Pillows, Pillows, Pillows..??..

[wookster]

:freaked: :freaked: :freaked:

http://hairlosstalk.com/surgicalops/ht9b.htm

There are multiple problems with patients who have received larger grafts.

[...]

As a result of the contraction of plugs once they have been transplanted, the density of hair in the plugs may actually exceed the donor density. This produces a pattern of excessive density within the larger grafts and empty spaces between them. In most patients who will have a significant amount of balding, there is not enough donor hair to both fill in the spaces between the plugs and cover all the area that needs to have hair. As a result, the surgeon is left with the dilemma of choosing between a pluggy look scattered over a large area or very high density in some areas with insufficient coverage in others. Often the patient is left with both problems!

It is important to note that one often observes less density in the grafts than one would anticipate from the size of the harvested plug. This can be due to a number of different mechanisms. Two of the most common are hair loss from poor harvesting techniques, and hair loss caused by a phenomenon called "doughnutting." In doughnutting, the centers of grafts get insufficient oxygen following transplantation and therefore, the follicles in the central portion of the grafts fail to survive. This results in hair growing only in the periphery of the grafts. This was a common phenomenon in 4- and 5-mm plugs, but can also be noted in grafts 3-mm in size. A "crescent moon" deformity occurs when these two problems exist simultaneously and the transection, in effect, cuts off half of the doughnut leaving a crescent moon shape. An additional problem is that, in these cases, even though the appearance might not be very pluggy, the total available donor hair is markedly decreased. These problems do not occur with micrografts or follicular unit grafts.

 

[michael barry]

what wook put up is pretty much my understanding of donutting of plugs. 4 millimeters across, the middle of them falls out and they look like little cherrios cereal pieces on a man's head. The industry claims that its becuase of oxygen deprivation.

The big ol' plus arent used anymore, and haven't been in a long time (since the eighties) and the modern follicular unit surgeries use small groupings of hair (never more than five), but usually average between 2 and 3 hairs, but closer to 2. They look twenty times better now than then.


I have to admit, its wierd that the hair in the big plugs would initially grow and then fall out later as it would seem that lack of oxygen would kill the centers right off, but thats what docs say happens.

 

[Bryan]

what wook put up is pretty much my understanding of donutting of plugs. 4 millimeters across, the middle of them falls out and they look like little cherrios cereal pieces on a man's head. The industry claims that its becuase of oxygen deprivation.

I have to admit, its wierd that the hair in the big plugs would initially grow and then fall out later as it would seem that lack of oxygen would kill the centers right off, but thats what docs say happens.

Well, the KEY QUESTION here would be the following: does anybody know (or can anybody find out) more about the timing issue of this so-called "doughnutting" effect? In other words, how soon after transplantation did the middle of the grafts start to fall out?

The reason for my asking that is obvious: the timing would be key to understanding whether or not the medical establishment's explanation for that phenomenon is legitimate. If it turns out that it takes YEARS for that to happen, then Stephen Foote would have a certain amount of credibility in claiming that it's actually a continuation of the balding process. But if it happened shortly after the transplantation (like within a few days, as I suspect it did), then clearly it is indeed some kind of trauma related to the surgery itself, and the medical establishment's explanation probably IS the correct one.

So we need to get more detailed information about this phenomenon of "doughnutting". If it turns out like I think it will, it will tighten the screws on Stephen Foote's theory even more! :wink:

 

[S Foote.]

No lack of consistency at all Bryan, just a lack of basic inteligence on your part. :roll:

Why didn't you address the specific issues I raised, instead of just repeating your usual theories about "doughnutting"?

Because you didn't raise a specific issue, you tried to claim my scaffold explaination was disproved by Nordstroms balding transplants. So i asked you some "specific" questions about any precise data from that study that would support your argument against my scaffold idea.

So answer my questions ?

