Frequently Asked Questions

Question 1: What causes hair loss?

Answer: The most common cause of hair loss is inheritance. Men and women inherit the gene for hair loss from either or both parents. Men are most commonly affected by the inherited gene as the hormone, testosterone, activates the genetic program causing loss of hair follicles. Currently there is no method of stopping this type of hair loss. The age of onset, extent, and rate of hair loss vary from person to person. Severe illness, malnutrition, or vitamin deficiency can accelerate this process. When applied incorrectly, permanent hair color and chemical relaxes damage the hair and follicle to the extent that hair loss can be permanent. Causes of hair loss do not include wearing a hat, excessive shampooing, or clogged pores.

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Question 2: Does it really work?

Answer: Yes. The transplanted hair is removed from on area of the body (donor site) and transferred to another (recipient site). The transferred tissue is not “rejected” as it is not foreign tissue. The transplanted hair maintains its own characteristics; color, texture, growth rate, and curl, after transplantation and re growth. The vitality of the grafted follicle is maintained by the rich blood supply to the scalp. Originally, large circular grafts containing 15-20 hairs were transplanted resulting in noticeable and unnatural results. Over years, instruments and techniques have been developed that allow us to achieve truly natural results by transplanting grafts very close together. Through the use of microscopes to dissect the donor tissue, higher grafts counts are attainable. Hair grows in the scalp in groups of one, two, three and sometimes four hair follicles. We transfer these groups of follicles after eliminating the excess surrounding fatty tissue. This allows the grafts to be placed closer together resulting in a denser and more natural result.

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Question 3: What can be expected immediately after surgery?

Answer: The post-operative course will depend on adherence to the instructions given after surgery. Small scabs will form on the scalp at the graft sites. Generally speaking, these scabs disappear in 7-10 days. Shampooing can be resumed in 48 hours after surgery. The suture (stitch) used in the donor area is undetectable as it is completely covered by your existing hair in most cases. An appointment will be made for the suture to be removed 12-14 days after surgery. It is advisable to take at least two days off work after surgery. A baseball type hat may be worn at anytime after surgery. Patients should avoid strenuous physical activity for at least five days after surgery. Typically the grafted hair will shed in 6-8 weeks. New growth will begin in 4-6 months and length will increase approximately ½ inch per month with full density taking 12-18 months.

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Question 4: I’ve been taking avodart for 4 1/2 yrs and got good results until about a year ago when it seems to be reverting back a little. Can the body build a resistance to dutasteride or other drugs and lose some effectiveness over time?

Answer:  As you’re probably aware, clinical studies have not been performed on Avodart with respect to hair loss. We can only extrapolate from those clinical experiences and studies done on men taking Propecia. These medications decrease the production of DHT by reducing the concentration of 5-alpha reductase which catalyses the transformation testosterone to dihydrotestosterone (DHT). The body does not build up resistance to DHT blockers. Propecia 5 year study results showed that while Propecia did continue to prevent hair loss, there was a progressive decrease in the amount of hair grown over the 5-year period. See http://www.propecia.com/finasteride/propecia/hcp/prod_data_highlights/hair_count_increases.jsp.

Avodart could have similar behavior in that less hair is seen over time but as in the case of Propecia, the amount of hair remaining after 5 years is significantly more that one would see if placebo or no medication were taken. So yes, medications can lose a degree of effectiveness over time but in the case of DHT blockers the effect is far superior to not using the medications at all. If you are not using minoxidil, it would be recommended to add this to your regimen. The new foam preparation has been very well received with far fewer side effects than the liquid.

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Question 5: I am 57 and have had multiple hair transplants with great results.  I

suffer from male pattern baldness.   Two years ago I began taking testosterone and HGH replacement therapy under the direction on an anti-aging physician. My concern is by increasing testosterone/DHT, am I at risk of loosing the grafted hair? What has been your experience with patients using hormone replacement therapy and hair loss.  Could Propecia mitigate the potential side effects of hormone replacement and hair loss?

