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Tucson (520) 290-5555 · Toll-Free (800) 840-9761
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drkeene@hairrestore.com |
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Surgical
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This image is a microscopic view of follicular units in a 0.25 cm square as they occur in nature. |
Dr. Keene uses the most advanced and effective technique of hair transplantation in the world. We extract the permanent hair follicles on the sides and back of the scalp that are not affected by male pattern baldness, and employ them as donor follicles. These permanent donor follicles are then transplanted in follicular units of 1-4 hairs (the way hair grows naturally) on the crown and front of the scalp. By using follicular units of 1-4 hairs, as they appear in nature, we avoid producing unsightly "corn rows" or other unnatural effects associated with hair transplant surgeries using grafts of 5 or more hairs. During our procedure, grafts are placed very close together, since too much space between groupings looks unnatural.
The procedure is done in megasessions of up to 3000 grafts during each session, depending on factors such as donor density and scalp laxity. So you can start enjoying your new, permanent hair faster than ever. Your transplants will be virtually undetectable by friends and family, leaving a natural hairline with virtually no scarring in grafted areas. A fine linear scar in the donor area is covered by overlying hair, and is typically undetectable.
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Physician's Hair Institute's procedure leaves a natural hairline. |
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Donor area two weeks after procedure. |
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Donor area nine months after procedure. |
As a board certified general surgeon, Dr. Keene utilized a double suture closure (internal and external) for many types of surgeries. She felt that this type of closure would be best in hair transplant surgery as well. This consists of an internal layer of dissolvable suture, which is the strength layer of the closure, and an external layer on the skin of nylon suture. This can be removed in only 5-7 days, making it much more comfortable for patients. A single layer closure often requires 10-14 days, and the suture becomes irritating to the skin, causing an annoying inflammatory reaction. When this happens, the result can be the “railroad track” scarring where the nylon leaves a visible white vertical scar across the linear horizontal one. An internal layer can also help prevent broadening of the incision, especially for large megasessions when the closure can result in more tension on the skin. The absorbable suture remains for several weeks to allow the wound to gain strength, and the result can be a finer closure.
The double closure typically results in a virtually undetectable linear scar, that is completely covered by hair in the donor area, and is typically very difficult to find after it is completely healed. Results can vary in patients with unusually tight scalps, and those who have had previous surgery that has removed some of the scalp elasticity.
Staples are much faster and easier to place than sutures, but less comfortable than suture to lie on. They also tend to be more painful to remove. Staples are more convenient for the doctor, the appearance of the incision is comparable with both, and this has been documented repeatedly in the surgical literature. But Dr. Keene feels it is worth the extra time it takes to use suture in order to increase your comfort.
Plugs: A plug occurs when a hole is punched into the scalp and a graft is used to "plug" the hole. When this occurs not only is a follicle grafted, but so is skin. This newly grafted skin can cause visible scarring. Dr. Keene's technique uses micro incisions which heal more quickly and the small amount of skin on the graft forms a tiny scab that falls off.
Since plugs are large amounts of hair and skin being placed into the scalp, unnatural "corn rows" appear because grafts are placed further apart. We insert mini grafts of 1-4 hairs with no skin transplantation close together, so scars and rows do not occur.
Micro/Mini
grafting: Micro grafts consist of one to two hairs and mini grafts
consist of three to eight hairs. These grafts are placed further apart which can
create an unnatural hairline. See picture:
Our procedure separates hairs into smaller units of one, two, three and four hair grafts, and places them closer together to recreate a natural hairline.
| Here grafts use plugs which are spaced further apart, therefore, producing unnatural "corn rows". |  |
There are three main factors we consider in determining a good candidate for hair transplant surgery:
Since incisional follicular unit grafting is a surgical technique using local anesthetic, good candidates for this procedure are reasonably healthy, have significant thinning and hair loss or hairline recession. There are no age restrictions except it is preferable that a patient be 25 years of age or older before considering the surgical option. The reason for this is that it is difficult to determine what the future hair loss pattern is going to be in a patient younger than 25. There may be exceptions, one being if the medication stabilizes the pattern. This is an issue because if after the procedure the hairline is too low and an extensive amount of hair loss occurs it will result in a limited donor area. Thus making it difficult to fix the affected area.
During the initial exam, Dr. Keene will evaluate existing hair loss and will estimate future hair loss based on your risk factors. Since hair is normally transplanted from the sides and back of the head, it is important that you have sufficient hair available to achieve your desired results. Dr. Keene will provide each patient with information so that they can determine whether surgery and/or medical treatment may best suit their needs.
Each patient can determine the number of grafts he will need for a particular level of density or area of coverage. A patient will base his decision on density preferences and current hair loss area as well as estimates of future hair loss. We can not give the same number of hairs as nature, but since hair loss is virtually undetectable until approximately 50% of the hair is lost, it is possible to achieve the same appearance of density as a natural head of hair. Other factors include:
 | Hair color - Lighter hair (decrease in contrast) requires fewer grafts than darker hair (increased contrast). |
| Hair caliber - Straight or curly hair - curly hair covers more effectively than straight. |
The following are a range of follicular unit grafts necessary to achieve density.
| Thin: 10-15 grafts per square cm on average - provides contour and thinning coverage, see through in certain lighting. |
| Moderate: 15-20 grafts per square cm on average - moderate coverage and contour. |
| Cosmetically Dense: 30-60 grafts per square cm on average - in most cases imperceptible difference between this density and normal hair. |
*During your consultation, Dr. Keene will help you determine what density is necessary to achieve your goals.
Dr. Keene believes all hair restoration surgeons should have the technical capability of cutting and placing grafts. Dr. Keene supervises every aspect of the surgery utilizing assistants to assist in surgery not perform it.
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