Suneet Soni, (M.S), (M.Ch)
Dr. Suneet Soni
Dr. Suneet Soni provides state of the art FUT and FUE surgery and uses all the latest tools and techniques providing his patients with excellent results.
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Dr. Felipe Pittella
Dr. Felipe Pittella
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. -
Jerry E. Cooley, MD
Dr. Jerry Cooley
Dr. Jerry Cooley and his staff were early adapters of using microscopes to do excellent all follicular unit hair transplantation. -
Hair loss - Race, Age, and Gender Considerations
Hair loss is a universal condition, affecting all ages, races, genders and nationalities. It’s estimated that “androgenetic alopecia,” or male and female pattern baldness affects 35 million men and 21 million women in the United States alone. This section examines how race, age and gender affect hair loss.
Race and Hair Loss
In physiological terms, human beings are all composed of the same bones, muscles, and everything else down to the cellular level. But there are specific differences.
Hair, in all of its variations, is one area in which human beings display their differences. Hair follicles can widely vary in terms of color, length, shape, thickness, strength and various other factors.
There are many ethnic groups to consider. But we will focus on the special considerations of Asians, Blacks (of African descent) and Caucasians.
Asian Hair Loss Considerations
Asian people typically have very straight hair. Their scalps contain fewer hairs per square centimeter, they actually have a lower hair density than that of Caucasian hair follicles. But because the individual hair follicles of East Asians are thicker, this gives the look and impression of greater hair density.
For these reasons, hair restoration techniques for East Asians, much like other races, must be sensitive to a variety of anatomic and cultural differences. For instance, East Asian females often have an increased likelihood of developing “diffuse alopecia,” or hair that thins evenly over the entire head than Caucasian females.
Even though it’s not a definite requirement, it’s very helpful for Asian patients to seek out doctors with experience in Asian hair.
Another consideration for East Asians considering hair restoration surgery is the increased chance of developing keloid scars. A keloid is a thick, irregularly shaped and elevated scar with uncontrolled growth that results from excess fibrous skin tissue. East Asians typically have a greater likelihood of keloid development than Caucasians, but less than that of people of African descent. Therefore, before undergoing surgery, East Asians may want to consider being medically evaluated for keloids.
African Hair Loss Considerations
People of African descent usually possess naturally curly hair. This curly hair gives the visual impression of increased hair density for a given amount of hair, which is beneficial in hair restoration surgery.
The hair follicles beneath the skin of people of African decent also typically curve more than Caucasians. This can make harvesting the donor hairs, without severing or transecting the hair follicles beneath the scalp, more difficult. A hair restoration physician needs to be very aware of this difference and adjust to its requirements.
As in the case of East Asians, people of African descent possess some unique hair and skin characteristics. Some of these medical conditions are more common in black skin than in white skin. This may increase the risk for post-surgical complications.
Those of African descent have a higher chance of developing keloid scarring when injured. This in turn leads to a greater chance of noticeable donor scars. Keloids aren’t a widespread problem. But those with a history of them are carefully evaluated in regard to their existing scars. The evaluation usually involves a small "test procedure" to determine if there’s a normal healing rate.
Another issue is that of postoperative skin discoloration. With darker skin, there’s often a greater risk of both increased and decreased skin color after injury or surgery. These risks can be determined by the patient’s medical and family history.
Ingrown hairs are also a more common problem in darker skin. If a patient has a history of ingrown hairs or other minor skin infections, this may signal a higher risk for ingrown hairs post-hair restoration surgery. Again, this risk can be determined by a small test procedure.
Caucasian Hair Considerations
Caucasians (white people) may have a wide range of hair and skin types. However, if someone has dense and or coarse hair, as well as skin color similar to their hair color, they will generally achieve the best results for a given amount of restored hair.
Learn more about aging and gender hair loss
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Modern Hair Transplants
In the 80's hair restoration surgery as a hair loss solution evolved dramatically, as the large punch grafts were gradually replaced with a more refined combination of mini and micrografts. This "combination mini micrografting" hair transplantation procedure no longer used the punch to extract the bald resistant grafts. Rather a strip of bald resistant hair was surgically removed from the back of the head and then trimmed into mini and micrografts.
Typically the minigrafts (4-8 hairs) were used to create fullness and density, while the one, two, and three hair micrografts were used to create a refined and feathered hairline in front. This combination procedure also normally used more grafts, several hundred grafts per session, rather than the approximately 50 to 200 large grafts of the original punch graft procedure.
