Today it is a very refined outpatient procedure that can produce full and natural looking results, even after only one hair transplant session.

When performed correctly not even a hair stylist will detect that a person has had a hair transplant.

However, to achieve such natural results it is critical that the hair transplant procedure be "performed correctly". To do so requires a hair restoration clinic that can perform a follicular unit hair transplant at the highest levels of skill, experience, and dedication.

What it takes to create natural results.

A great hair transplant is the result of using a state of the art surgical procedure and performing it with great skill and artistry. Today the acknowledged "gold standard" in hair transplant surgery is called "Ultra Refined Follicular Unit Hair Transplantation".

This relatively new hair transplant procedure enables a patient to achieve extremely natural results because it recreates and mimics the way a person's hair grows naturally, hair for hair.

Recreating Nature Hair for Hair

To understand this procedure you must first understand how hair grows naturally.

If you look closely at naturally growing hair using magnification you will see that hair actually grows in groupings of one, two, three, and four hairs.

These naturally occurring hair groupings grow in irregular patterns on the scalp similar to trees growing in the forest. These groupings are technically referred to as "follicular units".

By relocating these carefully prepared and isolated follicular units, physicians doing "follicular unit hair transplantation" recreate a natural pattern of hair in the balding areas.

Follicular Unit Hair Transplant tough on the clinic but easy on the patient.

To do this properly is a very time consuming process. It requires a team of skilled and meticulous medical technicians working closely with the lead physician.

All our physician members perform this hair transplant procedure with excellent results. They are granted membership in the Coalition of Independent Hair Restoration Physicians strictly based on their proven high level of experience, ethics, and skill in successfully performing this patient friendly procedure.

While the follicular unit procedure is more demanding upon the medical staff, it produces dramatic and life long advantages for the patient such as undetectable naturalness, rapid healing, and optimal use of their limited donor hair.

The Standard Hair Transplant, easy on the clinic but not on the patient.

Only a minority of hair transplant surgeons are committed to doing the follicular unit procedure properly. Many physicians continue to dissect grafts without regard to the integrity of the follicular units. Follicular units are often transected and damaged as donor tissue is cut to conform to the size of the recipient holes rather than to maintain the integrity of the follicular units.

Such common standard hair transplant procedures are quicker and simpler to perform than follicular unit hair transplantation from the hair transplant surgeon's perspective. The standard hair transplant procedure is also often more profitable for the clinic since it requires less staff time, training, resources, and skill. However, the results are generally suboptimal for the patient.

Respecting the Follicular Unit

Each follicular unit is surrounded by small glands, blood vessels, nerves, and a connective tissue sac making it a tiny self contained unit.

If these follicular units are damaged during removal or dissection, the hair may grow poorly.

Therefore it is important to cut only in the loose tissue between the follicular units to keep each follicular unit intact and avoid damaging it.

A Viable Alternative to Propecia in Treating Hair Loss?

Folexen S-equol , produced by Australian manufacturer Eclipse Nutraceuticals is considered an "all natural" hair loss treatment that boasts an impressive 87% success rate for preventing and reversing the effects of male pattern baldness with virtually no side effects.  Folexen S-equol has also been a hot topic of discussion on our popular hair loss forum. But, does this self-described "nutraceutical" live up to its hair growth hype?  Is Folexen a viable alternative to Propecia for treating the effects of male pattern baldness?

What is Folexen S-equol?

According to the FAQ on Folexen's website, the active ingredient S-equol is "a metabolite of a natural isoflavone called daidzein, which occurs in soybeans and some other food products".

Isoflavones are an organic compound produced almost exclusively by various bean types. In populations that consume large quantities of soy protein, studies have shown a lower incidence of breast cancer and other common cancers because of its role in influencing sex hormone metabolism and biological activity.

As a metabolite, S-equol is the product that remains after the isoflavone is broken down or "metabolized" by the body.

In addition to its active ingredient, Folexen contains the following GRAS (generally recognized as safe) inactive ingredients: starch, maltodextrin, allantoin, propionic acid. It may also contain hypromellose (vegetarian capsule).

But is there any evidence that S-equol  works to treat hair loss?

How Folexen S-equol Allegedly Works to Treat Baldness

In the body, testosterone is converted to the hormone dihydrotestosterone (DHT) via the enzyme 5-alpha-reductase (5AR). It's widely known that androgenic alopecia (genetic hair loss) results when genetically vulnerable hair follicles are exposed to DHT which then binds to the receptor sites of these follicles causing them to weaken and shrink over time. This shrinking process is known as miniaturization.

The recognized leader in the battle against the balding effects of DHT is the clinically proven and FDA approved drug Propecia (finasteride). Propecia works by inhibiting the conversion of testosterone to DHT, potentially slowing or even reversing the effects of androgenic alopecia. However, approximately 2% of males who take Propecia experience debilitating sexual side effects.

Unlike finasteride, Folexen's rumored ability to suppress hair loss and potentially regrow hair is based on the theory that S-equol can bind strongly to free DHT molecules, prohibiting them from binding to the hair follicles' receptor sites. Because Folexen does not suppress the conversion of testosterone to DHT, there is no resulting increase of testosterone in the body and therefore, no sexual side effects. But are there any clinical studies supporting that S-equol can truly prevent DHT from binding to hair follicle receptor sites and prevent hair loss?

Clinical Studies

Folexen's website references four articles in peer reviewed journals. Two of these studies center on S-equol's effect on prostate health while the other two don't appear to reference S-equol at all.

At this time, there appears to be no scientific data presented supporting Folexen's efficacy as a hair loss treatment.

Side Effects

The company claims that the product is virtually side effect free: specifically noting that it does not cause gynecomastia (enlarged breasts), erectile dysfunction or any of the other side effects that are experienced with some other treatments.

Some users however, did report mild diarrhea that dissipated within one week of commencing treatment.

What is the Recommended Dosage?

The recommended dosage of Folexen is 4 capsules per day (two every 12 hours), totaling 10mg of the active ingredient. Eclipse claims that the product has been tested safe at much higher concentrations (up to hundreds of milligrams) and there is some speculation based on available data that it may, in fact, require a dose as high as 100mg to match the Propecia's hair growth results.

Where to Buy Folexen S-equol

Folexen is only available by mail order from Australia. A bottle of 100 2.5mg capsules (25 day supply) costs approximately $40 USD + shipping but there is a discount for purchases exceeding 4 bottles and again for 9+ bottles. However, it's easy to see that even in bulk this treatment is several times more expensive than purchasing generic 5mg finasteride and quartering the tablet, as many finasteride users do.

As a natural product and not a drug, there are no shipping restrictions. Estimated delivery time is two weeks.

Conclusion

Time will tell if Folexen S-equol proves to be an effective weapon in the fight against androgenic alopecia or simply another product in a long line of expensive disappointments.

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.