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Once you have a follicular unit transplant (FUT), if the procedure was done with care, there is no question that the results can’t be detected in any casual encounter, or even on close inspection in most circumstances. Yet with that said, there is still a difference between patient results that go beyond the characteristics of (1) hair shaft thickness, (2) hair character, and (3) hair color.

Let’s take a look at a patient who had two hair transplant procedures. The patient is Dr. Jon Perlman, the well-known Beverly Hills plastic surgeon that has been featured on ABC’s television show, Extreme Makeover. After his first session, he had good results that nicely framed his face when his hair was groomed. But on close examination, his hair was somewhat see-through. Dr. Perlman has very fine hair, so the bulk of each hair shaft was lower than average. By undergoing a second procedure, the bulk was doubled and the results shown in the pictures below say a great deal about the change he experienced. He was more-than-satisfied after the first procedure and thrilled after the second one. A good transplant became a great transplant.

Sometimes patients will tell me something like, “I don’t want it too thick and I am afraid if I put too much hair there, it will look unnaturally thick.” In all of the years of doing this surgery, I have never, ever had a patient who told me that I had made the hair too thick in a single session. We have seen many of our patients (initially satisfied, but wanting more hair) receive another transplant and become transformed back in time to their youthful look. By performing NHI’s pioneering dense packing procedure, we can increase the density of hair in a single procedure, often reducing the number of procedures needed to obtain results like the one shown here, but when the hair is super fine (like the example below) then two sessions may be needed. For many people, hair is like money — the more you have, the better it is.

Click the photos to enlarge.

Before and After 2 procedures (2890 grafts total):


For more photos, click “



What is the difference between doctors and the various medical groups performing hair transplants. There appears to be a great deal of competition and as I go between groups, I get confused and overwhelmed.

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If you were looking for a good family doctor or plastic surgeon, you would most likely use certain criteria for selecting one over the other. Fundamentally, you would look for a well credentialed, caring, competent doctor who you like and feel comfortable with. Be sure that the doctor values you as a patient by spending time with you and discussing your agenda freely. Ask yourself if the doctor listened to what you were saying or lectured you about his/her ideas. That doctor must be trustworthy to take on your welfare or your family’s welfare, and not only must you believe in his/her skills, but you should also like him/her as a person. Although the various family doctors and plastic surgeons use physician’s assistants or nurse practitioners to help them manage patient’s needs, the doctor is always ultimately the person in charge, the one whose skills you will eventually depend upon. As most doctors practice in groups, you should feel comfortable with the doctors who work with your doctor in the group that you selected, as sometimes your doctor may be on vacation or off-call when you need him/her the most.

You should expect that physician extenders should be educated as physician extenders (nurses or certified physician assistants, not salesmen). Hair transplantation differs from standard family practice and cosmetic surgery procedures in that there is a team approach to performing surgery. Doing refined follicular unit transplantation takes a team of 3-6 people working together for hours, so the doctor’s team is as important as the doctor is. An old cliché says that a chain is only as strong as its weakest link, so the skills of the doctor as one link of that chain can easily be offset by inexperienced technicians in the surgical team or sloppy processes that are not put together carefully and not focused on the many detailed nuances that produce quality hair transplants. You should feel confidence in the doctor and the team and you should feel ‘integrity’ and trust in soul of that doctor.

In my hair restoration practice, I add many elements to build confidence and establish trust. I have an open practice, where new, potential patients can meet completed hair transplanted patients one-on-one. This offers the opportunity for new patients to probe the process and see up front what they will be getting if we perform the surgery. I focus heavily on patient education, not only by providing copies of some of the important medical articles I have written, but also in spending time with each potential patient (doctor and patient in a private room without a salesman). Then after the visit, I provide a detailed letter summarizing what I learned about the patient’s objectives, and a written Master Plan for what I think will happen to that patient. Fees are openly discussed by the doctor and quotes for surgical fees are put into writing. By far, most of our patients do not have surgery and can be spared surgery with appropriate medications.

