Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica.
Hello and welcome, Dr. Stephen Mulholland here in Toronto, Canada. Welcome to our podcast series. This podcast is on frequently asked questions or FAQs on FUE, the modern and intelligent way, with a linear scarless approach, to hair transplantation.
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How common is hair transplantation? In the United States alone, there are hundreds and hundreds of thousands of hair transplantations performed every year. Approximately 30% of all males are afflicted by some degree of male pattern hair loss or androgenic hair loss, so extremely common. The problem has been that we have done a very poor job, I think, until the last 15 years at giving men and women natural hair restoration results that don’t look transplanted, and certainly leaving them without the stigma of hair transplant scars. Now with the modern approach to FUE, follicular unit extraction, that’s what it stands for, that is now possible.
How does FUE hair transplantation differ from other techniques? Well, the principle competitor to FUE or, again, follicular unit extraction in transplantation, has been the typical and traditional strip graft, which has been available … It was available … It’s been available for about 30 years. Strip graft and FUE have the same common goal. We steal hair from the fringe area at the back of a man’s scalp. That narrow little Friar Tuck zone or George Costanza zone that you never lose. Even if you go totally bald, you always have that little strip of hair at the back at the bottom of the scalp and around to the sides. That’s the preferred zone, the zone we never lose.
Now there’s two ways to take the hair from there, and then put it at the top where you need it. Strip graft actually cuts a strip of scalp right out. It’s usually about two-inches wide or four centimeters wide, by about 14 centimeters to 18 centimeters long. That leaves a line scar right around the back at the bottom of the skull. And then on a windy day, a rainy day if you wear your hair short, you have a scar. The more hair restorations you do, because usually you need more than one or two during the course of your thinning life, you’re going to have more and more scars. And so although it works well, the donor site is marred by a disfiguring scar. A scar that can often leave the donor site very unattractive and the recipient or the patient very self-conscious.
With FUE, rather than a strip graft or rather than cutting scalp out, we take multiple hair units. Hairs grow in little groups. One hair per bulb unit. Two hairs, three hairs, or four hair families that grow in units. And we take them out with a little rotatory punch that can be .9 millimeters in diameter. And we don’t stitch, we don’t have to cut, there’s no bleeding, it just heals. So it’s a follicular unit extraction, a rotatory device, robotic or automated, that can take out little groups of hair families one at a time with no scar, no cut, no suture, therefore no visible evidence that you’ve ever had the donor site harvested.
How does the FUE recipient site work? How do we do the transplantation? Well, whether you harvest with a strip technique and a scar or a linear scarless FUE, now you have the hairs on ice ready to go. We make a tiny little poke with a needle called the recipient site. The right angle, the right depth. Then we implant one follicular unit at a time. So we use a slit implantation technique with no scars and no cutting. And the key to a naturally beautiful restoration is a perfect hairline, singles along the hairline, doubles and triples add mix behind that at just the right angle with the right densification. And again, that’s all become a perfected art in science. And here at SpaMedica, we’ve been doing FUE hair restoration for over a decade. I invested in the first automatic FUE machine called [Punch O Matic 00:04:41] way back in 1999. So we now have the FUE technique down to 3000 follicular units, often two, two and a half hairs on average per unit. So 6000 hairs are transplanted in a one day procedure under local anesthesia. And the results have never been better.
Do the results of FUE transplantation look natural? And again, it depends on the skill, the artistry experience of the implanter. You can harvest the FUE’s without a scar. Without the knowledge of the right angulation, where to use double, triple, single, or quadruple hairs, you can end up with an unattractive recipient site. So yes, done well, a recipient growth of FUE harvested hair can look amazingly natural to the point where some of the best hair restorations in Hollywood are amongst people who are famous athletes, politicians you don’t even know anymore. Gone are the obviously transplanted Ken Doll hairlines of the 1980s. And now with FUE, scarless, linear scarless donor site, and beautiful natural hair.
