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 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.

It was Hippocrates, the “Father of Modern Medicine”, who first recognized a connection between hair loss and the sexual organs. Hippocrates’ studies of eunuchs (men castrated before puberty) observed that these men did not suffer from hair loss.

We know today that this is due to the absence of testosterone, which is normally converted into dyhydrotestosterone or DHT – the active ingredient in baldness. In March 1995, Duke University researchers came to the conclusion that " . . . while castration may be a cure, it is not commercially acceptable."

Hippocrates had a personal interest in finding a cure for baldness as he suffered from hair loss. He developed a number of different treatments including a mixture of horseradish, cumin, pigeon droppings, and nettles to the scalp. This and other treatments failed to work and he lost the rest of his hair. The area of permanent hair on the back and sides of the head (from which donor hair is taken for hair transplants) is also known as the “Hippocratic wreath.”

Ancient Rome and Hair Loss

Moving from Greece to the Roman Empire, we find that Julius Caesar employed a variety of methods to hide his thinning hair. In addition to the laurel wreath that he wore, he first grew his hair long in the back, and then combed it forward over his bald spot. Yes, the “Comb Over” is ancient.
Learn how man has treated hair loss up to modern times.
Being a Eunuch – the sure way to stop baldness

In the 1940’s, the studies of Hippocrates and Aristotle were continued. Both men had concluded that eunuchs always kept all their hair.

This finding was backed up by the work of Dr. James Hamilton.

He discovered that certain male hormones (missing in eunuchs) were critical to the development of male pattern baldness.

There are a variety of hair loss remedy "concealer" products that are applied to the scalp and/or hair in the thinning areas to mask a person's baldness and increase the look of fullness of thinning hairs. These products such as Toppik, Couvré, and Prothik can work surprisingly well at creating the illusion of fuller hair.

Some of our member physicians advise their hair restoration patients to use such hair loss remedy products to enhance the look of fullness in their transplanted areas. These products can also be used post operatively to hide the immediate surgery.

Toppik - Toppik is an effective, safe, and easy-to-use product that completely covers up the scalp's thinning areas.

Couvre - COUVRe is safe for men and women, easy to use, and is totally undetectable to the world's toughest critics.

Caboki - Caboki is comprised of a series of charged microfibers that, when applied to the scalp, tightly bind hair shafts and create a denser, fuller appearance.

DermMatch - DermMatch is a safe and easy way to cover-up thinning areas and instantly provides the appearance of a natural looking head of hair.

Nanogen - Nanogen is one of the fastest, easiest ways to conceal thinning hair and hair loss.

Prothik - Prothik does an exceptional job of adding thickness and fullness to thinning hair while reducing the contrast between thinning hair and the scalp.

One product you used to see quite often in advertising is Avacor. According to Response magazine, Avacor was the third best selling product on the Internet in April, 2002. Avacor was originally manufactured by Global Vision Products. After being taken over by new management, it is now being manufactured by Avacor Products LLC.

Like most products that advertise 'Stop Hair Loss and Regrow Hair!', Avacor contains the only FDA approved topical drug minoxidil. Avacor, like other products with similar claims, mixes FDA approved drugs in their generic form with other ingredients in a multiple regimen of products like shampoo, lotion and vitamins.

Avacor historically cost approximately $239 for a two to three month supply and over $1000 for a year’s worth.  New prices are much more reasonable which range from $180 for a 3 month supply to $400 for a year’s supply of the men’s and women’s formula. Note that the ingredients in Avacor can be bought over the counter at your local store at a fraction of the cost for which they are sold in Avacor. However, they do offer 24/7 customer service and a 90 day money back guarantee.

Marketing Practices

Avacor, like other products with similar claims, has taken a lot of slack over the years for their controversial marketing tactics. Avacor has a checkered past and has previously been the focus of lawsuits and investigative reporting by major media like ABC news. Recently however, new management has taken over and claims they are very serious about selling quality products at more reasonable prices, without the hype and controversial marketing strategies. In looking at their website, while Avacor still uses slick marketing language to promote their products, the vast majority of their claims are much more realistic.

Avacor includes 3 distinct products that claim to provide “total hair care”. This includes a 'Scalp Detoxifying Shampoo', a 'Physicians Topical Formulation' and finally a 'Nutricap'. Avacor's Nutricap ingredients consist mainly of common herbs like saw palmetto, gingko biloba, keratin, resveratrol, and bilberry. While conjectured to inhibit the production of DHT, none of these ingredients are FDA approved or proven to stop hair loss. Avacor’s Physician’s Topical Formulation however, does contain 5% of the FDA approved hair regrowth agent minoxidil.

Other than minoxidil, no other ingredient is proven to regrow hair. A number of studies have been done that suggest saw palmetto inhibits the production of DHT, like Propecia. But, unlike Propecia, it has never been proven to stop or reverse hair loss.

Avacor Products

Avacor admits on their website that the only product proven to regrow hair is the Avacor Physician’s formulation which includes the FDA approved ingredient minoxidil (5% for men and 2% for women). The other products claim to provide hair with the essential nutrients for healthy hair growth but are careful not to claim to prevent the progression of male or female pattern baldness (androgenic alopecia). Perhaps this is why the Avacor Physician’s formulation can now be purchased separately. Costs of the Physician’s Formulation are still, but only a little more expensive than Rogaine topical hair loss treatment, one of the first and most popular topical minoxidil products.

