Dr. Cole plan to treat the CIT extraction sites with PRP to improve dermal healing. Dr. Cole also interested in reports that injection of PRP into the grafted area may improve hair yield. For example, Ubel found that PRP improved graft growth by 15%. Greco has reported that up to 75% of patients respond to when he combines his patented matrix complex. Therefore, they are considering its use in the recipient area. There are some that feel it may be useful in the treatment of miniaturizing hair associated with Androgenic Alopecia. Dr. Cole feel it is too early to make any claims with regard to improved yield or improved coverage, but is very interested in the possibilities. Current recommendations on the treatment of native hair with PRP suggests that the treatments should be repeated every 10 to 11 months.

Dr. Cole and the Cole hair transplant group are also offering microneedling to our patients to improve natural collagen induction in dermal layers.

I am appealing to any experienced FUT professional (doctor or patient) for a favor. I did my surgery on last week and I cannot tell if my doctor (who is highly reputable) did as many grafts as he said. Could you kindly look at the attached photo and give me your opinion as to how many incisions/grafts this appears to you (we focused just on the frontal area)?

Many thanks to any one who gives me some guidance.

If you really want to improve your capacity to know exactly how many recipient sites were made, you should insist that your physician use the Counting Incision Device from Device For Hair. You can see this at Counting Incision Device (C-ID) . This device will cost your physician only 22.00 to use and he can give it to you at the end of the case. This device allows you to know precisely the number of incision sites filled with grafts and it is the only way you can know for certain how many incision sites were made. Of course, if you have a site that is not filled with a graft, then you should not be charged for the graft.

We have found that most physicians are not willing to spend the extra 22.00 to be accurate with their incision site count. While the Physician is making thousands of dollars on your procedure, he appears to be less concerned with accuracy and more concerned with the extra expense. Therefore, you might want to purchase one for your physician and insist that he use it and then give it to you at the end of the case. This way you can be certain what was done.

Don’t rely on the surgery staff to count your grafts or your incision sites. They have no real interest in being accurate and they are often more concerned with what they are going to have for dinner than an accurate graft count. Try sitting at a counter and cutting grafts day in and day out. It becomes routine and monotonous. Over time, the surgery tech’s mind begins to wander and they next thing you know, they have lost count.
Insist that your physician use the Counting Incision Device (CID) so that you can be certain what the exact graft count is.

One important point to consider with the CID is that it is disposable. There is no way to properly sterilize it once it has been used. Insist that the physician use a new one on you and not one that he used on someone else the day before. It really is up to you to insure that you get what you pay for and that your physician use properly sterilized single use CID instruments on your case.

Getting back on the subject of your grafts, there is some elongation noted and many of the hairs appear to be falling over to the side suggestive that they are about to be expelled from the skin and lost in your shower drain. This would not happen one day after a procedure.

Many times when the scabs come off, they bring the transplanted, non-growing hairs with them. It is less common for scabs to contain non-growing hairs when you use Hair Cycle Biotin spray as this helps to get rid of the scabs faster and often leaves the non-growing hairs behind on the surface of the scalp. Use of Hair Cycle products can dramatically accelerate your post surgical healing.

Of course when the scabs take hairs with them, it is more difficult to determine how many grafts you had. It is only possible at this point to suggest how many remain. The overall density does not appear great so I would expect that you currently have somewhere between 1000 and 1500 grafts just based on the surface area treated and the remaining lower density as it appears in this photograph.

Also note that your hair transplant photograph appears to be older than one day. It is very unusual for the scabs to be shed in one day and most of your scabs are gone. The hairs in many of the grafts appear to have elongated beyond the length you would expect after only one day. When you transplant grafts, the hairs will continue to elongate for up to 11 days after a procedure. Some misinterpret this for growth of the grafts when in fact it is perhaps some growth, but it is also due to a shortening of the dermal sheath that tends to push the hair externally as the sheath shortens following the transplant. After a couple of weeks this lengthening ceases unless indeed the hairs are continuing to grow, which is uncommon. Generally, you will see only a handful of grafts continue to produce hair following a hair transplant. Many of these hairs will be puhl pinkus hairs meaning they will have a thin lighter color below a darker thicker colored hair. The thinner area usually signifies a retarded growth subsequent to the trauma experience by the growing hair following surgical trauma to the hair shaft.

(Click on the image to enlarge)

Body hair sometimes produces a very significant result, but often times the result is subtle. All individuals should keep this in mind when considering body hair transplants.  We continue to recommend head hair first over body hair whenever possible.

