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Dr. Jerry Cooley
Dr. Jerry Cooley and his staff were early adapters of using microscopes to do excellent all follicular unit hair transplantation. -
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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Procerin for Hair Loss: Product Review
Procerin is one of the top selling “all natural” hair loss products on the market today and is often an attractive alternative to drugs like Propecia (finasteride)and Rogaine (minoxidil). Procerin comes in both a tablet and topical form that can be ordered together or separately depending on your hair restoration goals.
Men and women suffering from androgenic alopecia (genetic female hair loss / male pattern baldness) have elevated levels of the hormone DHT (dihydrotestosterone) in their body. Procerin’s claim to fame is that it naturally blocks this DHT without reacting with testosterone like the drugs Propeciaand Avodart (dutasteride). This allegedly allows Procerin to stop hair loss and stimulate hair regrowth without unwanted sexual side effects. Procerin is so convinced their product works, that they offer a 90 day money back guarantee if you don’t receive your desired hair growth results. But how many balding men and women have successfully restored their hair with Procerin?
In order to fully evaluate the efficacy of this product, we must further explore each ingredient to determine whether or not this hair loss treatment delivers what it promises. Below you will find a list of ingredients and information that will help you determine whether or not Procerin is right for you.
Oral Ingredients:
The Procerin tablet includes a number of alleged “all natural” DHT blockers including saw palmetto for hair loss, zinc sulfate, pyroxidine, magnesium, and a proprietary blend of gotu kola, nettles, pumpkin seed, eleuthero root, muira puma root, and uva ursi. Many, but not all of these ingredients are also found in the highly popular hair loss treatment Provillus.
Oral saw palmettoand nettle root extracthave been used as “all natural” alternatives to treat benign prostatic hypertrophy (BPH) or enlarged prostates. Theories have thus been produced that they might also effectively treat baldness and alopecia.
Some studies suggest that Zinc when combined with Vitamin B6 may be able to inhibit the conversion of testosterone to DHT in the skin.
Pumpkin seed oils contain the ingredient delta-7-sterine that has been said to protect the prostate by competing with DHT. Therefore, it’s suggested that this ingredient might help reduce the risk of genetic hair loss.
Eleuthero, uva-ursi, muria puma, and horsetail are said to promote healthy hair growth, hair expansion, and a clean scalp. However, promoting healthy hair growth is not the same as stimulating new hair growth, hair regrowth, nor does it indicate they’re effective hair loss treatments.
Topical Ingredients
The Procerin topical solution contains saw palmetto extract, gamma linolenic acid, grape seed extract, azelaic acid, avocado oil, and nettle extract.
Azelaic acid when applied topically has been conjectured to inhibit DHT. Some anecdotal evidence suggests oral saw palmettomay inhibit DHT however; no such evidence exists for topical use. Though nettles are typically consumed orally, some speculate nettle root extract may help fight alopecia areata when applied topically.
Possible Side Effects
One false assumption is that “all natural” hair loss products don’t have potential side effects. Procerin reports directly on their website that reported side effects include mild stomach discomfort and from the topical formula, skin irritation. Additionally, be sure to research each ingredient carefully as some side effects are possible in larger quantities.
Dosage
Currently there are no standards on dosages of herbal medications in the United States. In addition, no formal clinical studies have been performed on them for treating baldness. Therefore, the suggested daily value listed on the ingredient package is based on something other than government regulation and scientific study.
Costs
The discounted cost of the combined formula for a 1 month supply of Procerin is about $50 and is discounted when you buy in bulk. It is also cheaper when you buy in bulk.
Conclusions and Our Opinion
Though we can appreciate the aspiration for balding men and women to use herbal products as an “all-natural” replacement for Propecia to treat androgenic alopecia, we’ve seen no third party clinical studies that support the ingredients in Procerin can successfully stop hair loss or stimulate hair regrowth. Due to the lack of compelling evidence in these other conjectured hair loss solutions, it may be more beneficial and cost effective to spend your money on Propecia (finasteride) for men only and Rogaine (minoxidil) that has helped balding men and women worldwide for years. For men who have experienced sexual side effects with Propecia, Procerin may at the very least, be worth trying as an adjunct treatment to Rogaine.
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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
Incision sutured together
Hair combed down after suturingThis 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 surgeryOnce 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 extractedThe 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.
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Dr. Timothy Carman
Dr. Timothy Carman
Dr. Timothy Carman performs large sessions of ultra refined follicular unit transplantation with excellent results -
Find the Hair Loss Treatment Right For You
Today hair loss sufferers have several legitimate and proven treatments for restoring their hair.
Over the past decade in particular, treatments for hair loss have made huge advances. Hair loss medication like Propecia (finasteride), Avodart (dutasteride), and to a lesser degree topical treatments like Rogaine often can stop or even reverse hair loss in most people.
