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My thoughts on why some BHT\'s don\'t take


#1

We have all seen some disappointing results from mega session body hair transplants. That leaves one to wonder “why” these hairs didn’t grow. After thinking long and hard, I believe that body hair when transplanted must undergo a much higher level of oxidative stress or body hair is more sensitive to oxidative stress. I was looking into post-op sprays particuliarly haircycle and I think there may be something to that product. It contains several antioxidants, particuliary alpha lipoic acid which is a super anti-oxidant. I can not come up with any other reason (other than mishandled grafts) for these body hairs not to take. I would vernture to guess I’m right. One interesting ingredient that could be incorporated into a post op spray would be Sea Buckthorn oil. I haven’t compared the seed oil to the pulp oil, but i would think the lighter, less oily, would be better as not to gum up the transplanted area too much.

Just my thoughts.


#2

There are many reasons why they do not grow, eg: they can be transected when they were taken out of the donor,.


#3

» There are many reasons why they do not grow, eg: they can be transected
» when they were taken out of the donor,.

again, graft mishandling. There are many cases by reputable doctors that wouldn’t have graft transected follicles to begin with that have done mega sessions that have failed. I think I’m closer to being right.

Body hair has something uniquely different in the terms of it being able to survive a transplant.

It appears from pictures and my general assessment that less grafting per centimeter works best in body hair transplant. (more passes can be done later)

I really believe oxidative stress may be a key factor.


#4

Until the grafts get blood flow they are basically under attack by free radicals. To me free radical scavengers are ESSENTIAL post hair transpant and especially with body hair.

The effects of oxidative stress:

These oxygen metabolites cause
damage by inducing cross linking, inactivating
enzymes, fragmenting DNA, attacking polyunsaturated
fatty acids, autoxidation, reacting with lipids,
proteins and nucleic acids and by thimine glycol
and 8-hydroxyguanosine formation. These metabolites
may be beneficial to the organism during phagocytosis
and tissue homeostasis and may be harmful
by causing cellular and tissue death. Organisms
have developed defences to protect themselves
from oxygen radicals. Superoxide dismutase, catalase,
glutathion peroxidases are antioxidant enzymes
which eliminate species involved in free radical
chain reactions. Ascorbate, tochopherol, urate,
glutathion are small molecule chain breaking antioxidants
which are able to repair oxidizing agents
directly…


#5

I agree about less grafts. I think some of those huge megasessions overdo it. I’ve always used folligen and salt water after procedures and have done well with it.


#6

» again, graft mishandling. There are many cases by reputable doctors that
» wouldn’t have graft transected follicles to begin with that have done mega
» sessions that have failed. I think I’m closer to being right.

Do you honestly believe that the technician or the doctor who is doing 20,000 grafts megasession will have the attention span to handle each and every single graft with the utmost care from start to finish?


#7

» Until the grafts get blood flow they are basically under attack by free
» radicals. To me free radical scavengers are ESSENTIAL post hair transpant
» and especially with body hair.

Yeah but the same can be said about regular head hair transplants.


#8

I completely agree. Smaller sessions are best.


#9

The number one reason for failure of FUE grafts to grow, whether scalp hair or body hair, are the 3 destructive FUE forces identified by Dr. Feller:

  1. Torsion (Twisting of the top of the graft while the base is still affixed to the lower layer of skin
  2. Traction (Pulling of the graft in an attempt to tear it free from the lower layer of skin)
  3. Compression (squeezing of the graft in order to get a good grip and prevent slipage while pulling)

Since body hair follicles are typically more fragile than scalp hair they will not tolerate these main destructive forces and are often planted “dead on arrival”.

Another obvious reason for poor growth if we can’t lay the blame on graft handling is the fact that there are some significant differences between scalp skin and body skin, not the least of which are thickness and vascularity.

One may simply argue that a body hair follicle simply can’t handle the comparative over vascularity of the scalp compared to thinner body skin.

