More on transplants

My patient came over yesterday so I could take out his stitches (from the hair graft site in the back of the head). I’m familiar with Dr. Kurgis’ work, but something VERY interesting struck me. First, a little background … and then the “interesting part."

In the “old days” surgeons assumed they needed large hair grafts so the follicles would “take.” Today they know that even a single follicle will re-grow. They also discovered that the larger grafts become “doll-like” because as the wound contracts (normal wound-healing) the follicles squeeze together and form a clump of hairs … a very unnatural “doll head” look. So, the mini-grafts are what all top surgeons do today (one hair, or one follicle unit). But there’s more …

When we did grafts (in the old days) we attempted to align the epidermis (of the graft) to the epidermis on the scalp (the receptor site). Problem is, this seldom was possible. If the (graft) epidermis is placed too deep, the epidermis at the hair forms a tiny depression; if placed a bit too high, you get the common “hair-transplant bump.” All of these errors look dreadful, and you all have seen these. (These are the ones we have to remove.)

Dr. Kurgis’ (brilliant) remedy is to not put the hair graft in all the way. Instead, he allows the graft epidermis to completely stick up above the graft site. In this way, the entire graft epidermis, and some of the dermis, desiccates. He WANTS the graft epidermis to die off! The epidermis at the graft site fills in (of course), and now the hairs is perfectly aligned and there is no possibility of a bump or a depression. (This was Kurgis’ thoughtful addition to this procedure.) But now, something even more interesting … and the reason for this post.

I noticed on this patient that the hair grafts in the front of his head didn’t look “put in” deep enough! Only about half of the follicle was placed in the graft site! Indeed, the entire (assumed) location of the bulge was ABOVE the scalp and therefore desiccated and non-viable (looked like a lumpy crust). So, here’s the explanation (from the surgeon).

In the front of the head, it’s preferable to have smaller hairs (and follicles). Having big hairs in the front looks unnatural. (Remember, they only use BIG hair grafts from the back of the head). So, to “create” smaller hairs/follicles he only puts the follicle in “half-way.” In so doing, he creates a smaller follicle and consequently a finer/smaller hair (for the front of the hairline).

Surprisingly, this “half” hair graft is able to completely survive and regrow WITHOUT a papilla and WITHOUT a “bulge.” So, what do you make of this? I have formed a conclusion, but I’m interested in your thoughts. (Funny how information from other procedures can impact what we do? I think this “revelation” might impact our treatment protocol.) Ideas?

Germinative cells in bulb make a hair to regrow?

About challenging everything …

I guess I’m a born skeptic. I challenge all beliefs, including my own. I’m posting this only because some of our most sanctified electrology beliefs might not be accurate: for example the unending belief that only anagen hairs can be successfully destroyed (yuck!)

In 1990, when I was doing research for my first book, I looked at the Hinkel reproduction of William Montagna’s drawings. I didn’t get it! Amazingly, EVERY electrology text “out there” had redrawn the Montagna drawing and it looked WRONG to me! So, I wrote to Montagna, and below is his answer to me (August 3, 1990). The point here is to challenge everything! Science loathes the “holding of ‘sacred cows’ or suppositions.”

In this letter, you can see how an actual MISTAKE by a leading researcher was simply accepted and therefore incorrect conclusions were made … and repeated over and over; and are still with us today!

Montagna letter:

Dear Mr. Bono

Many thanks for your letter of July 20 [1990]. The question you raise about the fate of the dermal papilla during catagen is proof of you interest in the hair growth cycle. In all of the stages of the cycle, the dermal papilla is never far from the field of action. In the diagram of the three main stages, the catagen state shown has not yet released the papilla. In the diagram on page 42, the papilla was left out of the drawing! I must have been dozing when I checked the drawing for accuracy, it was incorrect. All that remains of the bulb cells is the mass [of] fat which forms the hair germ.

Concerning the Inaba et. al., criticism, I have not formally published them, other than in the “Instantron book.” Frankly, that article, i.e., Inaba et. al., is not worth taking very seriously. If people quote the article to support their argument for hair follicle repair and de novo formation, they are scraping the barrel. In other words, they are panicky.

With good wishes to you,
William Montagna, PH.D.

Amazing that Montagna’s drawing was WRONG. Nobody challenged it and the misinformation got universally disseminated. (I also made conclusions from the Inaba experiment that were probably incorrect.)


Long ago I suspect about the futility of pursuing the dermal papilla. In fact, it has never been my goal.

Only a teacher who has not lost his soul student can work so hard to make us think about the nature of things.

Thanks Michael.

And thank you Jossie …

My conclusion is pretty simple: the target is the entire follicle.
I think all of us are “on board” with this simple idea.