If you transplant gray hairs from the body, will they be the same color on the scalp?

Hairs grafted from one location to another do not change their color. Generally, the amount of pigment remains the same, as well. This means that if your hair is brown, the grafted hairs will produce brown hair. If the grafted hairs are white, they will grow white hairs upon transplantation and regrowth. With age, hairs loose their ability to make pigment. Some hairs loose that ability before other hairs. For instance, hairs on the side of the scalp loose this ability to produce pigment sooner than the hairs on the top of the scalp or the back of the scalp. Some regions of body hair produce white hair sooner than other regions due to the loss of pigment formation capacity.

The cells that produce pigment are called melanocytes. When the ability to produce pigment ceases, the hairs will turn white rather than grey. Therefore, the term grey is really is inaccurate. Actually, true grey hairs are extremely uncommon, but they do occur due to a decrease in the amount of pigment rather than an absence of pigment production.

Hair also tend to maintain the same diameter as the pre-transplanted area. On some occasions the diameter will be slightly greater upon transplantation and other times the diameter will be the same.

Will stopping to use Nizoral have as dramatic of an effect as stopping Propecia? I know whatever benefits you get from using the shampoo will be lost upon stopping to use it but would it be as bad as stopping Propecia?

I’ve never seen a remarkable result from Nizoral or Minoxidil. I have not seen improved hair growth with Nizoral alone, but it is supposed to work as well as Minoxidil alone. They both stimulate some hair growth and may slow hair loss in some patients. I have seen rare remarkable results with Propecia, but most of the remarkable results on Propecia seem to occur when patients combine both Minoxidil and Propecia. When patients stop any of these medications, they will loose what ever benefit they received from the medication. If your benefit from any one of these medications was slight, your loss will be slight. Most of the time patients simply note a reduction in the rate of hair loss with these medications. Therefore, you can expect the rate of loss to increase once you discontinue any of them.

Transplanting too high of a density into a recipient area that is already relatively dense can cause fatal trauma to the pre-existing (native) follicles. High densities placed into an already progressively thinning crown can create a bigger problem than most patients seem to know prior to the procedure. For example, a surgeon transplants 200 multi-hair grafts on a patient who only has a 50 sq. cm. size area of recession, the patient will have a great risk of having an unnatural appearance.

In the future, after hair loss has occurred, the density that was once considered to be the corrective treatment can be problematic, especially for those patients who 1. Don’t have an adequate supply of scalp donor resource. 2. Experience poor growth from aggressive procedures. 3. Cannot financially manage restoring their hair loss. Chasing hair loss can be made easier by having a less aggressive approach, thus a procedure that formulates an exit plan. Clinics should have patients’ best interests at heart, improving their quality of life in the long-term. We prefer to put all patients on treatment plans for the long-term, rather than just treating them for present time.

Hair loss in a typical thinning crown (vertex), normally, gradually, recedes outwards in all directions until the entire crown becomes bald. The most difficult aspect of restoring density in the vertex is replicating the natural hair growth angles, as well as recreating the natural whorl. The crown/vertex naturally patterns itself in 360 degrees. This region of the scalp usually requires more transplanted follicles than any other area, due to the fact, that it has no consistent grain. Grafting a crown is a delicate process that requires skill and artistry. Follicular units found in the crown can naturally be single-hair follicular units or multi-hair follicular units. Patients seeking hair transplant surgery to restore the crown should understand that hair loss will continue to some degree, and that no hair transplant procedure can increase the overall volume of hair on their scalp.

Medical therapy can be advantageous for patients once they have researched the pros, cons, and possible side-effects associated with those medicines. Those who suffer from advanced hair loss, commonly use medical therapy because, their hair loss in the crown/vertex can expand to a degree that cannot be fully restored. Those patients must use other methods (body hair) to increase density in the area. This patient declined the use of any medication.

In 14 months post-op, the growth is ideal without this patient ever having to expose any scalp in the donor area or recipient area. We are excited for this patient and another successfully treated case.

*This Post was originally posted on the forhair hair transplant forums

I have been recommended 600 to 1000 grafts to the front.  I would like to know what is the highest density and graft count with more aggressive density on the front hairline.  I would like to have the front hairline to be suitable for a 36yo that is not on meds.

