Louise

Hi wb280, When inspecting/assessing your hair's characteristics physicians will look for miniaturized hairs in the recipient and donor regions. If the donor hair is miniaturizing, it will not last and should not be transplanted. Some clinics use magnifying loops or a Densitometer or a close-up camera. Dr Simmons inspects everyone's scalp personally with magnifying loops and/or a Microvid camera. The Microvid camera is a hand-held device that can be moved around one's scalp and the physician and patient can see the image on a computer monitor. The follicular groups can be easily seen as well as any miniaturization. If the hair is long enough to hide it, tiny patches can be trimmed to get a very close look at the donor hair. I hope this was helpful.

Hi Mike12, As a 22 year-old, you should be careful about hair transplantation because you have many years to lose more hair. I know that Dr. Simmons is cautious and conservative about hair transplantation in young men. You could have a consultation or virtual consultation to discuss all of your options.

Thank you Megatron. Nice to see that your hair is starting to fill in and it will be nicer to see your hair filling in in the months ahead!!

This 37 year-old man has average-fine, brown, straight hair and a Norwood 3V-5V thinning pattern with an s-whorl. He had average donor density and flexibility. While many men would be most concerned about the front, he was not bothered much by his receded hairline and was most disturbed by his bald mid-scalp. He preferred to start with his mid-scalp then to return to transplant his front later. We aimed for lighter coverage so that his mid-scalp would not overpower the front and so we would not use up too many grafts. That way we would be able to get enough grafts in the next session to finish the front. We transplanted 2304 FUG’s to his midscalp at 36 fug’s/cm2 extending into his anterior crown. His donor strip was 23.1 cm long by 10-11 mm wide and the closure was flexible. Dr Simmons performed a trichophytic 2-layer closure with routine undermining of both edges (but we now usually do 2-layer closures without undermining.) The right donor area was not used but a photo is included for comparison to the scar on the left. These photos were taken 10 months after his hair transplant. He has good donor flexibility and should be able to transplant 3000 grafts in front whenever he is ready.

I believe this has been tried...done. In addition to the compounded tension and increased stretching of the donor scar, there may also be a chance that the hair in between the two incisions may suffer. Not a good idea to stack one strip directly on top of the other at the same time. Hope this helps.

Future_HT_Doc, Thank you so much for the positive feedback!! I just wanted to let you know that we really appreciate your assessment of these photos.

At 4 months, your hair follicles are likely OK. Dr Simmons cautions patients about being in the sun for the first few months post op. A bad burn in the first few days could damage the grafts but we haven't ever seen this happen. Your recipient area may be more sensitive to the sun now than it was prior to your hair transplant. Sun exposure of a healing area can rarely cause permanent darkening of the skin but you would already be able to see this if it happened to you. If you are concerned it is best to ask your hair transplant doctor directly. Hope this helps.

Dr Cam Simmons – 4354 FUG’s to frontal area and crown. This 42 year-old man has average-coarse, black, wavy hair and a Norwood 5 thinning pattern. He had average donor density but great flexibility. We transplanted 2639 FUG’s to his frontal area and 1715 FUG’s to his crown on back-to-back days. We transplanted his frontal area using 56 fug/cm2 , then 49 fug/cm2 , and 42 fug/cm2 and his crown less densely using 36 fug/cm2 and 30 fug/cm2 so that it wouldn’t overpower the midscalp. At the time of his surgery he had existing hair in his mid-scalp but knew that he would have to have more hair transplantation if and when he lost this hair. He did not use Proscar or Minoxidil consistently and stopped them completely 8 months after his hair transplant. He knows that his hair in his midscalp is thinning and will have another transplant when it is too thin. These photographs were taken 1 year after his surgery.

Thank you all for the positive feedback. He is truly happy with his hair and we are pleased that we were able to share his results.

1966kph, TakingThePlunge, Mick from Farjo and Megatron, Thank you for the kind words. It is true, we have seen this before.... However, most wouldn't likely get this kind of improvement. The improvement was truly remarkable with this patient.

Gunny, Many patients are a bit nervous prior to surgery, don't worry! You will definitely find support and answers to your questions on this forum. Just before a patient is discharged from surgery and all questions have been answered, Dr Simmons helps each patient put on their baseball cap before they leave. The baseball cap needs to be loose-fitting and it is best if it is adjustable. Just be cautious when you are taking the hat on and off. Lift the baseball cap off upwards when removing it and place the baseball cap on directly downwards so that you are not disturbing/rubbing any of the grafts. Hope this helps.

Hi BigBill1234, That's a really great question. It is possible to revise a section of a scar that has "stretched" rather than revising the entire scar. It would really depend on the scar's location, how long and wide the area in question was and how flexible your scalp was. Is the area raised? Do you have any photos? There are different ways of fixing a stretched scar, depending upon the problem. If your donor was closed using a single layer closure, perhaps you may benefit from a trichophytic, double layer closure. Perhaps, excising the area would correct the problem or you may have grafts added to the area (FUE from the other side). Have you spoken with your surgeon yet? Most physicians will revise scars/offer to revise scars that patients are not happy with. I will speak with Dr Simmons and ask if he could elaborate a bit more. Hope this helps.

