Hair Transplant Blog

Reparation of a bad hair transplant with FUE technique and correction of scars. This 42 years old patient had his first surgery when he was 40. Than he had 2 more surgeries in a well-known “professional” clinic in Brussells which seems to have this slogan: “quick, fast and wherever will be will be”.
The is quite complicated: whereas he was happy about the first transplant, the two following surgeries emphasize even more the imperfection of the first one.

There are four imperfections:

The grafts are too big on the front part.

This anterior line is too regular, too round

Crescent shaped hair on the first inches due to the consecutives surgeries on a surface which was too short.
Very large scar visible when his hair are short.

The patient situation: Donour area, mainly the anterior line, is not very prety because of its irregularity, the unbalance of density between the anterior part and the back of the head. The donour area is blasted, the scar is unpleasing and it is very hard to take another strip of hair.

Correction

Using the FUE technique the grafts were taken, one by one, from the hairy zones of the head. This 1856 grafts were removed in two days (1015 and then 841, for a total of 4454 hair) and placed on the transplanted zone in order to fit in with the crowd of other bad grafts. The biggest grafts were removed from the most frontal part, and around the ones left there some one hair grafts were implanted in a regular way. The very dense crescent shaped part was not transplanted.

The scar was reduced after two months. The patient was lucky to have a very good laxity, which allowed us to take it off completely. The results will be posted in the next few weeks.

IMAGES OF IT

…I have had a bad hair transplant, three times! My front line is too straight, the grafts are too big and I have the impression that people only look at my forehead when they meet me…

Unfortunately, although nowadays hair transplant techniques prooved to be ready, some doctors still do not take enough care nor enough time in making the surgeries. There are two techniques to correct a bad hair transplant on the front part. You can either take off most of, or all, the bad grafts thanks to the use of micro punches, like the one used for the FUE technique,  or you have to implants new grafts between the huge ones in order to hide the non natural aspect.

…I am quiet worried. For over two months, I am using Minoxidil twice a day as my Doctor recommended me to do. I have the clear impression that I am losing more hair than in the past. Is it normal?

Sometimes, and in a few cases only (around 5% of the patients using the treatment), a hair loss may occur in the part treated with Minoxidil. Usually, it is just a transitional loss which often starts between two weeks and two months after the beginning of the treatment. It may be due to the acceleration of the loss process of those hair which where going to fall soon. I advice you to wait for two more months and then the beneficial effects of the Minoxidil should be visible. If this does not happen, you will have to stop it and possibly start to use Propecia.

I have read that the doctors use different kind of tools to make the recepient sites for the grafts. How does it work? How can it have an influence on the results of the hair transplant?

These tools can be classified in two categories: sharp medical instruments, or needles. As far as I am concerned, I decided to adopt Dr Hasson and Dr Wong’s system of little pieces of custom-made rasor blades cutted using a mini-shear. The advantage are that you can adjust them and they are very sharp. Moreover, they can be cutted on beveled edge and this helps to limit at lot the agression of the deep parts of the skin. I usually use three different sizes in order to make a very precise work throught the existant hair. I do not use needles because they cannot give me the opportunity to limit the depth of the recepient sites. Furthermore, they lacerate the skin tissues particularly when they are used to make hundreds of recepient sites (they can be used once). I believe that the quality of the tools can influence the result of the transplant: for the quality of the regrow and to make the surgery undetectable.

I would like to understand how the trichophytic suture works? I read that it is a new technique?

This is an old technique, which has been redescovered in 2005 by Dr Mario Marzola (Australie). In 1999, during the ISHRS Congress, Dr Simon Rosenbaum gave information about it; and this technique had its rebirth during the expansion of the FUE technique. In fact, most of the patients are worried about the scar left by the strip of the FUT technique. Many tests were done until the ISHRS congress in Las Vegas, in 2007, and only one technique of trichophytic suture has been chosen. A little strip of skin is taken, about 1 mm wide, from the inferior part of the skin which is going to be sutured in order to let the hair grow through the scar during the healing. Thanks to the trichophytic suture the scar is almost always unnoticeable, sometimes undetectable. Unfortunately, we do not have many indications yet that is why it must be used very carefully.

