Guidelines for BHT

Hair Transplant
1

Dear Forum readers and fellow HT doctors,

I would like to share our experience in BHT with others.
Below, I have formulated a set of guidelines that should help prospective patients as well as future doctors venturing into BHT.

These guidelines are based on our follow up observations in patients.

1. Preshave the body donor areas 3 to 5 days before the extraction. It is a simple step and very helpful to pinpoint the actively growing hair that need to be used.

  1. Use only the body donor hair in active growing phase for purpose of transplant. Do not use telogen hair.

  2. Assume the transplanted body hair will retain their original characteristics (length, calibre, color, predisposition to greying, curl, anagen/telogen %ages and hair growth cycles).

  3. Factor in the impact of growth cycles and characteristics of the body donor hair proposed to be transplanted.

  4. Mix the various body as well as scalp donor hair in any particular area of scalp.

Regards,
Dr. A

2

I like to point out that one of the more important keys here is definitely the telogen issue. I totally agree with Dr. A on this. In the past, I saw clinics not take this aspect into account. Well they did per say, but the argument was always… do telogens grow? Well no one ever figured that out… again an issue of what should have happened in BHT… proper research. So at least in this clinic, the telogen issue has been taken completely out of the picture. Good post.

3

hmm, perhaps you should consider asking bht patients to stop using propecia a couple months before surgery, who knows maybe propecia is really affecting the yield of some bht patients.

4

If I not mistaken, Dr. A said the other night that he actually would like his patients to TAKE propecia/other DHT blockers before having a BHT procedure, to evaluate if the BHT’s are affected by the meds… If there is apparent significant BHT changes then I assume that may change the surgical plan. This to me is a good idea.

5

very good points. thanks for sharing

6

Assume the transplanted body hair will retain their original characteristics (length, calibre, color, predisposition to greying, curl, anagen/telogen %ages and hair growth cycles).

Dear forum readers,

Following is a link to a relevant thread where specific cases have been discussed.
http://www.hairsite.com/hair-loss/board_entry-id-16834.html

When planning a hair restoration using body hair, it is important to start with the assumption that the transplanted body hair will not change their characteristics.

True, some patients note an increase in length of transplanted body hair. However, length is not the only characteristic.

Moreover, not every patient notices the increase in length.

Therefore, its prudent to start with the premise that the transplanted body hair will not change their original characteristics.

This is especially true about the remainder of the characteristics, viz., calibre, color, curl, predisposition to greying etc.

In suitable patients, body hair can be used judiciously even though they do not change their characteristics.

What is most important is that those patients, (as well as the doctors), not pin their hope on any change in characteristics.

Each hair on the body is endowed with its own set of characteristics.

A good doctor will be able to use the available hair in correct way to give the maximum impact.

Regards,
Dr. A

7

» 1. Preshave the body donor areas 3 to 5 days before the extraction. It
» is a simple step and very helpful to pinpoint the actively growing hair
» that need to be used.
»
»
» Regards,
» Dr. A

It is odd, but I thought I’d share a personal observation of mine based on the two times I shaved my entire body prior to a BHT. One would be surprised how much of the hair is not growing initially. I have noticed that after being home for a couple of weeks additional hairs have started growing.

To me, again based on personal observation, would it not make sense to shave much farther out than 3-5 days? The reason I say this is that hair grows extremely slow and I think that most body hair grows even slower. Lets say you shave initially 3-4 weeks in advance of your procedure. Isn’t it possible that you might actually have more hairs actively growing by the time of the procedure? You could actually do a final shave 5-7 days in advance as well.

I guess my point is that hairs that started growing initially when shaving 3-4 weeks in advance of a procedure would not have completed the anagen phase before the procedure itself. They might be much farther along in the anagen phase than hairs that started growing 2 weeks after the initial shave. I would suspect that the hairs that are farther along in anagen phase are much more likely to shed than ones that are just starting the anagen phase.

BTW, I know that it is a myth that shaving doesn’t speed up the growth of hair nor make it thicker or grow to a different length.

Also, it does make it easier to apply minoxidil to areas. Last year, I was using COSTCO minoxidil and I would have to remain unclothed for extremely long periods of time to allow it to air dry. This year, I have used the Rogaine Foam and boy what a difference it makes in the time to dry. It is more expensive, but worth it IMHO.

8

»
» It is odd, but I thought I’d share a personal observation of mine based on
» the two times I shaved my entire body prior to a BHT. One would be
» surprised how much of the hair is not growing initially. I have noticed
» that after being home for a couple of weeks additional hairs have started
» growing.
»
» To me, again based on personal observation, would it not make sense to
» shave much farther out than 3-5 days? The reason I say this is that hair
» grows extremely slow and I think that most body hair grows even slower.
» Lets say you shave initially 3-4 weeks in advance of your procedure.
» Isn’t it possible that you might actually have more hairs actively growing
» by the time of the procedure? You could actually do a final shave 5-7 days
» in advance as well.
»
» I guess my point is that hairs that started growing initially when shaving
» 3-4 weeks in advance of a procedure would not have completed the anagen
» phase before the procedure itself. They might be much farther along in
» the anagen phase than hairs that started growing 2 weeks after the initial
» shave. I would suspect that the hairs that are farther along in anagen
» phase are much more likely to shed than ones that are just starting the
» anagen phase.
»

Dear Checkingin,

Each hair has its own hair cycle.
While one may have just entered the active growing phase, other may be near the end of it.
Therefore, too long a gap will lead to some hair (towards the end of their growth phase), looking grown out but being in the resting phase.

