Answer:
I would recommend that you do lots of research before you commit to having a Fleming Mayer flap procedure. The main positive feature associated with a flap is the high level of density which can be transferred during a single procedure. Unfortunately, the trade-off for this density is a very artificial look. I have never seen a patient with a flap who looked natural from every viewing angle.

During the Fleming Mayer flap procedure, a strip of tissue from the side of the head is dissected and then twisted around and relocated where the hairline is to be created. Your concerns about invasiveness with this surgery are well founded. Since this surgery takes a section of scalp from the side of the head, it is possible that the resulting scar will be noticeable after the surgery. Furthermore, if the blood flow to the section of flap is compromised, the flap could lose its hair or become necrotic. (more…)

Website: http://www.miamihair.com
Email: drnusbaum@miamihair.com

Dermatologist/ Board Certified by the American Board of Dermatology

Dr. Nusbaum has been widely published in the fields of dermatology and hair transplantation and has been extremely active in research and professional societies. He is in demand as a lecturer and has presented dozens of programs, research findings, and clinical reports at medical conferences.

He graduated from the University of Colorado in 1974, then received his doctor of medicine degree from he University of Miami School of Medicine in 1979.

Dr. Nusbaum interned in Internal Medicine at Mount Sinai Medical Center in Miami Beach from 1979 to 1980. He did his residency in dermatology at Mount Sinai from 1980 to 1983, serving as chief resident in dermatology from 1981 to 1983. (more…)

Hello,

I hope you answer my question. My 12 yrs. old daughter has been diagnosed with Androgenetic Alopecia. Her hair has been thinning in the front and at the temples. We have been using the 2% Rogaine for 3 weeks, as recommended by her dermatologist. The hair in the back of her head seems normal. This is starting to affect her emotionally.

Is it too soon to think about hair transplant? Should we wait until she is 18? Please let me know.

We live in the Bay Area, Any recommended hair transplant MD’s??

Thank you for your time,
Mariam

Answer:

Androgenic alopecia is quite uncommon in a 12 year old male or female. I am curious how the diagnosis was made. There are multiple reasons for hair loss in the front and temple areas besides androgenic alopecia. If it is androgenic alopecia, one would consider a full medical workup to determine why it is occurring at such a young age. Androgenic alopecia has some characteristic findings. These include miniaturization of the hair and lightening of the hair color in the affected areas. In addition, there are also some characteristic histological findings under a microscope. I would have her seen as quickly as possible. In the bay area, I recommend Sheldon Kabaker, who practices in Oakland or Peter Panagotacos, who practices in San Francisco. They can assist you with a diagnostic work up, as well as a treatment plan. (more…)

I am 57 and have had multiple hair transplants with great results. I suffer from male pattern baldness. Two years ago I began taking testosterone and HGH replacement therapy under the direction on an anti-aging physician. My concern is by increasing testosterone/DHT, am I at risk of loosing the grafted hair. What has been your experience with patients using hormone replacement therapy and hair loss. Could propecia mitigate the potential side effects of hormone replacement and hair loss?

Answer:

First of all, if you were going to experience any loss of hair, transplanted or otherwise, you would have noticed by now, having taken testosterone (T) and HGH for two years. The loss would be the greatest in non-transplanted hair.

Theoretically the transplanted hair originated from a zone of follicles free of DHT receptors so they should not be affected by DHT or T. In reality the transplants behave like the donor hair and there have been reports of thinning of transplants if the donor hair thins. Most often this thinning is seen with age (senile alopecia) but can also be associated with medications or systemic illness. Fortunately the incidence of this is low. By taking T, DHT will most likely increase. As a precaution finasteride could be taken to lower the concentration of DHT. Finasteride reduces the amount of DHT by 70%. If you are increasing T and therefore DHT, even with blockage of 70% of the production of DHT there will still be more DHT.

