Thank you for your question.
You submitted your question with two photos. And you describe in the details of your question
that this is your third transplant. However, it’s your first FUT. And you’re concerned
about these bald spots in the donor area about the size of your thumb. And you’re asking,
is there a way to help this area either by transplanting more hair or is there a trick
to grow the hairs back.
Well, I can certainly share with you my perspective in a situation like yours. A little bit of
background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers, a
system that we developed that was derived out of our experience with hair transplant.
And we are able to help patients from around the world both men and women to non-surgically
address hair thinning with technology that is now become a category of regenerative medicine
technology. So I can certainly share with you a perspective that can give you an understanding
of what you’re dealing with those bald areas.
So just to back to what we were trying to achieve with hair transplant and that ultimately
led to Hair Regeneration, doing what was mostly FUT or strip surgery, the concern was always
about getting a good donor area healing and to try to minimize the widening of the scar
and to expedite the healing and to maximize the hair regrowth. And further, we wanted
our grafts to heal better. Well, I can tell you that using Acellular matrix and platelet-rich
plasma (PRP), we were able to achieve better healing of the donor area.
Now of course, in a situation like yours, where you’ve had two prior hair transplants
which were most likely FUE transplants or follicular unit extraction transplants, basically
your graft had to be harvested very far and wide in the donor area. And then when you
had gone ahead and got a second FUE transplant, those dots become closer together which means
the density was diminished. Now I can understand the strategic thinking which makes a lot of
sense that if you had an additional surgery, then instead of trying to do another FUE,
that you’ve gotten an FUT or strip surgery because frankly, the amount of density was
being essentially limited.
And so, when you are asking a question about growing the hair back, there actually is unlikely
to be any hair to grow back because the hairs have been transplanted. When you do hair transplant
surgery, you’re taking the whole follicular unit: the hair follicle with its adjoining
oil glands and sweat glands and fat and everything that goes with the hair. It’s really, in
a lot of ways, I always describe it as, it’s a skin graft with hair. So you’re moving
the whole hair unit. So the hair cannot really grow back in the area.
A lot of times, when we see our patients who are not coming in for primarily Hair Regeneration
and this means both men and women whose hair is thinning, we see patients also who come
from around the world who have had hair transplant. What we have learned and from our experience
is that we have been able to actually expedite the healing process of the hair transplant
so that the grafts actually grow better and grow sooner. Now this is of course empiric
data. It’s certainly vulnerable to criticism. But from experience doing transplants for
so many years and then seeing how people’s transplant do with our treatment, I think
our data has certainly a validity in helping our patients heal better. Now sometimes, the
patient also asks us to do the injection into their donor area and since they’re coming
from all over the world, we don't get to necessarily follow-up with them but I think that, still,
once a hair is gone, the hair is gone.
And so I think that what you have to try to figure out and you can certainly work with
your doctor on this is that for that area to improve coverage, it is my opinion, if
you’re going to transplant hair, well, where are you exactly going to transplant from and
how much hair can you really transplant? And if you were to transplant that hair, would
you not prefer to have it transplanted to an area that’s more visible which is in
the front?
That being said, I have discussed with my patients the opportunity to maybe consider
some scalp micropigmentation. And although it’s not a perfect solution, it might give
you some assistance in camouflaging. A lot of times, just strategic hairstyling can help.
But it is a trade-off and it is unfortunately the reality of doing as much transplantation
as one can. And so, I also advocate for even patients who have gotten several transplants,
I advocate strongly something to be proactive to slow down the progression of their hair
thinning. Now of course, I don’t see the top of your head so I don't know what degree
of hair loss you have. But I would say, when we do our evaluations, we look at our patients
who have transplants and we look with a microscope and very often, not only do we see transplanted
hairs but we see miniaturized native hairs.
So then we employ a treatment plan and we employ Hair Regeneration technology. This
is a combination of Acellular matrix and platelet-rich plasma (PRP). And we’ll actually be able
to stimulate the area so that we can further enhance the coverage. Hair Regeneration is
able to reactivate hairs that are currently not growing. That’s the nature or hair thinning
is that certain hairs, a large percentage of hairs enter a resting stage and that resting
stage is prolonged. We’re able to thicken thinning hairs and prolong the longevity of
the hair growth cycle. We also observe that even transplanted hairs can actually have
an improvement in their quality. And I think it’s consistent with the reality that multiple
transplantations creates a lot of scarring. And since we’re dealing with regenerative
medical technology, it stands to reason that the environment of where the transplanted
hairs are in, where there’s scar tissue and vascular compromise, that there is an
improvement resulting in improvement of the transplanted hair as well.
So I think that, for your specific question about the back, there are very few options
and certainly you’ve been so committed to your management that you should certainly
explore those. But I would also ask you to consider strongly a strategy to also help
maximize the longevity of scalp coverage with whatever tools are currently available. I
always explain to all of our patients, regardless of the number of transplants you do, hair
loss is progressive and the goal is to maximize coverage and maintain a certain look for as
long as possible. So learn about your options in the world of pharmaceutical and regenerative
technology and see what you can do about the other options I discussed for the camouflage
of the donor area.
So I hope that was helpful, I wish you the best of luck and thank you for your question.