Thoughts on "Touch ups"

[Mikey1970]

Would like to raise a question on the consensus of opinion in regards to HT touch ups.

 

So you have had your procedure, 6+ months have passed and the new growth is coming through nicely but there is a small gap that is irritating. Some gaps may even be filled by as little as 30 or so grafts but is it considered safe in having this done?

 

I myself have experienced significant permanent shock loss occur approx. 3 inches away from the area of work after having a tiny touch up of 30 grafts performed & therefore agonize over a situation like this.

 

Similarly if a long time has passed since the last procedure & you notice some weakness or a gap appearing. At what point should a person take the plunge & proceed with further work?

 

I think its a really relevant question for hair restoration and one that is rarely mentioned.

 

Cheers.

[hairfix]

I do have that problem as i have some density issues due to small "gaps". I need maybe 300-500 grafts to perfect it, but i definately recommend touch ups if you want the perfect result. I had an entirely new hairline drawn and it's hard to get the perfect result from 1 session only.

[Mikey1970]

The problem with "touch ups" can be shock loss. If a "touch up" causes shock loss somewhere else you can end up chasing the bloody thing forever & it could turn into a nightmare scenario.

 

Hoping to get some responses from surgeons and/or experienced posters on this.

[ModernHair]

I had too much thinness around the temples on both sides after my initial procedure so I went in for a touch-up at the one year mark. I'm 3 months since my touch-up so the new hairs are just starting to poke through but I will say that I had considerable shock-loss and thinning around the top third of my head. There's just so much trauma to your head during a hair transplant, even from a small procedure, that the hairs are definitely impacted.

 

I'm pretty sure it will all grow back (and it's already starting to recover a bit) but the past few months have definitely felt like a step backwards. That said, I'm glad I did it.

[Tav1]

I've technically had two "touch up" procedures since my initial 4,000 graft procedure back in April 2015. The first one was necessary to repair a necrotic area that developed shortly after my initial procedure. It was so early in the healing process that if surrounding "native" hair was impacted there would have been no way to tell. That entire process I documented in a previous post here.

 

The second "touch up" occurred in May of 2016, approximately 13 months out from my initial large session. This was purely voluntary and cosmetic to enhance was I thought was a slightly weaker left frontal portion.

 

I'm unable to locate a pre-op picture from the top down, but the first picture below gives you an idea of what I considered to be a weaker left front. The picture was taken 10 months after my 4,000 graft procedure.

 

The second (left/right comparison) picture shows shock loss as of June - one month out from my 200 graft touch up versus one week ago. Obviously, just in the past month and still only 13 weeks out from the touch up, the shock loss is starting to resolve itself. That said, as you can see, the initial shock loss was nothing short of "shocking!"

 

I believe there are several factors in play to insure a maximum recovery from touch up shock loss as well as to insure the new grafts grow as expected:

 

First, I would wait at least one year from any initial large area transplant prior to chasing perfection via touch ups. This gives the transplanted hair/any previously shocked out natural hair enough time to nearly fully resolve, cycle and mature, giving those hairs a much more solid foundation to withstand any subsequent trauma that occurs from touch up procedures.

 

Second, I would maintain a diligent regime of (preferably) Fin/Minox pre and post any touchup to insure you are impacting the scalp and body with the available "fuel" to resolve and grow.

 

Time out of body for transplanted hairs is much shorter in smaller FUE procedures obviously, so under the right conditions, one can assume that shocked hair may start to recover and newly transplanted hair may start to sprout on a more accelerated timeline - say versus the larger initial procedure.

 

Regardless, as ModernHair seems to have experienced as well as myself, touch ups can certainly be like taking twenty steps back from a hair standpoint before moving ahead. And it can be a little jarring seeing what even small procedure trauma can have on previously transplanted/native hair due to shock loss. We can only hope it is temporary. Just my two cents.

[rev333]

I do have that problem as i have some density issues due to small "gaps". I need maybe 300-500 grafts to perfect it, but i definately recommend touch ups if you want the perfect result. I had an entirely new hairline drawn and it's hard to get the perfect result from 1 session only.

 

Can't get a better answer than this

 

But yeah shock loss and transection of surrounding hair follicles are a risk

[Spanker]

I am wary of touch ups for small gaps just based on the trauma and shock loss that you get, plus eating into your donor. I could have a touch up now, but there would not be a cosmetic advantage. So, I look at it like this...I will not have a touch up where only I can see the difference. I want it to have an actual cosmetic impact. For this reason, I have not had a touch up and do not really see one in my very near future, even though I would like one.

 

The perfectionist in me wishes I had a little more density after being 4 years post of in a couple of spots, but chasing perfection is a dangerous game in transplants.

 

This is different that actually not meeting your initial reasonable goals, at which point, I am more inclined to say go for it.

 

Let me edit this to say that I totally understand wanting a touch up and I do grapple with it myself. I would love a 3 to 4 hundred graft bump and I think I have plenty of donor to it without much repercussion. However, I am trying to be donor stingy and I set a goal that I would not get a bump until my 40th birthday, which is in 2 years and 3 months...so I am hoping my hair holds mostly steady until then.

 

I am also starting to slowly go grey and I think I may be happy with less density as that happens, so it is a race between my DHT, melanin, and my patience.

Edited August 12, 2016 by Spanker

[GRIGRIMAN]

I am wary of touch ups for small gaps just based on the trauma and shock loss that you get, plus eating into your donor. I could have a touch up now, but there would not be a cosmetic advantage. So, I look at it like this...I will not have a touch up where only I can see the difference. I want it to have an actual cosmetic impact. For this reason, I have not had a touch up and do not really see one in my very near future, even though I would like one.

 

The perfectionist in me wishes I had a little more density after being 4 years post of in a couple of spots, but chasing perfection is a dangerous game in transplants.

 

This is different that actually not meeting your initial reasonable goals, at which point, I am more inclined to say go for it.

 

Let me edit this to say that I totally understand wanting a touch up and I do grapple with it myself. I would love a 3 to 4 hundred graft bump and I think I have plenty of donor to it without much repercussion. However, I am trying to be donor stingy and I set a goal that I would not get a bump until my 40th birthday, which is in 2 years and 3 months...so I am hoping my hair holds mostly steady until then.

 

I am also starting to slowly go grey and I think I may be happy with less density as that happens, so it is a race between my DHT, melanin, and my patience.

 

I'm in the same situation @Spanker.

 

I had 3,000 FUE in Dec 2013 with Dr Bisanga.

 

I would like a second op to address my crown. However, I have miniaturisation and worried the op would call shock loss and kill them. I also don't think it would make a massive cosmetic difference if I keep my hair clipped. I've therefore decided to wait until I'm 45 once my crown has matured (3 years from now).

 

On the other hand, I'm destined to loose the miniturised hair so I'm tempted to address the crown now and reap the benefits earlier in life.

[mosd]

I'm in the same situation @Spanker.

 

I had 3,000 FUE in Dec 2013 with Dr Bisanga.

 

I would like a second op to address my crown. However, I have miniaturisation and worried the op would call shock loss and kill them. I also don't think it would make a massive cosmetic difference if I keep my hair clipped. I've therefore decided to wait until I'm 45 once my crown has matured (3 years from now).

 

On the other hand, I'm destined to loose the miniturised hair so I'm tempted to address the crown now and reap the benefits earlier in life.

 

now thats a dilemma.