Docs who do NOT place grafts on HAIRLINE

[Hairfree]

I think its important to find out how many years of experience the techs have for a particular doctor you are considering. If you are going with a doctor who has produced excellent results for many years and have had the same techs from day one you are relatively safe with the techs placing in the grafts after the doctor has made the incisions. Beware of doctors that have had high turnovers with techs. Im sure that Pat takes this in consideration when picking those who qualify for the Coalition Doc list. I think you are safe with any of Coalition Docs. This is just my own personal opinion. Please correct me if I am wrong.

[Hairtechnician]

All doctors have different approaches to the various steps involved in the hair restoration surgery process. Dr Keene has no criticism of any particular doctor or their techs for their placing methods and skills, these do vary. But her personal approach is to participate in the graft placement for a number of reasons. These include being able to guide where the various size grafts are placed and concentrated. She makes different size incisions with custom cut blades for the various size 1 to 4 haired grafts, and feels she can more easily identify which incisions match with which size grafts, especially in the transition between zones. Keep in mind these are very minute incisions. Additionally, the 2-4 haired grafts often have a particular curvature, and how they are placed will influence the angle of growth. While the angle of the incision largely influences that, the curvature of the graft can also contribute. In addition, as has been pointed out, the grafts have to be handled very carefully to avoid damage. For these reasons, Dr. Keene prefers to participate in and guide the placement of the grafts throughout, because it does have a significant impact on the final surgical outcome. So she places along with her most experienced nurses. Her main placement assistant is an LPN who has been with her for 13 years.

[Hairtechnician]

I forgot to mention on my previous post that I am a hair restoration surgical assistant, and an independent contractor for Dr. Keene

[Bill - Seemiller]

hairtechnician,

 

Thanks for stating that you are a surgical assistant with Dr. Keene. if you could put that under your signature that would be great. You can do that by going to "Go", "Personal Zone", then "Profile" and you can add it under there. Thanks for your feedback

 

Bill

[Guest]

This is something that I am concerned about as I move foward to getting my HT.

I guess I need to ask that question of my potential doc. How much experiece do the techs who will be placing grafts have?

Turnover is a concern especially with doc's who don't have everyday booked.

I would imagne that there are a lot of cancellations & since all of the docs do only 1 transplant per day, what happens on those days they can't fill a cancellation. Do you send the techs home that day or do they do some kind of office work?

I am curious.

[Janna]

Between the two doctors at SMG, we have everyday booked couple months out.

 

Cancellations are very, very rare.

There may be one or two techs who depend on the hours, so they may do some light office work or duties that pertain to surgery. Otherwise, the rest of us get a day off.

[Guest]

Thanks Janna! That answers it for SMG.

I'm not so sure about other clinics.

[rp1979]

Hi thank you all for your inputs. I have an additional question on this matter. Perhaps Janna, Hairtechnican or others who have experience placing grafts can better answer this:

 

When you are placing the single-hair grafts on the HAIRLINE one by one, do you need to be selective and consider each graft's "caliber"?

 

For example: "This single-hair graft is of particular high caliber and should be placed at the very front of the hairline to capitalize on its cosmetic benefit to accentuate the hairline, while this other single-hair graft looks a bit frail, and perhaps should be placed further back in the scalp where its frailness can be hidden"

 

If you do need to be selective with each single-hair graft, is it easy enough with a trained eye to decide which grafts are of better "caliber" and thus better suited to be planted on the hairline?

 

Thanks.

[Janna]

We absolutely are selective about the single hair grafts. Not quite the reasons as you guessed. Picture peaks and valleys along the hairline once the incisions are made, we actually select the finer caliber singles to be placed in the peaks and one row in the valleys. If you looked at a person without a transplant, they have some wispy hairs right at the front. We then go right behind with average to high caliber singles for another 3 or 4 rows (don't take it literally when I say rows as it's all a bit staggered). You can tell especially with loupes on which hairs are stronger or finer. Good question, hope this helps.

[Guest]

Good answer Janna!

[AndrewYoung]

Here's something I've always wondered. If the first few rows are singles and behind that we have mutliples, coupled with the fact that we have all been receding for some time, aren't we naturally back in the rows that have twos and threes with our recession? I know my doc did a few 'rows' of singles up front too but wouldn't it actually add to the natural slight recession look if there were twos or threes up front?

 

Also, say I want to go in for a second HT to lower my line a bit. If there are a few rows deep with the singles and then when the line is brought down, do some further twos and threes get mixed in to that original line? Otherwise, don't I have a few rows of singles?

[Janna]

Andrew,

 

At our clinic, we plant two hair grafts behind the ones. The hairs that we transplant will remain, so even if you lose more of your native hairs, you will keep the singles we transplanted (of course you keep the 2,3,& 4's too). People you see with receding hairlines still look like they have single hairs when you look closely.

