Dr. Glenn Charles

Actually diffuse thinning is a difficult problem to solve. I agree that you see a physician so they can rule out any medical abnormality. It is important to be confident that the hair loss is genetic or not before making a game plan. There are also three other non surgical options that may have some benefit to you situation. First, is Propecia which is a known DHT blocker . The second is laser therapy which can help to improve the health of existing hair and may prevent further loss. The third is the new PRP treatment which exposes all the hair follicles in the thinning area to Platelet Rich Plasma that is packed with important growth factors.

With all the current talk about PRP this video is a good introduction as to what it actually is. Although the video does not pertain to hair restoration I think it is important to know what is is first. There are few videos available already and many more to come soon explaining how PRP is being used within the field of hair restoration.

If performed properly you should have a hard time finding the scar once full healing has occurred. Therefore doing transplants on the same day into the area where the strip is taken from makes no sense. In the right hands a similar result can be obtained when using either staples or sutures. I agree that sutures are usually not as uncomfortable as staples.

You have made a good choice. Dr. Shapiro is the Master when it comes to hair transplants. He is also a really good guy and one of the true gentlemen in our field of medicine. You are going to be amazed when its all said and done. Say hello to everyone over at SMG it has been along time since I have worked there.

I cannot answer this question for other doctors. I choose to try new treatments like PRP because I feel strongly that we are on the brink of some really great new technology. I have also been involved with stem cell research and am trying to figure out what if any role it may play in hair restoration. Some doctors are more conservative and do not want to take the risk of endorsing a new type of treatment in fear that it may not work and their reputation may be tarnished. There will always be patients who are willing to try new treatments. As long as they are properly notified of all potential risks and understand that the treatment may not work I do not see the harm in it. If we never tried experimenting with new ideas and treatments we might still be doing plugs.

That is a very good question, One that is difficult to answer. I have been doing hair transplants for over 10 years and have a few patients that looked great for many years and then did have some apparent thinning. However, the majority of my patients have had continued success with there hair transplants. I also have seen many patients who had the older plug type surgeries 15-25 years ago and still have most of the transplanted hairs intact. This leads me to believe that in most cases the transplanted hairs are for the most part permanent.

800 Follicular Units spread out along the hairline should not cause that much shock. Hairs that were previously transplanted tend not to shock as easily as weak original hairs. If they do go into shock it is usually temporary. How much shock you would get from this next 800 grafts really depends on how many original hairs are present and how densely the new grafts are placed in relationship to the existing hairs. Some have tried to use laser or Rogaine post-op to neutralize the shock loss, but these treatments have not been proven.

You will be surprised at how resilient the follicles are. I cannot give an answer of what is going to happen in your case, but you should keep following up with your physician to make sure this problem completely clears up. I recommend using warm compresses only if there is a few scattered red bumps, and if there is a particular area that is getting a bunch of pimple like lesions the patient is supposed to return immediately. Try and stay positive and remain patient.

It is very unlikely to loose a graft almost 3 weeks after the procedure. If you had a little bleeding it was probably just a scab that was not quite ready to come off. I do not know the details of your surgery, but even if one graft did dislodge it should not change your results. Most of the time if a grafts is lost it will occur in the first 4-5 days.

You should get some relief when the sutures are taken out. Many patients describe it as though someone was pulling the back of the hair and then let go. If this Friday will be 3 weeks you definitely need to get them out soon. If there is a lot of itching that is the bodies way of telling you they are probably ready to come out. I recommend you do not try to see how far you can flex your neck by trying to touch your chin to your chest. This will put additional stress on the suture site possible stretching out the scar. Good luck.

I think what I said may have been misinterpreted. I did not say that in every large session of 5000 follicular units or more there will be a 20% loss. It has a lot to do with how large of an area you are putting those 5000 grafts and the techniques used. The point I was trying to make is that if you try to squeeze to many follicular units into too small an area there may be a lower percentage of successful growth. By the way I have been to visit my friends Dr. Wong and Dr. Hasson in Vancouver and they perform excellent hair restoration surgeries. They have a very large staff with tons of experience. Because they perform these large cases on a regular basis I am confident they have a higher success rate than some of the clinics who rarely do cases of this magnitude.

Looks like I am going to be the first Doc to take a stab at this one. The answer to this question is quite complex. It would depend on what physician was performing the surgery. Meaning does a particular Hair Restoration Surgeon and their staff have the actual capability of carrying out a procedure of greater than 4000 Follicular Unit Grafts in a reasonable period of time. As important, does the patient really have the donor hair density and scalp laxity? If all of the above is true there are still many other factors that should be considered. How large is the area in which the grafts are to be transplanted into? Would the patient prefer to have 5000 grafts placed into a specific area and have 4000 grafts actually grow hairs. That is an 80% success rate. Or would they prefer to have 4000 grafts placed into that same area and 3800 grow successfully? Giving a 95% success rate. Saving those other 1000 follicular units for later if needed. Is the physician really giving that patient those large number of grafts? It is awfully hard to go back and count. Another important point is that in order to get these large number of follicular units in a single session the surgeon must take out a large strip of donor tissue. There certainly is a greater chance of leaving a larger donor scar. Has the patient been notified of this possibility. I hope so. The list just goes on and on. I will leave it here and wait for some responses. later.