Follicular Unit Hair Transplantation (FUT) the "Gold Standard"
The 90's saw the gradual introduction of a very refined surgical procedure hair loss solution now known as "follicular unit hair transplantation" or "FUT". This exacting and labor intensive procedure transplants hairs in their naturally occurring one, two, three, and four hair "follicular unit groupings" in which they grow naturally.
To create such natural follicular unit grafts, which mimic the way hair grows naturally, typically requires the use of high powered magnification. Such magnification enables the surgical technicians to properly visualize the follicular units in the donor tissue. They are then able to isolate them and cut them into 1, 2, 3, and some times 4 hair follicular unit grafts.
The Age of Natural Hair Transplant
Critical to the ultimate success of the follicular unit hair transplant procedure was the introduction of the binocular microscope by Dr. Bobby Limmer of San Antonio Texas in the late 1980's. Dr. Limmer found that by using the microscope he and his staff were able to successfully isolate and trim the naturally occurring follicular units into individual grafts.
For his part in pioneering the use the microscope in graft dissection and the follicular unit procedure Dr. Bobby Limmer was awarded the "Platinum Follicle Award" by the International Society of Hair Restoration Surgery in 1996. Many physicians now fondly refer to him as the "Godfather of Follicular Unit Hair Transplantation".
Dr Bobby Limmer
Dr BernsteinWhile Dr. Limmer pioneered the use of the microscope in trimming follicular unit grafts, it was Dr. Robert M. Bernstein, in collaboration with Dr. Bill Rassman, who pioneered and advanced the concept of large sessions of all follicular unit grafting. These large follicular unit sessions enabled patients to achieve both naturalness and density.
Dr. Bernstein, who coined the name "follicular unit hair transplantation", tirelessly advocated for its adoption in ground breaking articles and lectures that are today recognized as benchmarks in the advancement of this procedure. Click to read these ground breaking hair restoration articles and papers.
In recognition of his many contributions in both conceptualizing, pioneering and advocating "follicular unit hair transplantation", Dr. Bob Bernstein was awarded the "Platinum Follicle Award" by the International Society of Hair Restoration Surgery.
Over time the merits of this refined but difficult to perform procedure became accepted and the follicular unit hair transplant procedure has become acknowledged by most hair restoration physicians to be the "Gold Standard" for surgical hair restoration. Click here to see video of a Follicular Unit Hair Transplant procedure.
Some feel that hair restoration surgery has evolved to its highest degree now that it relocates hair exactly as it grows naturally. However, even the "Gold Standard" in hair transplantation has continued to evolve by becoming even more "ultra refined".
Today some leading hair restoration surgeons, including all members of the Coalition of Independent Hair Restoration Physicians, perform an ultra refined follicular unit hair transplant procedure using very tiny incisions that enable them to safely "dense pack" tiny grafts when appropriate. This ultra refined follicular unit procedure is a hair loss solution that enables patients to achieve cosmetic density in a given area after only one surgical session.
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Dr. Manish Mittal
Dr. Mani Mittal
Dr. Mani Mittal provides customized hair restoration plans for each patient. He's involved in every step of the procedure and consistently provides high-quality results with high growth rates. His ability to recreate hairlines with artistry and finesse makes him an optimal choice. -
Trichotillomania and Treating Hair Loss
Men and women who have the impulse to pull their own hair out may be suffering from trichotillomania. Trichotillomania is an impulse control disorder characterized by the repeated urge to and behavior of pulling out one's own hair. Impulse control disorders resemble substance addictions because the patient feels out of control of his or her own behaviors. Men and women with trichotillomania live relatively normal lives but typically show signs of hair loss, thinning, and bald spots all over the scalp and body from pulling it out.
Treating trichotillomaniagoes far beyond trying to stimulate hair regrowth.Even if Rogaineor laser therapy for hair losswere to regrow hair, there is a strong possibility that trichotillomania patients will continue to pull their hair out. Patients with trichotillomania therefore, should be treated at the source of the disorder in conjunction with using proven hair loss treatments.
In addition to medication, Habit Reversal Training (HRT) by a trained counselor has proven to be successful in treating trichotillomania. With Habit Reversal Training, the individual is taught to recognize and redirect their impulse to other more constructive activities. Often times, trichotillomaniapatients are asked to keep a journal of their hair pulling episodes. This can help the counselor and patient to identify and develop strategies to avoid situations that might trigger hair pulling episodes. Journals often include the location of the incident, number of hairs pulled, date, time, and their feelings and thoughts during the episode.
