• Menopause and Female Hair Loss

    Many cases of female hair lossare caused by hormonal fluctuations or changes in the body including those who have PCOS (polycystic ovarian syndrome), birth control pillside effects, a recent pregnancy,postmenopausal trauma, or menopause. Women with hair loss experience varying balding patterns These patterns can help determine the type of alopecia you have along with a thorough examination by a physician.

    Because of an imbalance between estrogen and testosterone due to declining estrogen levels, thinning hair and accelerated hair loss is common in women during menopause. Hair on certain areas of the head that is more sensitive to androgen hormones like DHT(associated with male pattern baldness) may thin or fall out. Similarly, declining estrogen levels may result in unwanted facial hair growth.

    In some cases, polycystic ovarian syndrome(PCOS), may accompany menopause and hair loss.

    Be sure to speak with your doctor on the most effective ways to cope with menopause and minimize hair loss during this transitional time.

  • Modern Hair Transplants

    Modern Hair Transplants

    In the 80's hair restoration surgery as a hair loss solution evolved dramatically, as the large punch grafts were gradually replaced with a more refined combination of mini and micrografts. This "combination mini micrografting" hair transplantation procedure no longer used the punch to extract the bald resistant grafts. Rather a strip of bald resistant hair was surgically removed from the back of the head and then trimmed into mini and micrografts.

    Typically the minigrafts (4-8 hairs) were used to create fullness and density, while the one, two, and three hair micrografts were used to create a refined and feathered hairline in front. This combination procedure also normally used more grafts, several hundred grafts per session, rather than the approximately 50 to 200 large grafts of the original punch graft procedure.

    Follicular Unit Hair Transplantation (FUT) the "Gold Standard"

    Follicular Unit Hair Transplantation - Step by Step

    The 90's saw the gradual introduction of a very refined surgical procedure hair loss solution now known as "follicular unit hair transplantation" or "FUT". This exacting and labor intensive procedure transplants hairs in their naturally occurring one, two, three, and four hair "follicular unit groupings" in which they grow naturally.

    To create such natural follicular unit grafts, which mimic the way hair grows naturally, typically requires the use of high powered magnification. Such magnification enables the surgical technicians to properly visualize the follicular units in the donor tissue. They are then able to isolate them and cut them into 1, 2, 3, and some times 4 hair follicular unit grafts.

    The Age of Natural Hair Transplant

    Critical to the ultimate success of the follicular unit hair transplant procedure was the introduction of the binocular microscope by Dr. Bobby Limmer of San Antonio Texas in the late 1980's. Dr. Limmer found that by using the microscope he and his staff were able to successfully isolate and trim the naturally occurring follicular units into individual grafts.

    For his part in pioneering the use the microscope in graft dissection and the follicular unit procedure Dr. Bobby Limmer was awarded the "Platinum Follicle Award" by the International Society of Hair Restoration Surgery in 1996. Many physicians now fondly refer to him as the "Godfather of Follicular Unit Hair Transplantation".

    Dr Bobby Limmer
    Dr Bobby Limmer
    Dr Bernstein
    Dr Bernstein

    While Dr. Limmer pioneered the use of the microscope in trimming follicular unit grafts, it was Dr. Robert M. Bernstein, in collaboration with Dr. Bill Rassman, who pioneered and advanced the concept of large sessions of all follicular unit grafting. These large follicular unit sessions enabled patients to achieve both naturalness and density.

    Dr. Bernstein, who coined the name "follicular unit hair transplantation", tirelessly advocated for its adoption in ground breaking articles and lectures that are today recognized as benchmarks in the advancement of this procedure. Click to read these ground breaking hair restoration articles and papers.

    In recognition of his many contributions in both conceptualizing, pioneering and advocating "follicular unit hair transplantation", Dr. Bob Bernstein was awarded the "Platinum Follicle Award" by the International Society of Hair Restoration Surgery.

