Sustainable Hair Retention

It is important to understand as we age our hair characteristics will also change naturally; when younger, later teens generally our hair is at its strongest and not uncommon to change slightly as we enter our early 20´s as men

MPB is generally relatively slow to manifest itself and deciding at what stage to treat hair loss is critical to your long term happiness; with the first signs of thinning if this is something an individual wishes to treat hair loss retention treatments should be the first option

Surgical hair restoration is not necessarily the best option in the initial stages of hair loss and is not a cure; until the hair loss pattern can be better established or the hair loss stabilises a hair transplant should not be considered

Especially at a younger age it is prudent not to panic if some thinning or miniaturising of hair is seen in the temples or generally along the hair line; almost every man will experience this over their lifetime even if MPB does not take an aggressive path

As to whether this will continue into advanced Male Pattern Baldness is a prediction to a great extent, genetically family history can be a guide but only that as the MPB gene can skip generations

The on-set of hair loss normally starts with the temporal regions of the hair line, causing the hair line to become more acute and exposing the temples to give the impression the forehead is larger; the V shaped hair line

The earlier treatment is started the greater chance of maintaining the growth you have; another option is to allow nature to progress and monitor the hair loss and then make a decision as to how best to treat over time

Although there are only 3 FDA approved hair loss treatments and results will vary from person to person it is the logical initial path to take; trying to maintain the hair line and potentially improve upon the weaker hair that is still growing can allow to keep the hair line or at least slow down the pattern of hair loss

The initial use of medications can sustain the growth of your hair for many years without the need for a surgical procedure; when deciding to start a treatment programme is specific to the individual and how severe they see their hair loss


Limit The Visible Scarring Potential

Any surgical procedure will create some degree of scarring, some more visible than others, dependent on the area and in the case of a hair transplant how short the hair is worn; also the natural skin healing properties and the skill of the doctor

This is important to understand that regardless of technique some degree of scarring remains, albeit relatively minor. Correct donor management is important to ensure the most FU´s can be removed safely and with minimum change to the area. Also post-operation healing and care by the patient is important to ensure the smallest scarring possible

The 2 techniques will leave different shaped scarring, FUT a line and FUE cylindrical; FUT the length of the line will depend largely on the number of grafts required, FUE donor will depend on the number of grafts required plus any transection

When both extraction techniques are performed to a high standard any visible scarring is minimal, even brushing through the hair it can be hard to identify; FUE the extraction points can be spread over a wide area, assuming the donor is not over harvested and FUT with later closure methods hair grows back through the line, camouflaging it further

There are limitations even when performed to a high standard, hair length; shaving the hair close to the scalp will leave visible, if different signs a surgical procedure has be performed

FUT, Follicular Unit Transplant, a single hair bearing strip is removed, the width of the strip is partly determined by the grafts required but also importantly the skin laxity, what width can be removed without creating tension when the closure is made

FUE, Follicular Unit Extraction, a cylindrical punch surrounds each FU individually, every extraction mark can potentially leave visible scarring with punch size, ability and skin healing properties playing important parts. The punch marks left heal over a couple of weeks

FUT, the line will become visible as a constant line even with hair growing through it when the hair is shaved; FUE although it is unlikely every extraction point will be visible with shaved hair but commonly a pattern of extraction is visible in areas, a man-made pattern of white dots in a symmetrical pattern

Decision Time For A Hair Transplant

Deciding when to commence surgical hair restoration can impact of how successful over time the result achieved will be and the individual’s long term happiness; starting too early when hair loss is minimal can result in long term consequences

As not all individuals will suffer from advanced hair loss some will require less restoration than others, but it is important that the donor supply, which is finite is not totally depleted to ensure restoration in the future can be carried out

If total restoration cannot be achieved in a single procedure then it is important there is no demarcation line between the native hair and the transplanted area; as this will leave an unnatural pattern of hair growth

When initially planning to restore an area of hair loss the surrounding areas also need to be assessed, weak, miniaturised hair that may still be giving coverage will recede in the future; placing into miniaturised areas will help to ensure the first hair transplant achieves a solid result