The excuse of lack of oxygen, is the industries way of trying to cover up contined balding over time in alledged "resistent" grafts. The importance of Nordstroms early study is it proves this excuse wrong! :wink:

Really? How does it do that? BE SPECIFIC.

Because the hair loss pattern known as "doughnutting" was not reported in the early studies using large grafts that ran for around two years.

The excuse for doughnutting hairloss is a lack of oxygen to the center of the grafts, due to the transplantation reducing the circulation in the graft and so causing oxygen starvation (hypoxia).

But no such hairloss was reported in those early studies, that certainly covered enough time to establish if hypoxia was causing hair loss in this doughnut patern.

The fact that this was not reported in the early studies, and the fact that this kind of loss is now regarded as inevitable especially in the very large grafts used in early studies. shows this is a long term effect.

In my personal experience with 4mm grafts, it takes around 6+ years to become noticable. This is around the normal scalp hair anagen period, and supports my contention that the follicles in the central area with no scar scaffold, stuggle to re-enlarge in a new anagen phase.

I know you will claim there is no direct scientific evidence concerning graft doughnutting, but the information is out there as i have referenced.

Remember Bryan, there is also no direct scientific evidence for the efficacy of Proctors particular formulas, but it doesn't stop you from trying to sell these every chance you get :wink:

So lets drop the double standards in your idea of scientific evidence on these forums shall we! :wink:

S Foote

 

[michael barry]

Bryan,

I'll ask Hairsite (David) about how much time elapses in donutting of plugs and see what he says.

 

[michael barry]

This is what I got from a surgical technichian who works for Dr. John Cole:


Dr. Cole wrote an article explaining donutting and some of the other complications of plug grafts.
------------------------------------------
» Evolving Aesthetics of Hair Transplantation

"For the first 20 to 25 years of hair transplantation, 3-4mm (millimeter) round, "plug" grafts were the standard units generally placed in balding areas. These were felt to be the optimal size grafts in terms of density (hairs per square mm) and in terms of blood flow (nourishment) to the tissues of the graft. In other words, these grafts, with 12 to 20 hairs each, could achieve high density in the recipient (balding) area; also, bigger grafts would be easier to move, but re-establishing their blood flow, especially toward the center of the grafts, would be tricky. Later, this was found to be a problem even with these standard grafts, and sometimes the hairs in the very center of the graft would die, leading to the appearance of a hole in the middle, hence the term "donutting".

Other cosmetic problems were soon recognized. Often, a raised area at the base of the graft led to the aptly named "cobblestoning" effect. Probably the most widely recognized negative effect is the so-called "doll’s hair" "toothbrush" or "cornrow" appearance. This results from a dense, round graft set in the midst of bald scalp; the effect is worsened by the fact that, as the graft heals in place, scarring causes it to contract. This increases the density (compresses the hairs into a bundle) even more, to a level not found anywhere on the head, therefore appearing unnatural. When these round grafts were placed at the frontal hairline, they often appeared as an inhumanly straight, regular row, which is not the way hairs grow in nature. Furthermore, if the patient’s balding progressed, these grafts stood out even more, to the point of becoming a cosmetic nightmare. Also, if the hair behind the grafts was lost, there developed an unnatural look further back in the scalp; this appears as a posterior, or "rear" hairline. In addition, the normal, natural direction of hair growth was not honored. Hair from the crown up to the front grows in a generally forward direction; there is a "whorl", or circular effect at the crown, and at the temples the hair abruptly changes to a downward, and then backward, direction. Often the large grafts pointed up at right angles regardless of location, which added to the less than natural appearance, and could severely limit styling options. From a logistical standpoint, grafting with standard plugs could be a nightmare."
-John P. Cole
------------------------------------------

You had also asked, "Does anyone know how long it takes for donutting to occur in these grafts???"

