I was wondering, what is “pitting” and how does it happen? Second, I had several “cowlicks” on my head before losing my hair. If I were to get a hair transplant, would I get those awful cowlicks again? — S.E.

Pitting is the result of placing large grafts in the scalp without properly controlling the depth of the incision. The surface of the skin becomes indented creating an unnatural pit. This can still happen in some clinics with less experience and old technology but never in our clinic.

Controlling angle and direction of hair is very important in creating a natural result. Cowlicks are a nuisance and make stying the hair difficult. It is good that you have lost the hair that once created a cowlick. The newly transplanted hair would be directed in the proper angle and direction and the cowlick of the past would not be an issue. In short, you would not get that “awful” cowlick again and nor would the hair ever change to the old direction (cowlick) once it is transplanted.

— Jerry Wong, MD

If you are thinking of having a hair transplant, visit our hair transplant surgery website for a free online hair transplant consultation.

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Do I have to cut my hair or have it shaved at recipient area at time of the hair transplant surgery? — G.S.

The necessity of shaving the recipient area depends on the number of grafts being transplanted in a given area and how much existing hair there is. For medium to small size surgeries where there may be sufficient spaces between the existing follicles, a surgery can then be performed without the shave. To obtain the best results though, generally, it is best to shave the recipient area if there is a fair amount of existing hair.

— Victor Hasson, MD

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My question is regarding hair flap surgery or if you call it scalp flaps. If a person is a Norwood 5 or 6 balding pattern and cannot achieve desired result from hair transplants would one be able to get full coverage or density from undergoing hair flap surgery? If there is not enough donor hair will a person get more coverage from hair flap surgery? — M.K.

A Norwood 5 or 6 can achieve adequate or desired density from follicular unit transplantation if he has sufficient donor hair and the surgery is performed by a qualified surgeon. Only a handful of surgeons can produce such a result. A flap procedure is not generally recommended by the top hair restoration surgeons. A flap can produce an unnatural hair direction and angle. A scar is created right at the hairline. Generally, high density up front and a significant drop off or lack of hair behind also contributes to an unnatural appearance. It is not as natural as a true follicular unit grafting procedure. If the patient has average donor area characteristics, the overall result of a follicular unit hair transplant will be superior to the flap even if the density is not as high.

— Jerry Wong, MD

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Good afternoon Dr. Hasson and Dr. Wong, I have a doubts about a hair transplant. I have diffuse alopecia in the upper part of the head. With long hair, I can cover the entire surface with an acceptable result. My question is, I have always read that the diffuse alopecia is more difficult to transplant, because is easy to damage the healthy hairs.

Is that true? Is possible to do? — I.P.

As you describe in your case, you have a diffused thinning throughout the top of your scalp. This type pattern of hair loss can be more difficult to transplant and cause damage to existing hair, especially for a lesser skilled clinic or doctor who is not using the right technology. In our clinic we routinely transplant amongst existing hairs and expect that with our innovations and level of skill, no viable native hair will be damaged. It is possible for Hasson & Wong to safely and effectively transplant a patient with your hair loss pattern.

— Jerry Wong, MD

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I understand that future treatments may compete with current hair transplant techniques, but what do you honestly think of future alternatives—especially for those, who do not have sufficient donor hair to cover their whole balding area? How long do these people have to wait for a cure and what role will hair transplants play in future? Is there a way of even improving hair transplants? I’m sure you know something about what the future holds for us. — J.S.

The next significant technology on the horizon is hair cloning. For those patients with a limited donor area that are not presently good hair restoration candidates, cloning or hair multiplication would potentially provide an unlimited supply of donor hair to transplant. This would, of course, remove restrictions on density, coverage and hairline placement for those with limited donor supplies. The technology is still several years away. Hopefully available in the next 5-10 years. When implementing this future technology, a good result will still depend on hairline placement, angle direction control, dense packing, large numbers of grafts etc, and all the same variables, principles and techniques used in today’s modern transplant. To achieve a good result, a top clinic will still need to be part of the process.

In our clinic, the improvements in hair restoration surgery over the last 10 years have been remarkable. There may be some innovations still to come in hair transplantation, but considering the results we are producing today, the majority of those innovations have been implemented. The donor supply aspect of the surgery is the next great frontier.

— Victor Hasson, MD

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Is shock loss bad? I keep reading about it as if it is some dreaded event. What exactly is it, why does it occur, and how is it prevented?
— N.A.

Shock loss can occur in the native hair and the recipient area. Hairs falls out as a result of trauma associated with hair transplant surgery. However, there are in actuality, two types of shock loss. The first type of shock loss is temporary and usually occurs (if it will occur) several weeks after the procedure. In temporary shock loss, any hair that sheds as a result of the procedure begins to grow back at roughly the same time that the newly transplanted hair begins to grow. This is the only type of shock loss that our patients will occasionally experience and usually it is minor. The second type of shock loss is permanent. This is usually caused by damage to the native hair as a direct result of an ill-prepared recipient site. More specifically, permanent shock loss occurs when the physician cannot match the angle and direction of the native hair accurately. In many clinics, there is little preparatory work performed at the recipient site. At Hasson & Wong, we have for many years prepared the recipient site to ensure accurate insertion of grafts to help prevent shock loss and so that graft growth mimics nature. This requires shaving of the target recipient area to better visualize the true angle and direction of the native hair. This allows us to make our incisions parallel to existing hair. If the incisions are not parallel then they will transect (cut across) the neighbouring hair, thus causing permanent damage and eventual death of existing hairs in the recipient area. This is, in our opinion, the number one cause of permanent shock loss which we’ve seen in some patients of other clinics. Because we endeavour to protect the native hair, our patients do not experience permanent shock loss.

Temporary shock loss is not a great concern and certainly not a dreaded event. To safeguard yourself against permanent shock loss, do research before choosing a clinic. Choose a clinic that pays close attention to recipient site preparation — one which shaves the recipient area as part of that preparation and has a track record of low incidents of permanent shock loss (check the hair transplant forums).

— Victor Hasson, MD

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