Author Archive for Bradley R. Wolf, MD

Dr. Wolf has practiced exclusively as a hair transplant surgeon since 1990. He received his Doctor of Medicine degree from Indiana University School of Medicine in 1980, and did his internship in General Surgery at Eastern Virginia Graduate School of Medicine in Norfolk, Virginia, from 1980-1981. He then did his residency in General Surgery there from 1981-1982. Dr. Wolf is an active member of a number of professional associations, and has lectured extensively on hair transplantation surgery at medical conferences in the U.S., Europe and Russia. He has also trained physicians from Russia, the Czech Republic, Belgium, Ireland, as well as from the United States and has also presented live surgery workshops at medical conferences in the U.S., Europe, and Russia. Dr. Wolf, who performs microscopically dissected Follicular Unit transplantation surgery, has earned a reputation of being honest, ethical, and dedicated to creating the best results possible for his patients. He is regarded as an expert in, among other topics, the aesthetic aspects of hair restoration surgery. In his lectures he has compared hair transplantation to Impressionistic Painting and Architecture. Dr. Wolf is the medical advisor for the International Alliance of Hair Restoration Surgeons and recommended by the American Hair Loss Association. Visit Dr. Wolf's Website:www.wolfhair.com

Hairpiece Caused Me To Lose More Hair - Can a Hair Transplant Fix This?

I think my hairpiece made me lose more hair. Is this possible and can I replace the hair that has been lost with a hair transplant?
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It is common to lose hair, permanently or temporarily, as a result of wearing any type hair piece. The hairs lost or damaged are generally those which were genetically programmed to eventually fall out but their loss is accelerated by the unnatural situation created by an appliance attached to the scalp. A warm, moist, dark environment with associated pressure from the base and attachment system can accelerate programmed (male pattern) hair loss. If there is traction from a glue-on system or from attachment clips, areas of permanent hair, not programmed to miniaturize and stop growing, can be lost due to traction alopecia. Alopecia is the medical term for hair loss. Placement of clips in the same location for months or years can cause circular areas of permanent hair loss.

Hair lost can be replaced with hair transplant surgery. Some of the most impressive before and after photos used in advertising are from patients who stopped wearing a hair piece, started minoxidil (Rogaine) and finasteride (Propecia) and received hair transplants. Read more

Recent Hair Transplant Didn’t Grow - Is This The Fault of The Surgeon?

I recently had a hair transplant and most of the grafts didn’t seem to grow in. Is this the fault of the physician and improper graft placement or am I just a bad candidate?

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It is unfortunate you experienced suboptimal growth. The degree of difficulty with respect to harvesting the donor follicles and placing the grafts differs greatly from patient to patient. Negative factors include scarring from prior surgery in the donor and/or recipient, greater than normal amount of bleeding, mushy/soft grafts, slippery grafts, tight, and/or sun damaged recipient skin. If a patient is unlucky enough to have all these negative factors present, it is likely that less than 100% of grafts placed will grow. On the other hand if the scalp hasn’t had prior surgery, bleeding is less than normal, grafts are firm and easily placed in flexible, normal skin, growth rates can approach 100%. Any combination of these independent variables can occur causing growth rates to vary.

A good surgeon will recognize a higher degree of difficulty and adjust the procedure to compensate for a negative variable(s). If grafts are difficult to place and placing one graft causes the adjacent graft to pop out, the spacing among incisions must be increased making dense packing difficult. Taking time to properly place grafts in difficult cases often solves a lot of problems. Read more

What Is The Difference Between The Woods Technique and An FUE Hair Transplant?

Years ago I used to read about the Australian doctor, Ray Woods. But now it seems he has vanished, or at least off the internet. My question is how does the technique he performed differ from FUE?
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Dr. Woods technique is essentially a form of FUE as far as it is known. He had never revealed to the medical community or the public, the tools or technique he uses. He does describe isolating, extracting, then placing individual follicular units but the details concerning tools and technique have never been described by Dr. Woods. From information obtained from the internet a number of years ago, at that time he did place the grafts in small holes or incisions made by small needles and performed up to 600 grafts a day. If more grafts were required, multiple days of surgery were performed.

