Laser Hair Removal Central

This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Jeffrey Epstein of Miami, FL who is an elite member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

We do not require any of our hair transplant patients to shave the hair in the balding recipient area, for a few important reasons: first, it makes it difficult to resume regular activities for the first few weeks after the hair restoration procedure, and second, during the course of the procedure, I find the presence of the existing hairs allows me to more accurately determine the relative thinness of different areas of the scalp. Yes, it may take as much as an additional 90 to 120 minutes longer to perform a procedure of 2500 plus follicular unit grafts when the hair is present, but this extra time put in is a small price for the advantages of leaving the hair alone.

Dr. Epstein

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

This question was posed by a female hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

I saw a very reputable hair transplant surgeon yesterday. I have receding hair at my temples so I went in to inquire about a hair transplant to those areas. Upon inspection, he indicated that I have about 30% or so hair miniaturization in the donor area. I’m very scared and am now thinking “am I going to go completely bald“? I have more questions. Has anyone with similiar problem had hair restoration surgery that can offer me some insight?  He says he can do the hair transplant but can offer no guarantee on how long it would last.

Also, how long to miniaturized hairs last and how fast does it progress? Is it normal for a woman at age 46 to have hair miniaturization?

30% is a fairly high percentage of hair miniaturization to be present in the occipital donor area, usually the best hair on most women’s heads who have female pattern alopecia. Most of the time I wouldn’t give a woman a hair transplant with that high of a percentage, simply because it also portends that a lot of the other hairs will probably be following in the same footsteps of miniaturization a hair growth life-cycle or two away from now. The good news is that hereditary female pattern hair loss is a very SLOW process for most women, and almost never occurs as rapidly as its counterpart in males.

The most curious part of your history is the fact that you described being thin in the temple areas only. Usually a woman with 30% miniaturization in the donor area will have an even higher percentage of hair miniaturization in the top recipient area behind the hairline, and yet you didn’t seem to complain about that at all. What degree of hair miniaturization did your hair restoration physician find in the top recipient area? Even if the hair on top was the same and no worse than the back, that degree of miniaturization would still be easy to see through and I would expect that would have been your main complaint ir at least mentioned along with the other temple problem.

Regarding the decision as to whether you should undergo hair replacement surgery, you certainly could, but your expectations would have to be lowered and realistic, especially concerning the number of years of your life you may get to enjoy this additional hair you gain by hair transplantation. For some women entering a critical period of their lives from a social or career standpoint, even 10-15 years of having increased hair density could be valuable to them and worth it. I have been fooled in a few cases in which I initially didn’t want to transplant a particular woman, she insisted on going ahead despite my low expectations for her, and she went on to do well over at least a 5-10 year period up to the present (and still doing well). In some others I can think of, it seemed like a high percentage of the donor hair, even the seemingly strong appearing ones, when they emerged in the recipient area one hair growthy cycle later (after going through the normal “shock” reaction all transplanted follicles undergo), an even higher percentage of them grew out “wispy” and the overall experience was not a forward step for the patient. Theoretically, one additional step that could be taken would be to “cherry pick” only the follicular units that contain at least one strong terminal hair and only use them, putting aside the severely miniaturized ones, as the injury to the scalp of the recipient incision is almost not worth the tradeoff for placing a hair that is unlikely to add to the cosmetic appearance and theoretically could hurt the chances for the good follicles to grow. I have transplanted hair in hundreds of women and must confess not having used this method yet. As per the other suggestions you received, Rogaine (minoxidil) will certainly slow down the hair loss process if taken faithfully. The comments about other medical diagnoses is important for completeness and can be ruled out with a couple of simple blood tests and a good history, but I must emphasize that they are very rare in most of our clinical hair practices.

The bottom line is this: if your expectations are not too high and are realistic and your hair surgeon feels that a positive result is possible, then you have a chance of being reasonably happy with your result for quite a few years.

Mike Beehner, M.D.

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

It’s gonna be 2 months on the 27th of May since my hair transplant.  When could I possibly start to see some real results?  When I slide my hand over my head I can feel prickly hairs but when I look, I can only see small thin hair growth here and there.  I also see some of my pores don’t have anything coming out of them. Any advice?. Or should I realistically be looking at the 4/5 month mark before any hair regrowth?

If you are experiencing any new hair growth at only 2 months after hair restoration surgery, you are way ahead of the game.

