Hair Transplant Progress-with ten months photos

Here you can see one of my patients' post-surgery progress.

Surgery Date: 08/26/2006

Coverage area: 68 sq. cm.
Donor area: 29 sq. cm.
Donor Density Increased: 40%

The photos are taken before surgery.




Immediately after the surgery-
For the first twenty-four hours, there will be a strip of bandage around the head. After that, you will be able to remove the bandage and shampoo your hair.
Some graft may appear whiter initially and will have same color as rest of grafts couple hours later.
The hairline design is irregular.
We implanted 200 single follicular units on hairline and 1200 modified follicular units.

9/8/2006
Two weeks after the surgery, scabs already fall out.




9/19/2006
The implanted area looks pink, the color should return to normal 4 to 8 weeks after surgery.

10/13/2006

Transplanted hair starts to fall out. Skin color returns to normal.

10/31/2006

Two months after surgery-

Pre-existing hair around or adjacent to the transplanted grafts may shed, giving a thinner look, but will begin to grow back within a few months.

11/29/2006

Three months after surgery-

One or more cysts may occur in the recipient area. They usually disappear by themselves after a few weeks.

12/12/2006

12/27/2006

Four months after surgery-

Transplanted hair should grow back 4 to 6 months after surgery.

1/22/2007

Five months after surgery-

More hair come out

2/7/2007

Hair look denser...

2/20/2007

And denser..

3/5/2007

Also coarser..

3/20/2007

4/5/2007

Seven months after surgery-

Ninety percent of the patients will be satisfied by 50% to 60% of donor site density. He received 40% density, which looks pretty good when seeing from the front.

6/22/2007

Ten months after surgery. :-)

Hair Transplant Progress Result

After the surgery is complete, the results should appear within the next couple months.

24 Hours After-
Bandages can come off. Soreness may be felt at the donor area.

One Week After-
Tiny scabs on graft area will start to disappear.

One Month After-
Transplanted hair will fall out.

4-6 Months After-
New hair starts to grow.

6-8 Months After-
Transplanted hair continues to grow and thicken.

One Year and After-
Final appearance of procedure is usually present.






Please see video of the Hair Transplant Progress!

Punch Graft Correction

The 4 mm size grafts were transplanted more than 20 years ago. Everyone blames the big grafts for causing the pluggy look. I think the big graft is only the indirect reason for the pluggy look. The graft is too big to place close enough to each other.

The direct reason is too big of the spaces among the grafts. If we are able to fill in all the spaces then the pluggy look will disappear. It is unnecessary to remove the big grafts. By not removing the large graft, they will help to increase the density and make the final result easier to achieve.

Please study the photos, to observe two facts.
1. Please notice the huge spaces among the grafts.

2. The large graft has the original density. Within the 4 mm graft, the distance among the hairs is kept in their original density. The hairs are appropriately spaced. The size of the graft is not the problem; the hairs are in their original form and not squeezed into a smaller space. The problem lies in the fact that the grafts (also known as plugs) are spaced too far apart from each other and the space in-between the grafts accentuate the pluggy look.

Immediately after we made the slits

The goal is to fill in all the spaces between the punch grafts.

Please see Surgical Correction of ‘Plugginess’ in Hair Transplants
Published on Hair Transplant Forum International
January/February 2006 Volume 16, Number 1

Scar Cover Up

The scar is very small, but it always bothered her because it showed up in her part line. It is visible to everyone when she parted her hair.
Six months after a small touch up, she doesn't have to worry about people seeing her part line anymore.

Young Patients-#4

This young patient is a 28 year old male who had been taking Propecia for three years. He had not noticed any changes in his condition and wondered if he should continue taking the medication, or even if he needed it in the first place.

Recommendation: Take photos on consultation date and discontinuepropecia for three months. Then take photos with the same angle, light, hair style and length tofor comparison purposes.

Lesson: Always take pictures before taking Propecia. The hair growthis slow (6-8 months)

making it difficult to notice the results. On the other hand, Propecia may not be the right hair loss solution for some patients. I have seen patients who don't think the medication is helping, but are so afraid of hair loss that they continue taking it anyway. Never forget to take pictures before taking Propecia to chart your own progress.

