How to Stop Hair Loss and Regrow it

For a man of Brad Pitt’s fame and age, his never-changing hairline remains something of a curiosity. Unlike many of his celebrity contemporaries, Pitt’s hair has remained thick and healthy without any apparent need for transplant operations. Does he have a miraculously resilient hair line, or has he managed to head off hair loss before it became noticeable?

For men approaching 50 years of age, as Pitt himself is, there is a 50-50 chance that they will have experienced some form of a hair loss, whether it be a receding hair line or thinning of the vertex. Certain health conditions or events increase the likelihood of hair being shed and in the case of Brad Pitt it is highly likely that he has experienced at least some of these.

Pitt has been photographed leaving a skin spa earlier this week showing clear signs of ageing, walking with a stick and sporting a greying beard. His hair though looks the same as always, thick, full and long.

So how has he managed to keep his hair so healthy? Or indeed at all?

Some celebrities, like Wayne Rooney, have had high profile hair transplant surgery to correct bald patches and thinning hairlines. Allowing your hair to thin to a level where a transplant is required can cost as much as £30,000 + as it did in Rooney’s case. What’s more, there is no guarantee that such surgery will be a success and preventative treatments are compulsory after having had a hair transplant to maintain the rest of the hair, so why not prevent the problem before it gets to this stage?

Men who observe hair loss early on and seek specially formulated, licensed and proven hair loss treatments can often regrow the lost locks before anyone notices and with minimal expense. If Brad Pitt has ever experienced thinning hair, then it’s most likely he has done the clever thing and undertaken the right kind of treatment to correct the loss before the paparazzi could get hold of the story.

Men who find that they have patchy hair loss or thinning hair at the temple and crown have a number of treatment options open to them with a high degree of regrowth success. Medications such as Propecia or Minoxdil are not only clinically approved by the health regulators on both sides of the Atlantic (the MHRA and FDA), but are also proven to prevent further hair loss and encourage regrowth. Using specially formulated versions of one or more of these treatments, along with the right hair growth boosters suited to the individual’s condition and pattern of hair loss, will ensure hair loss can be stopped and hair regrown in the great majority of cases.

The genius of this course of action is that hair can be regrown before the loss becomes noticeable. And if no one ever notices the initial hair loss, it is quite possible to maintain the appearance of always having had a full head of hair – just like Mr Pitt.

The Belgravia Centre has a long list of a-list celebrity patients that have never hit the tabloids for reasons of excessive hair loss because they have acted at the right time.

The Belgravia Centre takes the confidentiality of its clients extremely seriously, always ensuring anonymity and acting to protect their identities and hair loss treatments at all costs. Any client, male or female, can be completely confident of receiving the exact hair loss treatment they need without having to tell anyone about their hair health concerns. View the world’s largest collection of hair loss success stories to see what kind of results are so likely with our treatment programmes. All of the patients featured have of course consented to us using their comments and before/during treatment photos.

For clients who cannot attend our Victoria-based premises, we also offer an online diagnostic form and home treatment option. People electing to take this route are able to treat themselves in the comfort of their own home.

The Belgravia Centre is the UK’s leading hair loss clinic, but thanks to our postal prescription service we also serve clients across the world. But if you are able to visit our London centre for a free consultation, which is always advised, please call our helpline on 0800 077 6666 or message the centre.

So whether an A list celebrity or simply a concerned citizen, The Belgravia Centre have a range of treatment options available to meet their specific needs. We strongly recommend that men and women contact our hair specialists as soon as they notice increased shedding – we can then create a treatment plan to suit you. The quicker a diagnosis is provided and treatment begun, the less likely hair loss is to become noticed.

Whatever the degree of hair loss experienced, contact us today to arrange a free, no obligation appointment with one of hair loss experts to start treatment and the recovery of your hairline – before it becomes headline news.

 

Hair restoration surgeon Dr. Michael Beehner is recommended by the Hair Transplant Network. To view this discussion and other hair loss topics, visit our Hair Loss Social Community and Discussion Forums,

I am 29 years old and have been using Propecia (finasteride) for 3 years, Rogaine (minoxidil) for 3 years and had one hair transplant in the corners of hairline (temples?) of 1800 grafts 1 year ago. (See photo below)

Based on my photo, how many grafts do you think it might take to fully restore my crown? Who is the best crown doctor in your opinion? My donor is dense, hair is wavy, and hair diameter in thick (Spanish ancestors). No one in my family is slick bald. The only person with thinner hair is my mom’s dad but his crown is better than mine and he’s 65. My dad and his dad have Elvis hair.

