I’ve been trying to find the best ARTAS doctor but I am still confused. Some doctors say NeoGraft is the best surgery. It’s hard to choose or believe which is better. Where can I find the best doctor for this?

Follicular Unit Extraction (FUE) is a basically a harvesting technique in hair transplant surgery. FUE is a way for doctors to “take out” your donor hair. The other method is oftern called a “strip” method or Follicular Unit Transplant (FUT). The strip method harvests the hair follicles by taking a small linear cut of your scalp. You often see horrific hair transplant scars on the Internet related to strip scars. However this is not always the case.

The ARTAS robot is basically a tool or an instrument a doctor uses to harvest donor hair follicles using the FUE method. Instead of a doctor doing the surgery, an automated robot takes out the hair follicles. You still need the doctor to design and make the recipient sites to implant the hair. In other words, ARTAS does NOT perform the critical part of the surgery. The part that matters. The part that give you a new hair line. A great ARTAS robot that is used in surgery may still give you a horrible result if the doctor is not a skilled artist and surgeon. There have been cases where doctors (gynecologists or pediatricians) that are NOT hair transplant surgeons, doctors that have never performed a hair transplant surgery, buy the ARTAS robot believing they can be a great hair transplant doctor. Can you be a great cook if you buy the best cooking knives, pots, and pans? Can you be a great football player if you have expensive football gear?

The Neograft system is also an instrument a doctor use to harvest donor hair. The Neograft system has not been traditionally popular with hair transplant doctors. Instead, the Neograft system is sold to cosmetic surgeons and dermatologist who do not specialize in hair transplant surgery. In many cases there is a Neograft team of technicians that are contracted to come on the day of surgery to harvest the hair for the doctors. These people are called “ICs” Independent Contractors. Most ICs are not even nurses or hold any medical degree. This (ICs doing surgery) is illegal in certain states and a grey area in the field of hair transplant surgery. After the grafts are harvested, the contracted team usually place the grafts for the doctor. Some doctors who perform hair transplant surgery on a regular basis may have their own team but it is rare for a doctor to actually do the harvesting with the NeoGraft. You may want to ask about this when you are interviewing doctors. You may want to ask how many hair transplant surgery they perform a week. You may want to ask who does the actual FUE harvesting. There are cases where patients never see their doctor on the day of surgery because the entire surgery is performed by the IC or the technician.

Doctors who specialize in hair transplant surgery may have their own FUE instrument or automation device. Some examples are Dr. Harris who use his own SAFE system, Dr. Umar who use his own UGraft system, Dr. Shaio who use his own 4DFUE system. The ARTAS, 4DFUE, and Safe system are used at NHI by Dr. Pak and Dr. Rassman since they hold key U.S. Patents or technology used in the ARTAS. Dr. Pak also uses his own unique FUE device as well.

In the end, the best FUE surgery outcome should be judged by the final artistic result. The final result is NOT about the technical method of taking out the grafts (hairs). The ARTAS or Neograft are just machines or instruments. You cannot make a great football player with fancy uniform and a state of the art stadium. You don’t become a great race car driver because you own a Ferrari. It just means you can boast (advertise) about the Ferrari (ARTAS, Neograft) to draw patients in.

This is a photo of a female patient who had a hair line lowering and rounding hair transplant surgery. This is sometimes known as forehead reduction surgery.   Dr. Jae Pak performed the surgery at New Hair Institute Medical Group in Los Angeles.

female hair line lowering before after photo

*CLICK TO ENLARGE PHOTO

This patient did not like her square high forehead with receded corners.  She thought her hair line looked too masculine.  She considered a forehead reduction surgery to lower the hair line.  However, she was worried about the hair line incision scar.  She also wanted the hair line corners to be more rounded in appearance which a forehead reduction surgery could not achieve.

