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Patient Education
Booklet
1) Tranquilizer
2) Preparation of
the Donor area`s
hair
3) Anesthesia
4) Removing the
hairs from Donor
area
5) Types of Grafts
6) The Recipient
Site
7) Bandage
8) After session
9) Number of
sessions required
10) Final Results
11) Repair of
Unsatisfactory Prior
Transplanting
12) Confusing Claims
13) Summary
The following is a
summary of the
procedure that is
routinely given to
you during HAIR
TRANSPLANTATION
SURGERY:
1)Tranquilizer
You are given a mild
tranquilizer(usually
Diazepam), usually
orally, 1 hour befor
session. This
minimizes anxiety,
reduces discomfort,
and helps to prevent
or decrease any side
effects that might
be caused by the
anesthetic.
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2)Preparation of the
Donor area`s hair
Hair in the donor
area is clipped to a
2 mm length in one
or two zones that
are less than 12 mm
wide, and a total of
18-22 Cm long. The
hair above removed
area is left long,
so it can be combed
over and completely
camouflages the
donor area
immediately after
the procedure.
Position of the
patient
Donor area`s hair is
cut & clipped
up
3)Anesthesia
The donor area and
the recipient area
are anesthetized by
injecting a local
anesthetic with a
very small gauge
needle that is about
the size of an
acupuncture needle.
In addition to using
a small gauge
needle, we reduce
the sting when
injecting the local
anesthetic by
neutralizing the pH
of the anesthetic,
which is normally
stored in an acidic
form. (The acidity
is the main cause of
the stinging one
usually feels.)
Nitrous oxide
(laughing gas) may
also be used
simultaneously for
particularly
sensitive or nervous
people.
Anesthetizing the
area is the only
uncomfortable part
of the session.
Although it may be
hard to believe,
many patients have
told us that the
above technique
usually causes less
discomfort than a
visit to their
dentist.
In order to
accommodate patients
who prefer "no
needle" procedures,
we can use an
instrument called a
"dermajet", which
propels the
anesthetic into the
skin via pressure
rather than a
needle. Even though
no needle is being
used, such
propulsion does
cause a short-lived
sting at each site.
Most patients seem
to find this method
less satisfactory
than the use of
narrow gauge
needles, but both
options are
available.
For patients who are
particularly anxious
about pain, an
anesthetist can be
called upon to
administer a very
short-lived and very
safe general
anesthetic, which
induces sleep for 5
to 10 minutes during
which all the
potentially painful
needles are given.
It is, however,
worthwhile
emphasizing that
this is rarely
necessary as current
techniques produce
very little
discomfort for the
vast majority of
patients.
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4)Removing the hairs
from Donor area
After the local
anesthetic has taken
effect, A scalpel is
used to cut narrow
'strips' or
'ellipses' of
hair-bearing scalp
from the donor areas
and the wound is
closed with sutures.
(A similar method
can also be used to
remove scars in the
donor area). This
tissue is then
divided into a
variety of graft
sizes.
Immediately after
suturing Donor area
(The site is
compleletly
invisible)
Removed strip
A fragment of
removed strip
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5) Types of Grafts
Many types of grafts
are now used in the
recipient area.
Their advantages and
disadvantages are
discussed elsewhere
in this website—see
“Current Hair
Transplant
Options”. In
general, the smaller
the size of the
graft used, the less
noticeable treatment
will be
post-operatively and
in between sessions.
On the other hand,
in general, the
smaller the graft,
the lower the
density that can
ultimately be
achieved.
Follicular units
ready for placing
up
6) The Recipient
Site
In the terminology
of hair
transplantation, the
recipient site is
where hair is
transplanted. It is
the area of the
scalp where hair
follicles and the
hair that grows from
them are
transplanted to
correct hair loss.
The hair follicles
used for
transplantation are
harvested from the
donor site, scalp
areas at the side
and back of the head
where follicles are
not influenced by
the gene(s)
responsible for male
pattern hair loss.
With minor
exceptions, the
donor site is the
same for both male
and female hair
transplantation.