I think, at the age of 29, it would be a mistake to transplant your entire crown area, especially using maximal density, which I am sure is what you probably would want.

In looking at your “top-down” photo, I can see obvious thinning in a 9-10cm diameter circular area in back. At 29, you likely have 50 years of life ahead of you in which male pattern baldness is going to progress. And unfortunately, the square area of the crown/vertex does not increase in a linear fashion, but rather in a logarithmic way.

The great majority of men at your age with your degree of hair loss do, in fact, eventually go on to the classical U-shape of a Norwood VI pattern. With such a future likely, the top of your head will always be the number one priority to save donor hair for. You mentioned that you have already had some work done in the front. I have seen at least a dozen men over the years who had the crowns filled in when they were younger, and who came to see me 10-20 years later with a 1-2 inch wide “halo” of bald skin around the dense hair in the center, giving it the appearance of a “bulls-eye”. And, unfortunately, this “halo” area couldn’t be filled in because the donor hair supply was exhausted and had shrunk dramatically with the advancing baldness.

One other word of caution is that you have been on medications, which is a good thing and I’m sure you look better now because you have been on them. My hunch is that, if you had not taken medication, you would see quite a bit more balding presently and actually have better insight into what is going to happen in the future. So these treatments, which are great for helping delay the eventual balding pattern, do in fact “mask” what would really be going on now otherwise and thus can make you a little more over-confident now that everything can be filled in densely and cover your bald area for your lifetime. I’m simply saying that, for the great majority of men who are going to eventually be Norwood VI patterns, the center of the crown/vertex is not where you want a bunch of dense hair.

Two final points: For many men your age with a thinning crown, I will fill in whatever is on the horizontal plane, which often is almost 80% of the circular crown area, as seen from that top view, but I preserve a concave curve at the rear of this transplanting (as seen from the back), so that if the “bottom drops out” with a large area of balding beneath it, I am not committed to chasing after it.

The final point is that I think, at 29, some light coverage with low density 1-hair and 2-hair follicular units is okay to do at this time in your entire crown because that will never look freakish later should you bald to a Norwood VII or advanced VI, and it doesn’t take that much donor hair to likewise transplant in a similar fashion to the area in which baldness advances.

My cutoff for transplanting the rear vertex is 35 years of age. After that, I feel it is possible to make a pretty good assessment of where a given male is heading and being able to see if there is a comfortable “cushion” of donor hair available so that the top and the vertex can both be filled in.

As always, the goal is to be as helpful as possible for the patient, but not to create short-term happiness now and misery and deformity later in life.

Dr. Mike Beehner, M.D.

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

 

Each year, Phoenix Magazine publishes its list of top physicians from more than 50 fields of practice. This year, hair restoration was added to the list of specialties.  We are pleased to announce Dr. Shelly Friedman was selected as Phoenix, Arizona’s #1 Hair Transplant Surgeon for 2011. Dr. Friedman is also recommended on the Hair Transplant Network.

Only a select number of physicians are chosen for this honor each year. Phoenix Magazine nominates physicians for this honor through a peer-review survey.  This includes randomly surveying 5,000 physicians from around the Phoenix area, including M.D.s (medical doctors), D.O.s (osteopathic doctors) and N.D.s/N.M.Ds (naturopathic doctors). The surveys asks physicians to nominate doctors who, in their judgment, are the best in their fields and related ones. Physicians must be board-certified in their respective fields to qualify.

Dr. Friedman has been performing hair transplant surgery as the primary part of his practice for over 25 years and is the Founding President of the American Board of Hair Restoration Surgery (ABHRS), the certifying board for hair transplant surgeons.

Just as the hair transplant industry has evolved significantly since it began, so has Dr. Friedman’s technique. Dr. Friedman and his dedicated full time staff averaging 9 years of experience have the ability and experience to perform larger, densely packed sessions of high quality follicular unit hair transplantation exceeding 2500 grafts when appropriate for the patient.

Balding men and women seeking a solution to hair loss in Arizona and beyond are encouraged to consider Dr. Shelly Friedman. To join us in congratulating Dr. Friedman on his recent honor, please add your comments to the following discussion thread on our Hair Restoration Forum, Dr. Shelly Friedman is Named Phoenix’s Top Hair Restoration Surgeon of 2011,

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

 

Each year, Baltimore Magazine publishes a list of top physicians in the region from more than 101 specialties. We are pleased to announce that, this year, Coalition member Dr. James Vogel was named by his peers as one of the city’s top General Plastic Surgeons of 2011.

