What causes baldness?
The cause of male pattern baldness is no longer a mystery. Research has shown that when the male hormone - testosterone is exposed to 5-alpha-reductase, an enzyme in the hair follicle, it produces another hormone called dihydrotestosterone (DHT), which causes permanent hair loss.
This hormone (DHT) causes the hair follicle to shrink and grow a finer hair that is lighter in color, shorter and less deeply rooted than its predecessor. Most often, the hair in the balding region will continue to grow at an increasingly slower rate until hair growth ceases completely.
The pattern of progression, and the extent and speed of male pattern baldness, is largely dictated by genetics, hormones and age.
For men, this permanent type of baldness generally follows specific patterns. Even in the most extensive cases, a horseshoe shaped fringe of hair remains. This donor fringe is insensitive to the balding process and will last a lifetime. This is because this hair is genetically programmed in the root, or hair follicle, to be resistant to the effects of DHT.
The hair in this donor area provides the basis for surgical hair transplantation. These hairs, when transplanted into thinning or balding areas, will take root and grow, and continue to grow for the rest of a person's life.
This is also reffered to as the "principle of donor dominance". That is, the transplanted hair will grow in its new location as it would have in its original donor location.
Hair transplantation is an artistic, surgical redistribution of the permanent/long life hair follicles taken from the donor dominant areas, viz., the back and sides of the head to the bald/balding areas of the scalp.
These long life hair follicles are transplanted into the bald/balding areas of the scalp. With current microsurgical technologies, this results in a very natural appearing hair regrowth in the bald scalp areas. Just enough hair follicles are taken from the back and sides of the scalp so as to leave behind sufficient hair in the donor areas.
How long do transplants last?
For the vast majority of patients, virtually all transplanted hair lasts a lifetime.
Rarely, a small percentage of transplanted hair may be lost as the patient progresses to very old age.
How is this surgical hair restoration procedure performed?
Hair Transplantation is an outpatient office procedure performed under local anesthesia.
In FUHT, after local anesthesia, a hair bearing strip of scalp is excised from the permanent donor area. The strip wound is closed using self dissolving sutures/surgical staples.
Individual follicular unit grafts are dissected from the strip under magnification. Meanwhile, recipient slits are created in the bald areas of the scalp using tiny needles/blades. This too is performed after numbing the scalp using local aesthesia. The individual follicular unit grafts are placed into each such slit.
After the procedure, over a period of 5 to 7 days, the needle slits heal and the transplanted hair follicular units are locked firmly placed in their new location.
The patient's scalp is bandaged overnight. The next day, the patient can remove the bandage himself or may visit the clinic for its removal.
There is no need of admission.
We have developed techniques to reduce the discomfort of administering local anesthesis and most patients tolerate this brief period of local anesthesia administration very well. It is somewhat similar to the numbing injections administered by the dentist.
Modern, ultra refined, all follicular unit grafts, give a very natural appearing hair regrowth that lasts till ripe old age. Specific recommendations regarding number of grafts, density etc. are discussed at a personal consultation.
This depends on the size of the bald area as well as on the donor area.
When there is extensive baldness, it is better to place the donor hair artistically in a pattern to give the maximum coverage. In specific instances, various approaches using a combination of FUHT, FUSE and body hair to scalp transplants have been performed to cover extensive baldness.
A combination of the different methods ensures that a larger number of follicular unit grafts are available to cover large bald patches.
Please refer to our patient photogallery and our blog for the different approaches followed in various patients.
In case the patient wishes to utilize only FUHT, and has extensive hairloss, it iss advisable to go for an aesthetically pleasing, yet, conservative hair restoration. Individual patients who have followed such an approach are also listed in the photogallery section of our site as well as on the blog.
The number of sessions varies, and will depend on the:
- Area of scalp to be treated.
- Number of follicular unit grafts desired.
- Density of hair desired by the patient.
- Individual characteristics such as coarseness or fineness of hair v/s a particular area of bald scalp.
- Current stage of hair loss and future possible hair loss.
- Timeframe in which patient wishes to replace lost hair. Some patient prefer to go in stages.
- The laxity of the scalp donor area as well as the follicular unit density in the donor area of the individual.