Treating a trichotillomania patient's baldness may be done simultaneously or after proper treatment of the disorder. Rogaine (minoxidil)can be a helpful aid to HRT by stimulating the follicles underneath the scalp, potentially facilitating or expediting hair growth.Treating a patient’s hair loss while they continue to pull their hair out is not constructive. Since this type of balding is not genetic due to the production of DHT, Propecia (finasteride)won't likely help.
Patients who've suffered from trichotillomania for awhile may damage or even remove the hair roots by excessive pulling, making non-surgical hair regrowth next to impossible. Surgicalhair restorationmay be an option for trichotillomania patients whose hair roots are too damaged to produce new hair on their own. Hairrestoration surgeryshould be reserved only for patients who've been successfully treated and no longer suffers from trichotillomania.
Catching and treating trichotillomania early will most likely reduce damage done to the hair follicles and eliminate the need for hair loss treatment, since undamaged hair will return on its own.
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FUE – a new way of doing Follicular Unit Hair Transplantation
Follicular unit extraction is a minimally invasive procedure for performing follicular unit hair transplantation. However, unlike the predominant follicular unit transplant procedure, in which a strip of donor tissue is removed and dissected under magnification, the FUE procedure uses a small punch to extract each follicular unit one by one.
Both the strip excision and FUE procedures create 1, 2, 3, and 4 hair follicular unit grafts that are then transplanted into the balding area in the same manner. The primary difference between these two procedures is the technique used to harvest the follicular unit grafts.
Comparing the Strip Excision procedure to the Extraction (FUE) procedure
The common strip excision method of performing follicular unit hair transplantation involves surgically excising a thin horizontal strip of bald resistant skin from the donor area.
Strip Excision Procedure
Donor strip being excised
Incision sutured together
Hair combed down after suturingThis donor area is then sutured together. These sutures (either stitches or staples) are then typically removed about ten days after surgery. Some physicians use dissolvable sutures so that no removal is needed.
Patient’s donor area 2 months after surgeryOnce this linear incision is fully healed the patient is left with a thin horizontal scar in the back of the head. This scar is typically hard to detect since the surrounding hair conceals it, even when the hair is cut short.
To view a video of an actual strip excision surgery.
How the FUE Procedure is performed
With the Follicular Unit Extraction or FUE procedure 1, 2, 3, and 4 hair follicular unit grafts are carefully extracted one at a time using a tiny punch of one millimeter or less. Often the surgeon requires the patient to buzz cut a portion of their donor area so that they are able to see the patient’s scalp.
The follicular units are extractedThe follicular units are extracted by placing the punch around a single follicular unit and cutting a small circle through the skin around that follicular unit. The follicular unit is then gently pulled up and away from the loose tissue underneath the skin.
The small hole left behind after the follicle is extracted then heals over the following week. Normally this small round incision contracts as it heals making the resulting round scar smaller than the size of the 1mm punch that made the incision. The FUE patient ultimately ends up with hundreds of small round white scars, which are normally not detectable once the patient’s hair grows out.View a video of an actual FUE surgery.
To Extract or to Excise, that is the question.
Advocates for the relatively new FUE procedure claim that this procedure produces less noticeable scarring and no tightness or numbness in the donor area since no donor tissue has been pulled together and sutured. Many patients and physicians find the claim that FUE produces less visible scarring to be debatable.
Some physicians and patients also have concerns about the relatively new FUE procedure, such as the lack of formal studies regarding the percentage of follicles that may or may not be transected during the sight unseen extraction process.
In addition, since the physician must personally extract all follicles, one by one, the FUE procedure is very physician dependent and thus very expensive. The FUE procedure also requires considerably more time in surgery to move a given amount of hair to the balding area.
The standard strip excision procedure has the advantage of utilizing a collaborative team to carefully create the grafts once the donor tissue is removed in a strip. This collaborative approach enables a well trained staff to do sessions of 2,000 to 3,000 all follicular unit grafts in a single day. This team approach enables a patient to get a much larger number of grafts/hairs in one sitting at a much lower cost per hair than with the FUE procedure.
However, some believe that despite being relatively costly the FUE procedure may be appropriate for patients who have very limited elasticity in their donor area or who only need a small number of grafts.
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Provillus as a Hair Loss Treatment
One of the more popular hair loss products on the market today for those with thinning hair is Provillus. Available for both men and women, making promises to “re-grow beautiful healthy hair”, this product consists of a topical and oral solution with an FDA approved hair regrowth ingredient and a number of conjectured “all-natural” dihydrotestosterone (DHT) blockers.
