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Hello and welcome. Doctor Stephen Mulholland here in Toronto, Canada on Plastic Surgery Talk. Welcome to our weekly podcast. If you find these informational, enjoyable, entertaining, please subscribe, share and comment today. Our podcast today is on hair transplantation, which we’ve done many times before because it’s a very, very busy part of my plastic surgery practice and extremely common. In North America, hair transplantation is a billion dollar business.
The way we harvest it has changed completely. We’ve gone from strip graft harvesting using a scalpel and cutting out a chunk of hair and slicing and dicing that into little hair grafts to an automated, or robotic, rotatory punch system that harvests one hair family a time leaving a little trace of that harvest that’s .8 to .9 millimeters in diameter. Basically, when it heals you can hardly even see it. Why is that important? It’s allowed us to harvest from the back of the scalp or other body areas, like the back or the chest, the groin, the legs as donor sites without a scar.
This has opened up a tremendous opportunity in facial hair transplantation. Women and men, facial hair transplantation. For women, it tends to be facial hair transplantation to eyebrows. Eyebrows have been over plucked, traumatized from plucking where there’s no more hair growth. We will often then do hair transplantation into the eyebrows. For women also we can transplant into the actual eyelashes. Women without eyelashes from a hereditary lack of eyelashes or eyelashes that have been over extended or traumatized, or just eyelashes that are insubstantial and haven’t responded significantly to Latisse. So eyebrow/eyelash for women. For facial hair transplantation on men it comes down to the beard and the mustache. Occasionally a traumatic eyebrow injury, a hockey player or a car accident leaves a scar in an eyebrow. Sometimes we’ll do it in the eyebrow, but for men it’s about getting a full mustache and a full beard.
One of the most common questions I get, is it possible to grow a full beard if I have a patchy one? That’s the most common reason that we do FUE, or follicular unit extraction transplantation into a male face is for a patchy beard. A man who can grow a beard that’s pretty good here, but it’s weak in the mid mandibular body. Or they can grow a mustache, but not the full Fu Man Chu, or the bottom part of the mustache to connect the beard. Or the beard’s too thin and there’s nothing in the upper cheek, or there’s a weak vertical ascending portion of the mandibular body. There can be very patchy beard growth and we can do hair transplantation into the face, into the beard, to give a full luxurious look to that beard.
How is it performed? We take hair from certain areas of the back of the scalp, the preferred donor site where the man will never lose hair, and we strategically take the right shape and density of hair and we implant into the face. The growth is predictable, and generally you can create a very full luxurious beard when you have a patchy beard with hair transplantation.
So, is hair transplantation into a beard beneficial and does it look real? The answer is yes and yes. We can take hair from preferred donor sites, the back of a male scalp, and take just the right size, density, and caliber of that hair that more matches the caliber, size, and density of facial hair and transplant into the face with great predictability. We take the hair one hair family at a time, we create a little donor site slit with a needle, and we insert the hair graft to fill out the patchy areas where there is no beard. It can look extremely real with our techniques and strategy on density creation, on the right caliber and thickens of the hair, on the angulation of that hair. We can create very, very natural beard patterns.
The genetic code for hair growth at the back and the side of the scalp is a lot longer than a beard, so some guys can grow a very long beard. But some parts of the beard don’t grow that well, and one of the problems with hair restoration and transplantation into the facial areas you get very long hair. You have to be prepared to actually trim your beard much more frequently than you may normally have to do because that hair is genetically programmed to grow long, like a long ponytail at the back of your scalp. Trimming your mustache, trimming your transplanted beard, it becomes a fun chore to do after the hair transplant starts to grow.