NHI is unique in that we have a fully accredited surgical center where all of our surgeries are performed, ensuring safety for patients to the highest national standard. Our surgical center is audited regularly for following hospital quality processes and procedure. Very few (if any) hair transplant facilities adhere to such rigorous standards. Why is that important? Well, it is the patient’s assurance that our sense of quality is judged against the best healthcare facilities in the nation. When you select a medical group for your hair transplant procedure, you should not only know the facility, the staff competence, and longevity of that staff, but also the history of the doctor. Has the doctor been disciplined before the medical board for infractions in any form of conduct? What does the public and his colleagues think about the doctor (available through internet sources)? What is the doctor’s malpractice record? Have you met or spoken to his/her former patients, and if so, what do they tell you about their research prior to taking on this doctor as their doctor-of-choice?

I always tell my patients (and have written on this blog many times before) that there is good news and bad news for the hair transplant patient — simply put, hair transplants are absolutely permanent. Getting it done right the first time is far easier that trying to fix what might not be fixable if it is done wrong. By following this selection process, finding a good doctor should not be difficult. There are many good doctors out there, just be careful not to end up in the wrong place.

Tags: hair transplant, doctor, hair restoration, hairtransplant, hairloss, hair loss


Over the over again, women from all over the world are writing to me asking, “What can be done for me?” I will list alternative options below, but I want to warn those of you who are reading this material to recognize that none of this is proven to solve the hair loss problems of most women. If it works, it may work in selective women, those that have a more clear androgenic (male-like) component of their hair loss. In addition, some women with combined genetic hair loss and Polycystic Ovaries (PCO) develop male-like patterned hair loss and could be candidates for the hormone treatments discussed below. I am loathe to recommend these treatments, because I do not personally feel comfortable with recommending hormone altering therapies, as some of them may impact ovarian, breast, and uterine cancer risks — so with that warning, please read on.

Finasteride use in women:
There have been articles on the failure of 1mg of finasteride to impact women’s hair loss. Now, for the use of higher dose finasteride than normally prescribed in men, the Iorizzo article (see references below) concludes, Sixty-two percent of the patients demonstrated some improvement of their hair loss with the use of finasteride, 2.5 mg/d, while taking the oral contraceptive. It is unclear whether the success was due to a higher dosage of finasteride (2.5 mg instead of 1 mg) or to its association with the oral contraceptive containing drospirenone, which has an antiandrogenic effect. These two drugs may complement each other and to get the effect, they both may be needed. Further studies are necessary to understand which patterns of female pattern hair loss respond better to this treatment, for I am sure that all women will not respond the same way. The article leaves us confused. It is not clear which are those who can be treated and there are no statistics on safety and side effects (this was not the focus of the article, however). The entire article is based upon conjecture, something that the authors recognize is the problem that the limited study creates. What concerns me is that with the promise that 62% of women may be helped by Propecia, desperate women with the help of inexperienced doctors will start taking finasteride without understanding the long term impact of these drugs on women. Maybe downstream, we may see a Vioxx type side effect with regard to cancer. With that said, there is a suggestion in this article that finasteride may have value for women and if this can be seen with better, more controlled studies, then this may be a breakthrough. I suspect that women with a ‘male pattern’ to their hair loss may experience more benefit over those without it. This is conjecture (an educated guess) on my part.

Antiandrogen treatment for hair loss in women:
The second article (see references below) starts off, “It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy.” This opening correctly set the tone of the article. Two different medications were used: spironolactone and cyproterone acetate. Neither was clearly better than the other. Discussion of the authors said, “The treatment under a doctor’s care went for 16 months. 44% had improvement, 44% had no improvement and 10% had further hair loss“. Many dermatologist are presently using spironolactone and cyproterone acetate and there is selective enthusiasm for these drugs, but it is not universally accepted as the mainstay for treating women’s hair loss. Doctors come under a great deal of pressure to do something. The question here is will spironolactone and cyproterone acetate treatment provide enough benefit for the costs and the pain of the injections that are required with repetitive treatments over a prolonged period of time?


