Female Hair Loss Sufferer, caused by Lichen Planopilaris
1 358 358
2 1929 3858
3 1144 3432
4 299 1196
Total 3730 8844 Rate=2,37
A hair transplant cannot replace like for like hair lost so relies greatly on creating the illusion of fullness and natural density; this is achieved by strategically placing and distributing the grafts over the surface area
The obvious purpose of a hair transplant is to give more fullness of hair in an area of hair loss over the top of the scalp; and with this when the result has grown out is the question of hair style and hair length
A degree of hair length is required to enhance the illusion of fullness, the longer the hair gives greater coverage and blocks the light from reflecting off the skin
The better the hair characteristics the more flexibility in hair styling and hair length is available; coarse hair and a low hair to skin colour contrast help and allow for a shorter hair cut
The shorter the hair the less coverage is produced per hair and the scalp becomes more visible, this is true in the recipient area as well as the donor area
Regardless of technique, FUT or FUE, no one can promise that there will not be visible scarring in the donor area, and the shorter the hair cut the more obvious this may become; either the linear scar from FUT or cylindrical white dots by FUE
With either technique donor management is important to minimise any visible scarring, to not over-harvest with FUE and thin the donor and with FUT respect the laxity to ensure a neat closure
Before deciding to undergo a hair transplant research thoroughly, become hair educated and do not always believe what you want to hear, base your decision on facts and logic, not solely emotion
If hair is spread over the recipient area in a diffused pattern although coverage is achieved the result never looks natural or cosmetically desirable, a minimum density of hair is required to block the light from reflecting off the head
As it is impossible to replace like for like hair a hair transplant procedure relies on artistic and medical skills to achieve the desired coverage and look of density or fullness.
As hair loss progresses it becomes harder to treat the surface area; high Norwood Scale hair loss sufferers, NW6-7 may not be able to achieve a full coverage, dependent on the quality of their donor hair
To achieve coverage on a high NW candidate will require 6000 plus grafts or follicular units from hair line to crown, dependent on hair line placement and hair characteristics of the candidate, but not everyone can reach these number
A Master Plan is required to ensure that if hair loss progresses a balanced coverage can be achieved, fixing a low aggressive hair line may seem a good idea initially but if the coverage cannot be balanced it will look unnatural
The appearance of thickness is aided by the placement of the follicular units, the angle and orientation and the curvature of the hair shaft following the natural lay of the hair. Placing the hair at the correct angle can increase coverage and block reflection of light off the scalp
This can make a huge difference in the coverage achieved in a single procedure, with a well-placed hair line can result in total restoration and a full result being achieved in the minimum time frame and least inconvenience.
Large Sessions allows the patient to achieve the maximum aesthetic result in the shortest time frame, less down-time away from work and excuses to friends, family and colleagues, as well as it being financially more agreeable to the wallet.
Can total restoration or a full head of hair be achieved? The answer to this is yes and no, replace like for like hair lost, no, but have the cosmetic illusion of a full head of hair, yes
When deciding on the technique to best use; remember:
The harvesting method is not a matter of taste but a matter of necessity. Every patient has different characteristics and these should be taken into account when deciding on the best technique that should be employed
To gain the best long term result it must be thought about from the first session, then the optimum and maximum utilisation can be made of the donor area as it is untouched and has the greatest potential. Prior to surgery the donor and recipient area will have their best properties; the donor having the best density, laxity, no scarring and the recipient has also never been touched or impaired
Achieving high numbers is not only about the characteristics of the patient. The Doctor´s & Medical Team must be able to work together efficiently and with high skill to ensure graft survival and patient care is the priority
The hair loss pattern will determine the number of grafts required to cover the surface area. Each technique has pros and cons and before deciding on the technique to first use it is important to access the long term donor management.
