Recently, we have had more questions regarding the need for recipient site shaving so I thought I would take some time to post regarding the subject. The question about shaving is a good one and one that I would like to address. When one asks 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.
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 utmost of refined results the difference is night and day. 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.
This is an issue which I understand causes a lot of anxiety amongst prospective patients. I hope that this clarifys the issue . No ,it is not mandatory to have your head shaved/buzzed for a FUT procedure - unless you are having a procedure of more than 2500 FUs .
However ,we do strongly recommend that you allow us to do this . At our clinic we have thoroughly scrutinised and analysed every minute detail of the HT procedure to be certain that it is being performed optimally .The procedure can only be as good as its weakest point .We try to insure that no weak points exist .
If I ever see any surgeon performing any aspect of a surgery better than I am performing it , I would happily admit it and change my method .Without Dr. Seagers work on dense packing and Dr. Shapiros work on hairlines we would never be where we are now.
Shaving the recipient area allows for improvement in :
Graft site placement graft angulation graft direction dense packing reduced existing hair manipulation-during site creation and graft insertion reduced existing hair transection to zero
reduced graft handling during insertion reduction in total surgical time (essential in ensuring excellent graft survival in megasessions )
Hopefully now you understand why we recommend shaving .We understand that shaving may not be possible for some .We can still perform surgery but have to the limit the size of the surgery .
For those who choose a surgeon simply because he dosent require shaving - I urge you to study the photo that Jotronic posted - because as a poster already stated - the photo says it all ...
