Dr. Ted Miln is performing refined follicular unit grafting with incredible density, with results that are undetectable from his patient's native hair.
Currently the only solution for regrowing hair, particularly in the hairline area, is hair transplant surgery, an advanced surgical hair restoration technique.
Done right, a hair transplant is so natural that even a hair stylist cannot detect that a person has had hair transplants.
The days of the "corn row" or "Barbie Doll" hair transplants are long gone.
To achieve such truly natural results requires a dedicated and highly skilled staff doing a state of the art hair transplant procedure. The state of the art micro hair transplant procedure that our member physicians perform is called "Ultra Refined Follicular Unit Hair Transplantation".
Hair transplant surgery involves relocating (transplanting) the bald resistant hair follicles from the back of the head to the balding areas on the top and front of the head.
This process is effective and will last a lifetime because the hair follicles taken from the back of the head are genetically resistant to baldness, no matter where they are transplanted.
This procedure is regarded by most hair restoration physicians to be the "gold standard in hair transplants". Learn more about this hair transplant procedure.
Because this very refined procedure is difficult to perform at the highest quality level only a minority of all hair restoration surgeons perform it successfully. Our member physicians have extensive experience performing this advanced and very refined procedure with excellent proven results.
Today, hair transplant surgical hair restoration is an out-patient procedure requiring only local anesthesia. Most patients are surprised by how little discomfort they experience during and after their surgery. Many patients watch TV or sleep during their procedure.
Sharing information in the Hair Loss Learning Center forum with patients who have successfully restored their hair is a good way to begin the process of selecting a hair transplant surgeon with a proven record of restoring a natural hairline. Online consultation can put you directly in touch with one of the world's top hair restoration physicians in your area who can help you assess your options.
Today it is a very refined outpatient procedure that can produce full and natural looking results, even after only one hair transplant session.
When performed correctly not even a hair stylist will detect that a person has had a hair transplant.
However, to achieve such natural results it is critical that the hair transplant procedure be "performed correctly". To do so requires a hair restoration clinic that can perform a follicular unit hair transplant at the highest levels of skill, experience, and dedication.
What it takes to create natural results.
A great hair transplant is the result of using a state of the art surgical procedure and performing it with great skill and artistry. Today the acknowledged "gold standard" in hair transplant surgery is called "Ultra Refined Follicular Unit Hair Transplantation".
This relatively new hair transplant procedure enables a patient to achieve extremely natural results because it recreates and mimics the way a person's hair grows naturally, hair for hair.
Recreating Nature Hair for Hair
To understand this procedure you must first understand how hair grows naturally.
If you look closely at naturally growing hair using magnification you will see that hair actually grows in groupings of one, two, three, and four hairs.
These naturally occurring hair groupings grow in irregular patterns on the scalp similar to trees growing in the forest. These groupings are technically referred to as "follicular units".
By relocating these carefully prepared and isolated follicular units, physicians doing "follicular unit hair transplantation" recreate a natural pattern of hair in the balding areas.
Follicular Unit Hair Transplant tough on the clinic but easy on the patient.
To do this properly is a very time consuming process. It requires a team of skilled and meticulous medical technicians working closely with the lead physician.
All our physician members perform this hair transplant procedure with excellent results. They are granted membership in the Coalition of Independent Hair Restoration Physicians strictly based on their proven high level of experience, ethics, and skill in successfully performing this patient friendly procedure.
While the follicular unit procedure is more demanding upon the medical staff, it produces dramatic and life long advantages for the patient such as undetectable naturalness, rapid healing, and optimal use of their limited donor hair.
The Standard Hair Transplant, easy on the clinic but not on the patient.
Only a minority of hair transplant surgeons are committed to doing the follicular unit procedure properly. Many physicians continue to dissect grafts without regard to the integrity of the follicular units. Follicular units are often transected and damaged as donor tissue is cut to conform to the size of the recipient holes rather than to maintain the integrity of the follicular units.
Such common standard hair transplant procedures are quicker and simpler to perform than follicular unit hair transplantation from the hair transplant surgeon's perspective. The standard hair transplant procedure is also often more profitable for the clinic since it requires less staff time, training, resources, and skill. However, the results are generally suboptimal for the patient.
Respecting the Follicular Unit
Each follicular unit is surrounded by small glands, blood vessels, nerves, and a connective tissue sac making it a tiny self contained unit.
If these follicular units are damaged during removal or dissection, the hair may grow poorly.
Therefore it is important to cut only in the loose tissue between the follicular units to keep each follicular unit intact and avoid damaging it.