An average full length strip FUHT session in a previously non transplanted scalp varies from 3000 to 6000 grafts (average 4500 grafts). A second FUHT session can be performed after 1 year. It will usually yield less grafts then the first session (2000 to 4000 grafts).
The above estimates assume that
- all procedures have been performed at our clinic
- the patient is of Indian or Caucasian descent.
People of Far East (Asian descent - Japan, Korea etc.) and Negroid descent usually have lower follicular unit density in the scalp donor area.
The transplanted hair generally sheds within the first 2-6 weeks after the procedure as it enters a dormant phase.
The hair begins to grow approximately 2-8 months later. The hair then grows at the normal rate of 1/2 inch each month.
The transition from thinning hair or baldness to greater fullness of hair is very gradual. It takes 10 to 12 months to see the full improvement as the hair continues to mature in terms of length as well as calibre.
A scalp reduction is a procedure which is performed under local anesthetic (or, sometimes, under general anesthesia), in which a large bald area of scalp skin is excised and the wound is sutured close. This leaves a scar on the scalp which must later be camouflaged by grafting directly into the scar.
We, at Dr. A's Clinic, do not recommend scalp reduction procedures.
Scalp flap surgery is a procedure in which an entire segment of permanent hair-bearing scalp is excised, rotated and resutured into a bald area.
This is a relatively uncommon and invasive surgery and it is performed by very few surgeons nowadays.
The risks include improper hair direction at the hairline, visible scars at the hairline, as well as the more serious risk of partial or complete loss of survival of the flap and the hair within it.
We, at Dr. A's Clinic, do not recommend scalp flap procedures.
The great majority of our patients are quite comfortable both during and after their hair transplantation procedure. As you would expect, local anesthetics are used during the procedure. Being a surgical procedure, you would be prescribed certain antibiotics and pain killers to be taken for 5 to 10 days after the procedure.
Perhaps, some day hair transplantation physicians will be able to clone hair follicles from a patient's donor area. This could potentially allow a patient a virtually unlimited supply of balding resistant donor hair. This would be of particular value to patients who have very little donor hair available for hair transplanting.
Although this potential advancement is exciting, it is currently only in the early test stages and little, if anything, is known about its possible success.
This procedure has been called the logical end point of 30 years of evolution in hair transplantation beginning with traditional larger plugs and culminating in the move to one, two, three, and four hair individual follicular unit hair grafts, which mirror the way hair grows in nature. (Hair Transplant Forum Feb. 1997).
Hair grows in natural groupings of 1, 2, 3 and 4 hairs. These groupings are caller follicular units. The key to follicular unit transplantation is to identify the patient's "natural hair groupings" and use them intact to create from "micro follicular unit hair grafts" that are composed of naturally occurring 1, 2, 3 and 4 hair grafts.
The following picture shows what the follicular unit grafts look like.
Below is a zoomed in picture of the naturally occuring hair groupings in the scalp. As can be seen, the hair are emerging in random groupings(follicular units).
These follicular unit grafts are much smaller than traditional untrimmed micrografts that contain equivalent amounts of hairs.
Their size enables larger numbers of them to be placed in tinier, less traumatic incisions closer together. Using this advanced technique a surgeon can move more hair in a totally natural way - creating a natural look at every stage of hair transplantation.
It's known that using small follicular unit grafts of 1 to 4 hairs and large sessions of 2000-4000 grafts is the ideal procedure for a patient who wants to achieve the most natural result with the least number of sessions. As beneficial as it is for the patient, it is equally unappealing for the physician performing the hair transplantation procedure.
Such megasession procedure requires the physician to be more detailed and exact, both in the cutting and placing of the graft. Moreover, using smaller grafts results in the need for more of them. Thus it is more labour intensive. It necessitates a larger staff and longer time commitment to achieve the desired result. While it is more labour intensive and therefore more costly to the clinic, the belief is that the doctors should bear this added financial burden. This is because they're not moving that much more hair, they're just moving it in a better manner.
Some hair transplantation physicians say there is not sufficient circulation in the recipients site to place 2000-4000 grafts and ensure successful growth. That is not true. It may be the case with sessions of 1000 to 2000 grafts IF grafts larger than four hairs follicular units are used. Such grafts are called variously as minigrafts or bi follicular unit grafts. And it's usually physicians using grafts of this size that make this statement.
