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Followup of Hair
Restoration Surgery
1) Determining the
need for subsequent
sessions
2) Progressive hair
loss due to
Androgenetic
Alopecia
3) Hair Transplants
done many years ago
can be revised and
made more natural by
today’s techniques
4) Hairline
revisions may be
desirable as a
patient ages
5) Hair grooming and
styling
A) Shampoos
B) Conditioners
C) Styling aids
D) Hair styling
1) Determining the
need for subsequent
sessions
Surgical hair
restoration is a
permanent solution
for male or female
pattern baldness (androgenetic
alopecia). Often
patients require a
second procedure or
series of procedures
for the following
reasons:
1)
Hair continues to be
lost due to
androgenetic
alopecia and a
follow-up procedure
or series of
procedures is
necessary to
maintain the desired
hair coverage.
2)
Hair transplants
done many years ago
did not use the
refined techniques
available today, and
revision of the
original procedure
may be desirable to
achieve a more
natural look.
3)
The patient desires
greater density in
the area previously
treated.
4)
The position of the
hairline may need to
be adjusted forward
or backward in order
to be "age
appropriate.
Patients may have
their personal
reasons for seeking
a second hair
restoration
procedure. It is
imperative to
discuss these
reasons, in full,
with a hair
restoration surgeon
to be certain that
what is desired from
a second procedure
can be accomplished
surgically and
aesthetically.
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2) Progressive hair
loss due to
androgenetic
alopecia
Androgenetic
alopecia (male and
female pattern hair
loss) is an
inherited,
progressive
condition. It is
also an
unpredictably
progressive
condition.
For example, while
male pattern
androgenetic
alopecia may be
present as "monk
tonsure" central
hair loss in a man
and his brothers,
the man's son may
have androgenetic
alopecia in a
different and more
rapidly progressive
hair-loss pattern
than his father and
uncles. In this
hypothetical but not
uncommon case, the
son’s hair loss may
have started when he
was in his 20s and
been rapidly
progressive whereas
his father’s hair
loss started later
in life and was
slowly progressive.
The son may have
greater than 50%
hair loss by age 30
while his father
still has only
central hair loss at
age 50+. Although
androgenetic
alopecia is
inherited there can
be wide variation in
the way the genetic
predisposition is
expressed in family
members.
When hair loss
begins early in life
due to androgenetic
alopecia, as in this
example case of the
young man, early
consultation with a
physician hair
restoration
specialist should be
considered. Early
hair loss due to
androgenetic
alopecia can be an
indication that hair
loss will progress
rapidly and will
continue until most
hair is lost. A hair
restoration doctor
may recommend a hair
restoration program
that conserves
existing hair with a
hair restoration
drug approved by the
FDA.
An experienced hair
restoration doctor
is able to
anticipate future
hair loss, and place
transplanted hair
into those areas to
create a reserve
against future hair
loss. On the other
hand, surgical hair
restoration
procedures may be
required after the
original procedure
due to progressive
and unpredictable
hair loss. A
potential problem
over the years of
treatment is the
possibility that
androgenetic
alopecia will
outpace efforts to
restore hair, and at
some point there
might not be enough
donor hair available
for transplantation.
The surgeon will be
able to anticipate
the patients’ need
for subsequent
procedures, and
custom design the
long-term treatment
plan accordingly.
This is a critical
issue that should be
discussed by the
patient with the
physician hair
restoration
specialist in
planning a
comprehensive
approach to
long-term hair
restoration.
In women, subsequent
hair restoration
procedures may be
necessary due to
increased hair loss
from pregnancy and
menopause. A medical
and scalp
examination by a
physician hair
restoration
specialist helps to
determine if and
when subsequent
procedures are
required.
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3) Hair Transplants
done many years ago
can be revised and
made more natural by
today’s techniques
Hair transplants
have been available
as a treatment for
androgenetic
alopecia for about
four decades. The
instruments and
techniques were
those of that time.
Over the next 40+
years, and
especially within
the past 10 years,
both instruments and
techniques were
refined. The unit of
transplanted hair
evolved from the
"plug," or standard
graft, of numerous
follicles to
micrografts of 1 to
4 hairs. Techniques
were improved for
harvesting donor
hair, minimizing the
amount of tissue
removed from a donor
site. The emphasis
in developing new
instruments and
transplantation
techniques is to
improve the
naturalness of hair
restoration by
transplantation.
Hair transplants
done many years ago
using the "plug"
technique do not
appear as natural as
transplants done
today. The older
transplanted hair
often has an uneven
or clumpy hair
distribution—the
"rows of corn" look
sometimes associated
with older hair
transplants. A
problem with older
hair transplants is
that they may look
like transplants.
Most of these older
hair transplants can
be revised using
today’s techniques
to create a natural
look.
A hair restoration
doctor will examine
the patient’s scalp
to determine an
optimal approach to
revision of the
older transplant. A
number of approaches
are available, but
the approach to
revision must be
suitable to the
needs of the patient
and to the outcome
on which the patient
and physician agree.
