There are many hair transplant technical issues. That makes for a successful hair transplant. The skills of the Doctor and their technician team is one major aspect. Hair transplant technical skills required overlap between medical ability and an artistic side. Both can be learnt to an extent. But the best results are achieved when there is an innate understanding and skill. The goal is to make the greatest cosmetic improvement with a minimal impact on the hair and skin. As a result, creating natural-looking hair growth while minimising any negative effects or changes to the hair or skin. These are the fundamentals of good medical practice.
Hairline Design and Planning
Hairline planning can be a compromise. Between patient and Doctor. On occasions, individuals have unrealistic expectations. As a result, want the hairline too high or too low. A low rounded adolescent hairline can look fine on a young man. But, not with the facial features of an older man. The younger man still has vivid memories of their original hairline. Often there is a desire to create the same appearance. A middle-aged man may fear that an aggressive hairline may seem unnaturally low for their age.
The hairline is not only the front line. But is a continuous line. From sideburn to sideburn. From one temporal recession along the front to the other temporal recession. Along with the hair placement the design is important. To create a cosmetically natural look. Consequently to frame the face naturally. As well as complement the natural bone structure. Therefore the design doesn’t have to be aggressive to look natural.
Often a subtle change is more effective. As a result a high degree of artistic ability is required. Along with surgical expertise and skills. A jagged front edge is first created. This ensures a soft front line. Single hair follicular units make up the front line. Complementing the changes from one side of the head to the other.
Hairline height is determined by a number of issues. Including the pattern of hair loss. Along with the quality of the hair characteristics. To be able to maintain a balanced head of hair. As hair loss is often progressive.
It’s important to follow aesthetic beauty and bone structure. As there are a variety of facial shapes. The majority of men have a square structure. But it´s not an exact science. For example there are round, oval, oblong, triangular and pear-shaped. One aspect is always constant. The apex of a male hairline is always the lowest point. With a female hairline it is the opposite. From the apex, the hairline moves across the forehead. The up to the recession points. Before back down to the temporal area. This look resembles the letter “M” shape.
Often it´s felt the crown is a neglected area. Possible as it’s hard to measure. Because the crown opens on all sides. From the mid-scalp and the sides. To the back. Some genres the crown opens further. As a result drops down the sides and back. A small crown can be a circle say. For example 6×6. But to correctly measure. Use the PY equation to give the value of the circle.
Consequently this makes treating the crown complicated. Whether the area will expand. How many grafts to place now. For example, if the crown expands by 1cm on all sides. The surface area will dramatically change. Should the crown be treated first? The head of hair must not be “backload”. Therefore planning is important. In conclusion, crown work and artistic design go together. In some cases, the crown can be hard to treat.
The doctor creates the recipient sites. Small slits the hair units are placed into. They must follow the natural direction of hair growth. As well as the angle, orientation, and pattern of growth. Special attention is paid to this hair transplant technical. Not damage adjacent hairs. Transplanted or existing hairs. Both the length and the depth of the slit are important. As the microcirculation is just beneath the hair follicle. As a result if the incision is too deep can cause damage.
The trimmed grafts have little volume. The density can vary depending on the area. Also the hair characteristics. As well as the number of hairs in the graft. The grafts are placed using magnification. To ensure the precise placement of the grafts.
With precise placement, it is now possible to create a higher density of hair than in previous years, and this will give a much more pleasing result for the patient. This is the art of placing the follicular units close enough together to ensure a natural result/density in one pass; for example, the design of the hairline not having large gaps between each hair and having to place in between at a later date. The number of follicular units placed will alter dependent on certain factors, hair characteristics, hair shaft quality, ethnic origin, hair colour, curl, and your existing hair density. Dense packing is a great skill, being able to successfully place the follicular units close together without compromising the growth of each hair; the angle of the site and the size of the gauge used will all affect the result.
Grafts and Follicular Units
For hair transplant terms. The word “graft” refers to the number placed. Or the size of the procedure. For example “x” number of grafts. But, a graft is literally just skin tissue. Not a designated number. As a result the use of the word graft can be misleading. If the grafts are all single hair units for example. Not natural follicular units.
For instance, on average there are approximately 2.2 hairs per graft. A mix of follicular unit sizes. From one to four hairs. In this example 3000 grafts equates to approximately 6600 hairs. Smaller procedures reduces the average ratio. As there is a larger percentage of single hair units. Larger procedures the ratio can rise to around 2.5 hairs per graft.
Splitting follicular is not the norm. Only required if there is not the desired number of smaller hair units. Which is very rare. Even if the case, this would not be enough to alter the 2.2 hairs per graft ratio. If the follicular units are split on a large scale. The conclusion will be to damage the hair units. As well as be detrimental to the hair transplant result.
Transection and FUT or FUE
Can occur with either FUT or FUE- Although discussed more with the FUE technique. As there are a greater possibility transection rates spiral. There can be a number of negative effects if a hair unit is “transected”. For example, take a 3 hair unit is split into 2 and 1 hair. This would result in 2 “grafts” instead of 1. Transection can also kill the hair follicle. By damaging the follicular unit. By splitting follicular unit vital growth or survival factors of the unit could be damaged or lost, protective fatty tissue around the unit, genetic information, muscle receptors, and other glands may be missing or damaged. Leaving a partial follicular unit in the donor has no real benefit to the patient and often can later miniaturise due to trauma anyway.
There is usually no reason to split the graft with FUE as by the nature of the technique the hair units can be cherry-picked from around the scalp and enough single hair units, for example, can be found for hairline work, splitting and leaving hair in the donor can be detrimental and of no benefit and also reduces the hair count per graft so the patient loses out on their natural number groupings.
Shock-loss can occur to the hair in the recipient and sometimes donor area. The medical term for shock loss is effluvium. Meaning shedding. As a result of grafts placed in an area of already high density. Causing trauma and tissue reaction. Resulting in the existing hair to shed prematurely. Or aggressive harvesting in the donor. Including the over use of medications in both donor and recipient areas.
For most patients, effluvium is not a major issue and should not be a cause for concern. Hair can look thinner or loses body and lustre. This is generally during the first months post the transplant when the transplanted hair is still in the dormant phase.
There are a number of factors that can help reduce the effects of shock loss. Smoking/drinking in the coming days to the procedure. In general, the more miniaturisation one has the more likely will be shedding from surgery. In addition, the number of grafts placed in one surgery and the proximity in which they placed to one another will increase the trauma to surrounding follicles.
Checking The Grafts Under Magnification
The two techniques for harvesting hair differ in respect with the Strip technique the FU are intact in the donor strip whereas FUE the FU‟s are individually removed so already separated from each other, this means no need for dissecting and generally means less trimming of the graft is required. With Strip the FU‟s remain in the donor strip, this strip is placed in a holding solution to protect the tissue. The strip is divided into smaller sections and then into the individual units by the tech team. Aside of this process is to trim off any excess fatty tissue around the unit, this ensures the grafts are thin so can be placed close enough together to dense pack as well as to stop unnatural pitting or ridging of the skin in the recipient area.
This process within the hair transplant procedure must be carried out under stereo microscopes and by skilled technicians with precision and accuracy. Some hair types are harder than other to dissect even under microscopes, blonde or white hair or very fine hair make this more challenging. This excellence to precision during the process is vital; each follicle unit harvested for transplant must be preserved and prevented from being damaged as this would compromise the overall result.
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Your personal assessment is designed to answer your questions. Are you a good hair transplant candidate. What is your hair loss stage? Are your goals and expectations realistic? How many grafts, which technique and the cost.
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