However, neither Propecia nor Rogaine has been proven to restore hair in the frontal areas. Only hair restoration surgery has been successful in restoring hair in the frontal hairline area once it has been lost.
Done right, hair transplants are so natural that even a hair stylist cannot detect that a person has had a hair transplant. The days of the “corn row” or “Barbie doll” hair transplant are long gone.
Hair replacement systems or “hair systems” have also improved and become more refined. Those who are extensively bald and want to restore a full looking head of hair may find a hair replacement system to be appropriate.
There are also topicals, such as sprays and applications, which can do a surprisingly effective job of giving a person the appearance of having a much fuller head of hair.
Future hair loss treatments also hold the promise of making baldness a disease of the past.
Despite attempts by the FDA to regulate the promotion of hair loss products, balding men and women still need to be wary of the many questionable treatments that are often heavily advertised.Each hair loss treatment has its advantages and disadvantages. We believe in empowering you with the tools and assistance to explore and evaluate all your treatment options. Ultimately the best hair loss treatment is the one that works best for you.
We encourage you to take your time and explore all your options before committing to any hair loss treatment.
Explore this and other web sites and compare notes with other hair loss sufferers about what does or does not work.
Our hair restoration discussion forum has over 180,000 searchable postings by other hair loss sufferers.
If you post your question or concern, typically several people will reply with helpful advice and suggestions.
To get expert medical advice and review all your hair loss treatment options, consider doing a free consultation with one of our quality member physicians.
To learn about our physicians, or to arrange a consultation, visit our physician finder.
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Robert J. Dorin, DO, ABHRS
Dr. Robert Dorin
Robert J. Dorin, DO has been a specialist in hair restoration since 2002 and a member of our network since 2006. He offers advanced FUE and FUT procedures as well as PRP therapy. Prospective patients seek out Dr. Dorin for his personalized care and ultra-refined results. -
Azelaic Acid
An Active Ingredient in Several Topical Hair Loss TreatmentsAzelaic acid is a naturally occurring substance found in whole grains that contains a mild antibiotic designed to “clean” skin. It is also said to be a potential inhibitor of 5-alpha-reductase in human skin. A reduction of this enzyme may reduce the amount DHT (dihydrotestosterone) in the body and therefore, have a similar effect to finasteride; the active ingredient in FDA approved oral hair loss solution Propecia (finasteride). In theory, applying azelaic acid to the scalp may prevent or eliminate the binding of DHT to the hair follicle receptor, preventing hair loss and potentially stimulating hair regrowth. Azelaic acid can be found in many prescription acne medication and topical hair loss products like Xandrox and Provillus.
Combining azelaic acid with FDA approved hair regrowth solution minoxidil in a single topical product in theory, may prove to be a more powerful hair loss treatment for androgenic alopecia than minoxidil alone. This is why some conjecture that Xandrox may be a more effective treatment than Rogaine (minoxidil).
Azelaic acid has not been clinically proven effective as a standalone treatment for treating genetic female hair loss and male pattern baldness. It has also been known to irritate the scalp when applied topically. Though there is a low percentage, azelaic acid may interact with other medications. Be sure to consult your physician before using azelaic acid while on other medications.
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Crinagen Hair Loss Treatment
Crinagen is an all natural alcohol-free topical scalp spray clinically backed to reduce the amount of DHT (dehydrotestosterone) in the scalp. It contains no alcohol, and has displayed no side effects. Crinagen is also equally safe for men and women and is most effective in men and women with thinning hair. In addition to blocking scalp DHT, they both are reported nourish the scalp’s hair follicles. Crinagen usually displays its effects on average in five months.How It Works:
The product's main ingredients are Saw Palmetto, Zinc, and Azelaic Acid. All 3 ingredients are reported to reduce the production of scalp DHT and nourish the scalp's hair follicles.
Developing Realistic Expectations:
Crinagen has not been clinically proven nor approved by the FDA. Thus, like Revivogen and Tricomin, Crinagen should be used only after seriously considering proven treatments like Propecia (finasteride) and Rogaine (minoxidil).
Don't expect immediate results. It's recommended to use Crinagen for at least 6 to 12 months before determining its effectiveness. Documenting your progress with bi-monthly photos can help you determine whether or not Crinagen is working for you.
Hair shedding is a common symptom the first few months and a sign that the medication may be working for you. It's crucial to push past this stage with continued use for the recommended period of time.
To date, only surgical hair restoration is proven to grow hair in completely bald areas. You are invited to have a free virtual consultation with one of our prescreened hair restoration physicians.
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Jerry Wong, MD
Dr. Jerry Wong
Dr. Jerry Wong exclusively performs Ultra Refined Follicular Unit Hair Transplantation with outstanding results.
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