The purpose of hair
transplantation is
to restore aesthetic
balance to a
person's
appearance-a balance
that is lost with
balding of the
scalp. Whether hair
loss is confined to
one area (for
example, recession
of the hairline or
balding on top of
the head) or over
most of the scalp,
the aesthetic
balance of a
person's face is
compromised. The
hair loss area can
become the feature
that draws attention
away from the face
and dominates
overall facial
appearance.
Restoration of
facial
balance-restoration
of appearance that
pleases the
patient-is a process
that calls upon the
surgical science of
hair transplantation
and the aesthetic
artistry of the
physician hair
restoration
specialist. The
person with hair
loss consults a
physician hair
restoration
specialist because
he/she is not
pleased with the
change in appearance
created by hair
loss. The physician
hair restoration
specialist listens
to the patient's
wishes and concerns
and interprets them
in the context of:
1)
the patient's age,
location of hair
loss, degree of hair
loss, progression of
hair loss, and
availability of
donor hair
2)
surgical techniques
and procedures that
could be used to
address the
patient's wishes
3)
how these techniques
and procedures can
be used to achieve
the best aesthetic
result given the
patient's age,
characteristics of
hair loss, and
wishes of the
patient including
time and cost of
hair
transplantation.
The end result of
transplantation
should always be
optimum aesthetic
outcome for the
patient as agreed
upon between patient
and physician. The
patient should not
be "sold" an
approach to hair
restoration. Rather,
the patient and
physician should
agree on an approach
and an anticipated
outcome after full
and honest
discussion of (1)
the patient's
wishes, (2) the
physician's
recommendations, and
(3) the patient's
concerns about the
number of transplant
sessions required,
cost and potential
complications.
Primary aesthetic
concerns that must
be addressed
include:
A) The hairline:
A recreated hairline
should be placed at
an aesthetically
correct position on
the frontal scalp,
be natural in
appearance, be
appropriate to the
patient's age, and
be congruent with
the appearance of
other original or
restored hair on the
scalp. The skilled
and experienced
physician hair
restoration
specialist also
takes into account
how a recreated
hairline will "age"
as the patient ages.
The hairline should
remain appropriate
to the patient's age
over a period of
time; a hairline
that looks natural
when the patient is
28 should continue
to appear natural
when the patient is
48.
B) The part:
Unless the patient
intends to
habitually have a
very short hair
style such as a crew
cut, he will usually
comb his hair with a
part. If he had a
part before hair
loss, he should have
a part after hair
restoration unless
circumstances
individual to the
patient make this
impossible. A
natural-appearing
part usually begins
at a point where the
frontal hairline
curves inward and
upward from the
forehead. From the
origin of the part
at the frontal
hairline to its
termination at the
center of the scalp,
the placement,
density and quality
of hair on either
side of the part
should promote
comb-styling and
naturalness of
appearance.
C) Natural
appearance and ease
of styling:
"Natural appearance"
is the key phrase
describing hair
transplantation
today. The type of
donor hair selected,
graft placement,
size of grafts and
overall transplant
technique are
selected to assure
that transplanted
hair is as "natural"
in appearance as
original hair and is
amenable to styling
as appropriate to
the patient's
wishes.
Preoperative
planning is directed
toward achieving an
optimum aesthetic
result at the
recipient site-a
result that meets
the expectations of
the patient as
agreed upon after
full and frank
discussion between
patient and
physician hair
restoration
specialist. Optimum
aesthetic result is
achieved by the
physician hair
restoration
specialist's
skillful and
experienced use of:
A)
knowledge of hair
follicle biology and
its application in
the processes of
hair transplantation
B)
the physical
characteristics of
hair (caliber,
color, texture,
curl) and how to use
these
characteristics to
maximum aesthetic
effect at the
recipient site
C)
transplantation
grafts ranging in
size from
single-hair to
multiple hairs, and
which types of graft
are appropriate for
use in the patient
to achieve the
optimum aesthetic
result
D)
surgical techniques
of donor hair
removal,
preservation of
donor grafts between
removal from donor
site to implantation
in the recipient
site, preparation of
scalp skin for graft
implantation, and
implantation of
grafts at the
correct depth and
angle to assure
survival and
subsequent hair
growth at the angle
appropriate for
natural appearance
and ease of styling.
