Category: Repair

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Hair Loss InformationChild Attacked By Dog, Lost Most of Her Scalp – Hair Loss Information – Balding Blog

A friend’s 3 year old grand daughter was attacked by a dog and she lost most of her scalp. What remains is a small portion on the right side of her head, and the rest was replaced with skin grafts from her back. What kind of hair replacement / regrowth options are available for her? If it makes any difference in treatment options she is african-american.

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Everything depends upon how much good scalp she has left and the amount of good hair that remains. If, for example, a person lost 20% of their scalp (replaced by skin grafts), then the other 80% could possibly be stretched to cover the missing part, and in an ideal situation the stretched skin (that contains hair), might produce enough cover with artful surgery. If however, the proportions are the reverse (80% of the scalp was lost and replaced by skin grafts), the likelihood is that there may not be enough hair or scalp to move around to cover the defects. I would like to see a set of good pictures of her. If the child’s family does not have the means to pay for surgery, this can be done with minimal to no charge for those who could not afford this type of work. First, a doctor needs to make a careful examination, starting off with sending pictures if she is outside of California and can not be seen by me in person.

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Hair Loss InformationCan Trichophytic Closure Technique Remove My Scar? – Hair Loss Information – Balding Blog

As you can see in the picture I have had 2 HT strip scar procedures. I always liked to cut my hair short with a 1# guard but after 2nd HT scar (top one) I cut hair with 2 guard and it’s still visible. Right now I don’t know if I should get another HT but I do want repair work.

If I go and get the Trichophytic Closure Technique can my old scars be removed? How can this be possible?

How about body hair transplants into my old HT scars?

Will I ever be able to cut hair close again with a 1# guard?

Thank you

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No.

All cuts will produce a scar.

The worst doctor with the worst technique can operate on one patient and have a great result with minimal scarring. Likewise, the best doctor with the best technique (using Trichophytic closure, etc) can operate on another patient and have a poor result with wide scarring. In other words, everybody heals differently and some people are more prone to scarring.

Generally a Trichophytic closure technique will benefit 1mm of the scar margin. So if you have a 5mm width scar, a Trichophytic closure technique will make it look more like a 4mm scar. It is obvious that the wider the scar is, the less benefit will be obtained by the Trichophytic closure.

At NHI, we offer free scar revision to our former patients. Sometimes we are able to achieve an improvement, but as stated earlier, there will always be a scar.

Body hair transplants are not considered a standard of care in my opinion and are still controversial because of their long dormant stage and growth cycles.

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Old Plugs Now Showing – Hair Loss Information by Dr. William Rassman

I am 43 years old and had a procedure done 15 years ago involving mini grafts and micro grafts. Over the years it was fine and as I had a full head of hair and never really noticed the minis and micro grafts much.

Since last year I have lost some hair and the minis are now the transplants are more obvious to me. I have been very stressed, my wife left me and the hair started to fall out shortly after she left. I am not on propecia or rogaine or any other such drugs.

What can I do? With my hairline now looking pluggy and less and less hair to cover it, will a transplant help me? I am reluctant to have a transplant again as I am frightened that my pluggy look will be worse. Can I just remove these plugs and take on the bald look that I would have had normally?

Here’s my questions…

  1. Most of my grafts are middle size (about 1-2 mm in size). If I go with the FUE approach to thinning these grafts, how small are the holes created by FUE ?
  2. Are different sized instruments used ?
  3. What is the exact process ?
  4. How are these holes closed (sutures? ) and how long is the healing ?
  5. Do these holes upon closing leave a white spot like the pictures I have seen ?
  6. Some of my grafts are small 1-2 hairs but stand out (i think its the skin around is a little pushed in) ,doing this procedure will take care of the skin depression/irregularity ?
  7. What is the success of such procedures & What can I expect in terms of the look after this process ?
  8. I would like these grafts to be replanted on the top or in the scar area.
  9. Can you please tell me about this process and advise if what I am looking for is achievable ?

It is not unusual for people to see the older plugs when they lose hair. This is because many doctors would put plugs (in the old days) into places where hair existed as a prevention for hair loss or to cover a person’s eventual hair loss migration. This was and is today a terrible and immoral practice. I feel you have a series of options:

  • You can put back the hair that has hidden the plugs and go back in time, so to speak.
  • You can remove the plugs altogether. This will not bring you to look like the balding man you would have become, because the plugs tend to leave scarring and even removing them does not change the scarring.
  • You can remove the frontal plugs, thin out the plugs behind and redistribute the hair, and then transplant the entire frontal area.
  • You can lower the hairline very slightly and in doing this, you can add a deep transition zone which will bury the larger grafts that you have.

