Sharad Mishra, MS, MCh

Your doctor might have used a permanent stitch to prevent the forehead skin riding back up on the scalp. It is a routine practice, especially in revision procedures. It also helps to reduce tension on suture line, thereby improving scar quality.

If you can feel this internal suture, your body will most likely expel it on its own. However, if you experience swelling, pain or discharge from suture site; do consult your doctor.

FUT or strip technique can give high number of grafts. For example, a strip size of 25cm X 1.4 cm would have a total of 3500 donor grafts assuming a density of 100 FU / square cm. Of course if the density goes down to 40/cm2, the yield comes down to 1400 grafts. This figure should then be adjusted according to follicular wastage that occurs at the time of dissection. It may be as low as 2% in experienced hand but can go very high with novice technicians.

At the end, there is no definite answer to upper or lower limit. It depends upon a patients personal characteristics like skin laxity and density along the expertise of treating team.

Hello!

Transplanted hair in recipient area behave just like non transplanted donor hair and follow the hair cycle. At 2-6 weeks after implantation, transplanted hairs are shed during a process called anagen effluvium. This is due to surgical stress endured by the follicle during transplantation. Once they grow back, they will follow their internal biological clock which is unique for each hair follicle and will regrow after shedding at regular intervals.

Hi.

Two years post transplant, the results should be visible. If they are not, it is unlikely that any new hairs will come out now. IMHO the best way out is to consult your clinic again. They will certainly be having your pre-surgery pictures that you can look at and compare to the current ones before you consider the procedure a failure. Often, your primary clinic will also offer you good discounts for repeat session and may even agree to do it at operational cost.

Hey!

When you say silky hair I assume you mean low caliber hair. Now lets look at your question from a different perspective. Would the same number of low caliber silky hairs give as much coverage as coarser high caliber hair? The answer is no. The reason for this is that what we see in the transplanted area is hair 'volume' and not hair number. The volume of a single coarse hair will always be more than silky hair because its radius is more (remember pi X r2 X l) and so scalp coverage on a per hair basis will be more for coarser hair.

Now lets look at the other aspect of same problem. Can we give adequate volume and coverage while using silky hair for transplant? The answer is yes. All we have to do is simply increase the density of transplant. If there are more hair per square cm, the volume will increase and so would coverage. However, one should keep in mind that there is a limit to this increase and the quantum of surgery would depend on many more things than just mathematics. A personalised evaluation by a good hair transplant surgeon would give you best answers.

Dear Sean,

Stem cell therapy is so loosely used to market any treatment these days that it has lost all credibility. Currently there is no evidence of hair growth using stem cells. There have been some experimental studies on animals using dermal papilla cells but human trials have not yet begun.

What was probably sold to you in garb of stem cell therapy was PRP (Platelet Rich Plasma) injections which carries growth factors (chiefly epithelial growth factors) that are supposed to help hair growth. Currently, there are very few studies that support this therapy, but yes, it can be likened to a fertiliser for transplant.

Many surgeons including myself, inject PRP at the time of transplant if the patient requests for it. The blood for PRP is collected from the oozing incision sites made for implanting the grafts. In this way, no additional blood needs to be drawn for therapy. 

At the end of the day you must understand that auxiliary or alternate therapies are just that. A good transplant would give you assured and lasting results. BTW, you need hair in the hairline, frontal and temple area; not in the crown and back.

Best Regards

The brow scar as seen in the picture is very small, and would require transplant only if you are uncomfortable living with it. Personally, I would not be too much bothered by this scar.

Hey.

My preference for brow transplant is single hair follicular units. The reason for this is that brow hair exit at very acute angle from the skin and lie almost flat on the skin. This means that the hair roots should also be implanted at acute angles just beneath the thin skin of this region. As, multiple hair follicular units have bulky roots, the skin may appear unnatural and bumpy after implantation.

The best graft for brow is thick calibre, single hair follicular unit graft. It gives adequate volume, good control for shaping the brows as well as most natural appearance.

Hello Linda.

The description of your bald spots (two bald spots the size of a quarter) does not sound like androgenic alopecia and needs further evaluation before planning a transplant.

If these spots have been present since birth, you may be having congenital triangular alopecia which is amenable to transplant. But if it has come later in life, there are many possibilities. The commonest of these is alopecia areata, which is not an indication for hair transplant. If these bald spots are a result of injury or burn, hair transplant will be helpful.

The cost for hair transplant in India is 1$ per graft by FUT and 2$ per graft by FUE, but you should plan hair transplant only after the diagnosis is established.

The dilemma of hair restoration at young age is still not resolved. At one side is the strong psychological need for hair and on other side is the practical issue of on-going loss and final graft requirement. One has to devise a plan to balance these issues in long term. My personal approach to this problem is,

1. Stabilization: Stop or minimize ongoing hair loss with medicines. This not only delays baldness, but may even result in some cosmetically useful growth. 2. Frontal Coverage: A mature hairline design with deep temporal troughs and emphasis on frontal forelock region, not just hairline.

3. Conservation: Minimum number of hair adequate for desired cosmetic results should be used. My personal preference is FUE in such patients, as we can pick and choose the type of grafts. Avoid dense packing.

4. Reassess: As the need arises, further sessions should be incorporated in the plan. Body hairs should be used judiciously when required.

Perhaps, the most pertinent advice would be to plan long term with your doctor. Keep your expectations low and head high.