Who emailed this to me? and why?
01/30/2005 10:55 AM
I am glad Dr. Cole highlighted an issue that not enough people take into consideration: texture. The “toothbrush” metaphor is vivid. Of course, he did not say this would happen, only that it might if the HT was not performed perfectly. However, something similar might happen, although less severe and possibly temporary, even if the HT was well-done. This is an unavoidable fact of HT esp. in those with notably coarse donor hair. Dr. Hasson is another who’s posted eloquently about texture issues at the hairline.
When I saw hairtransplant patients in person, one of the real giveaways in certain cases was precisely this sort of texture issue. On some patients you don’t notice it at all.
IMO, NW2’s like yourself and NYCman may want to avoid or postpone HT for exactly this reason. I’d like to quote a post I made in response to ES a few weeks ago. I quote it because I’m the same sort of patient as you and NYCman – so maybe it will be useful for you guys to read.
Let me address your questions in order:
ES: “What do you mean by “the hair that WAS your hairline” ? Do you mean the hairline BEFORE any substantial hair loss years back, or the “thinning” hairline of a PRE-OP Norwood 2-3 that the new hairs are being blended in with?”
- Both the hairline before MPB and the subsequent miniaturizing hairline. If you closely inspect normal non-MPB hairlines you will notice that the hairs at the very front of the hairline are often finer; they grade very subtly into the thicker hairs immediately behind them. Indeed, one doesn’t need to inspect closely to know this. The eye already knows. That’s why in certain bright, unrelenting daylight situations even the uninformed will notice the relative coarseness of transplanted hair at the very front.
Side note. When I next see Dr. Cole we’ll be doing some very delicate work on my hairline, which I’ve intentionally left unfinished. I am considering the use of certain areas of BHT to try and mimic the naturally feathered effect described above. I predict that the use of “thin” BHT at the very front hairline, in order to secure these subtle (grading/feathering) effects, will become a standard technique of elite surgeons in the next few years.
ES: “In your opinion, does this texture difference have more to do with the new transplant hair having a THICKER hair shaft diameter than the thinning hair it is being placed next to; or may it have more to do with the surgeon NOT getting the hair “direction of growth” just right to match that of pre-existing hair?”
- The hair in the reconstructed hairline will be coarser. The donor hair is coarser. This relative coarseness is one of the great benefits of a HT as far as coverage goes, of course, but it often causes a serious aesthetic deficit when the eye registers the difference in thickness. Remember that your HT hairline will not be as dense as your original hairline. This forces the eye to try resolve the individual hairs in the hairline; thus, the impression of very slight plugginess that can mar even the finest HT hairlines. It is a real problem.
But this difference in shaft diameter does not exhaust the texture problems of HT hair. No; esp. in the first year after the plant, your HT hair may be not only coarser but darker and curlier. The general impression is one of wiry-ness. This tends to relax over time, but some of this give-away wiry-ness may remain permanently. I’ve seen it in 4 year old, all FU graft, modern-era HT’s.
“Direction of growth” is a separate issue. The elite surgeons are expected get this right.
ES: “What do you mean by a person may have "difficulty styling the new hair as they did the old hair?”
- I am glad you asked. Many prospective HT patients are under the illusion that the HT hair will be exactly like their original hair. This is absolutely false, not only with respect to density – which will always be inferior – but also in regards to all the things I’ve mentioned that make up “texture.” Say for example your original hairline was quite soft and always fell forward, into your eyes. You may find after HT that your new hair sticks up and doesn’t particularly fall forward. This is no subtle difference: it is a radical change. In some cases it may be a change for the better, allowing certain styles that would otherwise have required (density-defeating) gel to hold the hair in place.
In any case I think HT patients are often surprised by just how different HT hair really is. To be very technical. When hair is transplanted, the micro-environment that supports the follicle is changed. The hair follicle is a complex organ. It exists in a complex electrochemical stew. It is reasonable to suppose that the resulting HT hair in the recipient area is also different from what it was in the donor. After all, surgery traumatizes this organ, and, although grafts are hardy and often yield very well, the moved hair can’t be expected to preserve all of its original characteristics. That is, the act of surgically extracting follicles changes those follicles. Ideally, it changes them only subtly. In sum, I speculate that the very process of HT is what causes the alterations in texture. But I’m no Elaine Fuchs.
ES: “And lastly, I imagine that some patients in my category will have less of a “texture difference” problem than others based on their “hair characteristics”. Is there any reliable way to tell about this in advance?”
- No. There is NO WAY to reliably predict any aspect of HT results. Rational guesses are possible, and, unfortunately, all we have to go on. Anyone tells you otherwise is a bald-faced liar.