Nioxin is an excellent product including both a shampoo and conditioner formulated specifically for men and women with thinning hair."> While neither the shampoo nor conditioner hasn't been proven to have any effects on DHT (the hormone responsible for male pattern baldness); Nioxin's ability to strengthen follicles and energize cellular activity can improve the overall health of your scalp and hair. Nioxin therefore may have the ability to delay the effects of hair loss. For best results, use both the shampoo (refered to as Nioxxin Shampoo Scalp Cleanser) and conditioner (referred to as Nioxin Scalp Therapy) in conjunction with one another.
Nioxin Scalp Cleanser's cooling properties refreshes and cools the scalp promoting maximum cleanliness and freshness. Because of this, Nioxin shampoo, especially when combined with the conditioner also significantly reduces scalp itchiness and tenderness after hair transplant surgeryin both the recipient and donor areas.
Nioxin Scalp Therapy is an excellent volumizing scalp and hair conditioner that moisturizes and improves your hairs' natural resilience, while promoting a healthy scalp environment for optimal hair growth. Nioxin Conditioner is the perfect conclusion to the Nioxin Shampoo Scalp Cleanser.
Nioxin Scalp Therapy's minty fresh cooling sensation literally refreshes and cools the scalp promoting maximum cleanliness and freshness. Because of this, Nioxin also significantly reduces scalp itchiness and tenderness after hair transplant surgery in both the recipient and donor areas.
We strongly recommend using Nizoral shampooevery 2 or 3 days in conjunction with Nioxin. Its active ingredient ketoconazoleat 2% concentration has proven to be a moderate DHT inhibitor and has growth properties approximately as effective as Rogaine2%.
Developing Realistic Expectations:
Men and women sometimes suffer from hair loss for different reasons. Thus, diagnosing its cause is necessary to facilitate and promote proper treatment.
The Nioxin product line is an excellent scalp and hair cleansing shampoo and conditioning therapy but is not proven to stop hair loss. Thus, we strongly recommend using Nioxin in conjunction with the "Big 3" (Propecia, Rogaine, and Nizoral.
Dr. Barghouthi performs Ultra Refined Follicular Unit Extraction (FUE) and Follicular Unit Strip Surgery (FUSS) with excellent results. He and his staff can perform extensive mega sessions with dense natural results.
Dr. Felipe Pittella performs ultra-dense mega-session and Giga-session FUE procedures on Norwood 6 and 7 patients with excellent density and coverage. Dr. Pittella combines quality and affordability with coverage and density.
Hair transplant procedures have evolved a long, long way since they began in the early 1950's. The "corn row" or "doll's" hair look that was associated with hair transplantation has evolved into today's "follicular unit" procedure that, when done right, is undetectable even by a hair stylist.
The Concept of the Hair Transplant is Born
During the past several decades superstition, old wives tales, and guess work has gradually been replaced by science.
The early 1800's is renowned in hair restoration circles as the age of the con men. There were hundreds of hair restoration treatments released and many lasted well into the late 1900's. These "cures" were marketed by "doctors", whose only skills were those of fast-talking and nerves of steel (as well as bravery, considering they were conning hardened cowboys and outlaws!).
The salesmen hawked their products from the safety of their side shows and "Wild West" spectaculars. They used endless tricks to get people to buy their products, such as rubbing grease into people's hair, to make it look thicker.
In 1939, a Japanese dermatologist, Dr. Okuda, published a revolutionary method in a Japanese medical journal that would lay the ground work for modern hair transplantation.
This method involved using hair transplant grafts to correct lost hair from various areas, including the scalp, eyebrow, and moustache areas. However, this study didn't make an impact in the Western Hemisphere due to the interruption of World War II.
Hair Restoration Comes of Age
In the late 50's one physician in particular, Dr. Norman Orentriech, began to experiment with the idea of relocating or transplanting the hair on the back and sides of the head to the balding areas.
Dr. Orentriech's experiments showed that when bald resistant hairs from the back and sides of the head were relocated they maintained their bald resistant genetic characteristic regardless of where they were transplanted.
This principle, known as "Donor Dominance", established that hair could be transplanted from the bald resistant donor areas to the balding areas and continue to grow for a life time. This laid the foundation for modern hair transplantation.
The Scientific Era of Hair Restoration
During the 60's and 70's hair transplants grew in popularity. However, the standard of care used larger grafts that were removed by round punches and often contained many hairs.
This now outdated hair transplant technique could achieve good results with a full look if a patient completed all planned sessions. However, a patient was typically limited in the manner they could style their hair.