However, hair transplantation mega sessions of 2000-5000 grafts with grafts of 1-4 hairs are completely successful. Performing sessions any smaller would be counter productive to the patient as it would not maximize the procedures potential.
How much work you will need depends on various factors - such as, how much hair loss you have now, the amount of hair loss you will have in time, and your goals and expectations - or how thick you need it to be.
An approximate guide to your grafts requirements calculation is given at our graft estimates page.
Generally hair transplantation has become a dramatically better value over the past several years.
For a mega session of 2000 or more all follicular unit micro grafts, the cost per graft can be as low as $1.00 to $1.5 per graft. Of course, the cost of hair transplantation will ultimately depend on how much work you need to be satisfied.
We charge by the number of intact follicular unit grafts (not by hair). We consider charging by the hair as unfair to the patient as a majority of the follicular unit grafts in an average person's scalp contain multiple hair.
The short answer is yes, as long as the women's hair loss is concentrated in defined areas like in the classic male pattern baldness (i.e. the woman's hair loss is not too diffuse or thin throughout their entire scalp).
Consider what Dr. Dow Stough, hair transplant surgeon in Texas writes about women hair loss - "Hair loss in women is culturally unacceptable despite the fact that up to 40% of the female population experience some hair loss in their lifetime. It is not uncommon, but the stigma attached to female baldness is an extremely stressful and unwelcome event. In fact, androgenic alopecia in women can be psychologically debilitating. There have been several medical studies which have concluded that although alopecia is clearly a distressing experience for both sexes, it's effect is much more problematic in women. Most women go to extremes to conceal and treat their hair loss, they use a broad array of creative camouflaging and hair thickening cosmetic techniques in an attempt to mask the condition.
Women who are experiencing hair loss should undergo a thorough investigation by a dermatologist. The medical workup and testing for women with hair loss is very involved and time consuming. The most difficult cases, are women with diffuse hair loss, i.e. balding which is not concentrated in the frontal regions of the scalp.
In cases of nonpatterned alopecia, a dermatologist will usually recommend laboratory tests, which may include a complete blood count, iron levels and thyroid studies. An extensive medical drug history and family hair loss history must also be obtained, and in some cases testing for a hormonal imbalance is warranted.
For those women who do not have diffuse alopecia, the diagnosis is simplified and much more direct. These women are classified by the Ludwig classification system. There are three categories; Ludwig I, Ludwig II, and Ludwig III. Those with a Ludwig I pattern are not candidates for any surgical treatment. They are best treated with topical treatments. Patients with more advanced hair loss, those who are classified as Ludwig II or Ludwig III categories, are possible candidates for hair transplantation. They are acceptable candidates if they have an adequate amount of donor density. The donor area is the hair found in the back of the scalp.
In those women who have complete balding in the central and frontal of the scalp, hair transplants are a viable option. The results from this transplantation can be truly outstanding since many women retain the frontal hairline and it does not need to be recreated.
Hair transplantation in women with hair loss caused by cosmetic surgery also yields excellent results. By camouflaging the scars resulting from brow lifts or facelifts these patients are able to achieve their expectations".
We certainly invite you to bring a friend if he is interested. It won't affect fees.
We do not offer any discounts or special packages. Currently our fee structure is the most economical worldwide, for the quality we offer.
Quality, density and natural results are more important.
Hair pieces can be worn between surgical visits if you want, as long as proper hygiene and ventilation of the scalp are maintained.
For the first 7 to 10 days, post hair transplant, you have to be extra careful not to disturb the transplanted grafts while putting on or off the hair piece.
After that, in case your hair system requires use of adhesive, we advise you to take care that the adhesive/tape does not rest over the transplanted area.
While Propecia(Finasteride) and Rogaine(Minoxidil) have been proven to regrow hair, in a percentage of patients, they will not grow all your hair back.
Both products have not been proven to grow any significant hair in the frontal and temple areas, which are the main areas of concern for most people. Their greatest benefit seems to be in slowing down the hair loss process.
Scalp reductions were first introduced in the mid-1970s as a way of treating an individual with a midline bald spot. Although several design approaches can be used, an elliptical approach is generally the most common.
