Q: In which procedure do you generally see more of a change, the first or the second? — N.N., Flatiron, N.Y.
A: The answer depends upon the patient’s baldness. If they are very bald, the first session will be the most noticeable, since going from no hair to hair is much more dramatic than going from some hair to more hair. In addition, if someone is very bald, the first session is generally the largest, with less hair being transplanted in the second.
The situation is different if someone has had a hair transplant with only a limited amount of hair loss. In this case, the first session may be small (since that is all they need at the time) and the second session, performed after the person has lost additional hair, may be significantly larger.
In addition, while the impact of the first session was lessened by the progression of the person’s hair loss, the second session was superimposed on existing, permanently transplanted hair and may be more dramatic.
Q: My first hair transplant was a breeze. Will a second procedure be any different than the first? — B.B., Murray Hill, N.Y.
A: Generally in a second procedure, a patient can expect less swelling post-up although the reason for this is not known.
There will also generally be less shedding in the second hair transplant session since the weak miniaturized hair that will be shed is often lost in the first session and the previously transplanted hair is generally more resistant to shedding.
In a second session we generally, but not always, transplant fewer numbers of grafts.
If the old scar in incorporated into the new incision, then there will be slightly less hairs per graft since the density in and around the scar will be slightly altered.
For those who are bald, the second hair restoration is sometimes less dramatic than the first since the second is used for fine tuning rather than taking the person from completely bald to having hair.
Q: I have had 4 hair transplants with strips taken out for a total of 2600 grafts over 15 years. The last one was 1,650 grafts. My doc says my donor site is good for a few more but I think it has been probably stretched to its max. Is it believable that the skin can be stretched to such extremes safely? – Murray Hill, N.Y.
A: The scalp is very resilient to stretching, particularly in those with a loose scalp to begin with. After removing a strip, the laxity often returns to normal or very close to it within 6 months to a year.
The problem with multiple hair transplant procedures is not only that scalp laxity may decrease, but that the donor density decreases as well. If too much hair is harvested, the donor area may eventually appear too thin. This may happen with either Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE).
Therefore, it is important the doctor not only assess the scalp laxity, but the residual donor density.
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