You can go with the maximal density, but I’ve seen many patients from physicians who claim to place 70 to 100 grafts per sq cm that are growing 20 grafts per sq cm. One of two things occurred. One is that the patients received 20 grafts per sq cm, which is not likely. The other is that they received 60 to 70 grafts per sq cm and they lost 50 grafts per sq cm because the placed density was much higher than their scalp could tolerate. There are studies out there showing that densities of 40 per sq cm grow only 73%. I like to keep my maximal density between 40 and 50 per sq cm because I have seen consistent growth rates above 90% in my hands. The other problem with poor growth from an attempt to achieve maximal density is that it may poison the scalp for future surgery and nothing may grow subsequently. It is best to stick with a safe density of 45 per sq cm on the hair line and in the rest of the scalp. This seems to work best for my patients. It’s not as if 70 per sq cm will not grow in some patients. The problem is that you cannot tell which patients it will grow in and which patients it will not grow in. The only way to tell is to try it and if it does not work, the patient is in real trouble.

He can go with the maximal density, but I’ve seen many patients from physicians who claim to place 70 to 100 grafts per sq cm that are growing 20 grafts per sq cm. One of two things occurred. One is that the patients received 20 grafts per sq cm, which is not likely. The other is that they received 60 to 70 grafts per sq cm and they lost 50 grafts per sq cm because the placed density was much higher than their scalp could tolerate. There are studies out there showing that densities of 40 per sq cm grow only 73%. I like to keep my maximal density between 40 and 50 per sq cm because I have seen consistent growth rates above 90% in my hands. The other problem with poor growth from an attempt to achieve maximal density is that it may poison the scalp for future surgery and nothing may grow subsequently. It is best to stick with a safe density of 45 per sq cm on the hair line and in the rest of the scalp. This seems to work best for my patients. It’s not as if 70 per sq cm will not grow in some patients. The problem is that you cannot tell which patients it will grow in and which patients it will not grow in. The only way to tell is to try it and if it does not work, the patient is in real trouble.

One reason for poor growth with high densities is that you have to fractionate the follicular units to get densities above 50 per sq cm. This means splitting 3, 4, 5, and 6 hair follicular groups into 1 and 2 hair follicular clusters. There are many studies showing that fractionation of grafts can lead to lower yields and I suspect that the lower yield is much greater at very high densities. Of course fractionation is always done by in strip surgery although some clinics are more guilty of it than other clinics. This is one reason why my CIT procedure produces a much better result with far fewer grafts than any strip surgical procedure that I have seen to date.

Therefore, I would recommend that patients do not take this chance. Furthermore, it is not an option that I will give my patients because I’ve seen it fail for reasons that are not understood. Scalp hair transplant surgery is very safe and it has a proven success rate. I don’t see any reason to take unnecessary chances that put an almost sure thing in risk of overall failure.

Body hair transplants are not always a sure thing. However, we know from experience that they are even more susceptible to failure from high density. For this reason, I keep body hair transplants to a maximal density of 20 to 30 grafts per sq cm

I am NW VII at 57years, i have had just one strip procedure as usual it was insufficient and I would like to FUE only from my nape to my bald area i am not concerned about my crown and I believe that the total amount should be 6500 FUE to get a conservative nw3. I would like to ask you is this possible?

A NW VII typically looses 70% or more of their original scalp hair. This means that they maintain 30% of their original hair or less. In my opinion, this makes them a poor candidate for hair restoration surgery. The best you can hope for is what some call a frontal forelock that is isolated from the sides of your scalp. In other words, it is hair that sits on top of your head with a bald rim on the sides above the ears before you see hair again.
It does occur in nature, but it is quite uncommon. It can help to frame your face, but you must recognize that it can also look a little unusual to have hair on the top of your head, a bald fringe, and then hair again above the ears.

A typical donor area will have a maximum of 16000 follicular units. I think that a NW VII will have less. Of this donor area, you can expect to remove 50% or a little more in those with outstanding donor area characteristics such as a high density and coarse caliber hair.

In your instance, you can probably expect to remove no more than 5000 grafts in total. Of course, you may be able to move slightly more, but 5000 is a safe number to anticipate. This may leave you looking a little thin on the sides between the top of the head and the fringe of hair that normally remains in the NW VII.

We have added body hair in select NW VII cases, but body hair in general is a hit or miss. Some do well with it and some do poorly. Therefore, I always tell patients to try a little to see how they respond, but don’t bank on your body hair until you actually see how you respond to it. Many are quite happy with body hair, but some are quite disappointed with the results so try a little and see how you respond prior to expecting too much from this.