    Over time the merits of this refined but difficult to perform procedure became accepted and the follicular unit hair transplant procedure has become acknowledged by most hair restoration physicians to be the "Gold Standard" for surgical hair restoration. Click here to see video of a Follicular Unit Hair Transplant procedure.

    Some feel that hair restoration surgery has evolved to its highest degree now that it relocates hair exactly as it grows naturally. However, even the "Gold Standard" in hair transplantation has continued to evolve by becoming even more "ultra refined".

    Today some leading hair restoration surgeons, including all members of the Coalition of Independent Hair Restoration Physicians, perform an ultra refined follicular unit hair transplant procedure using very tiny incisions that enable them to safely "dense pack" tiny grafts when appropriate. This ultra refined follicular unit procedure is a hair loss solution that enables patients to achieve cosmetic density in a given area after only one surgical session.

  • Thomas Chung Wai Nakatsui, MD

    Dr. Thomas Nakatsui
    Dr. Thomas Nakatsui
    Dr. Nakatsui performs large sessions of ultra refined follicular units using the lateral slit technique with extremely natural results.
  • What are the Different Types of Alopecia?

    What are the Different Types of Alopecia?

    Causes and Treatments

    Alopecia is the medical name for hair loss to the scalp or body.  While Androgenetic Alopecia (genetic hair loss) is the most common, there are many other forms of alopecia related hair loss worth discussing.  Each medically named alopecia comes with distinct symptoms, a unique cause and exclusive treatments. Below, we've compiled a list of and description for the most common types of alopecia related hair loss along with the available treatment options for each.

    While the information on this website can be used as a guide, men and women who believe they are experiencing hair loss should always be properly diagnosed by a qualified hair restoration physician to determine its cause. To learn more about each distinctive alopecia hair loss condition, click the links below.

    Traction Alopecia
    Alopecia Areata
    Diffuse Patterned Alopecia
    Diffuse Unpatterned Alopecia (DUPA)

    Cicatricial alopecia (Scarring Alopecia)

    Alopecia Universalis and Alopecia Totalis

  • COUVRé Alopecia Masking Lotion: Product Review

    COUVRé Alopecia Masking Lotion

    For many hair loss sufferers, scalp "tinting" solutions are the most effective type of topical concealer. Tinting solutions like COUVRé, also commonly referred to as "masking lotions" or "concealing lotions," eliminate the contrast between thinning hair and the bald scalp by naturally darkening the skin and matching the tone to one's existing hair. By matching bald scalp to an individual's natural hair color, the harsh contrast of thinning hair is eliminated, and a fuller, denser appearance is achieved.

    Although several types of masking lotions currently exist, one of the most popular and trusted is COUVRé. However, what makes COUVRé distinct from other masking lotions, or different types of concealers in general? Is COUVRé a quality concealer for both hair loss suffering men and women? Most importantly, what are other concelears users saying, and where can balding individuals purchase their own supply of COUVRé masking lotion?

    COUVRé: What is it, and how does it work?

    Unlike comparable "shaker" application products (such as Toppik – a popular topical applicator product from the same makers as COUVRé), COUVRé is a tinted lotion, meant to minimize the contrast between dark, thinning hair and the balding scalp. According to the manufacturers, COUVRé is applied to the scalp using a specialized sponge applicator. Once the masking formula is on the scalp and providing sufficient camouflage, users are instructed to simply style hair normally and go about their day.  The manufacturer of COUVRé assert that the application appears subtle, natural, will not appear "greasy or sticky," will not stain clothing or towels, and does not interfere with pores or affect natural hair growth.

    The Benefits of COUVRé

    According to both the manufacturers and satisfied users, COUVRé offers various benefits over comparable concealer products. First, because the makers of COUVRé are confident in the product, they ensure that, unlike some other concealers, COURVe will create a natural appearance without looking greasy or sticky, and does not clog scalp pores or interfere with existing hair shafts. Because of this, not only is COUVRé useful for those with thinning hair, but also for patients awaiting new growth from hair transplant surgery. What's more, COUVRé does not contain any harmful chemicals, can allegedly withstand perspiration, rain, wind, and even physical contact (such as touching the scalp).  COUVRé comes in 8 different colors/tones (to match all hair types) and is equally effective in both male and female hair loss sufferers.  Although COUVRé will withstand a variety of situations without smearing or smudging, it easily washes completely away with water and shampoo.