Now to answer your numbered questions…

  1. The diameter of the punch is 0.9mm.
  2. None smaller at this time
  3. Usually it is best to use a two step procedure — score the skin first, and then use a dull punch second to core out the targeted FUs.
  4. These are not sutures; too small. They are left open and close on their own.
  5. This is a risk. The small white patches are far less obvious than the plugs. The lesser of two evils.
  6. Yes, in most of them, provided that they are not the larger grafts that had hair killed off during the transplant. There is a condition called donuting where much of the central hair dies in the older type of grafts. The skin changes with this older technique frequently are larger than just where the hair are.
  7. For each group of hairs that are successfully removed, the success is good. Please note that I used the term successfully removed. Sometimes the scars that surround the plugs make it impossible to get them either out at all, or completely out. Every person is different, as is each scar.
  8. Always do this.
  9. It can be achieved, but without examining you and testing you with a FOX biopsy or trying it, one can not be 100% sure.

For an example of the procedure, please see Dean’s Story.

Balding Forum - Hair Loss Discussion

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Scalp Biopsy as Child Resulted in 2 Bald Spots on Side of Head – Hair Loss Information by Dr. William Rassman

HI, I hope you can help me..im a 22 year old male and i have two bald spots on the sides of my head, one 4 times larger than the other. From what i can gather this is a result from a biopsy i had done when i was a baby due to pimples on the head. My mother took me to the doctor because they would swell up due to the chlorine in the pool. The doctor told my mother the hair would grow back and boy was he lying..to this day i have to wear black eyeshadow and keep my hair longer to keep it hidden..please tell me you know an answer to this..
thanks in advance!

Small scars on the scalp can generally be treated with a hair transplant with good results. It is dependant on the location of the scar, the size, your hair color & characteristics (wavy, curly, and straight). FUE is an easy way to treat small scars.

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Taking Grafts From Side of Head for Small Scar Repair? – Hair Loss Information by Dr. William Rassman

Hi, I was wondering, since my procedure only requires 50 grafts [scalp scar repair], do you think it would be okay for my doctor to make the incision to the side instead of in the middle of my scalp? Because I don’t want any scar to show when I have pig-tales or something. I forgot to ask this at my consoltation, although I doubt you would really be able to see it even if the incision was in the middle of my scalp, because the incision would be so small, and my doctor is using a trichophytic closure, so I doubt it would show anyways, but I just want to be on the safe side. Is the outcome any different if the incision is in the middle of the scalp or to the side?

Most people with a small number of grafts get an FUE harvest so that there will be no easily visible scar, no matter where the grafts come from. Alternatively, you could take the harvest with a strip from the sides, so that it could be parted in the middle without showing a scar. The FUE approach may be better. If you had your consultation here at NHI, please feel free to call 800-NEW-HAIR to schedule another consultation.

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FUE vs Hair Multiplication – Hair Loss Information by Dr. William Rassman

Sorry to bother you about my small scar again, but I have been doing a lot of research about Follicular Multiplication, and I have read that it is a lot like FUE, except they do not extract the whole follicle.(So the extracted hair will grow back). I was just wondering if that might be an option for me, becuase I have a very small scar on my scalp, and I would really like to fill it in with a small hair transplant, but I am afraid that the transplant will cause more damage to my hair than the scar is to begin with.

I don’t know what to do, because it is so small, but it bothers me, and I would really just like to get it repaired, but I don’t want to cause any damage to the rest of my hair.

An FUE procedure will not damage your scalp or hair. Hair multiplication is experimental and probably will not work. There are a number of companies like Aderans and Intercytex trying to induce formation of new follicles. Most researchers would accept anything, whether it be follicular neogenesis or rejuvenation or stem cell yields, or anything that will make a new hair, any way it comes. Unfortunately, this technology is probably years away, still.

Why not just fix this small scar if it is so bothering and get it behind you?

