hair transplant

Wine and Hair Transplant

2011-11-08T10:36:00.000-08:00

The top news around the world today. ONE GLASS OF WINE A DAY INCREASES
RISK OF BREAST CANCER. It shocked so many people, because not too long ago, they said to drink one glass of wine a day to protect your heart and was published on all medias, That encouraged many people to drink wine every night.
This kind of controversial report it is not the first to happen, and it happens very often. It is
like vitamins, they always have controversial reports.
It happened in hair transplant field too. To try to transplant more and more grafts in certain area, the grafts should be cut smaller and smaller, without doing any study about its impact to the quality of regrowth and hair quality. Especially a lot of FUE grafts and not even a intact graft
( like bare graft)
We all know donor hair is limited if it were wasted, we never be able to undo it.

Intruder

2011-11-08T10:23:00.000-08:00

After microscopy dissection was introduced, the chance for hair transaction during the surgery was mainly during donor harvesting.
To reduce it, the instrument changed from a multiple blade knife to a single knife. Instead of cutting blindly, the Haber Spreader and Tykocinski intruder were invented.
So far the intruder seems the safest and has minimum transecting rate( less then 1%).
The method is to score the outline about 2mm in depth, then make multiple insertions of the intruder into the incision line going to a depth slightly below the hair bulbs. Then, using two skin hooks to separate the incision gently. This way there is almost no transection and you don’t have to worry about damaging nerves and vessels.
Tykocinski intruder is easy to use and a great break through for donor harvesting.

Compare Different FUE Methods

2011-10-20T12:14:00.000-07:00

There are so many name and methods for FUE. I would like to organize them
in this form to make easy comparison.

	punch	motorized	unique point
2 step	sharp	no
3 step	sharp+dull	no
Safe system	dull	yes	*1
Roto core	sharp	yes	*2
Neo graft	sharp	yes	*3
Artas robotic	sharp+ dull	yes	*4

*1,Safe system
The initial rotation speed is only enough to allow the dull punch to penetrate
the skin and slow down the speed when pass deeper to separate the follicular
units from surrounding tissue. This will reduce transection rate of follicles.

*2, Roto core
Automatic rotation when downward pressure is placed. It has debris disposal
window to fasten disposal process and potential harm to the Punch tip.

*3, Neo graft
The device is used to extract follicular units and implant them in the recipient area
via a suction system. It seems a great idea, but has two major problems.
At first, suction has tendency to produce bare grafts. 2nd the contineous flows of air will dry up the delicate follicular units.

*4, Artas robotic
After initial calibration, the robot will work 100% automatic.
The quality of the grafts is excellent and transection rate is about 5-8%.
I would like to say it is the best way to have FUE procedure, if the price is
right.

No Linear Scar, New Approaches!

2011-10-20T11:56:00.000-07:00

You don’t like to have a linear scar at the back of your head.

FUE is not the only option anymore.

We have new approaches:

1, FUT+FUE approach
We can use FUT method to transplant as many grafts as needed (at the 50% of FUE cost ). With the Tricophytics Closure technique, it will ensure a fine scar. After 6 months if you don’t like the fine scar we can transplant 100 to 200 FUE grafts onto the scar to make the scar invisible.

2, FUT+FUT approach
First step as above but instead of using FUE graft to cover up the scar, we can cut only 2-3 cm strips to use as grafts.

3, FUT+TATOO
This approach is much easier.First step as above but use tatoo to make scar invisible.

Advantages of these approaches compare to total FUE (no linear scar from all approaches)-

1, Much better result. Grafts quality is much better to cut under microscope direct vision then blind FUE extraction.
2, No extensive shave at donor site during the surgery.
3, Leave only 100-200 small punch scars compare to thousand scars left from total FUE procedure.4, Save thousand and thousand surgery fee.

Disadvantage-You may need second minor surgery. But anyway, FUE procedure always needs more than one procedure too.

Sharp Punch and Dull Punch

2011-10-20T10:15:00.000-07:00

Hair alignment is different in and out of the scalp.

