Hair Transplant Questions
Before you select a hair-transplantation surgeon, be sure you’ve asked all of the necessary questions and received definitive answers. Always insist on reviewing Before & After photos and be sure to clarify that the surgeon showing them actually performed the procedures shown. Also, ask to speak personally with other patients. Do not make a rash decision. Do your homework.
What is Androgenic Alopecia?
The most common cause of hair loss is androgenic alopecia – male and female pattern baldness. The contributing factors are genetics and hormones. Hairs located in the front and crown of the scalp are genetically programmed to reduce in- size due to the hair growing tissue’s sensitivity to the hormone dihydrotestosterone or DHT. The hair becomes finer and finer, until it becomes practically invisible to the human eye and eventually falls out.
Does hair transplantation have any limitations?
The only limitation is the number of DHT - resistant follicles available in the donor area. We all have a fixed amount of genetically sound hair, therefore my priorities focus on the survival and growth of every possible graft and to use the donor hair judiciously so that the hair transplant will stand the test of time. What if I don’t have enough donor hair?
If this is the case, we will determine which areas are most critical to be restored and what overall looks are achievable. When we mutually agree on a look that is both achievable and compliments the shape of your face, we will then and only then proceed. If you are not a good candidate, we will tell you so. In some desperate situations a new technique called Follicular Unit Extraction can be used, where donor hair can be taken from other parts of the body such as the back, chest and legs, however this technique is considered experimental and currently has a number of shortcomings.
Have there been any advancements recently made in the field of hair restoration?
There are two noteworthy innovations that have revolutionized the process of hair transplantation. The first is transplanting natural groupings of follicular units of one-to-four hairs each. The second is the dissection of the donor strip into follicular units under the high-powered magnification of a stereoscopic microscope.
What are follicular units?
Hair grows in natural groups of one, two, three and four hairs, enfolded in a fibrous sheath. These natural groups are called follicular units. When I perform a hair transplant, I imitate nature- using single hair units on the hairline and units of two, three, and four hairs moving from front to back. Follicular units are the key to achieving a completely natural look and to the high survival rate of the transplanted grafts. Some surgeons dissect the follicular units of two, three and four natural hair groups into single hair grafts and then transplant them. Supported by a published study in the Journal of Dermatologic Surgery, this process, often referred to as single hair micrografting, actually contradicts the natural grouping of hair and produces less natural results.
Some clinics may dissect the natural hair groups of two, three and four hairs into single hair micrografts solely for monetary purposes. For example, a clinic may dissect a natural follicular unit comprising of four hairs into four single hair micrografts and charge the patient for four grafts instead of one. I often use the metaphor of a pizza in explaining this less than scrupulous practice. Would you pay more for a 15-inch pie cut into twelve pieces than the exact same pie cut into eight? I often warn: buyers beware.
How does the stereoscopic microscope improve the hair transplantation process?
In a word, results. The stereoscopic microscope enables me, via high-powered magnification, to precisely dissect the natural follicular units of one, two, three and four hairs from the donor strip. The precision of dissection that the stereoscopic microscope affords virtually eliminates trauma to any of the follicular units resulting in an almost 100% survival and growth rate. If a surgeon attempts to dissect using minimal or no magnification, he runs the risk of transection and the destruction of donor hair – our most precious commodity. An additional benefit not to be overlooked of dissecting follicular units under the magnification of a stereoscopic microscope is that it provides me with the ability to trim excess tissue from the hair follicle. Therefore, each unit to be transplanted is actually smaller. Smaller transplants mean that I can make smaller recipient incisions in the scalp, which enables me to artistically place the grafts closer together producing greater density.
What differentiates your practice from other practices?
Experience, skill, artistry, and ethics in conjunction with the use of the stereoscopic microscope in the process of follicular unit transplantation distinguish my New Jersey practice. I perform only one hair transplantation procedure at a time and refuse to use an “assembly line” approach where several surgical patients are juggled at one time. Once I begin a procedure, the patient has my undivided attention. This would seem obvious but is actually more of an anomaly than the norm. I also am personally involved in every phase, every step of your hair transplantation procedure. I do not believe that it is in your best interest, or mine, for a technician, qualified or not, to be directing a procedure.