Patients who stopped short of completing all planned sessions were left with hair transplants that looked obvious and unnatural. Such uncompleted hair transplant results are some times referred to as "Barbie doll hair" or "corn rows".
Many who have had these older techniques now refine or complete their bad hair transplants with today's very refined techniques to achieve a natural look that they can style in any manner.
Over the past several years surgeons have used various techniques to perform follicular unit hair transplantation. One such technique is the Lateral Slit Technique, also known as Coronal or Perpendicular Grafting. This technique’s name is derived from the angle and direction in which the graft incisions are made.
While there are other techniques for performing densely packed and highly refined follicular unit transplantation, the lateral slit technique offers a high degree of control over the angle and direction in which the transplanted hairs will ultimately grow.
The lateral slit technique has been used both intuitively and systematically for years by hair restoration physicians. However, it has recently gained popularity as a systematic and precise way of performing follicular unit hair transplantation.
How our member physicians use the Lateral Slit Technique.
Many of our physician members use the Lateral Slit Technique exclusively or in combination with other techniques for creating graft incisions. The lateral slit technique enables a surgeon to create graft incisions at varying angles (ranging from 10 to 90 degrees to the scalp), including very acute angles that will make the transplanted hair grow out lying flatter to the scalp. The ability to create incisions at very acute angles is particularly useful in areas such as the front temples and sides where the hair normally grows out lying flat on the scalp.
The graft incision determines the direction of the hair growth
The lateral slit technique also helps enable a surgeon to determine the direction of the graft incisions. This then determines the ultimate direction of the transplanted hairs growth. Thus a surgeon can use this technique to control and vary both the direction and angle at which the transplanted hair will grow in order to mimic the subtle changes in hair direction that occur naturally.
Each graft incision is created by analyzing the neighboring hair so the surgeon can reproduce the correct hair pattern. As a result, as each transplanted hair emerges from the scalp it will grow and lay in a similar direction as its neighboring non-transplanted hairs.
Lateral slits can enable denser packing of grafts
Lateral slit incisions also tend to be more parallel to the scalp and thus more superficial and less invasive to the scalp’s underlying vascular structure. This parallel alignment also enables a physician to place more grafts per square centimeter with out the grafts compressing or popping up since the pressure exerted on the grafts does not push them upward from the scalp.
Using blades cut to the size of the grafts
Some of our members use custom blade cutters to create tiny blades to make incisions that match the size and depth of each follicular unit graft being transplanted. This enables a surgeon to safely dense pack more grafts into a given area during a surgical session. Healing time is also more rapid, with minimal scarring.
Typically most clinic’s blades range from 1.5mm to 2mm in size. However, by using the custom blade cutter our physicians can create blades as small as .7mm for a single hair graft and .9mm for a multi hair graft.
In addition, the blades created by the custom cutter are squared off to match the shape of the bulb end of a hair follicle. Non custom cut blades are typically spear pointed which requires them to be inserted deeper thus causing more trauma to the scalps vascular structure.
The ability to control the depth of the incision each blade makes is also critical. Each blade is placed in a blade holder that is set to not allow the blade to go any deeper than required for the graft to being placed in the incision. This minimizes unnecessary trauma to the deep vasculature of the scalp, thus enabling close tight incisions, minimal tissue swelling, and quick healing that leaves no visible scaring, pitting, or cobble stoning of the scalp.
Placing grafts to maximize their aesthetic result and coverage
The plane and direction in which each follicular unit graft is placed on the scalp can also impact the ultimate appearance of density that can be produced with a given number of grafts. This is because hairs within a follicular unit are typically next to each other inline.
Therefore by arranging each multiple hair graft on the scalp in a linear fashion to the line of sight, each follicular unit will provide the maximum appearance of fullness and scalp coverage. This also mimics how hair is normally aligned on the scalp.
Special thanks to Dr. DeYarman, Dr. Sharon Keene, Dr. Jerry Cooley, Dr. Alexander, and Dr. Glenn Charles for contributing their expertise and photos for this section.
These types of treatments work by stimulating hair growth. However, they can't stop hair loss completely as they don't address the root causes of hair loss. Products that act to stimulate hair growth include Rogaine, Tricomin, Folligen, Proxiphen (along with Prox-N and Nano Shampoo) and Retin-A.
Tricomin
Tricomin, which is used by men and women, is a topical spray that has undergone a wide variety of scientific testing. The spray’s main ingredient is copper, which has been proven to be beneficial for hair.
