Dr. Bisanga - Safe Zone in Hair Transplant Patients

[Raphael84]

Safe Zone in Hair Transplant Patients

 

[asterix0]

Dr Bisanga I have a question:

Do you believe that in some patients, who are not on finasteride or Anti Androgen Medication, that donor hair taken from the most safe occipital Norwood 7 area can still be susceptible to male pattern baldness once transplanted in the recipient area?

It is not likely to happen in every patient of course, but to some with high androgen sensitivity do you believe it can occur?

Edited February 8, 2021 by asterix0

[Melvin- Admin]

Great video and topic 👏🏼

[Raphael84]

18 hours ago, asterix0 said:

Dr Bisanga I have a question:

Do you believe that in some patients, who are not on finasteride or Anti Androgen Medication, that donor hair taken from the most safe occipital Norwood 7 area can still be susceptible to male pattern baldness once transplanted in the recipient area?

It is not likely to happen in every patient of course, but to some with high androgen sensitivity do you believe it can occur?

This is one of the reasons why thoroughly assessing levels of miniaturisation within the "safe" donor area is very important. Patients with higher levels of miniaturisation with extensive loss and without committing to medication may not be viable candidates. 
One important factor here is also the patients age. If a patient is 50/60 without miniaturisation, this is quite different to a "younger" patient with extensive loss, then the likelihood of miniaturisation may be higher as this patient ages.

Miniaturisation and thinning as we age is natures process. Just like our ageing skin thins, so will our hair, even in individuals who have not experienced androgenetic alopecia. Females can be a good example of this. Hair quality and thinning may occur to approximately 15%.

For example, a "safe" donor area at 25, may not be the same as the "safe" donor area at 50.

Any follicle that may be susceptible to miniaturisation in the donor, that was taken from the donor and transplanted into the recipient area, would still be susceptible, so this is certainly something to be aware of.

[asterix0]

52 minutes ago, Raphael84 said:

This is one of the reasons why thoroughly assessing levels of miniaturisation within the "safe" donor area is very important. Patients with higher levels of miniaturisation with extensive loss and without committing to medication may not be viable candidates. 
One important factor here is also the patients age. If a patient is 50/60 without miniaturisation, this is quite different to a "younger" patient with extensive loss, then the likelihood of miniaturisation may be higher as this patient ages.

Miniaturisation and thinning as we age is natures process. Just like our ageing skin thins, so will our hair, even in individuals who have not experienced androgenetic alopecia. Females can be a good example of this. Hair quality and thinning may occur to approximately 15%.

For example, a "safe" donor area at 25, may not be the same as the "safe" donor area at 50.

Any follicle that may be susceptible to miniaturisation in the donor, that was taken from the donor and transplanted into the recipient area, would still be susceptible, so this is certainly something to be aware of.

Thanks for your response.

I was thinking of the case of patients who do not have DUPA, and who do not have extensive donor miniaturization where the doctor did the extractions.

Meaning, had no transplant been done, these hairs would continue to grow normally and healthy in the donor area.

My concern is I have seen user accounts, and in some athletes on TV who get transplants such as Rafael Nadal but are not on finasteride, and over the span of 4-5 years their transplanted hair begins to thin.

The reason, I think, is because the recipient area is much more sensitive to DHT than the donor, even healthy donor hair in some patients may become weakened by DHT over time if finasteride is not used.

I am suspecting because they are not on finasteride, some patients, even those who do not have donor miniaturization, may be susceptible to recipient thinning because they just have very high androgen sensitivity. 

Have you seen patients where this has occurred?

Edited February 9, 2021 by asterix0

[TommyLucchese]

I don't really get this. If the safe zone at 25 isn't the safe zone at 40... shouldn't we just refer to the safe zone at 40 as the safe zone?

[RandoBrando517]

2 hours ago, TommyLucchese said:

I don't really get this. If the safe zone at 25 isn't the safe zone at 40... shouldn't we just refer to the safe zone at 40 as the safe zone?

Is this the reason why FUT may be better?

[kramer79]

2 hours ago, RandoBrando517 said:

Is this the reason why FUT may be better?

In my opinion, yes.

Also...When someone gets their first HT, they are more than likely to address the frontal 1/3. If they use FUT to do this, they will probably have more of a permanent hairline/front than if they were using FUE in my opinion. I am talking about over time because we need to take in to account genetics, use of meds etc etc

I think people who use FUT for their hairline are more often not experiencing this "hair transplant thins over time" as much as someone who used FUE to re-create and build a new hairline. Someone looks in the mirror, sees their hairline and then makes a conclusion if the HT thinned out or not.