In summary, a NW VII is a poor candidate for hair restoration surgery. It is questionable whether you have enough donor hair to create an acceptable result. I would be surprised if you were able to get a total of 6500 grafts from your donor area and not make your donor strip scar visible, but it is possible. Therefore, I would proceed cautiously with any further treatment and don’t expect a miracle because it is impossible to expand the capacity of your scalp donor area.

One final note is that with your initial procedure you became 100% better because you added hair to a bald scalp. Assume that you next add 1000 more grafts to the original 1000 grafts from your strip procedure. With the second procedure, you increased from 1000 grafts to 2000 grafts in total, but you are only 50% better. You get the most dramatic result from the initial procedure and each procedure subsequent to this leaves you a with a less impressive result.

When can I resume exercise after a hair transplant?

After a strip surgery, it is recommended that you refrain from exercise for several weeks after the procedure to limit the widening of the strip scar. One advantage to CIT or FUE is that you can resume exercise the same day as the procedure. The reason is that you do not need to worry about increasing the width of a strip scar. You should avoid any exercise that might rub on the grafts, however such as standing on your head or martial arts.

With any hair transplant procedure, however, you must be careful with the grafted area. Anything that disturbs this area may result in the potential for a lost graft. Therefore, we recommend that you do not scrub the top of your scalp or pick at the grafts for the first 6 days after a procedure. I let my patients resume washing their scalp the following morning after the day of their procedure, but I recommend they use Hair Cycle shampoo, which has less lather and is easier to get out. I tell them to avoid letting the shower water hit directly on the scalp. I encourage them to use a cup of water on the scalp to remove the shampoo.

It is quite common, for some reason, for patients to hit the top of their scalp on the car, while getting into the car. For some reason they tend to do this right after a procedure only because they are being so careful not to do it.

Of course after 6 days the grafts are in place and you will not disturb them so you can resume normal shampooing and all physical activities.

How long after an FUE hair transplant before a person can – A, shave his head with a razor and B, shave his head with a number 1 or 2 setting? Also, how does HGH affect hair growth and hair loss?

Often times the head is shaved in preparation for an FUE procedure. It is possible to shave the head immediately after a procedure, but it is probably best to wait about 3 weeks. The appearance of the shaved donor area will depend on the total number of FUE grafts obtained in a procedure. FUE removes intact follicular units from the donor area. This will result in fewer follicular units. If 25% of the follicular units are removed from the donor area, this will leave gaps in the donor area where follicular units were removed in an effort to relocate them to the top. A number 1 guard will conceal these gaps, however. It is possible to clip to a number one at any time after a FUE procedure. If you are concerned about gaps in the donor area, one way to minimize these is to add body hair into the FUE extractions at the same time that grafts are removed.

There is no scientifically documented relationship between human growth hormone and hair loss or hair growth. There are anecdotal reports of grey hair regaining color and an increased rate of growth with HGH.

Can hair loss from anabolic steroids be reversed?  When I was in college I experimented with a couple of cycles of anabolic steroids. As a baseball player most of us used them to compete. Luckily I came to my senses in my senior year and stopped cold turkey. I noticed during that time that my hair began to thin. It continued to thin several months after I stopped using and then the shedding just topped. It’s now four years later and while my hair has not gotten worse, the hair I lost never grew back.

Is it possible to reverse hair loss caused by anabolic steroids or is this just one of the adverse side effects of steroids use that I will have to live with?

Anabolic steroids can accelerate hair loss in men or women genetically predisposed to androgenic alopecia. Certain medications could possibly reverse your hair loss, but it is not likely. These medications include Propecia and Minoxidil. At some point your hair loss may begin to progress again. Medications can help prevent or slow down the future thinning or loss of hair. You could try a course of medications for 6 to 12 months to see how you respond. If there is no improvement after one year, you are not likely to see any future benefit in terms of increased hair though progression of hair loss might be limited by
future use of medications. If you still desire to restore your hair at that point, you might want to consider an evaluation for you suitability for hair transplant surgery.

I am recovering from trichtilomania and the hairs that are gone that place stopped growing hair all together and you can see the scalp, I was wondering if there is a miracle to help me regrow or start regrowing my hair…my currant shampoo is nioxin and nizorel…

Patients who’ve suffered from trichotillomania for awhile may damage or even remove the hair roots by excessive pulling, making non-surgical hair regrowth next to impossible.
Hair transplants will restore the hair, but it is very common for those with trichotillomania to resume pulling out the hair after the transplants begin to grow.
First strp will be to address the trichotillomania from a medical/psychiatric medication or therapy approach and solve the underlying problem. Once the patient knows that the cause of the trichotillomania has been fully addressed (fo a long period of time, then the reward can be a hair transplant to put their hair back.