Dr. Cole explains that donutting occurs due to lack of circulation in the center of the graft. Re-establishment of circulation begins immediately after the graft is placed and continues throughout the healing process. Generally, by the second week circulation should be well established, depending on the patient's individual healing characteristics and activities during the initial healing phases.
---
I am not a doctor. I am a technical writer and surgical technologist trained in hair transplant. My opinions are not necessarily those of Dr. Cole, Dr. Mwamba in Brussels, or IHTI. My advice is not medical advice.
Post reply






Bryan,

I found this verbiage:
" the effect is worsened by the fact that, as the graft heals in place, scarring causes it to contract. This increases the density (compresses the hairs into a bundle) even more, to a level not found anywhere on the head"===
.......to be particularily instructive as to why blood flow might be compromised at a later date. If the grafts "shrunk" back on themselves due to scarring contraction, the lack of oxygen in the center of the grafts might be alot more palatable as an accepted medical phenomena.

 

[michael barry]

Jessica went on further about donutting and gave some examples of how theoretically long it might take for donutting..............and hypothesized as to why----she admits this is her own opinion:


" guess plug grafts would be subject to donutting at several stages in the maturation process. Initially if the center of the graft was not able to establish circulation, it would donut rather quickly. I would say in the first couple of weeks.

Then there is also danger in the later stages of healing where scarring causes the punch graft to contract. The contraction could strangle any circulation that was initially established, creating the hypoxia, as you had stated. This could happen anytime in the first year as changes to the tissue mature and settle.

Foote does have an interesting point. However, I don’t agree that the edema-DHT-lymphatic pressure idea would cause the donutting. But rather that the contraction of the graft can complicate the normal life cycle morphology of the hair. This might then lead to the inflammatory response that Foote is talking about.

During the anagen or growing phase of the hair, the root of the follicle extends down to the subcutaneous tissues. The cells of the follicle are hypertrophic and active. This phase lasts about 7 years on the scalp. But when the hair goes into telogen or resting phase, the entire follicle crenates and shrinks up towards the surface of the scalp. Contraction of the graft due to scarring could interfere as the telogen hair begins into the anagen phase again. There might not be room for the follicle to expand into it’s active form again. This phenomenon would be seen at around 6 or 7 years.

It is possible that this could cause inflammatory edema secondary to the follicle being compressed. There has been research that shows higher concentration of DHT in areas of inflammation on the scalp. The lymphatic pumps would be active due to the inflammatory response to deliver extra white blood cells."

 

[Bryan]

This is what I got from a surgical technichian who works for Dr. John Cole:

You had also asked, "Does anyone know how long it takes for donutting to occur in these grafts???"

Dr. Cole explains that donutting occurs due to lack of circulation in the center of the graft. Re-establishment of circulation begins immediately after the graft is placed and continues throughout the healing process. Generally, by the second week circulation should be well established, depending on the patient's individual healing characteristics and activities during the initial healing phases.

Jessica went on further about donutting and gave some examples of how theoretically long it might take for donutting..............and hypothesized as to why----she admits this is her own opinion:

" guess plug grafts would be subject to donutting at several stages in the maturation process. Initially if the center of the graft was not able to establish circulation, it would donut rather quickly. I would say in the first couple of weeks."

OUTSTANDING, Michael! Thanks for checking on that for me!

It's pretty obvious now, both from what Dr. Cole's assistant Jessica says and Dr. Cole himself says, that "doughnutting" is a phenomenon that occurs (if it's going to occur at all) quite EARLY in the transplanting of those old-fashioned large grafts. Maybe even the first couple of weeks or so, in fact! :wink:

Stephen Foote, on the other hand, has repeatedly tried to make us believe that doughnutting is a sign of further balding in those transplanted follicles, and therefore (according to his theory) it disproves the concept of donor dominance. But perfectly healthy hair follicles don't suddenly go "bald" in only a couple of weeks, or even a few months! :wink:

Does everybody now see the truth of what I've been saying for a long time? Stephen Foote will stoop to ANYTHING to try to keep his theory afloat, including being so incredibly lame as to claim that a short-term problem involving surgical trauma is actually a long-term continuation of the balding process.

