Hair Transplant Surgery - Scientific Papers

CORRECTING VERY LOW TRANSPLANTED HAIRLINES: FUE x LASER
AUTHOR: ANTONIO RUSTON M.D.

INTRODUCTION: ONE OF THE CHALLENGES OF OUR FIELD IS CORRECTING THE VERY LOW TRANSPLANTED HAIRLINES NOT ONLY BECAUSE THE STRATEGY ITSELF IS HARD BUT ALSO BECAUSE GENERALLY IN THESE CASES THEY ARE YOUNG PATIENTS AND THE DONOR AREA IS DAMAGED WITH PUNCHES AND/OR BAD SCARS, SO THE DONOR SUPPLY IS RESTRICTED.

OBJECTIVE: IN THIS PAPER, THE AUTHOR SHOWS THAT IT IS ABSOLUTELY POSSIBLE TO FIX VERY LOW TRANSPLANTED HAIRLINES, USING FUE OR LASERTHERAPY AND IN WHICH CASES HE USES EACH ONE OF THESE STRATEGIES.

MATERIALS AND METHODS:
THE FIRST ASPECT THAT WE HAVE TO TAKE INTO CONSIDERATION IS THE BALANCE BETWEEN DONOR AND RECIPIENT AREAS, NOT ONLY NOW BUT ALSO IN THE FUTURE WITH THE PROGRESSION OF BALDNESS.
AFTER THAT WE SHOULD ANALYZE HOW LOW THE DESIGN IS.
WHEN THE PATIENT HAS A VERY LOW TRANSPLANTED HAIRLINE, WITH PLUGS, LIMITED DONOR SUPPLY OR WHITE HAIRS, WE HAVE OPTED TO REMOVE THE PLUGS OR THE TRANSPLATED HAIRS USING THE FUE.
IN THESE CASES WE HAVE BEEN USING PUNCHES WITH DIFFERENT CALIBERS DEPENDING ON THE SIZE OF THE PLUGS.
WE HAVE PREFERRED, WHEN POSSIBLE, TO USE THE 1.00MM PUNCH THAT WE CONSIDER THICK ENOUGH TO REMOVE THE TRANSPLANTED HAIRS AND THIN ENOUGH TO NOT CREATE HYPOCHROMIC SPOTS OR SCARS, BUT IN SOME CASES WE STILL HAVE TO USE PUNCHES WITH HIGHER CALIBERS AND CLOSE THE WOUNDS WITH
NYLON 6-0.
THE ADVANTAGE OF THE FUE IS THE POSSIBILITY TO REUTILIZE THE FOLLICLES THAT HAD ALREADY BEEN TRANSPLANTED.

WHEN THE TRANSPLANTED AREA IS NOT TOO LOW, THE HAIRS ARE NOT WHITE AND WE HAVE A REASONABLE DONOR SUPPLY WE HAVE PREFERRED TO USE THE LASER TO CREATE A NEW AND HIGHER HAIRLINE.
THE ADVANTAGES OF THE LASER ARE: NO SCARS, NO RESIDUAL HAIRS, AND A MORE ACCURATE DESIGN.
THE LASER WE HAVE UTILIZED IS THE LIGHTSHEER 800nm, FROM 2 TO 5 SESSIONS; DEPENDING ON EACH CASE TO REMOVE THE UNAESTHETIC PLUG THAT IS OUTSIDE (LOWER) OF THE NEWLY DESIGNED FRONT LINE.

BUT WE ALSO HAVE TO FACE BODERLINE CASES, WHICH MEANS, CASES THAT WE DO NOT KNOW EXACTLY WHAT THE BEST STRATEGY OPTION IS, THE FUE OR THE LASER. IN SOME OF THESE CASES WE USE A COMBINATION OF THESE TWO STRATEGIES.

WHATEVER THE ADOPTED STRATEGY IS, WE ALWAYS DESIGN, TOGETHER WITH THE PATIENT, A NEW HAIRLINE, HIGHER THAN THE ANTERIOR ONE TO REDUCE THE TRANSPLANTED AREA.
WHATEVER IS ANTERIOR (LOWER) WILL BE EPILATED UTILIZING LASERTERAPY OR WILL BE REMOVED WITH FUE.

DISCUSSION AND RESULTS: IN PATIENTS WITH A VERY LOW HAIRLINE, WE PREFER TO REDUCE THE RECIPIENT AREA BECAUSE WE WOULD NOT HAVE ENOUGH DONOR AREA TO COVER IT.
IT IS VERY DIFFICULT TO CONVINCE THE PATIENTS TO REMOVE TRANSPLANTED HAIRS, WITH PUNCHES OR LASER, BUT THE REDUCTION OF THE RECIPIENT AREA ALLOWED US TO ACHIEVE DENSER AND MORE NATURAL RESULTS.
WITH THE USE OF FUE WE HAVE “SAVED” SOME HAIRS BUT WE HAVE TO TAKE INTO CONSIDERATION THE TRANSECTION RATE, THE REMAINING HAIRS AND THE HYPOCHROMIC SPOTS OR SMALL SCARS THAT GENERALLY RESULT (MAINLY IN DARKER COMPLEXIONS) .
WITH THE USE OF LATEST GENERATION LASER THE EPILATED AREAS SHOWED GOOD AESTHETIC RESULTS WITHOUT HYPOCHROMIC SPOTS AND THE IRREGULAR SURFACE AROUND THE PUNCHES DISAPPEARED BUT WE LOST THE HAIRS OF COURSE.

CONCLUSION: UTILIZING LATEST GENERATION LASER OR FUE, OUR KNOWLEDGE AND AESTHETIC SENSE, ALLOW US TO BREAK THE STIGMA OF THE ARTIFICIAL RESULTS EVEN IN PATIENTS WITH A VERY LOW HAIRLINE AND RESTRICTED DONOR SUPPLY.