Hair loss in women is a silent epidemic that effects the lives of far more women than is generally recognized by society or medicine. Approximately 40 percent of all hair loss sufferers are women, with a statistically significant percentage of women dealing with hair loss under the age of 30. Contrary to popular belief, the most common form of hair loss in women has little to do with diet or stress. Androgenetic alopecia, commonly referred to as male or female pattern baldness, is in fact usually the culprit and was only partially understood until relatively recently.

The majority of women with androgenic alopecia have diffuse thinning throughout the entire scalp. Some women may have a combination of pattern types that can actually resemble common male pattern baldness. Androgenic
alopecia in women can be caused by a variety of factors tied to the actions of hormones, including ovarian cysts, the usage of birth control pills, pregnancy and menopause. Just like in men, the hormone dihydrotestosterone (DHT) appears to be at least partially to blame for the miniaturization of hair follicles associated in women suffering with female pattern baldness and, just like in men, heredity plays a major factor in the process.

Surgical hair restoration might be a reasonable option for those women who exhibit AGA with a more distinct pattern of loss similar to that of men, where the back and sides of the scalp are less effected by the balding process, making for a stable donor area to be utilized in the hair transplant process.

IAHRS accepted member Marc Dauer, M.D. explains the process of hair transplantation in women who experience hair loss from prior cosmetic surgery procedures as well as common androgenic alopecia on the CBS television show, The Doctors.

Post FUE picture showing that FUE's are not necessarily "scarless" and that there can be considerable disruption to the donor area growth pattern.

There have been many wonderful innovations in the field of hair transplantation in the past twenty years, and some not so wonderful.

In recent years there has been a tremendous amount of buzz in the hair transplant industry about a procedure known as Follicular Unit Extraction. Commonly referred to as FUE, this is the process of removal of the donor hair that is to be used for the transplant process, literally one graft at a time. The process has gained popularity for several reasons, not the least being the fear that many patients have of the strip excision for harvesting donor hair. Despite the fact that strip excision is the gold standard for the procedure many patients are fearful of potential scarring.

It is very important for the purpose of this article to understand exactly what the difference is between the two procedures. With any hair transplant procedure you must harvest hair from the donor area in the back of the scalp. How you harvest this hair is the only difference between an FUE vs Strip Excision procedure. The rest of the transplant process is exactly the same. In the FUE process a very specialized tool is used to extract the grafts and the tool that is used is completely up to the surgeon and his or her personal preference. There are several devises on the market that work very well, I for one use a device called the Safescribe Motorized FUE Extractor.

Now why does any of this matter? Why am I going on about boring details of types of surgical instruments and different types of harvest methods for hair transplantation?

Well enter Neograft which is a machine that is used to perform the extraction process for an FUE procedure, but surprise, surprise if you were to perform an internet search on Neograft you would be led to believe that it is a evolutionary new automated procedure for hair transplant surgery.

Nothing could be further from the truth. Neograft is nothing more than the name of a machine that is used for performing FUE graft harvesting, with or without a skilled hair restoration surgeon operating the device..

The Neograft machine has been aggressively marketed to many physician practices across the country with the promise of an easy and profitable method for the non hair transplant trained physician who are trying to increase their bottom line, but yet don’t have the surgical hair restoration experience and training or the know how to put together a successful hair transplant practice.

No worries there though because the company that sells the doctor this very expensive piece of equipment will also provide the doctor with an entire technical crew that will essentially perform the entire transplant procedure for the non hair transplant physician.

As an experienced hair restoration surgeon who has performed a full one year fellowship in hair restoration surgery I am aware of all the detailed skills that goes into a good hair transplant procedure. These are skills that are not acquired in a weekend course and certainly should not be delegated to a non physician staff of traveling hair technicians. Quality hair restoration comes from an experienced team and that team should have an experienced physician leader.

Hair transplantation is a relatively easy but highly work intensive procedure that requires a surgeon with good surgical and aesthetic skills. Each patient is different and brings special needs and cosmetic goals. This is not a procedure that you want performed by an inexperienced team of surgeon and technicians.

As a consumer please don’t be fooled by what seems to be the next best mouse trap. The Neograft machine in the proper hands is a wonderful tool but in the wrong hands it is a bad hair transplant waiting to happen. FUE has its place but should not be marketed as the preferred method for hair transplant for any and all patients and that is exactly what the marketers of the Neograft machine would have you believe.

