Over the past several years surgeons have used various techniques to perform follicular unit hair transplantation. One such technique is the Lateral Slit Technique, also known as Coronal or Perpendicular Grafting. This technique’s name is derived from the angle and direction in which the graft incisions are made.

While there are other techniques for performing densely packed and highly refined follicular unit transplantation, the lateral slit technique offers a high degree of control over the angle and direction in which the transplanted hairs will ultimately grow.

The lateral slit technique has been used both intuitively and systematically for years by hair restoration physicians. However, it has recently gained popularity as a systematic and precise way of performing follicular unit hair transplantation.

How our member physicians use the Lateral Slit Technique.

Many of our physician members use the Lateral Slit Technique exclusively or in combination with other techniques for creating graft incisions. The lateral slit technique enables a surgeon to create graft incisions at varying angles (ranging from 10 to 90 degrees to the scalp), including very acute angles that will make the transplanted hair grow out lying flatter to the scalp. The ability to create incisions at very acute angles is particularly useful in areas such as the front temples and sides where the hair normally grows out lying flat on the scalp.

The graft incision determines the direction of the hair growth

The lateral slit technique also helps enable a surgeon to determine the direction of the graft incisions. This then determines the ultimate direction of the transplanted hairs growth. Thus a surgeon can use this technique to control and vary both the direction and angle at which the transplanted hair will grow in order to mimic the subtle changes in hair direction that occur naturally.

Each graft incision is created by analyzing the neighboring hair so the surgeon can reproduce the correct hair pattern. As a result, as each transplanted hair emerges from the scalp it will grow and lay in a similar direction as its neighboring non-transplanted hairs.

Lateral slits can enable denser packing of grafts

Lateral slit incisions also tend to be more parallel to the scalp and thus more superficial and less invasive to the scalp’s underlying vascular structure. This parallel alignment also enables a physician to place more grafts per square centimeter with out the grafts compressing or popping up since the pressure exerted on the grafts does not push them upward from the scalp.

Using blades cut to the size of the grafts

Some of our members use custom blade cutters to create tiny blades to make incisions that match the size and depth of each follicular unit graft being transplanted. This enables a surgeon to safely dense pack more grafts into a given area during a surgical session. Healing time is also more rapid, with minimal scarring.

Typically most clinic’s blades range from 1.5mm to 2mm in size. However, by using the custom blade cutter our physicians can create blades as small as .7mm for a single hair graft and .9mm for a multi hair graft.

In addition, the blades created by the custom cutter are squared off to match the shape of the bulb end of a hair follicle. Non custom cut blades are typically spear pointed which requires them to be inserted deeper thus causing more trauma to the scalps vascular structure.

The ability to control the depth of the incision each blade makes is also critical. Each blade is placed in a blade holder that is set to not allow the blade to go any deeper than required for the graft to being placed in the incision. This minimizes unnecessary trauma to the deep vasculature of the scalp, thus enabling close tight incisions, minimal tissue swelling, and quick healing that leaves no visible scaring, pitting, or cobble stoning of the scalp.

Placing grafts to maximize their aesthetic result and coverage

The plane and direction in which each follicular unit graft is placed on the scalp can also impact the ultimate appearance of density that can be produced with a given number of grafts. This is because hairs within a follicular unit are typically next to each other inline.

Therefore by arranging each multiple hair graft on the scalp in a linear fashion to the line of sight, each follicular unit will provide the maximum appearance of fullness and scalp coverage. This also mimics how hair is normally aligned on the scalp.

Special thanks to Dr. DeYarman, Dr. Sharon Keene, Dr. Jerry Cooley, Dr. Alexander, and Dr. Glenn Charles for contributing their expertise and photos for this section.

What is Traction Alopecia?

Traction alopecia is a form of hair loss resulting from the repeated yet unintentional pulling, twisting or rubbing of the hair. Traction alopecia can affect both men and women, though it's more commonly seen in women. Though it can be temporary, balding from traction alopecia may become permanent if these traumatic forces are applied to the hair and scalp repeatedly and for prolonged periods, resulting in scarring.

What Causes Traction Alopecia?

Practices that may result in traction alopecia include; wearing tight braids, ponytails or cornrows and extended use of hair extensions.  Due to the popularity of these hairstyles, traction alopecia has become one of the leading causes of hair loss among African America women.

Balding from traction alopecia can also occur from repeatedly wearing tight-fitting hats, helmets or other headgear.This is likely where the popular hair loss myth about hats causing hair loss derived, but it is important to note that, under normal circumstances, wearing a properly fitted hat will not negatively impact hair growth.

