Dr. Cam Simmons – 2681 grafts for a lady that recovered from Trichotillomania

[Cam Simmons MD ABHRS]

This lady in her late 20s suffered from Depression, Anxiety, and Trichotillomania throughout her teens but has made an excellent recovery. She has not pulled her hair for years and this was confirmed by her partner.

 

Trichotillomania is compulsive hair-pulling or twisting. Patients experience an overwhelming urge to pull or twist their hair. The tension builds the longer they resist this urge and there is a great relief after pulling or twisting their hair. This is usually immediately followed by remorse and guilt. Trichotillomania is a psychological condition first and a hair loss problem second. It can be extremely difficult to cure and often requires treatment by family doctors and psychologists, psychiatrists, or other therapists. Patients who still have active Trichotillomania often feel guilty and deny that it is still a problem so, as for this lady, confirmation is needed from a family member, loved one, or room-mate that patients are not still pulling or twisting their hair.

 

From a hair loss perspective, Trichotillomania is a form of Traction Alopecia and can cause permanent hair loss and scarring. Recurrence of hair-pulling would destroy transplanted hair and existing hair alike.

 

She had hair loss over the front and top of her head and scarring in the affected area but her hairline was spared. She could not cover the area with a side part and “always wore a hat everywhere.” There were no signs of current hair-pulling or twisting. She had average diameter, short, brown hair and average donor density but less than average flexibility.

 

Her donor strip was 29.3 cm long and averaged 1 cm in width. She had a single-layer trichophytic closure with routine undermining (but we usually use a 2-layer closure without undermining now.) We transplanted 2681 follicular unit grafts at a density of about 38 grafts per sq cm in the affected area. She had more 1s and fewer 3s than usual and had about 21% 1s, 55% 2s, and 24% 3s, by sampling. With the scarring in the area, dense-packing could cause poor growth so we would not have chosen to transplant at higher densities, even if more grafts had been available.

 

At 10 months, she doesn’t have the densest transplant ever and she may choose to increase the density later. However, she is happy and comfortable keeping her hair short and going without a hat.

 

There is always a risk of relapse of Trichotillomania but if there is good evidence of lasting remission, hair transplantation can be very helpful.

[RCWest]

WOW Dr. Simmons, those are outstanding results for 2681 grafts!! So that is 38/cm2, and you basically can't see it in a social setting at around 50/cm2. Is this correct? How many more grafts could she get, provided her scalp loosened up?

[TakingThePlunge]

Dr. Simmons,

 

Beautiful job! While, as you yourself point out, it may not be the densest hair transplant, it is a dramatic cosmetic improvement for this patient.

 

Thank you for sharing this case!

[Cam Simmons MD ABHRS]

WOW Dr. Simmons, those are outstanding results for 2681 grafts!! So that is 38/cm2, and you basically can't see it in a social setting at around 50/cm2. Is this correct? How many more grafts could she get, provided her scalp loosened up?

 

Thanks RC West

 

Sorry it took me a while to respond.

 

This lady may add some more hair in a year. Her surrounding hair is quite dense but a total of 50-56 grafts per square cm would look fairly full when dry and styled. (I don't use this much hair in the midscalp for a man with genetic hair loss.)

 

If we remove this scar as part of her new strip, she could likely get about another 2300 grafts but she would not need that many. The area is approximately 70 square cms so another 1400 grafts would likely be enough.