Answer: First of all, if you were going to experience any loss of hair, transplanted or otherwise, you would have noticed by now, having taken testosterone (T) and HGH for two years. The loss would be the greatest in non-transplanted hair.

Theoretically the transplanted hair originated from a zone of follicles free of DHT receptors so they should not be affected by DHT or T. In reality the transplants behave like the donor hair and there have been reports of thinning of transplants if the donor hair thins.  Most often this thinning is seen with age (senile alopecia) but can also be associated with medications or systemic illness. Fortunately the incidence of this is low.

By taking T, DHT will most likely increase. As a precaution finasteride could be taken to lower the concentration of DHT. Finasteride reduces the amount of DHT by 70%. If you are increasing T and therefore DHT, even with blockage of 70% of the production of DHT there will still be more DHT.

So the answer to your question is yes – finasteride could potentially decrease hair loss from DHT produced by an increase in exogenous T.  One has to be aware of the side effects of finasteride which are well documented.

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Question 6: I want to try Propecia but my wife is afraid to have it in the house since women are not allowed to touch the pills. Are her fears valid and if so why can’t women handle Propecia?

Answer: The official warning is that women should not touch or handle crushed or broken tablets. Finasteride is also used for enlarged prostate glands in men.  Some elderly men in long term care facilities or nursing homes that can’t swallow have feeding tubes and finasteride is crushed into a powder to put into feeding tubes to be administered orally. This warning stems from the possibility of a pregnant pharmacy worker who is crushing finasteride tablets to be exposed to a large amount of the powder on her hands with the risk of absorption in amounts that may affect the male fetus.

So your wife’s fears are not valid. The intact pills can be touched without the possibility of absorption. There is no reason for a female to touch the pills. Women should not take Propecia and its use is absolutely contraindicated in women who are pregnant due to the possible deforming effects on the external genitalia of an unborn male.

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Question 7: I recently had a hair transplant (about 5 months ago) and I think I’ve lost a lot of hair. Is it possible for a hair transplant to make your hair worse?

Answer: “Shock Loss” after hair transplantation is a well known phenomenon and occurs with loss of existing hair in the recipient site. Generally shock loss is temporary and reversible. Whether it is reversible depends on the cause or causes. There are a number of possible causes of shock loss.

1. Existing hair is cut above the surface during the making of incisions. This is like a hair cut and 100% reversible.
2. If a lot of hair is present prior to the transplant (existing hair) and care and time is not taken to preserve existing follicles during the making of incisions, these follicles can be damaged with the instrument that the physician uses to make the recipient sites. This loss of the follicles can be permanent due to direct trauma.
3. Hair follicles normally cycle into the telogen (resting) phase. Between 50-100 hairs are normally shed each day. By spraying and wiping during the surgery to see the spaces between hairs to avoid damaging the hairs, paradoxically, hairs which would normally shed in the future are essentially pulled out on the day of surgery. This cause of shock loss is completely reversible.
4. Injection of anesthetic with vasoconstrictor may increase the amount of shock loss especially due to the vasoconstrictor and especially its action on hairs which are miniaturized and would be lost in the future. This potential cause of shock loss is more theoretical and it’s impossible to say if it’s permanent or temporary.

Application of minoxidil prior to and after hair transplantation can decrease the incidence of shock loss. Even at five months post op, the use of minoxidil could help although shock loss should be complete after a few months. At five months post op, the transplanted hair and shocked hair are just beginning to re-grow so one would have to wait a full year to see the final result of any hair transplant. When full and appropriate care is taken during the making of recipient sites there should be little to no shock loss experienced by the patient.

So it is possible to have a net loss of hair after a transplant if care isn’t taken to avoid direct trauma to existing hair during the making of incisions and if there are a lot of miniaturized hairs just “hanging on”. Again, I would recommend the use of minoxidil to induce growth of existing and transplanted hair and finasteride to retain existing hair. Good luck and remember you must wait for a year to evaluate the full effect of your transplant.

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Question 8: I’m interested in having my mustache thickened up. I wanted to know what the best method for facial hair restoration would be. Should I have FUE or a regular hair transplant?

