We believe that patients have a right to full disclosure and a complete understanding of exactly what hair restoration surgery involves.

This step by step presentation shows how today’s state of the art follicular unit hair transplant procedure is typically performed.

Patient is prepared for surgery

During surgery hair follicles from the back of the head that are genetically resistant to going bald will be removed and relocated (transplanted) to the balding areas.

Donor area is trimmed

Prior to surgery, the hair in donor area that will be surgically removed is trimmed.

Donor area is prepared for surgery

Once the donor area has been prepared it is given local anesthesia.

Donor tissue is removed

The donor tissue containing the bald resistant hair follicles is then surgically removed.

Donor area is sutured

The donor tissue containing the bald resistant hair follicles is then surgically removed.

Hair combed over sutures

When patient’s hair is combed over the donor area the sutures are not visible. These sutures are typically removed approximately ten days after surgery.

Donor tissue is trimmed into follicular unit grafts

Surgical technicians then use microscopes to view the donor tissue in order to dissect and prepare follicular units hair grafts.

Bald recipient area is prepared

After being given local anesthesia, the balding recipient area is ready for surgery. No trimming or shaving of hair is needed in the top recipient area.

Incisions are made in the balding areas

Tiny incisions are made in the recipient areas in irregular patterns that mimic nature. The follicular unit grafts will then be placed carefully into these tiny incisions.

Grafts are placed into the incisions

Follicular unit grafts are gently placed into the recipient incisions.

Grafts are placed in varying densities

Typically the smallest one and two hair grafts are placed in the very front of the hairline, with three and four hair grafts placed behind them.

Patient immediately following surgery

Following surgery a patient will have hundreds of tiny incisions with short hair stubble showing from the new grafts.

Close up of recipient area after surgery

The tiny graft incisions heal rapidly. The redness and scabbing in the recipient area normally clears up within about one week.

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.

Female hair loss, otherwise known as Female Pattern Baldness (FPB), affects 1 out of every 4 women in the United States. Recent findings have found that the incidence of FPB has been reported to be as low as 8% and as high as 87%. And, it does appear to be as common for women as for men. Most often, menopause is the most frequent time for hair loss in women to become apparent.

For a woman to lose her hair can be even more troubling than for men. A woman with thinning hair is not generally accepted as part of the normal aging process. Society has come to expect a thick, luxurious head of hair as part of the attractiveness in women.

While males and females can both experience thinning hair, they typically do not lose their hair in the same order or appearance.

Women with thinning hair compared to Men

Typically men observe their hair loss earlier, whereas women will first notice it in their late 20's through their early 40's. Female Pattern Baldness (FPB) is often seen during hormonal changes. These include the use of birth control pills, following childbirth, or during or after the time of menopause.

Top view of patient, showing excellent growth of transplanted hair.

In addition, men typically have localized areas (patterns) of thinning, whilein women this usually occurs as thinning across the top, or over an even wider area. When women have very diffuse thinning over much of their scalp they are generally not good candidates for hair restoration surgery. However, women with localized hair loss, similar to the typical male pattern baldness, can successfully undergo hair restoration surgery.

Thinning hair in females is also characterized by an increase in the combination of normal thick hairs mixed in with finer, smaller hairs. This results in decreased density, and not total hair loss.

A woman's hair has also been proven to be more sensitive to the effects of stress than men's hair. Stress can result in hair loss in women and men. But this type of loss is not female pattern baldness. Rather, it is known as “telogen effluvium.” This type of hair loss is the shedding of hair in the resting phase when the body senses that it needs to divert its energies elsewhere. Therefore stress can temporarily changes the amount of hair that is shed. But the lost hair is likely to grow back.

The production of the hair loss-inducing androgens is also different among men and women. A woman produces a small quantity of androgens in the adrenal glands and the ovaries. The ovaries also produce pre-hormones, which are then converted to androgens on the outside of the ovaries or adrenal glands.

