Adding density to an existing transplanted hairline risky?

[Pangloss]

My transplants were done over 20 years ago. Now my side fringe has receded a bit and frontal hair seems to have thinned a bit.

Do you risk existing transplanted hairs by planting new hairs among them in the hairline area? Might there be either temporary or permanent shock loss? Do you gain more than you might lose?

Can the surgeon be sure not to accidentally damage the existing follicles when he makes the new slits?

Thanks for any opinions.

Edited May 14, 2020 by Pangloss

[HTHope]

Very curious about your questions as well. I’d also like to know if the scar tissue from the previous surgery can hinder growth of future surgeries 

[LaserCap]

On 5/14/2020 at 5:31 AM, Pangloss said:

My transplants were done over 20 years ago. Now my side fringe has receded a bit and frontal hair seems to have thinned a bit.

Do you risk existing transplanted hairs by planting new hairs among them in the hairline area? Might there be either temporary or permanent shock loss? Do you gain more than you might lose?

Can the surgeon be sure not to accidentally damage the existing follicles when he makes the new slits?

Thanks for any opinions.

The fact you had transplants 20 years ago, (and are still there), should tell you how sturdy they are.  (If permanent in the donor area, they'll be permanent wherever they're placed.  The follicle, for some reason, behaves as if it was still part of the donor).

During an intervention, the doctor is working with magnification and can clearly work in and around the older work, (and around the native hair as well). He may inadvertently give you a hair cut as the instrument he's using is very sharp).  Seems like shock loss but it isn't.  And, if for some unknown reason there is shock loss of the native hair, that hair will typically return 3-4 month later - along with the newly transplanted hair.

Have a conversation with the doctor prior to the procedure and voice your concerns.  Ask if a full panel is necessary prior to the procedure, particularly if there's been a change in your medical condition. (A self immune system could have an effect, for example).

Lastly, and to ease your concerns, have the doctor scope the area.  You'll be able to confirm there is typically a lot of space in between follicles.

[Melvin- Admin]

Transplanting in an area with hair is always a risk. The more hair you have, the higher chance of shock loss. The only way to minimize the risk of shock loss is to A. shave your head- this helps the surgeon when transplanting in between hairs. B. Do a smaller procedure, which also helps ensure the surgeon create sites safely in between existing hairs.

[gillenator]

Transplanted hair does not shock out as readily as diffused native hair providing the transplants were truly terminal hair (non DHT receptive)….even if the transplanted hair shocks out, it will grow back...there are no guarantees that weak diffused terminal hair will grow back.

Transection is always one of the risks if the recipient area is already fairly dense...but as was already mentioned, the surgeon utilizes a scope headset with light that allows a very magnified view of the existing hair shafts and the current angulation of those hair shafts as they protrude from the scalp....in addition the instrumentation has improved over the years so the surgeon can make the recipient incisions more safely with less invasiveness.

Scar tissue can potentially disrupt blood flow to the grafts if considerable work was already done to the area from previous procedures....this is why the overall yield can decrease attributable to the build-up of scar tissue from previous procedures.

[HTHope]

6 minutes ago, gillenator said:

Transplanted hair does not shock out as readily as diffused native hair providing the transplants were truly terminal hair (non DHT receptive)….even if the transplanted hair shocks out, it will grow back...there are no guarantees that weak diffused terminal hair will grow back.

Transection is always one of the risks if the recipient area is already fairly dense...but as was already mentioned, the surgeon utilizes a scope headset with light that allows a very magnified view of the existing hair shafts and the current angulation of those hair shafts as they protrude from the scalp....in addition the instrumentation has improved over the years so the surgeon can make the recipient incisions more safely with less invasiveness.

Scar tissue can potentially disrupt blood flow to the grafts if considerable work was already done to the area from previous procedures....this is why the overall yield can decrease attributable to the build-up of scar tissue from previous procedures.