Question: Exclusive use of single follicular units (SFU) seems to be the current norm, why does NHT insist on using mixed sized grafts?

Question: Exclusive use of single follicular units (SFU) seems to be the current norm, why does NHT insist on using mixed sized grafts?

Answer:
There are a number of reasons why many surgeons today use only SFU for hair transplants. Exclusively using SFU for hair transplants provides a more even "look" and fewer scabs immediately after surgery. As an additional benefit, surgeons can pack SFU more densely than modified follicular units.

However, there are three concerns:
1. Higher telogen (resting) stage hair loss due the process of thin graft preparation

Humans typically shed 60 to 100 hairs per day. These telogen stage hairs, or resting hairs, amount to 10% to 15% of our total hair at any given time. After about three months, the hairs re-grow and start the natural process over again. Telogen stage hairs are of concern for hair transplants because they are effectively invisible. In the process of preparing an SFU, the technician must trim off the tissue next to the SFU grafts possibly discarding the invisible hair inside the tissue. 10% to 15% of hair may be lost in this trimming process.

Photo: 10% to 15% of hairs are in Telogen Stage and are invisible.

2. Poorer growth rates when using thin grafts compared to "chubby" graft
Dr. Seager, Dr. Beener, Dr. Beeher, Dr. Reed and Dr. Raposio each conducted studies to compare the results of chubby and thin grafts. These studies found that re-growth rates for chubby grafts' are 20% to 51% more than the thin grafts. So far we haven't heard any report indicating that the thin graft's growth rates are better.

Photo: Thin follicular units-almost no tissue attached

Photo: Thin Follicular Units - tissues are trimmed off

Photo: Chubby Follicular Units

Photo: Chubby Modified Follicular Units

3. Cost to patient is almost double when using SFUs only

The cost associated with a hair transplant surgery is also an important issue. We work hard to earn our incomes - why should we waste it if we have a more affordable alternative to achieve our goal.

For example, here is a cost estimate for a typical SFU-only hair transplant for a hypothetical patient.
Assumes:

• A recipient area of 80 cm2
• A donor size of 40 cm2 needed for a 50% transplanted density
• Donor area contains about 100 FUs in one cm2
• Total grafts needed are around 4000 SFUs
• Total cost is around $20,000 at $5 per graft

In reality this surgery would likely cost much more than this estimate; in this calculation we didn't take into consideration potential hair loss during surgery or the growth rate.Remember that hair loss is a life long process. A patient needs to receive touch-up hair transplants once in a while to maintain a good "look". Over the longer term, the exclusive use of SFUs adds up to quite a sum!

Question: Do I need to come back for suture removal?

Question: Do I need to come back for suture removal?

Answer:

At NHT Medical Center we use a polyglactin 910 suture to close the donor area. I prefer using sutures to staples because they are more comfortable for the patient and result in a less noticeable scar. In addition, these absorbable sutures begin to fall off on their own 7 to 10 days after surgery as the wound heals. The patient does not have to return for suture removal saving him a trip back to the office.

This photo is of a donor incision five days after surgery. At this point you can no longer see the suture.

An article in the 1999 Journal of the Canadian Dental Association reported on the advantages of the polyglactin 910 suture compared to staples. In the survey, researchers evaluated 42 patients with scalp wounds from cosmetic surgeries. They closed half the wound with the irradiated polyglactin 910 vicryl rapide fast-absorbing suture and the other half with traditional staples. In the study of these 42 patients they found:

· No inflammatory reaction in the areas closed with the absorbable sutures compared to 1 case in the wounds closed with staples
· An average pain score of 1.82 reported by patients for the sutures compared to average pain score of 6.7 for the staples
· No patient reported suppuration, hypertrophic scarring, or alopecia with either method
· All 42 patients in the sample preferred sutures to staples

Scalp Stretch Exercise

To have the best scar and widest donor size possible, we strongly recommend you to do the Scalp Stretch Exercise twice a day, 60 repetitions per minute, ten minutes each time.