I’m often asked about FUE hair transplantation, how long will it last? The question really should be asked, “I’m gonna get hair restoration with hair that’s never gonna fall out. How many more do I need?” Because the hair restoration that we do, the hair that we take from the back from the preferred site and move into the recipient site, it is not going to die. So the results of a hair restoration once your hair has survived the grafting process, the revascularization, and starts growing, that hair is forever hair. Why is that? Well, the preferred zone, the fringe zone, the back of your scalp, those little follicles have a totally different enzyme apparatus genetically.
We don’t know why male pattern hair loss or bald guys exist in the human DNA. However, the balding guy, the guy with male pattern hair loss has good hair in the fringe zone. Those bulbs have a normal enzyme called 5 alpha-reductase. Those normal bulbs can take testosterone that a guy makes and convert it down to usable metabolite. The problem with male pattern hair loss and the genetic code that comes from your parents, it codes for bad follicles. Bad bulbs in the central oval. The front, the middle, and the back may have defective enzyme systems. The 5 alpha-reductase is not good at breaking down testosterone. And what builds up is a metabolite along the pathway that normally doesn’t exist. It’s called DHT, dihydrotestosterone. And that metabolite of testosterone acts very toxically on the bulb. Hammers away at the bulb for years and years. And in your early teens, mid-twenties, late-thirties. Depends on the concentration of DHT and upon the defective enzyme, the 5 alpha-reductase.
Your bulbs wither away and die. The hair falls out quickly or slowly and progressively and you get thin. Now some guys thin from the front back. Temporal recessions. Or they start in the crown and they crown out and their crown gets bigger. Then the front and the back meet. Now some guys get totally bald. George Costanza, Friar Tuck, no hair on the top, front, back, or the middle. Some guys just thin a bit. Some guys crown out. So there’s various stages or classifications of thinning called the Norwood classification. And not everyone goes totally bald.
So the question, how long will your transplant last? The hair from the back that we steal and move to the front will last forever. What doesn’t last forever is your recipient hair. You continue to express the genetic tendency to thinning over the years. So you do your transplant, we fix the zone. Everything looks good. But you have ongoing loss. The ongoing loss results in thinner and thinner hair of your natural hair in the recipient zone. And you may have beautiful transplant hair, but where it was doubling down in the hair you have, when you lose the hair you have, you look thin again. So you may need, in fact, plan on a number of stage transplants on average every five to eight years. And if you got full-blown, gonna be a Norwood Six, Friar Tuck, no hair left on your head, you may need four or five transplants over the course of 15, 20, 25 years to restore the front, middle, and back of your hair. So the short answer, the transplant hair last forever. Your own natural recipient hair may die according to its genetic code. And you may need to put more permanent hair up there to get the pattern and the density that you want.
Is there anything that you did as a hair restoration patient when you were a kid or young adult that caused this problem? The answer is no. Urban myth number one, my baseball hat was too tight. Urban myth number two, I washed my hair too much. Urban myth number three, I didn’t wash my hair enough. Urban myth number four, I kept pulling my hair. Tugging at it. Or adding … For women who get thinning, adding hair extensions. Urban myth number five, I didn’t cut my hair enough. Urban myth number six, I cut my hair too much. All these are not true. None of them will lead to male pattern hair loss. The real cause is genetic and there’s nothing you can do about it other than intervene. So what are the interventions for male pattern hair loss? The number one intervention, the one that works the most is blocked testosterone and production without testosterone, there can be no build up of metabolite.
How do we do that? We use a testosterone blocker called Propecia. Propecia, which is a commonly used, also called Finasteride, is a commonly used testosterone blocker used to treat prostate hypertrophy. Benign prostatic hypertrophy called BPH. And it will cut down the testosterone so you don’t have as much DHT built up. The problem is the side effects. Propecia Finasteride, won’t stop male pattern hair loss. But it’s the closest we have to delaying it for decades. So you may be destined to be completely bald. And if you start Propecia or Finasteride a little early enough, you will never go bald. You’ll thin gradually, but you’ll never go totally bald. It’s the only we know to truly prolong the inevitable genetic fate.