So the answer to your question is yes finasteride could potentially decrease hair loss from DHT produced by an increase in exogenous T. One has to be aware of the side effects of finasteride which are well documented.

Bradley Wolf, MD
http://www.wolfhair.com
IAHRS Recommended Hair Transplant Surgeon

- Accepted member of The International Alliance of Hair Restoration Surgeons

- One of less than 50 hair transplant surgeons throughout North America recommended by The American Hair Loss Association

Website: http://www.forhair.com
Email: info@forhair.com

John P. Cole, MD practices in Atlanta, Georgia, Chevy Chase, Maryland, Cleveland, Ohio, and Charlotte, North Carolina. Dr. Cole attended Mercer University on an academic scholarship from the United States Army and graduated summa cum laude with a degree in biology and chemistry in 1981. He continued on to the Medical College of Georgia, where he received his medical degree in 1985. Dr. Cole completed his postgraduate medical training at the University of Missouri in the field of internal medicine. He has dedicated his practice solely to the field of hair transplant surgery since 1990. He has maintained a private practice in hair restoration since that time. He is a member of the International Society of Hair Restoration Surgery, the American Society of Hair Restoration Surgery, and the American Academy of Cosmetic Surgery.

Dr. Cole was among the first thirty physicians to become a Diplomat of the American Board of Hair Restoration Surgery. He serves on the Board of Directors and examination committee for the American Board of Hair Restoration Surgery. In the interest of sharing his knowledge to improve the field of hair transplantation, Dr. Cole has written and presented many papers, both to hair transplantation societies and at educational seminars. (more…)

I am from Cyprus and I am a candidate for a transplant operation. I have found many answers to many of my questions in your site and I thank you for that. The reason I am getting in touch with you is that I have my doubts on the number of hair “roots” they can get per square centimeter for a hair transplant. Can you please inform me what is the MAXIMUM number of hair roots that can be taken from a square centimeter? I consider that important as the total cost of the operation depends completely on the number of hair the will transplant. For instance if the strip they will get is 28 square centimeters and with average density what would be a possible number ‘roots” to be transplanted

Thank you once again ! I look forward to hearing from you !

Answer:

When you say “roots,” I am assuming you are talking about hair “follicles,” as a follicle is the smallest unit which can be successfully transplanted. With that in mind, the average number of follicles per square centimeter donor tissue is roughly 100/cm. I have seen this number vary from between 40/cm to 160/cm. The higher the number, the more follicles the tissue provides. Someone with a density of 40/cm is unlikely to be a good candidate for surgery because of the low yield and because the donor region is so sparse that you would probably be able to see the donor scar.

Using your example of a 28 square cm donor section, the yield would be roughly 28 X 100 = 2,800 follicles. However, this doesn’t necessarily mean that the incision would be 28 cm in length. To calculate the surface area of donor tissue to be excised, you have to multiply the length of the incision by the average width. In my practice, I limit my donor incisions to 1.2 cm in width. Therefore, to obtain a 28 square cm section, my length of incision would be 28/1.2 = 23.3 cm.

Brandon Ross, MD
http://www.rmhri.com
IAHRS Recommended Hair Transplant Surgeon

- Accepted member of The International Alliance of Hair Restoration Surgeons

- One of less than 50 hair transplant surgeons throughout North America recommended by The American Hair Loss Association

Website: http://www.foundhair.com
Email: jsemd@foundhair.com

Facial Plastic Surgeon/ Board Certified by the American Board of Facial Plastic and Reconstructive Surgery; the American Board of Hair Restoration Surgery/ Fellow, American College of Surgeons

Dr. Epstein is considered one of the country’s leading experts in hair restoration surgery by the plastic surgery community. (more…)

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Reader’s Digest took the opportunity to acknowledge The International Alliance of Hair Restoration Surgeons as the place to find a hair transplant surgeon.

Image Magazine Sept 2007 Issue
(click image for larger version)

Southern California’s premiere lifestyle magazine goes “Unplugged” to empower their readers with the truth about hair loss treatments including surgical hair restoration.

