Medical Hair Restoration
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Dr. Wasserbauer participated as the lead researcher for Restoration Robotics.
From Market Watch – A Wall Street Journal Digital Property:
Restoration Robotics has created a high-tech treatment for transplanting hair follicles, that involves a robotic arm controlled by a surgeon working on a computer. Are robots the answer to baldness? Timothy Hay reports on digits.
Read Dr. Wasserbauers’ latest overview on Robotic Hair Transplantation.
I really would like to have a hair transplant, but I’d prefer not to have long scar on the back of my head. My concern is if the back of my hair thins over time that the scar will become visible.
Does it make more sense to have FUE as opposed to a strip hair transplant, just in case I do thin out more in the back and the sides? I figure that if this does happen, I can always just shave my head to a #2 and go on with my life without the fear of having a visible scar. Is this a logical approach, or have I misunderstood the benefits of FUE?
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Thank you for taking the time to write. You question is astute in that you are trying to take into account future hair loss – something not every patient thinks about. Let me try to answer you as best I can without examining you.
If you have thin hair at the back of your head, FUE may be your best option. You definitely need to check with a hair surgeon though to make sure you don’t have a diffuse unpatterned alopecia (in which case surgery would be ill-advised). FUE is a viable option for you providing you have been tested and found to be a good candidate. The testing consists of actually trying to extract a few grafts and making sure they can be removed intact. In my experience, about half of the patients who are interested in this technique are candidates for it. Recall that the actual scarred AREA (cm2) in FUE is likely greater than in the traditional strip method – it is just in little dots all over the back of your head instead of a line!
That being said, it is unlikely with EITHER method that the hair in your donor area will thin visibly OR that you would have to worry about the scar being visible if you shave your head down to a #2. The average donor area does not thin that much over time which is what makes hair restoration possible in the first place. Also, most scars performed by careful surgeons using trichophytic and a double closure (sutures both above and below the skin to reduce tension) will become visible between #2 and #3 on the average barbershop clippers. FUE is more expensive (due to the time and effort involved) and yields fewer grafts than the strip method, but since it is not as commonly performed, we have less data on its benefits than we do for the more traditional methods.
In the final analysis, the decision is up to you. You present a logical approach to try to head off potential problems, but the problems you are trying to avoid are less likely than you think. My suggestion would be to consult an experienced surgeon to make certain you do not have abnormal donor area thinning, that you are a candidate for FUE, and to make your decision from there once you have all the data! Viewing the scars of some live patients can also help.
I hope that helps!
Warm Regards,
Dr. Sara Wasserbauer
What risks, if any should be told to a patient with a VP shunt before doing a hair transplant procedure, and should the risk of disconnection be mentioned, and/or should patient not be allowed to do a hair transplant? – John
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Dear John,
Thanks for taking the time to write! Let me try to answer your question as best I can. Ventriculoperitoneal shunts are rare. Basically they channel excess fluid from around your brain to elsewhere in the body. These shunts do not typically involve blood or the circulatory system.
For most patients, the presence of a shunt like this should not pose a problem for surgery, but I would check with the neurosurgeon who placed it or neurologist that the patient sees for specific recommendations because the location of the shunt can vary from patient to patient. It may or may not even be in the area that the surgical plan involves. Common risks would include infection, pain, swelling, shock loss, hiccups, redness, and scarring among others, and these are routinely discussed with your hair transplant surgeon prior to any procedure. For the most part, however, complications with any sort of hair transplant procedure are rare.
The way you phrased your question makes me think of the legal ramifications of surgical complications. Of course, risks, expectations, and potential complications should be discussed with your hair transplant surgeon, and since this is such a unique situation, other experts might be consulted. As I mentioned, every shunt is different, just as hair transplant surgery involves different areas. There is no standard of care in hair transplant as to how to handle a patient who has one. Whether the patient should be allowed to do it or not is therefore really a question for the physicians involved.
I wish I had a more definitive answer for you, but hair transplants in patients with VP shunts are simply not that common. Good luck!
Warm Regards,
Dr. Sara Wasserbauer
Dr. Wasserbauer inserts hair grafts
I’m 43 years old and I have been slowly losing my hair for the past 15 years. I seemed to have retained a pretty good hairline, even though it is slightly higher than it used to be, however, the baldness in my crown has grown over the years. I recently began using Propecia and noticed less hair falling out in the shower, but I haven’t really noticed any regrowth. I would very much like to fill in the balding area of my crown with a hair transplant. Considering my current situation, would this be an appropriate step to take? Thanks, Tom
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Dear Tom,
Thank you for taking the time to write. Your situation is a common one and I’m pleased to hear that you have already started taking Propecia. This is one of the most significant factors for optimizing your long-term cosmetic results. In my experience, it cannot be counted on to preserve frontal density indefinitely, but Propecia WILL stop crown loss from enlarging appreciably. Besides, it is cheaper than surgery!
It is difficult to make an accurate assessment without seeing you, but at a consult with a reputable hair surgeon you should discuss your goals and expectations for your hair first and foremost. In your case, you seem to have a reasonable goal of filling in your crown. That being the case, there are three factors which will determine whether your situation isappropriate for hair surgery. These are 1) your donor area, 2) the size of your crown, and 3) the hairline and frontal density. Let’s discuss your donor area first.
Assuming you have average density and elasticity, and that you have less than 20% miniaturization in your donor area, a crown can be covered quite well. Before you begin this process, you might want to consider having enough donor area to cover the front should that become necessary. Pick a surgeon who practices trichophytic closure with interrupted subcuticular sutures for the best donor scar possible, and expect to need 1000 +/- 200 grafts to fill it in.
Crown size is a significant factor. If the area at the crown is bigger than the palm of your hand, completely bald, you wear it short, or if you have very fine hair, be aware that you can get good coverage from a first surgery, but you should expect a second surgery to increase the density. If that is the case, look for someone who will remove the first scar with a second surgery so you don’t end up with two in your donor area. If you already use hair from somewhere else to cover the crown, or if there is still some “tacking” hair (wispy hair with low density but it EXISTS) – you may only need one surgery.
Covering a crown is a little like trying to carpet a basketball – there are always spaces in between where you can see what is underneath because the surface is curved. That is why there are hair surgeons who specialize in recreating whorls and “shingling” the hair in the crown for the best cosmetic outcome. If your surgeon knows how to do this (and a good one will), you will end up with a better result.
Finally, consider how dense and how low the hair in the front is. Miniaturized hair throughout the frontal area is a sign that this area may need attention in the future. If you don’t have to use grafts to lower the hairline, it is best to save them for your first priority – the crown. That said, grafts in frontal areas really do give you the best “bang for your buck” so you might want to reinforce the area (or fill it in later to compensate for progressive loss), just remember to use your graft resources wisely.
In the final analysis, “yes” this would be an appropriate step to take given the above parameters. If you have realistic expectations and reasonable density, you can get some fantastic results at the crown. The next step will be to find a respected surgeon who will work with you.
Good luck with your hair goals!
Sincerely,
Sara Wasserbauer MD
