Hair Restoration Blog

Q:

Is my donor area thick enough and did I have any signs of miniaturization there? Most men I have seen that are bald on top have a much thicker back area of their hair that is not affected by mpb than I do. From your experience and knowledge is it good enough not only to be used as a donor now, but also in the future if I need to cover crown or do any other procedure. It seems to me that my hair is too thin in the back to conceal a scar and that it might possibly thin out a lot when im older. But I’m not a professional so please give me your opinion and insight. The scars all look thin enough for contentment but its when you dont have hair growing around it making it look like someone scrapped a bald line in the back of your head with a hair cutting tool.

A:

When I reviewed your microscopic exam I found it to shows you have only 10% miniaturization in that particular area.  Less than 20% hair miniaturization measurement is within normal range for someone with male pattern baldness (MPB). As we discussed before, if you keep your hair the same length as during your consultation, you should not be able to see the scar. We perform double edged trichophytic closure for most patients which minimizes the visibility of a scar even when you decide to keep your hair very short.

Q:

Hello,
I wanted to get more information like FUE transplantation vs. FUSS. I have been doing a lot of reading. How do you know if one is best and using a FOX test? I like the idea of the FUE but hear many claims that it is not good. However, I am not a big fan of getting a piece of my skin taken off. There is so much different information. Also all the normal questions that come with the procedure. I hope to hear from you.

Thank you for taking the time to read this,

A:

Great question! I realize that there is so much conflicting information on the Internet, especially relating to new technology and surgical techniques.

Follicular Unit Extraction (FUE) is a method we use to remove hair follicular units individually rather than taking a strip of the scalp and dissecting it into follicular units.

The truth of the matter is, there are many hair restoration centers which may promote one method vs. the other, strictly because they are capable performing it. They may lean towards recommending one particular one as oppose to another.

If performed correctly, FUE transplantation is a great solution for some hair loss sufferers, especially those with minimum hair loss or those avoiding a scar on their scalp. We also use FUE for people who suffer from significant pain or donor complications with previous strip procedure, and those with violated donor area for which removing more hair through strip is impossible.

With that said, most of hair transplant surgeries are still done through strip for many reasons:

• Strip hair transplantation gives liberty to the surgeon to maximize the quality and viability of the hair follicles. We anticipate some number between 1-5% as the highest for a trans-section of hair follicles in microscopic strip hair transplantation. This is because the grafts are all harvested under 3-D magnifications with stereotactic microscope.
• In FUE cases patients may have a high trans-section rate, meaning that some of the grafts are cut or damaged in the process of graft harvesting and may never grow into healthy hair. The trans-section rate might be very low in most people, with an average of 0 to 10%. However, in some people it might be significantly higher based on their hair’s characteristics. FOX test that should be done in for some people with curly hair, the FOX test can determine the patients who are not good candidates for FUE procedure. It is basically a small FUE transplant that determines the levels of a trans-section.
• In FUE Transplantation, we can harvest –up to 2000 grafts in one session. Sessions larger than that keep hair grafts outside of body for a long period of time that may jeopardize the grafts’ survival.
• These days, we have several methods, such as trichophytic closure, to minimize the visibility of the hair transplant scar.
• The cost of FUE is higher since it is more labor intensive.

I highly recommend having an evaluation by a hair transplant surgeon who is skilled in both FUE transplantation and strip method before you decide which procedure is right for you. A qualified hair transplant surgeon can discuss all your options so you can make an informed decision.

Q:

Hi Doctor,

I am a class VI hair loss patient and have had one hair transplant in the past to get some thin hair on the front and top.  I am keeping my hair very short on the back and my primary goal was to camouflage the scar in the back of my head from previous hair transplants. So far, I have achieved this simply with longer hair, and the rest of my scalp was covered with Toppik-like products.

Cosmetically, it was successful, but usage of this kind of product is a bit messy and cumbersome. Thus I have shaved my head completely to try a different route. With the help of tattooing, I was going to go for a shaved head. Of course, the scar is a show-stopper and I need to consider my options. What I would consider successful is this: short hair covering my head completely, even with relatively light density. Combined with tattooing and a self-tanner to reduce contrast, that would be a success to me. I am not “greedy” about the sides at the front, and will accept a 3 or 3A pattern.

Is it possible in my case?

A:

It is good that you are not after high density and that you are realistic about the final appearance of your hair.  Being a class VI with limited donor hair, it should be possible to create some light density in the large balding area, but obtaining more density would be impossible or difficult due to your insufficient donor.  You need to know what your priorities are and how many surgeries you are committed to have.

• If you only need to revise the scar and get trichophytic closure to minimize the visibility of the scar, one surgery is adequate.  Double edged trichophytic closure is a new technique that can improve the appearance of the scar tremendosly.
• If you are after achieving higher densities and scar revision, you may need several hair transplant procedures if you have enough donor for them.

Through a consultation with an experienced hair transplant doctor, your donor hair can be easily evaluated and that can give you a good idea about what could be expected (in your case).

Q:

Hey there, doc,

It’s been about three weeks since my second hair transplant in Los Angeles. As of this moment, when I bend my neck, there’s a tightness and tension on the back of my head (donor area). Can you tell me if this tightness will ever go away and be back to the way it was before my operation? I really want to be back in the gym doing my jump ropes and abs.

A:

I’d say to give it about three weeks and begin more gentle activities such as jogging, brisk walking, bike riding, or push-ups. As long as you don’t stretch that donor area by looking down (this is important), you ought to be OK.

Activities to stay away from four to six weeks after a hair transplant: wrestling, flag football, basketball, boxing, abs exercises, and surfing or boogie boarding. Make sure there isn’t much strain on the donor area. It’s sensitive and requires protection and non-contact to heal.

Remember: Activities which increase tension between the edges of the healing wound in the donor area, such as lifting barbells or weights and other exercises involving intense bending of the neck are to be avoided. You should wait at least six months for this type of exercise in order to prevent reopening of the wound or stretching and widening of the donor scar.

Over the last few decades, different therapies which effect wound repair have been proposed. The connection between wound healing and hair growth was already proposed by Dr. Catsarelis at the University of Pennsylvania through the WNT pathway (some molecular process that controls would healing and hair growth). Now, we review the emerging fields of gene and stem cell therapy in hair restoration and wound healing.

Gene therapy, initially developed for treatment of congenital defects, is a new option for enhancing wound repair. In order to accelerate wound closure, genes encoded for growth factors or cytokines showed the greatest potential.

The majority of gene delivery systems are based on viral transfection (intentionally contaminating the host cells with a particular virus that insert the desired gene to the target cells), naked DNA application, high pressure injection, or liposomal vectors, etc. Embryonic and adult stem cells have a prolonged self-renewal capacity with the ability to differentiate into various tissue types. A variety of sources, such as bone marrow, peripheral blood, umbilical cord blood, adipose tissue, skin and hair follicles, have been utilized to isolate stem cells to accelerate the healing response of acute and chronic wounds.

Recently, the combination of gene and stem cell therapy has emerged as a promising approach for treatment of chronic and acute wounds. This is good news for prospective hair loss patients: the idea that similar gene therapy techniques can be used to affect the baldness gene by switching the hair loss gene off and on.

This new study was done by Branski et al. at the Department of Surgery, The University of Texas Medical Branch and Shriners Hospitals for Children.