Hair transplant education for prospective patients

[ELITEJONES]

Thanks Dr. Arvind you have given so much information about hair loss but i want to know that i have facing problem of hair loss from front of forehead but major problem is my 90% turns Grey,what should i do looking for suggestion.

 

[ELITEJONES]

by going through this thread quiet informative!!!

 

[Dr Arvind]

Body Donor Hair - additional v/s alternate donor source

Dear forum readers,
The first and foremost thing to remember about Body donor hair is that it is an additional donor, not an alternate donor source.

Body and beard hair have different characteristics then scalp hair.
They have different -
1. Length,
2. Calibre/diameter,
3. Curl,
4. Sheen and texture,
5. %age of hair in anagen/growth phase,
6. Duration of Anagen/growth phase,
7. Predisposition to greying, etc...

Assume that the transplanted body and beard hair will retain their original characteristics after transplant.

The doctor and the prospective patient should plan their HT based on the above.

We have formulated Guidelines for BHT that we advise prospective patients to follow.

Guidelines for BHT -
These guidelines are based on our follow up observations in patients.

1. Preshave the body donor areas 3 to 5 days before the extraction. It is a simple step and very helpful to pinpoint the actively growing hair that need to be used.

2. Use only the body donor hair in active growing phase for purpose of transplant. Do not use telogen hair.

3. Assume the transplanted body hair will retain their original characteristics (length, calibre, color, predisposition to greying, curl, anagen/telogen %ages and hair growth cycles).

4. Factor in the impact of growth cycles and characteristics of the body donor hair proposed to be transplanted.

5. Mix the various body as well as scalp donor hair in any particular area of scalp.

Regards,
Dr. A

 

[Dr Arvind]

zionaxel wrote:

It is an interesting read, how is Zaydens repair coming along?

Very well indeed.
He visited us some time ago in October 2010 and was very happy to record an interview. I will try to upload it as early as I can.
Regards,
Dr. A

 

[Dr Arvind]

Graft estimates

Dear forum readers,
Graft estimates is another important topic for patients researching HT options for themselves.

How does the doctor give graft estimates for a patient?

The wrong way to do this is to limit the graft estimates to the number of grafts the doctor/clinic can perform e.g., I have come across Norwood 6 level of baldness patient given graft estimates of 2500 grafts at some clinic.

What is happening in this scenario?
At best, there is a miscommunication. The doctor maybe telling the patient that 2500 grafts is the total number of donor grafts he can perform for the patient. The patient on the other hand may tend to believe that 2500 grafts will give him good coverage (maybe even a full head of hair).


So for the prospective patient it is important to keep the following information in mind -

The full non balding adult scalp has average 100,000 hair follicles (or 40,000 follicular unit grafts).

The numbers may differ among different races. The blond Caucasian have higher number of total follicular unit grafts while on the other extreme are the negroid and the Oriental/fast east people.

Nevertheless, one gets a base idea.

Now, if you look in the mirror and see that half the original hair have succumbed to the effects of male pattern hairloss (hair have vanished/miniaturised); you would realize that the number of follicular units lost is approximately 20,000 (half of the original 40,000).


2500 or even 5000 follicular unit grafts are not going to return the original head of hair back to you.

What you will need to do is sit down with your doctor and devise the sort of hair restoration you plan. Depending on the HT doctor's philosophy and capability, he should let you know the total number of fu grafts available for transplant at his hands.
Then he will let you know what he can accomplish with the said number of grafts.

If what he can accomplish is alright with your expectations, go ahead.

Else, you will atleast be clearly in the picture and may decide that HT is not worth the trouble for you.

There is more on this topic but that for later.

Regards,
Dr. A

P.S. - meantime, you may like to research about how much total donor fu grafts YOU have available for use.

 

[zionaxel]

Dr Arvind wrote:

zionaxel wrote:

It is an interesting read, how is Zaydens repair coming along?

Very well indeed.
He visited us some time ago in October 2010  and was very happy to record an interview. I will try to upload it as early as I can.
Regards,
Dr. A

Good to hear, im sure Zayden is a happy chap..

 

[bullitnut]

would be great to see the vid cheers

 

[zionaxel]

@ Dr. Arvind Is Zayden now finished with having work done or is there still some way to go?

 

[Bastion]

Long read, worth while though.

 

[Dr Arvind]

Dear Zionaxel,
Zayden's repair ht procedures are finally over. He has promised to post his final results in the months ahead.

Meantime, we shall post the video interview he gave when he visited us recently. But that is for a separate thread.
Regards,
Dr. A

 

[zionaxel]

Ok thanks , good for him im sure its changed his life for the better..

 

[Dr Arvind]

How much is the total available scalp donor grafts?

There may be differences in this based on
- race,
- size of the head
- scalp donor area laxity
- donor area follicular unit density

But, we will talk about average case.

Option 1-
Strip FUHT - With multiple strip procedures (I do not advise more then 2 full length procedures in a person's life), most people can give 5500 to 7000 FU grafts.

FUSE/fue after strip excision - 1000 to 1500 grafts from scalp safe donor area.

Option 2-
Only FUSE/fue method extraction - 3500 to 5000 grafts.

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In addition to the above, we have beard donor area. The beard donor varies widely from person to person and it is not possible to hazard an average guess.

 

[JJ09]

Size of head, I`ve often wondered whether the size of my own balding scalp area has been reduced as a result of having three scalp reduction procedures or has stretch back occurred.

