Knowledge is Healing

The goal of hair transplant surgery is to give patients more hair than they had prior to surgery. However, unlike other cosmetic procedures, sometimes patients look worse after surgical hair restoration before they look better.

Some patients are plagued by a temporary hair loss condition known as telogen effluvium or “shock loss” which can occur anytime hair is transplanted in between or around existing hair.  This is true whether the hair is natural or previously transplanted. This often causes great concern for those who don’t expect it, and even those that do; it can be a real brain buster causing mild anxiety.

View this hair loss discussion thread to learn and discuss why shock loss occurs and how to get through the doldrums while waiting for new hair regrowth.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

Most balding men and women would love to restore their natural full head of hair by waving a magic wand and/or by popping a miracle pill. However, hair restoration involves careful and strategic planning with a skilled and experienced hair loss doctor. While Propecia (finasteride) and Rogaine (minoxidil) are typically good at slowing down or stopping the progression of male pattern baldness, hair transplant surgery is the only method of hair restoration proven to grow hair in completely bald areas.

Today’s state of the art hair transplants are very natural looking and undetectable by even the harshest critics. This explains its increase in popularity over the last several years. But while advancements in surgical hair restoration are indeed exciting, it’s crucial for men and women considering this procedure to develop realistic expectations. What can realistically be achieved with hair transplantation varies for each patient. Below, we’ve cited a few important tips in helping you learn what to expect from hair replacement surgery.

Supply Verses Demand: What can be realistically achieved depends on the supply of donor hair and the amount of baldness in demand of new hair. Most patients can typically only achieve an illusion of fullness even under the best circumstances. Thankfully, this is usually enough to provide patients with a cosmetically significant improvement. Those with advanced balding may have to make additional sacrifices and leave some balding areas untouched. To see what hair transplants can accomplish on patients of varying degrees of lost hair, view Hair Transplant Photos by Norwood scale.

The Unpredictable Future: Though family history can sometimes be used as a guide, female and male pattern baldness is both progressive and unpredictable. Thus, it is important to make the best use out of the available and limited donor hair supply, leaving plenty in reserve for the possibility of subsequent hair implant procedures that become necessary.

Reputable hair restoration physicians should always proceed with extreme caution especially on young patients. These quality doctors will often refuse hairline lowering procedures and extreme dense packing on patients if risks of significant hair loss are high. Age isn’t the only issue, but is to be strongly considered since risks of excessive hair loss in the future are much greater in young patients. The good news is that only a select rare group of men will progress to advanced stages of loss. See the Norwood Scale (men) and Ludwig Scale (women) for typical hair loss patterns of androgenic alopecia.

Going the Distance: While one hair transplant may or may not be able to meet your current objectives, restoration should be considered a journey rather than a single one and done procedure. Realistic expectations and a long term hair restoration plan should be discussed with your surgeon and agreed upon before undergoing even the first transplant. Be sure to discuss the risk of future baldness, the best use of a finite donor supply, and the realities of what hair transplantation can accomplish for you.

Doing the Math: The average donor hair supply with follicular unit transplantation (FUT) via microscopic dissection (strip surgery) is approximately 5000 to 8000 follicular units. For patients considering follicular unit transplantation via follicular unit extraction (FUE), a patient’s average donor supply is a little less – between 3000 to 5000 follicular units. Usually a combination of strip and FUE can provide more than either procedure itself but less than the sum of both.

In men and women with moderate to advanced balding, there is much more demand for hair than available supply. Thus, it’s important to work with a reputable hair transplant surgeon to develop realistic goals. To gain a proper perspective on the amount of hair needed for a full restoration, see “Can Hair Transplant Surgery Help Me Look Like Chris Martin from Coldplay?”

Bill Seemiller – aka Falceros
Associate Publisher/Editor

In the past I have been told that hair density of 50 follicular unit grafts per square centimeter should not compromise graft survival.  However, I was wondering would transplanting hair at 55 FU/cm2 or 65 FU/cm2 compromise vascularity or hair growth yield? Also, is any graft survival compromised leading up to achieving natural density? Cheers.