My wife keeps telling me that I need a hair transplant so here I am doing some research. Here’s my situation, I am 31 years old and seem to be a 3V on that baldness scale. One of my friends is taking Propecia  says it’s great stuff, but I am afraid of the side effects that I keep reading about. Is it even worth having a hair transplant if I don’t take Propecia to stop the rest of my hair from falling out? I’ve also read that once I start this process I might have to go through several surgeries and if I don’t take Propecia I can still look bald in time. Please advise. Thank you.
- – - – - – -

This is an excellent question. Firstly, there have been reports of sexual side effects with Propecia, but the vast majority of people taking Propecia report no adverse side effects and the benefits of taking Propecia, especially in younger patients, are significant. In my practice, I have all patients read and sign a detailed Propecia consent form that discusses in depth the benefits of Propecia as well as all the possible side effects and any associated risks. I let the patients know if they start to feel any of the adverse side effects to discontinue the medication. In addition, to patients who are thinning in the crown region, which it sounds like you are, I also recommend Rogaine 5% foam twice a day.

Studies have shown that patients who use Rogaine and Propecia together experience a synergy between the 2 medications which show more positive results than either medication taken independent of the other. I routinely perform a video microscopy on the scalp with my patients and if I see a large amount of miniaturization of follicles I may also recommend low light laser therapy. I have become a fan of the new LaserCap which, with it’s ease of use, provides excellent compliance among patients. I have seen great results with it low light laser therapy in patients who have a large amount of miniaturization.

In order for me to determine if you are a candidate for Hair Transplant surgery I would need to see you in consultation or look at your photos, but if you are a 3V it sounds like you likely could be a candidate. I always tell my patients that you will definitely have between 2-4 procedures in your lifetime to keep up with continuing hair loss. The number of procedures is affected by the rate of your future hair loss, which Propecia, Rogaine, and Laser Therapy can markedly slow down.

Finally, in response to your question about is it worth having a Hair Transplant if you don’t take Propecia, I would say yes. Mostly what Propecia is going to do is maintain the hair that you currently have and in some cases cause the miniaturized hair to become healthy again. If you stop Propecia, these effects will reverse. A hair transplant procedure will regrow hair that will be there permanently. This is the only solution that will have the most dramatic effect on your hair, and will not be dependent on you taking any medications. I hope this answers your questions.

Marc Dauer, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

I have been considering having an FUE hair transplant for almost five years and think that I am about ready to go through with it. I still have a relatively full hair and have only lost about two inches in my hairline which I would like to have restored. I have been on generic finasteride for 4 years with a very good response since I think my hair loss has come to a stop. I’m very concerned about the shock loss that I hear about and do not want to replace some hair only to lose even more in the process. Do FUE hair transplants have the same rate of shock loss as regular hair transplants, and since I am only concerned about my hairline is it possible to lose hair to shock loss behind the transplanted area? I look forward to your reply. Thanks!
- – - – - – - – - -

Shock loss (or anagen effluvium), by definition , is shedding of hairs due to physical trauma of the hairs by surgical tools.  There is no difference in its rate regardless the technique you are using .It concerns the recipient area.

Factors that promote it:
-No respect of hair angle while making incisions sites. ( you must stay parallel to the existing hairs to avoid any damage )
-Dense packing
-Fragile hairs ( hairs in end phase of anagen cycle )

Solutions:
-Strengthen your hairs with medications such as propecia or minoxidil prior the surgery
-Respect hair angle
-Decent grafting density

The hairs behind the recipient area won’t be concerned by this phenomenon.  Nevertheless,  in some other cases (very rarely) a patient may experience (not shock loss)  telogen effluvium due to the emotional stress caused by the surgery.  Some patients are so anxious and stressed, they could undergo the same phenomenon we observed when patients go through the emotional stress from parent’s death, divorce, etc…

Both of them are a temporary event and everything comes back to normal within three to six months when the cause is removed.

Rate of shock loss in our practice : 1 to 2 % .

Patrick Mwamba, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

I had my first hair transplant in June of last year and I hate it. I stupidly made my decision to go with my surgeon based on price and a sales pitch from a consultant who said that the reason their prices are so low is that they don’t need to advertise so the savings are passed onto their customers. I had it done in south Florida, where I know there are a couple of good doctors after reading your site, but I just thought that all the doctors where the same and I wanted to save money. Well I guess I got what I paid for and now I’m in need of help. What percentage of people are in my situation and can I eventually look like I have a normal head of hair even though I think I wasted 1200 hair follicles and $2800. The new hair is growing in different directions and is almost impossible to to style unless I use a lot of gel. Can this be corrected and improved upon if I go to a respectable hair transplant surgeon this time? – Mark
- – - – - – - – - -

Dear Mark,

Thank you for your question. Among hair restoration surgeons, hair transplantation has a well-deserved name for being an art rather than a science. Many of us have studied not only the surgical side but also the aesthetic side of this procedure.