  1. ARCH DERMATOL/VOL 142, MAR 2006: Matilde Iorizzo, MD; Colombina Vincenzi, MD; Stylianos Voudouris, MD; Bianca Maria Piraccini, MD, PhD; Antonella Tosti, MD, Titled Finasteride Treatment of Female Pattern Hair Loss
  2. British Journal of Dermatologist 2005, Article by R. Sinclair, M/ Weweromle amd D. Jolley from Australia titled: Treatment of female patterned hair loss with oral antiandrogens
Tags: hairloss, hair loss, female, women, woman, spironolactone, cyproterone, finasteride


What is dandruff and why do I have more of it than my friends? I can’t wear any dark shirt without snow on my shoulders. What can I do about it? Please help me understand what is happening to my scalp!

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Skin is not static. It changes and we shed it like a snake sheds its skin, but we do this a little each and every hour of the day. In two weeks, the average person will shed their entire skin surface and replace it with new skin. Scalp skin takes about a month to turn over, so the process is a bit longer. To understand dandruff, let’s take a quick look at psoriasis. “Psoriasis is a skin disease that causes scaling and swelling. Skin cells grow deep in the skin and slowly rise to the surface. This process is called cell turnover, and it normally takes about a month. With psoriasis, it can happen in just a few days because the cells rise too fast and pile up on the surface.” (source: NIAMS). Dandruff is like psoriasis in that the skin turnover is faster than normal (not anything as fast as psoriasis) and before it can be shed, it cakes up to form the flakes that you are observing and complaining about (dandruff).

Skin on different parts of the body shed at different rates and as we age, it is the genes in our body that determine how quickly the normal aging process occurs in our skin and the turnover rate of that skin for our age. The rate of aging and the daily changes in our skin can be influenced by extrinsic factors that can act together with the normal aging process to prematurely age our skin. Sun exposure is one of the most important factors that cause our skin to age but the way we use our body also impacts us. Exposure to varying environments will change the rate of skin turnover as well as the moisture that our skin has in it. Other external factors include things we do, like smoking, which has a duel effect, not only aging the skin and changing the water content of our skin, but it also decreases blood flow to some part of our skin anatomy (scalp). Over time, exposure to the sun damages our skin and impacts our ability to repair itself. Much of the damage is probably related to our exposure to ultraviolet (UV) light which damages our skin’s ability to repair itself. The skin which envelops our body becomes loose as we age and this process is accelerated when we do not protect our skin from sun exposure. The rate of skin turnover varies between people and dandruff is probably a reflection of the rate of skin turnover of our scalp skin for the flakes of dandruff are actually pieces of our skin which are shed prematurely. The higher the turnover rate, the worse the dandruff and the more frequent will be our complaints (e.g. itching, dryness) which plagues many of us.

The best way to manage your skin is to develop a sensible skin care routine. The scalp is no different. The use of moisturizers will soften and wet our skin; conditioners made for dry skin and dry hair will help restore moisture that is lost from the shampoos we use, which remove many of the protecting oils made by our sebaceous glands (sebum) that are designed to hold in moisture. Most important of all is the way you protect your skin from sun exposure, which can produce structural changes in your skin that are permanent. Older skin does not hold on to water very well, so older skin dries easily. Our outer skin layer (stratum corneum) may shed less as we age and the normal texture of the skin changes to reflect the loss of the supporting structures below the top skin layer. An older person’s skin appears dry and crinkly and this reflects a slowing down of collagen production as well as the fibrous elements that we call elastin. Elastin brings the recoil that returns the skin back to its normal position if we pull on it. In the typical aging person, the skin does not recoil very well when pulled upon and as such, it stands up after being pulled upon and it is also more fragile to injuries and environmental factors. Aging is a continuous process that normally begins in our mid-20s when most of our skin is healthy and hopefully not yet damaged by environmental factors. Dead skin cells do not shed as quickly and turnover of new skin cells will decrease as we age. The signs of aging are typically not visible for decades and this reflect the fact that our skin can take considerable abuse before it shows its age.

The dandruff on your head reflects many of the elements discussed above and the scalp skin is constantly exposed to drying from air and UV exposure, building up more damage over time.

Our body’s ability to replace itself varies significantly by body part and organ. For example, the outer layer of our skin completely replaces itself in about 2 weeks (scalp 4 weeks), while the lining in our intestine does it every 5 days. Our red blood cells replace themselves every 4 months (about 1/120th per day) and our bones about 10 years. Our chest muscles last 15 years, and our brains, well the part of it reading this blog, is as old as you are. So next time you get frustrated over the dandruff, think about what you have learned here, as it is a lot easier to moisturize and protect your scalp skin from sun damage than to simply ignore it as most of you do now.

