Corrective Hair Restoration

Hair loss is usually never a welcomed condition. To some of us, it is very disturbing and it undermines our self confidence by falling short of our self-image. It is understandable that no one wants to appear older than they are before they have to. What can be worse? Well, a bad hair transplant is without a doubt much worse. A properly executed hair transplant should be undetectable and completely natural looking. A poor hair transplant calls more attention to the already confidence compromised individual. The looks and reactions of the viewing public serve to further exacerbate the patient’s level of confidence, self-image, and happiness. It gives us great pleasure to help these individuals with less then optimal hair restoration outcomes. The problems range from the “pluggy”-look, doll’s head linearity, abrupt density issues, improper angling and mis-directed grafts. As if this is not enough, these individuals, with so much need of suitable donor, are almost universally left with little available donor. Often times, the donor area is replete with scars rendering the patient with the most need with the least available donor tissue and with greatly diminished tissue elasticity.

Below are two examples of Dr. Arocha’s corrective hair restoration work.

For the entire set of before and after photos from these two cases, please visit the Corrective Hair Restoration gallery on our website.

Donor Scars

Below are some examples of donor scars at Arocha Hair Restoration from strip procedures. Dr. Arocha employs two layer closures on all cases to minimize tension. When appropriate he employs trichophytic closure technique to allow hair to grow through the scar, making an already hard to see scar, even less visible. Employing these refined techniques ensures the best possible scars for our patients.

Immediately after surgery, two layer closure.

Rapid healing of wound, sutures still in place, with one week hair growth enough to make wound not visible.

Completely invisible scar a few months after the procedure.

Well healed scar which is nearly invisible, note the slightly increased scar at the site of greatest tension the junction between the horizontal (coronal) and the vertical (sagital).

One year after surgery, fine well heal scar is nearly invisible.

For more examples, visit the FUT Donor Scars Gallery on our website.

Premature Hair Loss Treatment Q&A

Recently, we’ve had a number of interested clients in their early 20s wondering if there is such thing as a minimum age to hair loss and/or hair restoration. The truth is hair loss can happen at any age in a person’s life. Here’s a relevant Q&A session that Dr. Arocha participated in for IAHRS Hair Transplant and Hair Loss Info Center. A young man describes how he has experienced hair loss since the age of 14-15 years old and wants to know if he is following the correct treatment plan.

Q: Since I was around 14-15  years old I have experienced hair loss, I’m now 17 and still losing hair. I have attempted minor treatments through a clinic, which determined I had male pattern baldness. When I was younger (15-16), the clinic suggested a hair loss treatment, I believe it contained minoxidil, and involved rubbing it on the scalp. After a year and little change except for irritation on the scalp, I quit.  The clinic suggested a Propecia pill when I was 18, and then a hair transplant at 21. After the scalp treatment I feel I have been tricked and should not trust them. Please help answer the questions, is this the right course of treatment or is there a better alternative, and is it possible to lose hair at such a young age from male pattern baldness? – George

A: Thank you for your question. Male pattern hair loss is a condition in which a pattern of hair is inherited, in which the hair is sensitive to DHT. Once puberty starts, testosterone production increases and it is metabolized into this DHT. The DHT will start the miniaturization process, that is, hair in this inherited pattern will start to become progressively thinner caliber and with decreasing pigment. It is a bit confusing, you stated that the hair loss started at age 14-15, which it can, then you said that you are presently 17 and still losing hair. Later, you stated that a clinic treated you for male pattern hair loss with minoxidil at age 15-16 for 1 year. Then at age 18, they put you on propecia, then a transplant at age 21. The treatment course is acceptable, except that I would have combined the minoxidil 5% twice per day and the propecia 1 mg per day, if indeed your condition is male pattern hair loss. There are other conditions that can cause hair loss that may be confused with male pattern hair loss. The hallmark of male pattern is miniaturization and the pattern distribution. If there is any uncertainly, a scalp biopsy should be contemplated. Hope this helps, George.

For more information, please visit the original IAHRS article here.

If you have a question for Dr. Arocha you would like answered on our blog, please email us.

