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.

Brilliant Hair Loss Treatment, or is it a Scam?

ElectroTrichoGenesis (ETG), also known as Cosmetic TrichoGenesis (CTG), is a little known hair loss treatment that makes some very lofty hair growth claims. How does ETG work and is it really clinically proven to treat androgenic alopecia(genetic balding)?

How ElectroTrichoGenesis (ETG) Works

ETG is promoted as a safe, painless and non-intrusive. Treatment is administered via an “ergonomically shaped couch with a semi spherical hood” manufactured by Current Technology Corporation in Vancouver, Canada.

The patient reclines on the chair and the hood (with disposable liner) is placed over the head but does not make contact with the scalp. This special hood contains electrodes that deliver “specified pulsed electrostatic energy” delivered passively to the scalp by the low-level electric field generated within it.

ETG is believed to stimulate the regrowth of hair through the positive influence of the pulsed electrostatic field it generates. This field is said to stimulate “changes within the hair bulge and the follicle, stabilizing hair loss and stimulating new hair growth”. Patients receive a single 12 minute session weekly.

Is ETG Clinically Proven?

The following three studies on the efficacy of ElectroTrichoGenesis (ETG) as a treatment for thinning hair have been published in peer-reviewed journals:

Maddin, W. Stuart; Bell, Peter W.; James, John H. M. (1990).
"The Biological Effects of a Pulsed Electrostatic Field with Specific Reference to Hair Electrotrichogenesis". International Journal of Dermatology29(6): 446–450.

Benjamin, Benji; Ziginskas, Danute; Harman, John; Meakin, Timothy (2002).
"Pulsed electrostatic fields (ETG) to reduce hair loss in women undergoing chemotherapy for breast carcinoma: A pilot study". Psycho-Oncology11(3): 244–248

Maddin, WS; Amara, I; Sollecito, WA (1992).
"Electrotrichogenesis: further evidence of efficacy and safety on extended use". International Journal of Dermatology31(12): 878–80

According to the 36-week comparative, controlled study conducted on male subjects at the University of British Columbia and published in The International Journal of Dermatology, 96.7% of those treated experienced cessation of hair loss and/or hair regrowth. Decreased hair loss was seen as early as 4 to 6 weeks but many patients required more time for results.

The pilot study conducted on women undergoing chemotherapy for breast carcinoma and published in  Psycho-Oncology,showed that twelve out of 13 participants had good hair retention throughout the chemotherapy period and afterwards with no reported side effects.

As with the clinically proven medical hair loss treatments Rogaine (minoxidil) and Propecia (finasteride), ETG is said to be most effective in the early stages of balding.

Conclusion

Although the data put forth in this article seems to paint ETG as a clinically proven and highly effective hair loss treatment, it’s important to note that the procedure is not new. The studies referenced above were published more than 13 years ago. If ETG truly works to stimulate hair growth and suppress the advancement of hair loss, why has it not become a fixture in the world’s leading hair restoration clinics? Where are all the glowing, unbiased reviews?

With no reported side effects, there may be no harm in giving ETG a try if there is a provider in your area and the fees are reasonable. However, balding men and women are encouraged to consult with an experienced and reputable hair restoration physicianin order to diagnose the cause of their thinning hair and learn about the outstanding medical and surgical options available today.

Causes and Treatments

Alopecia is the medical name for hair loss to the scalp or body.  While Androgenetic Alopecia (genetic hair loss) is the most common, there are many other forms of alopecia related hair loss worth discussing.  Each medically named alopecia comes with distinct symptoms, a unique cause and exclusive treatments. Below, we've compiled a list of and description for the most common types of alopecia related hair loss along with the available treatment options for each.

While the information on this website can be used as a guide, men and women who believe they are experiencing hair loss should always be properly diagnosed by a qualified hair restoration physician to determine its cause. To learn more about each distinctive alopecia hair loss condition, click the links below.

