Hair Loss Questions

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Hair Loss Frequently Asked Questions

Q: What causes hair loss?

There are dozens of causes for hair loss. For men, the main cause (over 90%) is due to male pattern baldness, also known as androgenetic alopecia. In other words, most men who experience hair loss can blame it on their genetics – the genes that they inherited from their mom and dad.

In women, the leading cause for hair loss, as with men, is genetic (female pattern hair loss). Women, however, are more prone to lose their hair from other conditions as well. For example, many women lose hair after childbirth, during menopause, or due to medical conditions that affect women more than men.

With regard to the “other” causes of hair lost: the list is long, but certain medications, medical conditions (thyroid problems, autoimmune diseases, fungal infections) can cause hair loss. Some groups of people suffer permanent hair loss from wearing very tight braids or weaves in their hair over an extended period of time.

Q: Why am I losing hair on my head but growing more of it in my ears, in my nostrils, and on my back?

If I had the complete answer to that question, I could solve the problem that millions of men, and some women, complain about every day.  There is some evidence that Dihydrotestosterone (DHT), a hormone, is involved in hair loss on front and top of the head.  Unfortunately, this hormone may also be involved in growing hair in other areas that many of us don’t want hair to grow.

Finasteride, a drug used for treatment of hair loss related to DHT, may be useful in helping with this process.

Q: Can stress cause hair loss?

Possibly.  There is a condition known as Telogen Effluvium, which has some relation to stressful events.  In many cases, this hair loss is only temporary, although some people can have chronic Telogen Effluvium.

There is also another condition, associated with anxiety or obsessive-compulsive disorder, in which people pull their hair out.  After years, this can condition, known as Trichotillomania, can result in permanent hair loss.

Q: How do I know what is causing MY hair loss?

A physician who specializes in dermatology or in hair restoration can usually determine the underlying cause of a patient’s hair loss.  Sometimes the process is as easy as just meeting with the doctor face to face.  Sometimes, the process can be more complicated, and might require some labs or even a small biopsy of the affected area.

Q: Why does it matter what is causing my hair loss?

For the majority of patients suffering from hair loss, there is a treatment available.   For a few, there are no well-defined or effective treatments available.  Before choosing to spend money and time on preventing hair loss or restoring your hair, it is imperative that you first have a diagnosis for the cause of the hair loss.

Q: I visited a hair restoration office and I was told that all patients are candidates for hair restoration surgery.  Is that true?

Absolutely not.  Some people have medical conditions that would make a hair restoration surgery completely ineffective.  For example, people with autoimmune diseases such as Lupus or Cicatricial Alopecia won’t benefit from a hair restoration surgery.  Other patients are simply too young, and need to wait.  If you have ever been told that you are a good candidate for hair surgery without first being evaluated by a physician who specializes in hair restoration, please see a qualified doctor before making any decisions.

Q: Are there other options for hair restoration besides surgery?

Yes! And in many cases, these options might be better for certain people than hair restoration surgery.  A significant number of our patients are started on medical hair restoration regimens rather than surgery.  Finasteride, a prescription medication, is an especially valuable option for many people.  This medication, known also by its trade name, Propecia, is by far the most effective hair loss medication available.   We have developed a regimen, that for many patients includes Finasteride, that is very effective in stopping/slowing hair loss, and in many cases, regrowing the hair of our patients.

Q: Does Finasteride work for everyone?

Unfortunately, it does not.  However, when used in conjunction with other medical therapies, it does work for most people (more than 70%).

Q: Does Finasteride have any serious side effects?

It can, but they are rare.  The most commonly reported and studied side effect of Finasteride is sexual dysfunction – meaning impotence or loss of libido.  This occurs in a small percentage of men who take the medication and typically resolves upon discontinuing use of the medication.

There are also studies indicating that while Finasteride can be beneficial to the prostate, it might also result in a higher incidence of more dangerous forms of prostate cancer.  Again, this only occurs in a small percentage of people.

And lastly, women who are pregnant or trying to become pregnant should be careful not to be exposed to Finasteride, as it could potentially cause birth defects in developing male fetuses.

Q: What other medicines or products do you recommend for your hair loss patients, besides Finasteride?

To be clear, not all people are good candidates for Finasteride.  So some patients may be given a completely different regimen.  The success of our medical hair restoration regimen has taken years of research and refinement, and we can’t publish it online.  However, patients who have a consultation and seek medical therapy will be surprised at how inexpensive the regimen is.

