Posts tagged: treatment

Trying To Understand The Benefits of an FUE Hair Transplant

Posted on May 26, 2010 by admin

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

Posted in Articles | Tagged advice, balding, fue, hair transplant, restoration, treatment | Leave a comment

FUE Hair Transplant Primer

Posted on May 24, 2010 by admin

As one of the few docs who does FUE routinely in my practice, I think it is interesting that all sorts of new methods for automating the process are being introduced. There have been many iterations of these machines and while none has yet panned out perfectly, I do see some hope on the horizon! For those of you who are novices to the idea here is a comparison of the two techniques;

TRADITION! The traditional FUT (Follicular Unit Transplantation) or “Strip” technique takes a thin strip of hair from the back and sides of your head. The two sides are brought back together leaving a thin line typically 1-2mm wide as the scar. Often, a “trichophytic closure” is used which allows the hair to grow through the scar, rendering the scar all but invisible. This scar is typically visible only if you buzz your hair shorter than a #2 on a pair of standard clippers (or if you shave your head with a razor.) It is typically NOT visible if you cut the hair at a #3 on clippers (or if you leave it even longer). This goes for wet and dry hair I find.

Traditional hair transplant methods result in stitches for about 7-10 days and obtain up to several thousand grafts per session. The surgery usually takes 8-10 hours (plan on being there the whole day although smaller sessions can end earlier). There is typically nothing visible in the donor areas (back and sides of the head), even immediately after the the procedure! Good surgeons typically charge $4-5 per graft giving it a variable price tag but usually in the $5-$13K range. (Cut-rate grafts are no bargain!) Most hair surgeons agree that this method is generally best for those looking for a single large session and as close to a full correction as possible in a single surgery.

FUE! Follicular Unit Extraction (FUE) also takes grafts from the back and sides of the patient’s head individually. Depending on how the patient prefers it, you can either shave the whole head or small “micro-strips” can be shaved for optimal camouflage – but some level of shaving has to be done because the hair has to be short for effective removal. The scars are small – about 1mm in diameter, and if you shaved the head they would look like little dots scattered all over the head. You actually have more scar area with this method, but since it is not in a LINE it is much harder to see!

FUE transplants take a full day as well (8-10 hours) and requires that the patient lies face down and on their side for long periods while the grafts are being removed. Recovery takes about 3-5 days and while there are no stitches, you do have a number of little tiny scabs all over your head which can be covered with hair (or just open if the patient can shave their whole head to start with.) If you shave your whole head, I like to compare the look to being hit with a shot gun, but it heals to a bunch of tiny little pink spots very quickly so amazingly, the patients who choose this option do not seem to mind! Surgeons who practice this technique typically can obtain 500-1000 grafts in a single session and charge $20 or more per graft. The range is large since the success of the procedure depends largely on patient variables that cannot be fully determined until the surgery starts. Most hair surgeons agree that this method is generally best for those looking for a single small session or several smaller sessions to achieve a full correction.

Hope that helps everyone!

Cheers!

Dr. Sara

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Concerns About Camouflaging a Hair Transplant Scar

Posted on May 24, 2010 by admin

What is the hair length needed to cover an average donor harvest scar on the back of the head? I currently keep my hair short on the sides (less than 1/2 inch) Also, where on the back of the head is hair strip collected from? Parallel to the ears? How long is the resulting scar in inches?
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Dear “Worried about Scar Camouflage,”

Thank you for taking the time to write! An average donor harvest scar should be done with a trichophytic edge these days, so hair should be growing through it rendering it nearly invisible. However, even without completing that extra step (which I consider essential but not all surgeons do) an average scar should be no wider than 1-2 mm. Based on an extensive survey of my patients, a scar like this would be visible if the hair were clipped at a #2 and invisible if clipped at a #3 length. Of course, variables like skin and hair color can impact this, but as a general rule this is what I advise my patients.

Now, as to where at the back of the head the donor area is located, the answer varies by patient, but you can get a general idea pretty easily with the following brief exercise; cup your hand at the back of your head. The area your hand is covering should be above the two bony bumps where your neck starts, but below the ledge where your crown ends and the length should be behind the ears on both sides. This is the donor area for many patients and since the lines of tension run like a string tied back behind both ears, that is how the tissue is removed for best cosmetic result. Larger sessions result in a longer scar and an average to expect would be 20 cm or about 7-8 inches – which is roughly the length of your hand from palm bottom to fingertip!

For those patients who want to preserve their ability to shave the head with a razor – I mean really SHAVE that area like boot camp – these expectations are especially important to hit home. If a linear scar is unacceptable, then an FUE surgery (Follicular Unit Extraction where the grafts are removed one at a time) would be the best option. These surgeries take longer, are more labor intensive/expensive (so not all docs do them), and require multiple sessions, but the results are natural, recovery is much faster, and the scar is, as I mentioned, typically undetectable.