Donor Harvest Q&A

Here’s our latest Q&A with Dr. Arocha regarding donor harvest. If you have a question for Doctor Arocha you would like answered on our blog, please email us with your question.

Q. Hi, Doc. I’ve been researching hair-transplantation, and I have a question concerning F.U.T. (strip-harvesting): I understand, in this method, a strip is excised from the back of the scalp, the wound then closed. I wonder, then, is not the overall surface of the scalp reduced in this procedure? After two or three procedures, especially, (or even after one large session) — when, totally, a reasonably wide portion of the scalp has been removed, will not a patient’s hairline, in accordance, also be shifted?

That is, the front hairline would move back by the amount of scalp excised, or, more likely, the “rear hairline” (which ends at the back of the neck) must certainly be “moved upward.” At least, this is how I imagine it would be. Is my logic flawed? I’ve been trying to understand this in researching the procedure, but the point still evades me.

I understand a physician will take into consideration laxity of the scalp, so what I’m talking about might not be immediately noticed — I also hear doctors will try to cut out strips that are longer rather than wider, to reduce tension — but, ultimately (again, especially when a large number of grafts must be harvested), will not the hairlines (front and certainly rear) be affected?

If not, why not?

A. Initially, there is a temporary shortening of the donor zone. Note the change in the width of the posterior fringe, the after photo is taken immediately post-harvest after a 2 cm wide strip was removed.

The effect is short-lived as the tissue stretching back to it’s original dimensions, this is the aptly named stretch back.

Q. If so, is this effect permanent? The piece of scalp taken out can’t “regenerate,” can it (and, if it could, would it regenerate hair follicles, too)?

A. No,the removed follicles will grow in the transplanted location, but they will not regenerate.

Q. Can hair that’s already been transplanted to a new location be removed and successfully retransplanted in another area (e.g., back to front, then, later, if need be, north of that region)?

A. Yes, absolutely. I have transplanted chest hair to scalp, where it grew happily for months. Then later these transplanted chest hairs were removed and could have been transplanted anywhere on this patient.

Wound Management

Having your hair transplant is just as important as post-surgical care. The secret to getting very fine scars that are minimally visible to invisible lies in the minimizing of tension vectors at the wound margins. Consequently, all my FUSS patients get two-layer closures. The deep layer, is the workhorse, it brings the wounds margins close or nearly touching by interrupted sutures. Then the superficial layer is closed with a running baseball suture. I use all kinds of sutures; always of course an absorbable suture for the deep layer, as this will stay in place. The choice of suture in closing the superficial layer is immaterial, as this suture will be removed anyway.

A few days after your transplant you may feel well and ready for anything but it is important to remember that wound management can seriously affect your results. A question many of our patients ask is when they can get back to their work out routines. Here’s the question from the patient and the answer directly from Dr. Arocha.

Q: When can I go back to the gym?

A: Wait one week to restart your aerobic routine. Two weeks and you can go back into the gym and do light lifting as long as you do not pull on the neck area.

Skin is plastic and has tremendous elasticity. That is why we call it plastic surgery, because of the skin’s ability to stretch. The scar or wound area is even more elastic because it is a weaker structure until that wound or scar matures. The maturation of a scar takes between six and twelve months. That is why it’s critical to limit weight lifting that pulls on the margins and by that I mean squats and anything that pulls on your shoulders and neck, which can stretch an immature scar.

For more information, please see: http://www.arochahairrestoration.com/en/art/104/

AHR Dallas website launch

We are excited to announce the recent launch of our new Arocha Hair Restoration Dallas website. The new website features patient before and after photo galleries, links to all of our social media outlets, in-set video player on the homepage, and much more. Take a look at the newest addition to the AHR online presence.

http://www.dallashairloss.com

The Temporal Peaks

Slideshare presentation by Dr. Arocha on Temporal Peaks. Presentation covers what they are, what their function is, and what can be expected during the surgical procedure. This presentation also includes before and after visuals of patients who have undergone hair restoration on their temporal peaks. A tremendous transformation can be seen in patients just by the restoration of their temporal peak areas.

Please refer to our Glossary Terms, Part III (final) blog entry for a temporal area vocabulary review.