Minor To Major Hair Loss

Hair loss is generally progressive and although the ultimate hair loss pattern can be guided by an individual´s genetics this is only a guide and hair restoration should not solely be planned with genetic factors in mind

Assuming treatment does work they can control hair loss for many years; they need to be used correctly and the positive results will only continue while the treatment is being used; stop and the hair loss will commence

As emotive as hair loss is at a younger age be careful not to lose common sense over emotion as we are all older for many more years than we are younger; at the time it may appear the best solution but many have made this mistake and regretted their actions

Surgical hair restoration is not always the best first option, especially on a younger age; there is no way to determine how fast or the pattern of hair loss and fixing a low hair line can create complications in the coming years, a balanced coverage and donor management issues

The hair line can take a relatively high number of follicular units for the surface area to cover; using so many and fixing the hair line low will increase the potential surface area to treat in the future as hair loss progresses

As we age the hair loss pattern matures, even a man in their mid to late 30´s and early 40´s may have only receded over the frontal area, around a Norwood 3 hair loss stage; this allows designing a new hair line much easier

It is always important to research and get the opinion of multiple hair transplantation doctors; do not always take the word you are a good hair transplant candidate just because it suits you to hear this

Advanced hair loss sufferers generally have lower expectations in terms of restoration; a natural result is priority but expectations of a low adolescent hair line is not the top significance for many

With planning it is possible to rebuild the surface area of hair loss, and on the right candidate achieve total coverage in a single procedure, even if this means a slightly lower hair density over the crown

Achieving total coverage with a natural hair density in one procedure is time efficient for the individual, only means entering the donor and recipient areas once, causing as little change to the skin and better healing

If total coverage can be achieved it is common the hair density over the crown will be reduced compared to the placement over the frontal and mid-section; few candidates can achieve total coverage and even density from hair line to crown in one procedure

Planning with any hair transplant is important as the first session the scalp is always in the best condition to maximise graft numbers; a mutually agreed plan between doctor and patient will ensure that both parties understand what can be achieved and the long term happiness of the individual

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Hair Loss And Donor Hair Miniaturisation

Hair loss can be slow and in the initial stages not recognised; the hair follicle goes through gradually stages before it stops producing hair. The first signs can be the hair shafts becoming finer and shorter

Hair loss is generally associated with the top of our heads, from the hair line to the mid-section and then the crown or vertex.

Certain hair loss types can make surgical hair restoration a bad option, especially when hair loss affects the traditional scalp donor area

Unlike MPB, Male Pattern Baldness or Androgenic Alopecia DUPA does not sustain a localised stable safe zone of hair to be able to harvest from via a hair transplant

MPB can be combined with DUPA hair loss sufferers, with a normal pattern of recession occurring over the top of the scalp and if the hair loss progresses to a high Norwood stage ending with the horseshoe pattern

With DUPA there is a general decrease in hair density of hair randomly but evenly over the scalp, sometimes combined with the miniaturisation of the hair shaft at the same time

Another sign of hair loss, more traditional MPB can sometimes be increased shedding of hair; it´s not uncommon for us to shed around 100 hairs per day, this is not a problem as long as 100 hairs regrow the same day, and then a balance is achieved

Because the initial changes can be subtle they can sometimes only be visible under magnification. Under magnification it is possible to compare various areas of the scalp and the hair calibre

An obvious sign of hair loss is loss of hair density, making the scalp more visible and the recession of the hair line and temples, enlarging the size and surface area of the forehead

When you have a consultation any miniaturisation can be assessed, not just over the top of the scalp but also the sides and back, known in hair transplantation as the donor area. It is usual to have a little miniaturisation in the donor

If a hair transplant is being considered too much hair miniaturisation in the donor area can make a hair transplant not credible. Miniaturised hairs should not be used as they are weaker and may not regrow when transplanted

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Hair Transplant Technique: FUT, FUE or Both?

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

Hair Restoration, Start With The Crown Or Frontal Third First

The crown is an important area and not forgotten but due to limitations with surgical hair restoration common sense and planning are vital to ensure a balanced natural look of hair coverage

Some men keep a relatively intact frontal area, relatively minor recession points that do not accentuate the size of the forehead; but instead the hair loss is more aggressive over the crown or vertex area

Others and more common is a thinning and receding from the hair line back over the frontal section, and the crown showing signs of thinning until the two areas meet with an advanced hair loss stage

Many feel crown restoration is considered second and unimportant, especially considering the frontal and mid-sections of the scalp. This is only because fixing the hair line and frontal generally will have a much greater impact as a cosmetic result

Due to the nature hair lays in the crown and coupled with the surface area the crown can require a large number of grafts; eating into the finite resources of the donor hair

The crown can expand on all sides, moving forward, backward and down both sides, it can open at quite a pace making it difficult to track; also the surface area can be large with not much difference to the frontal and mid-sections combined

If the crown is treated first it can complicate future restoration; if too high a density is placed it will require more grafts than is safe, if treated to early the area around can open leaving an island of hair that was transplanted

With the onset of thinning the best initial option is possibly hair retention medications; if caught early enough they can preserve the growth of the hair so hair loss is not obvious; even if not treated early it may be a good option and plan restoration with this in mind

As the donor area is a finite resource and the aim of hair restoration is to create a natural looking coverage of hair each individual has to take into consideration the limitations of their donor hair, the amount of hair available, the hair characteristics and the best technique to use to over time maximise the graft numbers