The FDA has conducted some clinical studies, with the subjects applying the treatment twice per day for 24 weeks. These results were shown to be very positive. However, the product’s parent company, ProCyte Corporation, chose to release Tricomin as a cosmetic. They wanted to avoid the FDA approval process, which tends to be very lengthy.
Tricomin may be an effective option for those who want a treatment that’s undergone scientific testing, yet isn’t drug-based.
The product can be used safely by men, women and children. It’s also non-irritating and has no known side effects. Tricomin can be used for any type of hair loss
The product should be sprayed to damp or dry hair twice each day. But if you’re using another topical treatment, such as Rogaine, you should wait a few hours before applying Tricomin. This is because the scalp may turn a greenish color when mixed with other products. However, this discoloration isn’t permanent and washes out. And like other treatments, Tricomin needs to be used regularly to maintain its results.
Besides the spray, Tricomin is available as a shampoo and conditioner. They should be used as an addition and not as a replacement, though.
For more detailed information of Tricomin Follicle Therapy Spray, Shampoo and Conditioner, click here.
Folligen
The makers of Tricomin make this product, available as a cream, lotion and spray. It was originally designed as a skin repair cream in the Dermatology Department at the University of California at San Francisco.
However, a 41-year-old woman with severe hair loss re-grew lost hair in two and one-half months with the cream. The company, Skin Biology, has since marketed this cream, which also contains copper-peptide as a hair loss treatment. The blue-colored copper-peptide complexes are meant to improve hair vitality and the health of the scalp and hair follicles.
Folligen products are meant for both men and women. They feature a cream for hairline application, spray for overall use, and lotion for bald spots. While Folligen may work on its own, its best results may be seen when it’s used with products like Rogaine.
Essentially, Folligen’s products soothe irritated scalps. They also relieve the itching and burning associated with Rogaine. However, the Folligen spray may cause itching or burning. Also, because the cream and lotion are bright green, it’s better to use them at night, while covering your pillow.
And while you can wash Folligen off easily, it’s not advisable for people with very light blonde hair to use the product. They may develop a greenish tinge to their hair.
Proxiphen, Proxiphen-N, NANO Shampoo
Proxiphen is a prescription formula topical cream that has not yet received FDA approval. It combines the power of minoxidil and other chemicals. The cream should be applied everyday for the first 8 - 12 months, and after that, every other day. Proxiphen is dispensed only when a physician gives a diagnosis of hair loss.
Proxiphen-N, the non-prescription Proxiphen is less expensive and is also not as strong. It’s advisable for patients to use minoxidil with Proxiphen-N.
NANO (nicotinic acid N-Oxide) shampoos and conditioners are an excellent compliment to your existing minoxidil treatment. They contain NANO, which is a minoxidil-like hair growth stimulator. They also have agents that stimulate hair growth. These products are beneficial when used with Proxiphen and Proxiphen-N.
In order to see some results, Proxiphen-N and the NANO products need to be diligently used for at least 8-10 months at the very least.
A one-month supply at prescription strength is about $100. A 2-month supply of Proxiphen - N will cost $59.95. A 90-day supply of NANO Shampoo and Conditioner will cost $39.95 and $29.95, respectively.
Retin-A
Retin-A (also known by its scientific name, tretinoin gel 0.1%), is a topical treatment that’s primarily used as an acne medication. However, research has shown that Retin-A, either by itself or with Rogaine, may grow some hair in those with male pattern baldness or female pattern baldness.
To use Retin-A, you should apply a thin layer with a gauze pad or cotton swab to the affected areas at bedtime. Remember to wash your hands immediately after using the product! You should also take care not to get any Retin-A near the eyes, mouth, or open cuts. The medication may irritate sensitive skin.
It should also be mentioned that if Retin-A is used more often, the results will not improve. Rather, the side effects may increase. These effects include an immediate warming of the skin. Other skin problems may include peeling, itching, scaling, redness and maybe mild stinging. Luckily, once your skin adjusts to the medication, these effects should subside.
Retin-A may also cause increased sensitivity to sunlight as well as wind and cold. For these reasons, you should avoid prolonged exposure to the sun and sunlamps. You should also use effective sunscreens, and wear protective clothing.
In regards to pregnant mothers, research hasn’t shown any risk of birth defects, as of yet. Nevertheless, physicians recommend using Retin-A during pregnancy only if necessary. You should also consult your doctor before breast-feeding. One tube of Retin-A Cream can be purchased for about $28.00.
