Besides for the possibility of a halo formation, another reason
to proceed with caution in the vertex is the angle of hair growth
giving an appearance of less density here. An
analogy should help with the explanation. When someone drives through
a pine forest, the forest appears much denser than if he flies over
it, looking straight down on the individual trees simply because
of the angle he is viewing it from. Similarly, if the same number
of follicular units were transplanted into the frontal scalp as
into the vertex, and these two recipient areas were equally bald
to begin with, the transplanted front would look much better than
the transplanted vertex. It all depends on the perspective. When
someone judges results in front, he does it by looking directly
into a mirror. He is looking through the transplant. In order to
judge the vertex, he must now take a second mirror directed to reflect
straight down onto the vertex. Even though the follicular units
grow the same in both locations, the growth in the vertex will look
thinner because of the viewing angle.
Another factor to consider when contemplating a transplant is the
final thickness of the transplant. Despite some advertising, a single
transplant does not give full
thickness. Only someone with coarse, curly hair may look like they
have close to full thickness after a single transplant. For someone
with average hair, and, in fact, even for many with coarse, curly
hair, higher densities will only be reached by re-implanting this
same area at a later time. I prefer to wait a minimum of six months
before re-transplanting this same area for several reasons. First,
I like to be able to be sure we are implanting the second series
of follicular units between the first set and not on top of them.
Second, the sutured donor site will be well healed at this time
and, hopefully, the surrounding scalp will be relaxed so that I
can harvest a strip with good width on the second excision. If they
are willing, I encourage my patients to wait a full twelve months
before deciding about a second transplant. Many patients who give
it this extra time realize that by letting the transplant get some
length to it and by styling it in certain ways, they actually do
not need another transplant. Although it is not full thickness,
it looks good. They realize they just needed some, not all, of their
hair replaced.
Depending on the nature of the hair and on how closely the follicular
units are spaced during planting, the patient probably will require
two to three transplants, at least, to take a balding area and give
it the impression of full thickness. I say “impression”
because it has been shown that we do not require our original density
of hair to look like we have full thickness. If I took a scalp that
had no previous hair loss and started plucking individual hairs,
I would have to remove approximately 50% of the hairs before it
would start to look like it was thinning.
Next Topics:
After The Hair Transplant
Choosing a Hair Transplant
Surgeon
Possible Hair Transplant Complications
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