Reese Hair Restoration — Hair Restoration Surgery in Minnesota by Dr. Robert Reese

First let me state that the "A", (or anterior) pattern of hair loss only represents about three percent of patients with genetic hair loss. "A" patterns are some of my favorite patterns to transplant because with strong mid-scalp and crown hair, the results can be dramatic and therefore very rewarding for the patient. However with that said, as a young man you must assume that there will be progression in your pattern of genetic hair loss to a 4A, 5A, or even to a Norwood-Hamilton 6 classification. Especially if you are not firmly committed to stopping ongoing hair loss by properly using either Rogaine, (minoxidil), Propecia, and/or Low Level Laser therapy for the long term. As a young man experiencing genetic hair loss, your primary concern must be an all out effort to stop ongoing loss. Stopping ongoing hair loss is the cornerstone of your successful result, not having a hair transplant procedure. If you are committed to "locking in" your 3A pattern, then hair restoration surgery could lead to you enjoying a full head of hair for the rest of your life.

If Rogaine, (minoxidil) did not provide you with an acceptable result, for whatever reason, then it is not the right option for you. Don't look back, simply move ahead with one of the other two FDA approved options. And you note that you have now chosen to use Propecia. All things being equal, I believe that Propecia provides men with the most convenient option to stop the progression of genetic hair loss. And convenience is critically important. If you make something easy enough for someone to incorporate into their daily lives, their compliance is much greater over the long term. And this coorelates directly with maintaining scalp hair counts over the long term. Consider taking monthly pictures of your scalp to more objectively monitor your result on Propecia. Remember that a "GOOD" result is NO CHANGE in the photos. This represents a stabilization in the progression of your pattern. Not every patient will improve the quality of their hair by using any or all of the three FDA approved options. But that is OK. If "regrowth", (slight thickening of the shaft diameter of the genetically susceptible hair) occurs, so much the better. But the goal is to stop your current pattern of hair loss from progressing. And virtually all men will achieve this goal by using Propecia for the long term.

Regarding your concerns about donor scarring with a transplant procedure, I will state the following. Every surgical procedure has potential advantages and disadvantages. With the advent of the "trichophytic" closure technique, scarring in the donor zone with "strip" harvesting has

greatly improved. It has improved to the point that I find that my patients can wear very short hairstyles without any concern. In my practice I find that I am limiting performing the follicular unit extraction, (FUE) technique to patients who require very small transplant procedures, (less than 1,000 follicles), or to transplant into wide donor scars initially created by another physician.

1) With the FUE technique the follicles are harvested from a much greater area of the donor zone, therefore, the harvested follicles may not be truly "permanent". Remember, what appears to be strong "permanent" hair today, may not appear this way in twenty or thirty years. You would then have invested in a procedure that was to provide you with "permanent" hair, only to experience loss of that hair if it is susceptible to your genetics at a later timeframe of your life. This is an example of why it is so critical for you to commit to stopping ongoing hair loss.

2) There are many reports of slightly "kinky" hair growth and unacceptably high follicle transection rates obtained with the FUE technique. I can only surmise that the extracted follicles are somehow "manhandled" by those who may not be experienced in the technique.

3) At the International Society of Hair Restoration Surgery meetings there have been case study reports of long term donor zone anagen effluvium, (noticeable long term thinning in the donor zone where hair is shed by the follicles in the near vicinity of the extracted follicles) associated with the FUE technique. If you saw what the donor zone looked like in these case studies, you might not be so interested in the FUE technique.

The bottom line is that there is no "one size fit's all" procedure. Each surgical technique, and every patient has potential advantages and disadvantages that need to be considered in creating the most appropriate surgical plan. If a hair transplant surgeon only performs a single technique, I would seek a second opinion.

The Physician members of the International Alliance of Hair Restoration Surgeons, (IAHRS) have been carefully screened for ethics, and consistent quality results. These physicians are considered among the "best of class" in the hair restoration profession. I recommend that you consider scheduling a consultation with one or more of the members of the IAHRS. You won't be disappointed.

I've had some work done to rebuild my hairline but don't feel it looks as natural as it should because my temples have receded and were untouched. So basically, I have a hairline that goes back to my ears.

I've spoken to one doctor who would not do temple work because it could potentially leave an odd patch of hair if further recession occurred. I've spoken to another doctor who seemed eager to do work on my temples because my transplant lacked balance. I feel like I really need some temple work but how risky is it to have work done in this area?