It is fortunate for
both patient and
physician that there
are a variety of
transplantation
techniques available
today, all of which
can be used to
produce natural
results. Several
techniques may be
used in
combination-for
example, mini-grafts
(5 hairs or more)
where density is a
primary objective,
micro-grafts (cut to
size with 1 to 4
hairs)and follicular
unit grafts (natural
groupings of 1 to 4
hairs) where finely
defined effects are
needed. The number
of transplant
sessions needed to
accomplish the
anticipated
aesthetic outcome
varies from patient
to patient. Multiple
sessions over a
period of months may
be recommended. This
allows the physician
hair restoration
specialist to assess
the outcome of each
session and use this
assessment to guide
the choice of size,
type and placement
of grafts for
following sessions
to assure a final
natural-looking
appearance. For
example, single-hair
or micro-hair grafts
of two or three
follicles might be
used to complete the
natural-looking
appearance of a
given scalp area.
Incisions in bald
area(Recipient site)
Fine insertion of a
follicular unit
Grafs are inserted
Completion of hair
transplantation in
one densely-packed
"mega-session" has
recently been made
possible by advances
in surgical
technique. However,
one must understand
that hair loss is an
on-going condition-i.e.,
the patient may lose
hair in the future.
In such an event,
more surgery may be
required than is
recommended at
present.
Mega-sessions should
be carried out only
by a skilled and
experienced
physician hair
restoration
specialist in
selected patients.
The choice of
multiple sessions or
mega-session should
be individualized to
the patient's needs
and wishes. The
"best" choice is the
one best for the
individual patient.
Immediately after
hair transplantation
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7) Bandage
Grafts are held in
place by coagulated
blood. To keep them
secure and properly
oriented, a
turban-like bandage
is usually applied
after the operation
and left in place
overnight. The
following day, the
bandage is removed
and the area is
cleansed. If there
is no more than the
average amount of
bleeding during
surgery and you are
willing to remain in
the office for one
or two hours after
the procedure is
completed, you can
go home without a
bandage. (Most
patients seem to
prefer the security
of an overnight
bandage). Whether or
not a bandage is
used, patients
return the next day
for follow-up
cleansing, hair
washing, and
check-up.
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8) After session
A crust or scab
forms over each
graft shortly after
the procedure, and
remains attached for
5 to 14 days. (The
smaller the graft,
the faster the crust
tends to fall off.)
When the area is
healed, the crusts
separate from the
scalp leaving a
clean, pinkish area
to indicate the site
of each graft.
Although these
crusts are visible
during the five-day
to two-week healing
period, many
patients can
camouflage them by
combing the adjacent
hair over the
transplanted site.
If a hairpiece is
normally worn, it
may be used to
conceal the crusts
after the first week
(and should be worn
as little as
possible for an
additional week).
DFUs, TFUs, “slot”
grafts and round
minigrafts leave
much less visible
marks than standard
round grafts, and
are virtually
undetectable within
7 to 10 days. The
holes made for
micrografts
disappear within a
few days to a week.
The hairs in the
transplanted grafts
are shed between the
2nd and 8th week
after the procedure.
Sometimes, they fall
out attached to the
separating crusts;
occasionally they
persist longer.
Rarely, some of the
transplanted
follicles do not
shed their hair at
all, but continue to
grow immediately
after the procedure.
With these
exceptions, the
grafts are usually
bare until 10 to 14
weeks after the
operation, during
which time the
follicles recuperate
to produce new hair.
A new generation of
hair is usually
visible at the
surface of the scalp
by the 12th week
after transplanting,
but this may occur
slightly earlier, or
up to eight weeks
later in a few
patients. These
hairs grow at the
same rate as they
did in their
original location
(which is usually 1
Cm per month).
