NY Hair Transplant Surgery : Philosophy on Restoration

Additional Topics:

-	Limited role of scalp reductions
-	Use of Propecia/Rogaine
-	Transition from a hairpiece to hair transplants
-	Temple area transplantation
-	Trans-gender Transplantation
-	About Donor Scars

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60 Railroad Place Suite 102 Saratoga Springs, NY 12866
Phone: 518-581-1872 Toll Free: 1-800-281-9198
e-mail: saratogahair@spa.net

Summary of our Philosophy
on Hair Restoration

Dr. Beehner in consultation

Drs. Beehner and Pawlinga with office staff

For each patient that presents to us for hair transplantation, our goal is to try and achieve as much naturalness and density as possible. We feel these two goals are best achieved when the plan is individualized for each patient, depending on what we are presented with. There are a host of factors that must be taken into account with each patient before formulating the best plan: Some of the more important factors are: the patient’s age, the hair-to-skin color contrast, the caliber of the hair, the patient’s goals for later styling, and, perhaps most important, the ratio of available donor hair in relation to the recipient area in need of coverage.

Choice of Two Different Transplant Methods

Click to enlarge images

Follicular Unit Grafts

Multi-follicular unit grafts (MFU's)

We also try in every case to involve the patient in the decision- making process. We explain that we offer both of the current philosophic approaches that exist in the world of hair restoration today: namely, the exclusive use of follicular unit grafts (1-3 hairs apiece), and the use of “combination grafting” (70% single FU’s and 30% Multi-FU grafts). After explaining this choice, the majority of our patients choose the "combination" approach. We think that, for many patients, using both types of grafts makes the project more affordable, gives a final result that has the greatest possible central density, and the visible border areas are just as natural as with an "all FU" approach. There are some patients in whom this decision as to the best method to use is very easy to make. For example, in a man with extremely dark hair and light skin, who has an oily, hyper-elastic scalp, we will only do such a patient with FU’s alone. Conversely, in a man with “salt and pepper” hair, it is greatly to his advantage to have some “combination” double and triple-FU grafts placed centrally for density. The bottom line is that we perform both of these types of transplant procedures, we explain the advantages and disadvantages of each approach, and we let the patient decide which way we will proceed.

Using a “Global Approach”
In transplanting our patients, we use a "global approach" to planning - which means that at each session we transplant the entire area that he or she wants covered with hair. We don’t "inch" our way backwards over a great many sessions, doing a "little bit at a time." After only two to four sessions, most men (and women) are completed. An important part of our planning is that we transplant FU’s into the adjacent , nearby rim of “good” hair where a patient’s thinning/balding is almost certain to expand into during the next 10-20 years. By placing hair in these adjacent areas, there will always remain in place a natural transition of hair to the nearby fringes.

How Many Sessions?
Besides the decision as to graft type, another important decision regards how many sessions are likely to be needed to achieve the patient’s goal of a “full, natural head of hair.” With rare exceptions, this process usually takes 2-4 sessions in our practice. Most of our female patients and those males with some remaining hair on top are completed in two visits. Most men who are totally bald take three sessions to complete. We believe there are several good reasons to accomplish a patient’s transplant over time in 2-4 sessions:

a) Such an approach respects the blood supply of the scalp, leaving some space for blood to reach all the grafts planted, with a resultant high-percentage yield of survival for those hairs.