Hi gill 

if a hair is in the telogen phase, and not seen since it is under the skin, can it end up being crushed/transected during the second surgery where density is added? 

[gillenator]

Yes this can occur and undoubtedly does happen...this really cannot be prevented since the surgeon cannot see under the surface of the scalp...but the good news is that only approximately 10% of the hair follicles is in the telogen phase....so the collateral damage is minimal. 

[Pangloss]

Thanks for the replies. Lasercap, what is a "full panel"?

[Pangloss]

On 5/15/2020 at 11:33 PM, Melvin-Moderator said:

Transplanting in an area with hair is always a risk. The more hair you have, the higher chance of shock loss. The only way to minimize the risk of shock loss is to A. shave your head- this helps the surgeon when transplanting in between hairs. B. Do a smaller procedure, which also helps ensure the surgeon create sites safely in between existing hairs.

Thanks Melvin. I don't mind clipping the existing hair very short if it will help the surgeon, though I'd rather not shave the scalp. Smaller procedures, like over several days, all for the hairline area, would be helpful? But that means more needle sticks with the anesthetic. Do these needle sticks damage follicles (especially unseen telogen follicles)?

Isn't adding density to existing transplants a routine thing? Surgeons don't just do the hairline one day and proclaim it "finished", then a year later the mid-scalp, all done in one sitting, then later the crown. People are always coming back to add density to existing transplanted areas, aren't they?

[Raphael84]

As @Melvin-Moderator explained, shaving can be key when transplanting into already reasonably dense areas. Non shaven recipient procedures are becoming more popular and requested for obvious reasons, but it is rarely the best option for the patient in terms of quality and long term result. Shaving allows the doctor to clearly see the exit angle and direction of the native surrounding follicles. The skill of the doctor is also obviously very important in this aspect.

[Pangloss]

My objection to shaving the recipient area prior to surgery is that I don't like the idea of dragging a razor along my scalp because I fear it will irritate the scars and make them grow. When you talk about shaving, do you mean with a razor or does the surgeon clip it with an electric clipper?

[Melvin- Admin]

1 minute ago, Pangloss said:

My objection to shaving the recipient area prior to surgery is that I don't like the idea of dragging a razor along my scalp because I fear it will irritate the scars and make them grow. When you talk about shaving, do you mean with a razor or does the surgeon clip it with an electric clipper?

I mean buzz it with an electric clippers, not shave with a razor.

[Guy73]

I always had my hair buzzed. Doctor said it is easier for them. I had major shockloss 1st,2nd, 3rd procedure. Even on second and third the transplanted  hairs from previous procedures shed! But my hair alway grew back starting in the 4th month. It sucks and I am sure this depends on the person because a friend of mine went to the same doctor and he never experienced shockloss to existing hairs. I might be a prime example it can be done because I don’t think I could get anymore hair to fit in my front even if I wanted. 😂 

[HTHope]

54 minutes ago, Guy73 said:

I always had my hair buzzed. Doctor said it is easier for them. I had major shockloss 1st,2nd, 3rd procedure. Even on second and third the transplanted  hairs from previous procedures shed! But my hair alway grew back starting in the 4th month. It sucks and I am sure this depends on the person because a friend of mine went to the same doctor and he never experienced shockloss to existing hairs. I might be a prime example it can be done because I don’t think I could get anymore hair to fit in my front even if I wanted. 😂 

did you ever experience donor shock loss?

[Guy73]

1 minute ago, HTHope said:

did you ever experience donor shock loss?

I probably had a little in the donor area. But I never had anything above a .8mm size punch extracted  from my donor. Also my doctor would draw a grid around my mapped out donor zone and each box would get about 35 grafts pulled from it which really gave my over all donors very uniformed look. My donor always seemed to recover well after a few months. 

[gillenator]

It's nice to hear when a surgeon uses a grid or other method to ensure that any area of the donor zone is not over-harvested.