    COUVRé Color Chart COUVRé Colour Chart

    Why COUVRé has Become Popular and Trusted within the Hair Restoration Community

    While COUVRé does offer many benefits above other concealer products, its popularity and reputation within the hair restoration community is likely due to several important factors. First, unlike some other concealing products, COUVRé application is both simple and fast. For many individuals, the ability to naturally conceal thinning hair without spending an excessive amount of time "getting ready," is a huge benefit. Furthermore, because COUVRé contains natural ingredients and does not interfere with native or implanted hairs, it is safe to use with other proven hair loss medications (like Rogaine/minoxidil and Propecia/finasteride) and during the new growth phase of hair restoration surgery. Because of its ease of use, effective nature, and ability to conceal hair loss in a variety of situations, COUVRé has become a reputable hair loss treatment and remains popular within the hair restoration community.

    What Real Hair Loss Sufferers are Saying About COUVRé

    To read real reviews on COUVRé alopecia masking lotion from other hair loss suffering men and women, visit our hair loss forum and social community.

  • Avacor. Is it worth the price?

    Avacor

    One product you used to see quite often in advertising is Avacor. According to Response magazine, Avacor was the third best selling product on the Internet in April, 2002. Avacor was originally manufactured by Global Vision Products. After being taken over by new management, it is now being manufactured by Avacor Products LLC.

    Like most products that advertise 'Stop Hair Loss and Regrow Hair!', Avacor contains the only FDA approved topical drug minoxidil. Avacor, like other products with similar claims, mixes FDA approved drugs in their generic form with other ingredients in a multiple regimen of products like shampoo, lotion and vitamins.

    Avacor historically cost approximately $239 for a two to three month supply and over $1000 for a year’s worth.  New prices are much more reasonable which range from $180 for a 3 month supply to $400 for a year’s supply of the men’s and women’s formula. Note that the ingredients in Avacor can be bought over the counter at your local store at a fraction of the cost for which they are sold in Avacor. However, they do offer 24/7 customer service and a 90 day money back guarantee.

    Marketing Practices

    Avacor, like other products with similar claims, has taken a lot of slack over the years for their controversial marketing tactics. Avacor has a checkered past and has previously been the focus of lawsuits and investigative reporting by major media like ABC news. Recently however, new management has taken over and claims they are very serious about selling quality products at more reasonable prices, without the hype and controversial marketing strategies. In looking at their website, while Avacor still uses slick marketing language to promote their products, the vast majority of their claims are much more realistic.

    Avacor includes 3 distinct products that claim to provide “total hair care”. This includes a 'Scalp Detoxifying Shampoo', a 'Physicians Topical Formulation' and finally a 'Nutricap'. Avacor's Nutricap ingredients consist mainly of common herbs like saw palmetto, gingko biloba, keratin, resveratrol, and bilberry. While conjectured to inhibit the production of DHT, none of these ingredients are FDA approved or proven to stop hair loss. Avacor’s Physician’s Topical Formulation however, does contain 5% of the FDA approved hair regrowth agent minoxidil.

    Other than minoxidil, no other ingredient is proven to regrow hair. A number of studies have been done that suggest saw palmetto inhibits the production of DHT, like Propecia. But, unlike Propecia, it has never been proven to stop or reverse hair loss.

    Avacor Products

    Avacor admits on their website that the only product proven to regrow hair is the Avacor Physician’s formulation which includes the FDA approved ingredient minoxidil (5% for men and 2% for women). The other products claim to provide hair with the essential nutrients for healthy hair growth but are careful not to claim to prevent the progression of male or female pattern baldness (androgenic alopecia). Perhaps this is why the Avacor Physician’s formulation can now be purchased separately. Costs of the Physician’s Formulation are still, but only a little more expensive than Rogaine topical hair loss treatment, one of the first and most popular topical minoxidil products.

