Q: What causes hair loss?

The most common cause of hair loss is inheritance. Men and women inherit the gene for hair loss from either or both parents. Men are most commonly affected by the inherited gene as the hormone, testosterone, activates the genetic program causing loss of hair follicles. Currently there is no known method of stopping this type of hair loss. The age of onset, extent, and rate of hair loss vary from person to person. Severe illness, malnutrition, or vitamin deficiency can accelerate this process. When applied incorrectly, permanent hair color and chemical relaxers damage the hair and follicle to the extent that hair loss can be permanent. Causes of hair loss do not include wearing a hat, excessive shampooing, lack of blood flow, or clogged pores.

Q: Why have a hair transplant?

The reason why men get hair transplants is to achieve a more or less “permanent” correction of hair loss in order to improve self-esteem and restore a more youthful self-image.

Q: Does it really work?

Yes. The transplanted hair is removed from one area of the body (donor site) and transferred to another (recipient site). The transferred tissue is not "rejected" as it is not foreign tissue. The transplanted hair maintains it's own characteristics; color, texture, growth rate, and curl, after transplantation and regrowth. The vitality of the grafted follicle is maintained by the rich blood supply to the scalp. Originally, large circular grafts containing 15-20 hairs were transplanted resulting in noticeable and unnatural results. Over years, instruments and techniques have been developed that allow us to achieve truly natural results by transplanting small grafts very close together. We have found that hair grows from the scalp in groups of one, two, and three hair follicles. We transfer these groups of follicles after eliminating the excess surrounding fatty tissue. This allows the grafts to be placed closer together resulting in a denser and more natural result.

Q: Who can get a transplant?

Any person with noticeable hair loss that includes thinning hair and bald areas, and whose remaining hair is capable of growing in a transplanted location (called a donor-dominant condition), is a candidate for hair transplantation. A donor-dominant condition is one in which transplanted hairs are able to survive at a new location and will live and produce hairs as long as they would have in their previous location. The most common condition seen is so-called male- and female-pattern androgenic alopecia (hereditary hair loss). However, other conditions such as scarring disorders resulting from injury, diseases, or previous surgery of the scalp, can also be treated with hair transplantation.

Q: When should a hair transplant be done?

A hair transplant can be done any time after there is enough hair loss in a particular area, such as the front, middle, or top of the scalp so that noticeable thinning is present on casual examination of the affected area. Hair loss actually begins long before it is noticeable and approximately 50 percent of the hairs in a given area are lost before noticeable thinning becomes apparent.

Q: How is a hair transplant done?

A variable sized section of living scalp containing live hair follicles is removed from the back of the head (donor area) and subsequently microdissected into small so-called follicular unit grafts that are implanted into small surgically produced recipient sites in the balding area (recipient area). The surgical sites are well-healed in 7 to 14 days, and after a delay of 8 to 12 weeks, the transplanted hairs begin to produce new hair shafts.

Q: Where is a hair transplant done?

Hair transplants are done in an outpatient setting. Patients walk in and walk out the same day. Patients are given oral, or in some cases inhalant/intravenous sedation, followed by local anesthesia to the donor and recipient sites.

Q: What are the main difficulties experienced by a patient before, during, and after a hair transplant?

The main problems encountered by patients before hair transplantation are usually concern about the cosmetic down time in the postoperative period, and varying degrees of anxiety about potential discomfort during and after the procedure. During the procedure, the patients often become restless due to the prolonged time required to achieve the results and because of this, sometimes have difficulty refraining from talking and moving, which makes the procedure more difficult for the surgeon and the assistants. Finally, after the procedure, the patients experience variable degrees of discomfort at the donor site and variable degrees of swelling of the forehead that resolve in a few days. Also, there are variable degrees of self-consciousness caused by the tiny scabs that are present in the recipient sites. However, most patients will say that the difficulties experienced in the postoperative period in no way equal the level of anxiety experienced during the preoperative period. The subconscious fear of detection by casual observers is not realized in the vast majority of patients during the postoperative period.

Q: Which regions of the scalp are best suited for hair transplantation?

The frontal scalp and the midscalp are the areas best suited for microsurgical hair restoration. The so-called bald spot (vertex) can also be corrected, but is somewhat less desirable.

Q: Can a completely bald head be completely restored by hair transplant surgery?

The answer is no, but this is a trick question. Obviously, a completely bald head cannot be transplanted because it has no donor hair to transplant! However, even a very bald scalp cannot be completely transplanted since the size of the donor area and the number of hairs present are smaller than the potentially bald area on the top of the head. However, if the potential donor site is sufficiently large and reasonably dense, a surprisingly large number of hair follicles are available for transplantation to the top of the head, and fairly large areas of balding scalp can be covered adequately with hair that is both natural and reasonably dense in appearance.

Q: What can be expected immediately after surgery?

The post-operative course will depend on adherence to the instructions given after surgery. Small scabs will form on the scalp at the graft sites. Generally speaking, these scabs disappear in 4-7days. Shampooing can be resumed 24 hours after surgery. The suture (stitch) used in the donor area is undetectable as it is completely covered by your existing hair. An appointment will be made for the suture to be removed one week after surgery. It is advisable to take at least two days off work after surgery. A baseball type cap can be worn at anytime after surgery. Patients should avoid strenuous physical activity for at least five days after surgery. Typically the grafted hair will shed in 2-4 weeks. New growth will begin in 3-4 months and length will increase approximately 1/2 inch per month.

Q: Is Hair Transplantation painful?

Most people are surprised at how little pain there is during the procedure. Some discomfort is to be expected as the anesthetic is injected into the scalp. Once the skin is anesthetized, there is no pain. If the numbing medicine wears off during the course of the procedure, more is injected to re-anesthatize the area.

Q: What will it look like after the procedure?

The grafts form small scabs in the days after the procedure. If one has enough surrounding hair, these scabs can be camouflaged with creative styling. If not, the small scabs may be visible but do not attract much attention. By keeping the scalp moist, the scabs usually come off in about a week or so.

Q: When can I go back to work?

Depending on the type of procedure you have done and the type of work you do, it is often possible to go back to work the next day. Your surgeon will discuss this with you during the consultation.

Q: Is hair transplantation expensive?

Hair transplantation is more expensive than a hair piece or some alternative treatments. However considering that the results are permanent, most people consider it a good investment in their future happiness.

Q: How many sessions will be required?

The number of the sessions will depend on the 1) area of scalp treated 2) the number and size of grafts used and 3 )the density which the patient desires 4) the individual characteristics of the patient, e.g. coarse hair will provide a more dense look than fine hair. The estimate of the number of sessions can be discussed during the consultation with your surgeon.