Thank you for your question.
You submitted several photos. And you state in the substance of your question that you’re
4 months after undergoing a hair transplant and you are concerned about the low density.
And you’re asking about the possibility of additional transplantation from the same
donor area. You’re asking about the proximity of hairs being transplanted together in terms
of what’s the maximal density achievable. And can you get a natural density after the
transplant.
Well, I can certainly share with you my approach to patients with hair loss in my practice.
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. Hair transplant has been a very big part of my practice. I am also
the founder of TrichoStem™ Hair Regeneration Centers. This is a system that we developed
that non-surgically helps patients with thinning hair both men and women who have been traveling
from all over the world for this treatment as part of a hair loss strategy. And of course,
I will discuss later, this is a system that evolved out of hair transplant surgery.
So to begin with, let’s deal with some basic issues and concepts that I think would be
fair to assume that your doctor probably went over with you and let’s begin with what’s
the objective of hair transplant surgery. Hair transplant surgery essentially is moving
hair from the permanent donor area which is the rim around the scalp where the hair is
never lost even with advanced hair loss and transplanting it to areas which lack hair.
Now the challenge with hair transplant surgery is an obvious mismatch between the available
grafts from the donor area and the desired coverage of the non-hair bearing areas, the
area that’s balding. So the standard approach in transplant surgery, especially for most
people who are ideal candidates or people with frontal hair loss is to essentially try
to frame the face by placing grafts towards the front.
Now, almost every hair transplant patient not only wants the front covered but they
want the middle and the back covered. And so whenever I do a consultation, I’ve essentially
drawn square centimeters, little square patterns in the frontal area and then I would show
what the actual donor area looks like and estimate the number of grafts. And invariably,
there’s always fewer grafts that would be necessary to cover the entire scalp. Now with
modern techniques, there are ways to actually harvest body hair to add volume.
Now when you ask about the number of hairs that can be placed close together, I would
generally say that even with modern very narrow small thin grafts, about 20 grafts per square
centimeter is about right. You see, every graft needs a perimeter of normal skin in
order for it to heal without it being lost. It’s a graft. And basically, we call it
a hair graft but it’s really skin bearing hair. So it’s really a skin graft, a lot
of small skin grafts with hair. There’s a certain amount of attrition meaning a certain
amount of hairs won’t make it due to the harvesting process, the processing as well
as just the healing process.
When we were doing a lot of hair transplants, we were using a material called Acellular
matrix. This is actually a material that is derived from pig bladder that was used for
wound healing to help improve the healing of the grafts as well as healing of the donor
area. Well, a very good side-effect turned out to be that thinning hair became thicker.
From that, we developed a system called Hair Regeneration. And the point of this is that
when we were doing these surgeries, one of the things that we always had to wrestle was
also the progression of hair loss. And this is something that hair transplant surgery
does absolutely nothing for. Hair transplant surgery will for a certain period of time
provide you a certain amount of coverage but you will still progress.
Now, all of hair loss is progressive. The difference between individuals is the age
of onset, the rate of progression and the extent of hair loss. So, when somebody, particularly
who is younger starts to lose hair at a younger age and is losing a fair amount pretty quickly,
you try to do everything you can to try to slow it down and stabilize it. And so in my
practice, we have used Hair Regeneration as a strategy for people who had hair transplant
to help them stabilize and maximize the longevity of the hair growth cycles after transplant
as well as for existing hair.
So what you should be also thinking about in addition to maximizing the coverage moving
forward is how do you stabilize your progression. And when I say stabilize, it’s not forever.
Hair loss is still progressive. So in our practice, Hair Regeneration, we have essentially,
for the majority of our patients who have moderate degree of hair loss with later age
of onset and moderate rate of progression, we have more than 5 years of stability and
improvement that we’ve been able to establish with this system. We have a lot of younger
people who are coming and we are continuously improving the process and the strategies that
I’m customizing them for younger people who have different rates of hair loss.
Very often, it is recommended in this strategy to add a DHT blocker like finasteride. And
unfortunately, a lot of people are afraid to take finasteride and we discuss the risks
and benefits of this drug with our patients.
So I would say that it is likely that you had this discussion with your doctor and naturally,
I think your doctor did their best to try to provide you with hair throughout the scalp
as is shown by your photos. A lot of times, people who undergo hair transplant in this
way will essentially employ strategies such as the use of topical fiber to help cover
those areas in between the grafts to help them blend the scalp coverage so that it looks
like you have more hair than you actually do. And these topical fibers come in various
colors and name brands.
So I think that you should of course, you’re only 4 months out. You still don’t have
the full growth of your grafts. Meet with your doctor. Discuss a strategy moving forward.
Discuss what is likely to be the case, not just before the hair transplant but what kind
of trajectory you are looking at. You always have to think of where you’ll be a few years
from now and not just trying to deal with short-term of coverage. We have so many patients
come to us who had transplants in their mid to late 20s and into their early 30s and by
the time they hit their late 30s, they barely had any coverage at all because they lost
all this hair. So being proactive with maximum medical therapy, treatments such as Hair Regeneration
will hopefully maximize the longevity that is the potential for your hair.
So I hope that was helpful, I wish you the best of luck and thank you for your question.