Q: Should I just start with a medical approach to my hair loss then do grafts if it doesn’t work?

In some people, especially younger patients, I think this is an ideal approach.  This doesn’t always work, however.  For example, a man with a receded but steady hairline for the past three years may be better served by having a hair restoration procedure.  In other words, some patients are “beyond help” with medicine and should proceed to surgery.

Q: I just bought (product name withheld), a natural supplement that they claim will regrow my hair.  Does it work?

Probably not.  Hair loss treatment has become a multibillion-dollar international industry.  While some treatments work, the evidence shows, time and again, that your best results will come after consulting the scientists (hair restoration doctors) who critically evaluate this evidence on a daily basis.  If something is shown, based on good studies, to be effective, I may recommend it to my patients.  If, on the other hand, it appears to just be an attempt of an herbal remedy company to cash in on millions of sales, I won’t.  Also, keep in mind….just because something is marketed as being herbal or natural doesn’t make it safe.

Q: Does hair restoration surgery work for everyone?

For the vast majority, it does work.  A hair restoration doctor’s job is to determine whether or not a person suffering with unwanted hair loss is a good candidate for any treatment at all, whether that is medical or surgical intervention.  If a patient is a good fit for a hair restoration procedure, and decides to proceed, they typically are very satisfied with the outcome.

However, some people (in my experience, less than 1%) do not get the results they hoped for after a surgery.  Every patient heals differently, and the rare person doesn’t get the expected results.  There are too many possible causes for a poor outcome to list – but just to name a few of the very rare causes: post-surgical infection, patient didn’t follow the post-op instructions, patient had an underlying medical condition that was previously undiagnosed.

Just a word of caution – any doctor, medical office worker, or salesperson who claims a 100% satisfaction rate, regardless of the treatment or procedure, is either misinformed or dishonest.

Q: I am interested in getting a hair restoration surgery.  My friend is also interested.  Can I get a discount on my surgery if I refer a friend?

This is actually a common question.  In California, at least, the answer is no.

California law prohibits physicians from incentivizing people with anything of value in order to receive referrals.  What we hope is that our work will speak for itself, and that your friend will visit us on the simple basis of our ethical work, friendly manner, and excellent results.

Q: Do you offer any help to patients who are traveling to Southern California for a hair loss consultation or procedure?

In many cases, we can help with travel costs.  Please contact our office for further details.

Q: How do I decide where to go for hair restoration surgery?

Making the decision to have surgery for hair loss can be intimidating and scary.  It is good to have a doctor who is available to help answer questions.

When you decide where you want to go for hair restoration, I strongly suggest you ask the following questions:

Who is the doctor? Is there even a doctor associated with your operation?

Unfortunately, some clinics may be loosely associated with a doctor, but the doctor has little to no involvement in the actual hair restoration process.  

Did he or she (the doctor) meet you and evaluate you personally on the day of the consultation?

It is very common for a person to be evaluated in a random location, by an untrained individual who essentially only acts as a salesperson.  It is critical, that before you start planning a surgery, you see a qualified doctor to confirm that decision.  What if you are not even a good candidate for hair surgery?  Do you want to leave that in the hands of a salesperson?

What is the doctor’s bedside manner like?  Is this someone you can deal with during the weeks and months of pre and post surgery care?

If a doctor is cold, condescending, or unavailable prior to a procedure, chances are that he or she will remain the same following the procedure.

Is the doctor going to be participating in the procedure?

Some doctors have no participation in procedures.  It is important that the doctor oversees and participates in hair restoration procedures.

Will the doctor even be present during the procedure?

Sadly, some doctors aren’t onsite while hair restoration procedures take place.  It should be imperative that the hair restoration surgeon is present, as this procedure takes the skill and direction of a highly trained surgeon to be successful.

How much experience does the doctor have?

Hair restoration is as much of an art as it is a science.  The more experience, the more likely the doctor can do a great job.  A doctor can have all of the credentials in the world, but if those credentials lack experience in hair restoration surgery, you may consider your options carefully.

How much experience does the doctor’s ancillary staff (nurses and technicians) have?