Having spent 17 years in the field, I can say that most patients can have corrective surgeries; some with less success than others depending on various factors. What your physician will need to take into account are the following: a photo of what is left of your donor area as well as your balding area; your expectations of this surgery; your age; your family’s hairloss history and whether or not you are currently on meds.

Below are a couple of photos of corrective surgeries:

Please let me know if you have further questions.

Melike Kulahci, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

I have been contemplating having a hair transplant for the past 5 years, but every time I think I’m ready I read a news article or see a story on TV about a new technique that promises the world. When I research what I just read it never seems to be what the news claims it was. Are there any real cutting edge techniques that I should know about, or can I just have a couple of consultations with my local doctor who is in the IAHRS and choose from there. I don’t want to have an outdated hair transplant if there is really something new that will give me a better looking head of hair.
——————-

Hyped treatment options for hair restoration have been offered dating back centuries and I’m sure we will continue to see new “miracle cures” in the future that will produce little more hair growth than snake oil. Although a new and effective treatment for male pattern hair loss is bound to emerge at some point in time, I am not aware of any pending breakthroughs. The fact of the matter is that contemporary surgical hair restoration has reached a state of refinement which can produce a result sure to fool even the most accomplished stylist or barber.  The only real limitation today is donor availability which prevents men with advanced patterns from achieving full coverage and density comparable to their adolescent years. However, amazing restorations are still possible for many and even those with advanced patterns may obtain significant cosmetic improvement under the care of a skilled surgeon. Although emerging technology such as follicular duplication may have the potential to allow a full, dense restoration for individuals limited by donor supply, I don’t believe one need deprive himself of what may be a significant improvement using the technology we enjoy today. I suggest you consult with several IAHRS surgeons to discuss your current options. You may be pleasantly surprised to discover what is possible.

Raymond J. Konior, M.D.
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

My 9 year old daughter was born with a port wine stain birthmark on the right side of her face between her eye and sideburn area. It was affecting her so we decided to have her undergo laser treatments which were relatively successful in lightening the birthmark, but caused some of her hair to fall out, about a half inch in that area at the side of here head. The doctor said it might not grow back and I’m very worried about that. When her hair is down it is not to noticeable, but she can not pull her hair back without revealing it. Is there anything that can be done for my daughter? Would a hair transplant be appropriate for a 9 year old girl?

Any help you can give me if very appreciated.
——————————-

Thank you for your question about your daughter. I’m not an expert in the lasers used for the treatmet of port wine stains and their effect on hair. If in a discussion with the treating physian it is felt that the hair loss is likely permanent with no sign of regrowth for several months after the treatment, then your daughter would likely be a candidate for surgical hair restoration. The good news is that transplant procedures into areas of hair loss due to laser removal, scars and burns are very successful, however she may need more than one procedure to achieve a higher visual density. It is not uncommon for of this age children to undergo this type of surgery for reconstruction but it does require a little special care in explaining the procedure and attention to the needs of the patient on the day of surgery.

James A. Harris, MD, FACS
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

I was in a car accident six years ago which left me with a 4 inch scar right behind my hairline. I was able to hide if with my hair when I combed it back, but now I seem to have less hair in front and notice that my hair line is receding rapidly. If I go for a hair transplant can the doctor add hair in my scar when they transplant my new hair line. I’ve been very self self conscious about the scar and now it’s becoming very visible as my hairline gets worse. By the way I am 29 years old.

Thanks for any help you can give me.
- – - – - — -

Hair transplantation on scar tissue has been discussed and well understood in Hair Restoration Surgery for decades. Scalp has a very well built blood supply system so each wound can be healed rapidly but not always perfectly. That means thickness of the new dermis can not be same as the elastic collagen fibers are more or less shrinked. Inserting new follicles in a sparse distance between epidermis and galea makes revascularisation process difficult as well as graft taking. This fibratic area blocks blood supply of the neighboring tissue. That means scars are getting centers of the balding process. You can be treated both on the hairline and the scar. But you have to be informed that success growth rate on scar tissue is less than on healthy virgin scalp.