Treating Traction Alopecia

The first step in treating traction alopeciais to change the habits leading to the condition. This may mean adopting a new hairstyle or altering your wardrobe. Finally, applying a vaso dilator like Rogaine(minoxidil) to the affected area can increase blood flow to the damaged follicles and effectively speed up new hair growth. Assuming the hair follicles have not been permanently damaged, new hair growth will likely occur though it may take several months.

In cases of severe and permanent tractional opecia, the only effective method of restoring hair to the bald areas is surgical hair restoration. State of the art, ultra-refined follicular unit hair transplantation allows quality surgeons to harvest DHT resistant hair from the donor region at the rear and sides of the head. These hairs are then implanted into the balding areas of the scalp, resulting in a natural and undetectable appearance. To see which physicians we recommend and for a free virtual consult, visit the Coalition of Independent Hair Restoration Physicians.

To learn more about how surgical hair restoration can be used to treat traction alopecia hair loss, view the following results from our hair loss forum and social community:

• Dr.Robert Dorin - 1909 Grafts on a Traction Alopecia Patient
• Dr.Victor Hasson / 3560 Grafts / One Session / Traction Alopecia / One Year

This hair loss product, meant for women, is a synthetic form of Progesterone, a hormone and steroid that occurs naturally in the ovaries. The body uses the Progesterone treatment to control a variety of functions. These include the regulating of the menstrual cycles, anticancer properties, the slowing and prevention of bone loss and ensuring the female sexual organs’ health. Another important function of Progesterone is to maintain the hormone balance of estrogen.

But in regards to hair loss, Progesterone treatment is an effective DHT-inhibitor. However, there has not been much research conducted as to Progesterone’s impact to male and female pattern baldness (MPB, FPB). What research was conducted showed that it may be effective at stopping hair loss, but not at hair regrowth.

Nevertheless, topical Progesterone has been used by some European dermatologists in Europe to treat MPB and FPB. For this, they only used 1% or 2% topical concentrations, and no more than 40mg a day. Researchers believe that higher doses could cause menstrual irregularities.

Topical Progesterone is available as capsules, vaginal creams and suppositories. Patients use the medication by rubbing it into the body’s soft areas, such as the breast, abdomen, inner thighs and the palms of the hands (which is thought to be the most effective area).

It’s advised that women use about 1/8-1/2 teaspoon, once to twice daily, for 21days. Physicians also advise women to stop using the medication for 5-7 days each month. They also advise women to change the application areas periodically.

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

We believe that patients have a right to full disclosure and a complete understanding of exactly what hair restoration surgery involves.

This step by step presentation shows how today’s state of the art follicular unit hair transplant procedure is typically performed.

Patient is prepared for surgery

During surgery hair follicles from the back of the head that are genetically resistant to going bald will be removed and relocated (transplanted) to the balding areas.

Donor area is trimmed

Prior to surgery, the hair in donor area that will be surgically removed is trimmed.

Donor area is prepared for surgery

Once the donor area has been prepared it is given local anesthesia.

Donor tissue is removed

The donor tissue containing the bald resistant hair follicles is then surgically removed.

Donor area is sutured

The donor tissue containing the bald resistant hair follicles is then surgically removed.

Hair combed over sutures

When patient’s hair is combed over the donor area the sutures are not visible. These sutures are typically removed approximately ten days after surgery.

Donor tissue is trimmed into follicular unit grafts

Surgical technicians then use microscopes to view the donor tissue in order to dissect and prepare follicular units hair grafts.

Bald recipient area is prepared

After being given local anesthesia, the balding recipient area is ready for surgery. No trimming or shaving of hair is needed in the top recipient area.

Incisions are made in the balding areas

Tiny incisions are made in the recipient areas in irregular patterns that mimic nature. The follicular unit grafts will then be placed carefully into these tiny incisions.

Grafts are placed into the incisions

Follicular unit grafts are gently placed into the recipient incisions.

Grafts are placed in varying densities

Typically the smallest one and two hair grafts are placed in the very front of the hairline, with three and four hair grafts placed behind them.

Patient immediately following surgery

Following surgery a patient will have hundreds of tiny incisions with short hair stubble showing from the new grafts.

Close up of recipient area after surgery

The tiny graft incisions heal rapidly. The redness and scabbing in the recipient area normally clears up within about one week.

Childbirth may result in hair loss. It's common for many women to notice hair loss about 3 months after they've had a baby. This too, is caused by hormones. But this is not something to worry about. You see, during pregnancy, hair that normally falls out is kept in by high levels of hormones. Once the hormones have returned to pre-pregnancy levels, this extra hair falls out. The normal cycle of hair growth and loss then begins again.