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Incomplete hairtransplants and the future

Dear forum readers,
Hair restoration surgeries have reached a level where, in the hands of competent clinics, people can get natural looking hair restorations.

The use of follicular units at the correct angles and directions. The hairline designs, the graft estimates based on calculation of the bald scalp area etc., is a long way ahead of the time when scalp reductions, flaps, plugs were inflicted on the patients.

Now, the patient does not have to blindly trust the doctor to do the correct thing. He is empowered and knowledgeable enough to be part of the decision making when designing a hair restoration procedure.

That is good.

The possible problem
In future, the biggest possible problem I foresee is cases where the patient gets a transplant but, for different reasons, can not/does not go for more transplants as he loses more hair.

That will lead to a situation of incomplete hair transplants.

The readers, future patients and the doctors need to introspect and come up with the reasons that can lead to such a scenario.

There will be some reasons that are beyond our control. There will be others that we can avoid.

It is necessary that we identify the reasons or triggers that we can avoid.

If a person is going for his first hair transplant, he should be ready to have to go for more, should he have more hairloss in future.

If you can not go for future touch ups, then do not go for the first hair transplant. Its much better to bald gracefully then to have an incomplete hair transplant.

Dr. A

Some scenarios
The possible scenarios that should be avoided.

  1. The patient comes for a consult. The doctor sees his current level of hairloss. Thinks he can give a good coverage by 3000 grafts. Tells the patient.

What can go wrong? - The doctor does not warn the patient that future hairloss may require him to go for more HTs.

The patient gets good growth, but sometime later, as he loses more hair behind the transplant, he feels cheated. “If the doctor had told me that I may lose more hair and may need more and more HTs, I wouldnt have gone for the first one”.

  1. The patient comes for a consult. The doctor sees his current level of hairloss. Thinks he can give a good coverage by 3000 grafts. Tells the patient.
    The doctor starts him on finasteride and minoxidil to prevent future hairloss.

What can go wrong? - The doctor forgets to mention that the medicines do not work for all.
If I have a headache, I take an aspirin. The aspirin will cure my headache (99% of the time).
Will aspirin give me an ulcer? (ulcer being the side effect). Maybe!

Similarly, when using minox or finasteride, arent we hoping that we will get the side effect (hair growth in this case)?

Therefore, it is wrong to put the patient in a false sense of security that you can go for a hair transplant and the medicines will prevent any future hair loss.

It must be impressed that he may or may not be a good responder.
Also, even if he is a good responder now, with time the medicines may not be able to maintain the effect.

Now the patient, who was led to believe that the medicines will DEFINITELY prevent future hairloss, loses more hair and is not prepared for further HTs.

More scenarios

  1. The patient has little body hair or facial hair.

He has a family history of extensive hairloss. Norwood 6 are common.

He is put on medicines and told that he may require more HTs.
A nice hairline and frontal area transplant is performed.

What can go wrong?

The patient does not know that the youthful hairline (coupled with lack of any additional body/beard donor reserves), means he may run out of donor hair but still keep experiencing further hairloss.

He is ready for more HTs, but he has depleted all his donor hair.

  1. The patient (Norwood 5 or 6) has good scalp donor reserves as well as ample beard and body hair.
    At the time of his first HT,the majority of the scalp donor is used up to create a very conservative hairline with a lot of scalp grafts being used up in the crown area.

Years later, he wants a more youthful, lower hairline but he comes to realize that he does not have sufficient scalp donor hair to recreate the basic matrix for the new hairline. The beard and body hair, by themselves can not recreate a new hairline.
He has hair to cover any further hairloss in crown. But little option for the front.
Wrong planning.

Please contribute with additional scenarios that can be avoided by proper education and awareness.
Dr. A

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