I have a study in progress looking at the growth rate of telogen Vs. anagen hairs. I placed two boxes in a bald crown. i then placed all telogen BHT grafts in one box and all anagen hair follicles in the other box. We really do not know which is going to grow first. Long ago, I hypothesized that one of the reasons that body hair comes in more slowly was that such a large percentage of grafts were in the telogen phase. Therefore, the discussion about anagen Vs. telogen is not new to me. I was the first person to discuss it as a possible reason for delayed growth. The fact is that we simply do not know why body hair grows in slower than scalp hair.We also do not know if telogen hairs grow in slower than anagen hairs. It may well be that telogen hairs grow quicker than anagen hairs. Body hairs have a much longer resting phase than scalp hairs. Body hairhas a much shorter anagen phase than scalp hairs. They also have a much longer resting phase than scalp hairs. When you transplant a hair,most of them go into a shock phase. In the past we have called this shock phase anagen effluvium because the hair is shed in the angen phase. What we've learned from transplanting body hair is that telogen hairs are also shed. A better term for this lost hair might be traumatic effluvium rather than telogen effluvium or anagen effluvium. This period of effluvium or dormancy tends to vary from one individual to another and from one follicle to another. Some hairs are never shed. Some begin to re-grow at 1 month, some at 2 months, some at 3 months, etc. The longer you go out, the more hairs enter the growth phase. The same should be true for body hair. We've evaluated patients at 1 year, 2 years, and 3 years. What we have found is that some have full re-growth at 1 year, while others are at the 30 to 40% mark at 15 months. Initial growth is often finer. This is true for body hair and for scalp hair. Body hair tends to stay finer for a longer period of time. This means that the coverage value for any body hair may be less for a longer period of time. Eventually, more and more hairs should enter the growing phase and they should also become coarser. Over time, the coverage value for any body hair should increase and more and more body hairs should enter the growing phase. The typical dormancy for body hairs can extend into 3 to 5 years for some body hairs or for some individuals. We have already seen improved coverage from the 2 year mark to the 3 year mark in some. Again, since the dormancy phase is much longer for body hair, and since trauma causes dormancy, hairs in a dormant phase may be the first ones to begin to re-grow. For some time, I have noted that when I clean an area off of a leg or of the chest, etc., I typically see new growth several months later in the area that I thought I had completely removed all the hair. I have found that in these areas the anagen percentage is much higher indicating new re-growth. What this means is that in an area where 40% of the hair was in anagen and 60% of the hair was in telogen, another fairly large percentage was in the exogen phase where no hair was actively growing and was not seen. Traumatic effluvium is an exogen phase. Telogen hairs are closer to a new anagen phase than are anagen hairs. Anagen hairs must first go into telogen and then into exogen prior to forming a new hair. While it is too early to predict which box will grow hair faster in my study, I am seeing more hair in the telogen box than in the anagen box at this point.
I suspect I have relocated more body hair in my office than anyone in the world to this point. Obviously, Dr. Woods has been doing the procedure much longer than me, but I do far more grafts in a typical day than he does. It is possible to predict which hairs are in anagen and which hairs are in telogen during the extraction process. Telogen hairs are much easier to extract than anagen hairs with a much lower probability of injury. Anagen hairs are usually darker and they also have a darker shadow under the skin than telogen hairs. Telogen hairs are harder to place than anagen hairs, however, because they have less subcutaneous fat and tissue below the bulb. They want to pop out more easily. Therefore, it takes much greater skill to place these hairs and much greater skill to keep them in. in other words, you do not want a novice surgeon or technician placing your body hairs. Our level of experience with body hairs makes us a logical choice for body hair relocation. If you are going to have a procedure done that yields a lower percentage or that is more difficult, you want to insure that the people doing it know how to best insure a successful transfer of the hair. Proper placement is just as important as proper extraction. It is a very difficult process compared to head hair. It must be done well and it must be done properly to insure the optimal result.
It is becoming more and more routine for us to re-locate body hair to the donor area so that we insure the best donor area, as well as, the best transplant we can produce. We are rapidly approaching the one year mark on this procedure. If the results are clearly better, we will begin to incorporate this procedure (FIT farming) with our standard FIT procedure at an affordable pricing structure. It remains our mantra to produce the best result for all our patients regardless of whether they require 600 grafts or 13,000 grafts. While strip surgery still has a prominent place in the field of hair transplant surgery, FIT is the future. It affords a less invasive procedure with a much better all around result. One can never predict a strip scar. FIT results are far easier to predict with regard to the donor area.