If I’m not totally sure to have a hair transplant, what are some good resources to help understand the process?

Understanding the process is of the utmost importance when considering hair transplant surgery. Many men have wound up with less than desirable results due to lack of information and/or the sales techniques of unscrupulous clinics.
The forhair.com website is a good place to start. There is a voluminous amount of information there with which a person may educated themselves about hair transplantation, the various methods of “harvesting” the hairs for transplant, and also about expectations and outcomes of the procedure.
The non-surgical treatments for hair loss are also discussed at length; this website has more written information that most potential candidates could read in many weeks. The information is truthful, in depth and free from the slick marketing techniques of many clinics.

Check these Hair transplant information and resources:
Forhair.com–Hair Transplant Information
Forhair Hair Transplant Forum
Hair Transplant Guide
IAHRS.ORG
Hair Transplant Information on this site:
Hair Transplant On Hair Loss Press

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Are many hairs transected as the surgeon makes extractions on the donor during hair transplantation?

Good question. The answer is that it varies wildly from surgeon to surgeon and clinic to clinic. We take great pride in having achieved some of the lowest transection rates in the hair transplant world.

Our transection rates with CIT are averaging less than 3% which is very low compared to the industry as a whole. Some published papers on FUE and other single graft harvesting techniques cite transection rates as high as 50 to 70% from their own clinics! This is a travesty, and should be mentioned only to be condemned. .

Single blade strip surgery has average initial transection rates (in our hands) of about 2%; again, it is all over the map depending upon the experience and expertise of the surgeon, and at least for strip, upon the experience and expertise of the surgical staff. One of the most important variables is the surgical technician staff; after the strip is harvested, the tissue is processed by these technicians. Their transection rates can range from 5% up to as much as 50% of the grafts, and is dependent on their training and skill. This is why quality control in a hair transplant practice is so very important (but unfortunately is not the norm by any means). In our practice, CIT has a lower transection rate (<3%) than strip; in strip cases, our technicians’ transection rates, plus the transection during harvest, averages 5%. So for us, even this relatively low strip transection exceeds our even lower CIT transection!
Remember that the training and expertise of hair transplant surgeons runs the gamut, from beginners with virtually no experience to speak of, to veterans with thousands of cases and thousands of quality results under their belts. However, there is one other factor that comes into play, which is standards. A physician may have years of experience, but set the standards in his practice very low. In this situation, sloppy work and poor technique, combined with minimal staff oversight and quality control, may produce high transection rates and other conditions that lead to mediocre results at best, and cosmetic disasters at worst.

We are proud of the high quality and dedication to excellence that we are known for!

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I have heard that it is possible through gene therapy and biological methods to make straight here permanent curly. Do you know if this is on the market yet for cosmetic purposes and if so please can you provide contact details of the clinics.

There are many potential gene therapies being investigated now. One company in San Diego (which researchers do not name) is supposedly working on a cream to help regrow hair using gene therapy. They evidently are also working on one to turn grey hair back to its dark original color, and one to cause a “permanent permanent” (straight hair turned curly). These are a ways off from being released to the public, if they even prove to be effective.
If they do work, at least partially, they would then have to go through FDA approval, which may take years and cost tens of millions of dollars (although there would certainly be plenty of investors in a product that would cure baldness, for example).
Also, there are many ethical questions that are only now being raised regarding gene therapy. Some have to do with creating “cosmetic or aesthetic perfection” for those who can afford it, and creating an undedrclass of “cosmetically challenged” humans, who cannot.

Certainly no one is going to forbid someone from marketing a cure for baldness, or a “genetic permanent”; however, these possibilities are at this point just that: possibilities. The press tends to take these things and run with them, but they are often exaggerated and made to seem closer to mass consumption than they really are.

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Can beard hair be removed through hair transplantation?

There are two ways to remove hair from the donor area. One is by strip method. The other is by removal of individual follicular units. The strip method is not acceptable because it will leave a permanent linear scar. Individual follicular unit removal is acceptable and does work. In fact we often employ this for transplant of beard hair to the scalp. We also use this method to remove unwanted facial hair. This can occur with some forms of face lifting where the hair from the beard is relocated behind the ear. This can be a very difficult and unnatural place to get a razor to shave the beard. We have also used this method to relocate eyebrow hair from a location well above the eyebrow and re-implant the hair into the thinner medial aspect of the eyebrow to create a natural eyebrow transplant.

