Doing the Math

[John P. Cole, MD]

Surgical evaluation involves collecting as much data as possible in addition to family history and patient expectations.

For example, we evaluated and treated this patient today. His cross sectional trichometry in his donor area was 89. Average is 69. He has loss confined to the frontal area. His hair diameter is 69. He is a NW 3A. He has 70 FU/ sqcm and 170 hairs per sqcm. He has 16415 total follicular units in his donor area.

We used a 0.85 mm punch to harvest his donor area. His transection rate was under 1%. He averaged 2.48 hairs per graft laterally and 2.8 hairs per hairs per graft centrally.

Based on his donor area characteristics, his expectations, and his surface area of loss, he is an optimal candidate fro hair restoration surgery. We evaluate all of these characteristics prior to every procedure. This is how one thoroughly evaluates a patient for hair restoration surgery. Of course, it helps to have a family history, but at age 47, we do not expect more significant hair loss in this patient.

[John P. Cole, MD]

Here's another example. A 24 year old patient heading to a NW 3V based on exam wanted to treat the front of his scalp. His donor area CST is 114. This is very high and quite good.

His family history includes a NW 5 in his father and his mother has a brother that is a NW 3V.

His CST in the front of the scalp is 49, in the mid-scalp it is 62, and in the crown it is a 26. His hair density is 200 per sqcm, which is quite high and he has a hair density of 176 per sqcm. He has a mean hair shaft diameter of 78 micrometers.

On exam he has thinning on the frontal hairline beginning at 5 cm above the glabella. He has more noticeable loss on the right side with much less loss on the left side. He would like to rebuild his hairline at it's present location. Most 24 year olds with hair loss do want to restore their youthful hair line. Even though his CST is only 26 in the crown area, one has to look carefully to see the thinning. Coverage is maintained primarily because he had such wonderful hair characteristics to begin with. He has lost 77% of the hair mass when compared with his donor area. However, consider that the average donor area has a CST of 69. Thinning becomes evident when about 50% of the hair mass is lost in the crown area of the average scalp. while he has lost 77% compared to his personal donor area, he has lost only 62% when compared to the average scalp. Thus, he appears to have early thinning as opposed to someone with less hair mass to begin with (lower density or finer hair).

His CST measurements do tell us that he has loss all over the top of his head. Thus, he is heading toward the more advanced hair loss seen in his mother's brother rather than in his father.

He has wonderful donor area characteristics. Still, we expect him to eventually become a NW 5 even though he really looks more like a NW 2V now and an early one at that. His wonderful donor characteristics make him a very suitable candidate for hair restoration, but he has other options. One would be Propecia combined with maximal medical management and the other would be PRP. He could certainly attempt a non-surgical solution first. On the other hand, the only sure way to restore his loss in the front now is hair restoration surgery.

What he should not do is build his hairline where it currently is located. One cannot build a 5 cm hairline in a 24 year old who is headed to a NW 5 even with his wonderful donor area characteristics. Any surgical approach in this 24 year old should be conservative because we expect him to have significant hair loss in the future.

This is a difficult decision for a 24 year old that still has some hair at 5 cm. Still, it is the right decision even though his hair loss appears to be quite minimal at this point in his life. This underscores the need for a through exam, diagnostic data, and a family history. If one simply approached this case based on where he appears to be thinning without doing an assessment of what to expect over time, there is a much greater likelihood that this patient would be in a difficult situation in 10 or 20 years. One should always approach a case with as much diagnostic data as possible. Short hair styles prohibit CST measurement, but they are invaluable in predicting future hair loss. Unfortunately, the test has not been out long enough for most patients to have benefited from the diagnostic information.

[35YrsAfter]

Hair restoration on the surface appears to be more of a free-form art. We see a lot of results from doctors worldwide reflecting a free-form approach to hair restoration. Hair restoration is an objective, measurable, calculable, computable, quantifiable art. Guesstimated hair transplants commonly don't look natural. If they do look natural, chances are that both the patient's donor resources as well as his/her finances were not maximally respected and utilized.

35YrsAfter also posts as CITNews and works at Dr. Cole's office
forhair.com
Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
email 35YrsAfter at chuck@forhair.com
Please feel free to call or email me with any questions. Ask for Chuck

[Artista]

Hello Dr Cole.. great thread!
Congrats , I heard that the Conference went well for all involved. Take care!!

[John P. Cole, MD]

Yes, it was a good meeting for all. There were some great presentations. We did two workshops on FUE trying to show physicians how to remove grafts at burst rates over 2000 per hour. We presented our Acell regeneration studies to date. Carlos Wesley's presentation was quite interesting. He has been quite fortunate in getting financial backing to develop an interesting approach to hair removal. I think there are plenty of questions related to his approach, but it's cool technology.

[Artista]

I agree Doctor,
I have been so impressed with Acell since its inception so many years ago now. Founder, Dr. Alan Spievack (RIP) first applications of his 'pixie dust' were quite amazing.
Im surprised that so many people do not know of Acell's origins prior to its introduction to hair treatments Dr Cole.
I know you have known all about its history , and of course of Dr Spievack (and his brother) .
I feel that you are leading the charge in Acell's exciting developments regarding hair treatment. Im glad that you and Dr Wesley were able to finally meet and exchange thoughts.
Yes, there are of course still plenty of questions to his approach as with any new treatment/method. In time all questions will be answered.
I certainly would like to speak with you at some point Dr Cole!
Im so glad that you are active on this particular forum.