follicle miniaturization speeds up with HT?

[herbert]

To any physician willing to explain:

 

I've read a lot about permanent shock-loss on "native" terminal hair in the recipient area after an HT.

What exactly causes this? (e.g. transection, poorer blood supply, any other kind of competition with the transplanted hair, etc.??).

 

And, secondly, I'm so worried about another possible effect (maybe more sneaky):

can an HT speed up the hair miniaturization process in the recipient area?

And in surrounding ones? (not involved in the HT)

If so, what causes this effect?

 

I'm maybe naive, but don't fear so much to shed my native terminal hair weeks after the HT and never see them come back... I'm much more concerned about the issue that the HT can "trigger" something in my recipient area (where I still have some terminal hair -- around 15 FU/cm2 in denser zones, e.g. forelock)... and speed up my thinning there, cycles after cycles... what I would have lost (miniaturized) in 5 years, will get miniaturized in 1 year or so...!

Is this possible? Am I too paranoid?

 

thanks for any explanation.

[herbert]

To any physician willing to explain:

 

I've read a lot about permanent shock-loss on "native" terminal hair in the recipient area after an HT.

What exactly causes this? (e.g. transection, poorer blood supply, any other kind of competition with the transplanted hair, etc.??).

 

And, secondly, I'm so worried about another possible effect (maybe more sneaky):

can an HT speed up the hair miniaturization process in the recipient area?

And in surrounding ones? (not involved in the HT)

If so, what causes this effect?

 

I'm maybe naive, but don't fear so much to shed my native terminal hair weeks after the HT and never see them come back... I'm much more concerned about the issue that the HT can "trigger" something in my recipient area (where I still have some terminal hair -- around 15 FU/cm2 in denser zones, e.g. forelock)... and speed up my thinning there, cycles after cycles... what I would have lost (miniaturized) in 5 years, will get miniaturized in 1 year or so...!

Is this possible? Am I too paranoid?

 

thanks for any explanation.

[Dr. Michael Beehner]

Herb,

In a relatively small percentage of hair transplant procedures, there will be a mild "shocking" to some of the "native" hairs within the "horse-shoe" shaped area on top. This is more likely to occur with very large sessions or with very dense packing, and is more common in females than in males. What occurs is that those hairs get "bumped" into their next life-cycle. Each hair on our heads grows for 4-6 years and then the hair follicle (the living portion that is under the skin) shrinks for three months, disconnecting from the hair shaft coming out from that follicle. The hair follicle then falls off into the shower drain or on to the brush that passes through the hair. We all lose around 70-100 hairs a day in this manner because of this normal "cycling." When a man is gradually "thinning," by definition he has a relatively high percentage of "miniaturized" hairs on top. These hairs are limited in how long they will grow and their shaft diameters are thinner and wispier. In the next life-cycle, they will grow even shorter and thinner in diameter. They eventually reach a turnover in life-cycles where it disappears from the scene and doesn't return even in wispy form. These hairs are certainly more susceptible to the "shocking" that occurs with transplant surgery. Their loss is also much less noticed when the transplanted hair starts growing out, since the new hairs are full diameter hairs that will grow long and they dwarf the contribution these wispy hairs would have made. It is disconcerting, however, for a patient when they look in the mirror two months after a transplant and realize they look thinner than when they presented to Dr. X.

Some doctors believe that pre-treating with Rogaine twice a day for a month or so before and after surgery helps to prevent some of this. There is no hard proof, but a lot of anecdotal stories by doctors suggests it might help. I use it before and after all surgeries on females and on men who have had a lot of work in the past.

One additional factor in causing "shock" during transplant surgery is the concentration of Adrenaline in the tumescent saline solution used. Around 5 years ago I greatly reduced the concentration we used and I have only seen one really noticeable shocking of existing hairs in that time span (occurred in a female 1 1/2 years ago). I hope that helps answer your question.

Mike Beehner, M.D.

[herbert]

Dr. Beehner,

thanks a lot for the clear explanation.

My main concern is that those hairs "bumped" into the next life-cycle will climb the "miniaturization stair" at a higher pace.

I mean, we all expect that an hair in a thinning zone will have a lower quality (in terms of shaft, length, etc.) in its next life.

If I remember well, there are a number of miniaturization classes (or "steps"), from terminal to vellus.

What worries me is that an HT does not just push an hair into its next life cycle, but then, permanently, influences the way the thinning hairs goes on miniaturizing.

E.g.: each new life-cycle, the hair will miniaturize faster (climbing up the miniaturization stair two steps at once).

 

So, HT pushing an hair in the next cycle is a price to be paid, but it's just a step on the stair. But what if the stair changes its shape, permanently???

 

I hope I've been clear enough; it's just a confused suspect hard to express.

 

Thx for any further explanation.

[Dr. Michael Beehner]

Herbert,

Yes, you are right. Having a hair transplant very often does lead to losing the miniaturized hair on top earlier than you would have otherwise without having a transplant. When you make the decision to have a transplant, you have to be so motivated on obtaining some dense, natural coverage from the hair transferred from the back of your head, that you're willing to put up with this other possible loss, should it occur. As I mentioned, it usually is only an issue for 2-3 months, after which the newly transplanted hair makes it a moot issue. For people who are ultra-paranoid of anyone at work or in their family from noticing that they have undergone hair transplantation, this can be tough to accept. This whole issue is a lot easier for the man who has some means of "cover-up," such as a hairpiece, a big comb-over, a job that allows wearing a hat all the time, or some strong hair in the rear that can be combed forward.

Mike Beehner, M.D.

[herbert]

Dr. Beehner, thanks a lot!

Does this "rule" apply to existing terminal hair, as well?

I mean, does their miniaturization speed up like that of nearly vellus hair...

or...

they just recover well after the HT effluvium (if any) and in the future go on thinning (if they are doomed to) without any negative influence by the HT?

This would be a much worse effect!!!

[Dr. Michael Beehner]

Herbert,

Strong terminal hairs on top in the recipient area are much more resistant to being "shocked" in my opinion, and, if it did occur, they would recover after their 3-4 month telogen hibernation phase and grow out full again. The most obvious way they could be taken out early would be if dense packing cut across the follicle shaft itself. This could either kill the hair or cause it to come back in a much "wispier" form. Research experiments by a number of physicians (Kim, Mayer, Limmer, Swinehart, and others) has shown that a certain percentage of "half-follicles" will indeed grow, but usually don't grow in their previous robust state. The other two factors that I believe would impact good strong terminal hairs in the recipient area would be extreme dense packing (which almost by definition dramatically increases the odds of transecting the hairs between these dense recipient slits/holes) or the use of excessively strong epinephrine (Adrenaline) concentrations in the fluids used in those tissues.

The bottom line is that, if the physician respects the blood supply to these good hairs in the area being transplanted, "effluvium" to these hairs is very uncommon. And if it does occur with a strong hair, the overwhelming majority of those hairs will grow back as before. There has been some interesting research and speculation by a Dr. David Whiting in Texas that some full-thickness terminal hairs are capable of directly going to extinction in one step without going through the short, wispy stage. There is still a little bit of "mystery" left regarding this subject that we don't totally understand.

Mike Beehner, M.D.

[herbert]

Dr. Beehner, thanks a lot indeed.

I think this definitely clarify the point...

 

Let's see if I've got it:

if no transection occurs, the terminal hair may be subject to an effluvium (go & come back) but not to a "forced" and faster miniaturization.

 

Just two more questions:

- which density is "extremely dense packing"?

- what does it mean "to respect the blood supply"?

 

Thanks a lot again!