Other ingredients that promote a healthy scalp and head of hair are also contained in this product. The theory behind Provillus is to revive the hair follicles with growth stimulators and attack hair loss at its source by blocking DHT.
In order to fully evaluate the efficacy of this product, we must further explore each ingredient to determine whether or not this hair loss treatment delivers what it promises. Below you will find a list of ingredients and information that will help you determine whether or not Provillus is right for you.
Topical Ingredients:
Minoxidil (found in Rogaine, Xandrox and other solutions) is an FDA approved hair growth treatment and many balding men and women use it with great success. This particular ingredient is what allows Provillus to advertise their product as FDA approved.
Azelaic acid has been found to clean the skin and potentially inhibit DHT, the hormone responsible for androgenic alopecia.
Combining these two “forces” therefore in theory, may be a more powerful treatment than minoxidil alone. However, no clinical studies have been performed on azelaic acid as a standalone product therefore, whether or not it can stop hair loss is purely conjecture.
Oral Ingredients:
The Provillus oral solution contains a number of supposed DHT blockers including saw palmetto for hair loss, Vitamin B6 and Zinc, pumpkin or cucurbita maxima, and nettle root. Because evidence exists that these ingredients may be an effective treatment for benign prostatic hypertrophy (BPH), theories have been produced that they might also effectively treat baldness. Though we can appreciate the aspiration for balding men and women to use herbal products as an “all-natural” replacement for Propecia (finasteride), the problem we have is that most of them only contain anecdotal if any evidence at all that they can successfully treat baldness.
Provillus oral solution also contains a number of components that are said to promote healthy hair growth and cleanse the scalp. These include eleuthero, uva-ursi, muria puama, horsetail, para-aminobenzoid acid (PABA), and magnesium. Understand however, that promoting a healthy scalp and hair is not the same as stimulating newhair growth and hair regrowth, nor does it signify an effective hair loss treatment.
Possible Side Effects
The only side effect that we could find listed on the Provillus website is an upset stomach. It is reported that taking it with food often stops this. Be sure to follow the links to the ingredients listed above as many of them also have potentially reported side effects. Consulting with a physician before taking any herbal hair loss medication is advised.
Dosage
Currently there are no standards on dosages of herbal medications in the United States. In addition, no formal clinical studies have been performed on them for treating baldness. Therefore, the suggested daily value listed on the ingredient package is based on something other than government regulation and scientific study.
Costs
A one month supply of Provillus topical and oral supplement for men or for women costs about $50 per month. Discounted prices are available when bought in bulk.
For the cost of Provillus, one can purchase generic finasteride and generic minoxidil which are FDA approved hair loss treatments for safety and efficacy.
Conclusions and Our Opinion
Given that Provillus topical treatment contains FDA approved hair regrowth ingredient minoxidil; we can at least agree that it may have some marginal benefit for men and women suffering from androgenic alopecia. However, due to the lack of compelling evidence in these other conjectured hair loss solutions, it may be more beneficial and cost effective to spend your money on Propecia (finasteride)for men only and Rogaine (minoxidil) that has helped balding men and women worldwide.
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Hair transplants - Are they right for you?
Most hair loss sufferers can benefit from hair transplants. However, some are better candidates than others and will achieve more dramatic results.
Different Patients Achieve Different End Results
Two Hair Transplant Sessions one totaling 1860 grafts the other 2995 graftsIt is important to have realistic expectations and to find a hair transplant surgeon who can meet or exceed your expectations.
Surgical hair restoration is largely a matter of "Supply and Demand".
The look you can and will achieve with hair transplants is determined by several factors. But the most critical factor is really a question of "supply and demand".
The supply of hair is how much viable bald resistant donor hair you have. The demand is how much bald area you want to cover and to what degree of thickness.
Your “Donor Hair” determines what you can achieve.
For virtually all hair loss sufferers, even those with severe baldness, there is typically hair that grows for life on the sides and back of the head. This is because the hair in this "donor area" is genetically different from the hair on the top of the head in people who go bald.
The hair follicles in the "donor area" are genetically resistant to the effects of such baldness causing hormones as (DHT) dihydrotestosterone. That's why they continue to grow, while the hair on the top (in the male pattern baldness area) thins and goes bald over time.
How much viable donor hair you have will largely determine how much you can accomplish with hair transplants. Most people have enough viable donor hair to do at least one or two hair transplant procedures.