Hair Transplantation

Definition

Hair transplantation is a surgical procedure used to treat baldness or hair loss.

There are several different options for hair transplants today however there are limitations. The most important limitation has to do with the source of hair grafts referred to as the “donor area”. This area in both men and women is genetically resistant to male and female pattern hair loss. Traditionally, hair transplantation was done by harvesting a strip of hair bearing skin from the back of the scalp and microscopically separating hair grafts for implantation to the areas which need hair. Unfortunately, this ‘strip technique” resulted in many people having undesirable scars. This prompted the advancement of other techniques such as follicular unit extraction or “FUE”. Unfortunately, FUE procedures depend on the donor area which is limited. Further, many FUE procedures end up harvesting hair outside of the genetically resistant area which means a significant percentage of the hairs being transplanted will actually be lost later on.

Hair Regeneration Transplantation

In our practice, we employ Hair Regeneration technology and methods to harvest the maximal genetically resistant hair for transplantation and optimize the healing of the donor area.

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How Many FUE Grafts Would I Need to Restore my Hairline?

I lost the hair around my peaks in my early twenties (I’m thirty now). It hasn’t worsened much since then. The miniaturized hairs have been like that for years. My hairline looks nearly identical to the hairline my grandfather had through most of his adult life, until he lost it all in his seventies. So, I suspect I should be able to keep what I have. However, I’d like to restore what I’ve lost. Approximately, how many FUE grafts would I need to do that? Thank you.

Doctor:

Thank you for your question!

You’ve noticed a progression of hairloss along your hairline into your 30 which again, you think started in your 20s and you’ve looked into your family history and expect that there’s probably a slow progression based other family members. So your question is, how many grafts will you need?

Well, I think another level of this question should be is what will happen should your hairline continue to recede even if the grafts are placed. This is a very common issue in hair restoration surgery in that, you may try to get a large number of grafts. In our practice, we basically do an average of anywhere between 1500 to 2000 hairs in a session and these are all dependent on the donor density in terms of how many hairs per square centimeter there is in the strip. Now, even if you’re doing follicular unit extractions or FEUs, well, it still means that you still need to get a certain number of hairs. So even if you’re doing punches and removing those individual hairs which are supposedly scarless which we know in our practice, you see we had a lot of patients who had FUEs done elsewhere who had a lot of scars. Regardless, there is a critical number you need.

Now, in order to reach that number, whether you have an FUE transplant or FUT transplant, you still need a number of hairs removed. Now, that is fine as long as you don’t progress. Unfortunately, for most men, progression of hairloss is inevitable especially if they’re not using any medical therapy such as the use of finasteride to reduce DHT.

So I’m going to introduce to a concept that we do in our practice. Being a hair restoration specialist for over 10 years and being a leader in the field of regenerative medicine as it applies to hair restoration, I can certainly speak for a lot of authority in this matter. The past several years, I have actually quantified and developed a method of preventing the progression of hairloss as well as reversing the thinning of hair using a material called extracellular matrix.

Now, this extracellular matrix is based on a wound healing concept and serendipitously it was figured out that some critical elements of hairloss which is progression of thinning seem to be reversed. And from studies that were based from University of Pennsylvania as well as Yale University, I essentially have theorized that what we are doing is restoring the progenitor cells which make the hair and are noted to be absent in the hair or should I say in the scalp of balding men and as well as the activation the dermal papilla which signals the bud area of the hair follicle to begin with this hair growth cycle. It’s all about cells and signals and this is very leading edge stuff because it’s been developed in the laboratory side. And in the past 3-4 years, whether it’s in Yale University, Pennsylvania, University of Tokyo.

Essentially, our hair regeneration system, we inject this extracellular matrix with platelet-rich plasma as well as other enhancing elements and literally reverse the thinning of the hair. So many of our patients who are, quote thinning and receding, as you are, will very often choose the injection .First, see how the results are and then at about a year, we strategically decide how to fill in some are which could be salvaged by the injection. I’d like to explain to my patients this way: You have a limited bank and you want to spend the currency wisely. So looking at the back of the scalp and looking at the density, we don’t want to throw all the hairs and to one are and then allow receding of the hair and then make those grafts look very obvious. I’m sure you’ve seen people who you look at and go home and say “Oh my God how bad are those plugs.” Well, it’s usually intentionally bad. It so happens they had hair grafts at a certain point where they have existing hair but eventually the hair grafts stayed in place but the hair receded and thinned down.