Why We Don't Use FUE

When Dr. William Rassman first presented the Follicular Unit Extraction (FUE) method in 2002, almost every hair transplant surgeon criticized it as it taking us back to the old punch age. The FUE punch measured 0.8mm in diameter, much smaller than the 4mm original punch, and caused more transection than the older technique.

Over time Dr. Rassman convinced some surgeons to use his method. Dr. Jim Harris then improved the FUE punch to reduce the transection rate.

Let's evaluate the pros and cons of FUE.

The advantages of FUE:
1. No linear scar/minimizes scarring
2. Can use body hair as donor hair
3. Better for smaller surgeries (i.e. eyebrows, facial hair, touch-ups, scar cover-up)
4. For limited donor hair availability
5. For persons whom would like to wear their hair short


Rebuttal to Advantages:

#1-No linear scar does not mean no scar at all, it still leaves hundreds even thousands of small, round scars, whereas with the trichophytic closure method (discussed on 1/30/07 - Hair Can Grow Through Donor Scar), the linear scar is almost invisible.(as picture below)

#2-In Dr. Rassman's New Hair News volume 12, 2007 comment on body hair transplants, he stated: “in the live patient viewing, one doctor presented two patients who had body hair transplanted into the scalp. The aesthetic impact was negligible fuzz on the top of the scalp…Based upon what I saw, the value of body hair transplants to the scalp may only have experimental value in today’s surgical practice.”

#3-A small area such as eyebrow needs 300 to 400 grafts. With the strip method, we need a linear donor skin of 1 cm in width and 5 cm in length. When the hairs are shaved, it will show a 5-cm long fine scar. With FUE, it will show 300 to 400 small punched scar. Which scar looks more natural?

#4-With limited donor hair availability the small scars are even more visible.

#5-Extremely short hair leads to the possibility of FUE scars and linear scars being visible. Patient cannot shave his head with either procedures.

Further disadvantages of FUE:
1. Price
2. Time in surgery

FUE costs 200-300 hundred percent more than the strip harvest method and requires more time in surgery. I know one surgeon in Australia who takes one week to finish one patient. Is it worth the time and money?

Further disadvantage of FUE( compare to strip method)

*Quality of grafts can't compare this strips method.
FUE is blind punch method, strips method is cutting under microscope direct vision.
Which way will produce better guality of the grafts? And better result of regrowth?
* When hair loss progress, FUE patients will be converted to strips method's patients.
* After extensive FUE procedure, because of scars and lower density. The result of strips
method will be discount.

One hair transplant physician states that, "I have practiced FUE for the past five years. Most of my cases are strip FUT, but I perform an average of two FUE cases per week. Unfortunately, there are unscrupulous practitioners who advertise FUE as a scarless surgery and, therefore, many prospective patients present requesting FUE out of this expectation. Patients must understand that there are punctate scars. Granted, they are not visible when FUE has not been extensive, but can be readily detected when harvesting has been extensive and donor hair worn very short."

Hair Can Grow Through Donor Scar

Since Dr. Mario Marzola presented Trichophytic closure in the 2005 July/Aug ISHRS Forum, (Dr. Patrick Frechet also presented a variation of the technique), the appearance of donor scars have been improved significantly. Now hair can grow through the scar.

This photo shows the scar on the donor site (shaved for purpose of picture taking). You can see that there are hairs growing on the red scar area.

If you keep the hair long, the scar is nearly invisible. (Click on photos to see enlarged images)

It is one of the most important discoveries in hair transplant history.

Previously, the hair transplant patient may have wanted to use the same donor area on the second surgery to remove the scar from the prior surgery. However, if we use the same donor area (where the scar is), we harvest 20-30 percent less donor hair. The density in that area was already reduced in the first surgery.

Now with Trichophytic closure, since the scar is not ugly, there is no point in using the same donor area anymore. If one needs a second surgery, we can use a new donor area.