past and create a transitional zone consisting of single and double hair grafts in front of the flap (this is only possible if the flap is placed high enough). Unfortunately in cases that the flap is not high enough we cannot do much to repair them and at times we have to remove some hair from the flap area to thin it out and make it look more normal.