Hair Restoration Blog

In a standard hair transplant procedure (follicular unit transplant through strip technique), having adequate scalp laxity is crucial to avoid complications in the donor area. Doing so has required the individual judgment of an experienced hair transplant surgeon but still leaves room for human error. If the surgeon removes too wide of a strip, there may be issues with wound closure, a visible wide scar, telogen effluvium (hair loss around donor wound), and/or skin necrosis. Areas around the scalp most at risk are the mastoids or the area behind ears.

Laxometer has been designed to minimize hair transplant complications (in 15th annual meeting of International Society of Hair Restoration Surgery) by helping assess scalp laxity more accurately prior to a hair transplant procedure. After the first assessment, the patient then practices the scalp exercise to increase mobility and is then reassessed the day of surgery. The more laxity the patient has the higher the chances of increasing the number of grafts that can be transplanted in a single hair transplant.

We performed a study on 37 different patients to assess the success and functionality of laxometer. In all of these patients, half of the donor wound was closed during the procedure to evaluate the impact of donor excision on the laxity of the donor area. Three (3) locations of donor area were assessed before and after incisions were made:

I.    Right side
II.    Mid line
III.    Left Side

The laxity of the sides were measured approximately 10-15cm above the mastoid bone from the midline. The incision was made using a double bladed knife to insure uniformity.

After excising the first half of the strip, laxity was measured on the secondary section prior to full incision and excision. If laxity has been compromised due to the first excision and closure, then the second incision will be smaller. Out of the 37 patients that underwent follicular unit transplantation through strip technique, only six (6) patients required a smaller incision due to a lesser laxometer reading caused by reduction of laxity. Our study shows that wound tension:

I.    May increase on the secondary side in some patients (~16% chance)
II.    May not be an issue in most patients (~84% chance)

Laxometer helps determine scalp laxity before, during, and after a hair transplant procedure for optimal excision and closure. It helps determine the maximum amount of tissue that can be excised safely helping increase the chance of more grafts that can used a single session. This practice is best applied on patients undergoing a mega-session hair restoration in which over 2500 grafts are being transplanted in one hair transplant session.

Mega session hair transplant surgery has been around for almost a decade since Dr. Rassman and others started doing bigger and bigger sessions. Before 1993 all could be done was less than 1000 and occasionally 1500 grafts per each session. Using newer techniques and larger team of experienced technicians, we at US Hair Restoration are currently performing large sessions on a regular basis.

Not all physician teams are equal. If a doctor routinely performs sessions in over 2500 graft size, then it would be safe to assume that this doctor has mastered the skills required for large session. Unfortunately, not all doctors have either the teams or the skills to accomplish the feat on a routine basis. Limiting the size of the session to under 2000 grafts, it may take more surgical sessions to accomplish the same goal as when twice the number is transplanted.

Many factors should come together for a megasession hair transplant surgery. First, the surgical team must be trained in doing large sessions with fast, efficient cutting and placing. The following points must be available for the surgery to be successful. The sessions should not take more than eight to ten hours, for more than that, the grafts that are out of the body awaiting placement produces reduced graft growth. Hair transplant surgeon should keep a larger team of technicians to help reducing the time of surgery.

The surgeon must know the nuances of prolonged anesthesia without increasing the risks to the patient. The patient’s scalp laxity must be very loose so that a wide strip can be taken safely (often these strips measure greater than 2cm in width and 22cm in length). The patient’s density must be high (50% higher than normal densities). Large sessions might carry increased risk of swelling and redness after surgery, but overall are not more risky than smaller sessions, but the above criteria must be bet or the yield would not be there. At US Hair Restoration, we offer megasessions to patients with extensive baldness with good donor quality with excellent results.