You should first consider laser hair removal for unwanted facial hair. This may require more than one procedure to remove all the hair. Laser hair removal is only indicated when you have pigmented hair. If there is no pigment in the hair or the hair has turned “grey”, you laser hair removal will not work. Removal of facial hair by CIT or FIT may require more than one pass, as well, to remove all the hair.

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I’m a woman over 40 and was diagnosed with androgenetic alopecia ten years ago. My 16 year old is losing her hair. I took her to the derm and was told that it is stress related. The doctor said that she did not see the genetic pattern. My daughter is losing her hair on the sides above the temple and also in her part. Isn’t this genetic pattern? I don’t know if I buy the whole stress theory. The doctor spent 5 minutes with us and ran her fingers through my daughters hair. Can stress hair loss mimic androgenetic?

There might be a stress component, but it is not a common cause of hair loss except with alopecia areata, which tends to be well circumscribed and circular in shape. There are different kinds of stress. There is mental stress and there is physical stress such as a severe illness or significant trauma. Physical stress can produce a global form of hair loss.
The fact that mom has the diagnosis of AA increases the chance of the daughter having a similar problem, however at 16, she is a bit young for that. Other possibilities are polycystic ovary syndrome; one would expect other signs of androgen excess with this (facial hair, acne, increased body hair, etc). The sides of the scalp are not a common area for androgen excess to present itself. Female pattern loss can involve the sides of the scalp however.
I am unsure what is meant by “above the ear”. If the loss is in the fronto-temporal recess, it could be androgenetic alopecia; if it is on the sides (parietal), that is unlikely and it may be a diffuse patterned or unpatterned alopecia.
The loss through the area of the “part” may indicate a Ludwig pattern of AA, which is a more typical “female” pattern, as opposed to the “male” pattern of temporal recession and loss of the hairline.
A thorough workup with a physician specializing in hair loss would be your best option at this point. You should look for any changes in density or hair diameter. You could follow this up with a biopsy properly performed. Make certain to perform some lab tests to look for anemia, androgen excess, iron deficiency, or a thyroid dysfunction.

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I am 27 and first noticed that i had hair loss about 24..My dad also has hair loss so its should be caused by genetic. About 1 year ago,i already had very little hair . I have been using Minoxidil 5 %, and Propecia, and it helps to control the hair loss but recently i realize that there is excessive hair loss even though i use it faithfully. I tried other ways of different treatment but i dun see any results. I recently saw this product “provillus’,its main ingredient is saw palmetto. It is said that it is similar to propecia but it doesn’t affect your sex drive ,Is this true? Can you please advise me on what other methods can i try,i recently just bought a laser set,do you think it will be useful?

Hair Loss is a multi-factorial problem. This is probably why some people respond well to DHT inhibitors such as Propecia and why others do not respond as well. Some people respond well to Minoxidil or Rogaine, while others do not. We recommend treating your hair loss with as many options as possible to cover as many potential causes of hair loss as possible.

You can purchase saw palmetto over the counter in a health food store and take the pills each day. Saw palmetto is a DHT blocker. We recommend you use this.

We also recommend you shampoo with Nizoral Shampoo at least once a week. Leave the product on for 5 minutes prior to rinsing. The product is a topical agent so it needs skin contact to do its job. We also recommend Hair Cycle shampoo and conditioner 4 to 5 times per week. Again, leave this product on 5 minutes prior to rinsing. Hair Cycle is an anagen stimulator so it will help you keep the hair in the growing phase longer. This should help you prolong the life of your hair. Hair Cycle is also healthier for your scalp since it lacks sodium laurel sulfate, which is the agent creating lather in most shampoos. This lather is the equivalent to engine degreaser and it is not healthy.

Other products you might consider include topical spironolactone.

The laser comb is expensive, but should help. We are working on a less expensive model.

You might find that decreasing the dosage of your Propecia to three times a week on Monday, Wednesday, and Friday has less of an affect on your sex drive.

Please note that Rogaine Foam is a new version of topical minoxidil and seems to produce less skin irritation. It also is better absorbed and does not leave your hair oily or greasy the way most minoxidil solutions do.

