Hair Loss InformationIntegrity in Hair Transplant Doctors – Hair Loss Information – Balding Blog

I am 45 years old and I came to your office 1 year and one month ago. I have a bald spot about the size of a silver dollar in the middle of the back of my head (I believe you call this the crown) which did not go away when I used the drug Propecia for the past year. When we met last month, you suggested that I get the dollar size area transplanted with 700 grafts. I am a careful buyer, so I went to [Note: Doctor’s name removed – let’s call him Dr. X] office for a second opinion. Dr. X told me that I needed between 2500 and 3000 grafts, 1500 in the back of my head and the rest in the front. I was shocked by the difference between the two opinions. Is it possible that you missed any hair loss I had in the front? Even though I did not see any problem in the front, I have been looking at my hair a lot lately, and I am now starting to think that maybe I have hair loss there too. If you are right, then where is Dr. X going to put 3000 grafts? If he is right, will you be chasing my hair loss every few months? Who do I trust? Should I keep getting more opinions?

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First, you should see me again and let me review your examination. Although I would be surprised if I missed frontal hair loss, there is no great mystique to the diagnosis of genetic patterned loss. We can mutually review this on the video densitometer which will absolutely show the existence of any hair loss one way or the other. I just met with another man who had a similar story to yours. He had frontal loss and no loss anywhere else, but when he got another opinion, he was told to transplant his entire head. Integrity and medical ethics should prevent doctors from transplanting men who do not need it. The buyer must always beware and is ultimately responsible for such decisions.

With regard to your comments about thinking that you may be losing your hair after staring at it day after day, just make sure you are not talking yourself into something that is not there. You have the power to control what is about to happen to you, use that power wisely and do not get sold on something that you do not need.

Hair Loss InformationHow To Get Started – Hair Loss Information – Balding Blog

dear doctor:
you stress on getting a diagnose from a good doctor to determine the baseline. Is regenix a good place to visit? or i can just go any skin doctor to do the diagnose? and where is your clinic located? i am 25 and notice hair lost when i was 22. i am in los angeles, CA. thanks

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Regenix offers hair care and accoutrements that make the hair thicker. They cleanse the skin, clean the pores and massage the scalp. Many people feel that this service is very helpful. I have seen visual benefits from thickening the hair shafts with the materials they give.

A good doctor can prescribe Propecia and make a medical diagnosis. If hair transplantation is appropriate, then a good hair transplant surgeon with high ethical standards may be able to diagnose your eventual hair loss pattern and put numbers to the rate and degree of balding. Monitoring the hair loss over time is an important contribution that a good doctor will add to your hair loss protocol.

Yes, I have an office in Los Angeles. Please visit newhair.com or call 800-New-Hair and visit me personally.

Hair Loss InformationLimited Donor Area – Hair Loss Information – Balding Blog

Hi,
I visited NHI for a consultation about three years ago and was told that while I was a candidate for a procedure, my donor hair sites were limited. I guess they determined that the back of my head just didn’t have enough follicles to take care of my developing baldness in the front and on the top of the head. My question is this: I’m curious about the recent developments in cloning and gene therapy. How far are we away from these advances? I hope soon.

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Since you are in the Los Angeles area, please come back again and let’s talk. A re-examination may have value. With regard to cloning, I have had a number of questions on this subject, which I’ve answered in the Hair Cloning section of this blog.

Hair Loss InformationResuming Physical Activities After Surgery – Hair Loss Information – Balding Blog

Hi Doctor,
I am an avid weight lifter and exercise quite frequently. I heard that after surgery, I won’t be able to my normal routine physical activities for 3-4 months. Is this true? What type of weight lifting am I allowed to do in that period and for how long? Thanks.

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There are two types of surgical approaches in harvesting of donor hair. One is where the surgeon removes a strip of skin and then sutures back together (standard for today’s Follicular Unit Transplantation). I generally ask people who have strip harvesting to hold off on body presses, sit-ups and other such types of exercise that can strain neck muscles for a few weeks after the surgery. All types of aerobic exercises. otherwise, are ok.

The second type of surgery is Follicular Unit Extraction (FUE), where the follicular units are harvested one at a time. With this procedure, you can resume full exercise within a few days of the surgery with no limitations at all. The FUE surgery is more expensive than the strip surgery and the surgeon can not as easily move as much hair in a single surgery. This means that FUE requires more procedures.

Patients who had FUE surgery have not complained about pain, but those that have had strip surgery generally have some discomfort, mostly on the first night.

