Common Questions About Hair Restoration

Courtesy of International Society of Hair Restoration Surgery

Here are some common questions and their answers concerning hair loss and hair transplants.

What causes hair loss?

The most common cause of hair loss is heredity. Men and women inherit the gene for hair loss from either or both parents. In men, the hormone dihydrotestosterone causes a gradual miniaturization and eventual loss of hair follicles that are genetically susceptible. The mechanism of female pattern hair loss is not clearly known. The age of onset, extent, and rate of hair loss vary from person to person. Men and women exhibit hereditary hair loss differently. Severe illness, medications, 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.

Do hair transplants 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 its 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 many years ago, large circular grafts (commonly called ‘plugs’) containing 15-20 hairs were transplanted resulting in noticeably unnatural results. Over years, instruments and techniques have been developed that allow hair transplant surgeons to achieve truly natural results by transplanting large numbers of small grafts very close together. We have found that hair grows from the scalp in groups of one, two, or three (and rarely, four) hair follicles, called “follicular units.” We can transfer these groups of follicles, called “follicular unit grafts,” after eliminating the excess surrounding tissue. This allows the grafts to be placed closer together resulting in a denser and more natural result. A significant amount of artistry is also needed in order to recreate the natural patterns of hair growth.

Is an undetectable hair transplant possible?

Yes. Today’s highly trained and up-to-date surgeons, using a combination of artistry and technology, can recreate hairlines and crown coverage in a manner that truly defies detection. Progressing beyond the old style ‘plug-type’ transplants has been possible using advanced techniques which allow the transplantation of large numbers of small grafts. An appreciation for the natural shape and patterns of hair growth allows surgeons to create wavy, randomized hairlines that look natural.

What can be expected after hair restoration 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 3-7 days. Shampooing can be resumed 24 hours after surgery. In our practice we only perform FUE hair transplant surgery so there are no sutures or staples and the tiny wounds heal with a 2-4 days and are invisible to the eye in 5-7 days. 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.

Are hair transplants painful?

Most people are surprised at how little pain there is during a hair transplant procedure today. 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-anesthetize the area. Advances in local anesthetic and the way it is applied allow for a comfortable and relaxing procedure. Most patients watch movies, listen to music or nap during their procedure.

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.

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 hair restoration surgeon will discuss this with you during the consultation.

Are hair transplants expensive?

Despite the initial cost of the procedure, hair transplantation can be less expensive than an artificial hairpiece over the long run. Considering that the results are permanent, most people consider it a good investment in their future happiness.

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 3) the density which the patient desires and 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.

After using Propecia® (finasteride) for a prolonged period, would cessation of use of the drug result in the same sudden rapid hair loss off all hairs that would have been lost without the use of the drug, like suddenly stopping use of Rogaine® (minoxidil)?

The hair would be lost until the point where an individual would have been without treatment. However, the hair loss is not sudden and will take several months to a year after stopping the medication. That is why missing a day or two of treatment, although not recommended, is generally not detrimental.

What are the possible harmful effects of Propecia and Rogaine? Especially in regards to women handling Propecia and/or a man taking the drug while trying to have a baby? Can the man cease taking the drug until he has fertilized a child?

There are no known harmful effects of either medication when used as directed by the manufacturer. Follow all package instructions. Propecia could be potentially harmful to a developing male fetus in a pregnant woman if a significant amount of the medication entered her body over time. This would require her to ingest the medication, so she should not handle broken or crushed tablets. The amounts of the medication in a male’s semen have been studied and found to be insignificant. The man can certainly cease treatment during conception efforts, but this is not necessary.

Is Propecia less effective in different races? Asian vs. Caucasian? Is it less effective for frontal vs. coronal pattern hair loss?

There has not been any noted difference in ethnic groups. Propecia is most effective in crown hair loss. It is less effective in frontal loss. It has not been shown to be effective in the temples (sides of head forward of the ears).

Is hair transplantation/hair restoration surgery a subspecialty of dermatology, and is it done as a fellowship post-residency?

The field of hair restoration surgery (HRS) is made up of physicians from many backgrounds including dermatology, plastic surgery, general surgery, family practice, ENT, and many others. Unfortunately, training in HRS in the typical residency is rarely at the same level as is performed today. That is why post-graduate education in HRS is so important and why the ISHRS is so important today in educating those physicians wishing to practice this specialty. In addition, ISHRS offers post-residency fellowship training positions in several centers around the world.

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