Generally speaking, a woman with hair loss will probably not experience total balding in a given area. But if there is total hair loss, this is most likely a sign of a previously hidden disease. For this reason, it’s important for females to have their hormone levels checked by a physician if they are experiencing heavy hair loss.

Finally, men and women react differently to various hair loss treatment options. In men, hair loss may be halted or even reversed by finasteride (brand named "Propecia"). However, Propecia is not safe for females or children. Minoxidil (Rogaine) can be effective for both men and women in treating hair loss.

However, for some women the causes of their hair loss are much more complex than the classic "male pattern baldness". Thus proper diagnosis of the underlying cause is vital before any hair loss treatments are attempted.

The following physicians are nationally well known experts in female hair loss. Feel free to contact them.

David Whiting in Dallas, Texas - 214 824-2087

Vera Price in San Francisco, California 415 353-4163

Maria Hordinsky in Minneapolis, Minnesota 612 625-1493

Wilma Bergfeld in Cleveland, Ohio 216 444-5722

For a web community that is dedicated to female hair loss visit HerAlopecia.com

Revivogen hair loss treatment is a "3 in 1" all inclusive product that comes with scalp therapy, one eyedropper, one shampoo and one conditioner.

This topical scalp therapy treatment, equally effective for both men and women, claims to be very successful at inhibiting the 5-alpha reductase enzyme, which converts testosterone into DHT (dihydrotestosterone). The makers of Revivogen claim that it is even more effective than Propecia in reducing DHT in the scalp without the unwanted side effects. It's also potentially the most potent topical antiandrogen on the market. Antiandrogen hair loss treatments like Revivogen inhibit the production of the male hormone DHT. The makers of Revivogen claim that it is even more effective than Propecia in reducing DHT in the scalp without the unwanted side effects.  This product however, has not been approved for hair loss by the FDA.

Revivogen all natural medicated shampoo is one of the few shampoos that includes ingredients scientifically supported to help inhibit the production of DHT and its binding to hair follicles. A 12oz bottle should last just under 2 months.

Revivogen shampoo has ingredients that complement the Scalp Therapy solution, increases scalp circulation, opens pores, and produces a cooling and refreshing menthol feeling on the scalp.

Revivogen Thickening Conditioner revives limp and thinning hair in men and women by moisturizing and strengthening the hair shaft. Natural proteins add natural volume, shine and create the appearance of thicker and fuller hair. For best use, we recommend using this conditioner with Revivogen Shampoo. Or, get the discounted Revivogen Shampoo and Conditioner combination instead to save money.

We strongly recommend using Nizoral shampoo every 2 or 3 days in conjunction with these treatments. Its active ingredient ketoconazolehas proven to be a moderate DHT inhibitor and has growth properties approximately as effective as Rogaine 2%.

How It Works:

Revivogen contains scientifically backed ingredients including Azelaic Acid, Vitamin B6, Zinc, Saw Palmetto, GLA and ALA which are fatty acids proven to inhibit the production of DHT. Reducing the amount of DHT in the body and scalp reduces the risk of vulnerable hair follicles dying and falling out.

For proper treatment, Revivogen should be applied at least once a day to the scalp's affected areas as well as the surrounding areas.  Once you've used the medication, you should not wash your hair for at least three hours.  This allows the active ingredients to be absorbed into your scalp  The effects of Revivogen may take some time to work.  Most users claim to experience their desired results after about 6 months of use.

Revivogen contains no reported side effects.

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. Revivogen is not clinically proven or approved by the FDA.

Revivogen and other antiandrogens (such as Propecia, Crinagen, Nizoral, Revita, etc.) may provide marginal benefit to men and women trying to maintain existing hair due to androgenic alopecia. Propecia by far is the most effective and only proven antiandrogen. For the best chance at regrowing hair non-surgically, adding a hair growth stimulant such as Rogaineor Tricomin is crucial.

