Hair loss is a lifelong progressive condition. Addressing hair loss with a surgical solution such as hair transplantation can be a great option. It’s very important for the prospective patient to understand the natural progress of their future hair loss and also understand how hair transplantation can play a role in that progress.
Surgical planning for hair transplantation is as important as the successful technical execution of the hair transplant. Dr. Ratushny frequently informs his patients with advanced hair loss that they may benefit from sequential hair transplantations to further augment and refine their results. Nonetheless, Dr. Ratushny believes that each hair transplantation should stand on its own even if the patient never has a future hair transplantation. However, there may be multiple benefits of having a follow up hair transplant:
- You can evaluate the final result of the initial hair transplantation. One year after the initial hair transplantation, both the patient and the hair transplant surgeon can assess areas of fullness and areas where a little more density can be attained if the patient decides to get a second hair transplantation.
- It can allow a patient to see if they would be satisfied with this level of hair restoration and gives them the option to decide whether they want to do another hair transplantation in the future or not.
- It can preserve their donor zone, which is the area in the back of the head that was used for the hair transplantation. Since the donor follicles don’t grow out after they are removed, people only have a limited number of donor follicles that they can use for hair transplantation for the rest of their life. Making sure that one hair transplantation doesn’t deplete a patient’s donor zone is important to ensure they have more options in the future in case they want to do a future hair transplantation.
The patient in the photos presented to Dr. Ratushny with Hamilton-Norwood Class 6 hair loss at the time of his initial hair transplantation consultation. Dr. Ratushny informed the patient that given his extensive hair loss and his hair transplantation goals, he may benefit from have sequential hair transplantation. The patient underwent his first hair transplantation, during which he had 840 follicular units transplanted, with a focus on the hairline and frontal scalp. Given that each follicular unit is made of 1-4 follicles, with an average of 2.5 follicles per follicular unit, the patient actually received approximately 2100 follicles transplanted. It takes approximately 1 year to see the final results of a hair transplantation. As one can see at the 1 year follow up visit, even 1 hair transplantation reframed the patient’s face and changed his appearance for the better. His hairline was also designed to appear realistic and was designed to appear like he was in an earlier stage of baldness. Given limitations of donor zone in light of significant recipient zone needs, it is important to design a conservative hairline in patients with advanced balding so as to have a realistic appearing result and have donor zone density left over for future hair transplantation.
The patient had a second hair transplantation after 1 year, during which Dr. Ratushny performed an FUE of 939 follicular units, which involved transplanting approximately 2347 hair follicles. The focus of the follow up hair transplantation was to augment the density at the hairline and frontal scalp by placing follicles between the original transplanted follicles. Additionally, the second hair transplantation also focused on the mid scalp. The patient came back a year after his second hair transplantation and he was very satisfied with the results. Additionally, the patient still has plenty of donor zone hair remaining if the patient ever decides to get another hair transplantation in the future. This is a good example of great results obtained with a sequential hair transplantation, while avoiding depletion of the donor zone with one very large hair transplantation.