Using FUE procedure to punch the grafts is a blind procedure.

There is no way to see through the skin. Therefore, two types of punch (sharp and dull punch) are used to reduce the transection rate.

	Deep Level	Advantage	Disadvantage
Sharp Punch	shallow, only cut through skin	less transection	bare graft caping
Dull Punch	deep to whole follicle	punch out whole follicle	more transection

* Sharp punch only punch through skin, need to use two forceps to pull out the grafts.Because the tissue around the follicles didn’t separate, a lot of time follicle come out without any surroundings tissue,that we call bare grafts. Sometimes during pulling, only skin pull out,follicle still stay in the scalp, that we call capping.*Dull punch method,use blunt dissection to isolate the follicular units from the surrounding tissue.Require more experience and skill to perform, even the speed of punch is very important.

FUE and Me

2011-10-11T10:33:00.000-07:00

In my 18 year hair transplant career, I have been seeing numerous old 4mm Punch grafts.

It was rare to see any grafts without transection. There are times I even see the graft without any hair.

Initially I believed using the new FUE 1mm punch would yield a much higher transection rate, but after I visited Dr.James Harris at Denver last year, I completely changed my mind.

Seven hair transplant physicians attended the workshop. Dr.Harris taught us how to align the angle, where the scalp entry point is, how to tighten the scalp and how to control the punch speed. He watched us perform the procedure and corrected our mistakes one by one. He was such a good teacher, he could tell us how the grafts would turn out before we did it, by observe our alignment. By the end of the workshop, everyone had reduced the transection rate dramatically.

Now I changed my attitude toward FUE. I recognized it as a completely different method now, even though it is still a blind procedure but the transection rate might be reduced dramatically via adequate training and practice.

Limitations of hair transplants.

2011-08-08T15:41:00.000-07:00

Hair transplantation is a surgery that relocates hair from the donor site to the front or vertex of the head. Hair transplantation itself cannot increase the number if hairs, it can only relocate the existing hair.
The more bald the head becomes, the larger the area is that needs coverage and less donor hair is available.With hair transplant surgery, we have to use less hair to cover a bigger area. To deliver 100 % density is impossible. How we use the hair is very important. The hair style, shape of the pattern of hair loss, color contrast and hair quality plays a role in what we should emphasize. Transplanting equal density throughout the head is never a good idea.

Hair Style and Hair Transplantation

2011-08-04T14:18:00.000-07:00

After 2 surgeries, parted from the side.

After 2 surgeries parted in the middle.

Before surgery.
Your hair style is extremely important after hair transplantation. We have to deliver 50-60% density to develop balance and a natural result. To make 50-60% density look like 100%, we recommend a part on the side or combing the hair straight back. Parting the hair down the center is not recommended!

Short donor hair

2011-08-01T10:22:00.000-07:00

Even with short hair, we can cover the donor site, but it is still visible to the naked eye. This is 3 days post op. We prefer the donor hair to be at least 3/4 inch in length. The donor site availability is limited when the hair is too short, because we prefer the hair to be long enough to cover the suture site.

Asian Hair

2010-08-12T14:59:00.000-07:00

Asian Hair

Caucasian Hair

Asian hair is much coarser, lower density and thicker skin. Caucasian hair is thinner with higher density and thinner skin.For hair transplantation, the principal is the same for both hairs, but there are a few differences.

Compared to Caucasian hair, Asian hair tends to have a lot of tissue surrounding the hair, if we trim the graft too thin, it will automatically remove 10% to 15% of hair which is still in the resting phase.

Asian skin also has a tendency to bleed more; the technique of Anesthesia needs to be adjusted.
Asian hair graft is more difficult to implant due to its thicker skin, so experienced technicians is of extreme importance.

We have offices in Taiwan, Japan, and California. We are one of the most experienced clinics in the world when it comes to dealing with Asian hair transplantation!

For more detailed info, please read Chubby vs. Skinny Graft.

