Doctors on Hair Loss & Hair Transplant surgery.

What is the importance of hair characteristics in hair transplant surgery?

These characteristics are significant in that they determine to a great degree how much coverage of the scalp there is, in order to block light. When light is not blocked and penetrates through to the scalp, the appearance is of thinning or balding.

The other big factor here is the density, which is another topic unto itself. The density is the number of hairs or follicular units per unit area (square centimeters or square inches or whatever unit you prefer; the centimeter is the standard for physicians). Although this density usually gets most of the attention when discussing hair loss, hair characteristics are equally, if not more, important.

First let’s look at color. At first, one might think that the darker the hair, the better the coverage. This is generally not correct. Lighter hair usually goes with lighter skin, and the tow together tend to mask thinning very well. Darker hair can cover well, but in the case of poor hair transplant work (pluggy looking, or larger graft on frontal hairline) they may stand out much worse than lighter hair. We will discuss color in more detail when we discuss contrast.

Curl is another very important factor in coverage. Generally speaking, curly hair provides coverage in proportion to the degree of curl (i.e., wavy hair gives better coverage than straight hair, curly hair better than wavy, very curly better than slightly curly, etc.). This has to do with light blockage as well. The curlier the hair is, the more it creates a meshwork of sorts (kind of like a thatched roof) which “stands up” a little bit off the scalp and keeps the light from penetrating to the scalp.

Contrast has to do with the difference between hair color and skin color. The closer to each other the hair and scalp are, the better the coverage. In a way, this “fools” the eye of the observer into not noticing the decrease in density. If a person with blonde hair and light skin loses 50% or his or her density, they may appear much less affected than a person with equally light skin and jet black hair. In this case the dark hairs of the second example are highlighted against the light skin and it shows the sparseness of the hair. The person with the blonde hair reveals very little difference between the hair and scalp, in other words, the observer cannot detect where the hair leaves off and the scalp begins.

Last, let’s consider caliber. Thicker strands of hair provide more “hair mass”, which is a term doctors use to describe the total effect of length times caliber. The more hair mass in a given area, the better the coverage. This makes intuitive sense. Imagine covering a hut with logs. If you place 20 logs as a roof, which will give better coverage, skinny logs or big round ones with large diameters? Of course, the bigger ones, so the thicker hairs do the same over the scalp. And remember, what appears as thinning or balding is simply the appearance of light shining through to the scalp.

Tags: balding, blonde hair, caliber, curly hair, diameter, hair characteristics, hair loss, hair mass, hair transplant, hair transplant surgery, scalp, shaft, skin

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I’m told by various strip physicians that the strip scar is a thin as a pencil mark. Is this true?

This is completely dishonest. The average strip scar is 2 to 3 mm wide and it can stretch from ear to ear. If you plan to cut your hair short, this can be a problem for you as it is obviously a man made scar. It is an obvious sign that you had a hair transplant. No one wants anyone to know they’ve had a hair transplant, however. No one wants anyone to know they had hair loss or that they ever considered hair restoration surgery. Even shorter hair styles can expose the strip hair transplant scar. Frequently we are told that a hair cut of a number 3 or shorter exposes the strip scar form a strip hair transplant.

There is a new fallacy you are hearing from strip surgeons, as well. They claim that their new trichophytic closure technique produces pencil thin scars that are invisible. We’ve seen 5mm wide scars produced by this technique. Five millimeters is ¼ inch wide. It is a huge gap with no hair in it. When the trichophytic closure works, it rarely works in the rear of the scalp. You will not see an advantage along the sides of the scalp usually. Furthermore, the tighter you make the scalp by performing successive strip procedures, the more likely it is that your scar will widen and stretch out. Furthermore, these strip scars can turn whiter than the surrounding skin or bright pink. This produces further contrast to the scars should they be exposed by a short hair cut or by a medical illness that causes thinning or loss of your hair.

One other problem you will never hear about from your strip surgeon is that strip procedure causes irreversible changes in your donor area hair growth angles. A strip is nothing more than a scalp reduction in the donor area. It alters hair growth angles for the rest of your life.

There is no reason to have a strip procedure. It really is up to the patient to demand the alternative, which is far better. Patients should begin to demand CIT, which is an advancement over our older FIT procedure. There is CIT and no quite CIT. Many physicians will tell you they perform FUE. This FUE procedure does not meet the quality of CIT. CIT is a proprietary procedure with quality instrumentation. Only CIT has proven results day in and day out with all types of hair including wiry, kinky hair seen in men of African decent.