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I am now 19 months post surgery from a body hair transplant with you. I noted significant improvement at the 9 month mark, but minimal since then. Can I expect more growth and more density from the body hair transplant I had with you 19 months ago. I live in Spain.

It’s always difficult to say if hair always grows. It really does not matter if it is head hair to body hair. It’s a bit easier when you place head hair on a bald scalp, however. The same is true for body hair. With body hair we’ve learned a few things. One is that lower densities can produce better yields than higher densities. What does this mean? Well, sometimes a yield of 60% to 70% is the best you will see with body hair and it could be 30 to 40%. With head hair on the other hand, the yield is always 90% or less. Usually the lowest you will see is around 70%. Again high densities seem to play a role in lower density with head hair. I’ve seen body hair results that surely look like 90% yields however. We also know that anagen hairs produce a higher yield than telogen hairs. I’m not certain why.

You have to understand the dynamics. Head hair is 80 to 90% in anagen. Body hair is 40 to 60% in anagen. Therefore, in reality, the best you should see from a head hair transplant is 80 to 90% and the best you should ever see is 40 to 60% from body hair. That does not mean that 10% of head hair and 40 to 60% of body hair died. It means that those percentages should always be resting or in telogen. As one hair cycles out, another cycles in and begins to grow. That’s the dynamics.

I think that most body hair transplant results to date seem to follow scalp hair in terms of growth, though we did recently get a 4 year photo of a patient that certainly seemed much better than his 14 month photo. What this means is that at about 8 to 12 months, the result probably peaked with minimal improvement thereafter.

Your comments about hair length are very important. One thing I’ve found with body hair is that while it does grow longer than on the body, it does not seem to grow more than twice the length it grew on the body. It also grows slower than scalp hair, but faster than body hair. Body hair grows about 0.2 mm per day while scalp hair grows about .44 mm per day. The same body hair transferred to the scalp grows about .34 mm per day. This is important in that it shows body hair does indeed begin to take on more of a scalp hair character when moved to the scalp. Since it will not grow as long as scalp hair, a shorter hair style should ultimately be preferred. This is what we have found. Individuals with significant loss such as yourself note better coverage with longer hair because they need the longer hair to cover all the bald surface area. Ultimately, however, you have a comb over appearance. With the addition of body hair density, you are able to groom your hair shorter, yet still have a better overall appearance without the comb over affect. The shorter hair style will generally make you appear younger as you mature and certainly looks more professional than the longer comb over hair style.

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I have a seemingly strange question. Has anyone tried taking advantage of medical donors with hair transplant procedure?

That’s a good question and one that we’ve thought about previously. I suspect one of the big concerns with this would be trying to match the donors. With life and death situation such as kidney and liver transplants, medical insurance will take care of the testing. With hair transplants, the procedure is not medically necessary so most insurance companies shy away from paying for hair transplant surgery. When someone dies, they check their organ donor status. If they are a donor, they are tested. If there is a suitable match in another state, the organs are air lifted to the patient. Such protocol for hair would be extremely expensive. Also, one often has immunosuppressive medications to prevent organ rejection. This would be quite expensive to the cosmetic surgery patient, as well since insurance companies would not pay the fee for on going immunosuppressant treatment.

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My reason for writing to you is over the past 8 to 9 months I have noticed an “excessive thinning” of my hair. My hair has also been dried out and brittle. I am a natural dark haired individual and do bleach my hair. I have been doing so for over 20 years with no negative affect.
I moved to south Georgia in September - into an older home, which has well water. I immediately noticed the texture of my hair changing. It became much drier and hard to style. I was told it might be because of the well water and the pH of the water.
What is your opinion? Are there any tests I can do on the well water? Would that cause hair loss? Is there any other tests to perform that might indicate something bad or missing in the water that would be so negative on my hair.

There multiple reasons people loose their hair. With female hair loss the causes may include hormonal problems. One should consider a thyroid problem. This could be due to an elevated thyroid or a low thyroid function. A change in medications might stimulate hair loss in women with female pattern loss and this should be considered too. One would generally see female pattern loss prior to age 62 if this were the cause.

I think you should consider the well water as a possible cause. There are numerous heavy metals present in well water and you can absorb heavy metals through the skin or through ingestion. There would include thallium, arsenic, mercury, copper, cadmium, or bismuth. A half gram of bundled hairs kept in their normal orientation (tops toward the top) sent to the National Medical Services in Willow Grove, PA can evaluate your hair for arsenic.
A low pH can sometimes cause copper in the pipes to precipitate out into the water and this can result in an accumulation of toxic levels of copper in your system.