    The Avacor Study

    At this time, Avacor’s proof comes in the form of the FDA approved study showing that minoxidil can stop and reverse hair loss.  No other study is provided with their product.  Their website also is much more realistic as to what their product line can accomplish for hair loss suffering consumers.

    Confidence in Products and Services

    Before you consider spending hundreds of dollars for any product or service, do a review. Legitimate products will have legitimate studies and have been reviewed on many quality websites. Doctors with real talent and satisfied patients will be able to show you dozens of photos and allow you to talk with past patients. Proven physicians will make available their resumes along with their formal education and associations they belong to.

    It is always best to review a product or doctor for information on their background before you make a decision for something as important as hair loss and hair restoration.

    Conclusion

    At the very least, the Avacor Physician’s formulation will be as effective as the Rogaine liquid formula or generic minoxidil. However, to date, both Rogaine and generic minoxidil are more cost effective than Avacor.  The nutricap, shampoo, conditioner and other products may promote healthy hair and provide it with volume, but make no claims of stopping hair loss or regrowing hair.

  • Surgical Hair Restoration - View our procedures in detail

    Surgical Hair Restoration

    Our physician members perform a very refined hair transplant procedure called "Follicular Unit Hair Transplantation". Today there are two methods for doing this procedure. They differ only in the methods used to harvest and prepare the grafts.

    Follicular Unit Extraction Video is provided courtesy of Dr. Alan Bauman.

     

     

    How the follicular unit extraction (FUE) hair transplant procedure is different than standard strip excision hair transplant surgery.

     

     

    How the minimally invasive hair transplant procedure known as Follicular Unit Extraction or FUE is performed.

     

     

    How follicular unit grafts are created under microscopic dissection and then placed into tiny incisions in the balding areas.

  • Anti Inflamitories

    Anti Inflamitories Nizoral

    In fighting hair loss, there may be certain unwelcome side effects produced. These side effects are the results of the body's natural immune response. These effects can increase hair loss, if not controlled.

    But with anti-inflammatory hair loss cure products, such side effects as itching, flaking, redness, and naturally, inflammation, are reduced. These topical treatment options include Tricomin, Folligen, Proxiphen and Proxiphen-N, Betadine and T-Gel and Nizoral Shampoos.

    Nizoral

    Here’s one shampoo that fits in with any treatment option.

    Nizoral, made for men and women, is available in any grocery store. Nizoral is effective at reducing itching, inflammation and other side effects of other treatments, such as Propecia. The shampoo also maintains scalp health. Plus, research has shown that using Nizoral for an extended period may help to treat male pattern baldness (MPB) and female pattern baldness (FPB).

    It’s advised that you apply Nizoral once every three days, in rotation with your normal shampoo. However, as Nizoral’s effects can last for several days, it is a very inexpensive treatment option. After one month of use, you should then use Nizoral once every 1-2 weeks. The shampoo should be applied to wet hair and scalps. You should then leave it in for 3-5 minutes before rinsing thoroughly.

    T/Gel Shampoos

    T/Gel is the brand name for a variety of shampoos and hair loss cure treatments. Primarily, these products are designed to treat such scalp problems as dandruff, itching, flakiness, and excess oil.

    The Original Formula shampoo contains 2% Neutar ®, which is essentially 0.5% Coal Tar. There’s also T/Gel’s Fine/Oily Hair Formula, Extra Strength Formula, and Stubborn Itch Control Formula. These varieties all feature Neutar, a patented product, which dissolves into the scalp as it treats the previously mentioned symptoms.

    T/Sal® Maximum Strength Therapeutic Shampoo features 3% Salicylic Acid. This effectively treats the crusty scalp build-up of psoriasis, as well as problems caused by excessively oily skin. This product should be used at least three times a week, unless other wise directed by your physician. T/Gel’s Healthy Scalp Anti-Dandruff Shampoo also contains Salicylic Acid, specifically 1.8%. There’s also T/Scalp® Therapeutic Anti-Itch Liquid, which features 1% Hydrocortisone. This is meant for treating severe dandruff.