Paired Graft vs. Intact Graft

2009-10-01T12:55:00.000-07:00

From July 2009 Dr. Michael Beehner’s report ~

One intact 2- hair graft: contain two single hairs follicular unit. This can also be cut into two 1-hair follicular units (paired graft). *paired graft=combine two grafts and insert into one slit.

One intact 3-hair graft: contain one single hair follicular unit and one two-hair follicular unit. This can also be cut into one 1-hair and one 2-hair follicular unit (paired graft).

BFU=Bi-Follicular Unit

Conclusion from Dr. Michael Beehner:

Intact follicular unit’s growth rate is better than paired grafts (93% vs. 70%)
3-hair follicular unit has higher growth rate than 2-hair follicular units. (99% vs. 83% on intact 2-hair graft, 49% on paired graft 1 hair+1 hair

Comments:
Intact follicular units and 3-hair follicular units are our modified follicular units (bi-follicular unit). Paired grafts are single follicular units. This is why our modified follicular unit (bi-follicular unit) has higher growth rate.
Another reason why we opposed to the paired graft is that the goal of hair transplant is to minimize the empty spaces among the grafts. When transplant same size of donor area and hair, paired grafts will increase the empty space.

The photo below shows the scalp skin. If you paired the blue circled hair into adjacent hair, the empty area will increase almost four times.

From another point of view, the intention of hair transplant is to use lesser amount of hair to cover a bigger area. But when you pair grafts, it covers less area. That’s against the purpose of hair transplantation.

Look at the picture above and imaging that if you paired all the hairs, the empty space becomes huge and unnatural. If you want to keep same space then we have to remove 50% of empty skin. Transplant area will be reducing to 50% smaller area.

Super dense packing (92 grafts/cm2), does it benefit the patients?

2009-08-21T14:10:00.000-07:00

Here is the abstract of another presentation that I did at the 2009 ISHRS annual meeting.

Super dense packing (92 grafts/cm2), does it benefit the patients?

I. Introduction
For past several years, mega-session with dense packing is the main trend in hair transplant surgery. The graft number and density get more and higher every year.
Does it really benefit the patient in general?

II. Technique
To precisely calculate the growth rate of the transplanted hair, we transplanted hair onto eyebrow instead of the scalp. We transplanted 544 grafts in an area of 6 cm2. The density is 92 grafts/ cm2.

Prior to this case, we usually deliver a density of 40 to 50 grafts/ cm2 on eyebrow transplantation.

We compare the result of the growth rate to find out if super dense packing benefits the patients.

III. Discussion
Six months after the 92 grafts/ cm2 eyebrow transplant surgery, we counted 455 hairs. The growth rate is 82%.

We have done about 300 eyebrow cases for the past 15 years and the average growth rate is about 96%.

With the super dense packing technique, we have sacrificed 14% of hair.

To grow 455 grafts with 40 to 50 grafts/ cm2 density, we only need to implant 474 grafts. The last 70 grafts (544-474) were wasted.

In order to achieve 92 grafts/ cm2 density, we have to cut the graft much smaller and instead of making 19G coronal slit, we have to make 20G needle coronal slit.

When we transplant hair onto the scalp, we had the same result. http://hairtransplantion.blogspot.com/2009/08/chubby-vs-skinny-graft.html

In the process of preparing the smaller graft, the technician must trim off all the tissue next to the grafts. Bare graft obviously has lower growth rate.

IV. Conclusion
So far no one knows what the best density for best growth rate is, maybe we never will.

I’m sure that depends on age, health, nutrition, etc. everyone has different limitation. Without knowing the body’s limitation, only looking for higher density is not the patient’s best interest.

Chubby vs. Skinny Graft

2009-08-20T16:13:00.000-07:00

The more denser-packing, the more skinny grafts.

Here are the study results that I can find about chubby vs. skinny grafts.

Conclusion:

All studies show that compared to the chubby grafts, the growth rate of the skinny graft is decreased 15% to 33%.