When a large area is
transplanted,
swelling of the
forehead frequently
occurs. While this
swelling is usually
mild and lasts only
two to four days, it
occasionally can be
severe enough to
cause a large amount
of puffiness around
the eyes.
Approximately, 1 out
of 50 patients have
swelling bad enough
to cause "black
eyes". Generally,
the swelling begins
two to three days
after the procedure
and is most
noticeable after the
first session. With
subsequent
treatments, it
usually occurs in a
milder form or not
at all. In view of
this, it's advisable
to schedule, if
possible, a holiday
to coincide with the
1st session. Please
be assured that the
swelling is
ALWAYS temporary
and has no harmful
effect on the
healing grafts. (An
intra-muscular
injection of a
cortisone-type drug
can be given at the
time of the
operation to help
minimize swelling).
Contrary to what
many patients have
been told, the scalp
(hairy or bald) has
an excellent blood
supply. A certain
amount of bleeding
during the
transplant procedure
is expected and is
controlled simply by
applying pressure.
The donor area is
stitched closed to
produce better scars
and to minimize
bleeding. The
stitches are
normally removed 7
to 10 days later.
The nurses will wash
your hair the day
after surgery when
any bandages are
also removed. You
should begin a
bathing routine
twice per day,
beginning the second
day after surgery,
during which you
soak your head for
10 minutes while
gently massaging
your scalp, and
massage while
shampooing your head
for an additional 10
minutes. This
accelerates the
separation of crusts
from the recipient
area and any
crusting in the
donor area.
Patients from out of
town are required to
stay in the city
overnight after the
transplant
procedure. This
allows us to remove
the bandage and
properly cleanse the
area the day
following surgery.
Patients should not
drive themselves
home on the day of
surgery because of
the lingering
effects of
medications.
Ingrown hairs are,
occasionally, a
temporary problem,
beginning 8-12 weeks
after surgery. This
is more often the
case when DFU and
TFU grafts are used
or if the hair tends
to be naturally
curly. It is easily
controlled, does not
cause any permanent
damage, and does not
occur in a majority
of patients.
A temporary decrease
in scalp sensitivity
is always noted
after transplanting
because nerves are
cut as donor grafts
are taken and
recipient sites are
prepared. Usually
this will correct
itself completely in
3 to 18 months as
the nerves
regenerate. Rarely,
there may be a
permanent slight
degree of decreased
sensitivity in one
or more small areas.
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9) Number of
sessions required
Generally, the front
third-to-half of a
totally bald area
can be completely
finished in two to
three sessions if
only micrografts,
DFU/TFU and/or slot
grafts are being
used, or three to
three and a half
sessions, if round
grafts are also
being employed. If
you have the right
hair
characteristics, two
sessions in a bald
area may produce
very nice cosmetic
results, but
patients who believe
that they can have
dense hair after
only one or two
sessions are being
unrealistic. If
round grafts are
also being used, the
4th 'half session'
is used to solidly
fill the area
started with round
grafts. Even if the
hair is wet or wind
blown, no plugginess
will be noticed.
Sometimes this 'half
session' can be done
at the same time as
the mid-scalp or
crown is being
treated rather than
as a completely
separate procedure.
Or, it can be
omitted because of
high-hair density.
Transplant sessions
may be done as far
apart as the patient
wishes. However,
they are not done in
any given area
without a 5-6 week
interval between the
first 2 sessions,
and an interval of
3-4 months or longer
between the
following sessions.
If entirely separate
areas are being
transplanted at the
same time (for
example the front
and the crown),
sessions can be much
closer. For example,
the crown can be
treated the day
after the front.
While the typical
session done in our
offices results in
the transplantation
of 1500 to 4000
hairs, the number of
grafts that should
be transplanted at 1
session and the
frequency of
transplant sessions
depend on the size
of the graft
utilized and the
characteristics of
each individual.