There are other treatments you can try. Low-level light therapy, Minoxidil, which is Rogaine, this evasive dilator, increased blood flow, maybe work a bit on the crown. Not so much on the front of the scalp. We have micro needling. And one of the most encouraging things recently has been use of stem cells. Platelet rich plasma, PRP. And this platelet rich plasma is blood that we’ve drawn in a normal blood draw. And we spin it down into stem cells with growth factors. And we inject it into your scalp. And it stimulates dormant hair follicles. It increases the density or stage of hair in growth phase. So you have more density. And it prolongs the inevitable male hair loss pattern you can experience. So PRP has become a very important part of prolonging the inevitable and sustaining a denser look while you are going thin.
The question also comes up then, if you’re going to do Propecia, are there any dangerous side effects? And there’s a small segment of guys that may develop a more aggressive version of prostate cancer. And so you want to have a doctor who follows you closely. Does prostate specific antigen test to ensure that you don’t get a cancer while saving yourself from baldness.
So is it a one-time treatment, FUE? You do your transplant, fix the thinning area, and you’re done? The answer is yes, but probably no. Yes, it may be the only session you need. If you have a mild variant of male patterned hair loss, you are destined just to have a bit of a crown. And you come in and you’ve got a bit of a crown in your 40s and 50s. It may be the only session you ever do. You might come in in your 40s and 50s. You’ve got a little recessioning, thinning of your forelock. We do a session to densify, create a stronger hairline. You may never need another one.
The other spectrum of the hair restoration patient comes in their 20s. Early 30s. They’re crowing out. They’ve got recessioning. And it’s progressive ongoing male pattern hair loss. They tend to be more near total baldness patients and often expresses over 20 years, they get balder and balder. So the answer is, when do you need another session? You stage the sessions for progressive, thinning, and baldness in different regions. You start at the crown, you start at the front. You may need to stage another session in several years time when another area becomes unacceptably thin. You may need to double down and densify. And you’re already transplanted when you’ve got an add mixture of normal recipient hair and transplants. But you continue to have ongoing loss of normal recipient hair. You have to double down on density.
And so at the right physician center like at SpaMedica and other centers out there with a lot of FUE experience, they act as the curator of your donor site. We have a donor site of so many hairs that we can steal. And we manage at a stage and interval when to do the next transplantation. On average, if you’re thinning in your mid to late 20s and you do your frontal zone and your crown, you’re gonna need four sessions over the next 20 years to get total scalp coverage as you lose the total top of your central oval. And we need to manage when we do those transplants together with your thinning male pattern hair loss progression.
And so do you need ultimate sessions? Yes, if you have progressive disease. Do you ever need to touch up or revise a treatment area? Rarely. We get way over 92% graft take. And if we just do just the right density, you’re gonna get a pleasing result. You can have ongoing hair loss. That’s not a touch up. That’s a predicted added density when you lose some of your recipient hair. Occasionally through scalp infection or complication, you can have some hair loss in an area where the transplant should have survived. In those rare instances, 1% of the time, well, we may need a revision or enhancement treatment of maybe several hundred to 1000 grafts in the area where there’s unpredicted and underwhelming survival of the graft. That’s rare. 95% of the time, most patients are happy with the density and they have ongoing stage restoration as their male pattern hair loss progresses.