 

When a patient comes back for a second procedure and want to bring their hairline down a little further, we start over again with the ones, fill in the old front hairline with two's and so on...

I hope I addressed your questions correctly.

[Gorpy]

Andrew,

I think you are saying that with natural recession multi-haired grafts start to show up on the hairline. I don't think this is the case. As recession happens in nature, I believe it causes formerly multi-haired FU's on the hairline to lose most of the hairs and become single hair FU's. So, in essence, you always have single hair FU's on the hairline.

[Hairfree]

This is an interesting discussion. I had a new hairline established in my HT 6 days ago. I did notice that my old reccedding hairline had small wispy hairs due to MPB. The hairs just become weaker and just stop growing. Were these wispy hairs doubles or singles? I thought that once a hair is a double it is always a double. Do they break down into singles before dying off?

 

Another question..Gorpy might be able to help me with this one. I only had 455 single hairs. Was that enough to do my whole hairline?

 

Janna..what do you do if someone does not have enough singles to make a hairline? Also, someone asked me why I didn't have any 4-hair grafts. I had mostly twos and threes from the donar area. Do some people not have any 4 or 5 hair grafts on their entire head?

 

Also, are the three and four hair grafts spaced further apart when placed in an HT and singles closly bundled together?

 

Look forward to the responses!

[Bill - Seemiller]

haifree,

 

Hairs that are dying whether they are 1s, 2s, 3s, or 4s will wither away slowly before they finally disappear or fall out once and for all. The hairs within each follicular unit may die at different rates, so it is technically possible for a 2 hair FU to look like a 1 hair FU...however, i would venture to say (though I'd like a doctor to clarify) that though this may happen, both hairs in the FU will be on it's way to it's end. I believe the whole FU is susceptible to MPB, not just certain hairs contained within the unit. So even if a 2 becomes a 1, the 1 will probably die too. But, my guess is, you won't see this happen...it's behind the scenes.

 

Every clinic is different, however, most clinics, if they don't have enough single hairs for a hairline will split some of the larger FUs into singles in order to create a more natural hairline. NOTE: This is not the same as splitting ALL 3 or 4 grafts into doubles. But inevitably, the goal of the clinic should be to provide the most natural result possible, and that might mean splitting a few larger FUs to create more singles for the hairline.

 

I too was surprised that you only had 455 1s and also no 4s. This is why I asked if Dr. Rahal split the 4s to create singles for the hairline. Though there has been a lot of controversy over the topic of splitting recently, there are times (individual cases) where it is valuable to split as I defined above.

 

If Dr. Rahal did not split any FUs to create singles for the hairline, then he probably used the 455 hairs to create the first layer of the hairline. Admittedly though, 455 in the front line is not a great number. My best guess then is that he used doubles to fill in the areas right behind the hairline. This should still create a cosmetically pleasing result....but I suppose if I had any surprise factor, it was that he didn't split any larger grafts to create singles for the creation of the hairline.

 

Just for informational sake, I'd ask Dr. Rahal what he did for the hairline, and how he strategically placed the singles and doubles to create the hairline. The tripples then would most likely be used further back behind the front line and doubles behind it, still mixing the tripples with other doubles as well.

 

Oh and 3s and 4s are typically placed slightly further apart than singles because they don't have to be placed as closely to create the same level of density.

 

Bill

[AndrewYoung]

Gorp,

 

Yea you had my question right. I mean if we are all receding and there are multiples, you would think some multiples would start to show up on the front lines. My guess is perhaps there are some. They have just turned so weak and frail that they break into ones or thin doubles that appear as ones.

 

Curious though if anyone stopped the hairloss (or slowed it) with finesteride or minox if they would start showing back up as stronger doubles. Might be an interesting problem to have new growing doubles up front, huh? I guess it just goes to validate another reason for the HT. Get the multis back growing and allow them to come off the front line with some singles placed up front.

 

Jana, what would be a typical minimum number of singles you need to rebuild. I am sure this depends on the thickness, hair color etc, but , in round figures, what would be a minimum you would need?

 

Hairfree, I do remember during my consult that, while my hairs were slightly less than avg thickness, they were pleased with the number of multis. When I said, really? She said, 'oh yea, there are a lot of patients that come in with tree trunk grafts but a large number of them are just that, singles.' I think it isn't as uncommon as you think to not have fours (in fact, Doc called these the lucky clovers!)

 

In fact, I would suggest that an even better measure than simply the number of grafts or hairs would be the overall total thickness of what you get. I would guess that you could have 1500 nice thick singles and I could have 2500 thin doubles and yours might look more full. Of course, that sorta measure would just about be impossible to do (can you imagine them not only counting the grafts and hairs but also trying to calculate an overall density/thickness?).

