The following sections address some fallacies commonly disseminated by hair transplant surgeons still using the older techniques.
Fallacy #1
A large number of small grafts cannot get the needed blood supply to grow properly.
Explanation:
Since the scalp has one of the richest blood supplies of any region of the body, and its blood supply is anastomotic (comes from many directions and is all interconnected), it can easily support large numbers of grafts, provided that the wounds made in the recipient site are very small. The great advantage of Follicular Unit Transplantation is that the grafts are small enough to fit into very tiny recipient sites. Those who make these comments usually have little experience with using small grafts and do not understand the anatomy of the scalp’s blood flow and graft oxygenation. The main issue is one of oxygen diffusion. Since oxygen must diffuse into the center of the newly transplanted graft, very large grafts will be oxygen-deprived in their center. This has been shown repeatedly by observing the phenomenon called doughnutting, the loss of hair follicles in the center of larger grafts. This phenomenon is noted in larger grafts, but does not occur in follicular unit grafts since the distance that oxygen must travel to reach the center of the graft is so short.
Fallacy #2
Large grafts produce a better, denser transplant than smaller grafts.
Explanation:
The density of a given area is determined by the total amount of hair transplanted, not by the size of the grafts. Larger grafts do not ultimately give you more hair; rather, they produce an unnatural look. The highest quality hair transplants require fine instruments and large numbers of delicate, small grafts. These grafts must be distributed in a way that balances the patient’s individual facial features and hair characteristics. Large grafts do not offer sufficient
flexibility to allow this "customizing," and they weight the transplanted area out of proportion to the rest of the scalp. Fallacy #3
Explanation:
While this statement is literally true, it represents a misunderstanding of the true aim of a hair transplant. The goal should not be to establish a dense, abrupt hairline, but rather to create a natural-looking hairline. A very dense hairline is not appropriate for most people as they age, just as a very flat hairline is not appropriate. This is especially true for someone who has less hair due to thinning or balding. It is up to the surgeon to balance density and naturalness to give his patient the best possible appearance. A dense frontal hairline made with larger grafts will never look as natural as a properly designed hairline using fine delicate grafts. The density of the transplanted area should always be appropriate for the long-term goals of the individual.
Fallacy #4
“Try a few grafts and see if hair transplantation is for you.” Explanation:
This statement is one of the most disturbing comments made by a doctor. The "try a few" mentality is, in our opinion, tantamount to medical malpractice, as it does not fully inform the patient of the potential problems of starting a process that he or she may not wish to complete. Fallacy #5
With a young balding man, the doctor rubs the hair in the back and sides of his
head and announces: "You have plenty of hair for a transplant."
Explanation:
Each one of us is born with a different, but finite, quantity of hair. New hair cannot be created. Scientific measurements (of hair density), such as
densitometry, provide the surgeon with much greater accuracy than subjective assessments when estimating the total supply of permanent hair. The
importance of accurately estimating the total donor reserves for proper long-term planning cannot be over emphasized. Beware of any doctor who says that you are a great candidate for a transplant before he spends the time to carefully examine you.
Fallacy #6
By cutting out some of the bald area in the back, scalp reductions save hair for future loss in the front.
Explanation:
Such statements reflect an unacceptable lack of knowledge. Hair is a limited resource that is depleted regardless of how it is moved. A scalp reduction is not a magical process (as it is often portrayed). It moves hair to the front of the scalp at the expense of the back. With a scalp reduction, the hair in the donor area is thinned considerably, and the scalp’s laxity (looseness) is decreased as the scalp is stretched to cover new area. This means that when the frontal hair is lost, the surgeon may not be able to harvest the quantity of hair needed to meet
the patient’s needs, as the hair supply might run out before the completion of surgery.
