Should preferred hair length greatly matter when deciding on number of grafts to be transplanted?
Yes, the shorter you like to wear your hair, the more grafts are required because it takes more hair to cover the scalp when the hair is cut very short. Longer styling length helps cover the scalp
Hello Dr
I was just wondering about donor scars. How high up is the donor area on the back of the scalp? Also in your opinion how long does the remaining hair usually need to grow to get a good cover-up over the scar? I prefer to wear my hair short but i was just curious to know what the norm is for most patients that go through the HT surgery.
Thanks
The donor area starts at the base of the skull (feel the prominent bone on the bottom of the skull) and go up a distance of 2.5-3 inches high. That is the donor area (see Norwood 7 art at right).
Scars from strip surgery vary in width. On average about 95% of patients will have a less than a 3mm high scar after one procedure and less than a 6mm high scar after the second procedure. Scarring varies and I see many patients who keep a very small scar (under 3 mm) for as many as 3 procedures. Likewise, some patients will stretch their scars more than others, and the scar could be 1cm high in the rare case. The wider the scar, the longer the hair has to be to cover it. Generally, the width of the scar (height) will require almost twice the hair length to cover it well, but that depends upon the hair thickness and the color / contrast between hair and skin color. On occasion, there is no significant visible scar in strip surgery and this is even more common when a trichophytic closure is used to close the donor area. In these patients, the scalp hair length can be 2-3mm long without showing anything. Having the FUE technique used will change the visible scar risk radically.
I have seen ads all over the newspapers on hair lasers. What is the deal on them?
When you probe what these devices actually do, you often hear either unjustified claims (which are not legal from an FDA or FCC point of view) or that “studies are being done†and naming prominent people involved in these studies (as if to justify their premature endorsements). We never hear about the final results of negative studies! Reports from prominent doctors in my community tell me that they have seen a very high disappointed group of early adopters who participate in these modalities, but then again, my community of doctors are not experts in these lasers and they may have been negative from the start, not keeping an open mind. Some doctors, on the other hand, have become enthusiastic about them, but most of their observations are based upon subjective observations. A small number of people report some gain from the lasers and some segments of the European medical community seem to be enthusiastic for its value.
I personally believe that the literature I read does suggest that there is some stimulation to the vasculature of the scalp and that this impacts hair regrowth, but if so, then the question should become “, Growth? By How Much?â€. I really think we should wait for final results on hair growth with good scientific trials before the medical community endorses this modality. I am supportive, however, of all uses of this modality on an experimental basis. What concerns me is if a doctor focuses upon money-making add-ons with any less than proven value defined scientifically like questionable creams and potions (like having a large display of hair conditioners, shampoos, “scalp cleaners,†etc as a focus on their medical practice that claim to make the hair grow), then the objectivity of the doctor as a consumer advocate will be questionable when it comes to these modalities. Sorry to be such a curmudgeon, but I will have to wait until I see some convincing proof of value before endorsing such approaches for saving my patient’s hair.
https://www.thecut.com/article/med-spa-hair-loss-treatments-balding-men-botox.html
The article calls out Ozympic as producing hair loss; however, I suspect that when people lose weight rapidly, hair loss is often a known side effect of a “negative nitrogen balance”, essentially losing your body proteins and fat. The body is intrinsically smart, so it knows that when you are losing weight, it has to sacrifice functions that are not critical to living, and hair growth is one of those dispensable functions. This is especially true in men with genetic hair loss, as weight loss can trigger genetic hair loss or accelerate what is already going on.
I have heard alot about the Implanter Carousel which i find very interesting and a great method of preserving the hairs and keeping them moist in the ‘carousel’ unlike the choi implanter were the hairs are left on a tray open to drying with warm air until they are put into the implanter. If you dont mind me asking, was the choi implanter an influence with its design and was the carousel, put simply, designed to better the disadvantages of the choi implanter. As they are an automated method of implanting the hair would that not take remove the artistry of a manual job. You once said on a answer to a blog on the subject of ‘The choi implanter’, ‘The Choi implanter is just a surgical tool. It makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills with the more traditional transplant tools used throughout the world. An instrument is only as good as the person using it, so I can not package the tool with the technique. The Choi generally requires ‘skinny’ grafts, which tend to dry out more easily, therefore, this instrument requires special skills, different than those that do not have to make the grafts skinny’. My question is how is the carousel different in the sense that an automated implanter such as the choi implanter makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills. Thank you, for all your advise.
It sounds like you know all the technical difficulties associated with follicular unit transplantation — are you a hair transplant surgeon?