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Tags: cit, cole isolation technique, donor area, fue, hair cut, hair growth, hair transplant, hair transplant surgeons, hair transplant surgery, instrumentation, physician, scalp, scar, strip, strip hair transplant, strip scar, thinning, trichophytic closure

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I would like to know what is the CIT hair transplant? why is it better then the strip?

CIT or “The Cole Isolation Technique” (former known as FIT) is a hair transplant harvesting technique developed by Dr. John P. Cole in the early years of this century. It is similar, but not identical to, FUE, or follicular unit extraction. CIT uses proprietary technology and instruments to harvest intact follicular groups ranging from 1 to as many as 6 or more individual hairs along with their intact dermal elements. It must be stressed that these dermal elements are essential for the growth of new hairs in the recipient areas (these are the areas of thinning or balding that are being transplanted). Extracting hairs without the dermal elements is easy, but amounts to nothing more than a “pluck”; these hairs will not grow.
As with any other harvesting method, the hair transplant surgeon will first outline the donor areas to be harvested, as well as the areas which will be receiving the harvested grafts later on. Then, local anesthetic is infiltrated into the donor area to render the skin and deeper structures numb and insensitive to pain. Then, just before harvesting begins, the area is injected with a “tumescent” fluid consisting of saline, and often medications to minimize bleeding. This tumescent technique is fairly common in a number of cosmetic procedures. It is beneficial in a number of ways; it helps decrease bleeding with medications and also by virtue of the pressure of the fluid on blood vessels in the tissue; it brings the skin up and away from deeper structures; it provides a taut, firm surface on which to score the skin, and it slightly separates the follicular groups from each other so that they may be more easily isolated from one another.
Then, the skin around the follicular groups is scored with the special instruments; the surrounding tissues are teased away from the follicles and then the entire unit, that is, the hair shafts, the dermal elements surrounding the shafts, the sebaceous glands and a tiny ring of skin at the top is gently pulled out. The graft is perfect, and ready for placement in the recipient area. No trimming or preparation is generally needed. This is one of many benefits of CIT compared with the older style strip harvest method, which requires microscopic dissecting of all grafts prior to placement, necessitating a large team using stereo microscopes.
Healing of the tiny sites from which the grafts are pulled commences almost immediately. Usually by the second or third day, the tissue has grown in to cover the hole and there remains only a pale pink dot at the site. In some individuals, this may eventually appear as a slight “white dotting”, which is not strictly speaking a scar, but rather an area of hypopigmentation. This just means that the cells within the follicles that produce the dark pigment called melanin are gone, and the skin here is a slightly lighter shade than the adjacent skin. This phenomenon is relatively unpredictable; it is most common in darker complexioned people, but may manifest in pale-skinned folks. Likewise, it may occur after CIT with very small instruments, and not at all with larger-sized extractors (or vice versa!)
We feel that, compared to a linear, ear-to-ear strip scar, these tiny white dots have minimal negative cosmetic impact. With the hair only a few millimeters long, these dots are undetectable. A strip scar, on the other hand, may be visible with the hair considerably longer, and it may widen, sometimes for no apparent reason. In addition, the strip scar changes the direction of hair growth below it, relative to the direction above it. Unless a person desires to wet shave their hair down to the skin, these white dots, if they do occur, are invisible to the casual observer.
Now, once the grafts are extracted and ready for implantation, the process is quite similar to strip harvest hair transplant surgery. Tiny jeweler’s forceps are used to very gently grasp the hair-bearing grafts and place them into miniscule recipient sites. These sites are created by the hair transplant surgeon using various blades or needles; each site is made carefully and with a deliberately natural pattern. The angle relative to the axis of the head is extremely important, because the hair normally grows in specific patterns. These patterns have a general similarity in all people, but there are specific ways in which these patterns diverge in individuals. A “cowlick” at the frontal hairline is a good example, as is a unique “whorl” at the vertex or crown. It is often appropriate to closely mimic the existing pattern to obtain the most natural effect.
The so-called angle of emergence is of utmost importance as well. This is the angle at which the hair emerges from the scalp. This angle may be quite acute, that is, the hair may lie down very close to the plane of the scalp. If an inexperienced or minimally gifted surgeon makes these angles too high, then the look will be peculiar and unnatural. We have seen many cases such as this, and it is especially noticeable at the leading edge of the frontal hairline; follicles growing on the hairline at or close to a 90 degree angle are an aesthetic and cosmetic disaster.
Regional placement of various graft sizes is another challenge for inexperienced surgeons. One hair grafts ONLY should be placed at the leading edge of the hairline. Two hair grafts are then placed behind these “singles”; the “full-sized” three, four, or larger grafts are only placed further back behind the soft, feathered hairline. We commonly see repair cases with two, three, and even four hair grafts all over the frontal hairline! Fortunately, we can now remove these unsightly, inappropriately-placed grafts with the CIT technique and redistribute them further back where they rightly belong.
As with all hair transplants, the hair shafts themselves, which are essentially dead protein, will begin to shed at about 2 to 3 weeks. However, the follicular germinal elements are safely lying dormant beneath the skin. Usually at about 3 to 4 months, the first “new” hairs will begin to emerge. There will continue to be further growth for up to a year or more, but usually the full cosmetic effect will be evident at about 12 months.