FOREHEAD REDUCTION Surgery:

Forehead reduction surgery for women with a high forehead has been popular since the late 1990s.  Dr Sheldon Kabaker  in Oakland California is a well known and prominent surgeon who has been offering female forehead reduction surgery for many years.  It sometimes requires the use of tissue expanders to drastically lower one’s hair line.   Since 2006 Dr. Gal Aharonov in Beverly Hills California has been offering a slightly modified approach to the forehead reduction surgery.  His method has gained great popularity from all over the world.  With third party review sites such as RealSelf.com, the hair transplant community saw a demand for women seeking an alternative to forehead reduction.  Potential problems of a forehead reduction surgery were the visibility of a scar along the hair line, and the limitations of creating an oval or rounded appearance.  While patients were happy with the drastic reduction in their forehead size, some were self conscious about their scar and would not wear their hair pulled back.  They addressed this with make up and sometimes a limited hair transplant procedure.

HAIR TRANSPLANT for hair line lowering:

An alternative for those women who did not want to undergo a forehead reduction surgery was a standard hair transplant procedure.  Hair transplant procedure involves harvesting donor hair from the back of the head to individually relocate single follicles to the front.  The limitations of a hair transplant procedure was that the results were not instantaneous. The transplanted hairs need to grow out from its roots. The advantage was a natural shaped hair line dictated by the artistry of the doctor creating the hair line.  There was no scarring along the hair line.

The results for this hair line lowering patient were achieved using Follicular Unit Strip Surgery (strip surgery) sometimes referred as Follicular Unit Transplant (FUT).   If Follicular Unit Extraction (FUE) method was used, it would have required shaving the back of the patient’s head.  This is something few women would accept. There is no shaving involved with the strip surgery and the incision around the donor area (back of head) is covered by the patient’s hair.  Even with the hair wet or hair up, the incision line (scar) will rarely, if ever be noticed.  This incision may be an issue for men who keep their hair very short.

FUE vs Strip scar on the day of surgery

If the incision is an issue for a patient, the alternative method of harvesting hair is known as Follicular Unit Extraction (FUE).  FUE harvesting is carried out manually by a highly trained surgeon or with an aid of the ARTAS robotic FUE instrument.  There are other machines available such as Dr. Harris’s SAFE system or the NeoGraft machine you may have seen advertised in airline magazines.  FUE method of donor hair harvesting may seem attractive for many patients because it is heavily marketed and advertised as a “no scar” surgery.  This is NOT an accurate statement and is shunned by doctors since FUE does leave thousands of permanent round scars.  Many patients have their FUE scars as well as strip scars camouflaged with Scalp MicroPigmentation.

Moth Eaten appearance of a FUE scar Before and After SMP

This reinforces the fact that the latest technology and fancy robots are not always the best choice. For most women, a small linear scar on the back of their head may be a better option than shaving their head for thousands of FUE “dot” scars.  Think of a C-section scar under long hair vs a moth eaten appearance on the back of a shaved head.

Talk to a doctor

The other day, I overheard a group of my friends speak (behind my back) that they trought that I had cancer because my hair was very thin. They said I looked sickly and it hit me like a truck. I have seem many doctors about my thinning hair in the past, but most told me that there was nothing to do about it. The other night I saw an infomercial on TV which showed the value of hair transplants for people with thinning hair. Is this the right next step for me?

The treatment of women’s hair loss must be approached differently than hair loss in men, as most women rarely lose all of the hair in a pattern as men do. In fact, much of the hair remains, but the thickness of the hair shaft becomes smaller than normal hair and the density of each follicular unit reduces from the normal of 2 hairs per follicular unit to between 1 – 1.6 hairs per follicular unit. When this is combined with the finer hair, then the bulk of hair in each follicular unit is significantly reduced. This reduction of hair bulk from miniaturization and loss of individual hair follicles causes the hair to appear thinner, at times making the patient look sickly. Because a relatively large area can be subject to this thinning, it is important that hair is transplanted in areas where it is cosmetically most significant or where it can enhance a specific styling plan to increase the appearance of fullness. Unfortunately, the process discussed above occurs, at time, even in the area we call the donor area, which in 99% of men, is perfectly normal regardless of the degree of balding present. In women with this donor area looking like the rest of the hair, this makes them significantly different from men whose donor area has normal hair, normal hair bulk and no significant miniaturization. If women have such hair in what we call the donor area, they are not candidates for hair transplantation under any circumstances. Too many doctors transplant such women just for the surgical fees, and these women are never made better, and at time even made worse.