What technique of hair transplantation is best for men who are seeking a mustache or a facial beard transplantation? Well, you have to consider the donor site and the recipient site, or how do we harvest it and how do we transplant and implant it. For the harvest perspective, gone are the days of strip grafting, of taking a large chunk, a large strip, usually 12 to 14 centimeters long and two to four centimeters wide, and then stapling or stitching that up in the back and leaving a linear scar. We use nonlinear scar techniques now where we take the hairs one at a time with automatic automated and robotic technologies. Artist, and Neograft, and Safe Graft are the three busiest and biggest out there. They all work through a rotatory mechanism that rotates down, extracts one hair at a time. That’s by far the best technique for young men or any age men who’s doing facial hair transplantation for the beard and the mustache because we leave no donor site scar at the back of the scalp. So nonlinear scarring techniques, Artist and Neograft are the best transplantation techniques for a facial hair grafting.
Then, of course, we need to take that hair that we’ve transplanted and insert it into the facial beard pattern with a great degree of skill and artistry so it looks natural. A stick and place is usually the most common technique where we take a small needle, make a poke and stick, we call it a stick, in the skin in the exact recipient site and place a hair in to replace and augment the beard or mustache. Then we do another one, and then another one, and then another one. By stick and place, by individually creating one hair augmentation at a time and dynamically creating that beard right in front of you, that’s the best, in my opinion being the busiest hair transplant center in Canada, that is the best way to create a very natural hair transplantation beard or a mustache augmentation for men or eyebrow and eyelash augmentation for women.
How does a facial hair transplant procedure work? Well, we divide the procedure into harvest and implantation. First of all, we meet with our patient. With a guy, we meet with them and we outline exactly what kind of beard pattern they want. How high, how thick, the shape of the sideburns, the height of the beard across the cheek, the shape of the mustache into the Fu Man Chu and the [inaudible 00:07:29]. We draw the outline of the beard we want to create or the mustache we want to create. Once we’ve got that we can estimate how many grafts we need. Then we outline at the back of the scalp how much scalp we have to shave in order to access through our Artist or Neograft techniques. Then we apply local anesthesia to the back of the scalp. We do that with nitrous oxide, laughing gas, and some medications so the patient is very comfortable. Then for the next two hours or so we target the number of hairs we need from just the right spot with just the right density and caliber that we’ll need to create and fill in our map and drawing of the beard we want to create, the mustache we want to create. Or for women, what eyebrow and eyelash volume and numerical density we need.
After the harvest, we create anesthesia on the face. We provide local anesthesia like I would with any facial injectable technique. Once we’ve made the area we’ve drawn anesthetic with our local then we can start to do stick and place. We keep all our grafts on ice so they’re nice and cool, and they’re not aging metabolically. We take them off the ice and we stick them in these little slits, so we make one slit at a time, until we fill in with optimal density and angulation the hair density required to fix the patchy beard, the mustache, the eyebrow, or the eyelash. Once we’ve done the implantation we go over post treatment instructions, and the patient heads home.
What are the pros and cons of hair transplantations? Well, one of the many advantages, it gives you the ability to create density and hair volume in an area where you’re challenges. That could be on the scalp if you have thinning in the frontal region, or the back, or the crown. It could be when you have an insubstantial, thin mustache or a Fu Man Chu, or you can’t grow a full beard. Or your eyebrow has been traumatized, or you plucked it as a woman. It allows you a natural hair growth in an area where you would have to resort to artificial techniques and strategies, like powders, or eyebrow liner, or eyelash optimization and fake eyelashes. It allows a natural creation of facial hair density and volume where you would have none with hair that comes from you, is you, feels like you, and is completely and 100% natural. The advantages are a natural, permanent solution to areas of your face or scalp where you have not enough hair.
The cons are you need an operation or a procedure to get this done. The advantages of the newer procedures we’ve developed over the last decade, they’re done under local anesthesia. There’s no risk of a general anesthetic. We have nonlinear scarring techniques where we harvest from donor sites that don’t leave a mark. We can do this usually all in one day. The recovery is quick with very little downtime. There’s almost no pain ’cause there’s no cutting, there’s no staples, there’s no stitches. We take what used to be a relatively morbid procedure with downtime and paid and made it essentially painless with no scar. Those are the advantages, the ability to give you a scarless donor site and augment suboptimal density in facial areas like eyebrows, eyelashes, beards, and mustaches.