It is possible to have grafting to the anterior part of the crown and letting the hair grow to comb towards the back covering the posterior portion of the crown. It really depend on your age , hair characteristics, other areas of hair loss or previous hair restoration, and of course your expectations. Just make sure you are satisfied with the frontal and middle areas first before you start a large crown project. If you want to provide more details about your previous work I would be glad to give you my opinion.

I agree. This can be completely normal. However, if the pain persists or worsens I would recommend contacted your doctor. It is always better to be safe rather than letting things go and finding out you had a problem that could have been corrected if treated earlier.

In individuals who have the gene for MPB (male pattern baldness) those effected hair follicles have something called a DHT receptor. In simple terms that is like saying that the hair follicles in the thinning/balding areas have a small lock attached their outer surface. The DHT molecules are like keys and when they float through the blood vessels which travel adjacent to the follicles the key may fit into the lock. This binding of the DHT to the receptor (key into lock) is what causes the weakening and eventual death of the hair follicle. It has been proven that the hair follicles in the donor area do not have the DHT receptors (locks) so the DHT cannot bind to them. That is why you can take hair follicles from the donor area and move them to the areas of hair loss and they act as if they are still in the back of the head.

If you want to restore your hairline the only way is with a hair transplant procedure. The lasers, Propecia, and Rogaine all have most of the effects take place in middle and crown areas. Make sure if you do decide to have a hair transplant that you stay conservative with the height of your new hairline. Being as young as you are you want to make sure that you will still have enough donor hair for future transplants if necessary. The donor scar if done properly should only be a pencil thin line that will be very hard to find. You should still be able to cut your hair relatively short.( #3 or #4 with a clipper )

At 2 weeks post-op it is highly unlikely that you actually lost a graft or hair follicles. Especially if there was no bleeding. It is between the 2-4 week post-op that you will experience normal shedding of the grafted hairs. Whatever sponge you were told to use is no longer necessary. At this point it is really out of your hands and up to a higher power. Keep the faith.

It is relatively normal to experience some shock loss of the surrounding original hairs 2-4 weeks after the procedure. It is disappointing to hear that you did not have that possibility explained to you in detail prior to the procedure. Some patients might decide not to have the procedure if that was a possibility, but would not get the choice if they did not know about that potential temporary set back. Hopefully most of your shock loss will be temporary. Hang in there and be patient.

With the technology available in the field of hair restoration the results should be virtually undetectable. Certainly some cases depending on the patients hair characteristics are more difficult than others. Some patients may require more procedures to achieve the same degree of undetectability as other patients get with a single surgery. Often the small dots you are describing do fade over time especially after the hairs start growing. In some patients additional grafting also helps that situation.

I agree with Dr. Shapiro more information is necessary to answer your question properly. Another important factor is where is the hairline going to be placed. You should definitely be a little more conservative on the first procedure and not start off with to low of a hairline. Remember this has to look good now and 20 years from now. I often will give my potential patients the worst case scenario. What happens if we do a large procedure in the frontal area and as the years go by you have more hair loss in the mid and crown regions? The patient may only have enough donor hair to finish the front and middle zones. They have to be comfortable with the fact that at some point they may have a very nice hairline with good coverage in the frontal and middle zones, but have thinning or balding in the crown. Most patients are ok with that possibility because it probably won't happen until they are much older. They talk about how the hair loss is much more important to them now while they are still younger.

I have been doing laser hair removal for almost 10 years and you are not the first patient that has regretted it and wanted transplants to put things back the way they were. The new hairs should grow normally unless you developed scar tissue from the laser hair removal which is highly unlikely.

I totally agree with Dr. Mejia. One of the main problems with transplanting into scar tissue is that the results are much less predictable than transplanting into normal tissue. A doctor can transplant the same number of grafts with the same technique into two separate scars and have great results in one and poor results in the other. Unfortunately, scar revisions don't always reduce the size of the scar and in some cases the scar actually comes out worse. So transplanting into a scar might be a good first choice and the patient can always try a scar revision later as a last resort.

Head size and shape absolutely play an important role when a hair transplant surgeon is evaluating a potential patient. A hairline should be created only after a thorough examination of the patients scalp including the shape, overall size of head, area of thinning or balding, and facial features. Not to mention trying to visualize and estimate from patients family history the area of future hair loss, and most importantly taking into account the patients expectations. It is true that people that have smaller heads may not need as many grafts to cover the thinning or balding areas, but may also have smaller donor areas which means less available grafts to transplant.

Taking a good quality multi-vitamin will certainly cause no harm and will most likely have some benefit. Most people do not eat a very well balanced diet and could use some vitamin and mineral supplements. There are several ingredients in most multi-vitamins that have been identified as having positive effects on hair. These include but are not limited to Selenium, Biotin, Folic Acid, and Zinc. I believe that vitamins and minerals will have a more profound effect on the hair quality rather than hair quantity.

Yes, it is posible that the technician did not insert the graft to the proper depth. However, hair follicles are very resilient and there is a good chance that the hairs in that graft will still grow. If there is any redness around that graft that is not present anywhere else or if there is any purulent drainage then you might want to get it cheched to make sure there is no local infection. You can always contact the doctor who did the procedure and ask them questions. Hopefully, they will make themselves available to you.