When we take these little hairs back out from the back of the scalp, a very common asked question, does the hair regrow there? And if it doesn’t, won’t I look bald at the back? Excellent question. If you look at the fringe hair, for most men, we have about 20,000 to 25,000 follicular units in that little fringe hair at the back in the back side of your scalp called the occipital zone. We don’t want to go too high because that may [inaudible 00:16:00] into the crown area. And you don’t want to transplant hair that will fall out one day. We want permanent hair that never falls out. Now we have a fixed amount of hairs there, follicular units. We have 20,000 follicular units. Now how much hair do you need if you have a full head of hair at the top? Front, middle, and back third. If you count up that oval, we need about 20,000 follicular units. That’s how much we had when we were 18 and we loved our hair. But if we take all 20,000 from the back and move it to count for all 20,000 you might lose at the front, you’re gonna be bald at the back. So we cannot steal all 20,000 follicular units from the donor site.
Really, what I found over the years, we can steal 12, maybe 15,000 follicular units. But if you go bigger than that, you’re gonna go thin. Too thin at the back. Because that hair does not grow again. We moved it up front and it’s now transplanted, adding density in your thinning areas. Now if you do the math, 12,000 in the back doesn’t fit into 20,000 in the front. So you can never have the thick, luxurious hair in all zones you had when you were 16, 17, or 18 years old. So something gotta give. And implanting, generally, we’re gonna air towards transplanting adequate density at the front two-thirds. The front and middle. If that’s long, thick, luxurious hair, you can do a comb back and then cover a little thinning crown area, then that’s the best plan. We let the crown thin, wither, and sometimes even go away to make sure the front two-thirds, the front third, the middle third, has nice hair. So we act as a transplant center of excellence for over a decade as your curator on how best to use that 12,000 into the 20,000 that you might be losing.
So the answer to the question is no. The hair we steal at the back never grows back. So if you take too much, we’re gonna leave you with a bald spot. And we can’t do that. So we gotta try to optimize the optical illusion of density, which is a lot of hair at the front and less hair as you go back. So it looks like you got a ton of hair. But if you look at the number of hairs per square centimeter, when you’re 16, 17, 18, most guys have 200 to 300 hairs per square centimeter at the front. And naturally only 100 per square centimeter at the back. We follow that same natural, less density as you move back in the scalp to keep you looking like you never ever were going to be or were bald.
Another common question I get. Can I … I’ve run out of hair or I don’t have enough donor site. Can I get hair from a donor? I’ve got a buddy, I’ve got a brother who’s willing to donate some of his hair. The answer to the question is that’s great if you need a kidney, or a liver, and you’re a great HLA match means that you have relatively few proteins that are formed between you. When it comes to hair, you are never gonna do a hair transplant from a donor unless they’re an identical twin because it’s not a tissue match and your body’s gonna reject it. The only way we tolerate livers and kidneys is we get a good tissue match and we go on immune suppressants for the rest of our life. These immune suppressants like Imuran and other anti-immune modulators are very dangerous drugs that make you susceptible to cancers, they make you susceptible to infections. And that’s okay if you need a liver transplant, you’re gonna die. But you’re not gonna die from being bald. So no one can ever get a donor from a foreign recipient without immune suppression and it’s not worth the immune suppression. No doctor would ever do that.
So the answer is no. The only person you can get a donor from that’s not you is an identical twin. And that would mean that identical twin doesn’t mind going bald and will donate the hair to you. If you have that kind of identical twin, you’re laughing. Because now you can take your 12,000 units and his 12,000 units and get the hair you want.
Another frequently asked question. Dr. Mulholland, I’ve done my hair restoration. Now I’ve used up 12,000 follicular units from the scalp at the back. I’ve got good hair in the front and the middle third. But what can I do about my crown? I’d love to do something for my crown. But I got a hairy chest, or a hairy back, or hairy legs. Can I use that hair? The answer is yes. But judiciously. The hair from the back of your head could grow very long. I mean, you can have a long mullet or a ponytail. It’ll grow nice and long on your scalp. But you don’t see anyone with braided chest hair or braided armpit hair. It’s genetically programmed to grow only maybe two centimeters. And that looks kind of like a shrub where what we want here is a tree, not shrubs.
