Transplant into a region that isn't thinning.

[Greg_Swanson]

Has anyone had their surgeon do this as a preventative?

For instance, if someone has to travel an extensive distance, is it advisable to maybe knock out some potential recession that is yet to occur? Maybe they're a NW 3/4, and the doc goes a bit further into the hair line. 

Or is this generally not advised due to shock loss?

I'm just wondering if this is something doctors look at.

Thanks

[Mr S]

Im also curious about this. Some docs seem to just transplant to the bald areas on say a nw3 and some will transplant the into whole frontal third.

[gillenator]

I would not want to risk possible transection of the existing hair nor run the risk of shock loss.  MPB is progressive in nature and why most of us will ultimately need more than one procedure in our lifetimes...so eventually more grafting will be needed.

Many docs however will impede the neighboring area with some light grafting especially if they see that the area is diffusing but not loss of hair yet.

[Dr Blake Bloxham]

Greg, 

Gillenator's post above , as usual, is pretty spot on: we typically do carefully reinforce thinning -- but not yet bald -- regions when possible. However, there is always a tipping point between an area you can safely invade and one you should not attempt yet due to the potential for shock loss. We require patients to trim for surgery and this, in my opinion and experience, cuts down on the potential for damage, so I frequently try to "reinforce" as many regions as safely possible during a transplant. 

[7Shel]

Interesting topic. Here’s a question: does the equation change when you’ve already transplanted a decent amount of hair into an area, but then want to add even more density? Is transection still a risk? Would it still be a poor decision to not shave the area?

Edited June 12, 2019 by 7Shel

[LaserCap]

There are a couple of factors to consider.  First, if the patient has shown the propensity to lose, he will continue losing.  When? Who knows.  2nd, and as an example, consider a patient thinning his temporal points.  If the doctor only works those areas and then continues to thin farther back into the pattern, he will end up with two horns.  It is advisable most times for the doctor to blend grafts to the area right behind the grafted area so that there is always connection. When I see photos of work not blended, it truly gives me shivers.  But this all depends on the type of loss we are talking about.  Say the patient has no loss whatsoever but is dealing with a birth defect, then it is OK to just work the area of concern and not blend any grafts to the perimeter.  I am not sure if I understand the shaving aspect of the question.  If you shave, the doctor can not see what he's doing.  You are best to leave that to the clinic.  They can cut and shave based on the needs and wants of the doctor based on whatever work is going to be done.

[hairlossPA]

I've always wondered how surgeons dont transect existing hairs when implanting into regions with hair already. if the head is clean shaved, how do they know where the follicles are sitting and not to cut them?

[LaserCap]

13 hours ago, hairlossPA said:

I've always wondered how surgeons dont transect existing hairs when implanting into regions with hair already. if the head is clean shaved, how do they know where the follicles are sitting and not to cut them?

First, they work using magnification.  2nd, doubtful they would shave, otherwise they would not be able to see where to go.  I recall having to  send away patients because they were too tightly shaven.  The Doctor could not even identify the pattern.  But let's say that during the site making phase, the doctor inadvertently cuts an existing hair...no issues, he just gave you a haircut.  That hair will continue growing.

When it comes to shaving, it is best to allow the clinical staff to do that the morning of the procedure. They have worked with the doctor enough time to know what his preferences are.

[hairlossPA]

everytime i’ve seen a recipient site with incisions, it looks like it’s clean shaven. not even buzz cut length hairs. but maybe there are hairs that i can’t see at that length?

[7Shel]

Still curious about transplanting between existing hairs when the existing hairs are transplanted, not miniaturized native hairs. It seems like the majority of doctors still want to shave instead of going the no-shave route. Are the results going to be worse? 

[LonelyGraft]

1 hour ago, 7Shel said:

Still curious about transplanting between existing hairs when the existing hairs are transplanted, not miniaturized native hairs. It seems like the majority of doctors still want to shave instead of going the no-shave route. Are the results going to be worse? 

I’m no expert but I think a good surgeon can relatively safely transplant within existing transplanted hairs and here are my thoughts:

1. Transplanted densities are nowhere near the original density of your hair. From my guess 40-50 grafts/cm2 is roughly about 50% or a bit higher of most people’s natural density

2. Transplanted hairs are usually more resilient and not as afflicted to shock loss as thinning or mpb prone hairs

 

i would guess it’s impossible to achieve natural density. But I think a good surgeon can help you achieve a relatively good density. I think you went with a great surgeon and have good results. Follow up with them and they should be able to give you their expert opinion. Good luck 

[gillenator]

Shaving is somewhat used ambiguously.  The whole idea of the doctor wanting to cut the hair short is so he can see the "direction" of the hair shafts as they protrude from the scalp.  As long as they can see the direction/angulation of the existing hair shafts, along with magnification, they can make the accompanying incisions more accurately and safely. 

This greatly helps to minimize transection of the existing hair.  Obviously the more dense the existing hair is within the recipient area, the more challenging it becomes.