Melike Kulahci, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

I’m considering having a hair transplant, but when researching on the internet I have been getting conflicting opinions about FUE vs. having a strip hair transplant. I’ve been told that I need about 2500 grafts to fill in my hairline and about two inches behind it. Besides the obvious advantage of not having a long scar on the back of my head, are there any other advantages to going with FUE that justifies the added cost? My bottom line is to have more hair. If the scar is going to be hidden in the back by my own hair, I am not sure the cost of FUE is worth it unless there are some other advantages that I am not aware of. Thanks for your time.
———————————

Hi this is Dr. Nelson Ferreira. Your question is a good one and I think one of the most pertinent questions in modern hair transplantation. First, let’s get definitions out of the way. The ‘STRIP’ method is not an acronym. It means a strip of hair bearing skin is taken from the back and sides of the head. The strip is then dissected into follicular units (hair grafts) using a microscope which are then planted (placed) into tiny holes in the thinning area. By definition, the patient will heal with a linear scar. The scar is usually very fine and camouflaged with your own hair. FUE is an acronym which stands for Follicular Unit Extraction. In this method, a sharp punch instrument is used to remove individual follicular units (FU) right at the surface of the skin. The punch instrument can be powered or used by hand. The FUE method is marketed as ‘scarless’ surgery. This is NOT true. ANY time you cut skin you will heal with a scar. With the FUE method, the scars are created by punches which are about 1mm in size or smaller. Therefore, the scar will also be 1mm or less in size. However, because the resulting scars are often small dots less than 1mm , they are almost impossible to see even if the hair is cut very short. This can be a big advantage.

Here are the main advantages and disadvantages of both methods:
Strip:

1) The strip is still the gold standard for getting hair grafts. In the right hands very little hair is wasted because the roots of the FUs are visualized under the microscope. “Perfect” grafts can be trimmed to size.

2) The strip has been around for more than ten years and large numbers of grafts can be reliably harvested and planted with a high degree of success.

3) The strip is still the most time efficient and cost efficient way to harvest grafts.

4) You must assume that you will heal with a scar and that you may not be able to wear your hair below a certain length. One to two on a clipper is reasonable.

5) Future surgeries can be planned to remove the old scar so that the patient heals with only one scar.

6) The healing time means one to two days of taking prescription pain pills and then most patients do well without prescription medications.

FUE:

1) Grafts can be harvested with such small diameter punches that the resulting scars are very difficult to see even with a very short haircut.

2) The healing time is quicker than with the strip method.

3) It is hard to have control over the size and appearance of the grafts since they are “ plucked” out of the scalp without ever seeing the root of the follicle. Sometimes, the grafts are very skinny and they have to be handled very delicately. Many doctors who do a lot of FUE admit that sometimes they unexpectedly get poor growth with the FUE method. This is probably related to the quality of the harvested grafts.

4) The FUE method tends to be much more labor intensive and costly

5) Future surgeries are harder to plan after a large FUE session. For example, after a successful FUE session of 2500 grafts, you will heal with 2500 tiny little scars at the back of your head. If you have another hair transplant two years later, the doctor will have to “search” for the good grafts in and around the first 2500 FUE scars. This can be tough. If you are successful with the second FUE session, you will have 5000 little scars at the back of your head. It would be unlikely that you could wear your hair very short and not notice 5000 little scars.

There are some doctors who seem to be getting very good at harvesting large numbers of grafts with the FUE method. They report good success at getting the grafts harvested and good growth rates. Like many surgeries, the most important part of the surgery can be planning and selecting the right candidate. I believe that the FUE is great for small cases ; patients who have do not have worrisome need for alot more donor hair in the future; a patient with great genetics (no class 4 or worse in family) or an older patient. If you understand that the strip method will leave you with a scar and, that you will not be able to cut your hair too short, it is usually the preferred method if you include all factors such as cost etc. If you need 2500 grafts there are many reputable doctors who can do a good job for you with the strip method. It would be harder to find a doctor who can do a good 2500 graft FUE hair transplant.

I hope this helps.

Ironically, I just did a FUE case on a young man who had scars from a trauma earlier in his life. I will try and post his pictures soon.

Nelson Ferreira, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

In October of 2010 Spencer Kobren spoke with IAHRS accepted member Jerry Cooley, M.D., about his groundbreaking research in the use of ACell’s MatriStem wound healing compound in surgical hair restoration. Since that interview, the hair loss community has been buzzing with excitement at the prospect of finally finding a solution to tackle the problem of limited donor supply in hair transplantation. While many experts in the field are embracing this new technology and conducting experiments within their respective practices, some are less exuberant about this possible breakthrough, and caution patients not to be overly excited about a technology which they feel has not yet been proven to live up to its claims.

Listen to Spencer Kobren’s interview with Dr. Cooley:
http://www.thebaldtruth.com/news/spencer-kobren-interviews-jerry-cooley-acell-matristrem/

View Dr. Cooley’s ACell PowerPoint presentation:
http://www.iahrs.org/news/dr-jerry-cooley-acell-matristem-slide-presentation/
http://www.iahrs.org/news/dr-jerry-cooley-acell-matristem-slide-presentation-part-3-4/

Join the discussion:
http://www.baldtruthtalk.com/showthread.php?t=3998