Tags: dandruff, scalp, psoriasis, elastin, skin


I read with disgust your piece the other day (Doctors, Crooks, or Con Men — How Do You Tell the Difference?) which attacked doctors in such a way that your readers will get an unfair view of the doctors who do good hair transplants and are honest and caring. There are many doctors with high integrity who try to get the best for their patients. Why don’t you promote them and talk about the wonderful things that we can do today, rather than dwell on the few rotton apples out there?

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From time to time, I just get overwhelmed by some issue and my frustration is shared with all of you. This is my blog, which is like a personal journal that I share with all of my readers. Sure, I answer hair loss questions that are written to me, but from time to time I also treat it as a place to express my thoughts and even vent my anger in hopefully some constructive way. The piece from the other day was clearly precipitated by one particular patient, but unfortunately, it was not such an unusual occurrence for me to see this problem come up. Of the four doctors who gave him opinions, two of them actually do good quality hair transplants that I have seen in my office, but the decisions they made when meeting this poor man were not necessarily driven by his agenda nor his welfare. I know, unfortunately, that many of the doctors in the hair transplant industry spend huge amounts of money promoting their hair transplant expertise. A 2 x 3.5 inch ad in the Los Angeles Times, for example, costs between $1300-2700 for each day it is run (depending on the day of the week and length of the contract), so when ads are run daily, the costs become staggering and the doctor is as much driven by his/her ability to support his ad budget and his staff salaries, as by his/her desire to be honorable and righteous. Does one agenda conflict with the other? I believe that they, unfortunately, do conflict.

To handle a high number of people responding to these ads, these doctors hire salesmen (often disguised as someone with medical expertise) who become physician extenders, often screening callers to find out who has enough money to afford a hair transplant. Salesmen earn commissions, and although commissions are illegal in California, the commissions in some form still are what drives the sales process. Every potential candidate is screened for his ability to pay the large fees, just as the prospective patient was quoted the other day. That patient had the money so I think that the blood hounds sensed it so the price incentives that were offered by one doctor had some sense of urgency to it. The process I just defined is sleazy and it is something that I have written about, much to my detriment in this heavily market-and-sales driven process. Unfortunately, this is not just a California problem, it is an industry-wide cosmetic surgery problem and some doctors from around the world fit well into the amoral mold I have defined here. But there are many good doctors out there as well, so shopping before you buy a hair transplant will probably lead you to a better choice than taking the first doctor you meet. Watch out for sales tactics that look like a used-car sales lot. Do not accept seeing anyone but the doctor who is going to do the work and never, ever accept anything that you are told unless the person is qualified to give you an opinion and can back up what the doctor tells you.

The doctor who wrote the above comment to me today does bring up some very important things. The surgery we can do today is almost miraculous and 6 of my family members who’ve had hair transplants think that I am God-like for how natural the work looks. I think that too many people have expectations of the deforming, pluggy, doll-look with corn rows, so it is a difficult road for today’s doctors to educate the public on today’s high quality reality. A hair transplant was not only good enough for my immediate family, but I also had it done. As I’ve shared before, I have performed surgery on the politicians, billionaires, CEOs of big businesses, celebrities, the Royalty of countries that my readers have read about, and a few probable mafia members from other countries who would not have allowed me to live had it not worked out and met their expectations. I am not the only doctor who can do this type of quality hair transplant, so please forgive me for yesterday’s and today’s diatribe. To complete my answer to the doctor who posed the comment to me, I must remind the doctors who are reading this blog that we have taken an oath to uphold our patients’ interests about our own. If our oath is not enough, most governments that license doctors require doctors to report any infraction in ethical behavior that we observe as a condition of licensure, something that even I do not adhere to, to the spirit and the letter of the law.