And so where do we use chest to scalp? Where do we use back to scalp? When we want landfill. Shrubbery. Let’s say we got a little thinning in the crown. We’ve transplanted a bit of hair. But we want to cover the white without using a powder like that nick powder. We can take chest hair, transplant it to the scalp and get the white look of a crown covered without having to use powders. And that’s the big use of chest to scalp, back to scalp, is coverage with shrubbery. Short hair from the chest so it obviates, or it camouflages, or hides the white of the scalp in a thin area like the crown.
When will my transplant hair look normal? How long does it take to grow out and look normal? That’s a very common question. So we shaped with stubble in the donor site. We take our little rotatory devices. A robot called Artas or a rotatory automated system called NeoGraft. And we harvest our little FUEs. About six to 800 grafts an hour. And we have them on ice. And we implant them. But when we implant them, the bulb goes in first, picks up a blood supply, then the hair’s gotta start growing. So it’s very short. Imagine how long if you had a number one blade, it takes that hair at the back to grow to be nice, and long, and full. It might take eight or nine months to get the hair length you want. So the FUE technique is very gentle. There’s no manipulation of the grafts. No shaving, no cutting down. We take it, we put it on ice, and we implant it. We don’t manipulate.
With a strip graft, there’s a lot of manipulation. Cutting, slicing, and dicing the grafts into small little graft units. So therefore when we implant it from the strip graft days through a little slit, there’d be a lot of shock hair loss. The transplanted hair would go into a shock phase from a lot that manipulation. And the shaft would fall out. The bald would take, but the shaft would fall out. And you have to wait four or five months to see any hair growth following the strip. With the FUE, non-strip, non-linear scar technique, there’s very little manipulation. The grafts go right on ice, decreases their metabolic rate, then we implant them. There’s a very high initial take rate without shock loss of about 50 to 60% of all hairs get a blood supply. So through diffuse and [inaudible 00:22:58], the bulb lives. The shaft hasn’t been traumatized so it stays in tact. And it’s sticking out about a few millimeters and just starts growing. So 50% of your hair with follicular unit extraction transplantation, it’ll start growing.
So you get stubble, hair shafts, and growth within the first three, four months. Now half the hair still does go into a shock phase called telogen effluvium, or TE, and these telogen effluvium hairs fall out from shock like the old strip graft technique. You’ll wait three, four, five months. Second phase growth happens. The bulb lives, pushes a shaft out the pore, and then you feel more hair. And then it grows and unites with the first phase growth. So first phase growth, first four, five month second phase growth, they unite. Get long together. By one year, you finally have that thick, wavy, recipient hair that you’ve been hoping for. So from transplant to we can call the final result on densification appearance, 12 months.
Is there anything that I can do as an FUE patient to enhance my growth to minimize risk of shock loss of the hair that I already have? It’s a very common question. And the answer is yes. We can use PRP or platelet reach plasma to inject in the scalp, a couple months, two treatments, one month apart, two months before the transplant, to optimize the toughness of the hair we’re transplanting to minimize shock hair loss of the recipient site.
So what is shock hair loss of the recipient hair? This is where we implant our donor hair, but the recipient hair is old. It’s withered. It’s been assaulted by DHT. It’s not strong hair. And the shock, the stress of the implantation causes that hair to fall out. And sometimes it doesn’t grow back. So a patient will say, “Well, I went through all of this. I put 3000 hairs out. But I was shedding lots of my long, normal recipient hair and it never grew back.” Well, that’s a disaster because now you’ve taken a transplant hair that’s gonna live forever, you lost your normal hair, and the net improvement is zero. There’s no net density improvement. And that’s a shock loss phenomenon. So when we analyze your hair and we look at that recipient, if you’ve got a lot of older, dying hairs, we do recommend PRP before the treatment to minimize shock loss. That’s the single most important you can do. Topical shampoos, nurti shampoos, eating right, low-level therapy, micro needling. All these things have a marginal benefit compared to PRP or platelet reach plasma injections, injections of stem cells, and growth factors.