    The prices for these products vary, but generally, a 16oz. bottle of the Original formula retails for about $13.00.

    Nioxin shampoo and conditioners

    If you have fine or thinning hair, you may want to consider the Nioxin family of hair products. These all-natural cleansers, conditioners, treatments and styling products are free of any drugs.

    Nioxin can improve the hair’s health by cleansing the scalp’s skin, strengthening the hair follicle and energizing the cellular activity. In addition, Nioxin is supposed to restore the scalp’s proper moisture balance. On average, the Nioxin products take about 45 days to show their effects.

    Nioxin has not been found to have any effect on DHT. However, by keeping the follicles healthy, these products may help delay hair loss. Because there are no side effects, the products can be used everyday. Nioxin typically costs $30-$125 per month.

    Click to learn more about Hair Cover Ups

  • FUE – a new way of doing Follicular Unit Hair Transplantation

    FUE – a new way of doing Follicular Unit Hair Transplantation

    Follicular unit extraction is a minimally invasive procedure for performing follicular unit hair transplantation. However, unlike the predominant follicular unit transplant procedure, in which a strip of donor tissue is removed and dissected under magnification, the FUE procedure uses a small punch to extract each follicular unit one by one.

    Both the strip excision and FUE procedures create 1, 2, 3, and 4 hair follicular unit grafts that are then transplanted into the balding area in the same manner. The primary difference between these two procedures is the technique used to harvest the follicular unit grafts.

    Comparing the Strip Excision procedure to the Extraction (FUE) procedure

    The common strip excision method of performing follicular unit hair transplantation involves surgically excising a thin horizontal strip of bald resistant skin from the donor area.

    Strip Excision Procedure 

    Donor strip being excised
    Donor strip being excised

     

    Incision sutured together
    Incision sutured together

     

    Hair combed down after suturing
    Hair combed down after suturing

     

    This donor area is then sutured together. These sutures (either stitches or staples) are then typically removed about ten days after surgery. Some physicians use dissolvable sutures so that no removal is needed.

     

    Patient’s donor area 2 months after surgery
    Patient’s donor area 2 months after surgery

     

    Once this linear incision is fully healed the patient is left with a thin horizontal scar in the back of the head. This scar is typically hard to detect since the surrounding hair conceals it, even when the hair is cut short.

    To view a video of an actual strip excision surgery.

    How the FUE Procedure is performed

    With the Follicular Unit Extraction or FUE procedure 1, 2, 3, and 4 hair follicular unit grafts are carefully extracted one at a time using a tiny punch of one millimeter or less. Often the surgeon requires the patient to buzz cut a portion of their donor area so that they are able to see the patient’s scalp.

    The follicular units are extracted
    The follicular units are extracted

     

    The follicular units are extracted by placing the punch around a single follicular unit and cutting a small circle through the skin around that follicular unit. The follicular unit is then gently pulled up and away from the loose tissue underneath the skin.

    The small hole left behind after the follicle is extracted then heals over the following week. Normally this small round incision contracts as it heals making the resulting round scar smaller than the size of the 1mm punch that made the incision. The FUE patient ultimately ends up with hundreds of small round white scars, which are normally not detectable once the patient’s hair grows out.View a video of an actual FUE surgery.

    To Extract or to Excise, that is the question.

    Advocates for the relatively new FUE procedure claim that this procedure produces less noticeable scarring and no tightness or numbness in the donor area since no donor tissue has been pulled together and sutured. Many patients and physicians find the claim that FUE produces less visible scarring to be debatable.

    Some physicians and patients also have concerns about the relatively new FUE procedure, such as the lack of formal studies regarding the percentage of follicles that may or may not be transected during the sight unseen extraction process.

    In addition, since the physician must personally extract all follicles, one by one, the FUE procedure is very physician dependent and thus very expensive. The FUE procedure also requires considerably more time in surgery to move a given amount of hair to the balding area.

