I do everything to ensure the most density possible.
Diagnosis and Planning
In the general population, the most common cause of hair loss is Male Pattern Hair Loss. However many other factors may be involved, both alongside Male Pattern Baldness as well as a myriad of many other conditions I treat. With an accurate diagnoses, I can determine if Surgical Follicle Renewal is the best option versus other non-surgical alternatives. Planning for this comes from a shared vision between both the doctor and the patient (and may also include a spouse or other confidant). The strategy must be particularly mindful of the risk of ongoing hair loss and includes a number of important factors such as hair color and texture, scalp complexion, personal history of hair loss, family history of hair loss and overall shape of the scalp, face and the general overall aesthetic appearance.
Photography is a good way to measure the progress and Dr John Frank will use multiple angles, exposures and lighting conditions to recreate your everyday natural appearance. Before beginning, we will carefully draw areas on the scalp as a roadmap to follow during the actual placement of the grafts. All of the steps in Follicle Renewal are necessary and important, however, the final results are ultimately judged by the cosmetically pleasing return of hair. For this reason, all planning, rationale, precautions, effort, focus AND VALUE JUDGMENT should be squarely focused on this principium or basis. Dr John E Frank, MD reviews the accurate estimate for the objective of the number of grafts as well as the technique for harvesting the follicles.
Harvesting the Donor Hair
Hair Is removed from the “Stronger” areas of the scalp, usually the back and the sides (often referred to as the Donor Area). We like to refer to it as the “Tropics”. The hair must be harvested with the entire bulb or root intact for it to be useful (simply plucking the hair will not work). Otherwise known as the Hair Follicle, this tiny bulb of isolated skin and hair is further processed, refined and isolated for the next step, the placement.
As the technique for hair transplant has evolved over the past 25 years, a number of techniques have been developed for the harvest of the hair follicles. One way to isolate hair follicles from the donor area is to remove a group of follicles from the body (thousands at a time) and then to dissect away each individual follicle using stereoscopic microscopes on a separate table away from the person. This is a standard, “strip” transplant, sometimes called FUT (Follicular Unit Transplant) using a strip or band of scalp. The other common way to isolate hair follicles from the donor area is to remove them from the patient one follicle at a time. Modern surgeons have been debating the benefits and detractors for both types of harvesting and the debate continues amongst these harvesting techniques.
The Handling and Refinement of The Follicles
During the stereoscopic dissection and isolation of the follicles, the utmost care must be taken to preserve the fragile tissue. The standard and proven factors to maximize survival of the grafts outside the body include gentle handling, hydration and refrigeration. Different preservation solutions are currently in use but until a clear and distinct one is proven, Dr Frank prefers to rely on sterile saline, rather than being swayed into the latest fad (ie PRP, Lactated Ringers or Other Iterations). Using stereomicroscopic vision, the extraneous skin and fatty tissue is removed from the main elements of each individual hair follicle until only the key growth centers remain. The graft is now readied for implanting back into the bald scalp.
With a design established, tiny clefts are created in the scalp just large enough to hold the new grafts. In a coordinated effort, Dr Frank and the technicians configure the openings which house each graft. For the John Frank MD Follicle Renewal Team, the important considerations include: contour, density, depth, size, orientation(as in coronal or sagittal), total number of grafts, angle or incline and gentle placement. For the patient, it is normally a relaxing, comfortable time, spent watching movies, socializing with our staff or catching-up on some work. You will be able to have lunch with us, take restroom breaks or inform relatives about your own status and the timing of the procedure. For us, it is the essence and quintessential part of the procedure. While we may appear to be casually working, it is our objective to succeed at perfectly placing the follicles in designed locations.
During the final steps of the placement process, we will diligently scan all surgical areas looking for spaces or potential missed areas and when necessary, delicately place the remaining grafts in a “Stick and Place” fashion. This is essential when re-creating a hairline zone. The properties and texture of each individual’s skin with regard to the elasticity, thickness and other factors influence how the grafts are placed.
We want you to be comfortable while we are working and will use gentle and delicate accoutrements-some with scary names, but all carefully designed to painlessly create the openings and gently place the grafts. We are certainly willing to show and review anything with you before, during or after the procedure.
Once the follicles are all placed and checked, the acute phase of healing usually takes from 48 to 72 hours. However the hair will begin growing over a lengthier period of about 4 to 6 months while the newly transferred follicles blend in with the surrounding scalp.
Prior to leaving our office however, we will review the aftercare with you as well as providing you with written instructions and helpful pointers. Your job will be to protect the new implants while keeping them as moist as possible. Nothing should preclude you from your normal routine within 24 to 48 hours of the procedure, but we are anxious to know the extent of your activities (no head stands please!) We offer that you come in for a hair washing and cleansing during the first 72 hours, however this is not mandatory.
Hair Growth and Aftercare
Once the grafts are in place, the healing phase begins. The surface of the skin begins to heal and the grafts deeper within the dermis are adopted as part of the surrounding tissue. During the first 48 hours, it becomes important to minimize contact with the surface of the healing scalp with anything but moisture. Try not to touch it. We prefer sterile saline, however a number of other solutions are being tested. Soon after the acute healing phase (3-4 days), any scabs or crusts should either fall off, rinse off or get pealed away from the scalp. There may be some temporary numbness of the scalp, secondary to the anesthesia and stress to the scalp. The next phase is really a waiting period over several months until the follicle growth centers begin to produce the new hairs.