Month: April 2005

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Hair Loss InformationLarge Sessions – Hair Loss Information – Balding Blog

Here’s a question I get quite a bit from people that just start doing their research…

Hi Dr Rassman,
I have been reading a little about hair transplantation but I am still very new to this stuff. I was wondering why all hair doctors can’t transplant a high number of grafts in a single procedure?

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Not all physician teams are equal. In our medical group, we (NHI) pioneered the large graft session transplanting as many as 4400 grafts in 1994. So performing a large hair transplant session is a function of experience and the skill of the surgeon and his team. If a doctor routinely performs sessions in the 3000+ graft size, then it would be safe to assume that this doctor has mastered the skills required for large session. Unfortunately, not all doctors have either the teams or the skills to accomplish the feat on a routine basis. For us, we have been doing sessions of over 3000 grafts for almost a dozen years and are performing sessions of this size almost every day. If a doctor must limit the size of the session to under 2000 grafts, it may take more surgical sessions to accomplish the same goal as when twice the number is transplanted.

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Hair Loss InformationScarring Advances – Hair Loss Information – Balding Blog

Have there been many advances to the visible scarring problem that is talked so much about?

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This is an interesting question, most appropriately directed to me. A small number of patients do develop noticeable scars (less than 5% of first time patients). This is more intrinsic to the healing properties of the patient themselves, but the techniques used by the surgeon have not generally been able to address the unique needs of the small number of patients with a scarring problem. Now there is a new closure process that allows the surgeon to better address the scarring risk in this 5% of patients that have a scar widening tendency. We are using this new technique in virtually all patients. We have actively solicited patients who have widened scars as a new business activity and have been repairing scars from patients who come from around the world.

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Hair Loss InformationDensity Limits – Hair Loss Information – Balding Blog

What is the limit for transplant densities?

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Hair can be transplanted at a density that approaches 35% of the original density in many people. The ability to place such densities depends upon many factors which include: hair thickness, skin characteristics, the size of the instruments for making sites, the skill of the surgical team at placing grafts tightly together and the processes that reflect the quality management of the surgical team. Not all doctors can place, for example, two hair grafts into a 0.9mm recipient site. Even in the hands of a good surgical team, not all hair grafts can be placed into a 0.9mm recipient site. So there is a balance between what can be done and what should be done. A surgeon with considerable experience in hair transplantation dense packing is best able to make the judgments required for maximizing hair densities. I pioneered Dense Packing with the first published mention in a 1993 article in the Hair Transplant Forum and have been using this technique ever since. More recently, we have moved to combining Dense Packing and Large Session surgeries to maximize yield and reduce the number of surgeries required to get a person to his goal faster.

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Hair Loss InformationVisible Scarring – Hair Loss Information – Balding Blog

Do most people have visible scars from a traditional hair transplant?

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The answer is that every person that receives a cut to the skin gets a visible scar. The more appropriate question should be: How often are scars large enough to be seen in social conditions? Most people who have donor hair taken with a traditional incision get a scar that is about 1-2 mm wide. A scar of this width can only been seen by combing back the hair and closely observing the scar with good lighting. Fully 95% of patients fall into this category. These scars should never be detected when the hair is at least 1/4 inch in length (this may not apply to a coarse, straight haired individual). If a person shaves his head, a pencil line scar will be evident in virtually everyone.

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Hair Loss InformationKeloid Question – Hair Loss Information – Balding Blog

An African American woman writes…

I am interested in the restoration process to my temples. Having black skin I am concerned with forming keloid scars in the visible frontal and back area. Does this happen? I noticed pictures of African Americans however they may be some of the lucky ones who don’t form big scars. Can you give me some more information on this?

There also didn’t seem to be any info on other possible pitfalls to take into consideration?

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Thank you for your email. If you are a known keloid former, then a test of the scalp may be the safest way to determine if you would form a keloid. Such a test might be performed with a very small incision in the area where the hair would come from and a few needle ‘pokes’ in the area where the transplants were to be placed. If you have no history of Keloids, and have had scars in the past that did not produce Keloids, then it would be reasonable to assume that you would not form a Keloid in a hair transplant area.

As a black woman interested in hair transplants, please make sure that you are evaluated by a good, ethical and competent doctor. With regard to Keloids of the scalp in association with a hair transplant, they are very, very rare even in black skinned people.