Since we are in the cosmetic difference business it is best to minimize body hair FUE procedures until the destructive FUE forces are significantly reduced. Once that’s out of the way we can look into deeper physiological reasons. For now, graft handling remains the rate limiting step.

Dr. Lindsey
Reston, Virginia


#10

There is a learning curve that applies to the performance of any procedure. This applies to FUE and BHT to a greater degree than it does strip HTs. Yet, I encounter more cases of failed growth from Strip HTs coming for corrective surgery in my practice than I have BHT and FUE combined. The majority of my patient base consists of patients with failed strip surgeries from all corners of the globe.

I have provided ample evidence of successful BHT surgeries in these blogs/forums as well as groups of discerning colleagues in several meetings. Many practitioners of FUE and BHT would simply have to invest in the hard work and the necessary learning curve entailed. With BHT and FUE, there are no short cuts, and a lot of hard work is required on the part of the doctor himself. The present approach adopted by the majority of strip clinics whereby the technicians subsume the major function of the attending surgeon/physician when applied to FUE and BHT would indeed result in major problems.

Ready Freddy:

The yield Flash has thus far had in the course of his repair using ~20,000 grafts (mostly non scalp) applied to an area equivalent to almost two NW6s most of which is scarred is thus far in excess of 75% (at the very least) at this early stage of 6 months after his last major session and only 2 months after his very last session.

Flash was referred to my clinic by a reputable Facial plastic surgeon that is well respected in the HT community as a provider of strip HTs and major HT related repairs. Flash’s only option was non scalp hair, and thus far I am humbled at the turn his life has taken as a result of his BHT work. Needless to mention that both the patient and the referring doctors are extremely pleased at his progress for what was hitherto deemed an impossible repair going in.

http://www.hairsite.com/hair-loss/forum_entry-id-19419-page-0-category-2-order-last_answer.html

A few caveats for readers and aspiring BHT practitioners:

  1. Optimal BHT growth occurs at 9 months: Here is an example of a patient that emailed me at the 6 month mark after his BHT concerned about relative poor yield. 3 months later, he emailed me his update obviously pleased at his result:

http://www.dermhairclinic.com/dhc_galdetail.aspx?id=18

  1. A lot of body hair grows in as very thin hair especially when implanted into a scarred area, while the potential exists for these to thickened (typically by the 9th month), the filler effect provided remains significant and would be taken into account by an experienced BHT practitioner during the planning stages.

  2. The fact that transplanted BH is likely to retain most of its characteristics in the recipient area and that hair cyles are of less importance to BHT yield as is the implantation of intact grafts (telogen or anagen)is something I first mentioned on this forum at least 1 year before it recently became fashionable in some quarters.

In the course of performing BHT, several factors that appear key continue to emerge. These would be handled in due course in appropriate channels. The BHT/FUE discuss in the blogs has been overshadowed by excessive drama and theatrics.

S. Umar, M.D., FAAD
DermHair Clinic
Redondo Beach, California
+1-310-318-1500
1-877-DERMHAIR (US residents)
info@dermhairclinic.com
WEBSITE www.dermhairclinic.com
Single Follicule Extraction & Transfer (SFET)
Using Head and Body hair

For more SFET-FUE and BHT results go to www.dermhairclinic.com


#11

ReadyFreddy
Dont take this the wrong way but you are honestly deprived of any knowledge learned about BHT over the past several years based on your comments . You are really showing your limitations to the realistic expectations from BHT. Flash - the 20,000 graft patient referred to - had exceptional yield (I would give an estimate closer to 80-85% yield from my perspective . Again the problem here is the same as it has been an unfortunately what I suspect will continue to see - complete and total comparison to scalp hair yields and coverage expectations which is not comparable when evaluating BHT results. As far as Dr Woods comments- honestly for an M.D to say that they havent gotten around to providing pics of large BHT cases after practicing for 8 years is simply unexceptable- especially when they are on a forum making judgement against another M.D who is sdvancing the field (which I suspect is why the resentment) . So easy to criticize the work of others. If I am not mistaken Flash was referred to Dr Umar by a very reputable plastic surgeon in California who knew of no other options for Flash to pursue. Now put yourself in Flash’s shoes and imagine how elated he feels now that he is well on his way to ending this disaster.

