| Dr. Robert M. Bernstein is a member of International Society of Hair Restoration Surgeons. Here the Doctor has answered some of the common questions bizymoms visitors have about Hair transplant.
Q. Who would be a good candidate for hair transplant surgery?
A. In general, men and women age 30 and older can be candidates, but there are a host of factors that determine if a person is a good candidate for surgery including; donor supply, extent of hair loss and expectations. There is no upper age limit. The median age for men is 35-40 and women about 45.
Q. How does hair transplantation work?
A. Hair transplants work because hair removed from the permanent zone in the back and sides of the scalp continues to grow when transplanted to the balding area in the front or top of one’s head. The reason is that the genetic predisposition for hair to fall out resides in the hair follicle itself, rather than in the scalp. This predisposition is an inherited sensitivity to the effects of DHT which causes affected hair to decrease in diameter and in length and eventually disappear – a process called "miniaturization". When DHT resistant hair from the back of the scalp is transplanted to the top, it will continue to be resistant to DHT in its new location and grow normally. In spite of this important discovery, for many years hair was transplanted in large plugs that resulted in a very unnatural appearance. Today, hair is transplanted exclusively in its naturally occurring groups of 1-4 hairs each, called follicular units. These groups of hair are obtained under microscopic control. Often several thousand of these tiny follicular unit grafts are used in a single hair restoration procedure.
Q. What can be done for people dissatisfied with previous mini/micrograft procedures?
A. If the grafts are too large they can be removed, divided into smaller units under a microscope, and re-implanted back into the scalp (the same day). If the mini/micrografts are well behind the hairline, they can, at times be camouflaged, by transplanting 1-2 hair follicular unit grafts in front of them.
If the mini-micrografts are in the wrong location or pointing in the wrong direction, they may need to be removed – either by excision or by laser surgery. If problem grafts are not too numerous, it is usually preferable to excise them, as it allows the doctor to re-use the hair.
Q. What are the possible harmful effects of Propecia and Rogaine?
A. The main side effect of Propecia (finasteride 1%) is sexual dysfunction, which occurs in about 2-4% of men taking the drug. Fortunately, these side effects are completely reversible when the medication is stopped. Propecia will also decrease a man’s PSA, the screening test for prostate cancer, so when having this test performed, your doctor should know that you are taking the medication. In higher doses, finasteride can decrease the incidence of prostate cancer. It does not increase the chance of having a more aggressive form (a concern that we had in the past, that is now felt to be untrue).
Q. The main side effect of Rogaine (minoxidil) is scalp irritation. The most common culprit is the propylene glycol in the 5% solution, although the alcohol in the 2% solution can be irritating as well. Minoxidil may occasionally cause an increase of facial hair in women, as well as dizziness or light-headedness. These side effects are rarely noted in men.
A. Both Propecia and Minoxidil can produce some hair shedding at the beginning of treatment, but this means that the medications are working and one should not stop the drugs for this reason. Any hair that is shed will regrow as the medications begin to exert their full effect over the course of 6 to 12 months.
Q. How many grafts/hairs are needed for hair transplant surgery?
A. It depends upon how much hair loss a person has. An eyebrow restoration can require as few as 200 grafts, a hairline 800 and a scalp, with significant hair loss, 2,500 or more grafts. An equally important consideration is the donor supply or how much total permanent hair is available for the transplant. This must be measured carefully by the physician, so that appropriate expectations can be set and a proper long-term plan formulated that takes into account future hair loss.
Q. What are the advanced hair transplant techniques?
A. Follicular Unit Transplantation (FUT), where hair is transplanted exclusively in naturally occurring follicular units, is the state-of-the art. In standard FUT, hair is removed from the scalp in a thin, long strip and then dissected into individual follicular unit grafts under microscopic control. A more recent means of obtaining the donor hair, the follicular units are extracted individually from the back of the scalp. This procedure, called Follicular Unit Extraction (FUE) eliminates the need for a line-scar, but is a less efficient procedure for obtaining grafts and causes more damage to hair follicles. New automated devices are being developed for FUE, but none have so far been shown to be as good as the manual, more labor-intensive techniques.
The Follicular Unit Transplant procedure itself is constantly being improved upon. The recipient sites in the scalp, that the grafts are placed into, are getting continually smaller, allowing more grafts to be transplanted safely in a single session. Trichophytic donor closures allow the donor scar to be barely detectable, even with the hair relatively short. New holding solutions allow the grafts to survive out of the body longer (facilitating large hair restoration sessions), new post-op care allows the hair transplants to heal faster, and medications can make the patient much more comfortable during the procedure.
Q. What are the new hair restoration treatments available for men and women?
A. Low-Level Laser Therapy (LLLT) utilizes cool lasers to stimulate hair growth and reduce shedding of hair. It is based on the scientific principle of photo-biotherapy. Photo-biotherapy occurs when laser light is absorbed by cells and stimulates cell metabolism and protein synthesis. Although the exact mechanism by which laser light promotes hair growth is still unknown, it appears to stimulate the follicles on the scalp by increasing energy production. Unfortunately, the effect on hair growth is modest at best and any long-term benefits have yet to be proven.
Latisse (Bimatoprost) is an FDA approved topical medication for eyelash growth. It is used to make eyelashes longer, thicker and darker. Applied once a day, it works in over 75% of those using it. Latisse takes about 16 weeks to work. The drug is available only through a doctor's prescription. Latisse is applied once a day to the base of the upper eyelashes. The bottom lashes receive the drug from the top lashes through blinking.
Bimatoprost is a compound derived from fatty acids designed to bind to prostaglandin (PG) receptors. PG receptors are present in hair, particularly in the dermal papilla and outer root sheath of the hair follicle. Although the precise way that Bimatoprost works is unclear, it is believed to affect the growth of hair follicles by increasing the percent of hairs in the anagen (growth) phase of the hair cycle and increasing the duration of this phase. Side effects occur in about 4% of patients using Latisse and include itchy eyes, redness and skin pigmentation. Although Latisse has been approved for use on eyelashes, it is also being prescribed for making eyebrows fuller. |
