transplantation of miniaturised hair?

[Happy]

in one of the other threads a very interesting issue was raised:

 

miniaturised hair in the donor area is not a very good foundation for a ht. hence my question:

 

does miniaturised hair get transplanted or not, in particular with a strip procedure?

[RCWest]

I would think that if the donor area is miniaturized then the doctor would advise against transplantation.

[wb280]

Happy, yah i raised that question and Dr Charles did give some information but as to the technical details, i think only the physicians can answer

 

Lets see what they say!

[Blake Bloxham]

Happy,

 

Before performing a hair transplant procedure, the physician will thoroughly check the donor area to make sure it is not thinning or 'miniaturizing.' If it is, you will probably not be a good transplant candidate (as these hairs are experiencing progressive loss and would eventually fall out in the implanted region), nor would the hair be transplanted.

[Happy]

hello all,

 

i suppose that with the miniaturisation process of hair it's not a black or white situation - in other words, whether you have miniaturised hair or not. i guess it's rather a matter of degree as to what percentage of donor hair is miniaturised and whether there is a certain acceptable threshold up to which a candidate is considered being a suitable candidate. maybe i am wrong.

 

hopefully some docs can chime in and give professional advice.

[Blake Bloxham]

Happy,

 

It's my understanding that the DHT (dihydrotestosterone - the hormone directly responsible for hair loss) resistant hair in the universal donor region should show no signs of miniaturization if it will be transplanted. A degree of miniaturization (even a small one) would indicate that the transplanted hair would most likely continue to thin and eventually fall out permanently. This is why individuals who suffer from thinning in the donor area or diffuse unpatterned alopecia (DUPA) are not good hair transplant candidates. A responsible hair restoration physician will analyze the donor hair before operating to ensure that it is not miniaturizing.

[Happy]

blake,

 

thanks for sharing your views and which, generally speaking, make sense: miniaturised hair is definitely a sign of a weakened hair which might fall out sooner or later, hence not a good bloke for a transplant.

 

however, in my view the crucial question still remains:

 

up to which stage is the degree of miniaturisation in the donor area still acceptable? i don't think it's as straightforward as your last post suggests, blake. i have just done some research into this topic and found one quite interesting article by dr. bernstein talking about evaluating a person for a ht. see my following post including sections of this article:

[Happy]

this article was published in 2007 of course not here in this forum but somewhere else (forgot to jot down the weblink). for clarity reasons the "quotation style" has been applied. so, here we go and have some fun!

 

 

In evaluating a person with androgenetic alopecia for a hair transplant, typically the physician determines the patient’s Norwood Class, designs a hair line, delineates the extent of coverage, “eyeballs” the donor area, and then decides upon the appropriate number of grafts. Taking specific measurements of hair density and donor miniaturization are not routinely performed. However, donor density and miniaturization are important variables in deciding which patients are good candidates for hair transplantation and are useful in determining how many grafts are needed in the procedure.

 

in other words, according to bernstein it is rather the norm that examination of donor miniaturisation is normally not done!! at least back in 2007.

 

At first, miniaturization involves only one or two hairs in select follicular units, but eventually progresses to involve all the hair follicles in genetically susceptible areas. It has been the observation of these authors that a shift from focal to generalized miniaturization precedes the actual loss of affected hairs, so that total hair counts remain relatively constant until end-stage baldness.8 Said another way, the progressive thinning associated with androgenetic hair loss (particularly in the early stages) is caused by a decrease in the hair shaft diameter of an increasingly larger number of hairs, rather than by the actual loss of individual hair follicles.

 

that's what we also assumed.