As to the fatigue factor of an M.D- if you will follow the cases (in this case Flash) he did his 20,000 graft case in multiple phases just as most other megasession patients have done. All work was not done in 1 trip . Get your freakin facts straight before posting BS !!!

I so look foward to other megasession patients hopefully being presented very soon in the future for further learning experience with BHT/beard hair . Funny thing is I dont see to many other M.D’s posting any results of such BHT sesssion (not even close ) especially in cases such as Flash’s case which no other M.D would touch.

19,000 grafts by Dr Umar
www.myhairtransformation.com


#12

I just wanted to clarify that small sessions over several days is what I was talking about. I have utmost faith in Dr. Umar; that is why I am going to him for 3,000 grafts this June. This is being done over the span of three days. His method is obviously working.

No disprespect intended, but if you lack faith in body hair transplants, stick with scalp. Even with a regular transplant there is no way to get 100% yield. I see the use of body hair as a great opportunity; beard hair is going to be used in my scars.

Again to each his own. I’m willing to take a chance on body hair because of the positive results I’ve seen.

Some body hair transplants look better than some scalp I’ve seen. It’s all about the skill of the doc.


#13

nice points but why r the posts getting repeated.


#14

Dr. Lindsey,

I’ve had the privilege of observing hundreds of body hair FUE procedures over the years. I definitely agree with you on the torsion and traction issues. Interestingly, even with severe torsion and traction issues many patients still seem to experience quite a bit of growth. I think it goes to show grafts are unbelievably resilient and some still grow despite the abuse they take.

However, I would like to comment I think “Compression” by itself isn’t an issue. Compression coupled with torsion or traction is definitely something to consider, but the key factors in my opinion are still the torsion and traction. Several studies have been presented at the ISHRS meetings showing we can bend, crush, and otherwise abuse properly harvested strip grafts and they still grow just fine.

» Since body hair follicles are typically more fragile than scalp hair they
» will not tolerate these main destructive forces and are often planted
» “dead on arrival”.

I tend to agree with this statement, but the biggest problem is lack of data. How many quality papers have been published on BHTs? I think most observations concerning the failure of BHTs are mostly anecdotal.


#15

» » Until the grafts get blood flow they are basically under attack by free
» » radicals. To me free radical scavengers are ESSENTIAL post hair
» transpant
» » and especially with body hair.
»
» Yeah but the same can be said about regular head hair transplants.

Thats why i originally stated in the first post that body hairs must come under more oxidiative stress AND OR more sensitive to it. I do not believe that most of the failurs are from the torsion and pulling.


#16

When I attended the ISHRS meeting in 2007, there was an HT doc from Japan who made an interesting presentation entitled “The Difficulties With BHT” before Dr. Umar presented 12 impressive BHT cases.

This doc from Japan demonstrated how hair extracted from different parts of the body grow on the scalp with different yields because of extraction/transection.

This doc drew grids on the scalp to track growth and counted the body hairs growing inside the “boxes”.

He determined that good extraction is the key to good BHT yield.
He claimed transection is very common in BH extraction.
According to him, removing the BH grafts from the body is very difficult.

In my case, Dr. Umar used 1000+ leg hair grafts to soften my 1990s transplanted hairline that wasn’t holding up that well anymore.
The BHT yield was excellent in my case, IMO.
Please see the link in my sig for complete documentation w/pics.

Dr. U. worked alone (except for one assistant who counted and sorted grafts only) and the grafts were in a solution before being placed for a fairly long period of time (hours).
That didn’t seem to be a problem with yield, IMO.

Good extraction makes all the difference, IMO.
There very well be other factors as well.

But remember, I’m a patient, not a doc or tech.
Had my first HT in 1992 at 23 years old.
16 strips, one BHT test and one BHT procedue of 1000+ leg hair grafts.