Would this have an effect on the available donor supply on a patient who has not had any strip procedures performed (unlike myself)...Dr Arvind, have you seen a patient in this predicament and what is your view on this?

Another thought is when a large strip is excised is there a stretching effect to the top of the scalp...

 

[Dr Arvind]

Dear JJ09,
Thats an interesting question.
I will break the answer in 2 parts.

1. Taking a large/wide strip will reduce the future laxity of the scalp (and reduce the available donor from which FUSE grafts can be extracted).

2. Scalp reductions do reduce the laxity of the scalp, and consequentially, reduce the width of the strip that can be excised.
However, post scalp reduction, the donor area from which FUSE/fue grafts can be extracted is not reduced (only stretched).
So, post scalp reduction, a larger proportion of donor grafts can be extracted by the FUSE/fue method then by the strip method.

Regards,
Dr. A

 

[JJ09]

Thanks Dr Arvind.

 

[Dr Arvind]

Pain in hair transplant surgery

I think this question would be best answered by patients who have already got the procedure done.

However, in brief -

1. Injections of local anesthesia are given in the donor and recipient areas to render them numb/pain free. So, the actual surgical procedure itself is pain free (even though it may look messy or horrifying in the pictures).

2. In strip FUHT, the sutured donor area will be tender after the effect of anesthesia wears off at the end of the procedure. Pain killers are prescribed for the same for 5 days.

3. The recipient area is usually pain free at the end of the procedure.

4. The donor area of FUSE/fue is usually pain free even after effect of anesthesia wears off. There may be minor discomfort or soreness for a couple of days. Most patients do not feel the need of pain killers after a FUSE/fue procedure.

 

[Dr Arvind]

Coverage v/s Density

Many times, patients having extensive hair loss (Norwood 5 or above) are faced with a dilemma.
If they are going in a multiple stage HT, should the grafts be transplanted to
- achieve the final desired density for a particular area, or,
- should the grafts be transplanted at a lower density to cover most, if not all areas of hair loss with some hair

Following are a few examples of patients with extensive hair loss choosing different options.
I do not advocate one option over the other.
Nor will any 2 patients necessarily be identical in their hair loss patterns (even if they are classified at similar levels on the Norwood scale.

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[Dr Arvind]

The significance of beard/facial donor hair in hair restoration

I would prefer that the facial hair not be clubbed with body hair as they differ in many aspects, including, most importantly, their growth cycles and the possible adverse effect of finasteride on them.

As per my knowledge, the first ever documented case of beard hair to the scalp by fue was performed at our clinic in Feb 2006.

Beard hair is a very viable source for augmenting the donor supply. In most cases, however, it can not be used in the hairline and temple points.

Its advisable to use it mixed with other scalp hair to help in easier blending once the hair grow.


Please note: Not all facial hair are the same. The chin hair, cheek hair, moustache hair or the hair low down on the neck all differ.
They differ in terms of their length, speed of growth, coarseness etc. You just have to examine a person with a grown out, untrimmed beard to understand what I mean.
The hair from different parts of the face would be suitable for different purposes. For example - hair from the edges of the beard (low down on the neck or high up on the cheek) do not grow very long. They would be better used for areas that do not require long hair length (previous strip scars would be the ideal place for them). Chin hair and hair towards the central parts of the beard grow longer. They would be suitable for adding bulk in the vertex areas.

Regards,
Dr. A

 

[Dr Arvind]

Another oft-asked question and one that has a significant impact on the decision of whether to and when to go for hair transplants.

Recent advances suggest the availability of successful genetic testing predict future hair loss.

----------------------------------------------
Other measures -
1. A familial tendency to hair loss (both on the maternal and paternal sides),
2. The age at which hair loss started. Though there are no definite medical studies that have documented this, the layman perception is that the younger age at which hair loss starts, the more severe/extensive it is likely to be.

Though not foolproof, the above 2 parameters can be used to try to predict the extent of hair loss that would occur if left untreated.

 

[Dr Arvind]

Some necessary definitions patients should know (Anagen, categen and telogen)

Anagen, categen and telogen
Hair growth cycle is divided into 3 phases. Anagen, catagen and telogen.

Recent advances have added more stages/phases but for ease of understanding, I am limiting this discussion to easy to understand, simple stages.


The active growth phase is called anagen. During anagen, cells in the root/hair buld divide mitotically to add to the hair shaft.
During catagen, the hair bulb ceases to divide and starts involuting and regressing. Catagen phase starts at the beginning of involution and ceases when the involuting bulb reached the level of the bulge.
Telogen is the resting phase of the hair. The hair ceases all activity and stays as a club hair. It may shed at any time from the beginning of the telogen to the time new angen phase commences.
The event at which the telogen hair sheds is called exogen.
Exogen need not be at the time of the start of the next anagen. Effects like traction, trauma may bring it earlier on in telogen.
The various phases of hair growth cycle differ in different hair (scalp, nape, body, beard hair etc. have different duration of the various phases).

For present, we concentrate on the scalp hair.
Anagen lasts for anywhere between 2 to 6 years. Catagen for 2 to 4 weeks and telogen for 3 to 5 months.
As a thumb rule, we can say A:C:T is 3yrs:3weeks:3months.
In scalp hair approximately 85% hair are in anagen, 12 to 14% hair are in telogen and 2 to 4% hair in catagen.