Transplanted hair typically start growing in thin and fine, invisible to the naked eye.  But as you are experiencing, they can be felt with your finger tips before they are seen. Transplanted hair will also “pop” through the scalp at different rates and times. Your hair transplant appears to be progressing normally. But the real fun doesn’t start for a few more months.

Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

This insightful information was posted on our hair restoration forum by Dr. Alan Feller of Great Neck, NY who is a member of the Coalition of Independent Hair Restoration Physicians.

Make NO mistake about it. A hair loss sufferer can lose some of his transplanted hair over the years. It’s not common, but it DOES happen.

What can happen in a few hair transplant patients is that the caliber of the transplanted hairs can actually thin noticeably within 3 years of hair restoration surgery. I have no idea why this happens, but it is a definite phenomenon in few patients. The way to counter this graft thinning is simply to implant more hair in the area.

This happened to a patient of mine who used to post quite frequently. I performed two hair replacement surgeries on him that gave him a thick tuft of hair in the front and top of the head. Then, about 2.5 years later he visited the office because of noticeable hair thinning in the recipient area. We did one more transplant and that did the trick. He has no problem since. He posted a professional portrait of himself and signed off the internet to go on with his life.

Making sure your hair transplant surgery is done right is just ONE aspect contributing to the final result. YOUR personal physiology plays just as important a role. The body does many seemingly qwirky and weird things and we are FAR from having all the answers.

Fortunately, the overwhelming majority of hair restoration  patients have “average” physiologies that allow for significant cosmetic improvement after surgery.

Dr. Feller

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

This question was posed by a female hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

The total number of hair grafts planted in a hair transplant procedure simply refers to the number of “building blocks” used in that case, whatever their size or composition. In modern hair transplantation, that usually can range from a 1-hair follicular unit graft up to usually a double follicular unit graft of 4-5 hairs, both dissected under microscopes. Ordinarily the number of grafts equals the number of recipient site incisions with two exceptions.

One, if extremely tiny incisions are made over the entire planting area and the physician feels that 3 or 4-hair follicular units are too large to use and instructs the assistants to split them into two smaller hair grafts each. Actually, two 2-hair grafts made by splitting a 4-hair follicular units will still count as two grafts, because the work was taken to cut them into separate units and two separate incision sites are made to place them in.

Two, if a patient has a larger percentage of naturally occurring 1-hair follicular unit grafts in the donor tissue, often two 1-hair follicular units will be “paired up” and placed into a single incision, which then becomes a 2-hair site, as opposed to making two separate sites and placing 1 hair into each one.

Fortunately most hair transplant patients have around 20% 1-hair follicular units, which works out to about the number needed to create a natural front hairline, and rear border. From the viewpoint of minimizing injury to the scalp and creating hair density, if there is an excess of 1-hair follicular unit grafts, placing two into a single incision is probably preferable. Whether one charges for 1 or for 2 grafts for the grafts placed in such sites can sometimes be problematic, as you have carried out the work to dissect two separate grafts, but only one placement act is performed, as they are usually gripped together as they are placed. In our hair replacement practice we prefer to keep 3 and 4-hair follicular units intact and simply make sure that a few of the micro-slits are slightly larger than the others in order to accomodate them.

An earlier commentator spoke of minigrafts and micrografts as both being over 4 hairs each. That is true of the definition of a “minigraft,” which was a cut-to-size graft cut under loupe magnification in the past. But a “micrograft” is a different animal and has always simply been a 1 or 2-hair graft, which in the “old days” was split off from a larger graft usually. The concept of the naturally occurring follicular unit wasn’t appreciated back in the 1970’s and early 1980’s. Many of us still use the term “micrograft” to refer to a 1-hair graft that is the result of splitting up a 2-hair follicular unit to make two single 1-hair grafts.  This is sometimes necessary when a hair transplant patient has hardly any naturally occurring 1-hair follicular units and they are needed for either eyebrow work or for the edge of the front hairline.

Many people, including myself, feel that giving the NUMBER OF HAIRS transplanted is a more accurate way to describe what was accomplished in a single hair restoration procedure. My experience is that most patients require somewhere around 10,000-12,000 hairs on the top of the head (frontal and midscalp regions) to look relatively full. Persons with extremely fine hair sometimes require more.

Mike Beehner, M.D.

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog