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Planning for a hair transplant: What to expect during the first session

In our experience, patient expectations more often influenced by patient age, stage of hair loss, and speed. Younger patients (20) with the memory of your scalp density and adolescents remains clear in their minds, are also more susceptible to rapid loss, hair, and the magnitude of the patients who need it most of the time education and the planning process. Other factors include the person's social situation (eg how it is perceived by significant others) and how took care of their hair loss (such as the use of a wick or continued use of a hat). It is for physicians to educate the patient and properly define their expectations, or that the patient can not be satisfied.

The patient should not come to believe that hair restoration surgery recover the loss. In an ideal situation, hair restoration surgery should maintain the appearance of the adult patient and give the same "look" like you would if you had simply "matured." The surgery should not try to restore the appearance of the adolescent patient. At a minimum, can prevent the patient is perceived as being bald. In a patient who is mourning hair loss in width, this alone can be a major achievement.

The young, rapidly balding patient poses perhaps the greatest challenge. Even a procedure large may be unable to compensate for the loss that may occur during implant need to fully develop. In this patient, including all aspects of the dynamic nature of hair loss is essential. The progressive nature of alopecia, the placement of realistic hairline, preservation of the crown, and the possible acceleration of the loss of the surgery itself should be clearly explained. If the patient does not include each and every one of these ideas, it is preferable postpone the surgery. The weather is always part of the doctor, because the progression of hair loss patients each of these issues more tangible for the patient, This simplifies the process of learning.

At the other end of the spectrum the patient who has been bald for many years is much easier to meet your expectations because they are usually reasonable, and small amounts of hair is a marked change in appearance. However, this same patient has worn a hair piece for many years identified to this aspect is much harder to please. As the patient was young, his reference point is a full head of hair. If the only purpose of this patient is going to destroy the hair is essential to determine the required amount of coverage they need to accomplish this. If it was not fixed in advance, a transplant can be perfect in everything, will a total failure if the patient still feels compelled to use his hair piece.

Several problems presented by patients with a more limited hair loss. The person making the recent growth of a hair root in adolescents (Norwood Class I) a mature hairline recession in the temples (class II) should not be transplanted. Note that the normal development and a hairline dishes are not natural as you get older. In this patient, nor should it try to "fill" the temples. You can also not be suitable for transplantation of a young patient at the beginning of class III. However, in one more class III patient with permanent loss of hair, over medium density, and no family history of baldness, but also desirable to alleviate the angles produced by bitemporal recession, but not eliminate it.

One last question about what to expect when the patient expects to see the results of your procedure. The normal cycle of follicular growth is variable. In most patients, the majority of transplanted hair begins to grow at about 3-4 months after surgery, hair additions included in the coming months. In a small percentage of patients, the rapid growth of most of the hair can be seen from 4-8 months or more, with new hair appear occasionally, until 18 months after transplantation. Since new transplanted hair will grow in diameter and length in this subgroup of patients can not sue the cosmetic improvement maximum of two years.

It has been speculated a lot about this so-called "dwarf" and it seems that a number of factors may be contributory. Although still is speculative, some of them are: 1) the asynchronous nature of normal human cycle of follicular development, 2) restoration of the growth cycle as possible after of post surgical effluvium (shedding) a new cycle, 3) the time of hair regrowth after surgery after falling, 4) and growth retardation result of a trauma registry, such as temperature change, drying and grinding, 5) the amputation of the dermal papilla during graft dissection with a latency for the regeneration of the bulb, and 6) local factors cause growth retardation, such as skin changes often asymmetric elastotic caused by the sun reaches protected the patchy baldness.

Carefully controlled studies, some of which are already underway, it is necessary to resolve the relative importance of each one of these factors. What that is the case, it seems that a large individual variability is an integral part of the transplant process. This must be clearly explained in advance to keep our patients to become "impatient" after hair transplant surgery.

The crucial meeting
Independently the number of procedures are in place, we must always take into account the critical first transplant procedure. The patient sees the first meeting, a statement of its future meetings. The first session builds confidence, it is essential that expectations are met. The first session is the most important as is the hair root and face frames. Hair transplantation in places like the initial position to camouflage operations later.