Dr. Beehner teaching new techniques at ISHRS Live Surgery Workshop in Orlando in 2006

b) The surgeon can be more artistic, similar to a painter, who goes back to his easel repeatedly, making artistic “touches” to his work as he views it unfolding.

c) A larger area of the scalp can be worked on. We offer a “dense-packing” 1500-3000 FU session, which seeks to fill in the area transplanted in one session, but it is a very laborious and expensive way to transplant, and only certain patient have the necessary hair characteristics that will enable this method to work. The hair must be reasonably coarse, the scalp’s thickness must be above average, and the number of 2 and 3-hair FU’s must be higher than average. (See section on “Dense-packing mega-sessions”). The great majority of our patients, both male and female, present to us requesting that at least the front 75% (all but the rear vertex) or the entire “U” shaped balding area be filled in. Using “combination” grafting, this is a do-able project and we have been very successful with our approach of using 2-3 sessions to accomplish the task. If all FU’s were scattered over such a large area, it would have a very uniform and “thin” look without the usual natural gradients of density we see in the natural state.

d) Gradients of density can more easily be created. In our transplanting, we try to reproduce a pattern of hair that could be naturally seen on someone’s head, such as in a man who is only starting to thin in the crown or the crease areas.

e) The financial burden of having a transplant is spread out over time a little more. In the meantime, even 6-8 months after the first session grows out, there is an immediate positive change in the person’s appearance. The patient can then control over how much time he wants to have the sessions and can schedule his follow-up procedures according to his wishes for more density and his ability to pay for the added work.

f) Hair survival percentages are very high. We have conducted 4 different research studies (see research section) looking at the survival of different types of grafts. Our studies suggest that the multi-FU type of graft more consistently survives in the near 100% range, and can be an important contributor for later density.

g) There is less risk for a wide donor scar. By limiting the width of the donor strip to 1cm in width, and then going to whatever length is necessary for that session, and spacing the sessions at least several months apart, the scalp in the donor area has time to once again becomes lax. At the next transplant session, the donor hair is obtained from just above the old scar, with a single thin scar resulting at the end of the 2-4 procedures. We feel that trying to obtain 3000+ FU’s at a single session requires a much wider strip and carries with it the risk for a wide scar later on.

Importance of the Front Hairline
From the start, we focus on creating a natural hairline. At each session 320-400 "follicular unit grafts" are placed along the hairline in a natural, undetectable, random pattern. 1-hair FU’s are always placed at the outermost rim, quickly giving way to 2-hair, and then 3-hair FU’s, so as to effect a graded, natural density to the hairline. We give the same attention to the other visible locations of the scalp, namely the rear border and the two "crease" areas. These other areas often become critically important later in life, should the hair in that area thin or recede. In all four of these areas, and also the crown as a whole, we believe it is best to only use "follicular unit" grafts, in order to preserve a natural appearance and minimize any risk of detectability.

Importance of the Doctor-Patient Relationship
The relationship between physician and patient in our practice is one in which there is a maximum opportunity for communication and knowing what the other thinks and desires. There is no pressure at all. Making a sale or scheduling a surgery is not our goal or priority. Establishing an open, trusting relationship for life between doctor and patient is what is most important. Follow-up calls or visits are always welcome. Direct access to Dr. Beehner, whether by phone, e-mail, or in person, is always available.

We Are Conservative in Our Planning
And finally, we are somewhat conservative in our planning approach. We appreciate and try to anticipate that baldness is a relentlessly progressive condition that goes on to some extent as long as you live. Because of this, we plan your transplant design in such a way that it will look good not only in the next few years, but also in 15-20 years. We generally do not transplant the vertex (crown) under the age of 38, as we have no idea how large it will become in later years.

In summary, if a person was preparing to make a very important purchase of something that had great personal value – such as an engagement ring for his fiancé, or a special painting for the foyer of a beautiful home – he would not blindly pick out with his finger an unknown Yellow Page listing, nor would he shop around and automatically purchase it from the merchant who listed a generic representation of the desired object at the lowest cost. This same care should be taken in choosing a hair transplant surgeon. Above everything, what you should be looking for is an artist – someone whom you will entrust with the all-important task of creating a natural appearing head of hair that will endure for your lifetime. Everything we do – the time and care with which we approach each procedure at our office – is geared toward creating a natural result that is both priceless and timeless.

Summary of our Philosophy on Hair Restoration

Summary of our Philosophy
on Hair Restoration