Carolina Hair Surgery

Propecia

We saw in consult today a 26 year old man, with continuing patterned hair loss.  9 months ago he was precribed Propecia, and the results, especially in his crown, were amazing.  Because of his relatively young age, his hair loss was caught in time.  His crown had totally reversed course, and he is now no longer a candidate for surgery in his crown.  It has been awhile since I've seen an ad for Propecia, but I wish more men, especially young men, knew they have this option for hair loss.

Female Hair Loss

                                                                                

Above is a female with patterned hair loss.  I have circled the area that hair loss is the most severe, in what we call the "frontal core."  To the above right is after we have made the small 0.5 mm "sites" where the grafts will go, and below is after surgery with the grafts in place.  Female hair surgery is tough,and I believe the best way to approach it is to concentrate on specific areas, and get it as dense as you can.  In any case, this lady had quite a bit of hair tissue moved to the area where she needed it, and should do well.

Thickening Female Hair Loss

Magnification

In hair surgery, we live in a magnified world.  Even the removal of donor tissue requires magnification today.  Yesterday we did surgery on a local dentist to restore his hairline, and like most hairline cases, we packed the grafts as close as possible.  When I place grafts this tight, up to 60 grafts per square centimete. I use 5x loupes to place this tight, and even then I wish I had more magnification, but I can't find commercially available loupes with more magnification.  Our field will go where optics take us, but for now I could not do without the loupes that are constantly on my head.

No More Plugs!

Even though "plug surgery," as defined as grafts containing more than 5 follicles, was gone long before I entered this field, almost every consult I did today (and everyday) has to include reassurance that "we don't do plugs."  The stigma of plug surgery still haunts the profession.  Here is an example of a patient's hairline we did several years ago.  No plugs!  OK, now I'm done.   

We Need a Study

In prepping for surgery tomorrow, and in continuance of the post yesterday, I am reminded of how little we know in this industry.  The patient tomorrow is having his hairline and frontal forelock density increased.  But again, how much is enough?  He has a good donor bank, and we will shoot for 50 grafts/ cm2. 

What I would like to do is pull 1000 men without hair loss off the streets and simply take photos of thier trimmed hairline and simply count the hair density.  That would be a good start.

How Much Is Enough?

Hair surgery is ultimately all about math.  How many grafts (and thus follicles) can be taken out, and how many can be put back in again.  A great pilot survey came out last month that looked at the average scalp density of hair follicles of male hairlines.  The numbers were surprisingly low, with an average of 52.1 follicular units per square centimeter in the hairline.  We can easily obtain that density with today's technology, given the proper donor/recipient ratio.  But the unanswered question is should we? 

Given that male pattern hair loss is progressive, and there is always a limited donor supply, in which patients do we "ramp up" to this mean density, and which do we "ramp down" to conserve hair for likely future sessions?  I believe answering these questions will be the next new phase for hair surgery.

Saturday Follow-Up

Saw a patient for Post-Op follow-up Saturday.  It was a typical hairline case with no grafts popping overnight!  Good follow-up care should always involve the patient, and making sure they understand why you are having them take the post-op precautions seriously.  This patient did everything I asked of him, and it showed the next day.  Let's hope today's patient does the same.