It is becoming more
common for patients
to have 1 or 2
'early'
transplanting
sessions before hair
loss has reached an
advanced stage. The
benefit of these
early sessions is
fourfold: the
remaining hair
provides natural,
immediate
post-operative
camouflage for the
initial session; the
transplanted hair
(once it has grown)
persists and
provides additional
coverage for any
later sessions;
sessions can be
spaced farther
apart, thus
spreading the
inconvenience and
cost over a longer
period of time; and,
because there is no
dramatic change from
bald or nearly bald
to hairy, the fact
that a transplant is
being done at all is
less likely to be
noticed by anyone.
In less than 10% of
patients treated
with FU and/or slit
grafts, there may be
some mild thinning
involving the
pre-existing hair of
the recipient area
within the first 2
to 3 weeks after a
transplant. This
thinning, if it
occurs, is temporary
and the hair will
regrow slightly
before or at the
same time as the
transplanted hair
begins to sprout.
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10) Final Results
It is impossible to
predict precisely
how many hairs will
appear in any given
graft. At least 90%,
and often 100%,
survive
transplanting. Not
uncommonly, more
hairs grow than were
planted because some
were in an invisible
'resting phase' when
they were originally
counted. After over
25,000 hair
transplant sessions,
we have never
encountered a
patient who failed
to grow hair.
Within a few weeks,
the colour and skin
surface of the
grafts has usually
blended in perfectly
with the surrounding
scalp. In some
patients, however,
the grafts may be a
shade lighter in
colour until they
are aged by sun
exposure. The grafts
are usually level
with the surrounding
scalp, but a few may
be slightly elevated
in less than 1% of
patients. Such
grafts can be
flattened with an
electric needle
without interfering
with hair growth.
The final appearance
is usually that of
early thinning to
'very early
thinning', which is
not meant to imply
'thin' hair, but
rather to convey the
idea that you cannot
expect to look like
you did when you
were a teenager.
As one ages, the rim
hair from which the
grafts were taken
also gradually
becomes less dense.
Thus transplanted
areas will also thin
somewhat. However,
they will never go
bald again. In
addition, as the
hair goes grey with
aging, it will look
thicker, so any
decreased density
may or may not be
noticeable. Because
of this gradual
thinning effect, you
may want to
transplant the area
a little thicker to
begin with. Or,
alternatively, you
may want to conserve
some grafts for use
in 15 to 20 years.
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11) Repair of
Unsatisfactory Prior
Transplanting
Most patients seen
for repair of
unsatisfactory prior
transplanting are
treated with a
combination of: a)
excision of part or
all of any old large
pluggy-looking
grafts, b) creation
of a new hairline
constructed
exclusively with FUs,
c) the use of FUs
and multi-FU grafts
behind the new
hairline zone. The
type of graft chosen
for any given area
will depend on a
large number of
factors but the
choice is based on
which variety of
graft will most
rapidly correct
noticeable
plugginess. Usually
at least two
transplant sessions
are necessary to
create substantial
improvement
Frequently, however,
patients will want
three or more
treatments (if
possible) because
each session will
result in more
improvement in both
the recipient and
donor area. With
regard to the
latter, improvement
of scarring in the
donor area is often
as important a goal
as is improvement in
the recipient area.
As a result of the
relatively new
technique of strip
harvesting, these
goals are not
incompatible. One
can often excise two
rows of wider scars
with a zone of hair
between them,
thereby creating one
narrow scar from two
wide ones
Follicular Unit
Extraction (FUE) is
sometimes also used
to obtain grafts
without creating new
linear scars. FUE
involves the
excision of single
FUs from the donor
area—one at a
time—rather than the
excision of a strip
that must later be
divided into
different types of
grafts. In most
patients Dr. Unger
sees, however, he
prefers to remove
old scars at the
same time as he is
obtaining more donor
tissue and he likes
to have the option
of using multi-FU
grafts as well as
FUs.
Befor Correction
After Correction
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12) Confusing Claims
The public is often
confused by
conflicting claims
and counterclaims
about exclusive
"follicular unit"
transplanting (FUT)
in advertisements
that can cost their
sponsors millions of
dollars annually.
