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Restoration Surgery
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Micro Grafting, Mini
Grafting and Blend Grafting
Number of Grafts
and Their Costs
The
Principles and Methods of Graft Transplantation
The
Growth of the Transplanted Grafts
The
Principle of Scalp Reduction
Hair
Replacement in the Female Patient
Before
and After Photos
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Micro
Grafting, Mini Grafting and Blend Grafting
I continue to stress the theme of naturalness and undetectability.
Ask yourself this question… when I look at a full
and natural hairline, what do you see? This question
can be best approached by saying; it is not what you
see, but rather what you do not see that produces the
naturalness. You don’t see an ordered and predictable
pattern of hair, but rather an uneven spacing with smaller
diameter hairs admixed with larger ones.
Therefore, to
reproduce naturalness, I employ not only regular size
grafts, but smaller grafts of varying size and hair
thickness, as well as varying hair shaft diameters.
It is exactly this variance that produces the desired
effect!
Beginning with
the first transplantation, I begin to “step down”
in size of grafts, mixing larger grafts with those that
are 1/8 the diameter of a straw, containing a few hairs
and placed discreetly and meticulously at the edge of
the hairline. This prevents the “corn row”
or “doll’s hair” type of appearance
which you are afraid of, I despise, and no patient wants!
Know that the
types and numbers of micro and mini grafts I use in
any particular case depends on the type of hair style
you wish, the extent of hair loss you have, and the
extent of hair replacement you wish to have. Remember
curled, permed or comb over styles will require less
blend grafting, whereas a straight back style requires
more. Furthermore, the treatment of bald areas in the
back of your head and the crown area require much less
blend grafting than the work necessary to develop natural,
undetectable frontal hairline.
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Number
of Grafts and Their Costs
Hair restoration is no longer just putting a specific
number of plugs in your head. Yet many of my patients
judge the efficacy and worth of a transplant procedure
solely by the number of grafts transplanted and their
costs.
Let me expand
on this a little. Suppose I transplanted 1,000 grafts
to your head and each contained only one hair (which
some doctors do). I would only move 1,000 hairs to the
bald area of your head, and at a rate of $6.00 per graft,
you would pay $6,000. On the other hand, suppose I transplanted
500 grafts but instead of each having one hair, some
of those grafts had 10 hairs and some of them had 12
hairs and some of them had 4 hairs and some others had
one or two hairs. You can now see that although the
actual number of grafts was smaller in size, the amount
of work and the amount of hairs restored were significantly
greater (almost four times as much). Yet the cost based
fee alone would be $3,000 – half as much!
The point here
is not to judge the extent, the worth, or the cost of
the procedure by the graft number alone or the cost
of each individual graft. I will be specific with you
as to what type of grafts you will need, where they
will be located, how they will be placed, and the overall
design of your procedure and treatment plan.
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The
Principles and Methods of Graft Transplantation
In the most advanced cases of male patterned baldness
is a horseshoe shaped fringe of hair persists. This
remaining hair is named “terminal hair”.
This hair is thicker, more pigmented and grows fully
and rapidly. This differs from what is called “vellus
hair”, which is noted directly in the balding
area. Areas where vellus hair is will ultimately go
completely bald.
You can see
that the principle of hair transplantation is a very
simple one, namely, to move terminal hair into areas
where there is no hair or where vellus hair exists.
The success of hair transplantation depends on the fact
that terminal hair follicles will continue to grow in
the transplanted site for the rest of your life. This
pattern of behavior has been consistently observed for
over 40 years. The rate of growth will be approximately
5 – 7 inches per year.
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The
Growth of the Transplanted Grafts
Take great comfort in knowing that the “take rate”
or “success rate” of transplanted grafts
is excellent. A great deal of caution is exercised to
make sure that the grafts are taken and cleaned properly,
then meticulously placed in the proper setting. We do
not attempt to place too many grafts in one session,
nor do we attempt to place the grafts too close together
in the initial procedure. This ensures the best success
rate.
How good is
that success rate? My patients have a consistent success
rate of 98 to 100%. That means that if 100 grafts are
placed, 100 grafts should grow – and grow well.
Great comfort is taken from this figure since that is
exactly the success rate we have produced over the last
25 years!
To ensure the
best quality take there is spacing between the initial
grafts. We put the graft site to rest and let it heal
for approximately 3 months. This provides the best possibility
of natural results. Then the fill in procedures begin.
We start by instilling the 1, 2, 3, or 4 hair micro
and mini grafts to produce a perfectly blended hairline.
Producing a fixed hairline in one session results in
low take and a dissatisfying end appearance.
The hair stubs
in the transplanted grafts usually are shed between
the second and third week post op. In 5% of the case
the originally planted hair stubs shed. Then, approximately
8 to 12 weeks later, you will notice a new generation
of hairs at the surface. These are permanent terminal
hairs that will grow at a rate of 5 to 7 inches per
year.
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Procedures for Performing Mini
and Micro Graft Transplantation and Scalp Reduction
On the day of your surgery, we will review the entire
scenario with you. You will be quite comfortable; then,
and only then, will the procedure be performed. It is
a comfortable experience, which is not painful. In fact,
I promise that both of these 2 and a half hour procedures
will be pleasant for you.
The transplant
site will be anesthetized by injection of local anesthetic.
In most cases anesthesia occurs rapidly. Then I take
a strip of hair from the back of the scalp and use it
to make hundreds of mini and micro grafts of varying
sizes. These grafts, which are held in place by your
own tissue, are arranged to produce the most natural
appearance possible.
Both of these
procedures require a “turban like” bandage
to be worn for at least one day. This helps the healing
process. The bandage is removed on the first post-operative
day in our office (or you may remove the bandage). At
this point you may shower and shampoo your hair, lightly
rinsing the grafted area under a mild stream of warm
water. On the fourth day, you may shampoo and style
your hair. On the seventh day you will finish the precautionary
antibiotics that were started prior to the procedure.
These precautionary antibiotics are taken in to prevent
very rare infections. Other medications are given for
those patients who have more swelling than others.
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The
Principle of Scalp Reduction
Twenty five years ago, I began explanations to my patients
on the principles of scalp reduction. At the time, the
procedure was nearly unheard of. Today, however, this
procedure is much more recognized and readily accepted
as one of the tools I use in hair replacement surgery.
What is it?
Simply this – instead of filling in all the balding
areas of the scalp, I surgically remove part of the
balding area and replace it with hair. How much do I
remove? This depends on the patient. Some patients’
scalps are very elastic; others are not. But, in almost
all patients, I can reduce the balding area by 50 to
sometimes 70% just by employing this procedure in one
or several sessions.
This procedure
does not change the shape of your head or placement
of your ears. It does reduce the amount of balding area
you have, thereby reducing the number of grafts as well
as procedures or sessions necessary to give you the
full natural look. I consider scalp reduction a vital
part of the armamentarium of procedures for hair replacement
surgery.
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Hair
Replacement in the Female Patient
The prevalence of baldness or hair loss in women remains
one of the most unappreciated statistics in modern medicine.
Over one million women in the Untied States suffer from
hair loss. Women most often will suffer hair loss in
the frontal and temporal areas of the scalp. Although
the gender is different the aim is very much the same;
to replace hair loss in such a fashion to provide complete
naturalness and udefectibility.
Due to the greater
flexibility and variance of hair styling as well as
acceptable hair length, woman are excellent candidates
for hair replacement surgery by means of mini and micro
grafting and scalp reduction. All factors such as time
intervals, spacing of the grafts, and post-operative
care remain the same as in male hair replacement procedures.
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