Hair Restoration
Why do we lose our hair?
Male Pattern Baldness (Androgenetic Alopecia) is the cause of 95% of hair loss or hair thinning in males. As young men reach early adulthood they generally produces a higher level of Testosterone. Some of the Testosterone is naturally converted to Dihydrotestosterone (DHT). DHT can be the cause of hair loss, usually on the front and crown of the scalp.

Each male can produce differing percentages of DHT. The hair follicles of each male may also be more or less sensitive to DHT. This is why male pattern hair loss is not the same in all men. In those men with extremely high levels of DHT or in those individuals whose hair follicles are very sensitive to DHT, hair loss may appear.

Fortunately, hair on the side and back of the scalp is more resistant to DHT. These hair follicles may be transplanted to the bald or thinning areas and can grow in spite of the DHT because they are genetically programmed to be resistant.

Baldness can occur in stages and can be progressive through life. As men grow older they can experience additional hair loss as they experience the natural decline in testosterone production. This may seem contradictory, but some Testosterone is required to grow hair, and when some men lose the minimum requirement of Testosterone, they may experience additional hair loss.
Hair loss may occur in up to 30% of females. When it occurs in females it is usually more diffuse, rather than more localized as with male pattern baldness. When females sustain hormonal hair loss it is usually seen as a generalized thinning.

As previously stated, Testosterone is required to grow hair. This is true even in females. As females go through menopause and the female hormones decline, they also lose Testosterone. Yes, females produce Testosterone; just not as much as males. But, when a female no longer has the minimum requirement of Testosterone, they can lose hair.

What can we do about hair loss?
It is our opinion that a combination therapy may be best. Some of the options include:
Minoxidil, also known as Rogaine.
Finesteride, also known as Propecia (in men only)
Follicular Unit Hair Transplantation
Low Level Laser Therapy, newly approved by the FDA

Although all of the above treatments may help treat hair loss, we are not enthusiastic about all of them. There is a long record of relative safety using Minoxidil and it seems to help in some patients. Low Level Laser may be of some help, but it is not a miracle cure. Hair Transplantation is the most effective treatment we are aware of. Finesteride can help slow hair loss, however, there are reports of the occasional damaging impact on male sexual performance. Therefore, at the time of publication, we will not write prescriptions for this product.

(Hair Transplantation)
Hair transplantation moves grafts of hair from the back and sides of the head to bald areas of the front of the scalp. This procedure actually transplants the roots of the hair. Once the grafts have established themselves in the recipient sites of the bald area, the hair follicles produce hair for as long as they would have, had they remained in their original site.

The technique of hair transplantation is not new. It has been used successfully for fifty years, and new refinements continue to help improve results. Transplantation does not increase the number of hairs, but it does redistribute the hair over a bald or thin area. Although the transplanted hair is never as thick as it was prior to any hair loss, with proper styling a satisfactory result may be obtained.
Who Should Have Transplantation?

Not everyone is a good candidate for hair transplantation. The patient with thick, wavy, or curly hair with a receding hairline or a patch of baldness on the top or crown, may be an ideal candidate.
A person completely bald on top of the head, with only a thin rim of hair around the back of the head, may have too large a bald area to be completely covered.

Today’s Hair Grafts
Tiny grafts of scalp containing 1, 2, or 3 hairs are used in our office. They are called Follicular Unit Grafts. Occasionally slightly larger grafts may be used in certain areas of the scalp.

The Procedure
The procedure involves the removal of a narrow strip of hair follicles from a donor area from the back or sides of the scalp. This area is meticulously sutured and repaired. It usually leaves only a thin line that is easily covered with hair. Occasionally, the incision line may widen.

The strip of hair is then dissected into tiny hair grafts containing 1,2, or 3 (occasionally more) hair follicles. The hair grafts (follicular units) are then precisely placed in a natural growth pattern on the top of the scalp in 0.75-1.0mm sites. The placement of tiny grafts allows for faster healing and better growth. We expect 70-95% of the grafts to survive. But, as one might expect, the procedure is very tedious and may take several hours to complete.

More than one stage may be required to obtain the thickest coverage possible.
The procedure is usually done in our office using oral relaxing medication, along with local anesthesia or the adjacent surgical center using twilight sedation and local anesthesia. During the procedure the patient can listen to music.

After Surgery
A turban-like dressing is applied with a ski-cap-type hat over the dressing. The dressing is removed the next day during your postoperative appointment. There is very little discomfort following this procedure. Swelling and discoloration at the surgical site peaks at about three days, and gradually subsides. Most patients are able to return to light work in three to four days, but must avoid strenuous activity. The surgical area is usually easily camouflaged with adjacent hair or a hat.

The transplanted hair may go into a resting phase and fall out at about eight weeks to make room for the new hairs; and is no cause for alarm. The transplant shock to the follicle is responsible for this hair shedding. In some instances, the hair continues to grow without falling out. The new hair may be seen coming in as early as 6 weeks after transplantation. Full results of the transplant can usually be seen in 12-15 months.

Hair usually grows approximately half an inch per month. The hair gets thicker and provides even better coverage with each of the subsequent stages. Although the coverage provided by hair transplantation is never as thick as it was prior to any hair loss, in an uncomplicated case, with proper styling, a satisfactory result is usually obtainable.

Hairline advancement surgery can usually be done at the same time as the hair transplant, if indicated.

HAIRLINE ADVANCEMENT
When there is a large balding area on the crown or back of the head, the edges of the hair may be advanced toward the midline to lessen the area of baldness. It is usually necessary to repeat the procedure several times to reduce the size of the bald area. An average of one inch width of the scalp can be removed per procedure. A number of procedures are needed because the scalp stretches very little. The number depends on the size of baldness and the tightness of the scalp. Each procedure is considered separately and is performed in approximately three to six month intervals.

The Surgery
The dressing, procedure, anesthesia, etc., are similar to hair transplantation.

After Surgery
Postoperative discomfort is minimal. The swelling and discoloration at the surgical site reaches its peak at three to five days and subsides soon thereafter. Most patients are able to return to light work in three to four days but must avoid strenuous activity. The surgical area is easily camouflaged with adjacent hair or a hat.

The surgical scar matures the same as any scar. Some stretching occurs because of the tension and lack of elasticity of the scalp. The hair surrounding the area is often used to camouflage the site. Additional procedures such as scar revision or additional hair transplant grafts may be needed to complete the process.