As most people want to frame their faces, the frontal restoration usually takes precedence over the crown for hair redistribution purposes. If the crown is treated first, the surgeon must be certain from the very start that the way the hair is distributed leaves enough hair in reserve to cover the remainder of the balding scalp. Scalp reductions, by addressing the crown first, significantly compromise this principle. In addition, scalp reductions can cause problems such as scarring, a thinned scalp, altered hair direction, and a host of other unwanted effects, that become more and more difficult to deal with as the patient’s baldness
progresses. Fallacy #7
Removing large amounts of donor hair is unsafe. Explanation:
The judgment of an experienced surgeon will insure that the amount of hair that is harvested from the donor area is safe and appropriate. If follicular dissection is performed carefully using microscopes, the amount of hair needed for the average large session is well within the safe limits of transplantation. The amount of moveable donor hair reflects the size of the donor area, the scalp’s looseness, the number of hairs per square inch, and the amount of scarring (if any) from previous surgeries. These factors must be considered before the surgical procedure, ideally during the patient’s initial evaluation.
Fallacy #8
With new laser technology, recipient sites can be made without injury to the transplanted area.
Explanation:
Lasers were introduced to hair transplantation to produce slits that were supposed to look better than punch holes, and to remove tissue to accommodate large grafts. The exclusive use of follicular units eliminates the need for lasers since the small grafts fit into very tiny micro-slits that can be created without removing tissue. Regardless of how precise the laser beam, or how small the zone of thermal burn around the wound that the laser produces, the laser still makes a hole or slit by destroying and removing tissue. This is essentially the same type of wound produced by the cold steel punches of the early days of hair transplantation. Lasers will always produce more injury to the recipient area than a micro-slit that does not remove tissue.
Chapter 23
A Final Note
In this book, we have presented a detailed overview of hair loss and its treatment. We have tried to offer a clear explanation of the various options available to men and women who are experiencing hair loss. The most common and rational options concerning medications, surgery, and hair systems have been discussed. Only by becoming an informed consumer can you make the right decision for yourself. The following points are important to remember: • Hair loss starts at varying ages. Some individuals become bald by their 20’s, or balding can slowly progress throughout adult life. Although you may sense that you are losing hair by simple observation, your physician can make a specific diagnosis of hair loss.
• There are many options for hair replacement today, from medications to hairpieces to surgical procedures. Be sure that you understand both the
advantages and the risks before you begin any course of treatment.
• The FDA approved medications, finasteride and minoxidil, can significantly delay the progression of hairloss and reverse early thinning. There are many more unproven remedies on the market. A knowledgeable doctor is the best source of information about these options.
• Make sure that when you go to see a physician for your hair loss problems you see the actual doctor. Do not settle for a salesman in a white coat. • Be certain your doctor understands your goals, needs, and expectations. Be certain that he or she performs only state-of-the-art surgical techniques or can refer you to a physician who does.
• Once popular procedures, such as scalp reduction and flaps, have an unacceptable rate of problems and are no longer used by most hair restoration surgeons. Some newly “hyped” procedures such as laser hair transplantation, may also cause more harm than good, and are not recommended by most physicians.
• Commonly practiced techniques, such as mini-micrografting, although relatively quick and easy to perform, rely on a multi-bladed knife to remove the donor tissue and can cause excessive hair wastage and less than natural results. • Only techniques using single strip harvesting and stereo-microscopic dissection can insure that the donor supply is used efficiently and without waste, and only Follicular Unit Transplantation can insure natural results.
• The physicians of the New Hair Institute first published an article discussing Follicular Unit Transplantation in 1995. This procedure has now become the “gold standard” of surgical hair restoration. To be performed properly, Follicular Unit
requires a surgeon who understands both the artistic and technical complexities of transplanting large numbers of very small grafts, a surgical team specifically trained in the stereo-microscopic dissection of follicular units, and facilities that are specifically equipped to perform this labor intensive, exacting procedure.
• Hair transplantation is moderately expensive but, in the long run, can be far less costly than other treatments. Transplanted hair behaves like the original hair. It grows and must be cut and styled like normal hair. If transplantation is performed properly, your transplanted hair can look perfectly normal and last a lifetime.
We hope that the information provided in this text has been helpful and we wish you luck in your search for a hair loss solution that will be right for you.