When Image Magazine’s Angela Fernandez was given the assignment to to provide her readers with cutting edge information about the 3.5 billion dollar hair loss industry, she decided to go straight to the source… Spencer Kobren and The American Hair Loss Association.

 Spencer discusses his own struggle with hair loss, as well as giving his advice on today’s cutting edge treatments. Dr. Paul Cotterill was also interviewed for the article providing his insight on low level laser light therapy and follicular unit hair transplantation.

 Both Spencer Kobren and Cotterill offer words of caution when selecting a hair transplant surgeon and discuss the importance of doing your research. The International Alliance of Hair Restoration Surgeons is recommended as as the only organization that independently screens surgeons “admitting only those physicians who meet the exacting medical, ethical and professional standards of the IAHRS board.”

Spencer Kobren explains how “hair transplantation is a team effort” and the important role that the hair transplant tech plays in the final outcome of the surgery.

Is numbness in the back/donor area permanent?

Answer:

The loss of feeling associated with the strip technique of donor hair harvesting should be temporary. The nerves in the back generally carry sensation vertically in an upward fashion. When the incision is made these nerves are severed, which causes a numb-type feeling directly above the incision line. The sensation in this region almost always returns to normal, but the length of time varies from person to person (usually anywhere from 2-3 weeks to a year). As the nerves gradually reconnect with one another, it is common for the patient to have a slight “pins-and-needles” feeling in a patchy distribution. Some things that could cause numbness to persist a bit longer are a history of prior scarring, keloids, and diabetes.-

Brandon Ross, MD
http://www.rmhri.com
IAHRS Recommended Hair Transplant Surgeon

What’s the difference between the Strip method and FUE (follicular unit extraction) for getting the donor hair?
Answer:

First and most importantly, I make sure my patients understand the greatest limit to any hair transplantation is that there is a fixed and limited amount of good genetic hair that we can transfer to the balding areas.

With that in mind, I explain that no matter how experienced the surgeon, when I remove the donor area with either method, I am removing it blindly (i.e. – I can not see under the skin until after the donor tissue is removed). The problem is that I can not see if the follicles have been damaged or transected until after it’s been removed. So it’s best to have as little tissue as possible exposed to any device removing the tissue.

With the strip method, we minimize the amount of donor area being exposed to the risk of damaging hair follicles while obtaining the donor hair. With F.U.E., the patient no longer runs the risk of having a linear scar on the back of their scalp, but there is a significant increase in the amount of surface area being blindly dissected and with that a significant increase in potential damage to the hair follicles.

While I use both methods to obtain donor hair, I make sure the patient understands the risks and implications of both and I help the patient make an educated decision.

Paul J. McAndrews, MD
http://www.hairgrowthdoctor.com
IAHRS Recommended Hair Transplant Surgeon

Why do I need to use Propecia and Rogaine? Why can’t I just have a hair transplant?

Answer:

The simplest way to answer these questions is to give you an analogy. A dentist does not prevent tooth decay, toothpaste prevents tooth decay. Just like tooth decay, hair loss is a progressive disease for men and women. You will continue to lose hair (usually about 4% density per year) if you do not use the “toothpaste” that prevents the hair loss – which is Propecia and Rogaine.

You can have a hair transplant, if you are a candidate. I can increase density by approximate 20% with one procedure. But that means after 5 years, you have essentially lost what you had gained. Then you need another transplant, and the cycle continues.

The greatest limitation to hair transplants is the fixed and limited amount of donor hair you have. The majority of patients don’t have enough to keep up with the progression of their hair loss. If I can help you prevent that hair loss with the medical therapies, then I can minimize the amount of restoration you will need and you will be a much happier and more satisfied patient.