If hair loss has progressed to an advanced state the need for grafts is high to cover the surface area. The larger the surface area the harder it is to treat the entire area in one procedure with either technique
The options is to treat the area over multiple procedures, starting with the hair line and working back over the frontal third and mid-section and later to treat the crown; this will require maybe 2-5 procedures dependent on technique and the quality of the donor resources
There are 2 recognised hair transplant techniques in use today, the FUT and FUE techniques. They differ mainly in the donor management and the manner the follicular units are removed from the scalp
Utilising the benefits of both FUT and FUE and combine the techniques to maximise the graft numbers in a single procedure; allowing for the potential to reach total coverage and possibly a “home run” result
By combining the two there is the potential to reach in excess of 8000 grafts on a good candidate; on an average candidate that would maybe only achieve 4000 grafts increase the number to 6000
Combining the techniques can also be of great benefit to repair hair transplant candidates; when the donor area has been impaired by improper previous surgery. Being able to remove a strip and widen the extraction zone at the same time can provide the maximum graft numbers to correct the pattern of hair growth over the recipient area
The safe zone, especially in the early stages of hair loss can be hard to define when using FUE as there are no obvious signs where it may be demarcated; if the lateral humps or crown drop later the safe zone is reduced
Progressive hair loss can mean hair loss drops down the sides and back of the head, extending the surface area of the crown, also known as the vertex; this will potentially eat into the size of the safe zone, especially with FUE
The demarcation line could still drop so it is important to leave a little leeway and not harvest the follicular units directly up to this line; this makes for a more safe an educated harvesting protocol.
Long term planning is a vital component to the success of the hair transplant, present and in the future; understanding the donor limitations, what each technique is safely capable of and accepting limitations
As the FUT donor is located centrally within the overall potential donor zone there is very minimal chance that any hair extracted is unsafe to transplant
The FUE technique relies on a wide surface area to extract the hair from as FUE reduces the hair density left in the area; so the wider the area hair can be removed from the lower the density change occurs
The hair transplant donor area is the band of hair around the back and sides of the head, for a man or a woman; an area that is genetically strong and the follicles do not suffer from genetic hair loss properties
Unsafe hair can be miniaturised hair in the donor, this should not be extracted, or even adjacent strong hair and hair outside the safe zone that can suffer from loss in the future
As FUE does rely more on a wide surface area, if a candidate has generally weaker characteristics in the donor it will reduce the total overall FU´s that can safely be extracted; assuming an educated extraction pattern is adhered to
FUT relies more on skin laxity when removing the strip, when performed well with good healing a further strip can be removed from the same area, englobing the first line and still reaching high graft numbers
In the early stages of hair loss important factors such as potential for future loss, recipient surface area, the size of the donor safe zone are impossibly to determine accurately
Prior to undergoing surgical hair restoration it is important to understand a hair transplant is not a miracle cure; as positive it can be on the right candidate it does have limitations that cannot be overcome
In more advanced stages of hair loss the ultimate pattern is easier to establish but also a compromise may be required on hair line placement to ensure a balanced and natural looking coverage can be achieved
Be aware that to rely solely on family “hair history”, especially at a younger age is ill-advised as hair loss does not always follow the genetic pattern of our paternal, maternal or siblings; it is a guide only.
A man in his early/mid 20´s with minor hair line recession wanting to rebuild the hair line to its original position; can this be achieved? Yes of course, with a relatively minor number of grafts the hair line can be rebuilt, 1000-1500 FU´s needed
The goals of the individual have been met but what happens as hair loss progresses over the years and the balance of hair to bald area becomes disproportionate and unnatural with a hair line fixed in a low position
Understanding the limitations and accepting them it is then possible to set your goals accordingly; this will go a long way to ensuring your long term happiness and well-being, and not being another “repair case” statistic.
As tempting as it maybe to jump into hair restoration it is always better to take a step back and rethink your goals long term. A hair transplant is not something that can be reversed if you do not like the result
As the donor hair is key to the long term result, especially as hair loss is progressive over our lifetime, it is essential to have a clear plan in the worst case scenario what the donor resources can give and what coverage can be achieved
Have the donor hair density measured, calculated the approximate average hair to FU count, good, bad or fair hair characteristics, skin healing and laxity, donor safe zone size, the best techniques to use now and in the future.