This 22 year-old patient first presented with very early thinning and a lot of miniaturized hair in a Norwood 4 pattern. It was too early for him to consider Hair Transplantation but Dr. Simmons started medical stabilization. He started Finasteride 1/5 per day but switched to using a pill-cutter and taking ? per day. He tried 5% Minoxidil lotion but found it irritating and did not try the 5% foam (or 2% lotion). He used Proscar alone for 20 months then returned for an assessment. Dr Simmons found that there was a slight improvement in his crown and less miniaturization. He continued 1/4 Proscar per day and added 5% Minoxidil foam, then returned 11 months later. His hair is shorter in his latest photos but we were careful to otherwise keep his style and the lighting consistent. It is clear that, after 31 months of Proscar and 11 months of Minoxidil 5%, he has had a noticeable improvement. Dr. Simmons feels that medical treatment should be considered successful if it slows hair loss and that medications won’t bring back hair on a bald scalp. Every once in a while, we can catch hair loss early enough that medications can make hair look better.

This 35 year-old man has average-fine, dark brown, wavy hair and a Norwood 3A thinning pattern. We transplanted 2489 FUG’s to his frontal area with densities varying from 56 to 42 grafts per square cm. Dr Simmons performed a trichophytic 1-layer closure with routine undermining of both edges. (He usually uses a 2-layer closure without undermining now.) At his 5 month follow-up appointment, he was already pleased with his results and was looking forward to some additional growth over the next few months. It was raining on the day of this patient’s annual follow up appointment and when he arrived at the clinic, his hair was wet. This gave us the opportunity to take and present his photos with both wet and dry hair. The final photos were taken 14 months after his surgery and he is very happy. He feels that his hair looks natural and that his donor scar is barely visible with short hair. He continues to take Finasteride and may not need more hair transplantation for a long time.

This 39 year-old man had a previous hair transplant in 1999 at another clinic and began wearing a hair system shortly afterward in 2000. He had a Norwood 5A pattern. His hair was wavy, coarser than average, and black with a touch of grey. His goal was to make his hair look natural enough that he could get rid of his hair system. Dr Simmons initially performed 30 FUE to reduce some of the larger grafts. On the same day, 2276 FUG’s were transplanted to his frontal area. The old grafts were compressed and splayed out under the skin so it was difficult to follow the direction with FUE. Sure enough, a lot of the hair in the old grafts grew back. In his second session, Dr. Simmons removed 6 “old plugs” from below his hairline by excising them with a 2.0 punch. He undermined slightly and sutured them closed. 2033 FUG’s were then transplanted to fill in the front and some of his mid-scalp area. His hairline is not perfect but he feels that it has improved enough that he was able to stop wearing his hairpiece. He cannot see the little scars where the old grafts used to be. He may return to transplant more hair in his midscalp in the future. Dr. Simmons feels that FUE can be a very useful tool to reduce old grafts but it doesn’t always work. In some patients, like this one, it is still worthwhile to completely remove old grafts. Louise __________________ I am a hair transplant technician, employed by Dr. Cam Simmons at the Canadian Hair Transplant Centre. Dr. Cam Simmons is a member of the Coalition of Independent Hair Restoration Physicians

Hello PD, Grey hair is very common and greying is gradual. As hair begins to grey, in a 3-haired follicular unit, often 1 hair greys at a time. When there is no greying, all 3 hairs may be black. Then it goes to 2 black hairs and 1 grey and then 2 grey hairs and 1 black to 3 grey hairs. This salt and pepper effect helps to keep the hair colour natural when transplanting grey hair. When harvesting a donor strip, we want to transplant all the hair. You can leave it grey afterward or dye it. If someone has a distinct pattern of greying we may strategically use more grey hairs in some areas and less in others. If the whole donor strip is grey, Dr Simmons will use a Haber Spreader to minimize transection during the "harvesting process". When dissecting grafts under microscopic vision grey hair can be translucent but we can trace the path of the hair from the surface to the white cap over the dermal papilla to avoid transecting the hair. We have found that dye stays on the surface and doesn't help that much with graft preparation. Louise

Hi Maxxy, Normally, patients are asked to wash their donor area daily. We provide our patients with a small tube of Polysporin Ointment and ask that they apply a small amount over the sutured area for a few days after washing. Generally, Dr Simmons uses sutures that require removal. We have found that applying the ointment helps minimize any scabbing and suture removal is more comfortable. Louise

Haircare99, I asked Dr Simmons for a photo to illustrate Bill's excellent description. This photo shows 1 single-haired follicular unit graft, 1 two-haired follicular unit graft, and 1 three-haired follicular unit graft. Louise I am a hair transplant technician, employed by Dr. Cam Simmons Dr. Cam Simmons is a member of the Coalition of Independent Hair Restoration Physicians

Hi Bill, Thank you so much for the warm welcome and kind words. Louise I am employed by Dr. Cam Simmons. Canadian Hair Transplant Centre. Dr. Cam Simmons is a member of the Coalition of Independent Hair Restoration Physicians