Don't expect immediate results. It's recommended to use Revivogen for at least 6 to 12 months before determining its effectiveness. Documenting your progress with bi-monthly photos can help you determine whether or not Revivogen has been successful in helping you maintain existing hair.

To date, only surgical hair restoration is proven to grow hair in completely bald areas. You are invited to have a free virtual consultation with one of our prescreened hair restoration physicians.

Hair loss Myths - What is or isn’t true?

Maybe you’ve heard that wearing a tight baseball cap too often will make you bald or that if you wash your hair too much you’ll suffer hair loss. Well, they’re both old wives’ tales.

So what really causes hair loss and what’s myth?

Brushing to Grow Hair?

The idea of brushing the hair 100 times a day to stimulate the scalp circulation is a fantasy. In fact, if you brush your hair too much, you may end up injuring and losing hair.

This myth stems from the thought that hair loss was due to poor circulation and that brushing or massaging would improve blood flow and nutrition to the follicles. The truth is, bald or not, there’s no major difference in scalp circulation.

Styling and Hair Loss?

There’s some truth and some fiction when it comes to hair styling and Hair Loss.

It is true that certain hair styles, such as corn-rows or tight ponytails, can cause hair loss. These styles put undue tension on the hairs. But as for hair sprays, perm solutions, or coloring resulting in hair loss there’s no truth to that idea. These applications may cause some damage to the hair strands. But the all-important follicles, located under the skin, stay safe.

And what about the idea that haircuts will make your hair grow back thicker and faster? That’s wishful thinking. Everyone’s hair growth and length depends on their own unique hair cycle, which is based on both nutrition and heredity. The longer your growth phase the longer your hair growth.

Blowing away your hair?

What about hair dryers? Are these follicular incinerators?

The good news is there is no evidence that hair dryers cause thinning hair. However, too hot or too much drying may lead to brittle and breakable hair. Let common sense guide you and hold the hair dryer at a normal distance from your scalp and dry to your heart’s content.

Vitamins and Steroids?

Think about this – if you were losing hair because of a lack of vitamins or minerals in your diet, why wouldn’t the back and sides of your head be affected? In actuality, vitamin deficiency results in an even distribution of hair loss all over the head. Of course, it doesn’t hurt to take vitamins on a regular basis for your overall health.

Your follicles width and amount are based on heredity. So claims of hair growing miracle drugs or natural hair loss treatments are untrue.

However, steroids use can cause hair loss. Research has proven that anabolic steroids raise the levels of baldness-inducing male hormones. For those who are genetically prone to hair loss, this can speed up the loss in as little as 3 to 6 months. While this loss may be reversed, it can be permanent.

Sexual Activity to Grow Hair?

Unfortunately, there is no truth to the idea that the more sex you have, the less hair you’ll lose! And the same goes for the rumors that the chemicals released during sex can affect hair loss. Science has yet to uncover any proof to this fantasy. But that doesn’t mean you shouldn’t keep experimenting.

The Hair Loss Family Tree

Many men believe that if their father has a full head of hair, they’ll keep a good head of hair. But hair loss or hair growth is set by a genetic combination determined by both sides of your family.Of course, if your family tree is filled with balding scalps, you do have a better chance of losing hair.

Treatments that work

While hair loss sufferers spend small fortunes on treatments based on myths, there are several proven treatments, non-surgical and surgical.

Currently there are only two non-surgical hair loss treatments that are FDA approved for Hair loss. These two are Propecia (Finasteride) and Rogaine (minoxidil).

Other treatments may or may not help stop or reverse hair loss, but they are not formally approved by the FDA

To learn about proven treatments visit our Hair Loss Solutions section.

There are a variety of hair loss remedy "concealer" products that are applied to the scalp and/or hair in the thinning areas to mask a person's baldness and increase the look of fullness of thinning hairs. These products such as Toppik, Couvré, and Prothik can work surprisingly well at creating the illusion of fuller hair.