You could have your physician work you up for heavy metal exposure. Blood levels, urine levels, and hair levels will generally tell you if you have been exposed to heavy metals. Often times you will have neurological findings or symptoms with heavy metal exposure.

Lab tests in addition to a heavy metal analysis include thyroid function tests, a CBC and ferritin level to evaluate you for iron deficient anemia, a dihydroepiandrosterone level to check you for elevated male hormones, a testosterone level, a FSH and LH. If the work up comes back negative, you could consider a properly performed biopsy. The dermatology department at the Medical College of Georgia in Augusta could perform most of this work up.

Heavy metal poisoning produces a characteristic form of anagen hair loss. A dermatologist should be able to assess you for any particular hair shaft abnormalities. Heavy metals were often found in pesticides and herbicides that could have found their way to your well water.

Of course hair coloring can make your hair brittle and cause breakage. This could be a factor currently and might result from a change in salons who use different chemicals or leave the agents on for a long period of time.

I usually see progressive female pattern loss begin after pregnancy or in the 40s to 50s. I do not see it begin in 62 year old women typically. Often times there is a family history, which means your mother would have exhibited these symptoms. Medications high in progesterone can stimulate hair loss in women prone to this form of hair loss. Any therapy would be directed at the cause. Therefore, it is best to determine the cause first. I think most of this work up can be done closer to your home. If it comes down to a biopsy, it probably is better for me to take, but I’d get the lab work up first.

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When and how does the new hair grow in after my hair transplant ?

Many people ask this question during and after their hair transplant; some actually think the hair will all continue to grow and they will have their “new head of hair” immediately. Unfortunately, most individuals have to accept delayed gratification as part of the transplant experience!

When the grafts are placed in the balding areas, they indeed may continue to grow for a few weeks. However, by about three weeks, the hairs begin to rapidly shed and soon most all of them are gone. The good news is that the follicle cells, the ones that make the new hair shaft that grows up and out, are still lying dormant under the skin.

At about three to four months, the first hairs begin to sprout through the scalp. At first, all new hairs will be finer, and slightly less pigmented than they will eventually be after some growth time. It is important to note that the grafted hairs do not all begin to come in simultaneously; they generally sprout in a “staggered” fashion, which means that each month some new sprouts will be noticed emerging from the scalp, until they all have grown in! Full growth will have occurred, on average, after about 10 to 12 months; full ingrowth may sometimes take a little longer on second and subsequent procedures.

Of course, the full cosmetic effect may not be apparent right away. This is because length and caliber of hair, as well as density, contribute to coverage. Once the hair has grown long enough and each shaft has become thick enough, then the full coverage will be apparent and the welcome decrease in the appearance of thinning and baldness will be noticeable.

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What is the importance of hair characteristics in hair transplant surgery?

These characteristics are significant in that they determine to a great degree how much coverage of the scalp there is, in order to block light. When light is not blocked and penetrates through to the scalp, the appearance is of thinning or balding.

The other big factor here is the density, which is another topic unto itself. The density is the number of hairs or follicular units per unit area (square centimeters or square inches or whatever unit you prefer; the centimeter is the standard for physicians). Although this density usually gets most of the attention when discussing hair loss, hair characteristics are equally, if not more, important.

First let’s look at color. At first, one might think that the darker the hair, the better the coverage. This is generally not correct. Lighter hair usually goes with lighter skin, and the tow together tend to mask thinning very well. Darker hair can cover well, but in the case of poor hair transplant work (pluggy looking, or larger graft on frontal hairline) they may stand out much worse than lighter hair. We will discuss color in more detail when we discuss contrast.

Curl is another very important factor in coverage. Generally speaking, curly hair provides coverage in proportion to the degree of curl (i.e., wavy hair gives better coverage than straight hair, curly hair better than wavy, very curly better than slightly curly, etc.). This has to do with light blockage as well. The curlier the hair is, the more it creates a meshwork of sorts (kind of like a thatched roof) which “stands up” a little bit off the scalp and keeps the light from penetrating to the scalp.