When the hair in this ‘donor area’ is reasonably unaffected by the disease process discussed above, then they might become candidates for hair transplantation. We generally confine the transplant process to a localized part of the scalp where balding is worst (such as behind the “frontal hairline” or “along the part”). When women have a dense, stable permanent zone and a loose scalp, it is possible to provide more coverage over the top of the scalp but far few women are able to get a significant benefit from a limited hair transplant.

Since hair transplantation in women generally involves placing hair into a part the scalp that is thin, but not completely bald, there is a risk that original hair in this area may be lost. This process is called “telogen effluvium” and is usually (but not always) reversible. In addition, if the donor area continues to thin, then the transplanted hair will also thin over time, since it came from the same area. For these reasons deciding when it is appropriate to perform transplantation for women can be difficult and requires the careful judgment of a very experienced and ethical physician.

In your before and after pictures, few patients show their face. Why is that? If I could afford a hair transplant and had a great result, I would show my face and feel proud of it.

First, with regard to costs, the costs have dropped significantly over the past decade because of better techniques and more competition. Second, cost is a relative term. What may seem “expensive” to one person may be “priceless” to another. In absolute terms hair transplants can typically cost under $10,000 and it depends on the number of grafts you need.

With respect to patients showing their face, this is a private matter for each individual. Some patients have no issue with letting the world know of their transformation. Some rather remain anonymous. We respect the wishes of each individual. In fact most patients rather not have photos published (even when it does not show the face). Some of our best work at New Hair Institute will never be published and go unnoticed to the public. There were a few of our patients on stage and in the audience during the recent Oscars for the world to see but their results will never be published on our site. Each patient has to sign a written consent form giving us permission to publish any photos (even if it doesn’t show their face).

Before hair transplant

After 2400 grafts

Even if your hair is thin all over how likely is it that you can give an appearance of thicker hair by moving some hair from less noticeable locations to the front?

This question covers a lot of territory:

1- If there is generalized thinning over the entire head and you are a male and the thinning is in the side and back of your head as well, you might have a condition called Diffuse Unpatterned Alopecia (DUPA). This condition is not good news, and these patients can not undergo a hair transplant as there is a poor donor area and therefore the doctor can not move enough good quality hair to cover the thinning area. Scalp micropigmentation (SMP) on the other hand, may be a good alternative (see: scalpmicropigment.com).

2- If there is generalized thinning over the entire head and you are a female and the thinning is in the side and back of your head as well, you will not be a candidate for hair transplantation as the transplanted hair will have poor growth. Again as I said in #1 above, Scalp micropigmentation (SMP) on the other hand, may be a good alternative

3- If you are a male and you have thinning on the front, top and/or crown area and you are under 30 years old, the first treatment course we would be to try finasteride (Propecia) and give you a year to see if some of the hair thinning stabilizes or possibly reverses in some of these areas. If you stabilize or reverse the thinning process, hair transplants can be planned at that point in time if appropriate, however, you must work out the hair supply/demand issues with your doctor. Thinning in men evolves into balding and hair transplants do best in treating balding. When we perform a hair transplant on a young man, we advise the patient to use the drug finasteride to minimize any shock loss from the hair transplant surgery.

4- For women who do not bald but have thinning and a healthy donor area, the amount of hair that needs to be transplant may be limited by the size of the thinning area and the amount of hair one can transplant in a single session. If the thinning is great, the benefits of even a large hair transplant (say~ 2500 grafts) might not be enough to make an appreciable difference. In these situations, I might transplant a female in particular area (like the frontal area to strengthen the hairline or a central or right/left part to make the area look fuller). In this way there can be a partnership between styling and transplants. This is difficult to explain but worth a consultation with an expert in this field.

Most important, there is a balance between the demand for hair and the supply of hair as the doctor moves it around.

