View Full Version : What Young Patients Should Be Aware of Regarding Hair Restoration Surgery

02-01-2013, 09:47 AM
A Publication (http://onlinelibrary.wiley.com/doi/10.1111/dsu.12108/abstract) co-authored by Carlos K. Wesley, M.D. (http://www.drcarloswesley.com) in the peer-reviewed Dermatologic Surgery (http://onlinelibrary.wiley.com/doi/10.1111/dsu.12108/abstract) Journal.

All of the improvements in our field over the past two decades have allowed for a younger patient population to benefit from surgical hair restoration. The great determiner in treating young patients, however, is not what we can do, but what we should do with the limited number of follicular units (FUs) containing "permanent" hair that every patient has. This publication (http://onlinelibrary.wiley.com/doi/10.1111/dsu.12108/abstract) serves as a cautionary tail in order to help clarify the limits of the finite supply of "permanent" donor area hair used in treating young patients. Together with hair transplant pioneer Dr. Walter Unger and his daughter, Dr. Robin Unger, Dr. Carlos K. Wesley conducted a survey of the world's most experienced HT surgeons with nearly 1000 years of combined experience in which they were asked the following:

"Keeping in mind that over the years the hairs closest to the upper, lower, and anterior borders of the fringe will be lost, how many FUs containing very likely permanent hairs can be harvested from a 30-year-old patient who you believe is destined to develop Type V or VI male pattern baldness (MPB) and has either higher than average, average, or below average donor hair density?"

The survey determined that patients with an average hair density and destined to develop Type V MPB were estimated to yield and average of 6,404 FUs, 4,963 FUs with below-average density, and 7,904 FUs with above-average density. When Type VI MPB is anticipated, estimated mean harvest yields are 5,393 FUs with an average density, 4,204 FUs with below-average density, and 6,661 FUs with above-average density.

While not serving as absolute dogma, these findings (http://onlinelibrary.wiley.com/doi/10.1111/dsu.12108/abstract) can serve as useful guideline numbers for patients and physicians alike to help choose appropriate surgical goals.

Follicle Death Row
02-01-2013, 12:25 PM
Interesting. My thoughts on hair restoration pretty much come down to whether or not you have 9000 FU available. If not I don't think a patient should undergo hair restoration unless they're older without advanced hairloss or have exceptionally coarse or curly hair.

02-01-2013, 02:31 PM
Currently there is a wide spread of opinions among doctors as to what constitutes a follicular unit. There still doesn't appear to be any solid, widely accepted definition. For instance, techs working at many hair restoration practices create what they call follicular units by dissecting grafts into units containing fewer hairs.

Related to improving donor supply, it's also important to consider emerging technologies. Among those are ACell, beard hair and even body hair. Of course when it comes to donor hair, scalp hair is always the best when there's an adequate supply. Beard hair and even body hair have proven to be a life saver for many patients. Some times body hair has little to no growth in some patients, so it's of course wise to do a small test session before diving into large body hair sessions. Beard hair is more reliable than body hair but for some patients the coarse appearance and curl can be unacceptable.

-35YrsAfter works at Dr. Cole's office.

02-01-2013, 03:45 PM
A follicular unit (FU) is a "natural occuring unit of hair" that is not manipulated.

FUs that are dissected into smaller hair bearing grafts are simply just that, "grafts". Some clinics (big chains are notorious for this), purposefully manipulate larger FUs into smaller hair bearing grafts so that they can ultimately charge more money for the entire procedure since the industry for the most part charges by the graft.

FUs can be extracted (FUE) or microscopically dissected (FUHT) within their native grouping without disruption and used entirely as a graft for placement.

FUs typically are established in natural groupings of singles, doubles, triples, and so forth. Not that many individuals have plenteous groupings above three hairs.

Just to clarify, BH should be a last resort and I for one would never say that it has been a life saver for "many". The truth is that BH is still in its infancy and very unreliable to date, period. Very few have benefitted from it to date. :rolleyes:

02-03-2013, 08:42 AM
"A follicular unit (FU) is a "natural occurring unit of hair" that is not manipulated."

