Transplanting Into Native Hair

[the B spot]

This was posted by Troy in actionradar's thread, so I am moving it here for discussion:

 

hey guys just popping. Whats are your thoughts about transplanting between native hair and at what point is it not worth it? Not trying to steal your thread this just came up so Im asking.

[the B spot]

This was posted by Troy in actionradar's thread, so I am moving it here for discussion:

 

hey guys just popping. Whats are your thoughts about transplanting between native hair and at what point is it not worth it? Not trying to steal your thread this just came up so Im asking.

[the B spot]

Interesting question Troy---

 

I have seen flagrant disregard for native hair and I have witnessed what I believe is a too conservative approach as well.

 

I think this is a situation where the patient has to know what his rate of loss is, so the Doc can attack this on a case by case basis.

 

For example, a guy has 80cm of balding area and in this area he has a density of 20-25 fu's cm/2.

Now his Doc says 2000 grafts will get him to 45-55 fu's and not endanger the existing hair (transplanting an addition 20-25 fu's cm/2)

 

Now a year- year and half goes by, the guy loses more hair and he now has a density 20-30 fu's that were transplanted and retained 10 fu's cm/2 of native density.

 

Is the procedure a failure?

 

The patient is still thin and might feel as if he was cheated or he should have gone to clinic B, because they said 3500 grafts in the same area.

 

It is up to the Doc to properly explain this and it is up to the patient to understand what a HT can and cannot do.

 

My personal feeling is 0-15 fu's cm/2 in any balding area should be transplanted with no thought to the native hair. (other than transection, of course).

 

Anything 20fu's cm/2 is a judgement call and needs to be addressed properly.

A HUGE difference exists if the patient is 25-35 vs. 35 and up as well.

 

If the patient is simply unsure as to rate of loss, then a 6-12 month waiting period, coupled with Propecia or Dut to stabilize the area is in order.

 

Of course, each doc and each patient is different, but a well thought out decision, perhaps put off for a few months may be the right decision.

 

Very tricky situation and one that is difficult to make.

 

Take Care,

J

[Bill - Seemiller]

B Spot,

 

Great thread and great post. I agree wholeheartedly with most of what you wrote.

 

Just curious...where did you get the specifics 0-15 fu cm/2 etc? Whereas I have a tendency to agree this sounds good, I'm just wondering if you are approximating or if you got these numbers from a doctor?

 

What I typically tell people (and you touched on it here), anyone considering an HT where transplanted hair will be placed inbetween native hair, should get on Finasteride first for approximately 6 months to a year to attempt to strengthen that hair, not to mention hopefully prevent further loss and maybe even regrow some. Since it's not always possible to predict the rate of loss (it could change anyway) and most likely hairs if a certain area has lost hair, the other hairs may be susceptible to MPB and on their last limb anyway, I tend to think getting on finasteride is a good safeguard. Why not do all you can to minimize the risk of permanent shockloss IMO?

 

Bill

[the B spot]

Just curious...where did you get the specifics 0-15 fu cm/2 etc? Whereas I have a tendency to agree this sounds good, I'm just wondering if you are approximating or if you got these numbers from a doctor?

 

Well, I think the "accepted" thin look is somewhere between 20-30 fu's cm/2, which is dependent on the hair characteristics of the individual.

 

Usually if this density is constant throughout the balding pattern, it seems to create a hair "outline", but you can still see the scalp pretty easily.

 

I think this type of balding is the kind where a patient would try to add to what he has, transplanting with respect to the native hair.

 

Spotty or erratic balding is much more difficult to transplant or approximate, in my opinion, which leads back to Troy's original question.

 

Anyway, these numbers are approximates only. 0-15 fu's cm/2 is for all intents and purposes.......bald.

 

Transplanting a 28-30 year old like myself and actually counting on this amount of hair to remain would be a waste of time, IMO (Frontal Half)--- Obviously, the crown area is different because meds can help you retain hair.

 

A guy 42 and on meds for 2-3 years would be treated much differently, usually by adding 20-30 fu's cm/2 to achieve a nice density of 40-50 and at least get to a nice coverage.

 

I agree that using meds for at least 6 months prior to a HT is a good rule of thumb---ESPECIALLY if one is trying to hold onto any existing hair.

 

Unfortunately for me, I did not even have 15 fu's cm/2!!!!!