Bryan, I found this verbiage:
" the effect is worsened by the fact that, as the graft heals in place, scarring causes it to contract. This increases the density (compresses the hairs into a bundle) even more, to a level not found anywhere on the head"===
.......to be particularily instructive as to why blood flow might be compromised at a later date. If the grafts "shrunk" back on themselves due to scarring contraction, the lack of oxygen in the center of the grafts might be alot more palatable as an accepted medical phenomena.

I agree, Michael. I think all this stuff pretty conclusively destroys Stephen Foote's "doughnutting" excuse.

 

[Bryan]

[quote="S Foote.":74571]The excuse of lack of oxygen, is the industries way of trying to cover up contined balding over time in alledged "resistent" grafts. The importance of Nordstroms early study is it proves this excuse wrong! :wink:

Really? How does it do that? BE SPECIFIC.

Because the hair loss pattern known as "doughnutting" was not reported in the early studies using large grafts that ran for around two years.[/quote:74571]

And now we know why: doughnutting doesn't ALWAYS occur. It depends on various unpredictable factors having to do with the surgical healing process.

The fact that this was not reported in the early studies, and the fact that this kind of loss is now regarded as inevitable especially in the very large grafts used in early studies. shows this is a long term effect.

Stephen, you shameless SHYSTER! :wink: See my previous post: you've been found out and discredited.

 

[michael barry]

Bryan,

I was struck by this thought by Jessica:

"During the anagen or growing phase of the hair, the root of the follicle extends down to the subcutaneous tissues. The cells of the follicle are hypertrophic and active. This phase lasts about 7 years on the scalp. But when the hair goes into telogen or resting phase, the entire follicle crenates and shrinks up towards the surface of the scalp. Contraction of the graft due to scarring could interfere as the telogen hair begins into the anagen phase again. There might not be room for the follicle to expand into it’s active form again. This phenomenon would be seen at around 6 or 7 years. "


In other words, if the graft didn't contract fast enough to kill the middle hairs initially, and the hairs could migrate down to the subcutaceous layer for that first growth phase, they might be in anagen for up to 7 years. THEN, as they start going into their first shed phase, the dermal papilla migrate upwards in the dermis to find a graft that has shrunken (contracted) inward, and vascularity is so compromised near the surface of the dermis, they would not have enough blood to really restart an anagen phase again when the dermal papilla first expands THEN migrates downward. The expansion could not take place after the years of contraction, so the downward migration would not follow----------------------thus giving us donutting as the middle hairs went into their first shed INDIVIDUALLY. It would look like the middle was being thinned out as each individual hair began a shed phase if the graft was contracting due to scar formation on the scalp-----an area of higher tension in the first place rather than the arm for instance.




I suppose Stephen could claim this is edema instead of graft contraction due to scar formation around the ring of the plugs. Ive read of a few guys who said that they had donutting right off the bat and some that didn't in the past---but I never really paid attention to it as its an outdated procedure.


By the way----------------Cole is one of the very best surgeons out there, incredibly natural-looking work.

 

[wookster]

In other words, if the graft didn't contract fast enough to kill the middle hairs initially, and the hairs could migrate down to the subcutaceous layer for that first growth phase, they might be in anagen for up to 7 years. THEN, as they start going into their first shed phase, the dermal papilla migrate upwards in the dermis to find a graft that has shrunken (contracted) inward, and vascularity is so compromised near the surface of the dermis, they would not have enough blood to really restart an anagen phase again when the dermal papilla first expands THEN migrates downward. The expansion could not take place after the years of contraction, so the downward migration would not follow----------------------thus giving us donutting as the middle hairs went into their first shed INDIVIDUALLY. It would look like the middle was being thinned out as each individual hair began a shed phase if the graft was contracting due to scar formation on the scalp-----an area of higher tension in the first place rather than the arm for instance.