How does your hair grow after a procedure like this FUE for facial hair augmentation? Eyebrow, eyelash, beard, or mustache. Well, there’s two answers to that question. How does it grow in the donor site, first. Remember, the hair that we stole from the back of the scalp to donate to the facial grafting, it never grows at the back of the scalp again. We need to spread it out over an area or a patch so there’s no obvious deceased density in the zone that we take it. The good news is that we have so much hair at the back of our scalp if you take 500, or 1000, or 1500 little hair follicle grafts you are not gonna look thinner at the back of your hair. You can donate that amount of hair no problem. In fact, when we’re doing hair restoration in men we can take up to 12000 follicular units from the back of the scalp over a series of transplants and the back never looks too thin. The hair that we shave at the back, it will regrow over a week or 10 days and it will hide the little donor sites that we had for the follicular unit extraction. You will not see any marks at all.
So the back grows naturally as well you shave your head with anything. You do a little haircut and you shave a patch down to a number one blade, it grows to number two in a week, number three in two weeks, and just grows naturally. The hair that we steal, the hair that we take, we put on ice and then implant. That grows in the recipient site in the following fashion. About 50% of all the hairs we transplant into an eyebrow, a mustache, or a beard, the shaft will fall out from the shock of the transplant. It’s called telogen effluvium, or TE, shock hair. It’s like re-potting a plant. You re-pot it, sometimes the blood and the flowers of the petal fall off from the new soil. There’s some hair that goes into shock loss, about 50% of the shafts will fall out. The other 50%, they nestle in, their root takes, picks up a blood supply, and within two weeks the shaft starts growing.
So, half the hair that we transplant into your eyebrow, your eyelash, your mustache, or your beard starts growing right away. The other half, the bulb lives. In 92% of the cases the bulb will live. It may lose its shaft through shock loss, but it will live. In about three or four months a second phase growth starts when the shaft starts to grow again. It will come out through the pore in the skin and will start to look like stubble, like you shaved your entire beard, you got little stubble, then it starts to grow. It will contribute to the first phase growth. It may take a few months to catch up to the length you like to keep your beard at, but you get first phase growth right away, by three-four months second phase growth. It unites with the first densification implantation and finally, by about seven or eight months, you start to see optimal density at the right length that you want for your beard, your eyebrow, your eyelash. Unfortunately, unlike hair transplant, you got to start trimming your beard, your eyelash, your eyebrow fairly quickly, ’cause it’s programmed to grow quite long at the back of your skull. Much longer than you want your facial areas. Within about two months you’ve got to take that hair and start trimming it. Beard trimming, mustache trimming becomes a much more frequent task than in the genetically programmed hair that grows naturally on your face.
Will I lose the hair that I have successfully transplanted into my face one day? Will it one day fall out? Will I lose hair where I implanted it? Will some of my natural beard hair fall out? These are common questions. The biggest question that males have when they think about this, and women, let’s say I get older and I have some thinning hair at the back of my scalp, but you stole the hair from the back of my scalp from my beard. One day if I go a little thin on my scalp will I go thin on my beard? Will it fall out one day? The second question I have is how much hair will survive the transplant? How much will die and fall out and never grow back?
Let’s answer that second question first, how much hair will survive? What’s the survival rate of facial hair transplantation? The survival rate of hair transplantation approaches that which we get in the scalp, meaning that we take the hair out, we implant it, over 90% of the bulbs will take and get a blood supply. The shafts will grow and they will live. You can expect over 90% of your hair will survive. About 8% of all transplanted hair bulbs do not pick up a blood supply and they die, and that hair will not grow.