Prior to the excision, a surgical balloon may be inserted below the scalp and filled gradually with liquid to improve the scalp laxity. With this procedure, an ellipse of bald skin is removed centrally in the crown area and the hair-bearing scalp on the sides of the head is stretched toward the middle to obtain closure.
Because scalp reductions do not allow for an upward and forward advancement of the entire scalp, they are not effective in treating patients who possess or have the potential for more extensive baldness.
Due to this inherent surgical limitation, as well as the aesthetic drawbacks, which include an excessive stretching back of the bald area and increased receding at the temples, the scalp reduction procedure is considered outdated for the treatment of moderate to extensive baldness. Newer hair transplantation procedures offer more predictable and better aesthetic results, and often require fewer surgical sessions.
The scalp is elastic. When the donor strip of hair is removed, the scalp on both sides is pulled together and sutured. The only evidence of surgery is a suture line hidden under the hair that grows vertically on the back of the head.
Elective surgery to improve physical appearance is universally accepted and is being performed successfully everywhere there are qualified specialists.
Hair transplantation procedures differ from general surgery, however, in that they involve only the outer layers of the body. Thus, any risks involved in hair transplant are similar to those with any out patient surgery.
Hair transplant, by itself, has no adverse effect on the brain, eyes, memory etc.
The discomfort associated with hair transplantation surgery is usually comparable to that of dental surgery. Pain medication is always offered, though its use is limited generally to the first few days after surgery.
Your newly restored hair will grow and require the same maintenance as your original head of hair. It's your hair and can be colored, permanently waved or styled in a variety of ways suitable to your lifestyle. You can even shave them off, they will grow right back.
Dr. A's clinic does not feel that the laser benefits the patient. It can damage healthy hair follicles, have a negative impact on scalp elasticity, and in general, slow down the healing process. The use of lasers in hair restoration has diminished greatly in the last 10 years.
This is a very good question. The answer is that today, if you see a recently completed hair transplant that doesn't look natural, that's because it's simply a bad hair transplant. Our Dr A's clinic's hair transplants go unnoticed by you and everyone else, in the great majority of cases, because they are so natural looking.
Modern research in hair growth has discovered that natural scalp hairs actually grow in small groupings (called follicular units) of 1, 2, 3 or occasionally 4 hairs per unit. So, it is our strong emphasis at Dr A's clinic not just to imitate nature, but to try to duplicate nature. We employ micro-technologies that use closely placed and randomly dispersed 1, 2, 3, and 4 hair units.
We have refined these micro-technologies to the point where often other medical doctors, even on close inspection, have a difficult time telling which natural hairs are original (non-transplanted) and which natural hairs have been restored (transplanted). That's why today the state-of-the-art at Dr A's clinic is follicular unit hair restoration.
Selecting the right physician is a very big decision because the quality varies widely. Actually seeing a "Sample" of your hair transplant specialist's ability on top of your scalp is the only gold standard. You can see how closely he can place these grafts, whether there will be any scarring and whether the surgeon has the proper aesthetic sense to give good looking hair. At Dr.A's clinic we go one step further. Our smallest sample costs the patient only INRs. 10,000/-. The criteria for judging the quality of the grafting are very simple : The number of grafts per square centimeter. The quality of grafting i.e follicular micrografts bearing 1 to 2 hair v/s punch grafts / minigrafts. Proper direction of these grafts as compared to surrounding hair. All hair grafts should point in same natural direction rather than haphazardly. At Dr.A's Clinic we can place 40 to 70 grafts / sq cm depending on the patient's requirement.
Preexisting medical conditions are always a concern of your Dr A's clinic. If you have a preexisting medical condition, please tell your Senior Counselor at the time of your consultation. For your convenience, we have listed responses from some of the most frequently asked medical questions:
COUMADIN: If you are taking Coumadin, you will need to be off Coumadin for a week prior to your hair restoration procedure. When you have a consultation, your Dr A's clinic physician may require an okay from your physician.
DIABETES: To determine possible candidacy for hair restoration you will first need to have a consultation with one of our physicians. Your Dr. A's clinic physician may require an okay from your diabetes physician, to confirm that your diabetes is under good control.
