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Dr. Carlos Wesley
Dr. Carlos Wesley is a board certified diplomat of the ABHRS and performs high quality follicular unit hair transplants with excellent results in NYC. -
H Rahal, MD
Dr. H. Rahal
Dr. H. Rahal and his staff perform large one pass sessions of ultra refined follicular unit hair transplantation with outstanding results. -
Ultra Refined Follicular Unit Hair Transplantation
The Ultimate in fullness and naturalness in one surgery session.
We’ve all seen the “pluggy” hair transplants of the past. But we don’t see today’s state of the art hair transplants because they go unnoticed.



Plugs Mini Micros Follicular UnitsFollicular Evolution - from plugs to micro grafts to ultra refined grafts
Surgical hair restoration has dramatically evolved from the big round “plug” grafts of the 1960 ’s and 70’s, to the “mini micrografts” of the 80’s and early 90’s, to modern hair transplant procedures using entirely follicular unit grafts .
Now hair restoration surgery is going through another important evolution that is improving both the naturalness and fullness that can be achieved from any one surgical hair transplant session.
Ultra Refined Grafting - Smaller Blades, Incisions and Grafts
Today ’s micro surgical blades, like the size of hair grafts, have become ever smaller and now enable hair transplant surgeons to safely make more tiny graft incisions in a given area then ever before. Surgeons are then able to “dense pack” select areas with as many as 40 to 60 follicular unit grafts per square centimeter. This graft density is as much as twice that of the standard follicular unit hair transplant procedure.


Such high densities of transplanted hair typically produce the appearance of fullness even after only one surgical session. Patients also experience rapid healing and no visible skin distortions due to the tiny size of these incisions.
Ultra Refined Follicular Unit Grafting - Hard on the clinic but easy on the patient.
Ultra refined follicular unit grafting raises the bar for physicians and their staff. This delicate and demanding hair transplant procedure requires more skill and careful attention to be performed properly. The smaller and more tightly packed incisions require more closely dissected follicular unit grafts that are carefully trimmed under microscopes. These small and densely packed incisions are also more difficult to place the grafts into.
This procedure also requires more careful patient selection, as “dense packing” of grafts is not appropriate for all patients.
Ultra Refined Follicular Unit Transplantation – the new “Gold Standard”

In the hands of a highly skilled physician and staff the Ultra refined follicular unit hair transplant procedure can achieve excellent new hair growth that is so natural that it is undetectable even under close scrutiny.
While the standard micro “follicular unit” hair transplant does produce natural looking results, its ability to achieve high density in only one surgical session is limited. Thus patients may have to do subsequent surgical sessions in a transplanted area to achieve a full look.
The many patient benefits of this new procedure are significant and include:
- The ability to get excellent hair density in only one surgical session.
- Minimal trauma in the graft recipient area with rapid post surgical healing.
- Little or no visible pitting or distortions in the transplanted areas.
- More natural direction and angulation of the transplanted hair.
All members of the Coalition of Independent Hair Restoration Physiciansare required to perform ultra refined grafting with excellent results. Learn more about the membership standards. -
Hair loss - Race, Age, and Gender Considerations
Hair loss is a universal condition, affecting all ages, races, genders and nationalities. It’s estimated that “androgenetic alopecia,” or male and female pattern baldness affects 35 million men and 21 million women in the United States alone. This section examines how race, age and gender affect hair loss.
Race and Hair Loss
In physiological terms, human beings are all composed of the same bones, muscles, and everything else down to the cellular level. But there are specific differences.
Hair, in all of its variations, is one area in which human beings display their differences. Hair follicles can widely vary in terms of color, length, shape, thickness, strength and various other factors.
There are many ethnic groups to consider. But we will focus on the special considerations of Asians, Blacks (of African descent) and Caucasians.