Some of our member physicians advise their hair restoration patients to use such hair loss remedy products to enhance the look of fullness in their transplanted areas. These products can also be used post operatively to hide the immediate surgery.

Toppik - Toppik is an effective, safe, and easy-to-use product that completely covers up the scalp's thinning areas.

Couvre - COUVRe is safe for men and women, easy to use, and is totally undetectable to the world's toughest critics.

Caboki - Caboki is comprised of a series of charged microfibers that, when applied to the scalp, tightly bind hair shafts and create a denser, fuller appearance.

DermMatch - DermMatch is a safe and easy way to cover-up thinning areas and instantly provides the appearance of a natural looking head of hair.

Nanogen - Nanogen is one of the fastest, easiest ways to conceal thinning hair and hair loss.

Prothik - Prothik does an exceptional job of adding thickness and fullness to thinning hair while reducing the contrast between thinning hair and the scalp.

In fighting hair loss, there may be certain unwelcome side effects produced. These side effects are the results of the body's natural immune response. These effects can increase hair loss, if not controlled.

But with anti-inflammatory hair loss cure products, such side effects as itching, flaking, redness, and naturally, inflammation, are reduced. These topical treatment options include Tricomin, Folligen, Proxiphen and Proxiphen-N, Betadine and T-Gel and Nizoral Shampoos.

Nizoral

Here’s one shampoo that fits in with any treatment option.

Nizoral, made for men and women, is available in any grocery store. Nizoral is effective at reducing itching, inflammation and other side effects of other treatments, such as Propecia. The shampoo also maintains scalp health. Plus, research has shown that using Nizoral for an extended period may help to treat male pattern baldness (MPB) and female pattern baldness (FPB).

It’s advised that you apply Nizoral once every three days, in rotation with your normal shampoo. However, as Nizoral’s effects can last for several days, it is a very inexpensive treatment option. After one month of use, you should then use Nizoral once every 1-2 weeks. The shampoo should be applied to wet hair and scalps. You should then leave it in for 3-5 minutes before rinsing thoroughly.

T/Gel Shampoos

T/Gel is the brand name for a variety of shampoos and hair loss cure treatments. Primarily, these products are designed to treat such scalp problems as dandruff, itching, flakiness, and excess oil.

The Original Formula shampoo contains 2% Neutar ®, which is essentially 0.5% Coal Tar. There’s also T/Gel’s Fine/Oily Hair Formula, Extra Strength Formula, and Stubborn Itch Control Formula. These varieties all feature Neutar, a patented product, which dissolves into the scalp as it treats the previously mentioned symptoms.

T/Sal® Maximum Strength Therapeutic Shampoo features 3% Salicylic Acid. This effectively treats the crusty scalp build-up of psoriasis, as well as problems caused by excessively oily skin. This product should be used at least three times a week, unless other wise directed by your physician. T/Gel’s Healthy Scalp Anti-Dandruff Shampoo also contains Salicylic Acid, specifically 1.8%. There’s also T/Scalp® Therapeutic Anti-Itch Liquid, which features 1% Hydrocortisone. This is meant for treating severe dandruff.

The prices for these products vary, but generally, a 16oz. bottle of the Original formula retails for about $13.00.

Nioxin shampoo and conditioners

If you have fine or thinning hair, you may want to consider the Nioxin family of hair products. These all-natural cleansers, conditioners, treatments and styling products are free of any drugs.

Nioxin can improve the hair’s health by cleansing the scalp’s skin, strengthening the hair follicle and energizing the cellular activity. In addition, Nioxin is supposed to restore the scalp’s proper moisture balance. On average, the Nioxin products take about 45 days to show their effects.

Nioxin has not been found to have any effect on DHT. However, by keeping the follicles healthy, these products may help delay hair loss. Because there are no side effects, the products can be used everyday. Nioxin typically costs $30-$125 per month.

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