Too often, doctors fail to give appropriate credit to the nurses and technicians who make hair restoration possible.  If you are in the process of looking for hair transplant options, I would suggest asking every doctor you encounter, “How much of the procedure do your technicians or nurses do?”  You may be surprised to find, for the doctors that answer with complete honesty, that the technicians do the majority of the work, and their skill is absolutely critical in the success of the procedure.

Q: What makes you, Dr. Searle, a good choice?

I am confident that my patients realize I genuinely care about their concerns and needs.  Before and after procedures, I provide patients with my mobile telephone number.  I don’t give a number that goes to an answering service; I actually provide a number that you can reach me on.

I am experienced in hair restoration surgery.  I have done hundreds of surgeries.  I am an active member of the International Society of Hair Restoration Surgeons, and I keep up to date on the latest advances in hair restoration surgery.

Q: How long have you treated patients for hair restoration treatment?

I have treated patients with hair loss since 2010.  I have performed hundreds of surgeries and also started hundreds of patients on medical hair restoration treatment.  I am an active member of the International Society of Hair Restoration Surgeons and strive to give my patients the best care possible.

Q: What are my options for hair restoration surgery?

Hair restoration surgery has become increasingly popular over the last several decades.  The procedure that initially popularized hair restoration is now commonly known as “plugs.”   You may know someone who had plugs.  Plugs are large groups of hair that are transplanted from the back of the head onto the front, and they have an unnatural appearance that many people say resembles “dolls hair.”

As technology and medical practices advanced, two other procedures became more common: the hair flap and the scalp reduction.  Both of these procedures can leave significant scarring and left many patients unhappy.  They have been mostly abandoned.

More recently, a procedure known as Follicular Unit Transplantation (FUT) was described in medical literature.  This procedure quickly became the standard for hair transplantation, and to this day, remains popular.  This procedure involves a strip of scalp being removed from the back and possibly including the sides of the head.  This strip is then dissected under a microscope and placed one graft at a time onto the front, top, or crown of the head.  The advantage to this procedure is that it creates a more natural appearance where the hair has been transplanted.  For example, rather than having a large strip of hair in the front of the head, or large circular patches of hair, the FUT allows a patient to more closely represent a natural hairline.

Q: What is a follicular unit  (part of an FUT procedure)?

A follicular unit is a group of hairs that grow naturally together.  When removed from a donor area (typically the back of the head) these hairs occur in groups of one to five or even six.

Q: What is an FUE?

An FUE, also known as a Follicular Unit Extraction, is an improvement on the FUT.

Technically, and FUE is a FUT.  But rather than taking a large strip of scalp from the back of the head, which the “FUT” has become synonymous with, an FUE takes smaller grafts from the back of the head.

Specifically, the FUE typically consists of a hair restoration surgeon taking one follicular unit at a time from the donor area.  The donor area is typically the lower portion of the back of the head.  The follicular units can be harvested using a very tiny punch (one millimeter or less in diameter) to capture grafts.  These grafts are then taken individually (each graft containing 1-5 hairs) and transplanted onto the area of hair loss.

Q: FUE vs. FUT?  The ultimate question.

In my career of hair restoration, I have done hundreds (more than one thousand) procedures.  I am often asked, “What is better, FUE or FUT?”

This is a difficult question, because technically, an FUE is an FUT.  The difference is that an “FUT” is obtained by cutting out a large strip of scalp from the back of the head, whereas an “FUE” is obtained by taking very, very small groups of hairs from the back of the head.  In both cases, we are working with extremely small transplants, aka follicular units, which occur in groups of 1-6 hairs.

However, when I am asked the even more difficult question: For a member of your family, would you recommend the FUT (strip) or the FUE?

The simple answer is that I prefer the FUE.  For most patients, given the advances in technology, the improvements in physician and technician training, and the overall results, FUE can provide a superior result.

Q: Why do you typically recommend FUE over FUT?

Simply put, because in the right hands, the results are typically better.

Never, ever believe someone who tells you that FUT (the strip) will leave you without a scar.  It will leave you, without a doubt, a visible linear scar on the back of your head.

The most experienced hair restoration surgeons in the world can’t perform a surgery that leaves no scar.  Typically, in the hands of an experienced restoration surgeon, especially those using the tricophytic technique, a patient will have minimal scarring.  However, every patient heals differently.  It is simply not possible to predict the size of a patient’s donor scar with FUT.