In our experience, for most patients to establish the frontal hairline is the most important function of the first procedure. First, the frontal hairline should be placed in its normal position matures. Hairline in this area should frame the face and restore balanced proportions of the patient's face in a way that is appropriate for a mature individual. In our opinion, current practice to create a hairline well above the position of the mature hairline, to reduce subsequent actions should be avoided. If the intention is to keep the hair in anticipation of a very limited choice of donors, most likely to maximize the impact cosmetic surgery through the creation of bitemporal recession or not to expand the transplant later in the crown. However, the position of the front Hair of medium height must not be compromised, as it defines the "look" of the individual. Creating a hairline too high (in the hope to preserve donor hair) only exacerbate the patient's baldness by extending the front and the distortion of normal facial proportions.

first meeting important objective must be to ensure coverage of the scalp is bald except for a crown. Because Norwood Class A patients, by definition, no hair loss extends into the crown, if possible, the bald area is covered in the first session. The amount of hair needed to cover the front and top of patient's scalp, of course, vary depending on the extent of baldness, but must always be an attempt to cover these areas in the first session, even if the coverage is light. In the general areas of the scalp, which already have sufficient coverage should not be transplanted. Despite the transplanted area banks must blend into the skin with hair, too aggressive invasion may accelerate hair loss and cosmetic offers no additional advantage. The objective should not be to restore density of adolescents do not need an aesthetic point of view, nor (as we) mathematically reasonable. Patients who want the density of adolescents should be treated equally with those who want a hairline in adolescents. Should be better educated and taken outside the surgery.

In general, coverage of the crown be an objective of the first meeting, but would face higher over cosmetics and have been transplanted successfully. From the front, upper leather hair is a single cosmetic unit, the graft can be left after this area has been treated. The patient can assess the adequacy of coverage of the first procedure, and if you want more volume or higher density, a second session can be used to complement transplanted into the first area. If coverage of the crown is covered in the first session, the patient's options will be much more limited and the capacity to produce a balanced aesthetic transplantation could be eliminated. An exception Norwood patients would be class III and IV Vertex, which are usually older than 30 are less likely to become very bald, and has a good donor density and laxity the scalp. In these situations, transplanting the crown at the first session can provide modest coverage in the region and serve to camouflage a limited number more bald spot. What practice should be avoided in these patients is several times the risk of transplantation of hair on the crown to achieve a high degree of density, since the density can often be argued that baldness progresses.

In addition to aesthetic considerations that make the important meeting first, there are many advantages working as a surgeon on a virgin scalp. In summary, the implants can be placed easier, safer and closer to the normal scalp because the blood supply and elasticity of the intact tissue. In the donor, the maximum density and mobility of the scalp and no scars provide a lock of hair birth. To take advantages of these factors, we must look at the first session, as many patients as possible goals. In our view, this can be done safely in a procedure is best done in a procedure, and should not extend more than two or more.

When a single session of Transplantation in mind?

Much can be reached in the first session. However, it is realistic to expect that the targets can be achieved through a single procedure in which patients undergoing these goals are possible.

As indicated above, we believe that the main objectives of the first meeting should be: 1) provide a framework for the face, 2) to cover the front, and, where appropriate, the top and the top of the scalp, 3) a completely natural.

In general, the doctor may suggest patients who could be content with a single session, there should be relatively stable hair loss. This is particularly important in the Norwood Class III, III, IV, V and patients whose own hair contributes to the aesthetic appearance of the front of the scalp. In patients with frontal baldness, the first successful procedure can frame the face and cover the anterior portion of scalp with hair loss so that even a second procedure is not needed immediately. For Norwood Class VI VII or patients whose front and top of the scalp are transplanted successfully in the first procedure, the satisfaction can be achieved in one session, because the expansion of the crown of white hair is relatively insignificant. However, if the crown cover is intended, therefore, that the head grows bald, transplanted grafts became in the center of an isolated island of hair and surgery followed.

A patient with lighter hair color are also more likely to achieve their objectives in one session and that these colors reflect light and give the appearance of more hair. In addition, low contrast of the underlying skin gives the illusion of more hair and skin that is filling "the space between the hair shaft. By contrast, the dark hair on light skin accentuates the spaces between the strands of hair. Sal and pepper hair works reflect both the light and create a visual detail to eliminate low-density areas. Certainly, any patient who does not possess the qualities of color genetics right hair color easily change to complete the procedure.

wavy hair usually offer better coverage than straight hair and is beneficial for transplantation. For as the hair color, can be managed after surgery to improve the aesthetic impact of the transplant. curly hair, the other party can sometimes work a disadvantage to the patient if complete coverage of the bald area is not expected. frizzy hair can increase the fullness of the area transplanted to such a degree that contrasts with a space that is bald may increase. In addition, very curly hair transplanted to the front and leather upper Hairy can not be easily brushed to cover baldness.