Paul J. McAndrews, MD
http://www.hairgrowthdoctor.com
IAHRS Recommended Hair Transplant Surgeon

- Accepted member of The International Alliance of Hair Restoration Surgeons

- One of less than 50 hair transplant surgeons throughout North America recommended by The American Hair Loss Association

Website: http://www.hairgrowthdoctor.com
Email: doctor@hairgrowthdoctor.com

Clinical Instructor of Dermatology,
University of Southern California School of Medicine

•Board Certified in Dermatology

•Fellow of the American Academy of Dermatology

•Fellow of the American Academy of Cosmetic Surgery

Paul J. McAndrews, M.D. is a Clinical Instructor of Dermatology at the USC School of Medicine, teaching the residents the latest advances in hair loss and transplantations. Dr. McAndrews also lectures extensively to other physicians throughout the United States on the etiology and treatment of hair loss. Dr. McAndrews has a private practice located in both Pasadena and Beverly Hills, CA. Unlike most hair transplant surgeons, Dr. McAndrews was formally trained in a residency on hair transplants and the pathophysiology of hair loss. (more…)

Located in Hasselt, Belgium Dr. Feriduni is offering some of the best state of the art hair transplant surgery in Europe. We were very pleased to receive his application and very fortunate to find him.

A little more about Dr. Bijan Feriduni:

The Practice of Dr. Feriduni is a professional clinic, specialized in aesthetic and reconstructive hair surgery. Years of experience of the medical team on the one hand, and the specialization of Dr. Feriduni within his field of expertise on the other hand, guarantee a high level of treatment certainty and a professional attitude. As a result of the compliance with the latest techniques and our disciplined internal co-operation, we can offer our patients an optimal and constant quality certainty. Visit Dr. Feriduni’s website

View Dr. Bijan Feriduni’s IAHRS Member page

I will be 30 years old in November and have been on Propecia for 21 months to prevent further hair loss. Fortunately it has significantly slowed the rate of loss, but did not regrow any hair. I am mostly stable now, although there is still some slight regression. Currently, I am a NW2.5V patient on the scale with more loss on the crown and less at the hairline.

I prefer to have the FUE procedure to fill in the existing frontal hairline (as this has not receded from its original location, but rather has become less dense), the mid scalp, and the crown. My goal is to restore adequate density to provide coverage over the affected area.

I am concerned about shock loss in the transplant area due to the relatively broad coverage of the existing hair, so please address this issue in your response. Please advise my options, including the estimated number of grafts to achieve the desired results and the associated costs of the procedure.

Answer:

At 30 even using Propecia, you could and probably will lose more hair. For this reason I’m not a big fan of grafting the crown in men less than 35. The only one exception to this rule is if FUE is used. If extensive loss ensues you could cut your hair short without seeing a linear scar. (more…)

I am going on a vacation to Hawaii in a month. Do you recommend I have my hair transplant procedure done now, or should I wait until after I get back?

Answer:

This is a difficult question to answer, as there are pros and cons with both choices. Obviously, the sooner you get the hair transplant, the sooner your new hair will be growing. The main drawback to having your procedure performed prior to your vacation is that you need to make sure the top of your head does not get a sun burn. While it is never a good idea to get a sun burn on any part of your body, evidence suggests that a sun burn on the newly grafted scalp region can lead to diminished graft survival. I usually recommend taking extra precautions, such as hats and suntan lotion, for a minimum of 3 months after surgery to avoid a sun burn in the grafted area.

Waiting until after your vacation causes you to wait that much longer for your hair to grow. However, it’s not as if all of your hair loss happened over the last few months- you’ve waited this long, so you can probably wait a month or two more. If you are afraid you may have trouble avoiding sun exposure during your vacation, I would recommend delaying the procedure until after you return.

-Brandon Ross, MD
http://www.rmhri.com
IAHRS Recommended Hair Transplant Surgeon

I am 27 with roughly type II hair loss. I would like to evaluate my ability to get a hair transplant to restore the front hairline. It is difficult to clearly show the difference in growing ability between the front and back hair because I just got a haircut before buying my digital camera. Basically all hair directly above my forehead is
getting sparse and thin and won’t grow beyond a certain length, and when the full head of hair grows long, it doesn’t keep up.