When can I get my hair barbered, styled, or cut both in the donor site and the newly growing hair on the recipient site? How long after a hair restoration using FUE do I have to wait? In general, you want to start barbering the back and blending in the levels of the hair from where it was very short to where it was adjacent to that. You can do that at about 10 days. So your barber can kind of blend in so things are looking the same length.
The other camouflage strategy for the area we have to shave, and why do we have to shave such a big patch anyway? It’s a very common question. We shave the big patch with FUE because if we take all the hair from one small area at the back, it’s gonna leave a bald spot. But if we spread out the hair restoration harvest, a big area, take one follicular unit family, leave five or six, move to another. Take one, leave five or six around it, we can spread those little .8 millimeter donor site defects. It doesn’t look thin. So we need a big patch at the back shaved. Which means you want to shave the whole back of your head. Let it grow out so you have a short style at the back and the side longer than the top. Or you just shave your head completely bald. If you can rock a bald hair look, it’s even easier for us as the hair restoration team because we could take it from the back. It’s all the same length. It’s short. We implant it. Easy to implant when there’s no hair in the way obstructing the view. And you just let all the hair grow then. The donor site at the back, the recipient, and the transplant hair at the front, let it all grow out. That’s option number two.
Some patients will grow very long hair at the back, like a old school mullet. And we can lift that hair up, shave our patch, which is usually about eight centimeters high by 14 centimeters long. And that long hair you have at the top falls over. The mullet hides it. And your donor site is hidden. And that’s what women do when we do hair restorations because they typically have very long hair at the back. If you’ve got enough tousled hair at the front, the little scabs that fall off in that first 10 days and then the stubble that starts to grow, you can’t see. And so your recipients that can be hidden by leaving your hair somewhat longer at the top. Or going totally bald everywhere and shaving your head allowing everything to grow out naturally. Those are some of the camouflage techniques that you can use to minimize the look of having a hair restoration procedure. And you can do your barbering or your hair styling usually at the back at around 10 days. And about six weeks to three months at the front.
Lets say you have gray hair. Are we gonna transplant gray hair to the front or the dark hair? That’s a common question. Well, clearly we’re gonna look for the darker hairs to move to the front. Especially if you’re in your late 40s, early 50s with early graying. We’ll leave the gray at the back and you can dye it.
And the next question, when can I dye my hair? Because you’re gonna have some gray hairs in the recipient if you’re older. But you can’t use toxical chemicals like dyes too early or you’re gonna kill these very, very young grafts trying to survive. So we don’t recommend dying your hair for six to eight weeks till after the transplantation. Till those roots are taken, the shafts are tough, and you can start re-dying your hair. Do dye your hair right up to the day before you do the transplant. And then allow the roots to gray a little bit for that six weeks, which is probably a couple weeks longer than you normally wait till you can dye it again.
When can I wear a hockey helmet, a construction helmet, or a toque, or a low cool Nike cap after my transplantation? The answer is you have to wait the adequate amount of time for the hair grafts to get tough. Because if you’re transplanting in the front, middle, or back and you wear something that comes right down on top and rubs along that like a hockey helmet, a football helmet, a construction helmet, or a low lying, a low toque on a cold winter day, or a Nike cap that you pull down tight to your scalp, it’s gonna traumatize those grafts, pull them out, dislodge them, interrupt them, and kill them. And you’ll compromise your results. So we wait six weeks till there’s tough hair, the shafts are tough, you can add color to your hair or dye your hair then. And you can wear a hockey helmet, baseball cap, or a construction cap and not worry about traumatizing your hair. So you gotta wait between transplant and healthy take and tough hair before you can start getting any kind of tense [inaudible 00:29:50] or friction on the hair of the transplant.