On another note, what is the best way to approach temple work. The hair on my temples is finer and grayer than the hair on the back of my head. I'm
worried that if I use hair from a strip for the temples, it won't look natural because the hair might be coarser and darker than my native temple hair. Can FUE be used to select finer and grayer hair from the sides of the head?

Thank you for your question. I will attempt to answer your concerns as follows.

1) I am at a disadvantage without seeing photography of your current frontal-temporal hairline, therefore, I am not able to evaluate whether your concerns are "overblown", or your current hairline truly lacks "balance". But what I envision is that a "too strong" of a hairline was created in the first place for you. When you experienced temporal hairline loss, it exaggerated the imbalance between the frontal and temporal hairlines. The point is this. It is absolutely critical to stop ongoing hair loss in the first place with one or more of the FDA approved options available,(Propecia, Minoxidil, or Low Level Laser Therapy) especially if a "strong" hairline is going to be created for the patient. If stopping ongoing hair loss were a "cornerstone" of your treatment plan, then you wouldn't be facing this current dilemma. And just as important, an age appropriate conservative hairline is the "safest" option for most patients because if the patient does experience ongoing hair loss over time, they will still look "natural", just not as "thick/dense".

2) The creation of an individuals hairline is likely considered the most important component in quality hair restoration work. It must be created with a "vision" of the future, i.e. if the patient goes on to lose more hair, will the transplanted hairline continue to look appropriately balanced and natural? Thi s past year I transplanted an eleven year old girl who had been accidentally burned at two years of age. One of the most important factors in her excellent result was the time that was taken in developing a hairline that would look appropriate as she continues to age, since her facial structure/characteristics will also change.

The creation of a hairline for a patient can be difficult at times because there are patients who will pressure the surgeon into re-establishing a "John F. Kennedy, Jr." type of hairline when this could be completely inappropriate for them. Of course, the hair transplant surgeon should have the judgement and experience to inform the patient whether a hairline is appropriate for them or not. If the patient does not accept the surgeons recommendations, then the surgeon should not perform the procedure on them at all.

3) I agree that reconstruction of the temporal hairline is best achieved by using donor hair from the parietal, as opposed to the occipital scalp. The hair growing from the parietal scalp is typically finer caliber and will more appropriately resemble the hair found in the temporal hairline.

Generally, when I reconstruct a patients frontal-temporal hairline, (for an initial procedure) I will need 2,000 to 2,200 follicles. In your situation, it sounds like only the temporal hairline requires reconstruction, therefore, I estimate that you will need, (plus or minus) 1,000 follicles to achieve the result. Assuming that you have 7 0 to 80 follicles per centimeter squared of your donor scalp, you would need two temporal/parietal strips, (one on the right side, and one on the left side) about 7 cm in length x 1 cm in width to achieve the appropriate number of follicles. Notice that strip harvesting in these zones will provide you with the most appropriate quality of hair to match the hair found for temporal hairline reconstruction. If you were to consider the follicular unit extraction technique, the follicles would be harvested from a much more expanded donor zone, which would likely include occipital follicles that would grow a caliber of hair that might be inappropriate for temporal hairline reconstruction. So if I were you, I would only proceed with strip harvesting for your particular situation.

I wouldn't be overly concerned about losing more temporal hair since I've already lectured you on stopping hair loss with one of the three FDA approved options. Also, your surgeon will transplant into the existing temporal hairline so as to offset any possible exposed temporal scalp if some additional hair loss is experienced.

The creation of the recipient sites, (allowing for the transplanted follicles to grow in an infero-posterior direction) is paramount in creating excellent temporal hairlines. I recommend to my patients undergoing either temporal hairline or eyebrow reconstruction to use a little gel, (starting about two months post transplant) to "train" the hairs to lie flat. This "trick" leads to very natural looking temporal hairline and eyebrow results.

4) The hair restoration surgeons profiled on the International Alliance of Hair Restoration Surgery web site are screened for both ethics in their practices, as well as being able to provide consistently excellent results. I would start the process there.

Hi I was born with a bi-latteral cleft pallet and am unable to grow hair in the middle where my mustache would be. I was wondering if you do facial hair transplants and if so do you know how I would get a quote on a price for that?