I have already gone for tricho analysis they told that I have a very low hair density I.e 100 per square cm. So now I would like to go for hair transplantation is it possible now

Low hair density means you will have less hair available for a hair transplant and your expectation and results will have to be discussed with your doctor. In general a normal hair density for a Caucasian male is 200 hairs in a square centimeter. It is also important to establish a diagnosis of your hair loss type and why you may have a low hair density. If you have a Class 3 pattern (just frontal corner loss), you should be able to have a hair transplant with your low donor hair. But if you have a condition such as diffuse unpatterned alopecia (DUPA) you will not be a candidate for surgery as the condition of the hair in the donor area is not healty. It is not normal to have 100 hairs per square centimeter. I never trust a single measurement, so you might have someone else reaffirm the density numbers.

In a very recent question, asked about hair cloning, you mentioned that “theoretically you will have an endless supply of hair and your hair density can be as high or higher than what you started with”. In another entry of yours, Dr. Rassman, we read that “Hair can be transplanted at a density that approaches 35% of the original density in many people.” and that “the ability to place such densities depends upon many factors which include: hair thickness, skin characteristics, the size of the instruments for making sites, the skill of the surgical team at placing grafts tightly together and the processes that reflect the quality management of the surgical team.”

What is different about hair cloning different, which allows us to place the grafts so tightly together that you will end up with a density of 100%

Perhaps there is a misunderstanding that I would like to clear up.

There is no limitation on the density of transplanted hairs, except on a per session basis. How close you can put the grafts together during surgery depend on the width of the grafts (not hair). Some grafts can be 1/16 to 1/8 of an inch wide.

You must understand that hair transplant surgery involves moving hair from one location to another location. It does not create new hair. Let’s say that you got 35% of your original density in one session, then you want the same number of grafts transplanted again, assuming that the donor supply is as good, you can probably come close to doubling the 35%. Again, if you then wanted to do another 35% equivalent grafts, you will be getting close to 100% of the original density. There is actually some limits to this process, for example, what is the size of the donor area, the blood supply and the availability of grafts from the donor area. When grafts are placed very, very close together, we call this term “dense packing”, a term I defined in 1994 in the Hair Transplant Forum.

If you are a completely bald Norwood 6 patient and want your original density of 200 hairs in a square centimeter, where would the donor hairs come from? You only have a limited number of donor hair and the surgeon has to use judgement to create the most effective use with limited number of donor hairs you have. Unless there is cloning, putting in an unlimited number of hairs is impossible.

If you are a Norwood 3 and want the original donor hair density, then it may be possible with multiple surgeries.

I recently performed beard and sideburn transplants on this African American man who did not have complete facial hair due to a genetic issue. I have been asked many times about this problem, so I thought I would show photos from the day after surgery. He received a total of 769 grafts (each side got about 380 grafts) to create what you see in these pictures. His natural curly hair made the results look better than if his hair was straight. Black hair on dark skin also helped.

Before SMP

This patient talks about how others were upset that he was visiting a hair transplant clinic when he had so much hair! They didn’t know he had SMP.

I am loosing hair from my crown portion of my head. I am in New Delhi (India) and one of the doctors at New Delhi advised me 1000 hair not grafts. How much area will 1000 hair cover?

There is a tendency for doctors in some geographic areas to prey on people losing hair. Your question supplies little information, but I will take liberties and assume that you’re a young man desperate over his hair loss. Based on the many, many emails I receive daily it seems that in India hair loss implies some lack of manliness and if you’re balding will not be able to find a bride. These young men will try anything offered and if they have the money, there are doctors who will offer hair transplants to anyone because they make money doing it. We see the same phenomenon in western societies.

If a balding person is ignorant, naive, has money to burn, and wants a quick fix, then the first solution for some doctors is to push for a hair transplant. That is not right, not moral, and makes the unfortunate individual into a victim, many times leaving him deformed in some way. Simply put, not everyone is a candidate for surgery.

While I have written posts like this from time to time over the years, I felt that it needed to be restated. This blog is written as our attempt to educate the public so that when anyone searches Google, low and behold, we come up. We try to make this blog easy to read and direct. I hope that we accomplish this.

To answer the question posed, yes 1000 grafts would produce detectable hair but the degree of cosmetic benefit or how much it would cover is highly variable with the type of hair loss, hair to skin contrast, hair length, etc. You need a second opinion from someone who can examine you. A one line question with a number will not address your problem.