What are the different FUE devices? There’s several on the market and what’s the best one? That’s a common question. And the answer is it depends on the clinic. There’s three big types of devices out there. There’s robotic, which is Artas where there’s a robotic computer algorithm for the rotatory punch rotating out the hairs using a .9 millimeter punch. There is automated, semi-automated technician controlled. The most common, by far, is NeoGraft, which is an automated rotatory punch that, again, rotates out the grafts. There’s other semi-automated and handheld FUE techniques. But they tend to be slower, not nearly as common. So the big two for FUE, Artas, and NeoGraft. They control most of the market.
Now the Artas people will say that the robot is best because it has less hair and it can harvest quickly. The NeoGraft centers will say, “Well, my technicians actually faster than a robot.” A little more accurate in the transection rate, which at the rate you cut through the shaft and don’t get the bulb out is lower on Artas practice if the technicians aren’t experienced with NeoGraft. And it’s lower with NeoGraft than the robot with NeoGraft technicians that are very experienced. So I would say what’s better depends on the clinic. Both can be very good effective ways to use a non-linear scarring technique. Rotatory punches powered by a robot or powered by a automated, semi-automated NeoGraft device and a technician. Both can harvest six, seven, 800 grafts an hour. And the neo implantation can either be semi-automated with NeoGraft or hand implantation technique at around 250 per hour per technician. So 500 per hour if they’re both implanting. Or with an implanting technique with a robot at around 250 per hour.
So I think they can be equivalent. Depends on the practice. Both can get great results. I have owned both for many years and I think they both give great results. So pick a practice with a lot of experience, with great before and afters, good testimonials before you decide which kind of FUE you’re gonna do.
Another common FAQ, how to decide on the best hair transplant center? Every city’s got two or three top centers. I’ve been the top FUE center in Toronto for over a decade. What makes me busy? What makes me one of the best, if not the best? Well, here’s what you should look for. Experience. A center with lots of years of experience trumps almost everything else. A center with excellent before and after should be patient, after patient, after patient of great results. Longevity, how long have you been in the business? So you’ve followed men from the beginning to the end of their journey, which may take 10 or 15 years. Testimonials. If you have a great center, you’re gonna have lots of guys who are gonna leave written, video, verbal, and before and after testimonials.
A center that has a great reputation online. Check out the website, but go off the website onto Real Self, Yelp, Rate MD, Facebook, Google Plus. These will help you decide the kind of testimonial power that a great center has. Brand recognition, word of mouth referrals. These are also very important parts of deciding who to go to. And then the consultation. You want to have a good consultation where they’ve done a good assessment of your donor site, recipient site. What are your goals? What are your expectations? What kind of recovery are you able to lend to this? And then they give you an honest estimate on the number of grafts it’s gonna take. They discuss the risk and the benefits without trying to hype or market. And give you a realistic sense of recovery and timeline and the number of transplants over how many years you may need and the financial investment to keep the hair that you want.
At the end of the day, a good hair restoration center will have all of those features. In the very end, you might dig into any medical malpractice, lawsuits, you can check that out. Usually through your local and state government. And check the state medical board or the College of Physicians and Surgeons and Canada. Make sure the physician is a certified physician, is a surgical specialist. There’s no specialty of hair transplantation residency. So it’s additional training you need to achieve after a plastic surgery, residency a facial plastic surgery, dermatology, or even family physician non-surgeon can get the expertise through the procedure. But it does take extra training. These are the factors and variables that I would look for if I was looking for an excellent center.
