Prior to establishing the nonsurgical treatment for thinning hair which we call Trichostem®
Hair Regeneration, minimizing the scars from hair transplant surgery was one of the most
significant challenges I faced when performing hair transplant.
I’ll discuss my perspective on how hair loss is optimally managed including hair transplant
surgery as well as nonsurgical hair loss treatment.
I’m Dr. Amiya Prasad, I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial
Plastic & Reconstructive Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I performed surgical hair transplant throughout my career with most of my experience being
with FUT which is an abbreviation for “follicular unit transplantation” also known as “strip
surgery”.
The “strip” refers to the strip of hair bearing skin that I would remove to use for
hair grafts.
As a Cosmetic Surgeon who routinely performs facial procedures such as facelift and brow
lift, I focused on how to attain a well-healed minimally perceptible scar.
One of the tools I used in this effort was extracellular matrix by ACell.
This material enhances wound healing through the activation of your own adult stem cells.
I routinely used this material to optimize healing for facelift incisions as well as
for reconstructive procedures.
This strategy worked out very well as I found the strip incisions to heal faster with overall
better long-term results.
I also used the same material to enhance the healing of the hair grafts.
A major frustration with hair transplant surgery is that a percentage of hair grafts will not
survive ranging from 10% to as high as over 90%.
I found that with acellular matrix that the hair grafts healed much better and the survival
rate of the grafts went up considerably.
I also noticed that after one year that thinning hair located outside of the transplanted area
actually increased in number and became thicker.
This was the inspiration for my developing a system of treating thinning hair without
surgery.
Around the same time, the popularity of strip surgery was being overtaken by a different
approach called FUE or follicular unit extraction.
This was essentially because of the frustration felt by people who had hair transplant surgery
with what was referred to as “ugly strip scars”.
In my opinion the so called “ugly strip scars” was the result of an aggressive single
procedure or multiple strip harvesting creating significant skin shortage and tension resulting
in suboptimal healing.
I would also assert that many people were being operated on who were not good candidates
for hair transplant surgery, which resulted in poor healing of the donor area incision.
In many instances, if the patient had straight or wavy hair, these scars could be hidden.
During this time it became a popular trend, particularly for younger people to wear their
hair very short making the strip scar less desirable.
This resulted in a growing demand for FUE surgery, which was being marketed as “scar-less
surgery”.
The term “scar-less” surgery is inaccurate.
The grafts are harvested in a much larger area than FUT surgery with small round skin
punches.
There needs to be a minimal distance between these punches, which results in a wide area
of hair bearing skin to be harvested from.
This area is way outside of the true permanent hair zone.
Further, the claim of scar-less surgery is far from accurate.
In actuality, there’s considerably more scar tissue in comparison to an FUT or strip
surgery.
The more significant issue is the survival rate of hair grafts.
In FUE surgery, it is generally understood that about 30% of grafts are transected which
means there is no root when the hair graft is placed.
In addition, due to the limited amount of tissue in each graft, the graft survival rate
is lower in comparison to FUT or strip surgery.
I find that when the question of minimizing scarring in hair transplant surgery is raised,
it is predicated on an assumption that hair transplant surgery is the best option for
your hair loss.
This may not be the case.
During the many years I performed hair transplant, I found that most people who come in for consultation
for hair transplant are men and women with thinning hair.
Typically, they would come in when they felt that their hair loss was getting much worse.
Frequently, the perception was that their hair loss was progressing much faster than
it was over the past few years.
The fact is that hair transplant surgery does nothing for hair thinning.
As mentioned earlier, I developed TrichoStem® Hair Regeneration in part because I recognized
that there was a potential to get results which could be better than surgical hair transplant.
How could that be possible?
Since most people coming in for consultation had thinning hair, I recognized that the density
of their existing hair was much better than the density that would be created with a hair
transplant.
Native hairs exist naturally more close to each other than a hair transplant can safely
achieve.