 

You are right though, these numbers are my personal approximations, based on reading and talking with others, but it should be noted that each individual is different, so make sure you assess your situation carefully.

 

Thanks Bro'

J

[hairbank]

Yes.......good thread indeed!

 

I agree with B spot in that it needs to be done carefully and on a case by case basis since all hair loss is different in one way or another. My main concern with transplanting into native hair is shock loss. I was a diffused thinner before HT #1 and all 1200 grafts where transplanted around native hair. Since it wasn't dense packed, I believe many of the natives survived but I likely lost some..........no way to tell for sure.

 

I'm not sure buy I might land on advising a diffused thinner of 20-25cm2 remaining hairs to just wait until it goes a little further and, as Bill mentioned, start on Finasteride ASAP. I really believe if a diffused thinner wants a HT, he/she likely needs to plan the HT as if ALL the native hair will fall out.

 

I envy those guys who are not diffused thinners and can "go for the gusto" in their areas of loss. I believe the majority of diffused thinners will eventually use the majority of their donor supply filling in, or just choosing to dense pack the first time.

[Bill - Seemiller]

B Spot...thanks for your answers. Well answered!

 

Hairbank,

 

I suppose there are pros and cons to all situations. Obviously those who are almost completely bald in an area don't have to worry about shockloss, yet they will need more transplanted FUs to give an appearance of density (assuming the one with native hair left doesn't eventually lose that hair). It just goes to show that individuals must be assessed just as that...individuals

 

Bill

[rp1979]

I'm also very interested in learning more about this whole issue of transplanting into diffuse thinning area. I found some interesting points that someone on another forum stated:

=============================================

1- Post HT shockloss is only a reaction. MPB is a chronic condition. MPB is not shockloss. Shockloss is not MPB. No matter how some people try to twist informations.

 

2- MOST of shockloss cases are TEMPORARY. That means that in most cases, shock loss is a passing phase. A trauma. Not a permanent condition. (with a top surgeon that is comfortable transplanting in diffuse areas).

 

3- PERMANENT and IMPORTANT shockloss is the 'exception'. In other words, it is RARE. Like in any surgeries, there IS a risk. But it is NOT the norm. (with a top surgeon that is comfortable transplanting in diffuse areas).

 

4- NOT EVERY DOCTORS ARE COMFORTABLE TRANSPLANTING IN DIFFUSE AREAS: Like not every cooks are comfortable cooking seafoods, or not every athletes are comfortable practicing many different disciplines. That may explain why some doctors, even great ones, are less comfortable than others with it.

 

5- Diffuse thinners have SMALL risks of important and permanent shockloss, but usually obtain SUPERIOR 'cosmetic' results from a hair transplant. Bald people have no chances of shockloss, but usually obtain inferior 'cosmetic' results from a HT.

 

6- NO SURGERIES ARE 100% SAFE: even if the risks of important and permanent shockloss is very small, it is a risk. No doctors can legally tell a patient that permanent shockloss is a myth.

 

7- MANY OF THE BEST DOCTORS ARE REGULARLY TRANSPLANTING INTO DIFFUSE AREAS: And they are successful doing it. They are the ones that create the very best cosmetic results. Period. They would certainly not jeopardize their whole reputation by doing regular dangerous and unsuccessful procedures.

 

8- DIFFUSE THINNER ARE CANDIDATES FOR A HAIR TRANSPLANT. And combined with proper medication to stabilize their hairloss, they make the very best 'cosmetic' results.

=============================================

 

WHAT DO PEOPLE THINK OF THE CLAIMS MADE ABOVE?

[Bill - Seemiller]

rp1979,

 

I agree with all the statements that this poster made. The only one that I'd argue is point number 5 and 8. Though I believe he's ultimately correct, I think a diffuse thinner must be handled with care...and ultimately it still comes down to individual cases. Since MPB is progressive, it's possible that a number of hairs in the diffusing area are miniaturizing, making them more susceptible to trauma (hence shockloss). Since permanent shockloss MAY occur to miniaturized hairs, it's important for diffuse thinners to be on finasteride for at least 6 months to a year in order to strengthen the hairs to minimize the possibility of permanent shockloss.

 

But ultimately, I agree with all the above statements when taking what I said into account.

 

Bill