[Gorpy]

Andrew, yeah that's interesting stuff. From my own experience, as my front thinned I could see that I had very few multi-haired Fu's left. So, my assumption is that what were once multi-haired slowly became single haired.

 

Yes, there are many measurments that could be done, but graft count and hair count are relatively easy to provide. Hair caliber is not only difficult to measure, but it can vary over the head, e.g. hair caliber tends to be less on the sides of the head.

 

Hairfree, I would like to hear from a tech or Dr on this, but I would think that 455 singles would be enough. Keep in mind that much of it depends on the doctors strategy and how thick they want to make the hairline.

 

If you consider that a typical hairline is about 10 cm across - going about 1/2 cm deep with singles means that you are covering around 5 cm2 of area with singles. So you can see that you could easily spread 455 in that area and maybe go a little deeper.

[Janna]

"Jana, what would be a typical minimum number of singles you need to rebuild. I am sure this depends on the thickness, hair color etc, but , in round figures, what would be a minimum you would need?"

 

Andrew,

The number of singles needed for a good hairline also depends on the size of the head. I would say on the average, we probably need around 300-400 singles when you're establishing a new hairline.

 

I also want to address that there are people who do not have any 4 hair grafts. Some people may not even have too many 3 hair grafts. There is, on a typical person, or on the average, a hair distribution of 14% 1's, 51% 2's, 29% 3's, and 6% 4's.

 

If we happen to get a patient who needs 300 singles and he naturally produced only 200 singles, we will cut down some of the 3's and 4's to get the singles we need.

 

Andrew, your suggestion about graft/hair count and measuring hair caliber for density/overall thickness--ha, ha, ha!! Let's get the hair count in place first.

[Janna]

Hairfree,

 

I think 455 singles in the hairline is most likely plenty for you. I'm a little perplexed as to why you did not receive any four hair grafts as your distribution falls within the "average" numbers. It seems odd that you'd have over 1000 three's with no four hair grafts. In my experience, those with no fours are the one with lower than average number of threes. It's like a double whammy.

[Bill - Seemiller]

Janna,

 

Great Information. I learned something today

 

Bill

[Janna]

Wow, no way Bill. I taught something to the great, wise one? I'm not even being sarcastic.

[Bill - Seemiller]

LOL Janna,

 

Well one can't know everything now can they? I get the pleasure of continuing my education while being here too .

 

Bill

[Hairfree]

Hey Everyone! Thank you for answering my questions and going even further with the details in the responses.

 

All of you made very clear points. I feel better now knowing I had enough single grafts (455) for the hairline. Now I need to find out if any of the 3's and 4's were split into singles. From what I was told at Dr. Rahal's office is that they do no split FUs. Most likely a misunderstanding on my part and I will send them an email. Just for educational purposes for all of us

 

One note, the head tech at Rahal's office dropped me off at the airport the day after surgery. We had a nice conversation and she told me that she has been with Dr. Rahal since day 1 (13 years) and that others there have been with him just as long. I figured I would throw it out there for anyone considering him.

 

From my short time as a member on this forum I also know that I would be comfortable in the hands of Janna at SMG and Dr. Keene's staff as well from just reading this single post. I can tell they put valuable time into helping others and have a good track record. They have excellent credibility and respect among the peers on this forum. I feel bad for those who never got the chance to come across this forum before getting a HT. Sorry for drifting off topic here!

 

Thank you Bill, Gorpy and Janna for your time and help! I will see if I can find out how my hairline was created.

[Hairfree]

I emailed Dr. Rahal's office because I was curious if they split any of my 4 hair grafts because I did not have any 4 hair grafts in the HT and a high number of 3 hair grafts.

 

Dr. Rahal personally sent me an email and explained the process. Here is what he wrote below:

 

when looking under the microscope a four hair unit is very dense with the four follicles sitting close together. in this case we do not split this into two different two hair units. ie we keep it as a four follicle unit and it will fit into the slit made for the 3 hair unit.

 

 

if the two units are farther apart and are distinguished to be two separate units then we divide them accordingly. so in this scenario we do not combine them to make a four hair unit. if we did we woud have to create a bigger slit to accomodate those four hair units because the follicles are not tightly packed. a bigger slit will mean more scarring, more bleeding etc.

 

in your case there were no four hair units, which is too bad, as it would have given you more hair overall in the session. but such is nature and we can't change it.

[Bill - Seemiller]

Haifree,

 

Thanks for giving us Dr. Rahal's response! You still had a good number of 3s though, so that should really help you out!

 

Bill