I am not aware of any changes in his technique over the years. Techniques do evolve and most physicians who keep up with current techniques adapt over time. Read more

Hair Transplant Duration, Cost and Type of Anesthesia

How long does it take to have a hair transplant done? Are you under general or local anesthesia? Also, what is the cost for one procedure?
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Hair transplantation is done under local anesthesia using the same local anesthetics that dentists use, lidocaine and marcaine. Lidocaine is also known as xylocaine. Novacaine is no longer used due to the incidence of allergic reactions. Marcaine is a long acting local anesthetic. The pain associated with a hair transplant procedure is none to minimal but there is discomfort from injection of the local anesthetics. Most patients comment that the pain associated with the procedure is less than a visit to the dentist’s office. There is discomfort in the donor area if strip excision is performed, after the procedure. There is little to no discomfort after a FUE (Follicular Unit Extraction) procedure.

Most physicians use some type of anxiolytic, or medication to reduce anxiety, the most common being valium. Some physicians administer the valium by mouth; some use an injection or the intravenous route. Some physicians start an IV and administer “twilight anesthesia” which is a combination of medications which make the patient unaware anything is going on but awake and breathing. Twilight anesthesia is generally used for the local anesthetic or numbing part of the procedure because this part hurts. The most common form of anesthesia is local anesthesia with a pill given my mouth to reduce anxiety. Read more

Facial Hair Restoration - Which Is Better, FUE or a Regular Hair Transplant

I’m interested in having my mustache thickened up. I wanted to know what the best method for facial hair restoration would be. Should I have FUE or a regular hair transplant.

The best method for facial hair restoration is transplantation most often using hair from the back of the head to, in your case, your mustache. It is important to find hair in the donor area that matches the texture of the existing hair in your mustache with regard to hair shaft diameter, color, and curl. Sometimes hair on the back of the head can be dramatically different in color and hair shaft diameter that facial hair. In such cases I have taken beard hair from under the chin, using FUE, to transplant to the mustache. Some doctors have described taking a strip from under the chin but I have seen unacceptable scarring using this method therefore if facial hair is needed I use FUE for harvesting.

The most important technical aspect concerning a facial hair transplant is to leave the hair on the grafts long enough to be able to tell the angle of the hair exiting the skin. When placed it is important that the angulation is correct. Some doctors recommend strip excision for this reason as the hair on the grafts can be left longer. The advantages of FUE are that there are no sutures, less pain, and less visible scarring. Since small numbers of grafts are generally needed for mustache transplants, FUE is ideal from that aspect. Also the exact number of grafts can be harvested after the incisions are made. Read more

Wife Won’t Let Me Take Propecia - Can Women Touch It Safely?

I want to try Propecia but my wife is afraid to have it in the house since women are not allowed to touch the pills. Are her fears valid and if so why can’t women handle Propecia?

The official warning is that women should not touch or handle crushed or broken tablets. Finasteride is also used for enlarged prostate gland in men. Some elderly men in long term care facilities or nursing homes that can’t swallow have feeding tubes and finasteride is crushed into a powder to put into feeding tubes to be administered orally. This warning stems from the possibility of a pregnant pharmacy worker who is crushing finasteride tablets to be exposed to a large amount of the powder on her hands with the risk of absorption in amounts that may affect the male fetus. So you wife’s fears are not valid. The intact pills can be touched without the possibility of absorption. There is no reason for a female to touch the pills. Women should not take Propecia and its use is absolutely contraindicated in women who are pregnant due to the possible deforming effects on the external genitalia of an unborn male.

Bradley R. Wolf, MD
Medical Advisor, IAHRS

Recent Hair Transplant - Losing A Lot of Hair | Shock Loss

I recently had a hair transplant, about 5 months ago and I think I’ve lost a lot of hair. Is it possible for a hair transplant to make your hair worse?

“Shock Loss” after hair transplantation is a well known phenomenon and occurs with loss of existing hair in the recipient site. Generally shock loss is temporary and reversible. Whether it is reversible depends on thecause or causes. There are a number of possible causes of shock loss.

1. Existing hair is cut above the surface during making of incisions. This is like a hair cut and 100% reversible.

2. If a lot of hair is present prior to the transplant (existing hair) and care and time is not taken to preserve existing follicles during the making of incisions, these follicles can be damaged with the instrument that thephysician uses to make the recipient sites. This loss of the follicles can be permanent due to direct trauma.

3. Hair follicles normally cycle into the telogen (resting) phase. From 50-100 hairs are normally shed each day. By spraying and wiping during the surgery to see the spaces between hairs to avoid damaging the hairs,paradoxically, hairs which would normally shed in the future are essentially pulled out on the day of surgery. This cause of shock loss is completely reversible.
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