Restoring relatively small area of hair loss can result in chasing hair loss on a constant basis, requiring small touch-up sessions to camouflage small thinning areas; this can deplete the door area and long term reduce the total number of grafts available

Planning is vital from the first procedure, understanding hair loss for the majority of men is progressive; a genetic hair loss pattern can be a guide but not the rule and it is a gamble to just rely on this information

For the vast majority of men hair loss is progressive, only a small % of men will only recede to have a mature hair line; male pattern baldness follows stages of progressiveness, frontal third hair loss to total loss of hair over the top of the scalp

Only a very small % of men can ever achieve total restoration of a high NW scale hair loss pattern in a single operation; and normally the crown even if covered will have a lower density of hair placed

Planning to cover the largest area possible gives the advantage of restoration in a single procedure and maintains the donor safe zone in the best quality if future procedures are required

For many this approach is considered the best, even with a lower crown density as they achieve full coverage from hair line to crown and a natural looking pattern of hair growth. If further density is desired it is still possible to achieve this with a another hair transplant in the future

The age of an individual and hair loss pattern will play a large part when a hair transplant doctor assesses how to approach surgical hair restoration; an ethical clinic will have the individual´s long term well-being in mind and make known any concerns they may have if they feel the goals are ill-advised

Best Time For Surgical Hair Restoration

Before deciding on a hair transplant it is important to understand the limitations of the procedure, for example how much hair have you lost and how much hair can be safely removed from your donor area

There is no simple answer to when it is best to have a hair transplant procedure. Losing one’s hair can be emotive for many and can provoke an immediate reaction to deal with it straight away

A hair transplant is not a miracle cure for hair loss, it is simply the movement of hair from one area of the head to another; it will not prevent further hair loss from continuing so planning is vital as a hair transplant is not a procedure that can be reversed

Treating minimal hair loss, especially in younger men can make it hard to measure long term hair loss and donor management, therefore it is vital to be cautious and not “pull the trigger” too early

There are many aspects to consider, for example, your age, your hair loss pattern today, the potential for future hair loss, family history for hair loss both paternal and maternal sides to name a few.

It is important to have a long term plan in mind to try and ensure that your decision is correct as you become older, that the initial planning, hair line placement/design still looks natural in the future

It is sometimes better in the early stages of hair loss to use hair loss prevention medications and try to stabilise the hair loss; this can prolong the time before looking at a hair transplant, and possibly see a pattern to the hair loss

Fixing a low hair line will mean if hair loss progresses aggressively the surface area to treat becomes larger and the donor may not be able to provide enough hair to effectively treat the area with a natural looking coverage

This does not mean it is impossible but correct donor management is required; prior to any decision the donor hair checked for density and characteristics to ensure a sustained and natural coverage can be achieved

Try to ensure your decision is based on logic and not just emotion, as the decision you take today will affect you in the future and your long term happiness.

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Coordinating A Hair Transplant Procedure

There are many aspects to be considered when performing surgical hair restoration, and it is important that the medical team are well versed, work efficiently and as a team for the well-being of the patient

A hair transplant is a team effort, with the Doctor controlling their team to ensure the day runs smoothly as each individual in the team has specific roles during the day

The doctors are skilled to perform all aspects of a hair transplant. Principle duties are design and planning, anaesthesia, FUE punching, strip removal and suturing and slit making in the recipient with custom-made blades

The Tech team are medically certified and trained in-house to perform the cutting and slithering as well as graft placement, with a professional but caring manner

Preparation Of Follicular Units Under Magnification

Preparation Of Follicular Units Under Magnification

The doctor needs to extract the grafts from the donor area, be it with FUE or FUT technique; this is the first phase of the procedure. Dependent on the technique this may be performed over the day, with FUE for example; whereas FUT the harvesting is performed in one pass

Time management is important to ensure the grafts remain out of the skin for the minimal time possible; this ensures greater medical care and for the well-being of the patient. The grafts then need to be separated into their follicular unit size and cleaned, a job undertaken by the technicians and checked by the doctor