Thank you for the e-mail. Yes, hair restoration is routinely performed to reconstruct a moustache. Generally, I consider this type of procedure to be a "specialty" case, i.e. a smaller but technically challenging case. I charge a flat fee of $5,500. for such a case. You will want to interview several excellent hair transplant specialists. You will do well to consider one of the excellent surgeons listed on the International Alliance of Hair Restoration Surgery web site, www.iahrs.com. The fee that they charge may or may not be different than mine, but those listed there have been carefully screened for quality work. I hope this helps as you continue to investigate whether hair restoration surgery is the best option for you.

Alright thank you for the info! Is that proecedure do-able over scars? If so do you know how I would see if my insurance would pay for such a procedure? I don't know if you would have to send them a bill or if I would have to talk to them about that.

Follicles transplanted into "scars" typically will have a 50% yield. Follicles transplanted into "virgin" scalp will have a low 90% yield.

If you were going to have your procedure with me, I would write a letter on your behalf to your insurance company requesting that they cover fees related to the reconstruction since you have a history of a cleft pallet. Whether they agree to reimburse for the procedure or not is ultimately up to the insurance company. However, I did have one patient last year whose insurance company did cover her two procedures. So it might be worth a try.

Generally, the patient is reimbursed from the insurance company after they have made payment to my practice for the procedure. But if you are "pre-authorized" by the insurance company, they will reimburse you.

Do surgeons ever perform hair transplants from non-autologous donors? I am a 56 year old female with considerable thinning all over and it does not seem to make sense to just shuffle the hairs to different places on my own head.

Thank you for your question. If you were to have a hair transplant utilizing follicles from a genetically dissimilar person your body would reject this tissue just as it would with any other transplanted organ. For example, if you were to have a heart transplant, you would need to be on lifelong medication such that your body would not reject the transplanted heart. In similar fashion, a "non-autologous" follicle would be rejected by your body without lifelong anti-rejection medication. It would make good medical sense to utilize these medications for something like a heart, or lung, or kidney, or pancreas, but not for a hair transplant. Therefore, the only acceptable tissue for a hair transplant would come directly from the patient, and/or a genetically identical person, i.e. an identical twin.

My suggestion is that you should rule out medical causes of your hair loss first such as inflammatory conditions of your scalp, or thyroid or other medical or hormonal disorders. This may include a scalp biopsy with pathologic evaluation, as well as simple blood tests. You might benefit from FDA approved options, (minoxidil and/or low level laser therapy) to stop ongoing hair loss, and possibly improve the quality of your existing hair. And you will benefit from a consultation with a credible hair transplant expert who can show you hair transplant results (in picture format) utilizing modern techniques that can lead to nearly astoundingly positive results for you.

Once you are "armed" with all of this information you should be able to make an educated decision on which option or options is best suited for you to assist you with your hair loss concerns.

I had a hair transplant one month ago and it seems like most of the scabs have fallen out with the hair attached to it. Is this normal, is the hair going to grow back? Any information would be greatly appreciated.

I will answer your question in the following manner. Prior to performing the transplant procedure, the follicles in the permanent "donor" zone are protected and nourished by their "lifeline" the blood supply. In the transplant process the permanent follicles, (containing the hair that is transplanted) are surgically separated from this "lifeline", (i.e. it's blood supply) and moved into the recipient zone. The transplanted follicles remain dormant and will not grow hair until the "lifeline", (i.e. the blood supply) has been re-established. This process takes several weeks. Generally speaking, it is expected that most patients will shed the hair from the transplanted follicles within a week or two of the procedure because the transplanted follicles, (having been separated from their lifeline) do not want to expend their residual energy growing hair until the blood supply has been re-established to them and protects and nourishes them. Typically the hair resumes growing from the transplanted follicles about 6 to 8 weeks after the transplant. There are some patients, (maybe 10%) that do not experience significant hair shedding with the transplant procedure, and start growing hair soon after the transplant procedure, but they are definitely in the minority. I gather that they are in the minority of patients who are able to re-establish a blood supply to the transplanted follicles sooner that the average patient. I tell my patients that the hair will START to grow, on average, about two months after the procedure. The hair growth will initially be fine caliber, and less pigmented, (i.e. like baby hair). And just as a baby grows slowly into a child, then a teenager, then an adult, your transplant result will proceed the same way until the hair growing out of the transplanted follicles resembles the hair from the donor zone. This process typically takes 9 to 12! months to complete. I recommend to my patients that they take pictures of themselves each month after the transplant so they can see their result progressing along. This is very reassuring for those patients that take the pictures. So don't worry. There is nothing wrong. You are following the path that most patients take who have the procedure. And I'm sure that you will be very pleased with your result.