The density of follicles in the donor area will also affect the procedure. In patients with high density, without hair follicular units, and therefore each implant contains more hair. In patients with a density very high, a significant proportion of implants containing 3 and 4 of the hair can be harvested each donor, giving a complete marvel, including a single procedure.

Patients with hair of average diameter than the average will be the best chance of success of the case. The cylinder of the skin surrounding the follicular unit from a patient with thick hair is more or less similar to one unit of fine However, the volume of hair is very different. The diameter or "weight" of patient's hair is a huge variable. Given that the density can vary by a factor of three times the weight of the hair can vary from patient to repeatedly. Although it is much easier to quantify the density (number hairs/mm2) more weight of a hair, is probably the most important outcome of the procedure. Patients who suffer from premature baldness have thin hair and dark high density are very difficult to meet in one session, the transplanted hair is often seen in the context of the population of thick terminal hair surrounding the bald area patients. By contrast, in a patient with similar hair thicker, satisfaction is easier to achieve in one session.

Contrary to what one would expect the patient to a large extent White-headed, even with the low density of donors, it can often be very satisfied after one procedure. These patients often have reasonable expectations and be bald many years are delighted to have hair on your face, covered with light in something higher, and "comb." Make sure expectations are met in session, the reality of supply and demand must be considered. It is clear that individuals in Norwood Class VI or VII model, only the light of the modest coverage can achieve in a single session, as the hair incident area exceeds the total supply of donors with a factor of at least 6:1, even under ideal circumstances.

Finally, personal hygiene habits also influence the success of single procedures. Patients who plan to comb the hair on the side instead of the back straight will the appearance of more fullness. Unfortunately, this hair style is not covered by the Crown. Many patients achieve "the best of both worlds", with hair slicked back diagonal.

References:

1. Bernstein RM, Rassman WR, Szaniawski W, Halperin AJ. Follicular. Rest Aesthetica Int J Surg 1995, 3:119-132.

2. Norwood OT. Male pattern baldness: classification and incidence. So. J Med 1975, 68:1359-1365.

3. Rassman WR, S. micrografts Carson in large quantities, the ideal hair restoration procedure. Dermatol Surg 1995, 21:306-311.

4. Headington JT: Transverse microscopic anatomy scalp. Arch Dermatol 1984, 120:449-456.

5. Kim JC, Choi, YC. The transplanted hair regrowth after removal of the bulb. Dermatol Surg 1995, 21:312-313.

6. Limmer BL. Link the theory of hair growth and experimental evidence of the practice of hair transplantation. Am J Cosmetic Surg 1994; 11:305-310.

7. D. Seager binocular stereoscopic dissecting microscopes: should we use? Hair Transplant Forum Int 1996; Vol 6 No 5:2-5.

8. Limmer BL. Elliptical donor stereoscopically assisted micrografting as an approach to refine hair transplantation. Dermatol Surg 1994, 20:789-793.

9. Kuster W, R. Happle The inheritance of common baldness: two B or not two B,? J Am Acad Dermatol 1984, 11:921-926.

10. Rassman WR, Pomerantz, MA. The art and science of minigrafting. Rest Aesthetica Int J Surg 1993, 1:27-36.

11. Demis DJ. "Dermatology Clinic." Philadelphia, PA: JB Lippincott Co., 1994 (1) 2-35 p3.

12. Bernstein RM. These reductions scalp missing? Hair Transplant Forum Int 1966, Vol 6 (3) :12-13.

13. Bernstein RM, Rassman WR. What is the delay growth? Hair Graft Int Forum 1997, 7 No. 2.

14. Cooley J, J. Vogel Loss of the dermal papilla during dissection and transplantation of bone: another cause of X-Factor? Hair Transplant Forum Int 1997, 7:20-21.

About the Author

Dr. Bernstein is Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York. He is recognized worldwide for pioneering Follicular Unit Hair Transplantation. Dr. Bernstein’s hair restoration center in Manhattan is devoted to the treatment of hair loss using his state-of-the-art hair transplant techniques. To read more publications on hair loss, visit http://www.bernsteinmedical.com/.

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