That is also the reason why its important to wet shave rather than trim the hair.

Wet shaving the body donor hair twice will also lead to a situation similar to wet shaving once, IMO.

Regards,
Dr. A

9

Any doctor as well as patient venturing into BHT must understand the importance of the hair growth cycles.

Much like the other characteristics, the growth cycles too are not significantly altered.

While talking of growth cycles, one needs to know two things -

  1. The duration of the anagen and telogen phase,
  2. The %age of hair in telogen for that area.

The duration of the anagen/telogen phase plays an important part overall, while the %age of hair in telogen gains increasing importance with each passing hair cycle.

Talking of durations -
Following is an extract

Hair Growth Tables
There are many factors that affect individual hair growth. These growth tables should only be used as a very generalized guide.

Telogen (%) Anagen (%) Duration of Activity

Scalp 15/ 85/ 2-6 years
Eye Brows 90/ 10/ 4 - 8 weeks
Cheeks 40 - 50/ 50 - 60/
Beard (Chin) 40/ 60/ 1 year
Moustache 45/ 55/ 16 weeks
Arm Pit 70/ 30/ 16 weeks
Pubic Area 70/ 30/ months
Arms 80/ 20/ 13 weeks
Legs & Thighs 80/ 20/ 16 weeks

Carl W. Bushong, Ph.D., LMFT
Richard A. Martin, Jr., M.D., FACEP
Kimberly L. Westwood, CPE, CCE
et al.

While the scalp donor hair have a growth phase of, an average, 3 years, most body hair have a growth phase lasting approximately 4 to 5 months.

Therefore, unlike scalp to scalp transplants, BHTs will show a marked cyclic variation.

10

Talking of percentages

Keeping in mind the chart given above, one needs to analyse the %ages of hair that are in the growth phase at any one time.

The scalp hair, having a active phase of 3 to 4 years has only 10-15% of the hair in resting phase. Most body hair have 50 to 70% of the hair in the resting phase.

How does that impact on planning a BHT?

When the hair are extracted from a particular donor area, the resultant will have that many hair in the active growth phase.

Since, only the actively growing hair are extracted, their initial growth cycles are closely synchronised.

Over successive growth cycles, the individual hair cycles lose this synchronicity as shown in the graph below.

image124.jpg800×513 24.8 KB

Relevant thread
http://www.hairsite.com/hair-loss/board_entry-id-1552.html

That accounts for some people noticing a decrease in the visible growing transplanted body hair after sometime.

(There are ways to address that, but that I will discuss later).

Therefore, its not that the transplanted body hair are being rejected.
Rather, its the hair following their own hair growth cycles.
Since these cycles are too different from the scalp hair growth cycles, people/doctors not conversant with them can get confused at what they see.

Regards,
Dr. A

11

Mix the various body as well as scalp donor hair in any particular area of scalp.

There are 3 options when venturing into HT.

  1. Use up the scalp hair before using the body hair,
  2. Use the body hair and reserve the scalp hair for touch up work.
  3. Use a mix of scalp and robust body donor hair (from various areas), in a pre planned manner from start to finish.

In our experience, Option 3 is the most logical one, especially, for people with extensive hairloss (Norwwod 5 or above).

In Option 3, the scalp donor hair provides a scaffolding and the body donor hair provides the filler.
The hairline and frontal areas will have a higher %age of scalp hair grafts.
As we go backwards, the %age of scalp hair decreases and body donor hair increases.

In Option 1, there are chances of certain scalp areas having only scalp donor and others having only body donor hair. That may not look very aesthetic.
In Option 2, there is chance that a high proportion of body donor hair may be in the resting and shed phase. To attempt to fill in the visible gaps at that time with scalp donor hair may lead to damage of the dormant body hair in that part of the scalp.

Therefore, when performing BHT, make it a point to mix the robust body hair from different areas being used AND mix them with the scalp donor hair. In a planned manner.

Regards,
Dr. A

12

Dear forum readers and fellow HT doctors,

Apart from the guidelines listed above, I will strongly recommend that any doctor or clinic wishing to enter the field must subject himself to extensive training with a successful BHT practitioner.
BHT is not just a matter of taking a punch and trying to extract hair from different body parts.
It requires proper techniques, proper instrumentation, the necessary physical skill and a thorough training.

Regards,
Dr. A

13

Doctor, how did you come up with those percentages? Was there a study to backup the percentages?