 

Miniaturization, unfortunately, can also occur in the back and sides of the scalp. When it affects a person’s donor area, it will have profound implications for surgery...donor miniaturization must be assessed prior to considering surgery

 

strange that despite this crucial factor miniaturisation doesn't play that important role for many surgeons in the pre-op assessment. guess why ;-)

 

but here comes some more interesting info:

Early detection of miniaturization in the donor area is a warning sign that the donor area is not stable and that the person may not be a good candidate for surgical hair restoration. If any miniaturization is detected in a young person, i.e. under the age of 25, red flags should go up that their donor area may not be stable. When miniaturization is noted in a teenager, the risk of developing diffuse unpatterned hair loss (see below) is significant. In an older adult male, some miniaturization, perhaps up to 20%, is consistent with being a good surgical candidate.

 

 

and i suppose what bernstein is now saying shows the whole gamut of trickiness when it comes to making a final decision about the suitability of a candidate:

 

Unlike men, adult women often have significant levels of miniaturization in the donor area, so the mere presence of miniaturization is not necessarily a contraindication to surgery. However, miniaturization does indicate an unstable donor supply and one has to make a judgment regarding the risk/reward of the procedure. The physician needs to consider the absolute number of full terminal hairs that are available for the hair transplant, the risk of further miniaturization, the area that needs to be covered, and the risk of the surgery accelerating the hair loss.

 

 

well, now we know more. or maybe not.:confused:

[Blake Bloxham]

Happy,

 

It looks like you've found some good information. That article from Dr. Bernstein states that hair loss patients with up to 20% miniaturization in the donor area could be hair transplant candidates. Frankly, I've never heard this number before and would be very, very careful when it comes to miniaturization in the donor region and hair transplantation.

[Dr. Michael Beehner]

There are a couple of things that pertain to this issue: As "Future HT Doc" pointed out, if there is more than 5% miniaturization or even a larger amount, then doing a transplant on that individual may not be a great idea, unless the patient understands that the gains may be only for 5-10 years.

In our practice, if the assistants are dissecting out FU grafts and come upon a single miniaturized hair, sitting all by itself as a 1-hair FU, we do NOT make an FU graft out of that but throw it aside. I don't feel that the injury of a recipient incision is worth the tradeoff of putting a follicle/hair in there that is unlikely to end up being a full terminal hair. On the other hand, if that same apparently miniaturized follicle is part of a two-hair FU bundle and the other is a non-miniaturized follicle/hair, then we definitely try to include the weaker appearing follicle, on the chance that it might contribute something or also - importantly - on the hope that it may be a hair in the very early anagen growth phase, which can sometimes be difficult to tell.

In general, I find it rare to find miniaturized hairs in the center of the 'good" donor hair; it is an issue that much more frequently applies to my female patients, most of whom have some small degree of miniaturization. It's then a judgement call as to whether they are a good candidate, and depending on the degree of miniaturization, then I lower the expectations in describing the possible benefits of HT.

Mike Beehner, M.D.

[wb280]

thanks Dr Beehner for the contribution of information!

[Danielkiwi]

I don't feel that the injury of a recipient incision is worth the tradeoff of putting a follicle/hair in there that is unlikely to end up being a full terminal hair. Mike Beehner, M.D.

 

Hello Doctor, Can you please elaborate on the injury of recipient area. What are the possible damages that can be caused by these injuries. Does incision in the recipient areas cause any kind of scarring? Does it damage the nearby grafts?

[Happy]

There are a couple of things that pertain to this issue: As "Future HT Doc" pointed out, if there is more than 5% miniaturization or even a larger amount, then doing a transplant on that individual may not be a great idea, unless the patient understands that the gains may be only for 5-10 years.

 

there is a huge difference between your threshold figure and the one that dr. bernstein mentions. what is your explanation for that?

 

On the other hand, if that same apparently miniaturized follicle is part of a two-hair FU bundle and the other is a non-miniaturized follicle/hair, then we definitely try to include the weaker appearing follicle, on the chance that it might contribute something or also - importantly - on the hope that it may be a hair in the very early anagen growth phase, which can sometimes be difficult to tell.

 

 

what are the signs then so that you can distinguish between a miniaturised hair and one in the very early anagen growth phase (single hair-fu and multiple hair-fu)?