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Women's Hair Loss Open House Transcript

The following is the transcript of the Question and Answer segment of Dr. Schweiger's Open House for hair loss in women. This open house event took place on August 13, 2009 at the Bernstein Medical - Center for Hair Restoration in New York, NY.

8/13/2009

Question: Who is the best candidate for a hair transplant?

Dr. Schweiger: A person who has cosmetically significant hair loss on the front and top of the scalp and who has an adequate supply of donor hair that is stable. Men usually need to be at least 25 to determine this and in women it is a bit older.

Question: What does "stable" mean?

Dr. Schweiger: Stable means a permanent donor area of the scalp in which the hair will persist over time. In some patients, the donor area is not permanent in that it will continue to thin, much like the balding area on the front and top of the scalp. Thinning is caused by a process called miniaturization.

Question: Then what's miniaturization?

Dr. Schweiger: In miniaturization, the diameter of the hair progressively becomes narrower and the hair becomes shorter (due to a shortened hair growth cycle) making the hair appear thinner. In the initial stages of genetic hair loss, the hair actually thins, rather than sheds (falls out).

Question: What's normal shedding? I do that all the time.

Dr. Schweiger: 85% of hair is new growth or in the anagen phase (growing phase), 15% in the telogen (resting phase). Hair that is in the telogen phase (the 15%) will shed and then grow back again.

Question: How long does a hair transplant last?

Dr. Schweiger: If the hair that is transplanted is stable, the hair that is transplanted will last your entire life. If the hair transplanted is not stable, it will thin over time. But remember that the hair is removed from the back of the head and placed to the front. We're not making new hair; we're moving it to the new location.

Question: What kind of anesthesia do you use?

Dr. Schweiger: Hair transplantation is done under local anesthesia. It's the same as a dentist would use but less concentrated.

Question: If you're taking a strip from the back of the head, won't I have a big scar or gap?

Dr. Schweiger: We take a long thin strip of hair in the back of the scalp and then the area is either sutured or stapled closed. This generally results in a fine, line scar that is buried in your hair.

Question: What is the surgery like?

Dr. Schweiger: After the patient is comfortable and given local anesthesia, I first remove the donor strip. The area is closed with sutures or more commonly staples. After the strip is removed, we carefully divide it into smaller pieces, called slivers, using dissecting microscopes to avoid any damage to hair follicles. Under microscopic control, the slivers are then further dissected into individual hair follicle units. The follicular units consist of 1 to 4 hairs each. We use the 1-hair follicular units for the frontal hairline and place the larger ones towards the center to reproduce the way hair grows in nature. I would design your hairline and create the recipients sites to accommodate the grafts and then the individual grafts are inserted into the tiny needle-point holes.

Question: How much of the hair actually grows?

Dr. Schweiger: They should all grow. Although 100% growth can not be guaranteed, we now know all the factors that contribute to growth and can control for these during the surgery. Examples would be the type of holding solution, its temperature and the best way to handle grafts when they are outside the body.

Question: What's difference between Minoxidil 2% and 5%?

Dr. Schweiger: 2% is the only FDA strength approved strength for women. The 5% is more effective, but also causes a greater incidence of facial hair - an infrequent side effect of the treatment. We find that if a woman applies the 5% once a day at bedtime, it well be far more convenient than the 2% used twice a day and has about the same low incidence of the side effects of facial hair. Light headedness is another side of minoxidil. If the 5% is applied at bedtime, the lightheadedness generally becomes a non-issue.

Question: Can you have someone else as a hair donor?

Dr. Schweiger: Unfortunately, the body would reject it. Interestingly, hair can be transplanted between identical twins, however if one twin was going bald, the other would as well. Since they would both need the hair, swapping would serve little purpose.

Question: You can't tell the difference between the new hair and the old hair with the newer techniques? Have you always done the newest techniques?

Dr. Schweiger: Yes, Dr. Bernstein developed Follicular Unit Transplantation in 1995, the procedure that supplanted mini-micrografting. Since then it has been the state-of-the-art. In our practice he and I use follicular unit grafting exclusively.

Question: After the procedure, can you see the plugs?

Dr. Schweiger: There are no plugs. We use only follicular units in the hair transplant and these are identically to non-transplanted hair.

Question: Would people be able to tell I had a procedure?

Dr. Schweiger: The first week to 10 days you will see some redness and the stubble of the transplanted hair. At ten days, the grafts are permanently in place and you can scrub any residual crusting off - so there will be little, if any, evidence of the hair transplant procedure. Over the next months the transplanted stubble will gradually be shed and then the follicles go into a dormant stage. At 10 weeks to three months, the new hair will start to grow, but the growth is gradually beginning with fine, vellus-looking hair. The hair will increase in thickness and in length over the course of a year. At the end of a year, most people will have full growth. The new growth is so gradual, it is virtually undetectable.