The slithering and cleaning of the grafts should always be performed under magnification; this ensures a high survival rate, reduces transection and allows for cleaner grafts to be placed

Whilst the techs are cleaning and dividing the follicular units in to the different size groupings the doctor will be making the recipient sites for the grafts to be placed into; this takes time in large sessions

The placement of the grafts is generally performed by the technicians, overseen by the doctors to ensure no slit are overlooked and the grafts placed in specific recipient sites; it is common that the technicians rest and swap over to maintain efficiency, also that more than one tech will place at the same time

Although the doctor cannot be personally hands on in every aspect on the procedure it is important that they are present and checking throughout the day and of course importantly when the procedure is finished.

It is important the patient understands who does what and is not surprised; so prior to the operation confirm with the doctor the roles of themselves and their team

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Hair Graft Extraction And Care

The first technical aspect of hair transplantation is the extraction of the follicular units from the donor area, either by FUE, Follicular Unit Extraction or FUT Follicular Unit Transplant techniques.

The donor zone has to be assessed as to, skin laxity, hair density, hair characteristics, and size of the safe zone; these factors will determine how many grafts and how easy it is extract the follicular units

Skin laxity affects each techniques, FUT the length and width of the strip that can be safely removed. FUE can affect the punch extraction quality; skin type physiology can make for a good or bad candidate. Skin characteristics will also affect the healing process and either hamper or help how visible scarring is left over the donor area

Extracted Follicular Units In A Holding Solution

Extracted Follicular Units In A Holding Solution

Hair characteristics, can affect the quality of extraction, fair or white hair makes it harder to visualise within the skin tissues, even under magnification, and curly hair makes it harder to divide the individual FU´s with FUT

With FUE as the extraction is blind, difficult hair characteristics can reduce the numbers that can be extracted otherwise the transection rate can spiral. Curly hair can make it harder to determine the direction under the skin

Hair density; the follicular unit density is generally measured per cm², the density will differ around the sides compared to the back which has the highest density and greater number of multiple FU´s

The density should be measured in points around the extraction zone to take an average reading; with FUE to ensure an educated extraction pattern to leave an even density throughout and FUT to determine the length and width of the strip

The safe zone is the area around the sides and back of the head that the follicular units are not susceptible to genetic hair loss. The size of the safe zone will be determined by the long term pattern of hair loss.

A conservative approach is advised especially with FUE, in younger candidates with minor hair loss as the true pattern of hair loss cannot be gauged and the only indicator is family history, which cannot always be followed.

FUE especially as this technique relies on a wide safe zone to reach high numbers otherwise over harvesting may occur with obvious hair less areas and loss of density. FUT the safe zone is isolated along the occipital bone, approximately in the centre of the donor region therefore in the centre of the safe zone.

From the very first procedure the donor safe zone and hair characteristics need to be assessed for the long term harvesting protocol. To ensure the donor is left in the best condition possible and to maximise the number of FU´s available as hair loss progresses to a natural result and balanced coverage can be sustained.

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Realistic Results From A Hair Transplant

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

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

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.

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

Of course it is possible to have multiple hair transplant procedures but the donor hair is a finite resource and needs to be managed well to ensure the maximum number of follicular units can be safely removed as hair loss advances

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

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

How realistic your goals are in relation to your hair characteristics and potential for advanced hair loss. 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.

A common response is “I will shave if I do not like the result or cannot have more procedures”; shaving is rarely an option as there will always be some signs a surgical procedure has been performed. This is not a good plan to enter into surgical restoration with.

Create a plan based on these qualities and then review your goals to ascertain whether at your stage of hair loss now your goals can be sustained over the longer term as the hair loss advances. 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.

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. In more stages of hair loss compromises may be required on hair line placement.

It is important to be realistic and objective, if your goals cannot be met and the reasons are explained logically it is sensible to come to terms with this and either not undergo a hair transplant or revaluate your goals to fit with what is possible with the hair resources available.


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