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Miles - 3000fuht (15 mth result) interesting case for young pts

Dr Arvind

Dr Arvind

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#1
Dear forum readers,
Patient nicknamed Miles, presented an interesting situation. Not that it happened the first time, but I think this is one that has not been discussed previously.

Apart from the facts that the patient is comparatively young (in his mid 20s),and wants a vitruvian design hairline and temple point recreation, he has an additional facet - he has a cowlick and a swirl in the frontal area.

In such a case, the doctor has to, in my opinion, make the patient aware of the situation, and make a decision on the hair directions based on mutual understanding of future possibilities.

Possibility 1 - To follow the natural hair directions and recreate the cowlick and the swirl.
Possibility 2 - To disregard the previous cowlick and swirl and to transplant hair in a forward direction.

Disadvantages of possibility 2 are -
1. Till the pre existent hair in the swirl and cowlick eventually succumb to MPB, they will present a grooming difficulty to the transplanted hair.
2. Possible damage to the miniaturising pre existent hair in the recipient area while creating the recipient slits.




If you have a similar hair situation, I would love to hear your choice when you decide to go for an HT.
It would be interesting aspect to consider.


Hints - It would be advisable to consider the history of extent of hairloss in family members as well as the current speed of hairloss (rapid, moderate or slow).


The following pictures depict the situation
http://www.hairlossexperiences.com/attachment.php?id=1823



I look forward to hearing your thoughts.
Regards,
Dr. A
 

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Convenes Serpents

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#2
If my hair characteristics were similar with a cowlick I would go forward with the thought I would lose the cowlick hair, therefor I would opt to disregard the previous cowlick and swirl and to transplant hair in a forward direction.
 
Bigmac

Bigmac

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#3
Cowlicks are tricky,i would opt for the same approach the CS stated.

Dr Arvind,what course of action did the patient have.
 
D

Dr Rogers

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#4
What is not always appreciated, is the ability of the skin to tell the hair how to grow. Many FUT surgeons have had experience of this happening - the cowlick is the classic example. The patient requests the doctor to ignore the "unwanted" cowlick and so the grafts are put in forward facing, yet the regrowth comes back matching the cowlick!
The skin actually coordinates the direction and curl of hair regrowth. However, this is only true for follicular units, which don't have much surrounding tissue from the donor area. The "messenger" molecules in the skin then are able to affect the hair.
The older micrografts and punchgrafts didn't exhibit this, as they retained thicker cuffs of surrounding donor tissue, making the hair "think" it's still in the original donor position.

 
D

Dr Rogers

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#6
It doesn't always happen, plus it does depend on graft size - more likely in single hair grafts than 2-3 hairs.
Also, some patients will request "ignore" the cowlick, some will say follow it.
However, since you can't guarantee whether the hair will follow the skin's command or not, inevitably there will be some surprises. It would help to see your before and after photos - you can always PM me to keep it private if you wish.
Unfortunately, unexpected results are always a possibility with anything medical.
 
Sparky

Sparky

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#7
Mmmmmm, I didnt request to ignore it, my transplanted hairs just grow against the cowslick making my hair nigh on impossible to style until it gets longer, I have to keep it maybe 4 inches long minimum.
 
Dr Arvind

Dr Arvind

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#8
Dr Rogers wrote:
What is not always appreciated, is the ability of the skin to tell the hair how to grow. Many FUT surgeons have had experience of this happening - the cowlick is the classic example. The patient requests the doctor to ignore the "unwanted" cowlick and so the grafts are put in forward facing, yet the regrowth comes back matching the cowlick!
The skin actually coordinates the direction and curl of hair regrowth.
Dr. Rogers,
Will you please elaborate on this?
Its something I have not heard or seen before. It would be nice if you can post some pictures immediately post op and of grown out transplanted hair.
Its interesting hypothesis and I would look fwd to seeing what you saw.

Regards,
Dr. A
 
Sparky

Sparky

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#9
I've never heard of this either, seems like a good way of blaming the patient for his/her not growing in the right direction. My directions are waaaaaay off.