Answer: The best method for facial hair restoration is transplantation most often using hair from the back of the head to, in your case, your mustache. It is important to find hair in the donor area that matches the texture of the existing hair in your mustache with regard to hair shaft diameter, color, and curl. Sometimes hair on the back of the head can be dramatically different in color and hair shaft diameter that facial hair. In such cases I have taken beard hair from under the chin, using FUE, to transplant to the mustache. Some doctors have described taking a strip from under the chin but I have seen unacceptable scarring using this method therefore if facial hair is needed I use FUE for harvesting.

The most important technical aspect concerning a facial hair transplant is to leave the hair on the grafts long enough to be able to tell the angle of the hair exiting the skin. When placed it is important that the angulation is correct. Some doctors recommend strip excision for this reason as the hair on the grafts can be left longer. The advantages of FUE are that there are no sutures, less pain, and less visible scarring. Since small numbers of grafts are generally needed for mustache transplants, FUE is ideal from that aspect. Also the exact number of grafts can be harvested after the incisions are made.

With advanced techniques in strip scar excision including two layer closure and trichophytic closure, taking a strip for the small number of grafts needed for mustache transplant should result in minimal scarring. So there are advantages and disadvantages with each harvesting technique. I would suggest using FUE if you cut your hair short and the scar from strip excision would be noticeable. If you don’t live near your doctor FUE has the advantage of not needing suture or staple removal. If you don’t and never plan to cut your donor hair very short, the scar from strip excision in the hands of a competent surgery should not be noticeable.

The important points to consider regardless of the harvesting method is (1) the exit angle of the transplants should match the exit angle of the existing hair and (2) sometimes a second session is necessary to attain full density.

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Question 9: I recently had a hair transplant and most of the grafts didn’t seem to grow in. Is this the fault of the physician and improper graft placement or am I just a bad candidate?

Answer: It is unfortunate you experienced suboptimal growth. The degree of difficulty with respect to harvesting the donor follicles and placing the grafts differs greatly from patient to patient. Negative factors include scarring from prior surgery in the donor and/or recipient, greater than normal amount of bleeding, mushy/soft grafts, slippery grafts, tight, and/or sun damaged recipient skin. If a patient is unlucky enough to have all these negative factors present, it is likely that less than 100% of grafts placed will grow. On the other hand if the scalp hasn’t had prior surgery, bleeding is less than normal, grafts are firm and easily placed in flexible, normal skin, growth rates can approach 100%. Any combination of these independent variables can occur causing growth rates to vary.

A good surgeon will recognize a higher degree of difficulty and adjust the procedure to compensate for a negative variable(s). If grafts are difficult to place and placing one graft causes the adjacent graft to pop out, the spacing among incisions must be increased making dense packing difficult. Taking time to properly place grafts in difficult cases often solves a lot of problems.

There are cases, of course, in which surgeon or assistant error can cause failure of a percentage of growth. These include but are not limited to inexperienced surgeon and/or staff, non-recognition of increased degree of difficulty, or situations in which multiple surgeries are done in one day, and/or adequate time is not allotted to a difficult patient.

To specifically answer your question, it could be a combination of the factors you mention or either one alone. Make sure you wait at least one year after surgery to critically judge final results. Also contact your surgeon immediately with any problems you encounter.

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Question 10: I think my hair piece made me lose more hair. Is this possible and can I replace the hair that has been lost with a hair transplant?

Answer: It is common to lose hair, permanently or temporarily, as a result of wearing any type hair piece. The hairs lost or damaged are generally those which were genetically programmed to eventually fall out but their loss is accelerated by the unnatural situation created by an appliance attached to the scalp. A warm, moist, dark environment with associated pressure from the base and attachment system can accelerate programmed (male pattern) hair loss. If there is traction from a glue-on system or from attachment clips, areas of permanent hair, not programmed to miniaturize and stop growing, can be lost due to traction alopecia. Alopecia is the medical term for hair loss. Placement of clips in the same location for months or years can cause circular areas of permanent hair loss.