Edited February 9, 2021 by kramer79

[RandoBrando517]

6 hours ago, kramer79 said:

In my opinion, yes.

Also...When someone gets their first HT, they are more than likely to address the frontal 1/3. If they use FUT to do this, they will probably have more of a permanent hairline/front than if they were using FUE in my opinion. I am talking about over time because we need to take in to account genetics, use of meds etc etc

I think people who use FUT for their hairline are more often not experiencing this "hair transplant thins over time" as much as someone who used FUE to re-create and build a new hairline. Someone looks in the mirror, sees their hairline and then makes a conclusion if the HT thinned out or not.

Thanks for the response, definitely gonna research FUT more now. I had written it completely off before.

[Raphael84]

21 hours ago, asterix0 said:

Thanks for your response.

I was thinking of the case of patients who do not have DUPA, and who do not have extensive donor miniaturization where the doctor did the extractions.

Meaning, had no transplant been done, these hairs would continue to grow normally and healthy in the donor area.

My concern is I have seen user accounts, and in some athletes on TV who get transplants such as Rafael Nadal but are not on finasteride, and over the span of 4-5 years their transplanted hair begins to thin.

The reason, I think, is because the recipient area is much more sensitive to DHT than the donor, even healthy donor hair in some patients may become weakened by DHT over time if finasteride is not used.

I am suspecting because they are not on finasteride, some patients, even those who do not have donor miniaturization, may be susceptible to recipient thinning because they just have very high androgen sensitivity. 

Have you seen patients where this has occurred?

We have not seen evidence to suggest that transplanted grafts become more DHT susceptible when placed in the recipient area. 
The entire idea of hair restoration is based upon the fact that follicles taken from the donor area, which is less susceptible to DHT, will maintain their genetic makeup (donor dominance) and resist DHT. If this was not the case, then would be likely that a much larger percentage of patients would experience thinning and loss of transplanted hair in the recipient area. This would then be a common phenomenon. Even patients who had surgery in the 80s and before, with old style hair plugs, have still maintained that transplanted hair today, some 40+ years later.

Whilst some high Norwood patients may have no or lower levels of miniaturisation in their donor area at the time of consultation/surgery, as you explained if they are not using medication, this will likely be the continued progressive nature of androgenetic alopecia that is causing miniaturisation in the donor area.
Also, many doctors are still not focusing on miniaturisation in the donor area, and are not assessing this and providing that empirical data.
 

21 hours ago, TommyLucchese said:

I don't really get this. If the safe zone at 25 isn't the safe zone at 40... shouldn't we just refer to the safe zone at 40 as the safe zone?

The difficulty is knowing how ones safe donor zone will be at 40. We all lose hair to different extents and at different rates, some patients use medication whilst others not, and we all respond uniquely to medication, some very impressively and others not so much. Other lifestyle factors and overall health can be an influence for some individuals.

If this approach was taken, then patients would not be viable candidates until the age of 40 to have that accurate assessment and data regarding their donor, which isn't really ideal, considering that the majority of patients are younger than 40 at the time of their first surgery.

It is not necessarily the surface area of the "safe" donor zone that may be influenced (although in patients with significant loss will also generally see a decrease in the "safe" donor area) due lower crown loss and the lateral humps dropping, but also the quality and levels of miniaturisation in ones donor as they age and loss evolves.

18 hours ago, RandoBrando517 said:

Is this the reason why FUT may be better?

Everybody has their own view and approach regarding this.
FUT has stood the test of time in terms of quality results, but both techniques have their pros.
The beauty of FUE is that your doctor can "cherry-pick" the most appropriate single hair grafts for your hairline. Softer singles from above the ears for example, as opposed to more rigid and stronger grafts that may be presented in the richer occipital area of some patients when using FUT. If FUT does not provide sufficient singles, then larger follicles would need to be dissected/split to provide those singles, which are not always as "ideal" as mother natures singles. Also, depending on the individual patient and their case, for example if temporal points are to be restored, FUE undoubtedly provides the better option to be able to source that perfect follicle.

If FUE is planned correctly with a thorough understanding and management of the patients donor area, there should be no concern in this regard.
As with anything, both FUT and FUE can be performed optimally, or poorly, with a large range in between, so it is always important to distinguish between the different levels of quality, of surgery.