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.

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, 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.

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 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 any time 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 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-anaesthetize the area.

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?

Hair transplantation is more expensive than a hair piece or some alternative treatments. However considering that the results are relatively immediate, and the transplanted hair should grow in it’s new location for the rest of your life, most people consider it a good investment in their future happiness. The number of sessions required will depend on 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.

After using Propecia (finasteride) for a prolonged period, would cessation of use of the drug result in the same sudden rapid hair loss of 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 medications. That is why missing a day or two of treatment, although not recommended, is generally not harmful.

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 would be potentially harmful to a developing male fetus in a pregnant woman if the drug entered her body. This would require her to ingest the medication, so she should not handle broken or crushed tablets. The amounts of drug 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 this type of specialty 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.

Hair Transplant Frequently Asked Questions May 1, 2019