The same thing is happening in your scalp. After having thousands of tiny incisions made in your scalp the body starts to produce edema to protect itself. Some of this edema seeps out of the scalp, either through incisions or pores, and once it dries it creates a crusty by product. Sometimes this can completely cover the scalp and then when it cracks it can look like earthquake cracks in your scalp. What is even worse is that these cracks or rivulets as I call them are devoid of hair. Don’t worry, the grafts are still intact but the hair follicle was taken out when the crusties fell off. All is well and the area will fill in once the new hair begins to finally grow in four to six months.

If you’ve never had a hair transplant understand that it acts just like non-transplanted hair if the procedure was performed correctly. You cut it when it grows long, you style it every day, and you can even have highlights or dye applied to it (obviously from my photos:))

What I have learned over time however is that if you have had a large area addressed with transplanted hair there is a sweet spot so to speak regarding the length and how it positively or negatively affects the appearance of your hair. By this I mean that certain lengths make it look fuller than others. I have found that for me a medium length will make the density seem the strongest. When I cut my hair really short the results seem to be a bit thinner and when it is really long (like shown in my HT# 3 gallery) it also can appear thinner. I am not really sure why this is the case but it has been confirmed over and over as I have had my hair at drastically different lengths.

So, the lesson here is, after your results have grown in you may want to experiment with different styles to find the one that best accentuates your appearance. If it looks too thin, let it grow a bit more or cut it a bit shorter. Good luck!

They need to be consistent. They need to be in good lighting. They need to show good detail. This list of do’s and don’ts is from my own experience over the past several years of taking photos of my hair transplant progress. I hope you can learn from my experience and pass it on to others. If you see anything that may need to be updated or modified then please let me know.

1. Use the lighting from the room you are taking the photos in. Do not use the flash accessory on your camera.
2. It tends to work out better if you take your photos in your bathroom. The environment is small, the lighting is usually adequate and you have a mirror in which to judge your angles.
3. Any lighting that you have available in the room should be slightly in front of and above the area to be photographed. You never want the source of lighting to be behind the subject,(you head).
4. Place the camera on a steady support such as a bathroom counter or shelf to steady your shots. Almost all cameras come with a timer delay feature of ten seconds. Use this to get the most stable images. You do not want any “blur” effects to ruin your shot. It will take several practice shots to get proficient at using your camera in this manner but it will be worth it. You can place your camera in one place for all angles of the shot. Turn yourself for each angle, not the camera.
5. CONSISTENCY!! Take consistent photos of yourself. This means taking photos from the same angles throughout your documentation process. This helps to truly see the progress.

   Suggested angles are…90 degrees left and right. 45 degrees left and right; face forward; face slightly turned downward to show hairline; Chin to chest to see overhead view; direct view of the back of your head to show the donor area; back of your head while looking slightly up to show your crown area. Remember, you don’t need to move the camera for these shots. Move yourself.

6. While taking photos indoors is more appropriate is does help to spice up your portfolio by taking some shots outdoors.
7. When taking close up shots of your hairline or any other particular area of interest make sure to turn on your macro feature on your camera. This should be used when taking photos from less than 1 1/2 to 2 feet away. If you don’t know how to enable this feature then look in the manual. If you don’t have your manual anymore then you can most likely download a new one from the manufacturer’s web site.
8. When you are finished taking your photos you need to review them. Ask yourself if the photos are what you would want to see from someone else. Are they clear? Are they consistent with previous photos? Do they give an accurate representation of what your hair really looks like?

The below photographs demonstrate the impact of flash photography on perceived end results of a hair restoration procedure.

Note how the density increases by several orders of magnitude with only the use of a flash. Be sure to click the thumbnail to see the larger image.

List of things not to do when taking before/after photos of your hair transplant.

1. Do NOT use a flash. The bright light from a flash can cause each hair to generate a strong shadow of itself lending to the illusion of more hair.
2. Do NOT allow lights in the background. It will cause an overall dark look to your hair resulting in an inaccurate view of what your hair really looks like. Some web sites employ this technique often to give their patients the look of having more hair than they do in reality.
3. Do NOT simply hold your camera in two or even one hand. This will lend to an increase in blurriness in your photos.
4. Do NOT be afraid to take photos of your hair with your face showing. You can easily block out your face or alter it so no one can see who you are. Even better is if you decide to go “full Monty” like I did. It adds a better overall depth to the hair transplant.
5. Do NOT take still images from a video camera. Stills do not have the resolution needed for showing good detail. They often turn out too dark or too grainy.
6. Do NOT use a web cam to take your photos. They never turn out good enough to see any detail. Investing in even the cheapest of digital still cameras is a drop in the bucket compared to the price of a hair transplant.
7. Do NOT allow even ambient light to enter the room where you are taking your photographs. If you are in your living room, kitchen etc. then close the blinds and/or curtains. If you are in your bathroom and have windows then close the blinds and the shower curtain. Ambient light will darken the overall look of your hair transplant.

Well, that’s it. Again, if you have anything to add or think I should change anything based on your experience then let me know. I am by no means an expert so I’m open to suggestions.

I hope this helps you to understand how to take good, clear photographs. If you can share them with others via your own web site like I have then you will be doing someone you may never meet a HUGE favor!

Peace,

Jotronic

After undergoing a hair restoration the grafts go through a bit of an adjustment period. Hair has two main growth phases; Telogen (the growing phase) and Anagen (the dormant phase). When hair grows it grows continuously for a few years (the number will vary depending on which Dr. you are asking).  Once this telogen phase comes to an end the hair goes into the anagen phase. I call it the recharge phase. During this three to five month period the hair shaft not only stops growing it actually falls out. This can be at any time during the anagen phase and can even happen at the end of the anagen phase due to the new hair regrowing in the old hair’s place and is pushing the old hair out.