Should I wait until I’m completely bald to have a hair transplant?
No, absolutely not. Do not wait. The current techniques that I practice allow me to insert donor hairs between your existing hairs, leaving them undisturbed while restoring density to your scalp. The successive placement of many of these grafts over several procedures can usually prevent the appearance of baldness in some patients who have remaining, but thinning hair, stay one step ahead of the onset of baldness.
How many hair transplant procedures will I require?
The number of procedures and the number of grafts varies from individual to individual. I would recommend a free consultation where I’ll be able to examine and determine the appropriate course of action. The key factors in determining the number of hair transplants necessary to achieve a patient’s desired density are:
A. Your current hair density in the balding area. Remember that this existing hair is likely to be DHT-sensitive as well resulting in additional hair loss as you age. It is always prudent to save some donor hair for this potential eventuality.
B. The density in the donor area, as well as the hair thickness, curl and color all contribute significantly to your final result.
C. In my experience, most patients who come to me with a type VI pattern will need two transplants, or possibly three, depending on the size of the bald/balding area and the ultimate density they would like to achieve. Patients who come to me at an earlier stage tend to need just one procedure to significantly improve their appearance. Additional procedures would be performed when and if their existing hair continued to thin.
Do you repair bad hair transplants?
Yes. I am able, in almost all cases, to reverse the misfortunes of a bad hair transplant. The cornrow look or unsightly flaps along the frontal hairline can now be corrected in order to achieve a much more natural hairline. I am able to repair even those patients with abnormally low hairlines from earlier transplants. I remove the plugs, dissect them under the stereomicroscope and then re-transplant them.
What important qualities should a hair transplant surgeon possess?
I believe that while there are numerous qualities a hair transplant surgeon should possess, the most critical are:
A. Formal training. Training must take place under the strict guidance of a residency program or a fellowship and result in Board Certification under the auspicies of the American Board of Medical Specialties (www.abms.org). Board Certification in Hair Restoration (www.abhrs.org) is certainly desirable. Double-board certification in a primary specialty, such as Dermatology, and Hair Restoration Surgery is the most desirable and such surgeons should receive higher consideration.
B. Technical skill. Modern hair transplantation requires the mastery of a plethora of technical skills, which are only achieved over time. I have performed more than 8,000 procedures and have been refining my surgical techniques for more than two decades.
C. Artistry. Recreating a hairline not only takes great surgical skill and experience, but also an intrinsic sense of artistry. I pride myself on restoring hairlines that are virtually undetectable. I recreate soft and natural hairlines paying meticulous attention to fullness, density, texture, and the angle and placement of each individual hair.
D. Ethics. I live my life and run my practice under the guidance of one rule, the Golden Rule – do unto others as you would have others do unto you. My commitment to you is the skillful blending of artistry and medical training, coupled with personal attention – always with the focus being your best interest and satisfaction.
Do hair transplants hurt?
My patients say that they only feel slight pressure during the procedure. Most of the time the are absorbed in a movie or napping anyway. Recovery is usually speedy. The majority of my patients are back to their normal activities in a week.
Should some people not undergo hair transplantation surgery?
It is my responsibility to inform all of my patients of all treatment alternatives. If you are not a good hair transplant candidate, I will tell you why. While I am able to help the majority of my patients, some individuals are better hair transplant candidates than others. Young patients, 18-25 years old, sometimes have unrealistic expectations. Medications such as minoxidil and finasteride can slow the process and should be tried first, or in conjunction with initial procedures. Patients who have unrealistic expectations are poor candidates. Patients who are not personally committed but rather are accommodating someone else’s wishes, also are not ideal candidates.
Why do you teach medical students and residents?
I am a very fortunate individual who firmly believes that it is my responsibility to give something back to society. I give back to society by sharing my experience and knowledge with the next generation of hair restoration surgeons so that, in turn, they too can change people’s lives. Surgeons from as far away as Turkey and South America visit our office to bring specialized techniques back to their own countries.
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