I will post tomo about another funny issue, but after breaking a new (expensive) window I’m going to chill out …

Hey Michael,

You might like a few of my collected links related to body and head hair below. Last one is from my own site that I hope to improve it some year soon.

Coen Gho (search his name on Google – he is multiplying donor scalp hair, and not cloning it. His work sounds a bit related to the stuff you mentioned in this thread):

Close to 400 pages of people using Rogaine to increase facial hair:

Surgeons moving body hair to the balding head:

Does not it indicate that treating 2/3 of the follicle in anagen is a bit much and it is enough to successfully treat at least 1/3 lower part of the follicle (if anagen) to eliminate a hair for good?

P.S. very sorry to hear about breaking a new expensive window.

Thanks a lot for the references: interesting! … I don’t think transplanting body hair to the head is a good idea; actually it’s a bad idea. Remember, the hair follicle will not “convert” to a head-type hair; it will stay a body-type hair (short). One “idiot” surgeon transplanted some (head) hair on one of my patient’s eyebrows! … So now she has to constantly cut the new transplanted hairs because they will grow to several feet in length! (Of course, she wants me to remove these now.)

Another “trick” in the transplant field is to take the “anagen follicle” and cut it in half and transplant both halves … thereby getting “two hairs for the price of one.” (The surgeon says that you only gain about a third more hairs doing this.) This shows that a hair can regrow form the “upper” AND the “lower” follicle.

Instead of trying to figure out exactly which part of the follicle to target (still not an absolute fact), why not just target the whole thing? Get all the possibilities and be done with it? And NO, doing this does not cause scars!

In my opinion, fear of causing scars, and therefore delivering “light treatments” over and over on the same follicle, results in scars (“pebbling” as I explained in a former post. I will have some photos to post in a month to verify this claim.)

Over the years (and yes my “specialty” is body hair) the “get the whole follicle” strategy has been my goal. Using a bare “tapered needle” and allowing the current to rise to the “anchor” the hair releases properly and I know I have achieved the goal: zapping all possibilities. (All potential “hair growing” parts are below the anchor.”) And, of course, any and ALL modalities and needle types can achieve this. Jossie does this with her Apilus and IB probe; I do this with manual blend and a bare needle.

How interesting!
I wonder what are the lengths of these halves? How long is “upper” and the “lower” follicle?

“I wonder what are the lengths of these halves? How long is “upper” and the “lower” follicle?”

Well, HALF of the anagen follicle … no need to measture the thing! Are two anagen follicles going to be the same length? Well, no!

If the follicle is 8mm, then half is 4mm. If the follicle is 6mm, then half is 3mm. You know: “half … ½ … 50/50!” When you are cutting the follicle, trust me, nobody is measuring!

Hi again Michael,

I am one of those who has been cursed with too much body hair and balding head hair (though not yet anywhere near a Norwood 6). So I have researched body hair to head transplants (BHT) for a while now, though I am not planning to go through with such a procedure as yet.

The consensus seems to be that body hair should be used as a filler and not in the front of the head. It seems like beard hair gives super results when moved to the head, chest hair is also quite decent, and from anecdotal evidence and surgeon posts, the chest hair does change to some kind of mean between the existing scalp hair and existing chest hair in terms of texture, length and so on.

At this point I have seen at least 100 before and after photos of patients who had predominantly or exclusively body hair moved to the head. Surgeons are very good at documenting exactly how many body versus how many scalp hairs were involved in the transplant.

If you or anyone you know is interested in this subject, the following surgeons are the most experienced and reputable at BHT from what I have read:

  1. Arvind Poswal (India – most experienced in the world)
  2. Ray Woods (Australia – inventor of this procedure)
  3. Sanusi Umar (US)
  4. John Cole (US)

There are some truly amazing photos and videos of BHT patients from these surgeons on their websites and on youtube. Ray Woods has also published something on this in a reputable journal.

I’ll have a look. Still the harvesting of the body hair will leave a strip scar. I suppose that would not be a problem if you don’t have the body hair removed later.

Okay, very interesting. Funny but in the REALLY old days they used a punch graft instrument to remove plugs of hairs. If they can remove a single hair (or unit), this sounds like a good idea.

I’m now “running this by” Dr. Chapple and Dr. Kurgis for their opinion. I’ll have an answer by next week.

(I did notice some very negative reviews about Dr. Woods.)

Okay Michael. I will post some BHT related popular links here assuming hairtell has no time limit on editing of posts.

Can’t edit above anymore, but this is an important link:

ARTAS robots have made FUE hair transplants much easier…no strip scars in the future!

damned amazing … I need to see this in operation. I’m wondering where the follicles go as they are being extracted? Also does the doc put in the follicles.

I’ll bet I can get to see this thing … maybe with Kurgis?