Hair Transplant Blog | Bernstein Medical - Page 77

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December 21st, 2005

Q: What causes graft popping during a hair transplant? G.K. – Carle Place, N.Y.

A: Popping, or the tendency for grafts to elevate after they have been placed into the recipient area, is caused by a number of factors including:

  • Packing the grafts too closely, particularly when they are placed on a very acute (sharp) angle with the skin
  • Rough placing techniques
  • Bleeding
  • Poor fit between the graft and recipient site
  • Natural characteristics of the patient’s skin, including the elasticity and stickiness of wound edges

The problem with popping is that it exposes grafts to drying (while they are elevated on the skin surface) and trauma (when they have to be re-inserted).

The judgment and experience of the surgeon performing hair transplants is extremely important in minimizing popping. It is important that the surgeon customize the site size to the different size follicular unit grafts and to test the recipient sites as they are made, to make sure that the “fit” is perfect.

Although it is important to place grafts close together to get the best cosmetic result possible, over-packing of the grafts risks popping and other factors (such as overwhelming the blood supply) that may lead to poor growth.

In the end, maximum growth of the transplanted hair should be the primary goal.

December 14th, 2005

Q: I am not yet ready for a hair transplant but am considering Propecia. What is your opinion on the “optimal dose”? I know Merck recommends 1 mg, but could I get away with taking less? Or would I get a better result by taking more (2-3 mgs)? — V.B, Darien, CT

A: You may get away with 0.5 mg a day. However, there are published data by Roberts et. Al. in the JAAD in 1999 showing a dose-response between 0.2 and 1 mg/day, with the lower dose showing reduced efficacy, from controlled clinical trials.

There is little evidence that a higher dose helps, but I often double the dose if a patient has been on 1mg a day for 3-5 years and then stops responding. The hope is that this can postpone the need for surgical hair restoration, but there is no scientific data to support that it will.

December 6th, 2005

Q: Can hair transplants grow in scars? P.N. – Westbury, N.Y.

A: Grafts will grow in scar tissue as long as the scar is not thickened. However, they cannot be placed as close together as in normal scalp because of decreased blood flow. When performing a hair transplant into scar tissue, it is often necessary to perform the hair restoration in multiple sessions to allow the area to gradually re-vascularize (allow the blood supply to return).

November 25th, 2005

Q: I am 19 years old and seem to be thinning all over, including the sides. My father has all of his hair but my grandfather is totally bald. Should I have a hair transplant now or wait until I am older? — T.K., Garden City, NY

A: Most likely you have a type of androgenetic alopecia called Diffuse Unpatterned Alopecia (DUPA).

In this hereditary condition, hair thins all over rather than just on the front, top and back as in the more common male pattern baldness.

The fact that the back and sides of your scalp are thinning (the donor area) precludes you from being a candidate for surgery. The diagnosis can be made by observing a high degree of miniaturization (fine hair) in the donor area under a magnifier. This instrument is called a densitometer.

For further information, please read the article:

Bernstein RM, Rassman WR: Follicular Transplantation: Patient Evaluation and Surgical Planning, published in the journal Dermatologic Surgery in 1997. Specifically, read the last part of the article.

November 18th, 2005

Q: Why can donor hair become frizzy and dry once transplanted? — G.F., Stamford, C.T.

A: Frizzing and kinkiness is a temporary phenomenon that is part of the normal healing process after a follicular unit hair transplant.

During the healing process, the new collagen that forms around the grafts can alter their growth. Over time, usually within a year, this collagen matures and the hair quality usually returns to normal.

If grafts have been excessively traumatized or grafts larger than follicular units have been used, these changes are more likely to be permanent.

November 10th, 2005

Q: Is it true that smoking is bad for a hair transplant and why? P.P. – N.Y., N.Y.

A: Smoking causes constriction of blood vessels and decreased blood flow to the scalp, predominantly due to its nicotine content. Also, carbon monoxide in smoke decreases the oxygen carrying capacity of the blood.

These factors both contribute to poor wound healing after a hair transplant and can increase the chance of a wound infection and scarring. Smoking may also contribute to poor hair growth.

November 2nd, 2005

Q: When performing a repair on an old, pluggy hair transplant, why can’t all the grafts be removed at once? A: We always try to do this, but it is not always possible. If the large grafts (plugs) are spaced too close together, suturing one will put tension on an adjacent graft and make it […]

November 1st, 2005

Q: Will the shock of a hair transplant make me lose my existing healthy hair and is it permanent? – Westport, C.T.

A: In general, only miniaturized hair (the hair that is affected by androgens and that has begun to decrease in diameter) is shed after a transplant. This hair would be lost in the near term anyway.

October 26th, 2005

Q: Are camouflage agents harmful to newly transplanted follicles after a hair transplant? A: Cosmetic camouflage products are not harmful to grafts per se, but they may make it difficult to keep the transplanted area clean right after the hair restoration procedure. They may be used safely as early as one week following a hair […]

October 21st, 2005

Q: I had a hair transplant two weeks ago and I just started noticing that some grafts were in my baseball cap at the end of the day. Am I losing the transplant and what can I do to keep this from happening? – Weston, C.T.

A: The follicles are firmly fixed in the scalp 10 days following the hair transplant. Hair is shed from the follicle beginning the second week after the procedure. This is perfectly normal and does not represent any loss of grafts.

What you are seeing is the root sheath that is shed along with the hair shaft. This looks like a little bulb, but is not the growth part of the follicle and should not be a cause for concern.

Two weeks following the hair transplant you may shower and shampoo your scalp as you normally did before the procedure without any risk of losing grafts.



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