Dr. Vogel is very involved in contributing to his profession and sharing hair restoration techniques with his peers. He is the past president of the International Society of Hair Restoration Surgery (ISHRS) and was the chairman of the scientific committee from 1993 to 1999. He remains actively involved in lecturing and writing with many surgical societies and professional organizations.

Adding to his list of accomplishments, Dr. Vogel has recently been asked by The Aesthetic Surgery Journal to serve as their international section editor on hair transplants. The Aesthetic Surgery Journal is the official journal of The International Society for Aesthetic Plastic Surgery.

Dr. James Vogel is a highly respected member of the Coalition of Independent Hair Restoration Physicians and recommended on the Hair Transplant Network. To learn more about Dr. Vogel and his ultra-refined follicular unit hair transplant procedure, click here to view his Coalition profile on the Hair Loss Learning Center.

Please join us in congratulating Dr. Vogel by clicking here and adding your comments to the discussion on our popular Hair Loss Forum.

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

 

This hair loss question was posted directly to Dr. Raymond Konior of Chicago, IL, who is a member of the Coalition of Independent Hair Restoration Physicians. See his professional answer below.

How much pain you feel during suture removal? Any tips one can use to minimize pain during/before the removal procedure?

Hair transplant patients with highly sensitive skin can purchase LMX Topical Anesthetic Cream and apply it over the suture line 30-45 minutes prior to the suture removal. I prefer that the area be cleaned prior to application so as to facilitate absorption into the local skin region. This cream will numb the superficial skin and make the suture removal process more comfortable.

Dr. Raymond Konior

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

 

This insightful hair loss information was posted on our Hair Restoration Social Community and Discussion Forums: by Dr. Jerry Cooley of Charlotte, NC who is a member of the Coalition of Independent Hair Restoration Physicians.

I hair restoration doctors talk about transplanting the crown border (I am talking about sides and not the bottom of the crown) with less density than the middle of the crown. When I get my crown fixed eventually as it is not all that bad yet, I feel that the center crown would not be all that important to me but rather the outside/sides of the crown would need more density to properly frame the head when viewing from the side. I know the crown side border typically is less dense even in non-balding men so maybe this is the reason?

It is complicated because there are many factors for the hair transplant surgeon to consider including the patient’s age, hair characteristics, current baldness, rate of hair loss, whether they are on Propecia finasteride, donor supply, etc. The goal is to produce not only a look that satisfies the patient in the short term, but also one that will stand up over time. It is best to be evaluated in person to get an individualized recommendation for you.

Dr. Jerry Cooley

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

 

Recently, Coalition member and highly acclaimed hair restoration surgeon Dr. Bessam Farjo of Manchester, United Kingdom was interviewed by the Times of India for a lifestyle article about hair loss.  Topics discussed include advancements made in hair loss research, state of the art hair transplant surgery and hair multiplication (cloning). In the article, Dr. Farjo discusses why he chose to specialize in hair restoration and his role in shaping its future through the ongoing research and development of new techniques.

Dr. Bessam Farjo has a long history of performing state of the art, ultra-refined follicular unit hair transplantation with outstanding results. Along with his wife and colleague, Dr. Nilofer Farjo, he founded the Farjo Medical Centre in 1992. Since that time, the Farjo Clinic has become the UK’s premier center for surgical hair restoration, medical hair loss treatment and research.

Dr. Bessam and Nilofer Farjo are both highly esteemed members of the Coalition of Independent Hair Restoration Physicians and recommended by the Hair Transplant Network. To learn about our criteria for recommending physicians, click here.

Click the image below to see the full article.

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

 

This below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by Janna, the lead medical technician for Coalition hair restoration surgeons Dr. Ron Shapiro and Dr. Paul Shapiro.

I’m undergoing a hair transplant procedure in the near future, and I’m wondering if I should get a haircut before surgery? Is it best to “shave” my head? How short should it be cut?

 I think it’s a good idea to cut your hair short but not shaved so that it’ll match with the post-operative shaved top.