Virtually Painless Hair Transplant Anesthesia

2009-07-31T12:46:00.000-07:00

I just attended the International Society of Hair Restoration Surgery (ISHRS) 17th Annual Meeting at Amsterdam last week.

Here is the abstract of my a pesentation about how to use anesthesia technique to perform a virtually painless hair transplant procedure.

Title: Virtually Painless HT Anesthesia

I Introduction
The ideal Anesthesia for HT includes many factors. Safety is a main priority. Blood pressure and heart rate must be monitored. Minimal blood loss, minimum airway obstruction and minimal if no discomfort for the patient is the ultimate goal for HT anesthesia.
This discussion will revolve around delivering painless anesthesia to the patient. There are so many nerves involved, so to apply painless HT Anesthesia is never an easy job.
The method I am going to mention I have being using for the past 15 years. We have modified it during the course of time and now all our patients appreciate it and have almost no side affects. I don’t recall the last time we have encountered airway obstruction, nausea or vomiting.

II, Technique- minimum sedation and stimuli
A. minimum IV sedation
The purpose of this is to relax the patients and not to put them to sleep.
Never give too much sedation. How to give the right dose is the most difficult part. Some practitioners might be reluctant to use IV sedation. The method works with just partial knowledge of the technique that I use.

B. always pre-numb the skin
Use a 30 gauge needle with bacteriostatic sodium chloride. Never use xylocaine for pre numbing purpose. Its ph is too low and will sting.

C. Two step super orbital block
Too my knowledge, not too many practitioners use a super orbital block because it is too painful to apply. I have created a 2 step block to reduce the pain to a minimum.
I pre numb the landmark with a 30 gauge needle and bacteriostatic sodium chloride and then apply 1cc of xylocaine on each side. I only stick the needle up to the subcutaneous area. The second block occurs after I remove the donor site and close it. It usual takes me about 30 minutes. By that time, even if I stick the needle deeper to numb the nerves, the patient usually doesn’t feel any or very minimum pain.

D. Massage.
Always use the vibrator if possible to interfere with the pain transfer path.

E. Inject the medication very slowly.
The speed of injection makes a lot of difference.

III Discussion
For sedation I use midazolam and narcotics fentanyl.

To prevent N&V, I screen my patients with two questions. Have they experienced nausea after previous surgeries and if they experience any type of motion sickness. If one of the answers is positive then I don't use any narcotics it at all. My max dose of fentanyl is 2ml.

I.V. midazolam relaxes the patient fast and efficiently, it never causes N&V, minimum cardiac impact and causes some amnesia.

We don't want to put patients into deep sleep, because it might cause airway obstruction. To give the right dose is very important and difficult. Everyone needs a different dose, so we give it incrementally in 10-15 minutes. In my experience I have never had to use antidote (Romazicon). I don't remember the last time I had to hold the chin to open the air way.

Worry About the Post-Op Scab safter Hair Transplant Surgery?

2009-07-01T11:36:00.000-07:00

See what camouflage product can help you immediately after the hair transplant surgery.

If you can use it efficiently then you do not need to worry about the post-op scabs.

An Email from a Stranger

2009-06-15T16:15:00.000-07:00

Subject: About NHT Philosophy

I checked your website and I was amazed with your frankness and integrity. I have had 2 hair transplant with very good results. I DID NOT get the surgeries done at your place. I went with another doctor who was a friend's referral. The reason why I'm contacting you is because I saw your gallery and read your Philosophy and was pleased with the way you present yourselves. As a prior hair transplant patient I KNOW what to expect from the procedure. I want to encourage people who check your website to definitely get a consultation with you because you seem very honest and explain REASONABLE expectations and your pictures are not altered to improve the appearance of results. Your website contrasts with the competition as you present actual results that are not photoshopped. Keep up the good work!

J. C. G.

Thirteen Years after Hair Transplant Surgery

2009-06-04T12:41:00.000-07:00

One of my patients who had hair transplant surgery done 13 years ago (1996) came in yesterday.

