Is it possible to kill dormant follicles by pushing a 0.7 punch in the skin when transplanting a graft?

Question

Jae Pak, MD · Answer

It may be possible to damage hair follicles if you cause trauma to the hair follicle.  Pushing a puch can be considered trauma.

Amiya Prasad, MD · Answer

Thank you for your question. You’re asking if it’s possible to kill a dormant hair follicle with a 0.7 millimeter punch when placing a hair graft. It’s fair to conclude you’re considering hair transplant surgery, and are concerned about the viability of dormant follicles when you have your surgery.
I can help you understand some of the science and rationale behind a treatment strategy I recommend for patients every day in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers, a system we developed using extracellular matrix and platelet-rich plasma (PRP) to help hair transplants heal better going back about 7 to 8 years. We’ve developed a treatment that non-surgically helps  hair loss for men and women suffering mostly from genetic pattern hair loss. So I am no stranger to the challenges of dealing with the consequences of hair transplant surgery, which is the rationale behind our Hair Regeneration treatment. 
When you place a hair graft, you are dealing with a scalp, depending on the advanced nature of the hair loss, with a certain percentage of existing hair you can see, and a certain percentage you cannot see. When you think about the science of hair loss that is androgenetic alopecia, there is a continuous decrease in the growth cycle, or the active growing phase, while there is a prolongation of the resting phase called the telogen phase. That means a significant percentage of hairs are actively not growing at any given time. 
You are aware by the way you asked your question that there is a certain percentage of collateral damage during a hair transplant, depending on the relevant density of existing hairs. It was always a rationalization by every hair transplant surgeon that when you are placing grafts, hairs that were thinned were going to go away anyway. 
When we were doing hair transplant and using extracellular matrix and platelet-rich plasma (PRP), we found that thinning hair actually became thicker. From this, we were able to develop painstakingly over several years a process we call TrichoStem™ Hair Regeneration. What I learned over time is a way to reactivate hair that was not growing, thicken thinning hair, and prolong the lifespan of existing hair. 
With more time treating a wide range of patients from young males with aggressive pattern hair loss, to older males with minimal to moderate progressive hair loss, to women of all ages, we developed a classification system that factors in gender, age, age of onset of hair loss, rate of progression, degree of progression, and other variables we have customized so the dosing and the strategy is optimized. When I came down to comparing in certain patients the question of transplant versus injection, it was clear that a significant percentage of patients actually had results with our injection that exceeded not one, but two hair transplants. The reason for this was that the reactivation of dormant hairs, hairs you are concerned about being potentially traumatized or damaged permanently by a stab incision in the scalp, or the placement of a hair during a transplant. 
When I look at our results, I look at thickening of the thinning hair, then realize it was an optimal strategy even for patients who are still getting a hair transplant. So it’s not necessarily a question of either/or. What I explain to my patients every day is every hair that is present, thick, and is providing scalp coverage is a hair that doesn't have to be transplanted. In my practice, when patients come to me with for example frontal progressive hair loss, and still want to get a frontal hairline developed, part of the strategy is to first do the Hair Regeneration treatment. In some patients, the addition of a DHT blocker, depending on our algorithm which some males of higher DHT sensitivity would still benefit from more than others, then we can see after the course of a year to 18 months how much scalp coverage there is with this strategy. Like I said, every hair that becomes thick and covers the scalp is a hair that doesn't have to be transplanted. It’s a reminder that there is a limit of the number of grafts that can be harvested and placed, so it works very well in synergy. 
It’s important to understand that hair transplant is one treatment strategy, but pharmaceutical, and stem cell or Hair Regeneration technology are all part of an overall treatment strategy. There is no cure for hair loss, but there are ways to optimize coverage maximally for every individual based on variables we look at. 
To answer again the question about a dormant follicle traumatized by a punch, the answer is yes. You have to go straight through the skin, and if there is a hair follicle underneath that, and the stab goes through, you are either going to damage the hair follicle directly, or indirectly through vascular compromise. The trauma and inflammation of surgery can also comprise the survivability of the grafts as, well as existing hairs. 
We’ve had patients who had a megasession surgery done elsewhere where 90% of the grafts did not survive. We have people coming from around the world who have had transplants, and are very challenged in getting the outcome they were hoping for. It doesn't mean you shouldn't do a transplant, but I suggest thinking about the potential to maximize coverage before you do the transplant. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Jason R. Dudas, MD · Answer

Any excessive trauma to the follicles can result in temporary or even permanent injury.  When creating the puncture sites for the follicular unit grafts, care must be taken not to injure the existing follicles in that area.  That is why it is critical that hair transplantation be performed by an experienced and trained physician who understands this.

William Rassman, MD (retired) · Answer

Normal terminal hairs are very difficult to kill but miniaturized hairs are easy to kill off. The use of a punch may not cause camage but your question is not clear

Is it possible to kill dormant follicles by pushing a 0.7 punch in the skin when transplanting a graft?

Answers (4)

Answer: Killing hair follicles

Answer: Killing hair follicles

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Is it possible to kill dormant follicles by pushing a 0.7 punch in the skin when transplanting a graft?

Answers (4)

Answer: Killing hair follicles

Answer: Killing hair follicles

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Everything you need to know about Hair Transplant

Our mission is to create a world where every investment in modern beauty is Worth It.