I remember in 1994, I spoke before hundreds of doctors attacking those whose ethics reflect the worst of the sleaze in the business. I openly called them ‘sleazy crooks’. I also remember that the audience stood up and applauded my comments because the large majority of doctors were also disgusted with those who dragged down this struggling new industry, making it particularly hard to break the monopoly that had been horded by a select few marketers. I felt good about my comments because I sensed that many of the doctors in the audience fully supported the victimized men we were focused upon helping. After many private congratulations in the hallway over my vocal position, one well known doctor waited on the sidelines. As the crowd that surrounded me thinned and dispersed, that well known doctor came over to me and said, “I did not like the way you talked about me.” He stomped off and I thought for a moment, remembering that I never named a name and the closest I came to identifying anyone was the label “ sleazy crook,” which seemed to have struck a sensitive cord with him. I think I remember saying, “If the shoe fits, its yours,” but I think that he walked away from me too fast to have heard my retort.

I hope that the doctor who posed his query to me here reflects those who supported my position in 1994 and would support this long winded commentary by me as well.

Tags: hair transplant, doctor, hairloss, hair loss, hair restoration


Here’s essentially a summary of what I’ve written in the past about miniaturization. This is just about as to-the-point as I can get with what the miniaturization mapping is and why it is important. For more in-depth text on miniaturization and mapping, please see: Miniaturization: Critical to the Master Plan for Hair Loss.

Miniaturization is part of the balding process where hair shafts become thinner over time before falling out. Thickness and the general health of hair can be measured by examining it under a special microscope, called a densitometer, for signs of miniaturization. Increased miniaturization in certain patterns, reflect a progression of balding. In addition, miniaturization and detectable hair loss is not evident to the naked eye until more than 50% of normal (non-miniaturized) hair is lost. As a result, many men/women do not seek help until significant miniaturization has already taken place.

At New Hair Institute, we feel that mapping the scalp hair for miniaturization is critical in establishing the guidelines for the treatment of hair loss. Mapping measures the miniaturization and density on different areas on the scalp, providing us with a ‘roadmap of data’ to quantifiably measure the current health of the hair. When a medical treatment (such as finasteride or Propecia) is started we can document its effectiveness with the initial and periodic measurements for miniaturization.

The responsiveness of each patient with drug treatment is different, so each patient must be diligent in acquiring follow up measurements to the degree of miniaturization and the location of the miniaturization by scalp area. Without quantifiable measurements for hair loss, there is no clinical science in the treatment, just hocus-pocus and blustering, a problem that is far too prevalent today.

If you are balding, you should have your scalp hair mapped for miniaturization to (1) estimate the pattern of hair loss now and for future loss, and (2) measure the starting point for miniaturization so that changes measured over time, can be followed. These measurements are very fast and easy. It is today’s Standard of Care that should be available to every balding patient wanting a Master Plan, for treatments appropriate to their future hair loss.



by Jae P. Pak, M.D., William R. Rassman, M.D.

Tags: hairloss, hair loss, miniaturization, hair mapping


Authors: Price VH , Menefee E, Sanchez M, Kaufman KD. Department of Dermatology, University of California, San Francisco published an article in the J Am Acad Dermatol. 2006 Jul;55(1):71-4. Epub 2006 May 3.

This is an important article which shows the impact of finasteride (Propecia) on the miniaturization process. It is clear from this study that Propecia produces much of its value by reversing the miniaturization process, making the hair shafts thicker, more so than growing new hair follicles. That is why it works well in people who still have hair that is being impacted by the genetic balding process, while being minimally effective in those men who lost most of their hair. The article concluded:

“CONCLUSION: Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs, such as increased growth rate (length) and thickness of hairs, contribute to the beneficial effects of finasteride in treated men.”

I know that many of my readers may be tired of the constant references to mapping out the scalp for miniaturization. This scientific study, by a prestigious university, shows that the degree of miniaturization in the drug treatment for hair loss is where the benefits lie. Mapping the scalp absolutely shows from ‘whence your hair came to where your hair is going’. The measurements of miniaturization is the diagnostic backbone for the diagnosis of genetic balding, particularly when it occurs in patterns (male pattern balding or MPB). Even female genetic hair loss has distinctive patterns of miniaturization and the skilled diagnostician who commands that knowledge, is more effective in giving advice and building the Master Plan that I keep talking about. The doctor should:

  1. make the diagnosis by mapping the scalp and analyzing miniaturization
  2. document the pattern of hair loss and miniaturization
  3. use his/her knowledge to predict what should happen when a person is treated with drugs on miniaturized hairs
  4. observe what happens when the drug is used on the miniaturized hairs by repeating the mapping process periodically over time
  5. build a Master Plan based upon the degree of miniaturization and its response to drugs and/or time
  6. get to know the patient and his/her goals
  7. evaluate the transplant option when appropriate
  8. learn how the treatments (transplants or drugs) impacts the patient’s goals and the balding process based upon successive scalp mappings, and
  9. re-evaluate the Master Plan based upon the knowledge of what has happened in 1-8 above.