What follows is Dr.
Vafaei's view of
what the scientific
evidence, to-date,
reveals.
If you feel you
would be satisfied
with light or
moderate hair
density, you may
want to consider
using only FUs for
your transplanting.
There are important
advantages to such
an approach. Some
can be found in the
section of this
website that
discusses the
various “Types of
Grafts”. In brief:
1)
FUs cause the least
damage to any
existing hair in the
recipient area.
2)
FUs produce the
least amount of
post-operative
crusting.
3)
FUs generally grow
somewhat faster than
other types of
grafts.
4)
FUs produce
absolutely no
clumping or
plugginess, and
therefore produce
remarkably natural
looking results
after even a single
session in an area
that is bald or
destined to become
bald.
5)Most patients will
not have sufficient
donor reserves to
transplant the
entire evolving bald
area relatively
densely; therefore,
FUT provides the
most flexibility in
the distribution of
the donor tissue
that is available.
This is because
single sessions can
be used in less
cosmetically
critical areas—such
as the crown and
still produce
natural-looking
results, while other
areas can be treated
more than once—for
example, the frontal
area—to create
higher hair
densities.
Transplanting an
entire bald head in
one "megasession" of
even 3000 or more
FUs will not result
in what most people
would call
cosmetically
acceptable hair
density. On the
other hand, when the
area to be treated
is relatively small,
for example the
front third or half
of a typically sized
area of MPB, such a
session can produce
very acceptable
results.
Only a small
minority of hair
transplant surgeons
carry out "megasessions".
Why? There is very
little difference in
work or staff
requirements between
doing a 1500 graft
session for each of
two patients in a
day or doing a 3000
graft session on a
single patient. If
anything, there is
slightly more work
and staff
requirements if two
patients are treated
instead of one. It
is also more
convenient for
patients to have a
single session than
several sessions to
the same area, and
it is, therefore,
certainly more
"saleable" to more
patients. The answer
to the question of
why so few surgeons
employ "megasessions"
lies with differing
opinions about
patient safety and
hair survival when
such large sessions
are utilized.
Megasessions of 3000
or more FUs
typically involve 10
to 12+ hours of
surgery. They are,
therefore, more
physically and
emotionally
stressful than more
standard sized
sessions. The
increased risk
associated with such
long sessions can be
minimized by careful
monitoring of blood
oxygen levels, blood
pressure, and pulse
rates, as well as
continuous
intravenous fluids
and drugs. Most
physicians,
nevertheless, feel
that the increased
risks outweigh the
benefits for what
is, after all, a
cosmetic procedure.
The choice between
patient convenience
and safety seems to
them to be properly
weighed towards the
latter.
“Dense packing” of
40, 50, or more FUs/cm2
in a single session
does produce a
greater hair density
than using a graft
density of 20 to 25
FUs/cm2. Thus,
photos showing the
results of such
dense packing can be
very impressive.
There is, however, a
substantial body of
evidence suggesting
that dense packing
FUs results in
reduced hair
survival. There is
a limited number of
FUs available for
transplanting and
anything that might
endanger their
survival should be
avoided.
The smaller the
graft, the more
easily it can be
injured by
technicians (as each
hair is closer to
the edge of the
graft). Three
thousand incisions
in the scalp
obviously will cut
more blood vessels
than 2000 or 1500
incisions. While
most megasessions
produce what appear
to be adequate
yields, a minority
produces very little
hair. It is likely
that there are many
patients between
those two extremes
who will grow hair,
but less than they
would have if a more
conventional
approach had been
used. In a similar
fashion, the current
competition amongst
some hair
restoration surgeons
to see who can
transplant the most
FUs/cm2 seems to be
ignoring the
vascular damage
caused by high
density FUs/cm2, and
its effect on hair
survival. For
example, 50 FUs/cm2 requires
a total length of 5
cm of incisions in
each 1 cm2 box if
the recipient sites
are made with
needles or blades
that only create 1
mm long incisions.
