HAIR TRANSPLANT FORUM

An interesting case presented to Dr. Cole yesterday. This female hair restoration surgery patient is biracial, with one African-American parent and one Asian parent. Due to her partially Asian heritage, her hair follicles are straighter than someone of purely African descent. (You can see an example of one of her three-haired follicular units in the photo.) Although this patient was not exhibiting any signs of female hair loss, she was unhappy with her congenital high hairline. She initially opted to try and advance her hairline with a hair transplant at another clinic. However, she was unhappy with the results and later opted to have a forehead advancement procedure. Unfortunately, this surgery left her with a slightly raised scar along her frontal hairline, which was increasingly elevated in the temple regions. This type of scarring can be described as hypertrophic, and is more common in people of color or Mediterranean-origin.

During this session, Dr. Cole was primarily concerned with grafting into the scar in order to provide coverage in the region the patient is most self-conscious with. He used his Power Cole Isolation Device tool, along with 1.0, 15-degree 2S3R punch set at a depth of 2.1mm. Dr. Cole transplanted 371 grafts via his CIT method. The transection rate in this particular case was around 3.7%, and the patient’s calculated density was 2.4 hairs per FU. In the future, Dr. Cole would like to focus on creating a more aesthetically pleasing temple design for this patient. He also plans to treat the hypertrophic scarring with low-dose Kenalog injections of 10 mg per cc; this should help the scar “sit down” and appear less prominent.

This procedure underscores one very important fact: more aggressive and/or invasive procedures (such as scalp lifting, forehead advancements, scalp reductions, flaps, expanders, etc.) will all carry greater risk. Although this particular patient was not satisfied with her initial grafting work, it was not done at a reputable clinic, and it is important to understand that grafting carries much less risk overall. The more aggressive procedures increase the probability that the patient will experience hair growth angle distortion and unacceptable scarring. One of the major problems with forehead advancement surgery is that the resulting scar sits directly on the hairline, and there is no hair in front of it to conceal it. A patient may be better off having this area grafted from the beginning, particularly if she knows that she is not an optimal healer.