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

Note: As aging starts, at any age in boys or girls above 5 years of age, as the hairline rises in the maturing process, it may leave behind a midline, pointed tuft of hair which is what we call the widow’s peak. If you draw a line from the tip of the widow’s peak across the upper forehead, you will see where these men or women’s child hairline was as its point always lies on the highest crease of the furrowed brow as ween in the first of our male examples. (see previous post: https://baldingblog.com/2014/12/30/hate-widows-peak/)

Former Vice Presidential Candidate Paul Ryan presents with a strong widow’s peak. This photos fortunately shows him wrinkling his brow. When he was pre-pubertal, his hair line actually was abutting this crease.

A young Andy Garcia with a strong widow’s peak

Actor Andy Garcia with a thinning window’s peak

Young man with widow’s peak

Young man with fading widow’s peak leaving only a small remnant of it.

Young man with subtle widow’s peak

This widow’s peak has a lick (where the hairs do not point straight)

This young man has a small amount of recession. I believe that what you see in these photographs is movement of the corners to the level of the mature hairline. What made his hairline ‘V’ shaped is that his juvenile hairline in only about 1cm from it original location when he was 10 years old. I known this because his widows peak extends only 1cm from the mid-line hairline and its point, is exactly where his 10 year old hairline was. Because he had only focused on the corners, we performed 800 grafts to flatten these corners. With his medium-coarse hair, one session will likely solve his problem. Two things worth noting: (1) the small area transplanted with a minimal number of grafts and (2) the fast healing. We instructed the patient to shampoo off the remaining crusts which he did over the next two days.

Click the photos to enlarge.

After (just 5 days post-surgery):

Before:

Hi there. I recently pulled my hair, in the front part of my scalp, just to see how bald I am going and noticed that the hair I pulled didn’t have a bulb at the end. Does this mean that I have permanently lost this hair?

You probably pulled a hair that was about to be shed, like the hairs you see in the shower. We lose 100-150 hairs per day. If you want to know if you are balding, see a specialist.

What sort of hairline does German football player Marco Reus look like he has?

I’ll admit that I don’t have the foggiest idea who this is, but Google Image Search was able to show me some photos. Photo 1, Photo 2, Photo 3

From the photos I saw (links to a random 3 above), it appears to be a solid hairline with possibly a slight bit of corner recession. It is difficult to be sure if there is really balding present, but I suspect there is some maturing of his hairline, as seen in photo 2 (some photos appear that he styles the hairline corners to mask this). In any case, this young man has the hairline that many men would be envious of.

Snippet from the article:

The dodgy seventies comb-over made famous by personalities like Donald Trump, Christian Bale in American Hustle and Bobby Charlton has been abandoned by modern men, according to new research.

Let’s be honest, the hairstyle, which saw men grow their side patches and sweep the extra hair over their bald patch, was never a good look. While men thought they were hiding a multitude of sins, in many cases they were actually drawing more attention to their lack of fuzz.

But modern men seem to have come to their senses. A study, by Crown Clinic in Manchester, reveals that the 21st century chap is opting for new methods to hide his lack of hair including shaving, covering up and going under the knife for transplants.

Read the rest — Death of the comb-over

This was just a survey of 1000 people by a hair clinic in the UK, but I’d agree that the comb-over is becoming less common than it seemingly was in past decades. With new surgical and non-surgical treatments available, men are able to take control of their hair loss rather than just styling the limited amount of hair they have.

It also helps that the shaved head look is fashionable, allowing men the option to just shave it all off or go for SMP to have that closely trimmed look.

Dear Dr. Rassman,

I am a 25 year male. For the last 3-4 years I’ve been experiencing temple hair loss, as exhibited in the attached photos. As far as genetics are concerned, my father at 55 is a thinning NW3 since his mid-thirties (his father a NW7 though, and on granny’s side no hair loss) and my mother is solid NW2(father’s side NW3 – turned NW4 in his 80s, and granny’s brothers NW2s). Judging by these photos, should I be concerned about my hair loss at this moment? Feel free to post my photos.

Click the photos to enlarge:

The temple peaks may have receded (I have no earlier photos to compare to), and your hairline appears to be maturing at the corners. I don’t consider that balding and you probably have no cause for concern, but there’s only so much I can tell from photos. The corners might have gone a little beyond the maturing hairline, but the photos aren’t much help in this case.

If you do have concerns, you can consider measuring the bulk of hair in specific areas of your scalp and comparing it to other parts of your scalp. More importantly, following up one year after the measurement to see if there is a change. Just one bulk measurement in time will not give you much information, so following up is a must. You can also consider a miniaturization assessment to see if the hairs have different morphology (miniaturization) around certain areas on your scalp.

In any case, you don’t appear to be balding to me, but we can let the readers comment.

If a younger patient (late 20s) wanted to ‘touch up’ their hairline to make it more symmetrical with a small transplant e.g 10cm surface area…approximately what density should this be at if you were to consider that the patient has fine hair and wants to be cautious with regard to future loss?

I’ve seen some surgeons using ‘dense packing’ produce great looking results, but i know these can be risky as future loss can leave a bad result…but would it be ok to transplant at a lower density in this case? And do you ever perform ‘touch ups’ to the hairline of a younger patient if they’re not on medication?

Also, are lower densities (i assume 25-30 per square cm?) going to give a very poor looking result for someone with fine hair?

Thanks

Each case is different, so you will need a diagnosis first to see if you are balding. Some young men get freaked out about a mature hairline (which is not balding), so it’s very important that you get a diagnosis before you can plan for surgery to address any cosmetic issues to the frontal hairline.

If someone wants a very full hairline (original non-balding density), for most people that would likely require more than one surgery, regardless of how densely packed the hair can get. If your hair was medium-coarse or thicker, you might get a reasonably full look in one session.

If it sounds too good to be true, it usually is. You should want to create a Master Plan with your surgeon to account for any future loss that might occur. Remember, you’re talking about a surgery to your scalp (particularly at the hairline, right in front of everyone that you interact with in person). You should want to make sure that if you do have hair loss progression, the results from any earlier surgery will remain natural in appearance.

Can you show me the difference between the temple peaks that are strong and weak. I need clarification on what they are.

Thanks!

Here’s a few celebrities with different temple peaks. Will Ferrell (left) has virtually no temple peak; Tom Cruise (center) has a weakening temple peak; Mario Lopez (right) has a very prominent temple peak.