Tags: bald pattern, balding, cit, dr. john p. cole, fit, follicular unit extraction, fue, hair loss, hair transplant, hair transplant surgeon, hair transplants, medications, physicians, punch size, saline, skin, stereo microscopes, the cole isolation technique, thinning

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Hair Transplant Video Results:
Here we have a 39 year old male, who was destined to be a class V. His request was for us to fill in the recessions, create a more dense frontal hairline, and add light coverage to the thinning crown.

Between early 2004 and late 2005, he had three smaller procedures, which together accounted for approx.4800 grafts, all via FIT/CIT technique. During his history of loss subsequent to his priors, he experienced additional loss therefore we transplanted on top once he came in during March of this year. In this year’s session, we transplanted approx 1200 grafts which include several hundred FIT farmed grafts to his donor.

 

 Hair Transplant Video Results [2:28m]: Play Now | Play in Popup | Download (143)

Tags: cit, crown, donor recharging, fit, fue, Grafts, hair transplant, hair transplant results, hairline, surgery, thinning, video

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what is the best possible treatment for baldness for a 23 years young male?

The best treatment for a 23 year old male with hair loss will vary somewhat depending on the degree of hair loss at this young age. If you have an advanced degree of hair loss, surgical solutions should not be considered. The reason for this is simply that hair loss is a lifelong process. Once it begins, it will continue the remainder of one’s life. Typically it will advance in stages. This means there will be periods when the loss is stable and periods when the loss accelerates quite rapidly. An advanced degree of loss usually means that one will lose an excessive amount of hair over their life time beyond the capacity of the donor area to keep up with the pace of loss. Eventually there will be a mismatch between supply and demand. This can result in an unnatural result later in life. One should avoid crown work when possible at this age or at least minimize the size of the grafts to one and two hair grafts that will appear more natural as the surrounding hair is lost later in life.

For the advanced degree of loss at an early age, medical and other non-surgical solutions would be the best options. These include DHT blockers such as Propecia and Avodart. It also includes minoxidil (Rogaine) along with Nizoral shampoo. We like Hair Cycle shampoo and conditioner too. One might also consider a hair piece.

Less aggressive degrees of loss should also be treated medically, but one might also consider a surgical solution. The surgical solution should never include a strip procedure. Rather one should have FUE or FIT when they are less than 30 years of age. It used to be that the only surgical option was a strip surgery that left a permanent strip scar. Today, this is not the case. Alternatives that avoid strip scars are available today and a much safer surgical solution.

It is a good idea to put off surgery as long as possible when you are young. The longer you wait, the more likely you are to know the bald pattern you are likely to develop into. In addition, you may find that you panicked as a 23 year old and solved the problem surgically. As men mature, sometimes they become comfortable with their hair loss. Once you begin surgery, you increase the probability that you may require additional procedures as you mature and your hair loss progresses. If you are certain that you want to maximize the hair on your head and you are not expected to have an advanced degree of loss, then surgery may be an option for you, however.

Tags: avodart, bald pattern, dht blockers, fit, fue, hair cycle, hair loss, hair piece, minoxidil, nizoral, non surgical solutions, Propecia, rogaine, strip, strip scar, young age

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