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.
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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.
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.
Eyebrow hair loss can be a very traumatic experience for any individual no matter their age or gender. Statistics estimate that over three million Americans experience eyebrow loss in just one year. Eyebrows play such a crucial role on our faces. They frame the eyes and help to express the emotions we are feeling. Fortunately, there is an alternative to penciling in or tattooing eyebrows to restore a more natural result. In the Slideshare Presentation below, Dr. Arocha covers the eyebrow reconstruction procedure. Presentation includes surgical and before/after photos.
Recently, we received an email from a potential patient regarding shock loss, a phenomenon where the native hair falls out after a hair transplant (temporarily in most cases). Here’s the question from the patient and the answer directly from Dr. Arocha.
Q: I have thinning and receding of my hairline and the top of my head. I’ve tried Propecia and Rogaine, neither of which have worked for the past few years. I’m afraid that my hair will shock if I get a transplant and I don’t want anyone to know I’ve had anything done. What are the chances?
A: I am very glad first of all, that you’ve had the foresight to be on Propecia. It is the most efficacious medication there is to slow or stop the progression of AGA (androgenetic alopecia).
Poor surgical hair loss is seen rarely in our practice. That is when the hair surrounding the transplant falls out after the procedure. This can be immediate, from cutting existing hair with the site marking tool, but is not true shock loss. It is temporary because the cut hair continues to grow. True shock loss is when the hair adjacent to the transplant falls out, going into a rest phase, returning in 3-4 months.
With the tiny blades we use and the very refined surgical procedures used on our patients, the chances that shock loss will occur is very slim. If it does occur, it will regrow within a few months. If you follow pre and post op instructions, it will also increase your chances of preventing shock loss or other complications.
For more on shock loss, visit our friends at the Hair Loss Q & A Blog: shock loss article.
Another article on shock loss from Dr. Arocha.
Final installment of some common hair transplant/hair restoration terms (taken from the International Society of Hair Restoration Surgery). Unless written in italics, all content was taken from the ISHRS website.
Recipient Area: Area where hair loss has occurred and hair follicles will be implanted during a hair transplant procedure.
Slit Graft: Hair obtained from a donor site directly or sectioned from a larger round graft is inserted into a slit made in the scalp by the tip of a scalpel blade.
Temples/Temporal Area: The two upper outer corners where the forehead meets the hairline. This is usually the first area where male pattern baldness is observed, causing the hairline to recede.
Temporal Point: The two triangular shaped areas of hair located in the lower outer corners of the forehead, where the temporal hairline meets the sideburns.
Vertex Area: The area in the top/back portion of the head which contains a swirl or spiral pattern of hair growth. Also called the ‘crown,’ it may be the first area where male pattern baldness is noticed.
Glossary of Hair Restoration Terms (taken from the International Society of Hair Restoration Surgery). Unless written in italics, all content was taken from the ISHRS website. To see a list of previous terms, visit this blog post.
Grafting: A variety of procedures where hair-bearing skin is removed from the lower scalp at the back of the head-the “donor area”-and transferred to thinning or balding areas.
Hair Economics: A theory that states only a limited or decreasing supply of hair exists, but the demand for hair increases as balding patterns develop.
Hair Flaps: Techniques to rotate large portions of hair from the sides and back of the scalp to the front and central areas of the head. Most effective when used with a tissue expander. See also “Scalp Rotation Flaps.”
Hair Follicle: A strand of hair and its root which is extracted from the donor area and transplanted to the recipient area during hair restoration surgery.
Hair Grafts: Hair follicles that have been harvested from the donor area and are ready for transplantation into the recipient area of the scalp. The numbers of hair follicles per graft vary widely depending upon the transplantation technique used. A graft may contain a single hair follicle, a single follicular unit, multiple follicular units, or even 20 or more follicles (as in a large round graft).
Hair “plugs”: A slang term typically used to describe the large round grafts that were used more commonly years ago.
Hair Transplant: A surgical technique that transfers hair follicles from the donor area to the recipient area.
Hairline Refinement: or “Hairline Correction” refers to the use of a variety of newer, more delicate grafting techniques to alter, camouflage or soften the “pluggy” looking results of older hair transplant techniques.
Male Pattern Baldness: An inherited condition in men which is triggered by the hormone Dihydrotestosterone which causes gradual miniaturization (and eventual loss) of hair follicles. Starting anytime after puberty with a recession of the hairline and thinning of the crown areas, it can eventually lead to complete baldness at the top of the scalp. The areas around the sides and back of the scalp are not typically affected by male pattern baldness.
Micrograft: A graft containing 1 or 2 hairs, obtained from the donor area with a micropunch or sliced off from a round graft (see below). A micrograft is typically placed into holes made in the scalp with a microneedle or punch.
Minigraft: A graft containing 3 or 4 hairs (small minigraft) or 5 or 6 hairs (large minigraft). There are many variations of minigrafts derived from round grafts.
Multi-unit grafts (MUG): Grafts that contain two or more follicular units in a single graft. This term replaces the older “minigraft”. In practice today, MUGs contain 2-6 follicular units per graft.
Multi-unit grafting: Hair transplantation using multi-unit grafts. In practice, these grafts may be placed into small round holes, slots, or slits. This would always be in combination with the use of FUT in the same procedure.