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Transplanting Hair Into Scar Tissue – Hair Loss Information by Dr. William Rassman

If you transplant hairs into a scar, is it true that the scar gets worse before it gets better?(does the scar stretch before the scar actually has hair growing)? If so, does it eventually get better?

Disguising a scalp scar with hair transplants is an ideal procedure that is often done at NHI. There are other factors involved such as:

  • the location of the scar
  • your hair shaft thickness and the scar thickness
  • the contrast of your hair color to your skin color to minimize the appearance of the contrast
  • the character of your hair (wavy, curley, straight)
  • the length of your hair (very short hair will require more densities than longer length hair)

It is not true that the scar gets worse from a scar transplant and then gets better, nor does it stretch from getting hair placed within it.

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Doctor Said FUE Would Leave Detectable Scars – Hair Loss Information by Dr. William Rassman

Hi, I am sixteen-years-old, and I just recently went to a consoltation with my parents to address the scalp scar, (non-transplant)that I had wrote about in a previous post. The doctor has been doing hair restoration for over 30 years and he seems to know what he is talking about. Well, my question is this, I went into the office thinking that he would recommed the FUE procedure to fill in this scar, but instead he told me he would be using FUT. He said that he would use a trichophytic closure and that the small scar he would make would be virtually undetectable. I asked him why he wouldn’t use FUE, and he told me that he performs this procedure, but he said that it would cost me twice as much and it would leave me with little scars that would be even more detectible than the trichophytic-closed scar. He said that my scar would require 50 unit grafts, and that this would be no problem. I just wanted to know your opinion. Does this doctor sound correct?

-P.S. My parents and I would really like to know, because we want to get the best treatment possible, and we need some advice. Thank-you

Either FUE or FUT will do the job. This doctor may not be comfortable with FUE, but it is not a procedure that produces any socially-detectable scars. In other words, FUE will not produce a noticeable scar (less than 1 mm punctate scars), versus a small, barely noticeable linear scar with FUT. The choice is yours. Although the FUE is often more expensive, I doubt that 50 follicular units would be an appreciable difference in costs.

As you are local to my Los Angeles office, if you and your parents are looking at options and would like a free consultation with an NHI physician, you can call 800-NEW-HAIR to schedule an appointment or visit the NHI site to request more info.

Balding Forum - Hair Loss Discussion

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My Hair Transplant Scar is 6mm Wide – Hair Loss Information – Balding Blog

Hi,
I had a hair transplant done 3 1/2 months ago. The hair seems to be growing in good but is blonde and fine whereas the rest of my hair is thick and dark, I am told it will thicken over time. But the main problem I think I have is that the scar along the bottom is about 6 mm wide. Along the sides up to my ears it is only 1 mm or less. The doctor told me I have good scalp laxity and it should not have stretched like it did, but I think it was because he took the hair too low on my head and in that area the skin stretches as I move my head up and down. It is like he took the hair from my neck and not my scalp. Another concern is that the hair is finer and lighter that far down on my neck and I am worried if it is even going to be permanent.

What do you think I can do to repair this scar? The doctor offered to “repair” the scar but wont it just stretch again? Have you heard about hair being harvested too low, or is this not a problem?

Thank you very much for your time.

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When donor hair is taken from the high neck (where it sounds like you are describing), it often scars. Some doctors mistakingly think that the neck hair is finer than the scalp hair and therefore intentionally take hair from the high neck. These often are flat scars that widen as you’ve described. From what you are saying about the rest of the scar, it is well healed without widening and this suggests that you do not have a problem with ‘stretch’. Removing these neck scars often leads to failure, so these may have to be transplanted to get the cover you need.

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Hair Loss InformationReducing Donor Scar – Hair Loss Information – Balding Blog

This blog is very informative. I have had transplants in the past, which look very natural (in my opinion). My concern is with the donor patches in the back. I would like to get more transplants, but the patches become noticable when my hair is short and any more bare spots would be obvious. Is there a surgical method/technique to minimize these blank spots? Thanks for the information.

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I have addressed this question many times. This is a problem more of the past than of the present. See: Techniques to Minimize Donor Area Scarring and Trichophytic Closure Photos.

You need a Master Plan developed to deal with scars and the need for hair in maximizing the value of the remaining donor hair. Scars can be dealt with in most people using the techniques described in the referenced blog entries above. After you read them, call me at 800-NEW-HAIR or write to me again if there are unanswered questions (be sure to reference this blog posting).