If a plan is made from the first procedure and understanding the donor limitations even high Norwood hair loss sufferers can achieve crown coverage with a natural looking density

Blending Body Hair With Scalp Hair Transplantation

Body hair, or BH, has become more used in recent years to increase the supply of donor hair; all care must be taken before utilising this donor resource for a number of reasons and it is not something that should be undergone without exhausting all options

Genetically strong scalp hair is used from around the sides and back of the scalp, the scalp donor safe zone; hair that does not suffer from the Male Pattern Baldness gene, and can be removed and replaced in the area of hair loss, the recipient area

In some cases the scalp hair donor may not be sufficient or has been depleted by previous hair transplant procedures; this is especially true when repair surgery is required and the traditional donor is impaired or classified as an “open donor”

Body hair is any hair that is not scalp hair, includes the beard, chest hair, hair on the arms and legs. BH can have many different characteristics compared to scalp hair, hair calibre, and growth phases, to name two and it is important to ensure that a natural blend can be maintained with the scalp hair

Dependent on the area of the body, for example beard hair can be much coarser compared to scalp hair; this can give slightly more coverage may be but the contrast when compared to the scalp hair can be huge

Generally body hair does not grow as long as scalp hair, the growth phase being shorter so if used this must be taken into consideration otherwise there will be obvious cosmetic differences compared to the scalp hair

Hairs grow in groups called follicular units, FU´s, with an approximate average of hairs per FU at 2.2 for scalp hair; body hair is almost always single hair FU´s, occasionally 2 hairs but very rarely more, so the average hair per group is much lower than scalp hair. This impact on the coverage achieved per FU and the total number of BH grafts required can be almost 3 times that compared to scalp hair

BH has been used with success on patients but this does not mean it is suitable for every candidate; there are many variables that need to be taken into consideration before taking this option as much is still not understood about the growth and use of body hair

When entering surgical hair restoration the aim is to cover the required area with a natural appearance that blends with the surrounding hair and create a balanced natural looking density over the scalp

Follicular Unit Transplantation

Like any surgical procedure there is always going to be a degree of scarring; when performed to a high standard the closure of the strip is easily hidden within the surrounding hair and even on close inspection hard to see

An advantage of strip is the follicular units are removed in the one strip making it able to harvest large numbers efficiently, along with a proficient and experienced team behind the doctor can then be divided in to the natural groups of follicular units

Follicular Unit Transfer, FUT or Strip Surgery; out of the two accepted techniques used today is the older of the two; FUT removes a thin hair bearing strip from around the sides and back of the head approximately in the zone known as the occipital area

As FUT relies on skin laxity for the removal this has to be considered when healing; not to create too much tension on the scalp, heavy exercise for example may create pressure on the area that can cause stretch back; so always take this into consideration when arranging your surgery and ensure you can adhere to the post-operative instructions you are given

With planning FUT can give the right high NW candidate an acceptable coverage from hair line to crown, albeit with a lower crown density, but if the individual is happy a result can be achieved in a single procedure

Once the strip is removed it is divided into smaller sections and then handed to the technicians who then divide into the individual follicular units, they are cleaned under magnification and kept in a holding solution

This process allows for only good quality grafts to be used and sustains a good yield or growth rate when the hair transplant matures; the process of extraction also allows for the overall procedure to run smoothly and efficiently; meaning that large numbers can be safely moved in a one day procedure; on the right candidate with good donor characteristics around 7000 grafts or FU´s

With future FUT procedures and acceptable donor healing the old line can still be removed when extracting more grafts; the graft numbers will probably be lower than the initial procedure but still enough to complete restoration even on high Norwood cases most of the time

Hair Calibre And Graft Distribution

Correct attention to the hair characteristics traits and how they will affect the quality of a hair transplant result are vital and all play a necessary role in the distribution of the follicular units over the scalp

Hair shaft diameter when cross sectioned can range from around 60 to 140 microns; a significant variant that needs to be taken into consideration prior to surgery and during the planning and distribution stages

The hair calibre can vary differently from person to person, fine, wispy hair to coarse thick hair, giving very different dimensions, coverage and shadow when placed over the recipient area

When a density figure is suggested many times the higher the number is considered the better, but this a falsehood; the density required is made of various other conditions that then give the density figure necessary

Hair characteristics play an important role in the make-up and result of a hair transplant; the better the hair characteristics can allow for total restoration and cover the surface area of the recipient with the least amount of grafts/follicular units possible

The variant in hair characteristics being taken into consideration can change the planning and graft distribution massively; from one extreme being the individual does not make a good hair transplant candidate to another candidate being able to achieve a “home run” result

This means that varying densities can be placed from one hair transplant patient to another and the ultimate grafts numbers can differ even if the same calculated surface area is treated; making the density not the first calculation to consider when planning

The hair shaft diameter plays a significant role in creating the volume a hair transplant relies on to create the illusion of density. Combined with the natural hair groupings per follicular unit, 1-4 hairs will determine the density required to be placed to achieve a result that blocks the light reflection off the scalp and creates sufficient fullness

Single hair units are placed along the hair line; behind the hair line multiple hair follicular units are placed. The 2, 3, and 4 follicular units are not randomly placed but strategically in areas to create the best thickness. Generally the higher the number of hairs a lower density can be placed