I’m a woman with thinning hair. Can I do FUE hair restoration, hair transplantation? Common question. The answer is absolutely yes. And most women who have thinning hair don’t even know that they can do the procedure. Don’t know that there’s something for them and it’s very embarrassing to have thinning hair as a woman. As a guy, we can still look kinda cool, and handsome, and attractive if we’re bald and shave our head. Women, it’s very embarrassing. It doesn’t look feminine, it doesn’t look virile, it doesn’t look … It just looks yicky like you’ve got an illness. And women don’t go totally bald. They tend to diffuse thinning. Diffuse thinning. And they have a different pattern of loss depending on the kind of female pattern hair loss, which is non-androgenic. And it’s usually genetic, like in there’s nothing they could’ve done to stave off going thinner. It’s called a Ludwig classification. And a class one female pattern hair loss generally has thinning in the front of the crown. And it doesn’t tend to regress. That’s just embarrassing. You can see the white scalp through the hair. A Ludwig two or intermediate female pattern hair loss will have it quite extensive in the middle. And a Ludwig three is a very large front half of the hair, which is quite thin. Diffusely thin throughout the top, but never completely bald.
So are women with thinning hair a candidate for hair restoration? Absolutely. And the FUE is perfect for them because there’s no permanent scar at the back of the hair. Women with female pattern hair loss tend to wear their hair long at the back so we can hide the donor site beautifully. And the good thing is that most women are not gonna go totally bald. So once we’re sure they’re Ludwig pattern one or two and bring the hair where they need it, it’s life long. There’s no ongoing progression. And we’ve solved the problem. So it can truly be life changing for women that suffer from female pattern hair loss. For very early female pattern hair loss, I also recommend PRP and I’ve got many, many, many women that are thinning, don’t want do do transplantation. We do three PRP, platelet rich plasma, sessions with stem cells and growth factors drawn from the patient’s own venous blood, inject it in the scalp, and after three sessions, 50% increase in densification curing them of their early Ludwig staging and very happy patients. No surgery required and it can be a life long improvement.
So if you’re a woman suffering from female pattern hair loss and thinning, don’t despair quietly suffering through the worst enemy being wind and water. A windy day or a rainy day exposes you have more scalp. Go to a center with a lot of experience in female hair restoration. And you can get your thick, luxurious hair you had when you were younger back again.
FUE sounds great, but can I do FUE to non-scalp areas? Like can I do it to my face? I’m a woman who plucked out my eyebrows, and I want to get thicker eyebrows back without painting or tattooing. Or I’m a guy who wants a nice [inaudible 00:37:42] stronger beard than the pattern I’ve got. Can I transplant to facial areas? The answer is yes. For over a decade, we’ve offered some of the best facial transplant FUE results that most patients don’t even know they can do. So we can transplant to the eyelashes. We can transplant to the eyebrows. We can transplant to mustaches, to goatees, and to full beards. So absolutely. We can get very natural, excellent results using FUE technique.
The one caveat is that hair is genetically programmed coming from the back of the scalp to grow longer than your facial hair normally would grow. And so the one down side of the FUE transplant as your eyelash, as your eyebrows, or as a male to the facial hairs, you get very long hair. And you gotta trim your eyebrows. You need to trim your eyelashes. And if you’re a guy and you want a very long beard, great to use hair from the back of the scalp because it’ll grow long. But it’ll grow longer than your normal facial hair. So you’re gonna have to trim your beard to keep it evenly. So yes, you can do it. Yes, it works beautifully. The only downside is you get overgrowth because it’s coming from the back of the scalp. And it always behaves like where it came from, not where it’s going. So FUE to the face, very popular. Very common. You really need to seek out an experienced center. Because that’s a very specialized area. And you really have to have the expertise of creating awesome looking facial hair pattern. And so make sure they’ve been in business a long time, they’ve done lots of FUE cases to the face, eyebrow, eyelash, mustache, side burn, or beard.
So thank you for joining me. Dr. Stephen Mulholland here in Toronto, Canada on Plastic Surgery Talk with our latest podcast installment on frequently asked questions for hair transplant patients who are exploring FUE, or follicular extraction and transplantation. If you found this educational, interesting, informative, and entertaining, please share it, subscribe, and comment. See you the next installment of our podcast series.