External pressure DOES appear to contribute to baldness then?


http://ssl.adgrafix.com/users/lifestag/ ... ative.html

J Dermatol 1990 Apr;17(4):240-6
A new apparatus for hair regrowth in male-pattern baldness.
Toshitani S, Nakayama J, Yahata T, Yasuda M, Urabe H
Department of Dermatology, School of Medicine, Fukuoka University, Japan.

A newly devised apparatus (Scalp-Tension-Relaxer, STR) can efficiently promote hair regrowth in patients with male-pattern baldness. When this apparatus is applied, the scalp is pushed up to relieve tension on the vertex. The efficacy rate of hair regrowth in alopecia patients was 40%. An investigation into the basis for the hair regrowth caused by this apparatus was directed toward the changes in hemodynamics and skin temperature of the scalp. During and after use of this apparatus, subjects exhibited an increase both in the cutaneous blood flow rate (as determined by laser Doppler flowmetry) and in the cutaneous temperature (as determined by thermography).

 

[S Foote.]

[quote="S Foote.":6c417]The excuse of lack of oxygen, is the industries way of trying to cover up contined balding over time in alledged "resistent" grafts. The importance of Nordstroms early study is it proves this excuse wrong! :wink:

Really? How does it do that? BE SPECIFIC.

Because the hair loss pattern known as "doughnutting" was not reported in the early studies using large grafts that ran for around two years.

And now we know why: doughnutting doesn't ALWAYS occur. It depends on various unpredictable factors having to do with the surgical healing process.

The fact that this was not reported in the early studies, and the fact that this kind of loss is now regarded as inevitable especially in the very large grafts used in early studies. shows this is a long term effect.

Stephen, you shameless SHYSTER! :wink: See my previous post: you've been found out and discredited.[/quote:6c417]

You really should not get involved with scientific debates Bryan, your failure to interpret the evidence is embarrasing :roll:

We know for "SURE" that the hair loss pattern known as doughnutting did "NOT" happen in "ANY" of the early studies using the old large grafts. As pointed out in that very informative post by Michael, this would happen very quickly if related to hypoxia as claimed.

Even your attempt to claim it only happens "sometimes" shortly after transplantation falls flat on its face for one simple reason.

I have already linked the fact that this is "very common" in large grafts. So if it happened (i'll be generous here) in lets say 50% of cases, the old large graft procedures would have never been used for all those years!

If it was not a long term effect and happened right after the procedure, the early experimenters and practitioners would have "SEEN" it!!! :freaked:

They would have asked themselves what is going on, and questioned the use of such grafts a lot sooner than history proves!

The clients would have experienced such hair loss "DURING" the different sessions they were having!

Do you think the whole large plug industry during the 70's and 80's, would have been able to keep this consistent failure rate quiet for so long if it happened "immediately"??

The whole body of evidence and basic common sense, says the "doughnutting" pattern loss in large grafts is a long term "consistent" effect! :roll:

Your inability to put even basic information together scientificaly Bryan, makes these debates a waste of everyone's time :roll:

I said before, i don't want to get involved in any more of this kind of ego driven pointless debate.

I have made my points and references here, and i am now away for a few days.

S Foote.

 

[michael barry]

Stephen,

To be fair, what Jessica tried to convey was that Dr. Cole's paper said 'contraction' in the grafts from the large amounts of scar tissue around them compressed the grafts to hair densities NOT SEEN anywhere on the human scalp normally. The now very thick hair in the graft is growing, but upon the first shed phase, tends not to regrow. The docs think its the shrinkage of the graft due to the scar formation around that great big ol' 4 mm plug taking place, so the middle hairs cant re-establish vascularity all that well, or enlarge either due to the tremedous pressure inside the donutting grafts. She didn't blame it on scalp edema in other words.

Its a wash on this issue between the two of you as Ive not been able to find but one guy who claims donutting happened within the first year (and I dont trust this guy). The industry's claim of hypoxia was buffed up by Jessica's explanation however, as she offered a much more feasible chain of events than just "hypoxia" from the outset, but rather explained how the hypoxia would occur over time due to graft shrinkage--------which is measurable.