Hair Loss InformationDoctor Concerns – Hair Loss Information – Balding Blog

Hello Doctor. Recently I had a hair transplant in NJ with a very respectable Dr., someone you have worked with, lets leave it at that. I was scheduled to have 1500 grafts, but after taking the string, the doctor came back in and said I have to cut another piece because we could not get 1500, so in total at the end of the operation I recieve 1800. I was alittle upset, because I had no choice of paying the additional 300, they gave me 100 free grafts for free, so I only paid for 200. Not only did this happend, but my original scar probably grew by another 2 to 3 inches. But anyway. It has only been 2 1/2 months and to be honest, I have less hair than I originally did. My original hair was evenly spaced, now, after the surgery it looks like I hae patches of hair. It looks so weird. To be honest, I have not seen such great results, I know that 2 1/2 months is nothing but so far I am displeased with the results. My question is, when you have results such as mine, and if you are displeased, should I contact the doctor, and if I should, why should I explain that I am not pleased with the results so far?

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Sometimes an initial estimate of a patient’s density is quite different from what is actually obtained during the hair transplant procedure and this affects the amount of hair that is harvested. When this happens, the surgeon may take more tissue to obtain additional grafts to more closely achieve the patient’s desired results. Additional grafts can be obtained by going back over the same area or extending the initial incision to one side. The surgeon makes that judgment based on factors noted during the surgery, such as scalp laxity.

Hair doesn’t generally begin to grow after a hair transplant for two to three months and when growth starts it is characteristically uneven. Although it is way too early post-op to have a sense of what the transplant will look like, it is still best to contact the doctor that performed the surgery with any questions you may have, as he would best be able to answer these questions and explain the reasons why specific things were done. I would encourage you to do this.

Hair Loss InformationHow Much Time Between Procedures? – Hair Loss Information – Balding Blog

I had my first restoration procedure March 2nd 2005. the new hair is about 1/4″ to 1″ long now, (6/25/05) I am improved but need more density. How long do I need to Wait between Proedures? I am 56 yrs old, use both Propecia and Minoxidil topical. How long before the doner area will be adequately “streachable”? Thanks for the mailing. I appreciate this site,

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I usually recommend a minimum of eight months between surgeries. You will be getting more hair growing out and more length with most of the benefit obvious at the 8th month. You will certainly have more bulk over the next few months. I am glad that you enjoy the mailings. Patient education is one of my passions!

Hair Loss InformationLateral Slits – Hair Loss Information – Balding Blog

Thank you for answering all our questions. This site is a great help!
Can you address the below paragraph pulled of Hasson & Wong’s (Canada) website?

“Hasson & Wong have pioneered the revolutionary Lateral Slit Technique. This technique of creating recipient site incisions allows for far more accurate control of hair graft angulation and direction. In addition, the coverage of bald scalp is increased on average by two hundred percent…Hair transplant surgery utilizing the Hasson & Wong Lateral Slit Technique is the only technique that is able to duplicate the alignment and distribution of hair as it occurs in nature. The result of this amazing technique is the complete absence of plugginess seen in other techniques including standard follicular unit transplantation.”

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Hasson and Wong do very nice work. I have nothing but admiration for them both. With regard to lateral slits, I have been doing them on all my cases for three years, but I have never been convinced that they are superior to vertical slits. The written studies done by different doctors throughout the world have not proven that lateral slits are any better. Patients who have had lateral slits on one side and vertical slits on the other side, are split on which side is better. So while there may not be any scientific proof that lateral slits are superior or inferior, it becomes a matter of physician preference, and my choice is to use lateral slits.

Hair Loss InformationDoctor Availability – Hair Loss Information – Balding Blog

I recently had a hair transplant and I hate to tell you how much I paid. What I am writing about is that after the surgery, the the instruction sheet they gave me is very poorly constructed and when I tried to call the doctor to ask questions, I got a message telling me to go to my local emergency room. Is that an acceptable way to do business or are there standards that doctors must adhere to with regard to giving patients the information they need?

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There are no standards other than the Hippocratic Oath which is: I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath. “To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction. I will prescribe regimen for the good of my patients according to my ability and my judgement and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.”

The oath of Maimonides: Oath and Prayer of Maimonides is another iteration of this oath, possibly more comprehensive and more extensively used today. Somehow I sense that the concept of an oath is either not taken seriously today or manipulated to meet the ends of the oath taker. Let’s look as some lines in the Hippocratic Oath as it pertains to your question:
“Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain to look upon his children as my own brothers never do harm to anyone”. I take this to mean that our patients should be treated as our children, with respect and with regard to the entirity of their care. “Making a surgeon (any doctor) available to a patient he accepts as his/her responsibility” I read with interest and found no bounds to the timing of the responsibility possibly limited by reasonableness. “In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing” Here I define the house as the body of the patient, again open ended with regard to time and mechanism and the failure to adequately communicate or make oneself available can clearly do harm so ‘Ill-Doing’ can be done by not taking this responsibility seriously.