BHT saved my hairline.
Choose your doc carefully.

Just my take on it.


#17

You know what guys? After reading everyone’s opinion, everyone is pretty much right. Torsion, transections, compression, crushing of bulbs from technician error as well as the physician having multiple errors, and drying of BHT grafts. BHT grafts from all of the different areas have a fragility threshold, i.e. leg hairs are more fragile than pubic or arm pit. When factoring this “fragile threshold” into the equation, one can see why clinic A has had better leg hair growth than clinic B. A fact that HAS been observed.

Rooster, on the whole scheme of things coupled with one or more issue above your dissertation into oxidative stress also has a role in the outcome of a BHT result. Although IMO and having seen different BHT docs perform this procedure first hand, most of the growth issues, I think has to do with procedure. However I am a big proponent of holding solutions that have anti-oxidants. A true anti-oxidant that protects grafts even upon transplanting them will have a very low half-life… such as hypo-thermosol. Only one clinic uses this product. Post operative sprays, IMO are good for the keeping grafts hydrated… and one can speculate that additives may cause better growth, but again we lack true research data on this. many times a post-operative spray product may be created to derive profit… who knows.

Now I read Dr. Umar’s post about the learning curve… and IMO if a doctor is determined enough and has the drive to understand BHT growth… then this can in fact be accomplished. My only argument is why did/does it have to be at the expense of the patient? Why has there never been a formal research into BHT? There is research for hair cloning.


#18

" the filler effect provided remains significant and would be taken into account by an experienced BHT practitioner during the planning stages.

  1. The fact that transplanted BH is likely to retain most of its characteristics in the recipient area and that hair cyles are of less importance to BHT yield as is the implantation of intact grafts (telogen or anagen)is something I first mentioned on this forum at least 1 year before it recently became fashionable in some quarters." Iteresting. Post. Hair cycles are less of importance. Ok. Question? You were trained by Dr. A. So do you have a few assistants like he does planting them? Or do you do what Dr. Woods does and plant yourself all the grafts?

#19

I forgot to add that anagen/telogen ratios matter in BHT. In that a long time ago, there was a large debate if telogens(BHT) were transplanted, would they cycle back into Anagen phase and begin growing. Unfortunately no real studies were performed to dicern this information. I believe there was one single experiment where telogen BHT’s were planted in a bald box and so were anagens, but nothing resulted and/or the experiment was not repeated.

There is a possibility that BHT failure/poor growth could be also directly related to transplanting telogen. No one knows. What does remain to be a fact is that patient by patient the number of telogens to anagens vary. I have seen a patient come in and have 90% telogen and 10% anagen(rare but has been observed). More often do we see a 70% anagen to 30% telogen… so if the clinic decides to transplant telogens (and many times they do… sometmes the technicians do not know which is which) then you must add that factor in the mix.


#20

» I forgot to add that anagen/telogen ratios matter in BHT. In that a long
» time ago, there was a large debate if telogens(BHT) were transplanted,
» would they cycle back into Anagen phase and begin growing. Unfortunately
» no real studies were performed to dicern this information. I believe there
» was one single experiment where telogen BHT’s were planted in a bald box
» and so were anagens, but nothing resulted and/or the experiment was not
» repeated.
»
» There is a possibility that BHT failure/poor growth could be also directly
» related to transplanting telogen. No one knows. What does remain to be a
» fact is that patient by patient the number of telogens to anagens vary. I
» have seen a patient come in and have 90% telogen and 10% anagen(rare but
» has been observed). More often do we see a 70% anagen to 30% telogen… so
» if the clinic decides to transplant telogens (and many times they do…
» sometmes the technicians do not know which is which) then you must add
» that factor in the mix.

Hairtech, good posts. Why is it Dr. Cole for instance says it may be 2 or even 3 years for a BHT to start growing? What are your thoughts on this? Dr. Umar says it is much shorter. I don’t see how the resting phase can be 2 years. I wonder what the thoughts are behind this.