As you mentioned, I wrote about the Choi Implanter before — What is the Choi Implanter?. There’s nothing else I can really add to that. The Hair Implanter Carousel was patented back in the 1990s and it works distinctly different from the Choi Implanter. It was designed to take advantage of a ‘machine gun’ approach to loading the grafts for implantation and percutaneous use and keeping them moist (as you wrote). I’ve used both and found the Carousel to be much easier than the Choi. The drying of the grafts was not a problem for the Carousel as it was for the Choi. Unfortunately, the instrument manufacturer was unable to produce a consistently high quality product and we ended up in court trying to get my money back for the build out of the Carousel, rather than getting the tool into the transplant surgeons’ hands.
A paper about the Carousel was published in 1998 and three videos of the instrument can be seen below:
Part 3:
I had hair transplant in 8 months ago.I noticed the new hair growing in the opposite direction compared to the original very early in the growth of the new grafts. The density is also a problem. People can tell something wrong with my hair. I tired style this with gels but I got tired of it & cant stand having hair anymore. What can I do?
This is a very difficult problem. I would have to see you and determine if we could use FUE to remove those hair that have the problem hair direction and then re-implant them. I would have to understand how many of the grafts have this problem but it can be done!
Every time I see a celebrity with a hairline like this, I realize how important hair is to a man’s appearance. Even this 50 year old coach is more youthful because of his hairline and his full head of hair. This is why I love what I do because I have created such looks in men who have been fairly bald or prevented men who were balding from not being able to obtain this type of look. Kyle has a juvenile hairline position with some maturing from his concave shape when he was 5 years old to his convex shape today.
Kyle Chandler (Coach Taylor, Friday Night Lights) is 53 and looks 35. Hairline of the gods from tressless
2019-01-22 11:42:142019-02-14 11:02:07Hair and Hairlines Make the Man! (From Reddit)
Dear Doctor,
Really Love the website. I wanted to know, I have read up on HGH and some of the positive side effects which were listed, are hair growth and thickness on the scalp. I was wondering these method hasn’t been used to treat hair loss.
Thank u.
Human growth hormone (HGH) is not something that should be taken lightly. I have met many men who have elected to take it and it is definitely effective at making the person who takes it feel more energy, younger, and have more vitality. While HGH may have many benefits (including some reported hair regrowth), there are also patients that suffer heart attacks. The final conclusions on safety are not out as far as I am concerned.
I am not religious so take what I’m about to say as my logical mind in action, but I believe that if we were intended to have the energy of a 20 year old when we are 60, then our bodies would continue to secrete growth hormone late into life. Since I believe in Darwin’s laws, older men with vigor would probably compete better for women, and survive in the bush better as they would be more stealth, but alas, that is not how we are built so I suspect that there are plenty of down sides. I am not an expert on the subject, so read on the various sites for HGH and interpret what you want.
A recent article I read in the LA Times a few weeks back discussed negative side effects of HGH, which can promote cancer. With the hype of Propecia and its side effects, HGH would not be recommended. Remember, there is always a risks and benefits of any drug use. My point is HGH is not a bad drug. It has its purpose and use. I just wouldn’t recommend it for treating balding.
This is the result of 3200 grafts from his first surgery, the second on his crown of 2200 more grafts about 2 months ago is now yet to grown out. He was thrilled this morning when he saw that he had to do something about all of that hair. So he combed it back and resent me the last picture from top down (to preserve his confidentiality) and another view with his hair combed back. Considering where he started from, that wasn’t a bad problem to have. He wrote: “I am unbelievably happy. Even after a long day, I get to look in the mirror and rejoice at the hair I haven’t had since I was 20. I also wanted to tell you that it affects my whole lifestyle in positive ways I didn’t fully anticipate. I used to have to keep my hair at an exact short length and then cover with a ton of concealer, and I lived in constant fear of wind, rain, etc. Going to the gym was a challenge because of the sweat. I don’t have to have my hair cut every three weeks, and I can engage in various sports and activities without that fear. I guess I was just so used to it that I didn’t fully anticipate how this would feel, in addition to how much better it looks.“
2020-03-05 04:53:272020-03-05 19:12:54Hair growth gone wild (photos)
Dr. Rassman I want to first thank you for maintaining such a top notch site. I have a question for you regarding transplanting hair into scarred tissue. I recently (4 months ago) had hair transplanted into a 1 and 1/2 inch long scar running front to back. I am seeing very little growth…if any. What seems to be present are a few graft which never fell out and have continued to grow. I am aware that growth in scar tissue may take a little longer than if it was to be transplanted into virgin scalp, however, to put my mind at ease I was wondering in your expert opinion, what is a reasonable timeline to expect growth in the scar? Thank you very much in advance for your reply.
It’s only been 4 months, so seeing a little growth is completely normal. I tell all patients to wait for a full 8 months before judging the hair transplant results. You just have to be patient.