The density of your native hair even when thinning can be 50-100 hairs per square centimeter,
while a transplant is typically about 20 grafts per square centimeter.
This means that reactivating hair that is not growing and thickening of your thinning
hair can result in better coverage than hair transplant surgery.
I worked everyday on dosing and delivery methods for optimal results using Acellular matrix
and PRP or platelet rich plasma.
I followed my patients closely with high resolution digital photography and microscopy every three
to six months for years.
It became clear that my hypothesis was right.
Contrary to the assumptions of hair transplant surgeons for whom the first line for hair
thinning is surgery, TrichoStem® Hair Regeneration provided more effective scalp coverage than
even 2 hair transplant surgeries.
In fact, the success of this system of hair loss inspired to me to build a freestanding
center in Northern Virginia, to help make our system accessible to more people.
One variable that is relevant, particularly for people with good density is that during
hair transplant, much of the existing thin hairs are permanently lost because of direct
trauma during surgery as well as vascular compromise and inflammation.
This has always been well known as so called; ”collateral loss” with the rationale being
that the thin native hairs were going to go away eventually and thicker hair were being
transplanted.
When someone has already lost a lot of hair and they are losing their hair at a fast rate,
hair transplant surgery cannot keep up with this degree of loss.
Each surgery after the first typically has less hair to harvest for grafts.
More surgery, means more scars.
I regularly see people who had several hair transplants over the course of 5 to 10 years
and still they don’t appear to have much hair.
Now, with TrichoStem® Hair Regeneration this approach of performing multiple surgeries
to keep up with progressive hair loss is no longer the first line of therapy for thinning
hair.
I feel that the only indication for hair transplant is to place hair in an area toward the front
where the skin is smooth and bald for many years.
For everyone else, since 2011, TrichoStem® Hair Regeneration has been the optimal system
for men and women with thinning hair in my practice.
There are of course limitations.
Hair loss is not cured, hair loss is managed.
Medical therapy such as DHT blockers and hormonal replacement can potentially optimize the longevity
of hair growth.
Hair loss is still going to progress.
However, the option to improve your scalp coverage with one to two treatments performed
over a 2 year period with longevity of benefit being typically 3 to 5 years and in many situations
even longer is far more accessible, convenient, less risky and more economical than surgical
hair transplantation.
Since 2011, I observed the hair loss profiles of a wide range of patients who came from
around the world and developed a classification system for hair loss for men and women.
This classification is used to create customized treatment plans based on gender, age, age
of onset of hair loss, rate of progression, degree of hair loss and other medical variables.
I find that during consultation, I generally suggest hair transplant to be something to
consider as a last option after achieving the full results of TrichoStem® Hair Regeneration.
99 plus percent of my patients don’t pursue hair transplant after TrichoStem® Hair Regeneration.
I’ve observed that most people look for a hair loss solution after they’ve passed
a certain threshold of hair loss.
This motivates them to pursue a solution.
I find that once there is a significant improvement and a stable appearance for several years,
they feel better and less anxious about their hair.
In fact, many people who’ve undergone hair transplant come for TrichoStem® Hair Regeneration.
As mentioned earlier, since hair transplant does nothing for hair loss progression, many
people who’ve had hair transplant have come to manage their thinning hair rather than
undergo a second hair transplant operation.
In addition, we’ve treated many people who want to optimize their hair transplant results
by coming in within the first three months after their surgery.
The benefits of improving the hair transplant healing process coupled with the reactivation
and thickening of existing hair helps to optimize scalp coverage after surgery.
In conclusion, the best way to minimize hair transplant scars is to not have a hair transplant
at all.
If hair transplant is going to be necessary, then I would suggest considering non-surgical
options to maximize the coverage and longevity of your existing hair before considering hair
transplant surgery.
For people who want hair in a smooth and bald area, if there is hair present in the mid
scalp and crown, a procedure like TrichoStem Hair Regeneration can improve the total scalp
coverage so you won’t need to be as aggressive with surgical hair transplant.
I hope you found this information helpful, thank you for your question.