The sides and back just need to be long enough to cover over the staples/sutures (in follicular unit transplantation/FUT cases). The ideal length will vary from patient to patient depending on their density in the back and sides. We have a hair stylist onsite,  so many of our patients get a trim to match up the sides to the top a day or two after surgery. 

Janna

Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

 

With her angelic face, unattainable physique and signature, flowing blonde locks, Mattel’s Barbie has epitomized the American standard of beauty and glamor since her “birth” in 1959. But, if one group has its way, at least one aspect of Barbie’s iconic look will receive a makeover this year. A grassroots movement born in the age of social media has created a Facebook page petitioning the toy maker to create a bald Barbie to “help young girls who suffer from hair loss due to cancer treatments, Alopecia and Trichotillomania” as well as for those who are having trouble coping with their mother’s hair loss from chemotherapy.

Balding men and women of all ages understand the psychological effects of hair loss. Those suffering from androgenic alopecia or one of the many non-genetic causes know the feelings of helplessness and loss of self-esteem that can accompany thinning hair. But, this pales when compared to a child who is not only balding but also suffering from an incurable and potentially life-threatening illness.

As a community by and for hair loss sufferers, the Hair Restoration Forum and Social Network is committed to educating balding men and women about effective and proven hair loss treatments and we support the creation of a Bald Barbie. Perhaps we can’t cure cancer but we have a unique opportunity to help alter society’s perception of hair loss and, most importantly, put smiles on the faces of little girls who have forgotten what it’s like to feel like a princess.

To lend your voice to the cause visit their Facebook page.

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

To share ideas with other hair loss sufferers visit the Hair Restoration Social Network and Enhanced Discussion Forum

Get Proven Treatments at the Best Prices by visiting our new Online Hair Loss Treatment Shop.

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Technorati Tags: bald, hair loss, Alopecia, Trichotillomania, Balding, androgenic alopecia, thinning hair, Hair Restoration, hair loss treatments, Bald Barbie

View the original article here

This article was submitted to us for publishing and was partially written by Dr. Carlos Wesley, who is recommended on the Hair Transplant Network. For a complete list of contributors to this article, scroll down to the bottom of this article.

Background

Hair transplantation procedures are used to treat various forms and degrees of permanent alopecia in both men and women. Intact hair follicles may be harvested from within the safe donor area of a patient’s scalp by either strip method or follicular unit extraction (FUE); each harvesting method has unique advantages and disadvantages. The refinement of follicular unit transplanting over the last decade has led to markedly improved hair survival and natural-appearing results.

This article provides a broad overview of the techniques used by various hair transplant surgeons throughout the world. Founded on the principal of donor dominance (ie, hair follicles continue to grow in the new recipient area to which they are introduced as long as they would have in the donor area from which they are extracted), the field of hair restoration surgery (HRS) has evolved considerably since its inception in the 1950s. Natural-appearing results are consistently achievable and reflect a surgeon’s technical skill and artistic creativity.

Indications

Hair transplantation is a surgical procedure used for the correction of androgenic alopecia (AGA), cicatricial (scarring) alopecia, or any form of permanent hair loss in both men and women.[1,2]

Patients should be in good health in order to undergo this form of elective surgery. Appropriate laboratory screening tests include, but are not limited to: complete blood count, serum chemistries, coagulation studies (PT, PTT, INR). It is also common for practices to screen for antibodies to HIV as well as Hepatitis B and C.

Upon initial patient evaluation, the physician must first determine the etiology of the patient’s hair loss. Only after first ruling out 1) systemic causes such as thyroid abnormalities, polycystic ovarian syndrome (PCOS), or iron-deficiency anemia, 2) dermatologic causes that may be treated medically, 3) and telogen effluvium (temporary hair loss that will resolve over a few months’ time), should a surgical approach to hair loss be considered.

Both men and women may be deemed candidates for HRS as long as their donor area (both current and projected) is able to yield a sufficient number of hair follicles to adequately address the projected recipient area (a calculation termed “donor to recipient area ratio”). A family history of hair loss in both the maternal and paternal branches should be investigated and compared with standardized scales of hair loss in women and men (Norwood Pattern, Ludwig Pattern, etc.). Young patients (in their 20s) with a limited hair density in their donor area coupled with a projected Norwood Type VII or greater hair loss, for example, will almost certainly not have an adequate number of permanent “fringe” hair follicle reserve to address the future recipient area and often cannot be considered candidates for the procedure.