Asian Hair Loss Considerations
Asian people typically have very straight hair. Their scalps contain fewer hairs per square centimeter, they actually have a lower hair density than that of Caucasian hair follicles. But because the individual hair follicles of East Asians are thicker, this gives the look and impression of greater hair density.
For these reasons, hair restoration techniques for East Asians, much like other races, must be sensitive to a variety of anatomic and cultural differences. For instance, East Asian females often have an increased likelihood of developing “diffuse alopecia,” or hair that thins evenly over the entire head than Caucasian females.
Even though it’s not a definite requirement, it’s very helpful for Asian patients to seek out doctors with experience in Asian hair.
Another consideration for East Asians considering hair restoration surgery is the increased chance of developing keloid scars. A keloid is a thick, irregularly shaped and elevated scar with uncontrolled growth that results from excess fibrous skin tissue. East Asians typically have a greater likelihood of keloid development than Caucasians, but less than that of people of African descent. Therefore, before undergoing surgery, East Asians may want to consider being medically evaluated for keloids.
African Hair Loss Considerations
People of African descent usually possess naturally curly hair. This curly hair gives the visual impression of increased hair density for a given amount of hair, which is beneficial in hair restoration surgery.
The hair follicles beneath the skin of people of African decent also typically curve more than Caucasians. This can make harvesting the donor hairs, without severing or transecting the hair follicles beneath the scalp, more difficult. A hair restoration physician needs to be very aware of this difference and adjust to its requirements.
As in the case of East Asians, people of African descent possess some unique hair and skin characteristics. Some of these medical conditions are more common in black skin than in white skin. This may increase the risk for post-surgical complications.
Those of African descent have a higher chance of developing keloid scarring when injured. This in turn leads to a greater chance of noticeable donor scars. Keloids aren’t a widespread problem. But those with a history of them are carefully evaluated in regard to their existing scars. The evaluation usually involves a small "test procedure" to determine if there’s a normal healing rate.
Another issue is that of postoperative skin discoloration. With darker skin, there’s often a greater risk of both increased and decreased skin color after injury or surgery. These risks can be determined by the patient’s medical and family history.
Ingrown hairs are also a more common problem in darker skin. If a patient has a history of ingrown hairs or other minor skin infections, this may signal a higher risk for ingrown hairs post-hair restoration surgery. Again, this risk can be determined by a small test procedure.
Caucasian Hair Considerations
Caucasians (white people) may have a wide range of hair and skin types. However, if someone has dense and or coarse hair, as well as skin color similar to their hair color, they will generally achieve the best results for a given amount of restored hair.
Learn more about aging and gender hair loss
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Dr. Christian Bisanga
Dr. Christian Bisanga
Dr. Christian Bisanga performs world class FUT and FUE hair transplants with excellent results exclusively at his clinic Brussels, Belgium -
COUVRé Alopecia Masking Lotion: Product Review
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

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.
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Diffuse Unpatterned Alopecia (DUPA)
What Is DUPA?
Diffuse Unpatterned Alopecia (DUPA) is a form of genetic hair loss characterized by diffuse thinning over the entire scalp. Unlike Diffuse Patterned Alopecia (DPA), DUPA lacks the stable permanent zone associated with other forms of alopecia.
Dr. O'tar Norwood defined DUPA in his 1975 seminole publication "Male Pattern Baldness: Classification and Incidence" as:
Diffuse, Unpatterened Alopecia (DUPA). In this type, there is a general decrease in the density of hair without any definite pattern, although it is usually more marked over the top and front. This type is common in women.
Identifying DUPA
Diffuse Unpatterned Alopecia patients have a similar pattern of hair loss to DPA patients but the balding tends to occur more rapidly. DUPA patients are also more likely to achieve the “horseshoe” pattern commonly associated with Norwood class VII baldness. However, unlike other forms of alopecia hair loss, the DUPA “horseshoe” takes on a thin and transparent appearance.
It is important that patients suffering from diffuse hair loss are properly diagnosed. While DPA patients are often good candidates for surgical hair restoration, DUPA patients typically make poor hair transplant patients due to the lack of a stable zone in which to harvest donor grafts.