I would like to know your opinion about the density of incisions. I have read that some doctors can reach 90 grafts per cm². Is it possible? Is it reasonable?

This is a very interesting question. There are two important limits for the density of the recepient sites. First, if you go over the number of 35 or 40 recepient sites per cm² there is a risk of bad regrow. There is also very often the risk that the grafts collapse because the density is not reasonnable. Second, the patients who asked for a high density forget that the number of grafts, even if it is an important number, must be spread on a surface big enough to make a satisfying result. If we increase too much the density, the surface to cover will decrease. It is better to think about it in this way. What is the best way to spread in density and on the surface the number of grafts reached? The key to obtain a good hair transplant is more the distribution’s strategy then the quest for maximal density.

…I have read once on an American web site that it is possible to make an eyelashes transplant. Could you give me more details about it?

Eyelashes Transplant is a fascinating topic. This technique has been redescovered recently. You will find all the details on my web site. We could use hair, or body hair which is even better, as donour area…

Good morning Doctor, is it true that the use of the microscope can improve the hair transplant, and the quality of the grafts? I am reading many dissimilar opinions on the internet and I do not see which are the advantages…

In my opinion, the use of the microscope is essential for the cutting of the grafts. Thanks to it, it is possible to avoid the transections (bad cutting of the hair which stops the regrow of the hair). It allows to cut and to sculpt the grafts making the thin ring of skin on the top as little as possible. It permits also to protect the telogen hair (the resting phase of the fu) which are shorter and transparents. For white hair, the microscope is incontrovertible. With the use of the microscope the transection rate is around 1%, while 10 to 40% of the hair are destryed during the naked eye cutting.

Doctor,
In August, I have had an hair transplant (not with you but with another serious surgeon, who is registered at the National medical association too) on my back area and I think I am feeling the hair coming out of my head. I already had a hair transplant with this Doctor, about 3 years ago, and I was really happy about the final result. At the beginning of August I asked him to perfect the previous surgery because a little line was hairless…but what worries me is the fall of the grafts implanted three years ago. In fact, although grafts existed on the left side of my front area, now I have this hairless strip. A few days ago this Doctor told me, once more, that the older grafts are going to grow back. If I am still worried, and I needed to ask to another specialist his advice, it is because after 4 months those grafts did not grow back (they fall 2 weeks after the second surgery). That is why I would like to know if the grafts that I lost (because of the anaesthesia? of the shock due to the new grafts placed next to them? …) will grow back for sure, and never fall again like the former ones?

Considering this hair loss process, it seems that you had a shock loss. Even if usually the shock loss occurs on the third month. Shock loss concerns, very often, already existent hair especially if there is a high degree of miniaturisation and it is linked to the degree of aggressiveness of the procedure. Personally, I am always extremely careful when there is a risk of shock loss. I never use adrenaline, and I reduce the number of incisions. I always ask my patients to take propecia and to use minoxidil during the weeks preceding the surgery. A shock loss of former grafts is very rare, really unusual. In spite of the fact that when you lose hair because of a hair transplant it can be permanent, with former grafts it is very exceptional if they do not grow back. That is why I recommend you to wait a couple of months before to consider a correction…

I am on minoxidil 2% (regaine) for two years and I am two months pregnant. My gynaecologist asked me to stop minoxidil but I am afraid to lose my hair again…

There are no studies on women about the effect of minoxidil on the foetus during the pregnancy, on the animals there isn’t any teratogenic effect. Nevertheless, it is beacuse a little part of Minoxidil can go through the cutaneous barrier when it is used on the skin that we recommend to stop the treatment during the pregnancy. Finally, until the childbirth, hormonal changes will compensate the eventual hair loss due to minoxidil cease.