I hope that helps! Good luck!

Warm Regards,
Dr. Sara Wasserbauer

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Xandrox – Has a Higher Dosage of Minoxidil Proven To Be More Effective?

Posted on May 24, 2010 by admin

I have a couple questions about minoxidil. I know the common potencies are 2% and 5%. Why not go higher? I found a website called minoxidil.com that offers something called Xandrox with 15% minoxidil. Is this legitimate or just a scam? Has anything over 5% proven to make no more of a difference? The website is run by a Doctor Richard Lee, have you ever heard of him? – John
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Dear John,

Thank you for taking the time to write. I have not heard of Dr. Richard Lee, but it is easy to check a physician’s credentials if you know in what state they are licensed. As for the minoxidil, all the science shows us is the efficacy for the 2% and the 5% formulations. Going higher usually increases the risk of side effects, and it might not be more effective. Remember that minoxidil was originally a medication for blood pressure that was taken orally (at much higher doses, incidentally). Pfizer decided to investigate it as a hair loss drug when patients began reporting the strange side effect of unwanted hair growth! So these drugs are not without effects on other body systems.

One of the reasons Dr. Lee is able to make his own formulation with a higher potency of minoxidil (and to give it a name) is that minoxidil is now generic. Once the patent expired and it became available over the counter, physicians and compounding pharmacists could then use it as an ingredient in their own proprietary formulations. ScalpMed and Avacor are good examples of this in practice, and they work because their ingredients (i.e. minoxidil!) are proven to work! You can even report the FDA approval for it on your labeling. It is often the case, however, that the active ingredient can be obtained more cheaply in the generic form at your local pharmacy.

Your question is not a new one, however, and you are not the only person who is asking it. If SOME is good, is not MORE simply better? I can tell you that over the years I have had patients try every new formulation out there and report back to me, and never once have I had a home run. If something was better, we would all be using it, doctors and patients alike, all over the world. There is not some great conspiracy among hair doctors to keep the REAL hair remedies for ourselves. Which is why my final advice to you would be that it is probably okay to go ahead and try it. If it works, great! I want to be the first person you tell about it!

Good luck, John! Let us know how it goes.

Warm Regards,
Dr. Sara Wasserbauer

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Female Hair Transplant

Posted on May 24, 2010 by admin

After Three Procedures I Am Noticing Further Hair Loss, Did The Hair Transplants Not Take?

I have undergone 3 hair transplant procedures and thought that they were successful. However, recently I have noticed further hair loss and am concerned that the hair transplants may not really be working for me, especially since reading that very, very few women are good candidates. It is difficult to tell if I am seeing just the normal loss of my hair or if the transplants did not take. Before I decide to have another procedure I want to be very sure that I am really a good candidate for the procedure. Thank you so much for your help. – Lauren
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Lauren,

Thank you for taking the time to write. Let me try to answer your question as best I can without seeing you and examining your scalp.

Hair loss, by its very nature, is relentlessly progressive. This is why a hair restoration surgeon takes into account future hair loss when planning a transplant – they must place hair in areas that might need hair in the future in addition to the areas that have already lost hair. In women, this problem can be worsened by the surgery itself – that is to say – if a hair is at the end of its life cycle, it may have its final “shed” at the time of surgery. This is mitigated by the fact that the new hair you get from the surgery is permanent so you end up ahead in the long run, surgeons are just usually more cautious with their female patients. Additionally, you do not mention what type of hair loss you have; is it androgenetic alopecia (female pattern hair loss), alopecia areata, or hair loss due to other medical problems?

There are a few things you wrote that are not necessarily true, though. Women are good candidates for hair transplant surgery. In the past it was thought that there were few women candidates, but we now are finding this is not true. Also, if the procedure was done according to the standards now used by most hair restoration surgeons, it is unlikely that the grafts would not “take.”

Since you are looking at another surgery, and since I do not know how many grafts you have had in your three surgeries thus far or even what type of hair loss you have, here is what I suggest; find a hair restoration doctor or a dermatologist that you trust and get a definitive diagnosis for your hair loss. To find one, consider checking some of the independent websites like the IAHRS (International Alliance of Hair Restoration Surgeons, http://www.iahrs.org/) or even the American Hair Loss Association (www.americanhairloss.org). This process may involve a scalp biopsy or some blood tests. You need to know what type of hair loss you have in order to explain any continued loss of hair or any possible failure of hair transplant surgery (which would be very rare). From there the next step would be to have that trusted hair restoration doctor evaluate what another surgery would accomplish for you.

Hope that helps and best of luck with your treatment.

Warm Regards,
Dr. Sara Wasserbauer

Posted in Articles | Tagged advice, dr. wasserbauer, female, grafts, hair transplant, restoration, treatment | Leave a comment