In some instances an
optimal approach
might be to place
micrografts or
single-hair grafts
irregularly
throughout the "corn
rows" to create a
more natural pattern
of hair density. In
other instances it
might be most
effective to remove
portions of the
older transplant
before inserting new
micrografts or
single-hair grafts.
Follicles and hairs
removed from the old
transplant may, if
they are in good
condition, be
separated into
micrografts or
single-hair grafts
for
re-transplantation.
Revision requires
close cooperation
and consultation
between the patient
and the physician.
The physician may
sometimes advise
against an outcome
the patient desires,
either on technical
or esthetic grounds.
For example, a
fair-skinned person
with dark, coarse
hair who expresses a
desire for greater
hair density may be
advised that greater
hair density could
result in a "bushy"
look. On the other
hand, a fair-skinned
person with light
red hair may need
greater hair density
in order to achieve
acceptable scalp
coverage. The
physician hair
restoration
specialist has
training and
experience on which
the patient should
rely. The patient
should understand
that revision of an
older transplant
often requires
several transplant
sessions.
Older transplants
sometimes resulted
in uneven
("cobblestone")
areas of scalp, or
scars around donor
sites. Many of these
skin defects can be
revised or
eliminated by minor
surgical procedures.
Hair transplants
done many years ago
, Bad results
Revision and
correction , More
acceptable results
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4) Hairline
revisions may be
desirable as a
patient ages
A man who loses a
great deal of hair
in his 20s and 30s
due to androgenetic
alopecia may want to
retain a "young"
look after surgical
hair restoration.
This has, in some
instances, induced a
patient to request a
relatively low
placement of his
hairline in the
forehead-temple
area. As the man
ages he may come to
consider this lower
frontotemplar
hairline to be
inappropriate to his
age.
Hairline revision is
accomplished by a
surgical procedure
that must be suited
to the needs of the
patient. It should
be performed by an
experienced hair
restoration surgeon.
Procedures that may
be considered
include:
1)scalp reduction to
elevate the hairline
2)scalp reduction
plus removal of
several rows of
transplanted hair
from the hairline; a
cosmetic surgical
procedure called a
forehead lift to
elevate the
forehead; and,
surgical excision of
hair from the
hairline
These or other
procedures may be
recommended by the
physician hair
restoration
specialist,
depending on the
surgical and
aesthetic
considerations and
the patient’s wishes
for outcome.
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5) Hair grooming and
styling
These are the final
steps in giving a
person the desired
appearance after
surgical hair
restoration.
Transplantation or
other surgical hair
restoration
procedures restore
hair to scalp areas
where it was lost.
Hair grooming and
styling, when well
done and regularly
maintained, improve
the final result of
hair restoration. If
dismissed as
unimportant or badly
done, hair grooming
and styling can
adversely affect
appearance no matter
how successful the
outcome of hair
restoration.
The physician hair
restoration
specialist can
provide grooming and
styling
recommendations for
the individual
patient. This update
provides some
general suggestions
and observations.
Hair grooming and
hair grooming
products
In the immediate
postsurgical period,
a patient should
follow hair-grooming
instructions of the
physician hair
restoration
specialist. Both
physician and
patient want to have
hair grooming become
a part of normal
lifestyle as soon as
possible. In the
immediate
postsurgical period
hair grooming
products (shampoos,
conditioners, etc.)
that might interfere
with healing must be
avoided.
After healing is
completed, patient
can use shampoos,
conditioners and
styling aids to
improve hair
manageability and
enhance cosmetic
appearance.
Shampoos have the
multiple purposes
including :
1) removing
excess oil from the
hair and scalp,
2) cleansing
the hair of
environmental dirt
and dead skin cells,
and
3) reducing
the number of
bacteria and other
micro-organisms that
live on the hair and
scalp. All
commercially
available "big
brand" shampoos
accomplish these
purposes. The choice
of the shampoo is
largely a matter of
personal preference,
including the
usefulness of a
shampoo in preparing
the hair for
styling.
Baby shampoos are
mild, and generally
leave the hair in
good condition for
styling. Shampoos
sold for adult use
may combine
cleansing detergents
with a number of
conditioners to
improve hair
flexibility—for
example, a
strong-cleaning
detergent such as a
lauryl sulfate may
remove so much oil
that hair becomes
unmanageable and
subject to static
electricity unless
appropriately
"conditioned". It
may be necessary for
the patient to
experiment with
several shampoos
before finding one
that is suitable.
Patients with skin
conditions such as
atopic dermatitis,
psoriasis, allergic
contact dermatitis
and acne should
continue to use the
shampoos and other
hair-care products
they have found to
be least likely to
aggravate their skin
condition. The
physician hair
restoration
specialist may have
specific
recommendations for
the individual
patient with a skin
condition.
Styling of tightly
curled or kinky hair
may be made easier
by use of a shampoo
formulated
specifically for
this type of hair.