With today’s technology is is easier to be a better doctor. For example, I carry a cell phone and EVERY patient has 24/7 access to me, even on when I am on vacation, provided that I have cellular reception. I constantly am trying to improve my written instructions and learn by each phone call. Even more importantly, I prepare each patient thoroughly prior to the surgery with:

  1. a book I wrote which is possibly the most extensive book in the world on hair restoration surgery;
  2. a one hour, private consultation with most patients (sometimes longer). After the consult I put my findings and recommendations into a three to four page detailed letter customized for each patient. That frees the patient up to listen and learn and ask questions of me during the consult, at the onset of the process;
  3. open house events which are well known all over the United States. We originated the open house concept in hair transplantation and during our Los Angeles Open Houses we sometimes have a dozen patient examples of our work that you can examine for yourself.

Education and preparation make post operative follow-up easier on everyone, patient and doctor. I set my standard of care high, to better serve my patients, starting at the time of our first meeting. So while you may not have received post operative care that met your standards (or that of NHI), the physician may have felt that they provided an acceptable level of care .

Hair Loss InformationThe Problem of Popping – Hair Loss Information – Balding Blog

I would very much apreciate it if you could explain what “Popping” is all about. As I understand it, it limits the amount of hair that can be successfully transplanted.

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Popping is a technical term referring to a problem with placing grafts into the recipient sites in the balding area in a hair transplant. The grafts are placed and then do not stay in place, ‘popping’ out of the site. In the early days when we didn’t trim the grafts as closely and the recipient sites were larger, the bulk of the graft was so large relative to the surrounding tissue, that the graft would not be held in place. When the surgeon placed another graft next to the one that was only a couple of millimeters away, the ‘mass’ from the graft into this next site, pushed the last graft that was placed out of the wound. You can imagine a cascade effect, you place one graft and then another and the first pops out. Then you finally get both the first and second secured and place a third when the first two then pop out. That was the way it used to be.

Today things have changed. When we introduced the microscope in 1994, it was evident that smaller and more accurate dissection meant better results than dissection with other less powerful magnification tools. The grafts are smaller and can be more carefully dissected, so that the bulk of today’s follicular units is less than the old minigraft. The recipient sites are much smaller today, we use needles in the 0.8 – 1.0 mm range to make the sites. The results of the smaller site is that the ‘hole’ that is made tends to ‘hug’ the graft and the ‘bulk’ of the graft is of less consequence in the hands of an expert graft placer. Today the best surgeons have staff whose skills have built over years, allowing the grafts to be placed without disturbing the last graft placed. So, popping which was a major problem when we were getting the number of grafts from 500 up to 2000 in 1993, became less of a problem as we moved into the 3000-4000 grafts per session size.

To conclude, your question of popping is more of a historical question than a problem today. What is still relevant today, however, is that surgeons who use larger sites (greater than 1.2mm in size) to manage their grafts, are still practicing older techniques and popping (which is not a problem for us) still remains one for those less skilled in the art of today’s techniques.

Hair Loss InformationCheap & Discounted Hair Transplants – Hair Loss Information – Balding Blog

When you buy a cheap airline ticket and you are flying American Airlines, neither the airline nor the seat is shoddy. But when you buy a cheap hair transplant, you may not be getting a ‘legacy carrier’ doctor. Cheap hair transplants means that it is highly possible that you will get the pluggy doll’s hair look, inexperienced surgeons, poorly trained teams of people working on you, and an absence of quality control. I know of one of my former technicians who did a hair transplant on a friend on his dining room table. The procedure was done outside the United States and his friend would have bled to death had he not gone to a hospital to stop the bleeding. On a more local level, I have seen many patients over the years who were enticed by a new doctor who wanted to build his experience by offering discount prices. Sadly, they now needed an experienced and ethical doctor to undo the damage. Fundamentally, I can recommend if you are committed to going to the cheapest place for a hair transplant, that you do your homework. Make sure that you extensively research their medical licenses, how they were trained in hair restoration, how long they been performing hair transplants, what techniques do they use, their board certifications and in what field, are they active members of recognized hair medical societies (like ISHRS), and what do their results look like – because you will usually get what you pay for.

I’ve touched on this before in a previous blog entry, Bargain Hair Transplantation.