Patient Education and Consent

Appropriately aligning patient and physician expectations is critical during the initial evaluation and consultation. Understanding the limits of a patient’s donor hair reserves, their hair characteristics, as well as their goals and motivation for undergoing hair transplantation can best help evaluate and articulate a projected outcome. Establishing this mutual understanding is one of the most effective ways to increase overall patient satisfaction.

Patients should be provided with written information regarding both preoperative and postoperative instructions. After reviewing the patient’s list of medications to rule out any that may adversely interact with anesthesia administered during the procedure, it is important that various medications that may affect bleeding time be discontinued. Aspirin or aspirin-containing products should be discontinued 10 days prior to a session. Nonsteroidal anti-inflammatory drug use should also be halted. Many cosmetic surgeons advise patients to refrain from alcohol consumption or intake of vitamin E and fish oil for 7 days prior to the procedure due to their tendency to increase bleeding.

Pre-Procedure Planning

Patients are advised to wash their hair with any shampoo on the evening prior or morning of the surgery. Once the region within the “safe donor area” (the region within the inferior parietal and inferoposterior scalp in which hair follicles are most likely to remain throughout a patient’s lifetime[3]) has been determined, the hair within that region should be clipped to approximately 1-2 mm in length with either scissors or an electric trimmer.

The donor area and recipient area into which the grafts will be placed should be prepped with a povidone-iodine (Betadine) antiseptic solution. However, scrubbing the recipient and donor areas with 4% chlorhexidine gluconate may be preferable in patients with white or grey hair as the Betadine may temporarily stain light-colored follicles.

The use of perioperative antibiotic use remains controversial in HRS. The decreased risk of wound infection must be weighed against the increased threat of hypersensitivy reaction and the possible emergence of resistant organisms. Prophylactic antibiotic use is most effective when administered 1 hour preoperatively and is not questioned in instances of endocarditis prophylaxis or other precautionary uses.

First-generation cephalosporins are most commonly used preoperatively. When hypersensitivity exists, erythromycin is an effective alternative. These prophylactic oral regimens coupled with topical antibiotic use along the donor wound postoperatively help reduce the already slim risk of infection. Some practices advise patients to continue use of oral and topical antibiotics for 3-5 days postoperatively.

Patient Preparation

Anesthesia

Preoperative analgesic and antianxiolytic medications are often given to patients in oral form prior to the surgery and intravenously throughout the procedure. In addition, local anesthesia is administered slowly and using a fine 30-G needle in order to minimize discomfort.

Local administration of 1-2% lidocaine with 1:100,000 epinephrine along the inferior edge of the clipped donor area provides ample anesthesia while minimizing intraoperative donor wound bleeding.

Local infiltration to create a ring block of anesthesia anterior to the anticipated recipient area remains the most commonly used technique for achieving recipient region anesthesia. Care should be taken in both the donor and recipient areas to limit the lidocaine dose to 7 mg/kg with epinephrine (maximum 500 mg) or 4.5 mg/kg without epinephrine (maximum 300 mg). After 2 hours, the local anesthetic should be reinforced with 0.25%-0.5% bupivacaine with 1:100,000 epinephrine (maximum 200 mg). This lasts approximately 4 hours.

Positioning

The patient should be placed in either a prone position or (less often) a seated position for donor hair follicle removal.

Monitoring & Follow-Up

Many practices employ postoperative compression surgical dressing not only to minimize local edema, but also to reduce the risk of graft dislodgement. Prior to positioning this dressing, surgeons should apply a topical antibiotic ointment, nonstick gauze, Kerlix gauze, and wrapped gauze to establish a turban-like pressure dressing. This dressing is removed on postoperative day 1 when the patient is given instructions related to scalp care.

Corticosteriods may be administered orally (up to 60 mg) followed by a tapered dose in order to reduce postoperative facial edema as well as donor area discomfort. If an intravenous line is established, dexamethasone may be given in doses totaling 12 mg during the procedure. Some surgeons also recommend local adminstration of triamcinolone acetonide 2.5 mg/mL in 0.5% bupivicaine along the inferior donor wound edge or anterior to recipient site created along the hairline to minimize postoperative edema.

Patients may experience postoperative discomfort along the donor wound edge. Typically, this is minimal and lasts only overnight. However, as this discomfort may correspond with edema along the suture line, some patients may require oral narcotics, especially if the pain persists for more than a day or two (rare). Generally, acetominophen with codeine, hydrocodone bitartrate 5 mg/acetaminophen 500 mg (Vicodan), or oxycodone 5 mg/acetaminophen 325 mg (Percocet) are more than sufficient to alleviate postoperative discomfort.