Treatment for Diffuse Unpatterned Alopecia
Not a lot is known about the cause and treatment of DUPA. However, about half of males who suffer from this form of balding benefit from Propecia (finasteride). Unfortunately, DUPA is about 10 times more common in females for whom Propecia is not a treatment option.
Conclusion
Anyone suffering from diffuse hair loss should consult with a dermatologist or hair restoration physician for a proper diagnosis. This is especially true for balding men and women considering hair transplant surgery.
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The Future of Medical Hair Restoration
Today's evolutionary high point - Ultra Refined Follicular Unit Transplantation
By relocating these carefully prepared bald-resistant follicular units, physicians doing "follicular unit hair transplantation" recreate a natural pattern of hair in the balding areas.
To do this properly is a very time consuming and exacting process. It requires a team of meticulous medical technicians working hand-in-hand with the hair transplant surgeon in a very lengthy surgical procedure.
Ultra Refined Grafting - Smaller Blades, Smaller Incisions, Smaller Grafts
Today's micro surgical blades, like the size of hair grafts, have become ever smaller and now enable hair transplant surgeons to safely make more tiny graft incisions in a given area then ever before. Surgeons are then able to "dense pack" select areas with as many as 40 to 60 follicular unit grafts per square centimeter. This graft density is as much as twice that of the standard follicular unit hair transplant procedure.
Such high densities of transplanted hair typically produce the appearance of fullness even after only one surgical session. Patients also experience rapid healing and no visible skin distortions due to the tiny size of these incisions.
Ultra Refined Follicular Unit Grafting - Hard on the clinic but easy on the patient.
Ultra refined follicular unit grafting raises the bar for physicians and their staff. This delicate and demanding hair transplant procedure requires more skill and careful attention to be performed properly. The smaller and more tightly packed incisions require more closely dissected follicular unit grafts that are carefully trimmed under microscopes. These small and densely packed incisions are also more difficult to place the grafts into.
This procedure also requires more careful patient selection, as "dense packing" of grafts is not appropriate for all patients.
Ultra Refined Follicular Unit Transplantation - the new "Gold Standard"
In the hands of a highly skilled physician and staff the Ultra refined follicular unit hair transplant procedure can achieve excellent new hair growth that is so natural that it is undetectable even under close scrutiny.
While the standard micro "follicular unit" hair transplant does produce natural looking results, its ability to achieve high density in only one surgical session is limited. Thus patients may have to do subsequent surgical sessions in a transplanted area to achieve a full look.
The many patient benefits of this new ultra refined procedure are significant and include:
- The ability to get excellent hair density in only one surgical session.
- Minimal trauma in the graft recipient area with rapid post surgical healing.
- Little or no visible pitting or distortions in the transplanted areas.
- More natural direction and angulation of the transplanted hair.
All physician members of the Coalition perform Ultra Refined Follicular Unit Hair Transplantation.
While many hair transplant physicians perform quality follicular unit hair transplants, only some of them are capable of performing large sessions of ultra refined follicular hair transplantation. However, all members of the Coalition of Independent Hair Restoration Physicians perform ultra refined grafting with excellent results.
The Future of Surgical Hair Restoration
The amount of hair you can transplant is ultimately limited by the amount of hair follicles you can safely relocate from the bald resistant donor area at the back and sides of your head.
Some day it may be possible for physicians to create multiple hair follicles from one original follicle. This process typically called Hair Multiplication or more incorrectly Hair Cloning is currently being investigated by several research scientists and hair restoration physicians.
If and when this process is successfully developed patients would no longer be limited by the finite amount of bald resistant hairs that can be relocated from their donor area. Hair multiplication would result in a virtually limitless supply of hair available for hair transplants.
This would be especially good news for men or women with extensive baldness and a very limited supply of donor hair. Even those with extensive baldness would theoretically be able achieve thick full heads of hair.