LUPUS (Erythematosus): Our physicians here at Dr A's clinic believe that, in many cases, it is not a good idea to transplant hair into an area where the hair loss caused by LE has occurred. After hair has been transplanted into such an area, the LE process (which caused the hair loss) could recur. However, in some cases (when LE has been inactive for many years) it is feasible to do hair transplants. Your Dr. A's clinic physician will determine this.
We offer you plenty of reasons to get it done in Dr A's Clinic :
1. We have a dedicated technical team devoted to give you latest in hair transplant. We take pride in telling that we are able to perform 4000 to 5000 follicular unit micrografting session in a single day which. I must add is considered the best in the field.
2. We have a quality procedure which includes ability to place follicular units at 60-80 grafts per centimeter sq.
3. World's lowest cost $1 per graft (approx.).
Dr. A's clinic can't fully account for the techniques of others, because we don't know exactly the protocols and variations they use in processing the results they achieve. We can talk to you about Dr A's clinic's own techniques, which include ultra fine all follicular unit hair transplants. This emphasizes the natural variations in the textures, angles and directions, character of the hair, size and shape of grafts and variations in color. The combinations in how the doctor uses these numerous variations significantly impacts the naturalness of the results and there are many permutations each time the doctor goes from donor to recipient area. We believe hair grafting is an art. And it is very important to give natural look in the final outcome. Use of only follicular units is the best way to achieve this.
1. Patient before and after photographs alone: In today's world of advanced photography, these can easily be "touched up" to give a false impression. 2. Patient refferals: A doctor may have just 10% satisfied patients but if he refers you to one of those 10%, you never come to know the fact that 90% are not satisfied. Rather opt for a "Sample" session. If he is a good transplant surgeon, he would never hesitate in demonstrating his skill. These both (select before after pictures and select referrals) are usually marketing gimmicks that have, unfortunately, been used to dupe a lots of simple minded patients by unscrupulous clinics.
A hair transplant surgeon should be able to place at least 2,500 follicular micrografts in a single session to be considered a reasonably good follicular micrografting surgeon. State of the art hair transplant centres, world over, areable to perform 4000+ follicular unit graft sessions in a single day. At Dr. A's Clinic, we have performed numerous 5000+ graft sessions.
Any good follicular unit micrografting specialist, who puts large number of densely packed grafts, would charge for the actual number of such grafts transplanted. This is the most time tested and transparent criteria. However, many surgeons try to learn the technique by hit & trial on their patients. For achieving this, they usually charge a lumpsum amount as they themselves are not sure of the number of grafts they would be finally be able to transplant. Having seen a lot of such unfortunate cases, I believe these doctors usually give very few micrografts in front, say one or two rows, followed by now discredited plug/standard grafts behind (inspite of having promised the patient only follicular unit micrografts).
This is a very important facility. It makes no sense paying for the number of grafts if you are not allowed to count and check them immediately after the procedure is over. At Dr.A's clinic, before putting the bandages, we make sure that the patient and his/her companion actually see/count the grafts with aid of a magnifier. And yes! these grafts are countable inspite of whatever some old fashioned plug graft specialists may say.
Whenever human skin is cut, it always heals by the process called "fibrosis". This fibrosis (commonly known as scarring) is the skin's way of healing. Thanks to the skill of our experienced hair transplantation surgeons, the healing sites in the transplanted areas are usually so small that the fibrosis is virtually undetectable. At Dr A's clinic , hair transplantation procedures are designed to produce a very natural look. In the great majority of cases, the microtechnologies currently used at Dr A's clinic make the restored hairline virtually undetectable.
FUSE (in-vivo follicular unit separation extraction) is a knife and stitch free hair restoration method. It is safe, minimally invasive, virtually non-scarring technique of extracting single follicular units (FU).
It involves separation of the graft bearing skin till the level of mid dermis with tiny but sharp micro punches, followed by the separation of the FU by careful microscope/ magnifier aided dissection (under direct vision) from its remaining dermal attachments, before gently sliding it out of its location for grafting into the recipient bald area.