So my suggestion to you prior committing to do a surgery is learning more about hair regeneration and consider this as an option in your strategy since you already anticipate maybe having a very slow progression. You might be able to restore a lot of those thinning hairs before you move forward to surgery and you may also be comfortable enough that you won’t consider having surgery.

So I realized I’ve added something new to the concepts of your learning about in terms of surgery but I think hair regeneration is very key element to treating hairloss so I hope that was helpful and thank you for your question.

 

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Would I Benefit from Hair Transplantation to Reduce Forehead?

I always had high forehead, but after health problems I lost more hair due to general anastasia and antibiotics. I’m using Minoxidil now 2% for 3 months and it’s getting a little better, but still I would like to do hair transplantation to reduce my forehead later. Do you think I will benefit from it and will the results be natural, without visible scars? Approximately how much will it cost in my case? In the picture attached I drew the line to show how much I would like it to get reduced.

Doctor:

Thank you for your question!

You have submitted a very good detailed history of your hair loss as well as good photos to help us understand what your goals are. And I appreciate of course the lines that you drew of the way you want your hair line to be.

Well, when someone like you come to our practice, I’m going to just give you an idea what typically is the process. First of all, we have to be clear on diagnosis there are some elements of your hair loss history that is a little bit unusual in terms of the history of someone who has female pattern hair loss so lets go back a little there are 2 types of hair loss that makes up 95% of all hair loss 1 is male pattern hair loss 2 female pattern hair loss the other categories of hair loss is something to do with inflammation or scaring. So when someone like you come with a history with this type of hair loss related to anesthesia and antibiotics, I just want to be sure that you have the female pattern hair loss that it may sound like that you may have diagnosed with.

Now female pattern hair loss is more defused thinning of hair compared to male pattern hair loss which is more about residing hair lines in the temple as well as in the thinning of the crown. With women, it’s defused and you see widening of the part and certainly the thing that makes me a little bit concerned is your hair line that you want is actually lower than what you always have. You said you have naturally have high hair line and I wonder if there is any recession of your hair line as part of your history. Sometimes women can have temporal residing of their hair and often looks like a mixed picture of both male and female pattern hair loss so if there are anything that would concern me, I would do a biopsy and a biopsy means using a what’s called a circular punch which is about 2-3 mm in diameter and taking several representatives section of the scalps that are out of plane site so it wouldn’t be obvious and sending it to a pathology lab. We use a very highly respected University pathology lab so that we are sure about the diagnosis.

Now as far as making decisions on achieving your goal, we have to understand the concept of how we do hair transplantation. Hair transplantation in the simplest terms is the movement of genetically resisted hair. These are hairs that don’t tend to thin which is usually at the back of the head in the middle portion were even in the most severely bald man or advanced hair loss. Women will still have a rim of hair that hair is taken out as strip and individual hair follicles are isolated and then placed in the front. Now the success of the hair transplant is dependent on how much density you have in your donor area, how thick those individual hairs are and of course how much coverage we want to achieve. Then when you move your hair line forward, like that you want to be able to fill the area but you won’t get the density with 1 hair transplant in my practice.

When someone wants to move the hair line forward, I tend to be very conservative about how we want to do that. We actually apply some other technology which I will discuss later on but briefly, I’ll try to explain where you see your hair line is the place the hair is thick but we can see finer hairs and maybe move the hair line a few mm based on what the yield is from the strip that we harvest and how much density we can achieve in hair transplantation surgery. Fortunately is one of the area where there is a lot of mixed messages, unfortunately, hair transplantation is not the same type of specialty like cardiology where there is a standard residency fellowship training. People have gone into hair transplantation or hair restoration from doing other specialties maybe never even completing a residencies and completing a fellowship. It’s a very scenario that is for the first 20+ years was kind of a fringe specialties with a lot of unusual characters working in it. So essentially a lot of this doctors basically are in the business in just doing transplantation and don’t really concern themselves very much with proper diagnosis, management and other things that are more formally trade than ethical doctors tend to do.