Complications

Complication rates in hair restoration surgery are very uncommon. In one study, they occurred in 4.7% of patients and included enlarged scar (1.2%), folliculitis (1.0%), areas of necrosis in the donor area (0.8%), keloids (0.4%), bleeding (0.2%), hiccups (0.2%), infection (0.2%), and pyogenic granuloma (0.2%).[4] This survey included physicians whose practice was not limited to hair transplantation, where the percentages are higher than those reported elsewhere.[5]

Donor Harvesting

There currently exist two methods of hair follicle harvesting: follicular unit transplantation (strip harvesting) and follicular unit extraction (FUE). Both possess unique advantages and disadvantages. Regardless of which method is employed, the importance of extracting hair follicles from within the safe donor area (see the image below) remains paramount.

Safe donor area. The shaded region represents the zone from which the highest percentage of hair follicles are most likely to persist throughout a patient’s lifetime.

Extracting intact follicles from this area for subsequent transplantation ensures not only that they are the most likely to remain in their new location for the longest period of time, but also that any scar remaining in the area from which they were extracted will be concealed by neighboring hairs for the longest period of time. Maximum follicle survivability is also aided by transplanting only intact hair follicles that are not transected by traumatic extraction. To this end, with either strip or FUE methods, the skin incisions are angled parallel to the hair follicle (rather than simply perpendicular to the scalp itself) to minimize transection.

Strip Harvesting

Within the safe donor area, a strip is excised as an elongated fusiform ellipse of full-thickness scalp using either a single no. 10 or no. 15 blade or a double-bladed scalpel with blades mounted in parallel.

Prior to strip excision, the desired donor region may be infiltrated at a depth of 4-5 mm with sterile saline tumescence in order not only to minimize follicle transection by aligning them more perpendicularly to the skin surface, but also to provide separation between the follicular bed base located within the superficial subcutaneous tissue and the larger nerve plexes and vessels which abound within the deep subcutaneous tissue.

The width of the elliptical strip (generally ranging between 10–15 mm) is determined by the laxity of the patient’s scalp in order to yield the maximum number of grafts while still limiting tension upon closing the edges of the resultant wound with either sutures or skin staples.

Regardless of the number of sessions a patient may undergo throughout his or her lifetime, only a single scar should remain. The scar from any prior session should always be included within the subsequent strip excision.

Follicular Unit Extraction (FUE)

Individual hair follicles or small, naturally occurring groupings of 2-4 follicles (follicular units) may be extracted either manually or with a motorized rotating punch device using FUE. Akin to a cylindrical cookie cutter, the punch incises a 0.8-1.4 mm diameter circular scalp area. The punched-out follicles are then manually extracted with forceps.

FUE has the advantage of not creating a linear scar, therefore shortening recovery time and allowing patients to wear their hair shorter in the donor area after the procedure. However, this method results in numerous hypopigmented punctate scars within the donor area. It may result in increased follicle transection rates (which reduce graft hair survivability), and it is more time consuming for the patient and physician.

Furthermore, as each individual follicle extracted must be separated by three or more intact neighboring follicles so as not to create a uniformly alopecic donor area, the risk of needing to harvest follicles from a larger surface area that extends beyond the limits of the safe donor area is heightened (click image below to enlarge).

The safe donor area in follicular unit extraction. The safe donor area (shaded region) is superimposed with a markedly broadened zone from which hair follicles were extracted via follicular unit extraction. Harvest follicles outside the limits of the safe donor area may lead to exposed scars and subsequent transplantation of non-permanent hair.

Over time, as the fringe hair beyond the safe donor area is lost, the punctate scars may be exposed and transplanted follicles harvested from this fringe area may disappear.

Creating and Dissecting Grafts (Follicular Unit Transplantation)

After either method of harvesting (though to a much lesser extent with FUE), the follicular units obtained must be trimmed under microscopic visualization using a razor blade (click image below to enlarge).

The graft dissection process. Hair follicles within the donor region of the scalp generally exist in clusters of one to four shafts of hair (above). Under microscopic visualization, these naturally occurring follicles are dissected out from the strip excised during harvesting (middle) in order to produce intact follicular units.