He had two sessions and the total density delivered is 50% donor site density.

He is not taking Propecia.

Please see the before/after surgery photos.

Get a Full Head of Hair within 30 Seconds

2008-07-07T09:34:00.000-07:00

Hair transplantation does not produce new hair, the procedure basically is the relocation of hair from the back of the scalp to the frontal area of the head. Since an adult head never decreases in size, we must take into consideration that the more hair loss one encounters, the larger the area of baldness there is to cover. Based on this fact, understanding and obtaining the best distribution of hair to cover weak areas of the scalp is of extreme importance when wanting to achieve the look of a full head of hair.

In 95% of men, the areas of greatest thinning are at the vertex and the center of the top of the head. Because of this, one who may start to experience balding should take into consideration hairstyles that will diminish the look of thinning hair. A center part is one style that can show weaknesses of thinning hair, as seen in the following pictures. Let's also take a look at pictures taken at the same time, but with a change in part location only. The difference is very clear:

The one and only exception that we have seen is Northwood class 2, as seen in this photo:

Sagittal vs. Coronal Incisions

2008-05-26T15:01:00.000-07:00

Although coronal vs. sagittal incisions have been discussed over the years, there still are no definitive conclusions. Let us consider two aspects.

First, let's talk about the appearance of the results of the coronal vs. sagittal slits. The use of coronal incisions makes most sense only in areas where one can clearly see the hair's root. When viewing someone face-to-face one is able to clearly see the hairline, along with the hair's roots.

This is the part of the scalp where it makes most sense to use coronal incisions. When viewing the top of the head you can't see the coronal arrangements, because one cannot see the roots Therefore, using the coronal slits or the sagittal slits does not make much of a difference.

Secondly, we have not yet seen a study on the comparison of the regrowth rate of hair implanted using coronal vs. sagittal incisions. Therefore, we can only assume that because the coronal incisions are perpendicular to the blood vessels in the scalp, theoretically, they have a higher chance of damaging the blood supply. Therefore, the follicle survival rate should be higher when using the sagittal incision, due to less blood vessel damage.

According to the above reasons, we here at NHTMC only use coronal incisions for the hairline and sagittal incisions for the rest of the scalp. Here is a photograph for better viewing of our technique:

Happy Patients

2008-05-01T14:54:00.000-07:00

Great results don't require using all single follicular units. For this fine haired gentleman, we only used 50 single follicular units (SFU's). Please listen to his testimonial.

One Surgery
Donor Size=30 sq. cm, Coverage Area=92 sq. cm.

Density=30/92 which gives 32%
Number of grafts used: 50 single follicular units &

1232 modified follicular units. Total number of grafts=1282

Date of surgery-August 9, 2007 and then eight months after one surgery (Photo taken on April 24, 2008)

Super Dense Packing-92 grafts per sq.cm.

2008-03-31T14:09:00.000-07:00

Surgery Date: December 7, 2006

Patient designs preferred eyebrow shape.

The length of the eyebrow is about 5 cm.

The widest part is 0.6 cm.

The narrowest part is about 0.2 to 0.3 cm.
The eyebrow area is 5 cm x 0.6 cm=3 cm2 on each side.

The eyebrow outline is about 11 cm (5cm +5cm+0.6cm +0.3cm).
We made 125 slits on the outline, the distance between each graft is about 0.8 mm.

We made 277 slits on an area of 3 cm2.
(The slit number depends on graft number available.)

This photo shows same direction of transplanted hair and original eyebrow hair.
(Coarser hair is the transplanted hair and the fine hair is original eyebrow hair.)

We transplanted 277 grafts on one side of eyebrow (area=3cm2).
This is about 92 grafts in one centimeter square.

June 20, 2007
Six months after surgery- Our patient was very happy with the results. We have achieved his goal in one surgery.

Comments:
The average density on this eyebrow is 92 grafts per cm2. Should I be proud of it? No. Not at all. Every hair transplant facility should have no problem to achieve this super dense packing. As long as you make the slits very small and trim all the tissues around the hair.