Question: Do you cause head trauma?

Dr. Schweiger: The hair transplant is limited to the scalp skin - there is no underlying trauma to the head.

Question: How long is the procedure?

Dr. Schweiger: Surgery generally begins at 7:30am and you would be with us for the whole day. You'll be watching television, sleeping, watching movies, and take stretch breaks as you need them. Most patients say that the experience was pretty pleasant.

Question: Do you give us Valium?

Dr. Schweiger: Yes of course! (laughter). At the start every procedure you receive valium, and then versed, which is like short acting valium. If you need more during the procedure it is available.

Question: How many women are candidates?

Dr. Schweiger: We have found that 15-20% of women with female pattern hair loss are candidates, the rest have diffuse hair loss (without a stable permanent zone).

Question: What kind of medical therapies do you recommend?

Dr. Schweiger: One of the medical therapies we recommend is Minoxidil either the 2% or 5%. We recommend the foam less often; as it tends to get hung up in the hair has a harder time getting to the scalp. The other is the laser hair comb. A few years ago the FDA approved the HairMax Laser Comb for use. It is hand held and delivers a low level light laser beam into the scalp which stimulates hair growth in select patients.

The protocol is 3x/week for 15 min (Monday, Wednesday and Friday). About half of the patients felt they had some benefit. But in many if it doesn't work because they don't use it for the entire protocol. Just like Rogaine, you have to continue to use it to have any benefit. There is only one clinical study so far but it did stop the hair loss.

Question: What about Aldactone. I hear a lot about Aldactone.

Dr. Schweiger: Like Minoxidil, Aldactone (the generic is Spironolactone) is a high blood pressure medicine but it is also an anti-androgen which is why it is useful for hair loss. It seems to work best in women with androgen excess. If the history points to this, we will perform blood tests to confirm the elevated levels.

Question: How about Propecia? Can I use Propecia?

Dr. Schweiger: Propecia is an oral medication that blocks the conversion of testosterone to DHT. It can cause birth defects if pregnant women ingest it, or repeatedly handle the crushed pills. At present, it is only FDA approved for men in whom it appears to be very safe. It may have a role in younger women suffering from hair loss who have the male pattern or who have had a hysterectomy. We don't know the long term side effects in women.

Question: What distinguishes your procedure from others?

Dr. Schweiger: First, we recommend a hair transplant only to patients that will benefit from the surgery. And this is accomplished with a careful examination and detailed history and understanding the patient's needs. For those persons who are good candidates for surgery, you will be having the procedure performed by those that developed it. There are an innumerable number of nuances that go into a great procedure, from graft dissection to the art of hairline design, and we have been refining them for the past 14 years - ever since we first pioneered Follicular Unit Hair transplantation in 1995.

Question: I have had hair weaves for years. Can I still get them?

Dr. Schweiger: Hair weaves and extensions are fine as long as they are on loosely. Tight braids can cause traction alopecia. But as long as they are loose and aesthetically acceptable, then it's fine.

Question: When a patient comes here for a hair loss examination, what do you do?

Dr. Schweiger: We take a history and perform a careful examination that includes checking hair density and miniaturization. If there is evidence of systemic disease, we may do blood tests for thyroid, anemia, testosterone, iron stores and androgens. We might also do a scalp biopsy if there is a suggestion of scarring hair loss. Once we know the diagnosis, the treatment options are discussed in detail.

Question: Can stress cause hair loss?

Dr. Schweiger: Normally a person sheds 100 to 150 hairs per day. Stress (either psychological or physical) can increase this amount two to three fold in a condition called telogen effluvium (TE). In TE, some of the growing hair is shifted to the resting phase, increasing the amount of hair that would be shed at the end of this phase (which generally lasts about 3 months). Telogen hairs are easily pulled out from the scalp and appear as normal hair with a small bulb at the end. This is in contrast to the miniaturized hair that characterizes genetic balding where the hair is finer, but pulls out no more readily than normal, healthy hair. Telogen effluvium due to acute stress, such as pregnancy, some medications, general anesthesia or physical trauma, is usually self limiting and the hair usually grows back within a year.

Question: Is breakage the same as miniaturization?

Dr. Schweiger: In hair breakage, the hair is more fragile as a result of perms or other treatments that damage hair. The hair shaft literally breaks off and you can see the split end. In miniaturization, the hair becomes shorter and thinner, but the end is tapered and generally does not break off.

Question: Where do you stand on biopsy?

Dr. Schweiger: Usually a biopsy is performed when we are trying to confirm the diagnosis or determine the cause of scarring alopeica, since this can be a contra-indication for a hair transplant, but treated medically.


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