Hair loss and replacement questions and answers

1. What causes hair loss? The most common cause is genetics. Other causes are hormonal, such as thyroid imbalances, stress, or excess testosterone causing an increase in DHT (dihydrotestosterone). Many men taking steroids have increases in DHT causing permanent hair loss. In men genetic hair loss is called Male Pattern Baldness (MPB) and in women Female Pattern Baldness (FPB). Common causes in women are braids or tight hair pulled back causing Traction Alopecia.
2. Non-surgical treatments are minoxidil 5% (Rogaine) foam or solution, and in men Finasteride, a prescription medication, which prevents conversion of testosterone to DHT. Often both are used together to reduce hair loss. Another excellent product is Spectral-DNC spray, which reduces DHT topically in nanoparticles that to absorb better.
   PRP (platelet-rich plasma) scalp injections can also be successful. Blood is drawn from the patient and processed to isolate the platelets, which contain multiple growth factors, and then micro-needled into the scalp. We now use Exosomes instead of PRP, as it has many more growth factors, and there is no blood draw from the patient. Often Exosome treatments are used with hair transplants to prevent further hair-loss in the balding areas.
3. For women, hormones should be checked. If normal, they can try minoxidil and/or Spectral sprays and/or exosomes, but for men and women, hair transplants are often the best and longest lasting results.
4. Hair transplants: Hair grafts are removed from the back of the scalp, where they are not destined to fall out, and micro-grafted to the balding areas. In their new location, they will usually grow permanently.
5. What are the current hair transplant techniques? FUE (follicular unit extraction) involves removing 1-millimeter micro-grafts containing from 1 to 4 hair follicles (thus hairs) with a “punch.” FUE grafts require no sutures and leave no visible scars in the back of the scalp. FUT (follicular unit transplant) removes the grafts by removing a hair-bearing strip of scalp, closing the defect with sutures, and dissecting the strip into the same 1mm grafts as with the FUE. FUT is faster and only a strip of scalp needs to be shaved, but it does leave a minimal scar hidden by hair. Usually, woman have the strip because of the limited cutting of hair in the back of the scalp. Also, more grafts can be taken using the strip if the donor site is small.
6. What is NeoGraft? An automated FUE technique allowing a greater number of grafts to be taken than manual FUE.
7. The most important factors for successful and natural appearance? Skill and experience of those performing the grafts. The hairline must be designed naturally, the grafts must be placed in the proper direction, and the grafts must be single hair follicle grafts for a totally natural hairline. Behind the hairline, grafts with 2 to 4 follicles are used for more density.
8. What are the expectations? Grafted hair starts growing at 3 months. With the solution we soak grafts in between taking and inserting the grafts, growth often starts immediately. Full density is 1 1/2 years.
9. Is anesthesia involved? Local anesthesia is used to numb the scalp, and if the patients prefer, also, oral sedation.

Dr. Ronald Finger, MD, FACS is a board-certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com