Shampoos for kinky
hair are usually
conditioning
shampoos that aid in
detangling hair and
reducing grooming
trauma caused by
combing tangled
hair.
A hair conditioning
agent may be used
with, or after, a
shampoo to make the
hair easy to comb
and more manageable
for styling. An
appropriate
conditioner can also
add to the luster of
transplanted hair.
The physician hair
restoration
specialist may have
specific
recommendations for
the individual
patient regarding
selection and use of
a conditioner.
The general types of
hair conditioners
are:
Short-contact
conditionersare
applied during or
immediately after
shampooing, and are
left on the hair for
a few minutes before
being rinsed off.
The short contact
time provides little
or no long-lasting
conditioning, but
the hair is made
more manageable for
wet combing.
Deep "protein"
conditionersare
applied after
shampooing, and left
on the hair for up
to 30 minutes before
removal by a second
shampoo. These
products contain
hydrolyzed proteins
derived from animal
tissue. The protein
conditioners
temporarily
strengthen hair
shafts and repair
split ends; to
maintain the effect,
the conditioner must
be reapplied after
every shampoo.
Protein conditioners
are especially
useful when hair
styling is made
difficult by hair
damage from dyeing,
permanent waving or
daily grooming.
Leave-in
conditionersare
applied after the
hair is dried
following a shampoo,
and left on the hair
as a styling aid.
The conditioner is
removed with the
next shampoo. Some
of these products
are formulated and
labeled specifically
as blow-dry
conditioners [see
discussion of
blow-drying below],
or as conditioners
for people with
tightly curled or
kinky hair. The
oldest
hair-thickening
"leave-in"
conditioners are
pomades and
glycerine-based
products that are
applied to the hair
to aid in combing
and improve
manageability. Newer
products cover hair
shafts with a thin
coating of a
polymer. The polymer
coating temporarily
repairs hair shafts,
gives hair more
luster, and
eliminates static
electricity as a
styling problem.
Hair thickeners and
polymer coatings are
not usually
appropriate for use
on fine-caliber
hair, as the weight
of the coating makes
it difficult to
style fine hair.
Styling aids are
gels, mousses and
sprays applied to
the hair after
shampooing. Their
principal value is
to add shine to hair
and increase the
ability of hair to
"hold" a style. Gels
and mousses are
usually applied
before styling, as a
styling aid; sprays
are usually applied
after styling to
"hold" the style.
Styling aids can be
very useful in
1) holding hair in
place and
camouflaging freshly
transplanted areas,
and
2) holding hair in a
position to make
"less" appear to be
"more". None of the
styling aids should
be used before
postsurgical healing
is completed; while
not harmful, they
can cause stinging
and burning on
unhealed scalp.
The simplest forms
of styling after
surgical hair
restoration are
combing and parting.
Both combing and
parting may be
revised as necessary
when transplantation
is accomplished in
several sessions
over a period of
months.
Parting is
esthetically most
acceptable when the
hair is parted in
areas where hair
growth is uniform.
The part should not
be made so as to
reveal large areas
of bare scalp. As
transplantation
proceeds through
several sessions,
the part may be done
differently after
each session to
achieve the best
possible appearance
until hair
restoration is
completed and the
part stabilized.
As the transplanted
hair matures, grows
in length and
increases in
diameter, more
volume will be
realized. Volume is
proportional to
width of the hair
shaft and length of
the hair. Hair
length can be
controlled by the
patient; the longer
the hair, the more
volume is present.
Increased volume can
be attained by
combing the hair to
the side of straight
back. With the part
in the appropriate
position, the hair
can be combed to the
left or right to
increase the density
horizontally. This
is usually limited
to four or five
inches. When the
hair is combed back,
the increased volume
can help to cover
the area behind the
transplants and/or
the crown. Usually,
more length and
hence volume can be
realized by combing
the hair back versus
to the side.
Combing can be used
to sweep hair over
areas of the scalp
where an appearance
of greater hair
fullness is desired.
With the use of
styling aids such as
gels and mousses,
hair can be combed
into a desired style
and maintained in
that style until the
next shampoo.
Styles that are not
as popular after
transplants include
the "flattop" and
"bangs". A large
amount of density is
necessary to create
the flattop look.
Unless a significant
amount of hair is
present in the area
prior to
transplantation, or
the patient has
thick hair shafts,
the flattop style
cannot easily be
accomplished. In
order to have bangs,
the patient must
have isolated
frontal hair loss
with good density
behind the hairline
and frontal half of
the scalp. Combing
thr hair forward
reveals any thinning
behind the hairline
and frontal half of
the scalp.
For many patients,
careful blow-drying
can add body and
volume to
transplanted hair.
Blow-drying is often
facilitated by use
of a blow-dry
conditioner [see
discussion of
conditioners above].
The physician hair
restoration
specialist may have
recommendations for
the individual
patient.
Hair dyes are
sometimes used to
create an impression
of greater hair
density, or of
younger age, after
hair
transplantation.
Before using a dye,
the patient should
check with a hair
restoration
specialist.
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