Answer:

It would be ideal to see you in person to get a good look at your hair loss and discuss all your options. There are medications you can take, minoxidil (Rogaine) and Propecia (finasteride) which can prevent further loss and actually add some density to the miniaturized hairs still hanging on. You appear to have a receding hairline and generalized thinning at the hairline and front. A hair transplant would increase the density of the hairline and front and could be used to recreate the hairline at an appropriate level. The transplanted hairs remain there so we have to be careful where they are put so they look appropriate as you age. There are a lot of aspects to discuss, beyond the scope of this post. You can get more information at our website, wolfhair.com. Again the best next step would be to schedule a consultation, for which there is no charge. In summation, you appear to be a candidate for transplants. In addition I would highly recommend the use of medications to prevent further hair loss.

Bradley Wolf, MD
http://www.wolfhair.com
IAHRS Recommended Hair Transplant Surgeon

I am wondering if I can wear a hat after the surgery. Also, how long until I can wear my motorcycle helmet?

Answer:

You can wear a baseball cap right after the surgery, provided that it is loose and flexible. Many people bring a hat or a bandana with them to the procedure and then wear it home so nobody sees that they have had surgery. The one caveat about this is that the hat cannot come in contact with the newly grafted follicles. It is okay if the hat touches the donor area on the back of the head, but if the hat is too tight or pushed town to far, there is a chance that the grafts will stick to the hat and subsequently be pulled out when you take the hat off. This can usually be avoided by wearing something loose that can be tilted a little forward.

The motorcycle helmet, on the other hand, represents a problem. We recommend waiting about 2 weeks after all of the tiny scabs have fallen off before you begin to wear a helmet. Generally, helmets are fairly heavy, which means that they are likely to press down on the head. This, coupled with the helmet vibration inherent with riding a motorcycle, could lead to damage to the new grafts and a diminished survival rate.

-Brandon Ross, MD
http://www.rmhri.com
IAHRS Recommended Hair Transplant Surgeon

Hello, I had my surgery two weeks ago and I noticed that many, if not all, of the scabs on the top came off with the hair attached. What percentage of this hair will grow back?
Answer:

That is a completely normal occurrence during the immediate post-operative period. After the procedure, the transplanted hair shafts are expected to fall out at or around the same time as the scabs fall off. Occasionally a portion of the grafts (the percentage varies widely between patients) will retain the original hair shafts and begin growing new hair from day 1. The usual course is for the transplanted follicles to shed their hairs soon after they are grafted and then start growing a new hair anywhere from 3 months to 12 months thereafter. The survival should be near 100%, whether the hairs shed after the surgery or keep growing and all of the follicles should be generating hair within a year.

-Brandon Ross, MD
http://www.rmhri.com
IAHRS Recommended Hair Transplant Surgeon

Website: http://www.rmhri.com
Email: bmr@rosscmg.com

Dr. Brandon M. Ross is the president and cofounder of La Jolla’s Ross Medical Hair Restoration, Inc. He serves as the only physician in this practice, which ensures that his expertise will serve every patient who enters his door. Dr. Ross is a firm believer that great care and planning must go into every surgery he performs. Therefore, he performs only one procedure per day and he utilizes only the most innovative techniques the industry has to offer. Dr. Ross specializes exclusively in hair restoration for both males and females to ensure that his attention is undivided. It is with his tremendous focus and naturally gifted hands that Dr. Ross is recognized as one of the leading hair restoration physicians in the United States.
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I had hair restoration surgery performed by Dr. Wolf in June 2006 (about 1 year ago). I am satisifed with the results, but I am wondering if there is any continuing maintenance I should know about.

