How does the recipient area change after 1 or 2 hair transplants? If 1 mm punches are used to place the grafts, does it result in less yield from future hts due to scarring or does the tissue return to normal? How would this effect something like acell if it does turn out to be the solution for the limited donor supply problem?

I think you are referring to the donor area. No surgeon should be creating recipient sites with a punch in modern day hair transplant surgery.

If you mean the donor area (back of the head) that has been harvested with 1mm FUE punch, then the logical answer is that the donor area would be depleted of however many grafts/hairs were harvested. The donor area, depending upon your donor density, can supply 4000-9000 grafts in your lifetime. As the number of grafts come out, the remaining supply will obviously decrease by that same amount. The resultant scarring of the donor area may (or may not) impact any future FUE surgery. Each and every patient is different.

Finally, I do not know how ACell will impact hair transplant surgery in general. It is anybody’s guess at this point.

Dr Rassman

In contrast to transplants using scalp donor hair, I appreciate that the probability of technical and cosmetic success with body hair and other nonhead hair transplants for severe cases of baldness remains unclear. Today I read an article in a well-regarded journal that describes 3 patients who had a significant cosmetic need resulting from poor previous surgical procedures and exhausted scalp donor supply (Umar S. Ann Plast Surg. 2011 May 2. [Epub ahead of print]). The article appears online in this month’s journal before its appearance in print and can be accessed here.

The outcomes with nonhead hair appear to be excellent. Given the varied and anecdotal results with BHT (and nonhead hair, in general) infrequently reported (in blogs) by different patients and physicians (1) do you see a role for nonhead hair in individuals who are in situations similar to that described by Umar?, and (2) wouldn’t it be of great value for those who perform nonhead hair transplants to pool their experiences and data to potentially better understand (and publish in a peer-reviewed journal) those patient or physician factors, or both, that may contribute to and predict good outcomes?

I have seen some good results reported from body hair transplants (BHT) so there may be instances where it could be an option, but I don’t generally recommend it due to the variability in texture and growth cycle. I’ve previously written about using scalp and body hair together in transplantation, and remain neutral. My opinion continues to be that body hair should only be used when you run out of donor hair from the scalp, but having said that, I would consider it as one of the last options.

With respect to pooling the experiences and data for a better understanding, I believe it is a great idea. In practice, I don’t know how the accumulation of data from all the body hair patients and their surgeons would be delineated. By that I mean that most surgeons wouldn’t want to publish or admit to bad outcomes, nor would certain patients want to participate in the study. My point is that it stands risk of a skewed study… but perhaps I am just a skeptic.

Have you performed multiple Hair Transplants on one person only to discover that the person might somehow not be suitable for further Hair Transplants because the grafts didn’t grow in from either operation.

No. I have seen men that lost hair following transplants (shock loss), but it was likely their native hair that fell out. This is a real problem in young men, especially if they did not take Propecia before surgery.

I have also seen men with DUPA (diffuse unpatterned alopecia) who have had failed transplants as well. Patients with DUPA are not candidates for hair transplant surgery. Hair transplant failures are most often the result of poor techniques and quality control of the process by the doctor and his staff.

Out of curiosity, is it possible to artificially create a cowlick using transplantation? Have any patients ever asked you for this?

Yes, creating a cowlick is possible. I have done a few of them, but it is rarely asked for. Many men hate their existing cowlick.

Hello Doctor

a very well known doctor claims that he was able to harvest 7600 grafts from a patients beard and transplanted it to its scalp. Now is that possible?

I have done several beard to hair transplants and they are relatively easy, but I really don’t know if the beard contains 7600 movable grafts. Is it possible? I suppose. Some people may have very high density hair in their beard.