procedures are not just medically difficult to perform
and hold many complications that a virgin scalp does not,
but it can also create a high expectancy and consequently
can be an emotional experience.
also has to be understood that it may not be possible to repair
all of the damage previously caused by bad procedures, and
it may take multiple procedures to achieve the required goals
. When assessing a repair case it is usual to set out priorities,
areas that cause the greatest concern are given priority to
ensure that these areas are treated with optimum effect; if
areas have to be left until a later procedure then rest assured
there will be a good reason, the ultimate result. As with
any hair transplant there needs to be an honest and open dialogue
between doctor and patient, so both understand and agree the
goals and the patient is aware that limitations can apply
as to what can be achieved.
times it will be necessary to remove old grafts and redesign
the hair line, this can be achieved with a FUE
punch, if the grafts are too big or placed close together
a punch may not be possible and the area needs to be sutured.
It may not be possible for all grafts to be removed, and some
may grow back, as a result a future procedure may be necessary.
poorly placed or angled grafts normally comes pitting and ridging
of the skin; this is either a “crater” created when
the graft is placed or a raised area of tough skin around the placement
area. Pitting can repair after the graft is removed and over time
the skin should return to normal, but this can depend on the size
of the graft and how difficult it was to remove. Ridging or cobblestoning
is less forgiving on the scalp. Both factors will impair the placement
of new grafts and may cause a lower yield than expected from a virgin
scalp because of the scarring aspect. This may affect the density
or thickness because the yield is lower or the placement was decided
to be lower to protect the yield.
donor area is vital to a repair and will determine the result that
can be achieved in the near and longterm future. If the donor area
has already been impaired, this may mean it has been over harvested
with a large punch via FUE or incorrect position of the
strip scar or stretching back of the scar. When dealing with
an old strip scar there are options, either to englobe the scar
if wanting to remove more grafts, revise the scar or add grafts
into the scar to camouflage it. Englobing or revising does not ensure
a thinner scar than before, it is impossible until the incision
is made to know the depth of fibrosis under the skin or to determine
how the new scar will heal. Do not assume the scar will be smaller,
and certainly not invisible. To add grafts into the scar can be
a good option depending on the size of scar and how well it has
healed. It is considered that the yield will be lower when placing
in a scar line and it is prudent to place a lower density initially
and measure the yield before using too many precious grafts that
might not subsequently grow.
Hair FUE (BHFUE) uses the same principles of extraction as FUE,
but the hair is extracted from various parts of the body and not
from the scalp. BHFUE is recommended in cases where there is insufficient
scalp donor hair.
is a relatively new form of hair replacement; it is important to
appreciate that because of genetic variants, hair characteristics
and growth rate, BH will behave differently to scalp hair and the
yield can be much slower and lower. BHFUE in certain special instances
may be the answer to repair or restore hair but only after an extensive
consultation period. A patch test would also be undertaken.
compatibility of scalp and body hair is very important; studies
show that body hair has a very short anagen phase and a very long
telogen phase, hence the length can be different from scalp hair.
In addition the colour and curl must be compatible to the natural
scalp hair. Usually the colour is rarely a limitation but the curl
can sometimes differs and we need to have a satisfactory degree
compatibility to continue.
photo illustrates extraction of the chest hair graft.
is BHR Policy to always patch test body hair FUE prior to
the patient undergoing any extensive procedure. The patch
test is completed and then assessed over six months, if results
are found to be positve then we may proceed. The body hair
patch test is free of charge at BHR.