Frequently Asked Questions about Hair Loss & Hair Restoration, Dr. Shelly Friedman, DO
Frequently Asked Questions About Hair Loss & Hair Restoration
What causes hair loss?
There are many causes of hair loss in both men and women, but approximately 98% of all hair loss is due to Androgenetic Alopecia, also called male or female pattern hair loss. Androgenetic Alopecia involves the genetic sensitivity to the male androgen (hormone) Dihydrotestosterone or DHT. Each scalp follicle is either sensitive or insensitive to DHT. If a follicle is susceptible to DHT, over time the follicle gradually dies resulting in the growing phase (anagen) shortening and the resting phase (telogen) lengthening. This phenomenon is called miniaturization.
Can hair really be transplanted and grow in a new location?
Hair can be moved and transplanted any place on the scalp and will maintain the color, characteristics, texture, curl, and growth rate from that particular donor area. As long as the hair being transplanted is from the same individual, there is no reason for the hair not to grow.
Are hair transplants painful?
Most patients have the wrong image in their mind concerning hair transplants. They assume that hair transplants must be painful, but are totally surprised by the fact that they do not experience any pain or discomfort during the procedure. We routinely premedicate or sedate all our patients with Valium (as long as they have someone driving them home following surgery). Once sedated, we numb or anesthetize the scalp using a local anesthetic similar to what a dentist uses to numb the mouth. Most patients are so comfortable during the procedure they either fall asleep or watch television. Post-operatively, the only area of slight discomfort is the donor region where the strip was removed and closed with sutures. We provide an oral pain medication such as Hydrocodone that can be taken if the discomfort does not resolve with Extra Strength Tylenol. Most of our patients do not need post-operative pain medication after the first night.
How much time do I need to take off work?
You can return to work the day following surgery, after your hair has been shampooed in our office the next morning. For a period of two weeks following surgery we recommend avoiding any heavy lifting, exercise, or sports. This allows the grafts and the donor region enough time to heal thoroughly.
What is the cost of a hair transplant?
Hair transplant fees are calculated on a per follicular unit graft basis. Depending on the surface area planned for transplantation, will dictate how many grafts can be placed within the recipient area. The more hair and grafts we transplant, the more the surgery will cost the patient.
How many procedures will be required?
The number of procedures depends largely on the size of the surface area planned for transplantation, the number of grafts that can be safely harvested at one time, and the subjective density the patient hopes to achieve. Although many patients are completely satisfied after one procedure, approximately 60% of our patients return some time in the future for another procedure to either cover more surface area or try to obtain more density.
How many grafts can be transplanted in one surgery?
The number of grafts which can be safely transplanted is determined by:
- The density of follicular units per square centimeter within the donor region. This can be visualized pre-operatively with a densitometer. The more follicular unit grafts per square centimeter, the more grafts we can obtain from one donor strip.
- The elasticity of the skin over the donor region. The more elastic or loose, the wider the donor strip that can be harvested. The width of the strip cannot be greater than the skins elasticity and the ability to close the incision with little tension on the skin edges. The average strip measures 1.0cm-1.3cm in width.
- The larger the scalp the longer the strip that can be removed. The average donor region measures 28cm-31cm in length.
- How much the patient wants to spend in any given procedure. Since our charges are based on a per graft price, the more grafts transplanted, the higher the cost of the surgery. Since each person requires a certain number of grafts, it is prudent to try to transplant as many grafts as possible to reduce the number of surgeries overall.
- The number of grafts transplanted also depends on how many hair technicians are working on you, and their skill and experience. This is another reason why you need to go to a full time hair transplant office rather than going to an office that performs hair transplants once or twice per month. The technicians’ credentials are as important as the surgeon’s qualifications.
When will I see the grafts growing?
Growth is contingent on the individual, but most patients will begin seeing new growth in four months, yet it can take as long as twelve months for all the grafts to grow. We have noticed that due to fibrosis under the skin, the grafts transplanted during a second surgery may take longer to grow. Once the grafts start growing, they grow at approximately 1/4 -1/2 inch per month.
How long do I need to wait between hair transplant procedures?
It is prudent to wait until all the grafts have grown from the first surgery before performing a second procedure. Typically, a second procedure can be safely performed in 9-12 months.
What medications are FDA approved for hair loss?
Propecia is a medication for men that has been available by prescription only since 1998 in the United States. Propecia is a pill which is taken orally once daily. The drug is not available to women due to the potential for birth defects. Propecia has been shown to stop hair loss in approximately 90% of patients, but the results will be reversed if the medication is stopped.
Rogaine is available over the counter for men and women. The medication is offered in either liquid or foam, and is applied to the scalp twice daily. Rogaine has been shown to slow hair loss in men and women, but similar to Propecia, any benefits derived from the drug will be lost when the medication is terminated.
If my original hair stopped growing, why will the transplanted hair grow in the same area?
The transplanted hair is harvested from a safe donor area that is genetically programmed not to be sensitive to the hormone that causes hair loss, Dihydrotestosterone. As long as the transplanted hair is taken from the permanent donor fringe, the hair will grow indefinitely.