Does Minoxidil Improve Graft Survival After a Hair Transplant?
Q: Does minoxidil play any role in the survival of the grafts after a Neograft/FUE procedure? — J.W., Philadelphia, PA
A: When a doctor performs a hair transplant, the hair should be taken from the permanent zone so, by definition, that hair is not affected by medication (i.e. does not need to be maintained by either minoxidil or finasteride). If the doctors using Neograft are suggesting that minoxidil increases survival, then they are probably harvesting hair outside the permanent zone. To clarify, I use the ARTAS robotic system for our FUE procedures, not Neograft, as the former is a far more accurate device for harvesting.
Is the Dose of Finasteride the Same for Everyone?
Q: Does a man’s height and weight affect the dose of finasteride or Propecia he should take? i.e. will a 6’4″ man need a higher dose than a 5’7″ man. — T.B., Rye Brook, NY
A: The dose of finasteride is the same (i.e. 1mg) regardless of a person’s height or weight. The reason is that one needs only 0.5mg a day for it to be effective, so there is much leeway built into the dose (but the rate of non-responders is slightly higher at the 0.5mg/day dose). That said, after 5 years or so, finasteride seems to be less effective and doctors often increase the dose a bit. The next step-up is generally to take 1/3 of a 5mg pill each day. Keep in mind that the dosing we are speaking about is for hair loss (androgenetic alopecia). When finasteride is used for prostate enlargement, the dose is 5mg a day.
Can I Have a Hair Transplant if I Have a Scar in My Donor Area? If So, Which Do You Recommend, FUT or FUE?
Q: I have a diagonal scar in the middle of my donor area that I got during a childhood accident and I am concerned that it will limit my options for hair restoration. Will this type of scar prevent me from having either FUT or FUE? Do you recommend one or the other? — R.F., Upper West Side, NY
A: Traumatic scars in the donor area do not preclude us from performing a hair transplant. With an FUT/strip procedure, we can remove all or part of the scar when we excise the donor strip. In Robotic FUE, the ARTAS Robot can be programmed to avoid a scar during harvesting. In either procedure, we can improve the appearance of the scar by implanting follicular unit grafts directly into the scar tissue. The hairs will grow permanently in the scar, just like ones we implant in the recipient area, and the scar will become harder to detect.
It is important to note that transplanted hair will not grow in a thickened scar. If your scar is thickened, the doctor can thin it out (soften it) with injections of cortisone. They are usually repeated at 4-6 week intervals in advance of the procedure. The number of injection sessions required depends upon the thickness of the scar and your individual response to the medication.
The presence of a traumatic scar should generally not determine which type of transplant you have. That should be decided in consultation with your physician based on factors such as how much volume you need, how you intend to style your hair, how short you would like to keep it, how soon you need to return to strenuous physical activity, and other general considerations for a hair transplant.
We recently posted photos from a patient who had a robotic hair transplant with a scar in his donor area. The photos include images of his donor area (with scar) before his procedure, immediately after robotic graft harvesting and 11 days post-op. View this patient’s before after photos.
Q: I am an MMA fighter and I want to get a hair transplant. How long do I have to be out of commission and which type of procedure should I have, FUE or FUT? — J.A., Columbus, OH
A: With any type of hair transplant it takes 10 days for the transplanted grafts to be permanently fixed in place. The difference between FUE and FUT is in the limitations of activity due to the donor area. With FUE one would need to abstain from MMA for the same 10 days it takes the recipient area to heal (the grappling component of Mixed Martial Arts is the most stressful on the scalp). With FUT, however, one would need at least three months for the linear donor scar to heal before one could resume contact sports like MMA.
How Can I Better Understand How I Will Look After My Hair Transplant Before The Actual Procedure?
Q: How can I better understand how I will look after my hair transplant before I actually do the procedure? — E.M. ~ Wantagh, N.Y.
A: A key part of a hair loss evaluation is for the doctor to manage the patient’s expectations for possible benefits from both medication and surgery. The way we decide how to plan a hair transplant is through a careful history and examination, demarcating the extent of the hair transplant on the patient’s actual head and photographing it. When showing other photo results to patients, it is important to not only show before and after photos of the recipient area but also of the donor area; how the back of the head looks immediately after the procedure, at post-op intervals, and at different hair lengths. Most importantly, one should point out that every patient is different so that a picture of another person does not necessarily represent what you might achieve.
What Problems Can Arise from Transplanting the Crown Too Early?
Q: What is the problem with transplanting the crown too early? — P.L., Newark, NJ
A: If a person’s hair loss continues – which is almost always the case – the crown will expand and leave the transplanted area isolated, i.e. looking like a pony-tail. The surgeon can perform additional hair transplant procedures to re-connect the transplanted area to the fringe, but, as one can see from the photo below, this is a large area that can require a lot of hair. It is often impossible to determine when a person is young if the donor supply will be adequate. If there is not enough donor hair, then the island of hair may remain isolated. Most importantly, it uses up a lot of hair that might be better transplanted to the front and top of the scalp – areas that are far more important cosmetically.
The front and top of the scalp are more important to one’s appearance than the crown, and these areas should be the first priority when planning hair restoration surgery.
As an exception, if a person has a family history of baldness limited to the crown, even at an advanced age, and the person in question is following this pattern, then earlier treatment of the crown may be considered.
Lastly, if you do treat the crown in a younger person, or one with whom the extent of hair loss is uncertain, the crown should be transplanted with light coverage only. That way a limited amount of hair will be used up in this area and there will be enough left over for the more cosmetically significant top and front of the scalp.
Q: I have read several articles on the internet which suggest that resistance training can accelerate male pattern baldness. Is there any truth in this? –B.F., Altherton, CA
A: Anything that raises androgen levels in your body can potentially accelerate hair loss. That said, I suggest that you should exercise as you normally would. As long as you don’t take drugs to enhance your workout, the effects should be minimal.
How are Recipient Sites Programmed into the ARTAS Robot?
Q: How are specifications for making recipient sites inputted into the ARTAS® robot? — A.F., Queens, NY
A: At the outset of the procedure, the physician sits at a computer terminal that is connected to the ARTAS Robot and enters the specifications directly into the robot’s software. Variables programmed in this manner include the number of recipient sites, density of sites, angle that the hair will extrude from the skin, depth of recipient sites, and the minimum distance away from existing hair follicles that a site can be created.
How Does the ARTAS Robot Avoid Transection of Hair Follicles During Recipient Site Creation?
Q: How does the ARTAS System avoid damaging hair follicles in the balding area during recipient site creation? — R.K., Brooklyn, NY
A: The ARTAS robot‘s optical guidance system enables it to accurately create recipient sites in areas of thinning hair without damaging existing hair follicles. During the recipient site creation process, the robot uses its advanced image-guided optical system to scan the surface of the skin, locate existing hair follicles in the recipient area, and then create recipient sites at a specified distance from these existing hairs.
The ARTAS robot carries out this process rapidly, accurately, and consistently according to the physician’s programmed specifications. Thanks to the microscopic precision of the image-guided technology, the robotic hair transplant system can avoid injury to follicles that can result when Follicular Unit Extraction (FUE) is performed using manual techniques.
Hair loss has a variety of causes. Diagnosis and treatment is best determined by a board-certified dermatologist. We offer both in-person and online photo consults.