(An 18-g needle
produces an incision
that is
approximately 1.2 mm
long.) Making 5 cm
of incisions in
every 1 cm2 box of
scalp tissue would
intuitively lead one
to expect massive
vascular damage in
that small area and
consequently lower
rates of hair
survival than could
be expected with
less FUs/cm2. Yet
some practitioners
are suggesting even
higher FUs/cm2 densities.
How then does one
explain claims of
100% hair survival
by proponents of
megasessions and
dense packing and
photos of excellent
looking results
after only one or
two sessions?
A)
The claims of 100%
or more survival
have been based on
studies in which FUs
have been inserted
into holes made in
small areas (1 cm2)
that were surrounded
by otherwise intact,
untreated skin.
This is not at all
comparable to what
actually happens
during a typical
transplant session
in which thousands
of additional
incisions or holes
are made, each one
of which severs some
blood vessels and
thus reduces the
blood supply to the
recipient area,
which in turn could
reduce hair survival
rates.
B)
Apparent hair
density is not
dependent only on
the number of
hairs/cm2. The less
contrast between the
hair and skin color,
the more curl or
wave, the more "frizziness"
to the hair and the
higher the hair
caliber, the thicker
or denser the hair
will appear to be.
An increase in hair
shaft diameter of
only 0.01 mm for
example will
increase hair volume
by 36%.1 Thus, the
impressive results
seen in photos of
selected patients by
proponents of
megasessions and
dense packing are
both possible and
real. Nothing that
has been said here
should in any way be
construed to mean
that I believe
intentional
deception is being
used by anyone. Even
if 35% or more of
the hair
transplanted by a
few proponents is
dying, if enough
hairs are
transplanted densely
enough the results
may, in fact, look
excellent after two
sessions or, less
commonly, after one
session if the
patient's hair
characteristics are
particularly
advantageous.
Given the fragility
of the FU graft, FUT
is obviously very
dependent on perfect
technique. Good
hair survival is
possible if
technique and
quality control of
technicians are
excellent. It
should be
recognized, however,
that hair count
studies are
notoriously
difficult to do,
with results that
may or may not be
scientifically
valid, and therefore
it would appear to
be wise to use
micrografts/FUs
without megasessions
or "dense packing"
whose intention is a
completed result
after a single
session. “Dense
packing”, if used,
should also only be
employed in limited
areas until such a
time as good hair
survival rates in an
entire recipient
area (not, for
example, a 1 cm2
box) are documented
by independent
evaluators.
In summary, patients
are often anxious to
have as much done as
quickly as possible
and are, therefore,
anxious to believe
that there is no
intrinsic problem
with megasessions
and/or dense packing
for quick results.
However, increased
risk and the
possibility of
lesser hair yield
permanently should
be weighed against
the temporary
convenience of a
faster result.
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13) Summary
In summary With the
new techniques of
hair transplanting,
the hairline no
longer appears as
abrupt or dense as
was the case with
older traditional
grafts. Micrografts
create a very
natural looking
hairline. This
enables patients to
wear their hair in
virtually any style
including combing
the hair straight
back. Micrografts,
DFU and TFU grafts
create a more
feathered, less
tufty appearance,
thus avoiding the
'Barbie-doll' look
that sometimes is
present with round
grafts before the
area has been
densely
transplanted. They
also do not result
in the removal of
any existing hair in
the recipient area
and are, therefore,
particularly
advantageous for
transplanting in
patients with
'early' MPB or
female pattern
thinning. Most
women, in fact, can
now consistently
expect cosmetically
significant
improvement whereas,
as recently as 10
years ago, most
women were not
acceptable
candidates for
transplanting.
Current techniques
have increased the
proportion of
patients who can be
helped by
transplanting while
at the same time
producing far more
natural looking
results than those
of the past. These
new techniques are
also remarkably
effective in helping
to correct
cosmetically poor
results of older
types of
transplanting. New,
more natural looking
hairlines can be
created in front of
old pluggy ones
while spaces between
the older grafts are
also filled.
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