I have been using regular shampoo, going in the sun, etc. Are there ways to maximize the results going forward, or things that I might do at this point which could damage the hair?

Also, my procedure concentrated on the frontal hairline. Some of the new hairs are wavy/frizzy. Is there a good way to deal with this?

(more…)

•Specializes in Follicular Unit Transplantation

•Specializes in Hair Transplant Repair and Reconstruction

•Accepted member of The International Alliance of Hair Restoration Surgeons

•One of less than 50 hair transplant surgeons throughout North America recommended by The American Hair Loss Association

Website: http://www.wolfhair.com
Email: wolf@wolfhair.com

Dr. Wolf has practiced exclusively as a hair transplant surgeon since 1990. He received his Doctor of Medicine degree from Indiana University School of Medicine in 1980, and did his internship in General Surgery at Eastern Virginia Graduate School of Medicine in Norfolk, Virginia, from 1980-1981. He then did his residency in General Surgery there from 1981-1982.

Dr. Wolf is an active member of a number of professional associations, and has lectured extensively on hair transplantation surgery at medical conferences in the U.S., Europe and Russia. He has also trained physicians from Russia, the Czech Republic, Belgium, Ireland, as well as from the United States and has also presented live surgery workshops at medical conferences in the U.S., Europe, and Russia. (more…)

These days, many balding men choose to go to the other extreme and shave their scalps. I caution patients not to have a transplant if they are considering this because the transplant will leave a fine, linear scar in the back where the donor strip was repaired. Similarly, if the patient wants to keep his hair so short (burr-type cuts) that someone could see through the hair to the scalp, then I warn him that he should expect that the donor scar will likely show through in the back. This is an especially common problem for those in the military. On the other hand, if the patient wears his hair long enough that someone cannot see through to the scalp, the donor scar should not be apparent unless someone is picking through his hair.
(more…)

First and foremost, the person considering a transplant must determine whether his expectations are realistic. Most men assume they will be able to have their baldness filled in entirely. If someone has a few small areas to repair, that is possible, but if someone’s balding is advanced, he probably will not have enough hair to donate to fill in all of the areas. It must be remembered that we are rearranging hair, not creating new hair. On occasion, I suggest to patients in consultation that with their high levels of expectation regarding the amount of hair they will need to be happy, that they should probably purchase a hairpiece instead of a transplant.
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A scalp may be divided roughly into two separate areas. One is the area susceptible to balding and the other, of course, is the area not. The horseshoe fringe of hair left behind on a bald man’s scalp is the area from which hair can be safely donated. Hair transplanted from this area of the scalp will not be susceptible to balding even when it is placed right in the middle of the bald scalp. This new hair maintains the same characteristics of the hair left behind in the donor area no matter where it is transplanted to the scalp. This is what is meant by donor dominance.

Multiple methods may be used to harvest this donor hair. In the early days of hair transplantation, the hair was removed in 4 mm plugs about the size of a pencil eraser. Multiple plugs were removed simultaneously and the area was allowed to heal in by itself. Although the healing areas were messy the first week because of the weeping from the open wound, the areas tended to heal well. The primary problem was the cobblestone scar pattern left behind. Eventually the plugs were taken out in rows so that the edges could be sewn together.

(more…)

- Accepted member of The International Alliance of Hair Restoration Surgeons

- One of less than 50 hair transplant surgeons throughout North America recommended by The American Hair Loss Association

Website:http://www.norwood-lehr.com
Email: lehr@norwood-lehr.com

Perhaps the greatest compliment and best introduction to Blaine Lehr, M.D. is a statement from O’Tar Norwood, M.D., one of the true pioneers in the field of hair transplantation (creator of the Norwood Baldness Scale, author of 1st two textbooks of hair transplantation, cofounder of the International Society of Hair Restoration Surgery, founder of the Hair Transplant FORUM International, and recipient of two of the highest awards—Golden Follicle Award and Manfred Lucus Award).
(more…)