That is the histological or biological definition of a follicular unit, which SHOULD be the standard within the hair restoration industry. In reality, hairs sometimes grow exactly on the border of what is considered a separate follicular unit according to the histological standard. Although not perfect, the histological definition of a follicular unit is the most accurate and SHOULD be the standard within the hair restoration industry. It currently is not. Patients commonly get charged for two or more follicular units when techs at a clinic dissect a naturally occurring FU.

"Just to clarify, BH should be a last resort and I for one would never say that it has been a life saver for "many". The truth is that BH is still in its infancy and very unreliable to date, period. Very few have benefited from it to date."

Within the context of doing a test area first and waiting to see if BH delivers a cosmetically satisfactory result, I believe that body hair can be a lifesaver and has been for many.
Yes, body hair is considered a last resort and rightly so. As a repair patient, I believe most other repair patients will tell you that they would rather be bald, even a Norwood 6 than live the rest of their life appearing in public like a failed hair transplant experiment with scars showing through their hair and an unnatural looking hairline and/or hair direction. I personally didn't get a great result with body hair, but it did work in my scars and on my hairline. To me, that's a lifesaver within the context of my expectations. I simply didn't have enough scalp hair to repair the mess a well-known clinic left me with years ago. Body hair has been a huge disappointment to many as well. IMO, patients in need of repair work should ask their doctor to do a test area if they have no other donor option.

-35YrsAfter works at Dr. Cole's office

02-04-2013, 03:47 PM
Some of those hair groupings are at times referred to as MUGS (multiple unit groupings) or even other terms which indentify multiple FUs that are closely situated to each other. MUGS are also natural occuring and some can be extracted but often require much larger punch sizes even above 1mm in order to extract them intact. IMHO, they are more readily contained and preserved with microscopic dissection because the forces of torsion, traction, and compression can adversely affect the grafts and follicles (transection) and even do collateral damage to the neighboring FUs within the extraction/donor region. Everyone is different and why some patients are not candidates for FUE.

I appreciate your comments on every patient first undergoing a test procedure with BH and clarifying your opnion.

Thanks for sharing your insight 35 years after. I have read some of your other posts and want to thank you for sharing your journey with us. Also happy for you in that you were able to improve your own situation and quality of life with BH. You obviously did alot of homework and online research. There was no internet back in the day and probably why I chose to wear hair systems before the FUHT became a reality.

My hope is that BH, HM, and other clinically attainable options manifest in the years to come to the point where the benefits greatly outweigh the risks.

Carlos Wesley, MD
02-04-2013, 04:38 PM
Thanks for your comments. I particularly like your critique of "artificially-created" FUs rather than those that are naturally occurring. As if it's not unethical enough to take a 3-haired FU and divide it into 3 single-haired FUs in order to charge more, there is not necessarily a transferable hair survival rate between those two scenarios.

The naturally-occurring FU contains the healthy, intact follicle anatomy that is most likely to generate the growth of 3 hairs. The "artificially-created" FU, isn't as likely to generate the growth of 3 hairs due to:
The stem cell-containing portion of the follicle is more likely to be severed when "splitting" natural groupings;
The removal of protective dermal and subcutaneous tissue that protects the stem-cell containing portion of an intact follicle from forces such as dehydration, inappropriate storage temperature, and traumatic handling makes the "artificially-created" grafts less likely to survive after transplantation.

Finally, the pleasant surprise of more than 3 hairs growing after a naturally-occuring 3-haired graft has been transplanted may stem from the inclusion of a dormant follicle embedded within that healthy dermal/subcutaneous tissue that surrounds the naturally-occurring grafts. That's not something you'll likely find when the "artificially-created" grafts have been stripped down.

02-05-2013, 08:40 AM
I would hardly consider BH in its infancy as it has been out for at least 10 years. With that being said it should be used as a last resort.

I would consider Acell, Robotic Fue, Plucking and SMP in its infancy and when you venture down the road where something new is being used remember you are the test pilot.

02-05-2013, 04:01 PM
Just because something surfaced 10 years ago does not mean that it has any substantiated proof or validation. At best BH is inconsistent and the lack of results to date support that opinion.

Trials on cloning go back to the last century in Japan but still has nothing viable to offer to date. :rolleyes:

02-05-2013, 08:05 PM
Yes I agree and that is why I waited so long before attempting a repair using body and beard hair and also why it makes techniques with even less history, substantiated proof or validation even riskier.