Our clinic can achieve 92 % density easily, but why we do not perform super dense packing on all hair transplant procedures?

I have checked the growth rate of the eyebrow hair six months after the surgery; the total re-growth is 455 hairs. The growth rate is 82%. Our average growth rate for hair transplants on the scalp is about 96%. In other words, with the super dense packing technique, we have sacrificed 14% of hair.

The super dense packing method is not suit for all potential hair transplant patients. Factors such as skin color, contrast, hair quality, degree of baldness and the texture of someone's hair can require a different size of graft to achieve the best result. We will work with cases individually to best fit the wants and needs of the patient.

For comparison reasons, please see the following three photos:

Our regular hair transplant grafts

Grafts used for super dense packing

Grafts used in live surgery meeting

Which one do you think will have the best growth rate?

Hair Transplant Progress-with ten months photos

2007-04-10T15:37:00.000-07:00

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

2007-04-06T14:05:00.000-07:00

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

2007-02-27T16:18:00.000-08:00

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

2007-02-27T15:41:00.000-08:00

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

2007-02-22T16:52:00.000-08:00

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?

2007-02-22T15:58:00.000-08:00

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?

2007-02-07T13:56:00.000-08:00

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

2007-02-05T15:57:00.000-08:00

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

2007-02-01T11:04:00.000-08:00

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

2007-01-30T13:34:00.000-08:00

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.

Young Patients-#3

2007-01-26T13:49:00.000-08:00

A 26 year old male who is concerned that his scalp is visible in the daylight.

His hair doesn't show any sign of miniaturization.

The problem is his hair style, in which the hair sticks together. Also, the contrast between his hair and scalp color is too sharp.

My Recommendation: Consider changing the hair styling; or even changing the hair color to one more similar to the scalp color.

Young Patients-#2

2007-01-25T15:23:00.000-08:00

Case 2a

29 year old male lost his frontal hair. The coverage area is 64 square centimeters.

Vertex hair is coarse. No sign of miniaturization on his vertex area. Propecia alone will not be able to help to re-grow hair at hairline.

My Recommendation: surgery and Propecia as an option.

Case 2b

A 21 year old man came in with his parents. He was so depressed by his frontal hair loss he had difficulty concentrating on school.

I recommended hair transplant surgery and Propecia was advised.

Coverage area was 60 square centimeters with a 30% increase in density.

When he came back for follow up one year later, his hair had grown back with no further sign of miniaturization.

The whole family is very happy.

Before:

After:

Case 2c

When E.A. flew to Orange County from Wisconsin ten years ago for his hair transplant surgery, he was only 23 years old and very depressed about his hair loss.

I performed surgery and advised him to take Propecia to prevent future hair loss.

He is now 33 years old. I saw him recently and he is much more confident in his personality and appearance.

Please see his 21 day surgery diary at: http://www.hairtransplant.com/month/patient4.htm

Young Patients-#1

2007-01-24T13:35:00.000-08:00

Each patient is unique.

I offer individualized treatments to all my patients, especially the younger ones. Younger patients require particular attention because their hair loss progress is often unpredictable and donor hair limited. Under these conditions, hair transplant is not always the best option for young people. I have to use hair loss pattern, size, age, hair quality, gender and other factors to give them different plans.

These recommendations may include: surgery, Propecia, Rogaine, observation and sometimes a different hair style or hair color.

In the next several weeks, I will mention them one by one.

******************
Case 1a:

A 32 year old male came for a hair transplant consultation.

His concern is his vertex area.

His vertex hair is thin and fine; the frontal hair is thinner and softer than donor hair. This is one of the first signs of hair loss.

Vertex thinning area is about 90 square centimeters.

Family History: His father is a Norwood pattern class 6.

His main concern: He is young and has the potential to lose as much hair as his father did. If we do the surgery at the vertex now, we might run out of donor hair and be unable to cover the front in the future.