    The standard strip excision procedure has the advantage of utilizing a collaborative team to carefully create the grafts once the donor tissue is removed in a strip. This collaborative approach enables a well trained staff to do sessions of 2,000 to 3,000 all follicular unit grafts in a single day. This team approach enables a patient to get a much larger number of grafts/hairs in one sitting at a much lower cost per hair than with the FUE procedure.

    However, some believe that despite being relatively costly the FUE procedure may be appropriate for patients who have very limited elasticity in their donor area or who only need a small number of grafts.

  • Hair transplantation FAQs

    Hair restoration procedure results

    Hair transplantation is really about relocating (transplanting) the bald resistant hair follicles from the back of the head to the balding areas on the top of the head.

    This process works for a lifetime because the hair follicles taken from the back of the head are genetically resistant to baldness, regardless of where they are relocated to.

    Learn more about hair transplantation.

    Hair transplantation, when done right, can be so natural that even your hair stylist will not know that you've had it done.

    But the skill and techniques of hair transplant surgeons does vary widely, as do their results. It's important to choose the right procedure and clinic to assure that you will get completely natural results.

    The state of art hair transplantation procedure that we recommend is called "Follicular Unit Hair Transplantation".

    To learn more about the leading hair transplantation physicians who perfrom this procedure, visit our recommended physicians page.

    A typical session of between 1,500 to 3,000 grafts normally involves a full day of surgery on an out patient basis. Most patients will arrive in the morning and will have their procedure completed by late afternoon.

    View a step by step overview of a typical hair transplant procedure.

    Patients are given local anesthesia in the donor and recipient areas. Most patients find that once the anesthesia is given that they feel no pain or discomfort during the surgery. Following surgery patients will typically feel some amount of soreness and numbness, with some mild discomfort. Most patients are pleasantly surprised by how minimal the discomfort from the surgical procedure is.

    Today hair restoration clinics typically provide free no obligation consultations, with surgical sessions priced either per graft or by the session. Prices typically average around $5 to $6 per graft.

    It is normal for the price per graft to drop as the size of the surgical session increases. Many clinics will offer a reduced rate per graft once a certain surgical session size (i.e. 1,000 or 2,000 grafts) is exceeded.

    To compare the long term costs of hair transplantation to other hair loss treatments, visit our hair transplant cost section.

    The amount of grafts you will need ultimately depends on your degree of hair loss, now and in the future, and on how full you desire your hair to be.

    For help estimating the amount of grafts/hairs you may need, click here.

    To use our interactive graft calculator, click here

    With today’s very refined micro hair transplantation procedure the incisions are very small and less invasive than past procedures. This results in more rapid healing. Most patients feel fine within a day or two following surgery, although some numbness and mild soreness can be expected for several days following surgery.

    Immediately following surgery a patient’s recipient area is typically pink with scabs forming around the micro incisions. These hundreds of tiny incisions will heal rapidly within a week to ten days.

    During the first few days after the surgery a person’s hair transplants will be noticeable if there is no previous hair to mask these temporary scabs. However, most patients feel comfortable being in public without wearing a hat within 5 to 7 days following surgery.

    Once the transplanted hair grows out the results should look entirely natural, even under close examination.

    Normally it takes between three to five months following surgery before the transplanted hair follicles begin to grow new hair. The transplanted hair grows in very thin initially and gradually grows thicker and fuller over time. After one year a patient’s transplanted hair will be fully mature and will continue to grow for a life time.

    Since the hair follicles that are transplanted to the balding areas are genetically resistant to going bald, they will continue to grow for a life time – just as if they had been left in the bald resistant donor area.

    To understand why some hair follicles are genetically resistant to going bald, while other are not, click here.

    The most important decision in restoring your hair is the physician you choose. The skill, talent, and experience of hair restoration physicians vary widely, as do the end results. Who you choose will determine how natural and full your new hair will be for the rest of your life.

    View tips on selecting a hair restoration clinic.

    Find an excellent hair restoration physician in your area.