Contrast has to do with the difference between hair color and skin color. The closer to each other the hair and scalp are, the better the coverage. In a way, this “fools” the eye of the observer into not noticing the decrease in density. If a person with blonde hair and light skin loses 50% or his or her density, they may appear much less affected than a person with equally light skin and jet black hair. In this case the dark hairs of the second example are highlighted against the light skin and it shows the sparseness of the hair. The person with the blonde hair reveals very little difference between the hair and scalp, in other words, the observer cannot detect where the hair leaves off and the scalp begins.

Last, let’s consider caliber. Thicker strands of hair provide more “hair mass”, which is a term doctors use to describe the total effect of length times caliber. The more hair mass in a given area, the better the coverage. This makes intuitive sense. Imagine covering a hut with logs. If you place 20 logs as a roof, which will give better coverage, skinny logs or big round ones with large diameters? Of course, the bigger ones, so the thicker hairs do the same over the scalp. And remember, what appears as thinning or balding is simply the appearance of light shining through to the scalp.

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I’m told by various strip physicians that the strip scar is a thin as a pencil mark. Is this true?

This is completely dishonest. The average strip scar is 2 to 3 mm wide and it can stretch from ear to ear. If you plan to cut your hair short, this can be a problem for you as it is obviously a man made scar. It is an obvious sign that you had a hair transplant. No one wants anyone to know they’ve had a hair transplant, however. No one wants anyone to know they had hair loss or that they ever considered hair restoration surgery. Even shorter hair styles can expose the strip hair transplant scar. Frequently we are told that a hair cut of a number 3 or shorter exposes the strip scar form a strip hair transplant.

There is a new fallacy you are hearing from strip surgeons, as well. They claim that their new trichophytic closure technique produces pencil thin scars that are invisible. We’ve seen 5mm wide scars produced by this technique. Five millimeters is ¼ inch wide. It is a huge gap with no hair in it. When the trichophytic closure works, it rarely works in the rear of the scalp. You will not see an advantage along the sides of the scalp usually. Furthermore, the tighter you make the scalp by performing successive strip procedures, the more likely it is that your scar will widen and stretch out. Furthermore, these strip scars can turn whiter than the surrounding skin or bright pink. This produces further contrast to the scars should they be exposed by a short hair cut or by a medical illness that causes thinning or loss of your hair.

One other problem you will never hear about from your strip surgeon is that strip procedure causes irreversible changes in your donor area hair growth angles. A strip is nothing more than a scalp reduction in the donor area. It alters hair growth angles for the rest of your life.

There is no reason to have a strip procedure. It really is up to the patient to demand the alternative, which is far better. Patients should begin to demand CIT, which is an advancement over our older FIT procedure. There is CIT and no quite CIT. Many physicians will tell you they perform FUE. This FUE procedure does not meet the quality of CIT. CIT is a proprietary procedure with quality instrumentation. Only CIT has proven results day in and day out with all types of hair including wiry, kinky hair seen in men of African decent.

With all the disadvantages of a strip procedure for hair loss you might ask yourself why all physicians don’t make the switch to CIT. The answer is very simple. They don’t want to work that hard. CIT is a far more complex procedure that requires the physician to learn new skills. Strip hair transplant surgeons are used to their strips and the ease with which they are performed. Don’t expect them to change. The only thing that will cause surgeons to modify form their scar forming strip procedures is for patients to begin demanding the less invasive CIT procedure.

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What is Maximum Medical therapy for hair loss?

People with hair loss, and certainly anyone even CONSIDERING hair transplant, may want to use a regimen of maximum medical therapy. This just means using a number of different medications that have different mechanisms of action to try to “cover all the bases”, so to speak. Attacking hair loss by targeting different aspects of the process is a way of using the synergy between various agents to maximize the effects.

Finasteride (Propecia and Proscar) is an agent that blocks the formation of dihydrotestosterone (DHT), a hormone that has been implicated in male pattern baldness (androgenic alopecia). This is a first line drug for men with thinning hair or balding. It is not beneficial for women; in fact, it can cause birth defects if a woman is exposed to the drug and gets pregnant. It has few side effects in men and has been used for about 25 years with a good safety record.

Minoxidil (Rogaine and many generic versions) is topical, or placed directly on the scalp. Side effects are few, and it has a synergy when used with finasteride. This may be used in men and women, and is considered by many to be the drug of choice in women with hair loss</