This 9 step process is the standard of care today and anything less than this is less than what every hair loss victim should accept.

Too many times, readers of this blog tell me that they have gone to their doctors and asked to have their hair mapped out for miniaturization and the doctors they speak with essentially call mapping ‘hogwash’ or BS. As you can see from what I wrote here and the published article I referenced above, mapping out the scalp for miniaturization is possibly the most important part of the doctor’s evaluation of hair loss. Too many doctors look at the scalp hair, run their hands through it and make a diagnosis and a recommendation based upon a naked eye evaluation (as if to suggest that there is a microcope on the ends of their fingers), but this approach brings no sophistication, little added value, and no clinical science to the ‘hocus pocus’ that has been associated with hair loss and its diagnosis. The standard of care dictates that the 9 step process outlined above is the basic minimum a patient should expect when he/she visits an expert in hair loss. The metrics of miniaturization is the foundation for the clinical diagnosis of hair loss.

Tags: hairloss, hair loss, miniaturization


I am the inventor of Rejuvx and after selling thousands of bottels of my product i guess i must have a formular that must give some results other wise people would not keep on buying it, my product has never been sold to regrow hair as i belive as a chemist that is never going to happen but it has helped thousands of people have a fuller healthier head of hair

Regards Edward Horton
Presient c.e.o RejuvX

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Soap BoxThank you for the letter and finding BaldingBlog. First, I need to point out to readers that I have no way to verify if this is a legit email from the actual inventor of Rejuvx, but I have no reason to think otherwise so I’ll take it at face value.

I am a bit confused that your letter states Rejuvx has “never been sold to regrow hair“, because I just visited your website which states: “Within weeks of using Rejuvx, people experiencing hair loss will notice improved growth“. There may be a fine line from a legal FDA point of wording here, but that is not my specialty.

Back in the late 1980’s and early 1990’s the Helsinki Formula was advertised to treat hair loss and was one of the best selling products for hair grwoth on the market at the time. What most people do not know is that the Federal Trade Commission (FTC) in accordance with the Federal Trade Commission Act of 1914 filed a suit against the makers of Helsinki Formula stating their advertising constituted a deceptive trade practice. The court concluded that the product had a “placebo effect”. In other words, many companies have sold great amounts of product and have yet to do what they claim, so pointing out that you have sold “thousands of bottels [sic]” really holds no meaning but suggested value.

There may be laws and regulations, but manufacturers advertise what consumers want to hear. Desperate people spend money in hopes that a cure for balding is as easy as 1, 2, 3. Most of these claims will go under the radar of the Federal Trade Commission, because there is an art to stating certain claims without breaking the law and the FTC cannot possibly prosecute all of those that are in violation (they pick and choose their battles).

The Rejuvx website states, “The abandonment of artificial ingredients additionally makes Rejuvx prescription free, since it does not cause any significant side effects.” — No significant side effects imples there are SOME side effects and I would love to know what they are and so should potential buyers for proper disclosure. If there are side effects of any type, then I would be happy to contact the FDA’s enforcement arm to look into the language you are using and in pursuing a full disclosure so that the public will know the safety factors about your product. I believe that the FDA is empowered to investigate and report on the safety of products sold that have side effects and only they can judge what is and what is not significant.

I am pleased you have a successful business. It illustrates the fact that we live in a society obsessed with hair loss, and the appearance and worship of youth. While my statement may trigger a spectrum of theories and opinions about our vanity, it is also a catalyst for many to profit from our insecurities. My ultimate point is that it is (and it always will be) a buyer beware market.