The Avacor Study

At this time, Avacor’s proof comes in the form of the FDA approved study showing that minoxidil can stop and reverse hair loss.  No other study is provided with their product.  Their website also is much more realistic as to what their product line can accomplish for hair loss suffering consumers.

Confidence in Products and Services

Before you consider spending hundreds of dollars for any product or service, do a review. Legitimate products will have legitimate studies and have been reviewed on many quality websites. Doctors with real talent and satisfied patients will be able to show you dozens of photos and allow you to talk with past patients. Proven physicians will make available their resumes along with their formal education and associations they belong to.

It is always best to review a product or doctor for information on their background before you make a decision for something as important as hair loss and hair restoration.

Conclusion

At the very least, the Avacor Physician’s formulation will be as effective as the Rogaine liquid formula or generic minoxidil. However, to date, both Rogaine and generic minoxidil are more cost effective than Avacor.  The nutricap, shampoo, conditioner and other products may promote healthy hair and provide it with volume, but make no claims of stopping hair loss or regrowing hair.

Balding Has Been Cured

Try telling that to 80 million men and women who are suffering from hair loss in the United States. They will laugh at you. Yet on a daily basis we are bombarded with ads for hair loss treatments like Avacor, Hair Genesis, Fabao and Procerin that use misleading advertising to sell their products. Thanks to their persuasive messages promising to regrow hair, consumers will spend nearly one billion dollars trying to find an effective hair loss remedy and fall victim to misleading advertising like this.

Thinning hair is a source of distress for millions of men and women so it is not unusual for them to seek help from anything that sounds like it will work. Most questionable hair loss products use similar, misleading marketing techniques ranging from claims to testimonials and photos.

Hair Loss Product Claims

Many hair loss products claim to be able to restore hair through the use of drugs, herbal lotions or other exotic applications like lights, lasers or electrical fields. While many of these products have been around for years, there is little evidence that they can restore hair.

How are they allowed to make such claims? These products often use small amounts of generic drugs found in Propecia and Rogaine (finasteride and minoxidil) which allows them to make the claim to stop hair loss or they imply hair growth with 'cosmetic' claims.

Misleading Marketing

Some hair loss products lead you to believe that they can stop hair loss by parsing their words. They can't come out and claim to regrow hair or stop hair loss, so they advertise vague claims like "thicker, fuller hair". This is a 'cosmetic' claim that any product can make. Be advised that cosmetic claims cannot restore hair or grow hair because they are not proven to do so.

False Testimonials

With the anonymous nature of Internet postings, people posing as users will mislead others with false testimonials. Often, positive reviews are produced by people compensated to post these messages. Since there is no real regulation of online postings, consumers are advised to take testimonials with skepticism.

Phony Photos

Most product advertising that claim that you can "Regrow Hair!" or make your hair 'thicker and fuller' and show a photo of a balding person with thin hair next to a photo of the same person with thicker hair covering the baldness. Photos don't lie, do they?

Well, yes they do.

You can prove it yourself. Take a photo of a head with thinning hair using a flash camera and then photograph the same head without the flash. The photo with the flash will look like a bald head and the photo without the flash will look like more hair.

Lighting, length of hair and how the hair is arranged on the head determine whether a photo of a head looks bald or not. Most people go through the same routine as balding advances: they push hair from here to there and hair spray it into place in the hope that no one will notice that we are going bald. To the extreme, this becomes the 'comb-over' hair style.

Review the photos of hair loss products you've seen. In most cases there will be just a few and they will all have misleading elements like lighting, hair style and length of hair in the 'before and after' photographs. If the products or services are really legitimate, there should be dozens of photos, if not hundreds or thousands.

The FDA and the FCC

Sadly, we think that the United States Food and Drug Administration and the Federal Communications Commission (agencies who regulate such issues) can stop these scams. Unfortunately, they can't. Since the FDA approved Minoxidil and Finasteride as effective in stopping hair loss, any inclusion of these products in any form enables marketing companies to make hair restoration claims.

Even the studies done for Rogaine and Propecia are not that encouraging. When Rogaine was studied (active ingredient is minoxidil), 16% of the placebo group had measurable new hair growth. Four out of twenty-five people had real, measurable hair growth when they believed they were using something that worked. Both studies were limited in time and scope. To read the studies that were done achieve FDA approval, visit the FDA web site and scroll down to Propecia and Rogaine. (http://www.fda.gov/cder/foi/nda/index97.htm )

Hair Loss and Hair Restoration

If a person is genetically prone to hair loss and balding, FDA proven hair loss treatments may help slow the process if they are used early and often. If you are like many and have already lost more hair than you're happy with, there is only one option to restoring your own natural hair: hair transplants. Hair transplants have become an art in the restoration of natural hair which is genetically resistant to the causes of balding.

Like any surgical solution, your success depends upon the quality of the doctor you choose. Doctors who are successful in restoring a natural looking head of hair are carefully reviewed by the Coalition of Hair Restoration Physicians for membership in this exclusive organization. They must allow access to past patients, confirm their training and provide photos and videos of their patients.

While hair transplants are not possible for everyone, they are now more natural and affordable than ever before.

View hundreds of real hair transplant photos done by the world's top hair loss specialists who are members of the Coalition of Hair Restoration Physicians.

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.