An over looked FUE issue...

[hairtech]

This week a patient came to us with a problem that I felt that was interesting...

Basically, this was a person that had a very minimal hair loss problem however he wanted to address it. He is 30 years old... hair loss stabilized for over the last 5 years and takes no meds. or topicals. His hair loss was only on the right side "ditch" area. The left side, temporal peaks, and frontal tuft is basically perfect. So he was looking to shore up the right side and be done with it.

Normally in a situation like this, most clinics would turn him down. Mainly because this type of work is so minimal that it is not cost effective. However he found a clinic that would do this work.

This patient went for for only 200 to 500 grafts to shore up the one corner.

Here was the the over looked issue... The patient's frontal third and hairline is light in color. His donor area has light and dark grafts mixed.

The person performing the FUE extracted the grafts that were the easiest. It was only 200 to 500 grafts right? So why not extract the easiest ones... which were the dark and course ones...

Well one can see that in my crude drawing you can imagine what that left him.

A patch of strong grafts in a corner of an area where the surrounding area is light.

Long story short... we corrected this by going for the very light folliclular units and Ron Shapiro softened the abruptness of the darker ones. Please comment!

 

[Prohairclinic]

Indeed this is a very particular situation you describe.

However it is common to see that donor hairs are often darker than the frontal hairs, especially with blond hair. This is no problem if the entire frontal area is covered.

B

 

[jonzi]

You have touched upon one of the main issues I have with hairtransplantation. I dont think this only applies to people with minimal hairloss but also in to individuals who has a big differnece in texture between the hairs on top and the hairs in the back of the head.

Very often I get this feeling of "harshness" when I see some hairtransplant results. It can look very artificial, rigid and course. Often this effect is very limited in pictures given by the ht clinics and much more apparent in pictures taken by patients themselves. I think flash usually hide this effect quite well.


When I analyze this situation i bit more Ive come to this relaization why my eyes react so strongly to it. Usually, when people begin loosing ones hair in the front density goes down but so do also hair diameter. Hairs become lighter and softer. With hairtranspantation the same kind of density as a person beginning to go bald is achieved but now the hairs are coarse and totally unaffected by DHT. The result in this way goes against nature and therefore instantly tell my subconcious that something is off.

Now a good surgeoun can probably counter this effect by choosing the right grafts for the inital centimeter of the hairline. However, Im curious, how much is this effect discussed in ht clinics around the world?

 

[topccat29]

Actually it is one of the reasons I believe FUE is the best approach for most patients having their first procedure. Normally the hairloss is in the hairline and a skilled doctor can pick and choose which hairs would be most appropriate and mix well with the existing hairs. You can't seem to do that with strip as you are taking a large group of thickest caliber hairs from the sweet spot of the donor area and trying to place them around hairs that are more then likely much thinner in caliber along with being lighter in color.

Obviously the previous doctor was completely clueless to this fact. This seems so basic how is it even possible for someone to be in this business and not know this. BTW HT nice artist's rendering looks exactly like some of the paint by the numbers work I have seen over the years.

 

[mars]

Jonzi you hit the nail on the head,i think the irregularities are really important in making a hairline look natural but some miniturised wispy blond hairs at the very front of the hairline would be the icing on the cake.

 

[hairtech]

Great comments by all of you. keep them coming... On a side note, it took around 120 grafts and we lasered the very strong previous transplanted hairs.

 

[mars]

I also think the issue jonzi pointed out is irrelevant for people who's hair is grey,grey is good imo for ht's,less density needed to achieve a decent look too,i am greying at 26 my dad was all grey by 40,i am happy with this.

 

[sl]

Some good points raised.

It is imperative in any hair line and temple work that the hair calibre and colour is considered. Not only are single haired grafts needed in the first few mms, but the right type of single haired grafts.

Placing even singles, if harvested from the occipital area, can bring about problems in that the colour can be darker and most certainly the hairs will be coarser. The problem can also exist when a patient is considering body hair as a donor extension if the scalp is exhausted.

Hair from the beard area for example is usually not a choice for refined hair line work, so whether scalp or body hair being used the doctor needs to think carefully when chosing the grafts for the immediate frontal work.

Colour variation however can be a normal side effect of surgery, ie the transplanted hair, even the finer ones, can take on a darker appearance for the first year or even longer as the hair goes through cycles and normalises and eventually blends in. I have seen this many times and especially in fairer patients.

 

[hairtech]

Good point. Except in this particular patient he had obvious darker high caliber follicle and very light lower caliber hairs. Se we hunted and pecked for the lighter finer ones for the frontal hl and then slightly less thinner ones for behind the hairline. The previous ones transplanted were as obvious as my drawing above. Those we hit with a laser to try to lessen the coursness.

 

[jonzi]

Here is a great example of the "harshness" being fixed by FUE of nape hairs. Really good work. The prior is certainly not bad, simply rigid and course.

Now, people always jump on Umar for using nape hairs as these may not be permanent. However, I think in this case its a no brainer. I would definitly take the after result any day of the week. Even if it meant only lasting for 10-15 years.

http://www.youtube.com/watch?feature=player_embedded&v=Bu0hZTmZuPQ

 

[Bigmac]

How easy is it to select the correct coloured grafts when the donor area is shaved down as the hair shafts change in colour from one end to the other.

I.e,my hair can be brown on the bottom half and grey on the top half.

 

[hairtech]

Well that is a tough question to answer in my opinion. The only thing that may give a clue to the difference in color is the courseness at the shaved level from one follicular unit to the next... In this particular case it was so obvious that even at the shaved level you could see the dark one and the lighter ones.

It really proves what I have said for years now... and this is again... my opinion. In 2002 there was 1 to 2 FUE clinics... and fortunately I was apart of that back in the day. In 2012, there are practically hundreds of FUE clinics.

My opinion is for the prospective patient to look for the most seasoned staff and the most experienced clinics. And there are a few out there... Not all hundreds of them are good.[):h::

 

[Bigmac]

Thanks Hairtech and you ae correct that peole really do need to research these Fue clinics before booking surgery.