Tags: hairloss, hair loss, rejuvx, ftc, helsinki formula, fda


There’s a doctor in the bay area that is claiming to do hair transplants with robots. What is this about? Robots??? Can you tell me more about this?

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Robot“Restoration Robotics, Inc. (Mountain View, CA) is a company using image-guided robotic technology to perform hair restoration by emulating the FUE technique. The robotic technology is in development. Currently, it is not approved by the FDA and the technology is not for sale”, said a company spokesperson when I contacted them. I also found this press release about Restoration Robotics from 2003, here.

I can imagine the scene of a movie with robots doing hair transplants, starring 3-CPO from Star Wars. I am sure that we will be hearing more about robotic-assisted hair transplants in the future and I doubt that it will be as frightening as I just made it sound. This is an exciting conceptual solution to the Follicular Unit Extraction (FUE) quality problem.

There is also the Medicamat Punch Hair Matic, first announced in late 2004 in this press release — Punch Hair Matic rescues baldies — which says: “Medicamat of France will be launching its new robot for hair transplantation”. I have been familiar with this company, which purchased the technology from a long term friend in the mid-1990s, Dr. Pascal Boudjema, one of the brightest inventors that the hair transplant community has ever had.

Their press release goes on to say: “The Punch Hair Matic (which is patent-protected) is a robot using micro-instruments to remove follicular units, which makes surgery simpler, faster, and less debilitating for the patient, with more convincing aesthetic results.” They report a very fast surgical time (2 hours to do 700 grafts) for the transplant (appears to be an FUE technique).

In many ways, Medicamat has been doing small punch grafting longer than I have, considering that they have been using smaller and smaller punches for many years. The evolution to smaller punches has been slow and methodical.

Today, the shoppers for FUE transplants pass through a mine field (a ‘buyer beware’ business for sure) where doctors from all over the world (with little or no training) are using manual techniques with varying degrees of success. Regardless of their expertise, they are telling the public that they specialize in FUE and are experts in the technique. At least, the robot approach promises to standardize the technique and the quality of the output. So we have a horse race now between two companies offering what may turn out to be competing technologies. Only the public can benefit here, so I sincerely hope that one or both of these companies succeed in making the business for automated hair transplants work.

Tags: hair transplant, robot, robotics, hair restoration


Miniaturization occurs in men and women who are balding. Miniaturization is the process where a normal thickness hair shaft becomes thinner and thinner over time due to the genetically determined effects of aging and/or androgenic hormones on the terminal (normal) hair follicle. The process of miniaturization is a slow process in genetic balding. Hair shafts may lose 10% of their diameter, then 20%, then 30% and so on. Each degree of increased miniaturization reflects further progression of the genetic balding process. The instruments that measure miniaturization were invented (and patented) by me in the early 1990s (patent ) and they are in wide spread use today. Socially detectable hair loss is not evident until more than 50% of average weight hair has been lost (more with fine, high contrast skin/scalp color hair and less with coarse, low contrast skin/scalp color hair) and as a result, many men do not seek out expert help until they see some evidence of balding (which they too often deny).

When a doctor views the scalp hair with high magnification, the degree of miniaturization and the location of the miniaturization are both critical to establishing (1) the diagnosis and (2) the rate of the process, which progresses over time. Because miniaturization is a relative measurement at any one time (comparing finer hair to the thickest hair), it takes substantial experience before this measurement can be useful to the individual clinician. In our experience, from examining and following tens of thousands of patients with the hair densitometer (video microscope), we have found that assessing the degree of miniaturization has useful predictive value when evaluating the risks of hair loss and in establishing hair loss patterns. The amount of miniaturization in each section of the scalp tells the physician just how far the balding is progressing or has progressed. In men who show more and more areas of miniaturization over time, the genetic balding can be considered active. In men treated with finasteride, if the miniaturization is reduced or the hair count is increased, it can be assumed that the balding process is coming under medical control.

We know that hair loss occurs in patterns (see Norwood Chart), but these patterns are what the eye can see. When the naked eye picks up these patterns, the miniaturization is always in a more advanced state. The balder the patient is, the worse is both the absolute hair count (density or healthy hairs) and the relative fullness of the miniaturized hair shafts. Clearly, miniaturized hairs that have a reduced hair circumference of 10% will have more bulk value than a hair circumference reduction of 70%.