So it is important to at least understand that when you’re doing your research so it in terms with your game plan, I would also add something relatively unique to our practice and that is the application of a regenerative medicine technology. You see when people do transplant it is great to say I transplanted X number of hairs but unfortunately a percentage of those hairs don’t make it. In fact, we have seen in our practice who come to our referral who have had transplants where they got mega sessions where it was huge in numbers. And when I look at their result, I barely saw any hair and there are so many factors that can cause that. Very often has to do with bleeding, blood pressure and just the way the tissues are manipulated.

Unfortunately, it’s not such a straight forward procedure that were people want up each other were patient will go shopping and one transplant doctor will say I’ll move a thousand hairs and the next transplant doctor will say ill do the same and will cost 12000. Hairs doesn’t work like that. There is an understanding of tissues that unfortunately a lot of transplant doctors don’t understand. Being a multi specialty cosmetic reconstructive surgeon, I understand a lot of this because I have done this work at other areas of the body. And I have a different sense of surgery so I can understand the tissue tolerates is a factor in this.

Now that understanding, we have applied a concept of regenerative medicine using a material called extracellular matrix that’s derived from the pig bladder and it’s made by a company called ACEL. Now this material does it allows healing and the activation of the adult stem cells such that there is virtually no scar tissues but rather healing by duplication of native tissue. In so many ways it accelerates the healing process and what we have seen clinically is that the yield of our hair transplants have been significantly enhanced. Not only we are getting number grafts that we placed but actually see increased density greater than the number and now let’s explain a little bit about that. It turns out based on what our clinical observation has been that the extracellular matrix combined with platelet-rich plasma appears to successfully reverse the thinning process of hairloss so hair that is thinning turns around thickening and the progression halts.

Now the interesting thing about the clinical medicine is that we find things that work and then we look to basic science to explain it and this has happened a lot in many areas for example the commonly drug used minoxidil for topical use was actually discovered a hair loss solution starting from a i believe it was a letter that was written in the journal medicine where a doctor noticed a patient treated with a blood pressure medication called Minoxidil actually started to grow hair. So the serendipitous discovery of benefit is very often the source of great things that happen in medicine.

So in our situation, we have been able to transfer the advanced healing that’s used for hair loss or hair transplantation and applied to hair thinning. So my game plan for you is also factoring in what is the future of your hairline. You see, you make an assumption that your hairline will stay where it is and it won’t recede any further but we have to think about the future. If you go to any restaurant, you’d find any man who’ve has a hair line who’s in their 60’s over here that looks pluggy and that’s why hair transplant has a bad reputation is that people think of plugs. And why does he have plugs? Well, he had hair next to those plugs where unfortunately was not able to take any medications or medical treatment or to follow up surgery and he ended up losing hair and that’s all that’s lefts.

So in planning your surgery, I would employ a regenerative surgery and adjust the procedure based on the yield and the quality of the hair that come out during the harvesting. So at this point, your job is to do more research and meet with hair restoration specialist, do not shop on price, don’t shop on wild claims. But get the sense of the ethics and understanding of the hair physiology. It’s important that you understand that the doctor should have a clear appreciation and understanding of the process you’re going through and making sure that you have a proper diagnosis and being realistic and rational about the treatment plan for you. Most likely you will need two transplant sessions in order to get close to the hairline you want. Remember, it’s just not about placing the hairs, it’s about achieving the density. So to recap, we discussed the proper planning of transplantation and proper diagnosis of the hair loss condition and the application of regenerative medicine for hair treatment. So I know that was a long answer but I hope that helped you make your decision. Thank you for your question!

Precautions

Although hair transplantation is a fairly simple procedure, some risks are associated with any surgery. It is important to inform the physician about any medications currently being used and about previous allergic reactions to drugs or anesthetic agents. Patients with blood clotting disorders also need to inform their physician before the procedure is performed.