Bryan might be able to look around on it. Im burnt out on the subject myself. Im psyched about the HM trials, ACELL, and Wnt signalling that Dr. Kurt Stenn (Aderans) and Costarialis are working on.



Wook..................................Ive never heard of that device, but it would seem that someone could perform its function with their hands once or twice a day if they believed in that. Just push the sides of the scalp up???

BTW Wook...................I had a dog when I was a kid that looked just about like your avatar except he was black and white like a panda bear. That was a great pet.

 

[Old Baldy]

old baldy,

some of Doctor's posts about balding mentioned the lack of inflammation in some men who balded......................thats where I got that from. You'd have to dig back in his posts though, and there are alot of them. Ask him about it and he can probably detail where he found that info.



Rick, Im thinking were close on the ICX, Aderans, ACELL, or Follicla (Wnt) fronts anyway man. I honestly think we are going to have headfulls of donor-area quality hair in the next decade. Im getting very confident about this as the big names in hair are all researching in this area now and all seem so confident about it.

On inflammation, I'd read an article a while back that discussed the first feature of inflammation in Androgenetic Alopecia was around the infidulum or the hole in the dermis where the follicle emerges. It starts there.................very interesting that. An overproduction by the dermal fibroblasts of some growth inhibitor? What could it be? I wish I knew man.

Interesting about the inflammation info. you posted. I seem to remember Doctor saying what you stated he said IIRC.

Yes, I also believe HM and other advanced stuff will eventually make our ailment a "thing of the past".

 

[powersam]

michael barry is the unsung hero of hairloss. he is the dude who understands this stuff yet takes the time to make sure we do also. the guy who has alway stood in between retarded arguments between foote and shelton. the guy who takes the time to make it more accessible if someone doesnt understand. all hail the barry.

 

[vq0]

the online hairloss community is grounded by michael barry.

 

[michael barry]

very kind words gentlemen. Gracias.

 

[wookster]

The now very thick hair in the graft is growing, but upon the first shed phase, tends not to regrow. The docs think its the shrinkage of the graft due to the scar formation around that great big ol' 4 mm plug taking place, so the middle hairs cant re-establish vascularity all that well, or enlarge either due to the tremedous pressure inside the donutting grafts.

How much pressure impedes growth and causes miniaturization? of the middle doughnutted follicles? :hairy: :freaked: :hairy:

 

[wookster]

Im psyched about the HM trials, ACELL, and Wnt signalling that Dr. Kurt Stenn (Aderans) and Costarialis are working on.

Interesting...

http://www.clonemyhair.com/hairlossnews ... 90033.html

In the reported experiments scientists produced relatively large wounds on the backs of adult mice. When wounds reached a certain size new hair follicles developed at the center of wounds. This developmental process closely resembled normal embryonic development of hair follicles.

It appears that as the part of this hair neogenesis non-hair skin stem cells were able to transform into hair cell types. It was shown that the stem cells that gave rise to de novo hair follicles were not stem cells usually associated with hair follicle development (i.e. bulge stem cells).

Dr. Cotsarelis comments: "...They're actually coming from epidermal cells that don't normally make hair follicles. So they're somehow reprogrammed and told to make a follicle..."

Research team of Dr. Cotsarelis also developed a way to magnify this normal regenerative process, making mice to grow twice as many new hair follicles by supplying skin with a specific signaling molecules.

Dr. Cotsarelis is affiliated with with Follica Inc., that has a license for the patent on this process of hair regeneration from wounds (see our patents section). He predicts that it will be more than 5 years before a baldness treatment will be available.

 

[wookster]

When wounds reached a certain size new hair follicles developed at the center of wounds.

Just pure conjecture, but it seems that hairs growing in the middle of a wound is an inverse effect to the doughnut phenomenon :? :hairy: :?