Health Store

This hair loss question was answered by Dr. Glenn Charles of Florida who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

Do all the good doctors require you shave your head before hair transplant surgery?

There are some great hair transplant doctors who require the patients shave the hair and other excellent hair restoration doctors who do not require shaving. One thing for sure is that the surgery is easier to perform if there is no hair to work around.

The question is what is more important? Making the surgery easy for the doctor and staff or keeping the patient happy even though the surgery may take a little longer. When a hair transplant megasession of densely packed grafts are placed into an area that has existing hair, there is often the development of postoperative shock loss and significant thinning hair. This can be very upsetting to the patient. Some physicians may choose to require shaving prior to surgery to avoid the potential patient complaints. Interestingly enough I have heard that some doctors actually charge more if the patient does not shave.

Dr. Glenn Charles, D.O.

—

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Coalition member Dr. Alan Feller recently released a new and revolutionary surgical tool designed to make the follicular unit extraction (FUE) procedure easier and more effective. Since FUE places forces on the hair follicles during extraction that could potentially damage the grafts, the development of this tool was designed to reduce these forces and create more viable and better quality grafts during hair transplant surgery.

Though state of the art tools can assist in making the hair restoration procedure safer and more effective, ultimately, nothing replaces the experience and skill of a dedicated hair restoration physician who can adapt as needed based on patient characteristics and circumstances.

To learn more about and discuss this revolutionary tool for follicular unit extraction, visit this hair loss discussion thread. You are encouraged to offer your experience and input on this important topic. You can also view a video demonstration of how this FUE tool is used to effectively reduce the risks of follicle transection.

Bill – aka Falceros
Associate Publisher/Editor

This insightful article was written by Dr. Bernard Nusbaum of Coral Gables, Florida.  Dr. Nusbaum is a member of the Coalition of Independent Hair Restoration Physicians. 

Hair transplantation for hairline reconstruction is gaining popularity among women with hair loss, thinning hair, high hairlines and those who have undergone cosmetic facial procedures which can alter the hairline, such as face and forehead lifts.  While male hairline patterns have been described in the medical literature, these parameters, when applied to women, do not achieve appropriate facial framing and a “feminine” look.

There is a general lack of   information describing natural hairline patterns in women.  Most descriptions only address the height of the hairline by evaluating vertical facial proportions. In order to develop guidelines for female hairline restoration design, we studied 360 female volunteers at an informal hair salon setting and determined the most common features necessary to achieve a feminine, natural look.  The average age of the subjects was 41 with a range of 16 to 70.  This type of extensive survey has never been done before and we hope that with greater awareness of what occurs in nature, hair restoration results in women will improve.  Below you will find the results.

A widow’s peak was present in 81%.  Peaks or mounds on the sides of the hairline were seen in 98% of the subjects.  86% had these side mounds on both sides and 12% had a mound on one side only.  Of those with mounds on both sides, 64% had a more prominent mound on the right.  Of those with one mound, 83% had the mound located on the right.  The average size of the widows peak and side mounds was determined.  Hairline cowlicks were present in 64%; 61% had one cowlick, 3% had two cowlicks and one subject had three cowlicks.  Of those with one cowlick (219 women), 70% had the cowlick on the left.  It is interesting that brain development and right or left “handedness” has been associated with cowlick position and direction.

The precise locations of the hairline structures were measured and averages were determined. The average height of the center hairline, as measured from the middle of both eyebrows was 5.4 cm.  Due to the large number of women studied, these averages are very accurate in determining the most common hairline shapes and locations.

The shape of the receding temples was concave triangular or concave oval in 87%.  99% of these women had fine hairs within the receding temples.

No correlation was found between age of the subjects and shape of the receding temples or height of the hairline, meaning that these features are most likely inherited and not age dependent.

Based on our findings, the following are proposed guidelines for designing the hairline in women via surgical hair replacement:

1. Creation of a widow’s peak.
2. Hairline 5.5 to 6 cm above the mid-eyebrow, taking into account the point at which the vertical forehead transitions to the horizontal frontal scalp.
3. Creation of side peaks or mounds
4. Concave triangular or concave oval temporal recessions with fine hairs within the recessions.

Since balding in men gets worse over time, receding hairline patterns are appropriate for male hairline restoration, while such patterns are inappropriate for female hair loss sufferers in achieving a “feminine”  look.

Due to geographic location, the women in this study may represent a particular ethnic background and ethnic differences may exist.

Bernard P. Nusbaum, M.D.

 —

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Today, physicians and scientists demonstrate that platelet rich plasma (PRP) may actually wake up dormant follicular stem cells and could quite potentially become the next major breakthrough in treating hair loss and growing hair. While some people feel this is yet another marketing attempt to rob balding men and women of their hard earned cash, others are very excited by its potential.