Treatment Suggested: No surgery right away, instead take Propecia for six months. I always take pictures for comparison. Without the photos it is always difficult to tell the difference.

Case 1b:

Some of my patients on Propecia end up not having surgery after taking the medication.

This patient is on Propecia and never had surgery.

Before Using Propecia

After Using Propecia

Case 1c:

23 years old patient came in for consultation. I advised him to take Propecia first.

The patient took Propecia for two years. The medication helped him grow hair on the crown area and prevented further hair loss.

There was still some thinning on the frontal area and receding hairline, so I performed a hair transplant surgery and used 12 square centimeters of donor. The surgery increased density by 25%.

Conclusion:

He is very happy with the results. By taking Propecia first, he saved both a lot of donor hair for future use and the surgery fee.

Painless Hair Transplantation

2007-01-23T12:56:00.000-08:00

We perform the NHT Anesthesia Technique. Ninety-nine percent of our patients consider the hair transplant experience almost as easy as having a hair cut.

The NHT Anesthesia Method is an art of modern anesthesia. Our facility uses minimal dosages of medication, so it is extremely safe. The patient relaxes without being put to sleep, and feels little to no discomfort throughout the entire process.

The two kinds of pain patients face are psychological and physical.

Physical Pain is not the only problem patients face. In many cases, the fear of surgery causes as much distress for the patient. Psychological fear causes patients to tense up or become pale. They start to sweat and their heartbeats slow down significantly, only to jump up with even the slightest touch. Therefore when discussing a painless procedure, we must consider both psychological and physical discomforts.

We use “Twilight Anesthesia” to reduce any psychological discomfort our patients might feel. The anesthesia relaxes our patients enough to remove the discomfort, while allowing them to follow oral commands and respond. Since Twilight Anesthesia is not a general anesthesia, patients are conscious throughout the procedure.

To reduce any physical discomfort, we use the finest needles available. We apply a vibration before the injection, warm up the local anesthesia and use nerve blocks. To further ensure the comfort of the patient, we pre-numb the skin before applying the stimulus anesthesia agent. Tumescent anesthesia is used to make the anesthesia last longer than 10-15 hours. Furthermore, to ensure our patients' comfort after surgery, we provide the latest, best oral pain reliever which can be taken once a day. Patients can now rest comfortably after the operation without disturbance by the suture on the donor site.

See one of our patient's video testimonial about our near painless anesthesia.

The gentleman had one very painful hair transplant experience in another facility. He tried to use a hairpiece because he didn't want to go through another surgery. He didn't like the hairpiece at all. Finally, he found our clinic and had the nearly painless procedure.

Hair, Eyebrow Transplant, Scar Revision

2007-01-12T11:20:00.000-08:00

Before and after two surgeries. 50% density added.

Eyebrow: 150 grafts on each side.

Scar revision: Scar due to car accident. We removed the scar and transplanted hair onto the surrounding area.

A Testimonial Letter

2007-01-03T15:39:00.000-08:00

I just received a testimonial letter from one of my patients.

****************************

I was ambivalent toward the hair transplant. For years, I would try to kid myself about baldness, try to be one of those who (apparently) are not bothered by it. At the same time, I took started spending a few minutes a few times a week on the Internet investigating hair transplants. That led me to Dr. Chang and NHT. (I also confirmed on the Internet that there were no complaints about his practice.)

My wife and I visited his office for an initial consultation, and were very impressed. I had seen ads for hair transplantation, and had heard a relative’s accounts about a couple of those clinics, and was expecting to encounter a sales environment. Instead, I found that Dr. Chang has a very gracious, humble manner without any attempt at persuasion. My wife read the diplomas and noticed that Dr. Chang practiced as an anesthesiologist prior to opening his hair transplant clinic. This is impressive, since that specialty is among the most accomplished and responsible in the medical field, and it assures the highest physical comfort level during the transplant procedure. Yet Dr. Chang does not use it as a selling point.