In follicular unit transplantation (FUT), only hair follicles separated into their naturally occurring clusters of 1-4 (or more) hairs are transplanted, rather than large grafts containing multiple (3 or more) follicular units. The average naturally occurring follicular unit contains approximately 2.3 hairs.

Resultant grafts should retain a pear shape in which the epidermis has been maximally trimmed while the dermal and subcutaneous tissue surrounding the follicle isthmus and inferior portion remains (click image below to enlarge).

Two methods of hair follicle harvesting (follicular unit extraction and strip harvesting) tend to result in follicular units of slightly different quality. In general, follicular units harvested via the strip method possess more subcutaneous tissue around the hair follicle bulb. This may aid in protecting the follicular units from dessication and mechanical trauma during follicular unit placement.

This optimal micrograft shape is frequently achieved after strip harvesting, but rarely from FUE. The cushioning provided by the intact surrounding tissue helps maximize graft viability by minimizing desiccation during pre-insertion storage and mechanical trauma to the follicle from handling.

Creating Recipient Sites

Various techniques are utilized to create and prepare recipient sites for subsequent transplantation of follicular units. With each method, the critical element of following the angle and direction at which the hair follicle exits the scalp results in the least damage to existing hairs and the most natural-appearing transplanted hair.

The most widely accepted density of recipient site creation distributes 30 follicular units per square centimeter. Some practitioners advocate for dense packing of more than 40 follicular units per square centimeter. However, the viability of grafts may be compromised as competition for a limited blood supply increases.

Various techniques exist for recipient site creation and graft insertion. Blades may be cut to match the size of the follicular units to be inserted. Hypodermic needles (18-21 gauge) may be used to make incisions for subsequent graft placement. Recipient site size increases as the surgeon moves posteriorly away from the hairline and the priority shifts from single, fine-caliber hairs to multiple and higher-caliber follicular units.

A stick-and-place technique can be employed to virtually eliminate the time between which the recipient site is made and the graft is placed within it.

A spread-and-place technique minimizes mechanical trauma from graft handling as the graft is placed into a smaller recipient site.

Graft Insertion

Jeweler forceps or similar non-toothed forceps are generally used to gently place the grafts into recipient sites. Transplanted hair follicle viability is maximized by minimizing mechanical trauma to the follicle. This is accomplished by handling the subcutaneous tissue along the base of the graft rather than the graft itself. Furthermore, some implantation devices exist that allow for near-simultaneous recipient site creation and hair follicle insertion.[6]

References

Unger WU, Unger RH, and Wesley CK. Lebwohl et al. Androgenetic Alopecia Treatment of Skin Disease, 3E. 2008:36-38.Unger W, Unger R, Wesley C. The surgical treatment of cicatricial alopecia. Dermatol Ther. Jul-Aug 2008;21(4):295-311. [Medline].Unger WP. Delineating the “safe” donor area for hair transplanting. Am J Cosmetic Surg. 1994;239-243.Salanitri S, Goncalves AJ, Helene A Jr, Lopes FH. Surgical complications in hair transplantation: a series of 533 procedures. Aesthet Surg J. Jan-Feb 2009;29(1):72-6. [Medline].Knudsen RG, Unger M. Unger W, Shapiro R, Unger R, Unger M. Hair Transplantation. 5th Ed. New York: Marcel Dekker; 2011:419-422.Kim JC. Unger W, Shapiro R, Unger R, Unger M. Hair Transplantation. 5th Ed. New York: Marcel Dekker; 2011:404-6.

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

 

This question comes from a member of our Hair Loss Social Community and Discussion Forums: 

I recently underwent hair transplant surgery (follicular unit transplantation) and I’m wondering if I’ll experience any sort of additional hair loss from the procedure? Additionally, how soon, after the hair transplant procedure, can I shave my head?

Shedding of native hair after hair transplant surgery is generally called “shock loss,” and although it can take anywhere from 3-5 months for this hair to come back, it should all regrow.

Secondly, by day 10 (anywhere between day 7-10) the newly implanted grafts will be completely “anchored” and resuming normal grooming activity (within reason) should be fine (though you need to keep post-operative tenderness and scalp overuse in mind).