Second question, let’s say you have a successful hair transplantation procedure and you’re aging. You’re getting into your 30s, and then your 40s, and then your 50s. You’re starting to grow bald and you’re losing hair from your scalp. You realize, “Wow, half my face is from my scalp, will my beard go bald?” The answer is no, ’cause where did we steal that hair? We harvested it from the fringe hair at the very low part of the nape of your neck. That area, that Friar Tuck zone where even bald guys, George Costanza bald, Friar Tuck bald still have a rim of hair around the low back of their scalp around the sides. It’s called the preferred zone or the fringe zone. That’s where we steal the hair from when we do facial hair transplantation. Even if you go totally bald, you will still have a beard because we stole the hair from an area that never goes bald.
What is the cost? What is the price of a facial beard or a facial mustache, eyebrow, or eyelash transplantation? In general, for scalp transplantation the cost of an FUE, or follicular unit extraction, transplantation procedure is dependent upon the number of grafts that are transplanted. In general, it is going to cost you for scalp transplantation usually between eight and $14000 if you’re gonna do two or 3000 follicular unit transplant. The price per follicular unit across most clinics in North America can be anywhere from $10 per graft to $15 per graft. The price of your procedure will depend on how many grafts you need. The average amount for a mustache is, in terms of numerical content, can be anywhere from 750 follicular unit transplants to 15000. The price for most full mustache or beard in most major urban markets could be anywhere from six-nine-nine, or $7000, to as much as $12000 because a full beard and mustache will often take 3000 follicular units.
Eyebrow transplantation and eyelashes, it’s less dependent on how many grafts you need and more dependent on the delicacy and specialization of the area. We’re one of the few clinics in Canada that does eyelash transplantation, so we charge about $5000 for eyelash or eyebrow. Even though you might only need 250 to 500 grafts, because it’s a very delicate, very specialized procedure, it needs a skillset and a specialized center to do so, and a very delicate area. For eyelashes/eyebrows you’re looking usually around five to $7000. For a full mustache, it might be anywhere from six to $12000. A full beard with a mustache could be as much as, like [inaudible 00:18:11] transplantation, as much as 12 to $15000.
Are there any additional prices or costs associated with my facial hair transplantation? Well, the good news is no. When you think of scalp transplantation, we often see guys three or four times for multiple sessions over 10 or 15 years. As they get thinner and thinner and balder and balder they need to bring more and more hair up to their scalp. Each procedure might cost 10 to $12000 and they have to do it three or four times. It might cost them between 35 and $50000 to keep the total head of hair going over three sessions in 10 years. That’s totally different with let’s say a beard transplant or a mustache transplant, because you are not gonna lose facial hair. It’s a one time cost. You’re not coming back to top up your beard because you’re losing hair as you get older. For a mustache, beard, eyebrow, eyelash it’s usually a one time fee. You get the density you want, the look you want, and there’s no associated cost.
Occasionally, a guy will come back in a year, his beard has grown out, his mustache has grown out. Or a woman, her eyebrow has grown out. Comes back and says, “I love it, but I got a couple patchy areas here and there. Can you add like 100 grafts?” So sometimes there’s a small fee to do an enhancement density top up at one year, but then that’s it. There’s no ongoing hair loss in your face and you’ve had a one time expense to get the facial hair you want, and that lasts for your lifetime.
The final analysis, the big question always is, is hair transplantation to my face, my facial area, the right option for me? The answer is if you want a full luxurious mustache or a beard, or as a woman an eyebrow or eyelash, you don’t want to use eyebrow liner, paint, or powders, you want it to be natural and look attractive, and be actually real then transplantation of hair done without the strip linear scar technique but with FUE is absolutely the right option for you.
So, thank you very much for joining me, Doctor Stephen Mulholland, for Plastic Surgery Talk here in Toronto, Canada with our weekly podcast series. This one has been on the very specialized and interesting area of facial hair transplant ions. For females, eyebrow/eyelashes. For males, usually … Sorry, females would be eyebrow/eyelash. For males, mustaches and beards. If you have found this to be interesting in content, informative, entertaining, please share. Otherwise, subscribe and comment. Leave a comment if you’ve found this to be entertaining and informative. Look forward to seeing our next podcast here at Plastic Surgery Talk.