However, experts believe that we are at least ten years away from hair multiplication being available, if even then. But perhaps some day scientists will be able to use gene therapy to halt the balding process without drugs or surgery.
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Dr. Taleb Barghouthi
Dr. Taleb Barghouthi
Dr. Barghouthi performs Ultra Refined Follicular Unit Extraction (FUE) and Follicular Unit Strip Surgery (FUSS) with excellent results. He and his staff can perform extensive mega sessions with dense natural results. -
Viviscal Hair Loss Treatment Product Review - Can it Really Promote New Hair Growth?
Viviscal's hair growth vitamin and dietary supplement taken twice daily promises to "reverse hair loss" and grow thicker hair in both men and women experiencing balding and thinning hair. Its primary activeingredient, AminoMar C™ Marine Complex, is said to be a proprietary blend of ingredients and proteins that "provides the essential nutrients needed to nourish thinning hair and promote existing hair growth".
The entire Viviscal product line includes an "all natural" dietary supplement, a shampoo and conditioner, and a scalp lotion. Viviscal is promoted as being 100% natural, drug-free, gluten-free and safe from harmful side effects. But can Viviscal deliver on its promises to reverse hair loss and grow new hair?
In 2011, Viviscal advertisement was banned in the United Kingdom by the Advertising Standard Authority (ASA) who deemed that its claims to maintain optimum hair health were unproven. The ASA concluded:
"Because the evidence sent did not show that the ingredients in Viviscal had been shown to have a positive effect on hair health, we concluded the claims that the product could 'nourish hair follicles' had not been substantiated' and ruled the advert cannot be broadcast until it is changed."
However, as with many similar products promising to grow hair, substantiating their hair growth claims may not be a simple task.
Viviscal’s manufacturer does reference a number of studies that seem to support their claims of growing thicker hair. For example, the results of "Scientific Pilot Study #1" on 40 hair loss suffering females with an average age of 35 concluded, "Viviscal was well received by test subjects and the analysis of hair counts showed a mean reduction in hair loss of 46% in only 10 weeks." Additional studies are cited on Viviscal’s website.
Recently, we learned that Dr. Glenn Charleshas publicly endorsed Viviscal. Dr. Charles has an outstanding reputation for performing state of the art hair transplant surgery and is a highly esteemed member of the Coalition of Independent Hair Restoration Physicians.When asked to comment on his public endorsement of Viviscal, Dr. Charles stated:
"I have never had any hair loss patients display any negative effects. I describe it to my patients as a natural supplement that can promote a healthier scalp and hair. It may also, in turn, slow down the hair loss process. I tell all my patients that there are no guarantees with this product. Although most patients believe that they did have improvement after using this product, I admit that some patients do not see any noticeable changes that either they or I can identify."
Other hair loss experts are not as optimistic regarding Viviscal’s hair growth potential. Coalition member Dr. Bill Rassmanof Los Angeles states:
"I am skeptical of the photographs (results) and the changes shown make me doubt what the Viviscal marketing department wants me to see. Viviscal reportedly contains ‘special marine extracts and a silica compound’ - and yet I’m to believe this will regrow hair? If these photos were real, the product would have taken over the market years ago."
It's also important to note that Viviscal does notmake any claims on their website that their products can reverse the effects of genetic hair loss. Instead, it simply states, "Viviscal works to reverse hair loss due to stress, poor nutrition, and many health related ailments".
So is Viviscal an effective hair loss treatment? More research may be needed before this question can be effectively answered.
While there may be no harm (potential side effects) in trying it, at an average cost of $600 per year there are certainly more affordable and proven treatments available. The only clinically proven and FDA approved medical hair loss treatments currently available are Rogaine (minoxidil) and Propecia (finasteride). While Rogaine may be used by both male and female patients, Propecia is safe and approved only for male hair loss sufferers. Always consult your physician before adding any treatment to your hair loss regimen.
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