Apart from the fact that the FU’s are carefully separated under direct vision to avoid any inadvertent damage in FUSE; it is... A freely taught and shared technology – Dr. A has distributed knowledge about performing FUSE freely on the net for other doctors to emulate and improve. It, therefore, is widely seen, emulated, examined, verified and replicated. Moreover it is a dependable and logical technique. FUSE is the only technique to be examined by the maximum number of doctors including many so-called competitors for flaws. FUSE has been widely discussed & debated among doctors as well as patients. We believe this transparency in our operating procedures is your guarantee to getting a safe and good technology. We also hope that open debate may lead to further improvements.
It is possible to achieve near natural apparent density in FUSE. We have till March 2004 been able to place upto 90 to 110 FU/sq cm. And we aim to be able to further increase the density. But one has to keep in mind- (i) The availability of FU’s: A person with lots of donor area & limited bald area will definitely qualify for more FU’s placed per sq. cm. than a person who has virtually no hair on chest, back etc., limited scalp donor hair & extensive baldness to cover. (ii) The artistic merits of placing the FU’s in different areas of baldness specially if the donor hair are less.
We are currently using a range of needles varying from 20 gauge to 24 gauge. Often the choice of the gauge depends on the girth of the FU to be placed. We value safety above all. It is no point trying to place a graft thicker in diameter than the diameter of, say, a 24-gauge needle into a 25 gauge needle hole. Remember, not only do we have to create minimal trauma in the recipient area by the needle, we also have to ensure minimal trauma to the FU during placement. Keeping both these variables in mind we have used needles as per the requirement of each patients hair. Single hair follicle (medium thickness) – 24 gauge needle...... Single hair follicle (curly & above average thickness) – 23 gauge needle...... 2 hair FU – 21 to 22 gauge depending on hair thickness...... 3-4 hair FU – 18 to 20 gauge needle.
The punches used for FUSE vary from 0.75mm to 0.9mm (average 0.8mm) The punch to be used depends on how widely the hair of a FU is spaced out while emerging from the skin. Trying to extract larger FUs with punches whose diameter is less than that of the FU at point of emergence from the skin is, obviously, illogical. We, however, do not use 1mm or larger punches.
Yes, hair can be grafted in between existing hair. We normally prefer to trim the existing hair if we are to graft hair in between them. But whether or not it will actually lead to an increased apparent hair density depends upon the individual patients genetically programmed hair loss pattern too. In simple terms, we graft hair, which will keep growing thereafter, but even we cannot predict when and if you will lose your pre existing hair.
We perform both FUSE/fue grafting as well as Follicular micro grafting (strip method of harvesting the donor area). We feel neither of the procedure is perfect for everyone. While follicular micro grafting does give a line like scar in the donor area, it is normally not visible even under a hair growth of 1to 2 cms. Similarly, FUSE gives no obviously visible scarring but the person does have to roam around with a shaven head appearance for a couple of weeks after the procedure which does not suit some patient’s schedule. We leave it to the individual patient to decide on the type of procedure they wish to opt for while at the same time giving pros & cons of both of them. We believe our patients can make their own intelligent choice instead of being forced in to any one procedure.
On the human scalp, hair grows in form of naturally occuring groupings containing 1, 2, 3 or, rarely, 4 hair follicles each. These groupings are called follicular units. Also reffered to as follicular unit grafts by hair transplant clinics.
In certain locations, like the hairline, the temples and the swirl, nature shows a preponderance of 1 hair follicular units.
While performing a hair transplant, in the refined procedures, care is taken to place the 1 hair grafts in the hairline, temples, centre of the swirl area etc. The multi hair follicular unit grafts are placed in the areas behind the front feathered hairline zone to buit up the density.
Similarly, in the more advanced combination procedures where the scalp grafts are augmented by facial and different body hair grafts, the doctor has to plan the location of the different types of grafts according to the hair's individual characteristics.
When planning a hair restoration using body or beard hair, it is important to start with the assumption that the transplanted body (and/or beard) hair will not change their characteristics. True, some patients note an increase in length of transplanted body hair. However, length is not the only characteristic. Moreover, not every patient notices this increase in length of transplanted body hair. Therefore, its prudent to start with the premise that the transplanted body hair will not change their original characteristics. This is especially true about the remainder of the characteristics, viz., calibre, color, curl, predisposition to greying, hair growth cycles etc. In suitable patients, body hair can be used for transplanting in the scalp recipient areas, even though they do not change their characteristics. This has to be decided by the physician after examining the body hair.