However, I did want to mention that all hair restoration clinics have unique post-operative instructions, and you should definitely run these questions by the operating clinic before fully committing to any set plan.
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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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Hair loss is frightening, and dealing with it can lead to stress, panicky decisions, humiliation and depression.  Hair loss is a problem and many people want to find solutions.  Hair loss may occur as a side effect of chemotherapy drugs and as a result of radiation to the head. Hair loss can occur at the scalp, body, face, underarms and pubic hair area, depending on the type and amount of chemotherapy drug or area of radiation.  Hair loss affects a large part of the population.  Hair loss has afflicted mankind since time immemorial.  Hair Loss can occur as a result of Lysine deficiency.  Hair loss research and development continues at a steady pace.  Hair loss treatment has a huge role to play in the overall restoration of your hair scalp. A good hair loss treatment can contribute excellent results.  Hair loss is generally confined to the flanks this is the area on the sides of a pet just ahead of the rear legs.  Hair loss from chemotherapy or radiation therapy isn't just upsetting; it can be a nuisance and uncomfortable to boot.  Hair loss causes  are a quite controversial issue as there is no general agreement about what are the main factors that cause loss of hair.  Hair loss is a common condition that affects many men as well as women.  Hair loss (also called alopecia) is a potential side effect of chemotherapy and radiation therapy.  Hair loss,  if not checked on time, can often permanently impede looks and destroy self confidence, qualities one cannot do without in today's competitive and appearance judgment world. Rather than waste time and money on hair treatments which do not work or have side effects, try  Saini Herbal Scalp & Hair Conditioner .  Hair loss is a common problem that is faced by individuals today.  Hair loss is a normal part of aging.  Hair loss prevention is also achievable through the herbal route, though these systems have not seen sufficient study.  Hair loss can be achieved voluntarily or involuntarily.  Hair loss , either temporary or permanent, may occur for a variety of reasons.  Hair loss can also be caused by burns, X-rays, scalp injuries and exposure to certain chemicals -- including those used to purify swimming pools and to bleach, dye and perm hair.  Hair loss is very  common in women, more common than one would imagine.

Treatment can control outbreaks and possibly help prevent the spread of infection.  It can be accomplished with antifungal shampoos, dips, and/or ointments depending on the location of the affected areas.  It is highly variable depending on the type of IBD. Oftentimes dietary management alone is adequate.  It might be repeated every few months.  Treatment is aimed at stopping the local reaction. 

Treatment is based on underlying cause.  It is difficult, but preventive measures are available.  It is usually topical cortisone, and 3050% of people recover within 1 year.  It is usually with an oral fungal medicine, though topical lamisil cream can be tried at first.  Treatment is to treat the primary condition and keep the lesions clean and dry. 

Treatment is surgical in most cases and mortality is high.

Hair loss is very  common in women, more common than one would imagine.  It may involve hair all over your body, including your eyebrows, eyelashes, and pubic hair.  It may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area.  It can occur as a result of Arginine deficiency.  Hair loss can occur as a result of Silicon deficiency - Silicon supplementation can accelerate the growth of Hair.

Hair loss may occur if male or female hormones, known as androgens and estrogens, are out of balance.  It is a multifactorial problem affected by genetics, hormones and environmental issues, as well as diet and daily activity.  It is quite common among men and women and being affected by alopecia is not so unusual.  It is usually occurs over the area being treated, but some people lose all of their hair.  Hair loss is a big  worry to many people, both male and female.

Hair loss is a common cause of worry among all individuals’ regardless of gender or age.  It is frightening, and dealing with it can lead to stress, panicky decisions, humiliation and depression.  It will often result as a reaction to the way in which stress impacts the balance in your body.  It is a common problem that is faced by individuals today.  Hair loss is a problem and many people want to find solutions.These articles and tips are share with us.

Hair loss can mean different things to different people.  It is one of the most common presentations, especially on the abdomen and inner thighs.  It is a common and often distressing side effect of some cancer treatments.  It is sudden, and it usually falls out in clumps over a short period of time.  Hair loss is common nearly two out of every three men develop some form of balding.

Hair loss is mostly suffered by men due to male pattern baldness.  It can occur for many reasons, the most common of which is hereditary baldness.  It may also occur as part of an underlying disease, for example, lupus or diabetes.  It can also be caused by thyroid problems, zinc defciency, drug reactions, and other problems.  Hair loss has been noticed and studied throughout the ages, and some interesting discoveries were made in ancient times.

Hair loss is a classic symptom of iron-deficiency anemia.  It is usually at its worst 3-6 months following surgery.  It is usually patchy with obvious signs of scalp inflammation.  It is nonpruritic and may be accompanied by hyperpigmentation and follicular keratosis.