Transplant Options

Balding senior man, rear view, head and shoulders

Christopher Robbins

   Yet another disappointing aspect of aging is hair loss. Back in the 1940s, a dermatologist discovered that certain hair follicles are programmed to last a lifetime, while others have an expiration date. He also found that if you transplant those lifetime follicles to another location, they will retain that programming, explains Dr. Bruce White of St. Louis Cosmetic Surgery. The lifetime follicles tend to be lower on the head, around to the back, explaining the common male-pattern baldness.

    White explains a transplant process that takes a narrow strip of scalp, with ‘lifetime’ follicles, cuts it into small grafts and transplants them in the thinning areas. “We generally separate the follicles into micro-grafts of one or two hair follicles or mini-grafts, which may have from three to five hairs,” describes White.

    Hair transplants are labor-intensive, requiring a whole team of nurses to assist the surgeon. White urges anyone considering this procedure to choose a provider wisely. “Ask if the doctor does a lot of hair transplants or only a few,” he suggests. “The doctor should want to know what bothers the patient most about his or her balding and explain how he will meet the patient’s needs. I would also ask if micros or minis are used, and when each is done. Minis give more density of coverage, but micros look more natural. It also depends on the quality of the hair.”

    White tells clients with profuse hair loss that he can’t cover all of it thickly, so they have to prioritize. Some people want a thick growth of hair at the hairline and ignore the back, but others are more concerned with the bald spot on the crown. For some patients, however, White says there is too much baldness to get reasonable coverage from the available donor hair; and they just have to look in the mirror and say, “Bald is beautiful.”

    Dr. Michael Nayak of  Nayak Plastic Surgery says, “Medically, there are only four proven approaches that can stop or reverse hair loss. Topical minoxidil (Rogaine) not only stops loss but encourages regrowth. Oral fenasteride (Propecia) is effective, stopping the conversion of testosterone to dihydrotestosterone.” The other two treatments are antifungal shampoos and low-level red laser treatments.

    Surgically, Nayak says, the vast majority of hair transplants these days are follicular transplants in mini or micro units. He likes to mix the two because normal hair grows irregularly, and this system looks more natural. The hairs get planted in the hairline, temples, crown or wherever needed by needle sticks at specific angles to mimic the natural orientation of the hair. More than 90 percent of transplanted follicles take, Nayak says.

    The initial transplanted hairs fall out but the follicles remain, so clients don’t see the results for about three months. Then the hair starts growing and over the first year becomes thicker. Nayak says if the bald area is large, it can’t be covered in one session. Once the first group is established (after about a year), additional follicles can be more effectively placed.

    A new hair transplant technology is available at the Lifestyle Center for the first time this month, says Dr. Richard Moore, medical director. Called the NeoGraft Automated Hair Transplant System, the device extracts the hair to be donated in mini and micro follicular units, rather than having to remove a strip of scalp and suture the donor site. Technicians with an average of 14 years of experience direct the harvesting and perform the grafts.