In all, the competent, helpful, and low-key approach of Dr. Chang made it easier for me to finally decide that I wanted to go ahead with the transplantation. At the initial consultation, I had expressed my inclination to tackle the rear area first. Dr. Chang explained why it would be better to take the front first, and ultimately on the day of the surgery I decided that he was right. (After the hair grew in, I realized how right he was.)

The first session consisted of the maximum donor area, 30 cm. That day went smoothly and painlessly, with the entire staff ensuring that I actually enjoyed the experience. The only discomfort was in the days following the surgery, as expected from the website information and literature. Through that period, the office was supportive, although I only needed to wait it out without any particular medical assistance.

We again visited Dr. Chang after the hair grew in. I was very pleased with the front-view result, but I realized from side and rear views that I wanted fuller coverage. He had done a lot with the 30 cm donor area, but I had started out with a lot to cover! Here, again, Dr. Chang did not act like a salesman. In fact, in his polite manner, he stated that my hair looked good, and asked if I was sure I wanted a second session. I appreciated that this gentleman was making it easy for me to make the right decision for myself, not for his business.

At this point, I am looking forward to the second session hair growing in. Having seen the results of the first growth, I know it will be great. It’s been only two weeks since the second session, and the NHT clinic sent me an email just to check in. It was in response to that email that I raised the possibility of writing a testimonial – it was my idea, not theirs! In all, I’m proud to write this, and to encourage you to go to NHT.

R.C.
California

What is NHT's philosophy for hairline design?

2007-01-03T15:37:00.000-08:00

Question: What is NHT's philosophy for hairline design?

Answer:

We believe that one’s hairline should be designed in according to one’s preference. In general, a hairline design should take into consideration the shape of one’s face. For instance, most Caucasians have longer and narrower faces, therefore, longer and narrower hairlines are considered. Whereas a flatter hairline may suit a square face better, as is the case for many Asian faces.

We also recommend that the center of hairline be at least 1.5 cm higher than the highest wrinkle in the face.

But person is unique and everyone has different preferences. A few people prefer to have lower and flatter hairlines. They are mature enough to drink, vote, and to be in a jury. Why can't they decide what kind of hairline they want? In situations like this, we will offer our advice repeatedly, but also respect the patient's decision. He or she has the right to have what they want. As long as the person feels great about his hairline, why should we judge him with our standard?

An example of a low hairline requested by my patient.

Happy with One Surgery

2006-12-29T16:01:00.000-08:00

One of my patients, B.J., just came back for his six month check-up. He expects to complete his hair transplantation in two sessions and is very happy with the result of the first surgery. No one can detect that he had the procedure done.

I performed the procedure for him on April 28, 2006. We delivered 35% density.

Post surgery photos are taken on December 8, 2006.

Please see his before and after surgery photos.

Please see his video testimonial!

The Bald Truth of Hair Transplant-

2005-05-23T15:57:00.000-07:00

The Bald Truth of Hair Transplant-
Why some surgeons can finish their job in 10 minutes in an 8-hour surgery?

There is no other cosmetic surgery similar to a hair transplant procedure.

In other surgeries, a surgeon can use different assistants without any impact to the surgery. The reason is that the surgeon is the only one who does the surgery.

But for a hair transplant procedure, it is a completely different story.

A hair transplant procedure utilizes team work and the technician’s responsibility is very significant. At times up to ninety-five percent of the work is handled by the technicians. I can say that if the technicians decide to quit then the surgery has to be cancelled. No hair transplant surgeon can finish the job alone.

Hair transplant surgery contains six steps:

Anesthesia
Donor Harvesting
Suturing
Slit making
Dissection
Implantation

Among them, anesthesia, sutures, dissection, and implantation can legally be handled by nurses. Slit making depends on which state the facility is located. Most states allow nurses to make slits (California is an exception).

The job left solely for the surgeon is donor harvesting.

Usually when we need surgery, the most important step is selecting a surgeon. When choosing a hair transplant surgeon, there are many additional factors to take into consideration.