For no known reason having a hair transplant actually triggers the anagen phase of a hair follicle’s cycle. This is why with virtually every hair transplant performed the hairs will fall out between three and five weeks post-op.  No one knows why this happens but it is perfectly normal and part of what some call the “ugly duckling phase”.  You are basically taking five steps backward before you take twenty forward with your new hair.

The hairs usually stay dormant for three to five months but some patients will sprout earlier and an unfortunate few will sprout later. This is a very small percentage of patients, so few in fact that I cannot remember any patients that took this long to start growing. Once the hair starts to sprout it will not come in all at once. There will be some areas that come in sooner than others so in the beginning the new growth and appear rather patchy. This is when the phone calls to the clinic really kick in with quesitons about the growth.

Usually at about the six month mark a healthy percentage of the hairs have started to poke through. I would wager this to be about 60% but this is very subjective. By eight to ten months is when all of the grafts should have come through and with a decent amount of length of at least one inch or more for most of the grafts.

The debate now moves to anything past the eight to ten month mark. I have recently read that results take at least 18 months to come to fruition. This is not an accurate statement. True, hair characteristics will continue to change/improve well past the one year mark but the full growth should have been realized well before the one year mark. Very small and subtle changes continue to take place for months after the initial burst of growth but they are so subtle it takes months just to see the change.

I realize this could have been the actual point by those that say results take a year and a half or more to realize but it should be made more clear that the actual growth comes on a lot sooner than this. Texture and yes even slight color changes do take longer to work themselves out. In the first few months after the growth has really come in the hair can have a kinkier texture than the native hair in the recipient area. This almost always works it’s way out to where the hair softens with time. Any wave that should not be there will also work itself out.

Bottom line, don’t think that it will take a year and a half or longer just to see the change you are looking for. It will happen in less than a year and will be the biggest change you will have. The time afterward is for the very subtle changes that will continue to improve your overall appearance.

The following factors are arguably the most important components of hair transplant surgery:

• Coverage
• Density
• Angle Control
• Naturalness

Before analyzing these issues, I should address the issues of density vs. coverage.

In the initial assessment of any patient the physician will assess the final hairloss pattern and amount of hair in the permanent donor zone. Patients with less donor hair and greater degree of final hairloss will most likely need coverage more than density. Patients with relatively more donor hair and a lesser degree of final hairloss (ie: 2A – 4A) will usually desire greater density.
We would thus plan our surgical intervention with either coverage or density as our goal.

Until this point in time the problem has been that unless we achieved density the transplant looked pluggy. Follicular unit transplant for the most part addressed this issue by allowing us to achieve density with relative ease. However, follicular unit transplantation does not generally provide a good aesthetic result if the grafts are not densely packed. Here the hair-dense follicular units stand out against the background of bald scalp.

The lateral slit technique addresses both the issues of achieving greatest possible density and naturalness at relative low density.
To understand this concept one must first understand that all multi-haired FU’s have one plane in which they provide greatest coverage. In this plane the follicles are seen to be lying along side one another rather than on top of one another.

By creating recipient sites which maintain the FU graft in the plane where the follicles of the FU lie alongside one another we get improved coverage. In addition the grafts do not look pluggy as would be the case where the follicles lie on top of one another. We are thus able to achieve much greater naturalness even with lower density transplants.

We must thus make the skin incision at 90° to the direction of hair growth irrespective of the location on the scalp. In the frontal scalp the incisions would thus be in the coronal or lateral plane. In fact nature employs this exact setup.
Observe the graft orientation in the following photos of donor hair.

How does this technique allow transplanting at greater densities?

1. Maintaining a healthy blood circulation in the recipient area.
   This is done by limiting the depth of the incision in the recipient skin such that it does not affect the circulation of the skin. In the lateral slit technique the incision is shallower than with sagital incisions.
2. Reducing compression of grafts, which occurs when many grafts are transplanted at high density.
   In traditional sagital (front to back) incisions the pressure that the grafts exert on the site walls of the incision are all added together by the pressures produced by its neighboring grafts.
3. In the lateral slit technique the pressure is exerted in an up and down direction.
   In this plane there is free expansion into the area above the scalp, and the individual pressures executed by each graft do not affect the pressures executed by neighboring grafts.

Recipient sites are made as small as possible. This is done by measuring an individuals FU size and creating a recipient site with a custom cut blade, accurate in size to the nearest hundredth of a millimeter.

No other technique even comes close to the lateral slit technique in maintaining precise graft angulation. In our technique the graft is tightly sandwiched between the front and back walls of the incisions.

The photos below show the immediate post operative views of hair transplants using our technique. You can clearly see how the follicle angulation is precisely controlled.

There are several other advantages to this technique and its implementation which are however beyond the scope of this discussion.

In conclusion: I have used the sagital incision method on approximately 2000 cases up until 1996. Since that time I have done approximately 2000 cases using the lateral technique. In my mind these is no question of the superiority of the latter technique.

The technique was first performed by my associate Dr. Jerry Wong. I have simply refined it. In our combined experience of over thousands of cases using this technique we are unaware of any cased of poor transplant growth due to this technique. Additionally we are unaware of anyone who employs our technique together with follicular transplantation who has experienced poor graft growth.

Article courtesy of Doctor Victor Hasson of Hasson & Wong Hair Transplant Clinic