Hair lost can be replaced with hair transplant surgery. Some of the most impressive before and after photos used in advertising are from patients who stopped wearing a hair piece, started minoxidil (Rogaine) and finasteride (Propecia) and received hair transplants. Much of the growth seen on the after photos is not from the transplants but from the damaged or stunted hair which has been brought back to life with the removal of the unfavorable environment and stimulation of growth with medical treatment. Patients are often surprised at the amount of hair that regrows when they take off the hair piece and stop clipping their hair short in anticipation of a hair transplant. It would be ideal to remove the hair piece and use the medications for 6-12 months to realize your actual baseline pre-operative hair volume.

While hair transplants cannot be used to replace every hair a patient has lost with or without a prior hair piece, it can greatly increase your volume of hair. Post-operatively, to realize full regrowth of the transplants, it is exceedingly important to wear your hair piece as little as possible. The actual regrowth of the transplants is directly proportional to the amount of time you are not wearing the hair piece. Ideally a patient should discontinue wearing the hair piece at all to get full and prompt regrowth. If you need to wear your hair piece while the transplants are growing, it is imperative to convert to the clip on system if you are not already using it, to secure the hair piece, not have any glue or tape on any of the grafts (especially the hairline), and wear the system as little as possible. After surgery it should not be worn at all for a minimum of one week, preferably two weeks, then only worn during business hours and removed when sleeping and during weekends. You can wear a hat to cover the area.

Finally, patients who wear a hair piece are used to seeing a lot of hair volume. Often hair pieces are too thick making them noticeable. Hair transplants cannot replace this amount of hair. So the patient must be informed and ready to accept less hair than they see in the mirror when wearing a hairpiece. As a result, more than one surgery is often necessary to attain desired density. In my experience, when properly informed patients are ready to discontinue the cost and maintenance of a hair piece, if they follow the recommendations given above, they are thrilled with the results of properly performed hair transplantation surgery.

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Question 11: How long will I be off work?

Answer: There are many variables involved when returning to work. Whether you have strip or FUE surgery, we recommend that you take at least two full days off, post op, to devote solely to aftercare. After those two days it is a matter of personal choice. One thing to keep in mind is post op swelling, which can develop twelve to forty eight hours after surgery. Depending on the amount of hair in the transplant area, there will most likely be visible scabbing. A loose fitting hat may be worn during this period. If a hat is not an option for your particular occupation, we recommend taking off a week to ten days while the scabbing heals.

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Question 12: Is hair transplantation covered by insurance?

Answer: Hair transplantation surgery for cosmetic proposes is not. If hair loss occurs secondary to an injury or accident, it is possible that it may be covered.

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Question 13: Can hair be transplanted from one person to another?

Answer: Anti-rejection drugs would be necessary to prevent rejection. Due to the side effects of these medications, the cost-benefit ratio is not appropriate for cosmetic purposes as it is for life saving organ transplants.

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Question 14: Can medications cause hair loss?

Answer: There is a long list of oral medications that have been implicated. Two common medications are coumadin (a blood thinner) and isotretinoin (Accutane®). Ask your physician if you have questions concerning your medication and hair loss.

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Question 15: Is hair cloning yet available as a treatment option?

Answer: Hair cloning, or autologous cell multiplication, has been a “medical promise of the future” for several years. However, cloning as a viable treatment for hair loss is still several years away.

One might assume that the small size of hair follicles would make them simple to clone. However, growing a hair follicle in a test tube would be as complex as growing a set of teeth! The first step is to successfully replicate healthy cells that grow hair, outside the body, and introduce them into a scalp successfully. The end goal is a cloned hair follicle that produces hair consistently, with the growth and texture of one’s natural hair. These goals have not been accomplished yet.

Hair cloning research is typically performed in the lab versus the clinic. Wolf Medical is quick to adopt new methods of hair regrowth and is in contact with those who are researching hair cloning. We will keep you posted on updates in hair cloning and other hair regeneration procedures as they are available.

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