Along with Propecia, Rogaine is one of the only proven hair loss medication options approved by the FDA for treating hair loss. Minoxidil, (Rogaine’s active ingredient), was originally created as a drug for treating hypertension (high blood pressure). It was then discovered that one of its side affects was growing hair. Minoxidil was then tested for use a topical application for regrowing hair. The results were sufficiently impressive that the FDA approved it as a treatment for hair loss.
Rogaine works by revitalizing shrunken hair follicles, thus increasing their size. When you use Rogaine every day, your follicles may increase in size, and the growing phase may become longer. This may then produce longer, thicker hairs.
Rogaine is a clear alcohol-based solution and should be applied to a person’s thinning area with its supplied dropper or spray twice a day.
The solution is approved and available in two strengths -- Regular (2%) and Extra Strength (5%). Individual users of Regular strength Rogaine have claimed success rates of 30-40%. Meanwhile, users of Extra Strength Rogaine have claimed success rates of 50-60%. Currently, the average price for a 2oz. bottle of Rogaine is about $20-30 per month. Minoxidil is also available as a generic and can be purchased over the counter without prescription.
It’s important to note that Rogaine (minoxidil) does not cure baldness and scientists have been unable to determine just how it works. What is known is that Rogaine increases the blood flow to the areas of the scalp that surround these balding areas. Currently some researchers believe that Rogaine (minoxidil) works by opening the follicle’s potassium channels located in the cells. It’s theorized that these channels, when opened, may regulate hair growth.
Rogaine can’t grow hair on completely bald scalps or in the frontal hairline areas. It has been found to be somewhat effective in maintaining or growing hair in the crown area (the top back of the head). However, Rogaine is only effective at delaying hair loss. It is also more effective in women than in men. And again, the reasons for this are not understood.
What can I expect with Rogaine?
Rogaine (minoxidil) generally only regrows hair in a minority of men and women. In most cases, the best case scenario for hair growth with these treatments is a thin coverage of thin hair.
The real benefits of Rogaine (minoxidil) is keeping what hair you have or slowing your thinning. Rogaine’s success depends on how advanced your hair loss has become.
You must apply it to your scalp twice a day for life to get and maintain any benefits. Research shows that using Rogaine (minoxidil) only once a day is ineffective. If you stop taking Rogaine (minoxidil) you will loose whatever hair you preserved or regrew within 2 to 4 months. And while Rogaine may stimulate hair growth, it may not prevent the hair follicles from their eventual deterioration.
It's also true that Rogaine's effects may diminish over time. Some doctors believe that patients can build up a tolerance after many years of use. But it's possible to fight this tolerance by taking a week or two off from the treatment every 3-4 months. However, it's not advised to take this break unless you've taken the hair loss medication consistently for at least 12 months.
Are there side effects from Rogaine?
There are only minor side effects with Rogaine. But some users do experience certain problems such as scalp irritation, itching, and dandruff. However, this can be treated with a good shampoo like Nizoral or Neutrogena T-Gel. There may also be an increase in hair shedding at the start of the treatment. You shouldn’t panic, as this may actually be a signal that the treatment is working.
Due to the medication’s alcohol content, some users may develop a contact rash or irritated skin. And with excessive doses, some users may experience dizziness or a rapid heartbeat. However, with normal use these effects are uncommon.
Rogaine users with severe, refractory high blood pressure experienced some problems. One such problem was “hypertrichosis,” hair growth on the face or other bodily areas. This side effect appears in about 3-5 % of women who use the 2% solution, and higher among women using the 5% solution.
Rogaine and Hair Transplants
Some hair restoration physicians have come to consider Rogaine to be instrumental right after surgery. This is especially true when grafts have been placed in and around existing hair.
The shock of surgery can result in temporary hair loss. Rogaine is thought to possibly help prevent this temporary loss of healthy preexisting hair. The 5% solution has been found to be more effective for men and women. However, some physicians believe that the hair loss medication should be stopped a week or two before surgery. They feel that Rogaine may increase bleeding, while dilating blood vessels.
After surgery, most patients wait a week or two before restarting Rogaine. This gives the graft areas time to heal. However, taking Propecia is not interrupted by surgery.
Dr. Barghouthi performs Ultra Refined Follicular Unit Extraction (FUE) and Follicular Unit Strip Surgery (FUSS) with excellent results. He and his staff can perform extensive mega sessions with dense natural results.
Dr. Felipe Pittella performs ultra-dense mega-session and Giga-session FUE procedures on Norwood 6 and 7 patients with excellent density and coverage. Dr. Pittella combines quality and affordability with coverage and density.