In our practice we use a video densitometer to map each patient’s scalp. We typically map and digitally photograph a series of discrete areas on the scalp that reflect the balding and non-balding areas. The non-balding donor area (back and sides of the head) reflect the numbers of hairs per square inch the patient was probably born with. By comparing the donor area with other areas that might be balding, we will have very relevant numbers that will reflect the eventual balding that the naked eye will pick up as the balding progresses.

As an exercise in thinking out the process that the skilled doctor performs, follow the thinking on the following case example: Miniaturization in the recipient area (front, top and crown) can often delineate which areas of the scalp are most likely to bald and which are stable, anticipating the patient’s future Norwood hair loss classification. If a 38 year old man has most of the miniaturization in front and very little in the mid-scalp and none in the crown, then the physician may safely assume that the eventual hair loss pattern will probably not go much beyond a Class 3A or 4A pattern (worst case scenario). View the diagram below and click the button for a view of the degree of miniaturization of the patient illustrated here. From this, a Master Plan can be derived depending upon how the existing hair loss is bothering the patient. If the hair loss is just showing some thinning, it may be logical to treat it with finasteride alone, while if the hair loss is more advanced, looks like it is balding and it bothers the patient, then it could be treated with a hair transplant. Because the doctor knows the miniaturization pattern and the age of the patient, he may confidently predict this patient’s worst case and with that information, the patient can budget his time and money to do or not to do a hair transplant. That is why I say that the future management of hair loss needs a Master Plan. In Patient QQ, this is just what happened. He had one hair transplant procedure 10 years ago and because he had limited miniaturization to the frontal area, I could predict that he would probably not need further work for some time. If his situation was to evolve differently (such that he lost more hair than I had predicted) then he could always have had another transplant (if he needed and/or wanted it). He was close to 50 when he came to see me, near the end of his hair loss process. Now his experience with me is just a fond memory of a difficult time in his distant past.

We feel that predicting the short-term loss (the extent of miniaturization in the recipient area, as well as the rapidity of the loss) is critical in establishing the guidelines for treatment, whether it is a hair transplant or drug intervention. In the very early stages of hair loss (the man in his early-mid twenties), findings of increased miniaturization can anticipate future balding even before any loss can be seen to the naked eye. Often, the reason a person seeks a consultation from a hair restoration expert is that there is some change in the “rate” of his hair loss (often more hair seen on the pillow or in the shower). A patient who is very gradually losing his hair is less likely to seek help, compared to a patient who suddenly has acceleration in the rate that he is losing hair. Usually large numbers of hairs undergo miniaturization before any are actually lost and the time the drugs are most effective is in this early phase. In men, DHT is the hormone responsible for these changes.

Ideally, if you are balding, you should take finasteride after mapping your scalp to identify if you have male pattern baldness. The focus upon mapping for miniaturization is to (1) estimate the pattern of hair loss, and (2) measure the starting point for miniaturization so that changes caused by finasteride can be measured over time. Although it takes around 6 to 8 months before you can see the effect of finasteride visually from hair length, it is highly possible that the impact of finasteride on the emerging hair will be earlier than the projected 6-8 months. The measurements are very fast and easy to get from a hair transplant physician and it is today’s Standard of Care that should be available to every balding patient wanting a Master Plan for their future hair loss and hair loss management (medical or surgical).

With successful medical (drug) treatments like finasteride, the miniaturization may be reversed (partly or completely). The responsiveness of each patient is different, so each patient must be diligent in acquiring follow up measurements of the degree of miniaturization and the location of the miniaturization by scalp location. The same diagnostic criteria should and must be followed in women. Without good, reproducible measurements for miniaturization, there is no clinical science in the treatment of hair loss, just hocus-pocus and blustering, a problem that is far too frequent today.

Click each zone or area in the image below to see a microscopic view of the miniaturization (or lack thereof) in a typical balding male:

PZ = Permanent Zone
T1, T2 = Temples
F1, F2 = Frontal
M = Middle
V = Vertex

The below image is a guide to see examples of normal, moderately miniaturized, and advanced miniaturized hair. Click to enlarge.



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