This insightful information was posted on our hair restoration forum by Dr. Brad Limmerof San Antonio, TX who is a member of the Coalition of Independent Hair Restoration Physicians.

I agree with what has been on the hair loss forum discussion thread “Graft Survival and High Hair Densities” by various members regarding percentage yield.  As Coalition member Dr. Charles points out a very important point regarding this question, “there are countless variables that go into this equation.” Some are hair transplant patient dependant and some are hair restoration clinic/technique dependant.   Thus, the outcome can be different between patients even though they go to the same clinic.

We have typically approached the problem of yielding densities higher than 50 FU/cm2 by a 2 pass approach. While more conservative than some (who produce nice results), I feel it minimizes 3 important risks to the patient:

1. Less than optimal hair growth
2. The Potential for ridging (dermal fibrosis below the skin – which is basically scar tissue resulting from the multiple recipient sites create in such a small area)
3. Permanent neovascularization (redness that won’t go away – resulting from capillary proliferation during the healing process)

Sorry for the diversion from your question, but the problem of lower yield can often be easily addressed. Ridging and redness can be permanent. Granted this is not always going to occur at high densities, but this had not been seen with follicular unit (FU) micrografting until ultra high densities became more common. It was a problem seen years ago with plugs/minigrafting but is now occasionally being seen again. So while not an absolute contra indication, at least be aware of the possible risks.

Brad Limmer, M.D.

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Bill Seemiller - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Balding men and women with hair loss who’ve decided to get a hair transplant are usually excited with dreams of getting their hair back. And though the end result of a hair transplant is a fuller head of hair, the expression, “the devil is in the details” is vital when learning how to fit surgical hair restoration into your life, especially during the first several months of healing and waiting for new hair growth. This includes returning to work, concealing your hair transplant from co-workers, friends and family, how long it takes to heal and look normal, etc.

Visit this discussion thread to discuss how to prepare for the first few awkward months after surgical hair replacement including when it’s ok to return to work. Your experience and input is welcome and encouraged.

Bill Seemiller – aka Falceros
Associate Publisher/Editor

25 Oct 2009 05:08 PM

I sprained my knee about 4 weeks ago. I want to get back into my fitness routine, but I am not sure how to go about it. How do I start exercising again without risking reinjury?

You will want to make sure that you are at a point to start again safely. You will want to get your doctor's advice and permission to proceed with your workout routine. Your doctor is a professional and he will know if it is safe to do so. Do not worry that you are starting back at square one. You would have to be out of commission for a couple of months to be at that point. If you are still experiencing a great deal of discomfort, wait until you feel ready to begin. Pushing yourself when your knee is still tender will only set you back even further. If you are a person who enjoys physical activity and needs it to feel good you are probably at your wit's end waiting to start back up again. This is understandable, but you must be patient.

When you are ready to resume your previous exercise activity it is best to move carefully. Do not force your knee into a position that exacerbates discomfort. Do not do any exercises that put weight solely on your knees. Do not do any exercises that involve putting pressure on your knee. When my knee was sprained I was out of my routine for approximately 4 to 5 weeks. I started back at the gym with caution and with my doctor's blessing. His words were, "Use caution and play it by ear. You will know when to stop. Do not go beyond that point." I was extremely hesitant when I climbed up on the elliptical machine. The first few movements of the elliptical were enough to send a warning to me. It hurt. I got right off of it and concentrated on exercising my upper body. It was wonderful to move my body again. I tried the treadmill next and I did just fine. I was not running, but walking pretty smoothly and without pain. This is something that you will have to gauge for yourself. After a week or two I was able to do more. If you are feeling pretty good once you start exercising you can visit the gym again a couple of days later. I would not go two days in a row until you have exercised for about a week or two. If you are feeling pretty good after that slowly increase your gym time. If you are having discomfort you will have to back off for a while until you are feeling better again. I realize that it is very frustrating, but if you are not careful you will just set yourself back. It will take time, but before long you will be right back where you were before your injury.

Angel Lynn writes in weight loss, single parenting, fitness, media and health.

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