OK Bryan.
First off, i have no problem at all with the data provided by Nordstrom and the other reputable scientists, who conducted the earlier studies using 4mm "plug" grafts and larger. I certainly do "NOT" think they are lying as you try to claim.
In fact it is those early well documented "peer reviewed" studies that "PROVE" my point Bryan! There is absolutely "NO" mention of the hairloss now refered to as "doughnutting" in the peer reviewed studies!!
You yourself have been quick to point this out Bryan right!
So now many years on from those original studies, we hear about the common repairs performed on the very same type of large plug grafts that were used in those studies. According to all the articles including one right here on HairLossTalk.com, hair loss from the centre of these large grafts is very common in grafts of 4mm and over, even effecting 3mm plug grafts!
http://www.hairlosstalk.com/surgicalops/ht11.htm
Quote:
"The main issue is one of oxygen diffusion. Since oxygen must diffuse into the center of the newly transplanted graft, very large grafts will be oxygen-deprived in their center. This has been shown repeatedly by observing the phenomenon called doughnutting, the loss of hair follicles in the center of larger grafts. This phenomenon is noted in larger grafts, but does not occur in follicular unit grafts since the distance that oxygen must travel to reach the center of the graft is so short."
http://www.newhair.com/resources/mp-200 ... pair-1.asp
Quote:
"In clinical practice, one often observes less density in the grafts than anticipated from the size of the harvested plug. This can be due to a number of different factors. Two of the most common are loss of hair from poor harvesting techniques and hair loss caused by a phenomenon called "dough-nutting." In dough-nutting, the centers of grafts receive insufficient oxygen following transplantation and, therefore, the follicles in the central portion of the grafts fail to survive. This results in hair growth limited to the periphery of the grafts. Dough-nutting was a phenomenon seen with 4- and 5-mm plugs, but also with grafts 3-mm in size."
Leaving the reason offered for this graft hair loss to one side for a moment, we can definately conclude that "doughnutting" is "REAL", and a very common effect in large grafts!
Moving on to the "excuse" given by the transplant industry for this hair loss "common" in these grafts.
This is put down to hypoxia. Hypoxia is a lack of oxygen, in this case it is claimed that hair is lost because of the distance oxygen has to defuse into the centre of these large grafts. The follicles in the centre of these grafts are then lost because of oxygen starvation it is claimed.
If this is true, the early peer reviewed studies by Nordstrom etc would have seen this, but they didn't did they! The most hypoxic conditions exist very early on after transplantation when the blood vessels are healing. There could well be a case for hypoxia causing the initial hair loss reported in those studies, often called "shock" loss.
But after this initial loss, the hair then regrew "throughout" the large grafts in those studies as "you" have said yourself. There was then no reported thinning, or any other hair loss pattern reported in the two years or more that those studies ran for. So if hypoxia did exist in the grafts used in the early peer reviewed studies as is claimed, it "CERTAINLY" did not prevent full terminal growth throughout those large grafts did it!
So the conclusions indicated by this body of evidence, should be clear to anyone with any basic reasoning ability!
The pattern of hair loss in the larger grafts called doughnutting, is now a recognised fact. Because this was "NOT" seen during the period of the early studies, it "HAS" to be a longer term effect that happens later than the two year time frame of those studies. Also whatever causes this long term hair loss cannot possibly be related to hypoxia, because the most hypoxic conditions exist early on and there was no such loss reported in those studies!
I have first hand experience of graft "doughnutting" in the 4mm grafts i had in the early 80's. Anecdotal maybe, but i believe my own eyes and it takes 3 to 4 years for this to be noticable in my experience.
So if you don't agree with my conclusions Bryan, you are either going to have to deny the evidence reported in the early peer reviewed studies, or deny that "doughnutting" exists at all!!
The only logical conclusion based on the evidence is a continuation of normal male pattern baldness in these alledged male pattern baldness resistant follicles. The time frame matches this, as does the thinning from the centre outwards. In my opinion the only thing that protects the follicles at the edges of these large grafts, is the fibrose tissue that formed around them during the healing process as i have argued before.
Unless of course you can provide any other logical explaination for "doughnutting" based on the facts at hand?
S Foote.
