Does FUE Change Donor Planning?

Let’s firstly consider the rationale of strip harvesting. In this technique we harvest all the donor hairs in a selected area. If we choose the strongest donor hairs from the “safest” zone we can be more confident of the longevity of the result. This makes it an efficient harvest of the safest zone. Post strip harvest, there is minor thinning of surrounding areas but the same area can be re-harvested including removal of the previous linear scar.

Let’s now consider the rationale of FUE harvesting. In this technique we partially remove hair from the donor zone. The harvest is typically in the 25-35% range of available hairs. Overharvesting of any individual area produces a significant variation between donor zones leading to the desire to harvest the stronger areas in future surgeries. This is unlikely to be a problem in smaller cases with small harvests, but in extensive balding requiring large harvests, this theoretically creates a problem.

So, how do we deal with this potential problem? It is my view that extensively bald, younger patients should be encouraged to maintain long-term medical therapy to limit further possible hair loss. They should be properly warned as to the possibility of future thinning of some of the grafted hairs. This is probably wise regardless of donor harvesting technique, to prevent extension of the balding area, however with FUE it may also act to preserve the grafts harvested from the less safe areas and reduce the possibility of unmasking of FUE donor scars. 

Finasteride - the latest updates

At an international conference recently it was discussed in depth about Finasteride and the possible sexual side effects resulting. It was again concluded that Finasteride is a safe medication and side effects were mainly dose dependent and went away completely upon ceasing the medication. It's been noted that recent media reports on the severity and incidence of side-effects have been extremely overstated and that Finasteride remains the best option for treating male pattern balding.

In my care, side effects are very uncommon and a minimal, intermittent dose of the medication is all that is required to give long term stability of hair loss in most thinning men.

The Latest Treatment for Pattern Baldness

The most interesting topic discussed at our recent annual meeting of the ISHRS (International Society of Hair Restoration Surgery http://www.ishrs.org ) was the new research to come out about prostaglandins. Medications currently being created to treat illnesses including Asthma, by preventing specific prostaglandins (inflammation chemicals) may have other benefits e.g. stimulating growth of thinning hair in men. While the new medications are a few years off yet, these medications may turn out to be the next chapter of medicines that successfully affect thinning hair. Also discussed where the interesting versions of prostaglandins, some of which actually hindered new hair growth, whereas others stimulated hair growth.

The latest information about hair loss treatment

I have just recently returned from the Asian Association of Hair Restoration Surgery Annual Meeting in Seoul, Korea. It was very well attended with over 250 surgeons attending to find out the latest information about hair loss treatments.

Of particular interest to me were the presentations regarding the influence of the recipient site on the growth rate of transplanted hair. The original research was performed in Korea over 10 years ago and showed the surprising result that, contrary to our earlier belief, the body site where the transplanted hairs are placed influences and changes the growth rate of the hairs.

The relevance of this is that hairs in different regions of the body grow at different rates. Therefore when using scalp hair to reconstruct eyebrows the transplanted hairs initially grow at the scalp hair rate which is three times faster than the eyebrow rate. This means that the transplanted eyebrow hairs have to be trimmed regularly as they grow much longer and faster.

Over time however, the surrounding eyebrow skin somehow influences the transplanted hairs and they slow down considerably to more resemble the growth of normal eyebrow hairs. Even more interestingly, if the transplanted hairs are then removed from the eyebrow and re-transplanted back into the scalp, they then begin to speed up their growth rate again! Amazing stuff.

The other benefit from this research is that it shows that certain body hairs can successfully be used to replace lost hairs in the scalp. Over time these body hairs will more closely resemble natural scalp hairs in appearance and growth rates. Despite this, body hairs should only be used as a last resort when there are no more usable scalp hairs available as donor hairs.

Follicular Unit Extraction (FUE) VS. Strip Harvesting

Many of my patients have been reading about the supposed superiority of Follicular Unit Extraction (FUE) versus Strip Harvesting during hair transplant surgery. Be aware that it is very important to separate the marketing from the actual science. Both techniques involve cutting the skin. There is no such thing as a scarless technique for hair transplants.

Both techniques produce the same sized graft. Both techniques leave scar/s which may, or may not, be visible to the naked eye. The difference being that FUE produces small, circular, dot type scars that may also have a white coloured appearance. Strips produce linear scars that may have hair growing back through them and be very difficult to see with the naked eye. Short haircuts are usually possible with either of the techniques but shaving the entire head will probably show scars with either of the techniques.

Combating Hair Loss for Men & Women with Low Powered Lasers

There has recently been a lot of interest in low powered laser devices and their effectiveness on treating hair loss. Research suggests that it has a mild stimulatory effect on hair follicles. Laser could be an effective secondary (i.e additional) treatment for hair loss in patients who have mild balding or thinning. It also may be effective in seasonal increased hair shedding (i.e a moult).

However, the way the laser is delivered and the amount of laser exposure is critical to the chance of success. A new device called the Lasercap (http://www.lasercap.us) applies 224 laser lights continuously to the scalp area in the comfort of your own home. It uses rechargeable batteries, can be worn under a hat or cap and can be used at your convenience. Suggested dosage schedules are 15-30 minutes every second day.

The major advantage of the Lasercap device, compared to other hand held devices, is that the correct energy level is continuously applied to the scalp area. Other hand held laser devices only apply energy for a very short period of time if they are used to the manufacturer’s instructions. If you would like to know more about this additional treatment for mild hair loss, please contact our Sydney Hair Loss Clinic Ph:1800 685 399.  The Lasercap can also be ordered directly from The Knudsen Clinics.

Short Hair After Hair Transplant Surgery

A common trend for male patients is the desire to wear their hair short after surgery. We have received many inquiries at our Sydney hair loss treatment clinic about whether its possible.  The good news is that this can be achieved. The modern donor technique overlaps the donor area skin edges whilst stitching allows hair to grow back through the donor scar. This is called the trichophytic technique and almost always creates a great result that is almost undetectable, even with a very short number two haircut!

Some patients would like the ability to shave their head after the transplant.  This is slightly unrealistic however, as no matter which technique is used for the hair transplant, all surgery creates scarring to a certain degree. The modern techniques that we currently use minimize the visibility in both the recipient hair area (the thinning/balding area) and the donor hair area. Our website has further information about Hair Transplant Surgery. If you have any questions about this, please feel free to visit our Sydney Hair Loss Clinic or call us on 1800 685 399.