Traction Alopecia
Alopecia Areata
Diffuse Patterned Alopecia
Diffuse Unpatterned Alopecia (DUPA)

Cicatricial alopecia (Scarring Alopecia)

Alopecia Universalis and Alopecia Totalis

For many hair loss suffering men and women, topical concealers are a necessary aspect of the "daily routine." Usually composed of hair shaft adhering microfibers or darkening cream, concealers help balding men and women both camouflage areas of noticeable baldness and increase the apparent density of thinning hair. Below, we provide our readers with a product review of the new and popular hair loss concealer Caboki.

Caboki was released back in 2005 but is only just now receiving more attention, most likely due to increased advertising. Like others before it, Caboki concealer claims to be a "hair loss breakthrough". Despite ambitious promises, Caboki's claims leave several unanswered questions: is Caboki really a breakthrough concealer? How does it compare to other, similar products like Toppik, DermMatch and COUVre? Is Caboki a worthwhile product for purchasing, or will it fall from grace like other alleged "breakthrough" hair loss miracles before it?

While many products, such as "Toppik" (a popular microfiber-style concealer) and "Couvre" (a concealing cream) are popular and trusted within the hair loss community, new, unproven concealers arrive on the market every day. What's more, many of these new concealers try to "best" the products currently offered and claim to camouflage hair loss in a way "never seen before." However, as with many alleged miracle cures, these products often fail to meet expectations and leave hair loss sufferers disappointed and discouraged. So let's explore how Caboki works to conceal hair loss below.

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. According to the manufacturer, these microfibers are comprised of two different elements: Moroccan Gossypium Herbaceum fiber and iron oxide-based natural (mineral-based) colorants. The makers of Caboki claim these elements allow the product to create a natural, healthy appearance, capable of withstanding harsh lighting conditions, sweat, wind, and rain.

However, because these elements have been used in other concealer products (Toppik particles, for example, are both charged and made from natural keratin), Caboki still must demonstrate why it's revolutionary. So, what makes Caboki a "hair loss breakthrough?" According to the manufactures, Caboki differs from other concealers in the following ways:

• Caboki particles, unlike other microfiber concealers, are negatively, not positively charged. Allegedly, positively charged particles (usually made from wool fibers) possess a greater tendency to repel and oppose not only each other, but also the positively charged hair shafts. Because of this, when the particles attach near each other on a hair shaft, they are more likely to repel and detach. According to Caboki creators, negatively charged fibers (made from Moroccan Gossypium Herbaceum fiber) do not experience this intense phenomenon, and create a much greater (200%), electronically attractive (negative to positive), bond. If this is true, Caboki microfibers should bind and adhere to hair shafts with a much stronger, more permanent affinity.
• Because Caboki particles create a stronger charged bond, the thicker, more volumized hair shafts are likely to stand erect and less non-bonded concealer will collect on the scalp. This combination, according to Caboki, will eliminate the "dull, flat" appearance associated with other concealer products.
• By only utilizing natural elements (Moroccan Gossypium Herbaceum fibers and iron oxide colorants), Caboki avoids some of the potentially harmful synthetic dyes, fillers, and artificial preservatives used in other concealer products.

So, it's now clear why the manufacturers of Caboki believe it is a superior product, but does this mean Caboki is a legitimate hair loss concealer? Does it truly outshine other concealer product currently on the market?

While the product is still fairly new, most anecdotal experiences and testimonials from real hair loss suffering men and women are positive. Most individuals believe the negatively charged Caboki particles bind strongly to the positively charged hair shafts and create a longer-lasting increase in density. Furthermore, the particles seem to be more resistant to potentially damaging elements like water, sweat, and wind. Having said that, many individuals report some common problems experienced with other concealer products – concealer wiping off on pillows and clothes, some smearing with sweat, and difficultly creating a natural appearance in the hairline. However, these same individuals claim the problems occur less frequently with Caboki. Altogether, it's likely that Caboki is both a helpful hair loss concealer and equivalent to other products currently on the market. While it is clear that Caboki does possess some advantages and interesting claims, it could be difficult to quantify whether it truly exceeds or simply meets the standard set by other available hair loss concealers. Truthfully, only time and the opinion of hair loss sufferers will determine whether Caboki lives up to its claims and defines itself as a legitimate concealer breakthrough.

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.