• 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.

  • Damkerng Pathomvanich, MD

    Dr. Damkerng Pathomvanich
    Dr. Damkerng Pathomvanich
    Dr. Damkerng Pathomvanich and his experienced staff regularly perform large densely packed megasessions with outstanding results.
  • Child Birth

    Child Birth

    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.

  • The Future of Medical Hair Restoration

    Hair Restoration Future

    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.

    Learn about modern hair loss drug treatments that work.

  • Stemcelex – A Revolutionary Stem Cell Hair Loss Treatment?

    Stemcelex – A Revolutionary Stem Cell

    Stemcelex is the newest product in a long line of hair restoration therapies claiming to “cure” hair loss via stem cell therapy. Given the recent onslaught of news regarding stem cell based hair loss treatments, injectable baldness cures, and research breakthroughs, it’s not surprising to see new therapies claiming to aggressively fight hair loss through these same mechanisms. However, is Stemcelex truly a stem cell based, regenerative hair loss cure, or is it another therapy simply riding the recent wave of interest in these types of non-invasive, revolutionary treatments?

    At first glance, Stemcelex seems quite impressive. The product website is filled with scientific explanations, graphs, charts, and diagrams explaining the science behind stem cell based hair restoration. Stemcelex even states its affiliation with Dr. George Cotsarelis, a researcher at the University of Pennsylvania Medical Center who, along with a talented research team, recently discovered that the bald scalp does not suffer from a lack of stem cells, but rather a dysfunction in the pathway to properly activating stem cells to produce hair. The finding was significant and Dr. Cotsarelis’ involvement and the seemingly detailed science look promising, but what about Stemcelex itself? Does it utilize these scientific breakthroughs and offer an effective treatment for hair loss?

    Unfortunately, despite the impressive name recognition and detailed explanations, Stemcelex doesn’t appear to live up to its lofty hair restoration claims. Despite claiming to “activate” the dormant stem cells described by Dr. Cotsarelis, Stemcelex does not offer any sort of feasible molecular/stem cell based therapy. The website cleverly explains the science behind stem cell inactivation and the promise of reversing the dysfunctional pathway, but instead of reinforcing Dr. Cotsarelis’ view that cures for reversing the inactivation pathway are not yet understood, Stemcelex claims to actually fix the stem cell inactivation through a series of unproven homeopathic and herbal treatments for hair loss.

    So, what is actually inStemcelex? The treatment involves a three day cycle of different lotions and topical treatments for baldness applied twice a day.

    Day1: On the first day of the hair restoration cycle, a topical lotion made from Jaborandi Pilocarpus is applied twice after washing and thoroughly drying one’s hair. According to Stemcelex, Jaborandi Pilocarpus is a parasympathetic activator (it excites the nerves that cause the body to “rest and digest” during periods of relaxation) that rids the scalp of excess oils and dandruff that impede healthy follicular hair growth. Furthermore, Stemcelex claims that Pilocarpus naturally darkens and thickens existing, native hairs. According to the experts, Pilocarpus has no reproducible pharmacological applications and any evidence that it actually thickens and darkens hair is anecdotal.

    Day 2: The second day of the cycle involves Veratrum Lobelianum, a family of herbs commonly used in Chinese medicine.  Stemcelex claims these herbs can penetrate the scalp and activate the necessary molecular signaling to “regenerate” the hair follicle stem cells. Furthermore, Veratrum allegedly down-regulates or prevents the production of Dihydrotestosterone (DHT), the hormone directly responsible for male pattern baldness. According to the research, members of the Veratrum family have been used in everything from a Native American poison to a drug researched in human blood pressure.  Currently, they are used in cancer treatments. Although the science behind cancer therapies indicates that the drug could have some molecular benefit in signaling cell activation and inactivation, there has been no research or evidence suggesting that Veratrum is useful in fighting, reversing, or preventing the effects of male or female hair loss.

    Day 3: During the third day of the Stemcelex cycle, a kelp based topical extract is applied twice daily to provide nutrients to the “new hair growth” and also ensure that the scalp remains clean and healthy. This step of the treatment doesn’t claim to be more than a simple dose of nutrients useful in good scalp hygiene.

    After reviewing the active ingredients behind Stemcelex, there is no evidence to suggest that Stemcelex is an effective hair loss treatment at this point in time. The idea of activating the dormant stem cells is important to finding a molecular cure to hair loss, but despite understanding this importance, Stemcelex doesn’t offer any concrete stem cell reactivation agents. It’s possible that Veratrum may prove useful in cell signaling and reactivating dormant cells, but the current research and evidence simply don’t support its use at this time.  Furthermore, Stemcelex charges a hefty $99.85 for a month supply of the treatment which may keep even the most curious and enthusiastic hair loss suffering men and women away.

    Altogether, the idea of reversing dormant hair follicle stem cells is important, but therapies for effectively stopping and rewiring this pathway do not seem to exist at this point in time. Unfortunately, this seems to nullify the claims made by Stemcelex and prevent it from becoming a stem cell hair loss cure.

  • Dr. Özlem Biçer MD

    Dr. Ozlem Bicer
    Dr. Ozlem Bicer
    Dr. Biçer provides ultra-refined follicular unit extraction (FUE) at an exceptionally low-price. Dr. Biçer's practice combines quality with affordability with a patient-centered focus and attention to detail.
  • Hair loss - Race, Age, and Gender Considerations

    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

     

  • Diffuse Unpatterned Alopecia (DUPA)

    Diffuse Unpatterned Alopecia

    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.

  • 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

  • Procerin for Hair Loss: Product Review

    Procerin

    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.