I just turned 30 years old and really would like to do something about my hair loss this year. I feel that my receding hairline is making me look older beyond my years. This is my problem, I am not a big fan of taking medication and I am also very concerned about the long term side effects of Propecia. I think I would be a Norwood Class 3 with thinning sides, but the hair on the back of my head is extremely thick. Would it be a waste for me to have a hair transplant, but not take Propecia? Thanks in advance, Carl

In my opinion, modern hair restoration surgery deals with an imbalance in "supply vs demand". What I mean by this is to say that most patients that I perform consultations on have a larger "demand" area, (i.e. the area of the scalp that we transplant into), and smaller "supply" areas, (i.e. the available donor follicles). Stated another way, most patients have a "mismatch" in the larger recipient zone compared to the smaller donor zone. Therefore, it is important for me to council my patients about the importance of "getting serious about stopping hair loss" such that the recipient zone does not continue to expand over time. Many of my patients are not enthusiastic about long term drug therapy, and that is OK. I only recommend FDA approved options to stop ongoing hair loss. And the male patients have three options to choose from. Commonly the patients will ask me, "Which of these options is best for me?" I suggest that they answer that question by putting their options on a "scale of justice". By this I mean that they can choose either long term drug therapy, (i.e. either Minoxidil or Propecia), or non-drug therapy, (i.e. low level laser therapy). If the patient is strongly opposed to long term drug therapy, then they have answered their question for themselves and should utilize long term low level laser therapy, 15 to 20 minute sessions, three times per week, on non-successive day's, (i.e. Monday, Wednesday, Friday for example).? They should consider low level laser combs that are "cordless" to increase patient convenience, and therefore compliance. If the patient finds this regimen too demanding, then they should consider long term drug therapy. Again, I ask the patients to place the two options, (Minoxidil and Propecia) on the "scales of justice" and consider them from a "cost vs convenience" standpoint. The main advantage of Minoxidil is it's low cost, (about $8. per month). The main disadvantage of Minoxidil are that it is not convenient to use, (twice daily topically to the scalp). On the other hand, Propecia is safe, has no known drug interactions, and is very convenient to use, (one pill by mouth daily). However, Propecia is expensive, ($70. to $75. per month in my geographic area). In my opinion, concerns regarding "sexual side effects" with Propecia use is truly rare, and not of any significant concern for the healthy male patient. It is my understanding that Propecia is scheduled to be available as a generic medicine, (and therefore less expensive) by mid 2013 when the patent expires. Recently we have found that patients can purchase Propecia for less money if they have a Sam's Club or Costco membership. If they go to the Propecia web site, www.propecia.com, and print off a coupon, this saves them an additional $25. for each three month supply of Propecia that they purchase. This effectively takes the monthly cost of Propecia down to the low to mid $50. per month range. Since the patients weigh out the "cost vs convenience" issues for themselves, (I am comfortable with this because the options are all approved by the FDA), they will choose the correct option that is most likely to lead to long term compliance with one of these products and significantly increases the likelihood that they will stop ongoing hair loss, (allowing the recipient zone to not expand further over time). If none of these options is considered "acceptable" then the patient can still get a wonderful result with modern hair restoration surgery. Especially since there is no "guarantee" that they will continue to lose additional hair over time. However, statistically speaking, they are more likely to continue to lose hair over time without the use of one of the previously mentioned FDA approved products, and the likelihood that they will seek out a second hair transplant procedure in the future rises for most with time. Most of my patient only have one hair transplant procedure. All of these patients get a natural, "finished" look with a single hair transplant. But all of the patients also want more "density", and some will elect to have a second procedure even in the face of a recipient zone that is not expanding. So the "safest" strategy is to use one of the three medical options discussed above as an "insurance policy" against expanding the recipient zone over time, and therefore obtaining the most "density" possible with a single procedure. So, is it a "waste" to proceed with surgical hair restoration as a Norwood 3? Absolutely not!? If your procedure is performed by a qualified, full-time,? rofessional hair transplant surgeon, it will be one of the very best investments that you ever make!