Blood is made from approximately 93% red blood cells (RBC), 1% white blood cells (WBC), 6% platelets, and plasma. When platelets are activated in the body, these sponge-like molecules form branches and release healing proteins called growth factors. Though growth factors have a multitude of responsibilities, the cumulative result is accelerated tissue and wound healing. The basis for the benefit of platelet rich plasma lies in decreasing the RBC count to 5% since they are less useful in the healing process while increasing the platelet count to 94%.

A recent case study on a 26 year old hair loss sufferer suggests that platelet rich plasma can stop and reverse hair miniaturization caused by androgenic alopecia or male pattern baldness. While this 26 year old patient had hair transplant surgery to recover lost hair in the hairline, his posterior crown was traumatized using a 1 mm micro needling roller and platelet rich plasma injected into the crown. The result suggests that PRP not only stopped hair loss, but reversed miniaturization.

Recently, we polled input from dozens of leading surgeons regarding their opinion and experience with PRP. While most haven’t had the opportunity to experiment with it yet, Coalition members Dr. Jerry Cooley and Dr. Alan Feller are using it in their practice.

The Benefits of platelet rich plasma (PRP) in wound healing and hair transplant graft survival have been described and discussed by Dr. Cooley. See The Benefits of Platelet Rich Plasma in Surgical Hair Restoration. Meanwhile, Dr. Feller recently started to experiment with PRP as a hair loss treatment. To learn more about his involvement with PRP and participate in a discussion about it, visit the hair loss forum topic “First platelet rich plasma (PRP) Treatment in New York”. Read the patient’s story by visiting “Consultation and PRP Treatment with Dr. Feller”.

Coalition member Dr. Ron Shapiro is hopeful that PRP will become an effective treatment for baldness however admits that to date there is no empirical evidence to indicate it’s efficacy. Without such evidence, there is only the theory of it working.

Like any other conjectured treatment for baldness, scientists have a long way to go in proving that platelet rich plasma has any real benefit to balding men and women worldwide. At this point, all we can do is wait and watch as research continues on whether or not platelet rich plasma may be the breakthrough us baldies have been waiting for.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

This insightful information was posted on our hair restoration forum by Dr. Timothy Carman who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

Many hair restoration doctors don’t perform hair transplant megasessions and they appear to be limited to do only 3500 grafts or maximum 4000 grafts.  The few doctors that do perform megasessions go up to 5000 grafts plus.  What’s the reason for this?  Are megasessions unsafe due to limited blood supply?  I know doctors recommended on the Hair Transplant Network do perform megasessions and their patients have great results, but why do other doctors limit themselves?

 In general, the maximum amount of donor grafts available in any one hair transplant session is dependent upon three factors:

1) The patient’s hair density in the donor area;
2) The length of the strip removed; and
3) The width of the strip removed.

Number one, the patients density (average = 100 FU/cm2), is what it is- this factor is beyond the surgeons/clinics control. If this number is 110 or 120 FU/cm2, the total amount of potential grafts available can dramatically increase.

Number two, the length of the incision, is limited by the size of one’s head and the relative hair density of the hair on the sides of the head. How far the incision is extended up the sides is an area where one needs to not only observe a patient’s density at the time of surgery, but also (especially in the younger patient) the anticipated thinning hair that may be in the future based on the patients genetic (family) history and hair loss pattern to date. This is critical, as, a cavalier approach for the sake of “getting big numbers” may backfire in ten years if the patient thins on the sides, revealing the incision scar.

The third factor, the width, is the area where most of the “controversy” comes into play. 1 cm? 1.5 cm? 2.0 cm? 3.0 cm? In my opinion, as a surgeon, this is an area where it is critical to know when “enough is enough”; closing a wound under “too much” tension is where one will get into some serious scarring issues. There is no sense in creating a great lawn of recipient grafts at the expense of a bad scar that needs future attention. It has been shown that pre-operative scalp stretching exercises can increase the laxity of the donor area, affecting the amount available at the time of surgical hair restoration. We recommend that our patients do these routinely prior to surgery.

Of course, there are other design/planning issues that go into the size of the session.  For example, given the age of the patient and his hair loss pattern and family history, it may be advisable to begin with a “smaller” session of 2000 grafts to recreate a more conservative hairline and reinforce the frontal forelock, while buying time to see how the patients ongoing hair loss progresses, so that more prudent use of his grafts can be made in the future.

Overall, a point I stress at my consultations is that, in my honest opinion, in plastic/cosmetic surgery “one size does not fit all”, and, accordingly, the surgical plan and design should be tailored individually, to address the individual’s needs and goals. Ultimately, the goal should be a natural, undetectable transplant that will stand the test of time.

Dr. Timothy Carman

—

Bill Seemiller – aka Falceros
Associate Publisher/Editor