Dr. Cole has already setup a clinic that offers CIT (Cole Isolation Technique) in Korea.  The purpose of offering CIT in Asia is to educate other hair transplant doctors to produce excellent results with the minimally invasive procedure.  Our operation in Korea is a part of our efforts to provide quality hair transplant surgery to all individuals in Asia.  The most recent technology in CIT hair transplant surgery is created at the main office located in Atlanta, Georgia. The Cole Hair Transplant Group offices all have the same common goal of satisfying each patient and making their visit a wonderful experience.

For additional information on low-cost CIT in Korea & China, contact The Cole group: Contact Form.  The Cole Hair Transplant Group offers free in-person consultations with Dr. Cole.  The Cole Hair Transplant Group o

ffers 18+ years of hair transplant experience and provides high-quality hair transplant procedures.  It also specializes in the non-strip scar method of hair transplant and reconstructive hair transplants.

This news originally posted on forhair.com in the following URL:
CIT in Asia news in forhair.com

I am a 36 year old American Indian female with very long black hair. I have noticed that i have been losing my hair on top by my center part. I have bi-polar disorder, i have been on the same prescription for two years. I have always had extremely thick hair and now it feels so thin. What do you think could be causing this and what can i do to get my hair back to it’s normal fullness? I do not get periods anymore, i had a uterin embolisation three yrs ago. I am very vain about my waist length hair. Please help me.

There are many medications that can cause hair loss. It would be helpful to know what medications you are on.

With women hair loss can begin in your 30s, 40s, or 50s due to normal female pattern hair loss. The cause of this form of hair loss is not as well understood as male pattern hair loss. It will generally leave an intact frontal hair line with loss beginning just behind this. Over time it continues into the top and the very back of the top scalp. It can also involve the sides and back of the scalp in some women. All women with hair loss should rule out hormonal diseases including hyperthyroidism, hypothyroidism, and an elevated level of male hormones. You should also be checked for iron deficiency anemia that can come from heavy periods though this does not seem possible in your case. Laboratory testing includes a T4, TSH, FSH, LH, DHEA, CBC, Ferritin level. Some connective tissue diseases such as lupus can cause hair loss so you might check a WESR and an ANA. If you are having joint problems such as arthritis, this might point to a connective tissue disease.

If all these tests are normal, consider two 4mm biopsies of the affected area that should be read by someone who is a dermatopathologist experienced in reading hair biopsies. It is important to obtain intact hair follicles when taking these biopsies and they must be taken from where you are having hair loss. These can often identify the cause also tell us if you have a more difficult form of hair loss to treat such as a scarring alopecia such as lichen planopilaris.

Someone experienced in evaluating hair loss might be able to help evaluate possible cause of your condition by performing an examination of the hair shaft diameters and a hair pull test.

I heard the tern “Donor Recharging”, what does it means?

CIT donor recharging is a method of preparation where each extracted scalp follicular unit is replaced with a body hair follicular unit. The exchange of these grafts isn’t always one for one but the purpose of CIT donor recharging is to replete the donor area and help the donor area from being too thinned from harvesting with hair transplant. CIT donor recharging also stimulates the production of melanin, a pigment in the donor area. Donor recharging allows patients with higher degrees of hair loss to maximize their scalp hair donor supply and fill-in the absence of extracted follicular units. The results with donor recharging are subject to the same limitations as BHT and results cannot be guaranteed. CIT donor recharging results vary from patient to patient and the appearance of the results is unpredictable.

Resources:

Click here to read more about donor recharging

Rechargeable donor area ?

Donor After 6,000g Harvested with donor Recharging

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

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!

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 underclass 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

There is some evidence that an anti-fungal shampoo containing ketoconozol (Nizoral) may help slow hair loss. It can be used twice a week and has the added effect of decreasing dandruff and itching of the scalp. There are also a variety of over the counter preparations (Hair Cycle products) and internet-marketed preparations that are available. Many of these contain minoxidil and other ingredients. Some of these are topical androgen (male hormone) blockers; there is little scientific proof of their effectiveness, but many men swear by them, and they may work for some.

The most important thing one can do with these latter agents is read and read some more. Information from sources other than the manufacturers is likely to be more objective and may help one with informed decisions.