Dr. Hasson provided me with an excellent explanation as to the benefits of cutting the recipient area hair short just prior to surgery. While not all patients will be comfortable in doing this, Dr. Hasson does explain the benefits of cutting the hair short in his below explanation -


"All,

I originally typed this post in response to Bezane and his question to Pat regarding recipient site shaving. I feel that this is a very important issue and deserved it's own thread.

Bezane,

The question you ask about shaving is a good one and one that I would like to address.

When you ask if it is necessary to shave the pre-existing hair before surgery- the answer is- “it depends”.

Depends on what? It depends on the quality of the result that you are looking for. Some patients (and doctors) will be satisfied with a less than optimal result while others will want to achieve the very best result possible. For this long term gain a patient may have to endure some inconvenience including buzzing of the recipient area.

There are multiple technical factors that come into play during the creation of recipient sites and the subsequent graft placement. These include:

1.) When thinning areas are shaved down the “thinning process” takes on a different meaning. With the use of magnification it will be seen that some follicular bundles are absent (and there are wider spaces between remaining bundles) and that some bundles are significantly miniaturized. It will then be possible to place new recipient sites in the place of absent bundles and alongside miniaturized bundles to recreate the density. This can also be done in a uniform manner so that if the pre-existing hair eventually disappears, due to progression of hairloss, the transplant can still look reasonably natural. If the recipient site is not shaved the surgeon must part through the hair again and again looking for any empty spaces and trying to fill the spaces as best as possible. This is not really as exact a process but much more hit or miss.

2.) The hair exits the scalp at an exact angle. The only way to precisely match that angle is to buzz the recipient hair down (in a way similar to how ALL doctors need to shave the donor hair when taking out the donor strip).

3.) Transection of existing hair below the skin surface is possible if the incisions are not made exactly parallel to the surrounding bundles. We often see this as a “halo” type effect when performing repair procedures.

4.) When inserting grafts the technicians can easily identify the recipient sites and ensure that all sites are filled. This can be achieved with no trauma to the pre-existing hair.

5.) When hair is buzzed no manipulation of the pre-existing hair is required at all. When the hair is not shaved it needs to be combed through (hundreds of times) by the physician who makes the recipients sites and again by the technician who places the grafts into the sites. This repetitive trauma of combing through the hair again and again will result in “hair shock”, a shedding of the existing hair. When this hair falls out in 2 to 3 weeks there will be a 2 to 3 month wait before it returns. Whereas if the hair were buzzed it would grow from day one 1 and keep growing. A number 3 buzz cut often will look good at 10 to 14 days post operatively and blend in with the recipient site well.

Bezane, all these factors are relatively unimportant if you are trying to place to 2 or 3 hundred grafts into recipient sites however if you wish to have the ultra refined type of result that Pat Hennessey advocates, the difference will be night and day.

I apologize if what I’ve said in any way contradicts what others have told you but I feel you should hear this from the doctors who basically developed the process you know as “ultra refined follicular grafting”.

I have attached photos of a patient who has undergone a mega (mega mega) session into a large area of thinning scalp- before and ten days after surgery. Hopefully my reasoning will be self explanatory.

Sincerely,

Victor Hasson MD"



mc1.JPG (223 Kb, 1808 downloads) Top view

Below is the side view.



mc2.JPG (211 Kb, 1788 downloads) side view

Pat, thank you for supply this great explanation. Still not too thrilled at the idea.......but enough whinnng from me on this subject.

I had Dr. Cooley buzz my recipient area. He made it clear I didn't have to do that, but that the procedure would be more efficient if we did, and I agreed.

Why make things tougher on the doctor? This is a tough job. My hats off to the top docs on this site, or...it will be in a few months...off that is.

It seems to me though that if you get all your hair clipped to something like a #7 that you're not going to trim anything too close for the doctor in the donor area, but after the procedure you'll have a slightly closer match to your HT and still have decent coverage of the scar.

Does that make good sense?

mark h

Wow!

Thanks, Dr. Hasson, for that informative and very well written post. It really helps to get this kind of advice from a leading doc in his field.

And thank you Pat for bringing it to our attention.

I am having a HT with Dr. Keene in tuscon in late June. She comes highly recommended but I hear she doesnt require the area buzzed prior to transplant. Should I do it anyway? Or are there those who feel its not neccessary.

You'll have to trust Dr. Keene on that...........I've seen many of her results with no shaving down but from my prospective, if you are dense packing or going into diffused thinning areas, the benefits outweigh the costs.

Fin,

I would agree with hairbank. Why take the chance of not getting the best possible job for the sake of buzzing the area?

hairbank, I noticed you're going back for more with Dr. Wong. Are you just adding some density? Your hair looks pretty good as it is now.

Hey Rhodeman,

Yes.........Hair Greed got the better of me !

I've never really had much dense packing in the frontal third and really no hairline/temple/widows peak work done since I lost my hair from the crown forward. The plan is 3500 or more grafts to fill in those areas and dense up the sides of the crown ((1500 for hairline/temple work, remainder for added density elsewhere - if that makes sense).

As time gets closer, I'll start posting pics of where I'm at, in detail, and EXACTLY what I'm going to address.

Thanks for the interest, my friend!

The debate "To shave or not to shave" is an old one. Clearly, you will have to make your own conclusion.

My opinion is this in a nutshell.

It makes things easier on the clinic to shave, but clearly many doctors still yield positive results without shaving.

IMO, however,

Doctor's who do NOT shave the recipient area can still yield a good result, but with a lot of native hair in the way, it makes things more difficult for the clinic, increasing stress on the native hair and thus increasing risks such as shockloss.

Just my thoughts.

Falc

On another note. If you have so much hair that you need to "shave down" . You are probably not a great candidate. Furthermore the guys that don't want to buzz the area are indeed not candidates that more often than not will be chasing hairloss... Something they leave out at the consult I guess.
Also the above work is great and warrented a little buzz for optimum results.

hairbank,
can't wait to see the results, should be awesome.

aquarius, cool pic.

I would vote for shaving down based on my experience. I had a lot of work done in in an area having a "fair bit" of native hair and had extensive shock loss. I was not advised of shaving being an option, if there was a chance to lessen the shock loss, I would have done it in a second.

Bayer

As I said Bayer; You had to much and you were going to work the next day...: (Why freak you out you had too much hair to risk)Ethical huh?
Rhodeman - Thanks
I busted nuts to create it.
Lemme know if you need a cool avitar , before I forget how.
Both of my bitches say it looks like me when I get off my bike.
It's a Ninja not a hog.

Aquarius,

Sweet avatar indeed. It's Smith from the Matrix 3! Awesome.

I know how to make them...if I find the energy maybe I'll animate one and use it.

Falc