With FUE, on the other hand, as the surgery is far less invasive, it will almost always result in less evident donor scarring.  My FUE patients have little to no evidence that they have had a hair transplant.

Furthermore, with advances in technology, FUE has become close to, if not superior, to the strip method in terms of graft survival.  Done in the right hands, a good FUE will have more than 90% graft survival.  An FUT might also have this rate of success, but this process includes many technicians working under microscopes, advanced handling of the grafts, and in many cases, destruction of the grafts by unnecessary manipulation.

Finally, with regard to post-operative pain, FUE is far superior to the strip (FUT) technique.  Imagine having a strip of scalp cut out of the back of your head from ear to ear, having it sutured together, and hoping that it heals correctly while you endure the pain.  The FUE avoids this issue.  No scalpel, no sutures, and reduced risks of excessive bleeding, infection, and pain.  The FUE is absolutely superior in these areas.

In a nutshell, for a person who may want to shave their head closely in the future, don’t even consider a strip (FUT) surgery.  FUE is the only option.  For a person who hopes to go back to work the day after a surgery with little to no discomfort, an FUE is superior.  Several years ago, I would have strongly endorsed FUT over FUE, but with the advances that have taken place, I believe FUE is superior.

Q: Have you had any unhappy patients after a surgery?

Of course.  After performing more than 1,000 procedures, it is inevitable that someone will be unhappy.  These patients are few and far in between, fewer than 1%.  However, not every surgery turns out the way that we expected.  We do the best we can, and if someone is unsatisfied, we do the best we can to correct a problem.

I look at online reviews of my favorite restaurants from time to time, and typically, the reviews are glowing.  There are the few people, however, who had bad experiences at my favorite places to eat.  There are also those who are clearly angry individuals, who make a living off complaining about everything.

It’s impossible to function as a medical practice, or a business in general, in today’s world, without encountering a disgruntled customer.   We, as a medical practice, can only promise that we work hard to rectify the few, very few, complaints that we have.   But even more important, we do everything we can to make sure that we never even have a complaint.

Q: Are there any possible side effects or drawbacks of having a hair restoration surgery?

There are a few potential side effects, which we always try to avoid.

The main ones for hair restoration surgery are: scarring, infection, bleeding, and poor graft survival rate.  Infection and bleeding are typically controlled with the medical and surgical routine that I use with my patients.  There is, more so with FUT (strip) than FUE, the possibility of greater than expected scarring.  It is rare, in either case.  I rarely perform FUT cases any longer, and I have never had a patient complain about scarring with an FUE.  The internet, however, is littered with photos across the world of people with large linear scars from FUT.

Some patients have lower than expected graft survival rate.  We strive to ensure that all of our patients have more than 90% of their grafts survive.  Certainly this can’t be guaranteed, but typically this is the case.  There are some patients who have unexpectedly low graft survival.  This could be due to the surgeon’s technique, a patient’s postoperative care, or an underlying medical condition.  In these cases, we work with these individuals to try and get them the number of surviving grafts that they had expected.

Q: What is the cost of a hair surgery?

It depends on how much hair you need and who your hair restoration surgeon is.   Hair restoration surgeons typically charge between $2 to $25 per graft, based on my research.

Typically the cost of a surgery is based on the number of grafts needed, and the price per graft.  There are some offices that are pricing it per “area” but that pricing is unclear and confusing to most people.

A graft, which typically consists of a “follicular unit” in modern hair restoration, is between 1-4 hairs.  The average is 2 hairs.  So, for example, if you are told that you need 1,500 grafts, you will likely expect to have twice that number, or 3,000 hairs transplanted.

On average, theoretically, a hair restoration surgery could cost as little as $2,000 and as much as $75,000.  Typically, the costs run between $5,000 and $25,000.

Q: How many grafts are needed?

This depends on the amount of hair loss that you have and the amount that you want to improve.  With the exception of facial hair (eyebrows, beards, mustaches), most surgeons will recommend between 500-4000 grafts per session.  Of course, these numbers can vary greatly based upon your needs and the hair density of your donor area.

Q: How fast will grafts grow in?

Grafts can grow in as quickly as 2 months.  This is rare.  Grafts usually take an average of 6 months to start growing in.  It can take up to 18 months before they appear following your surgery.

Q: How long is the procedure?

This depends on the number of grafts, but typically is completed between 4-8 hours.

On the surgery day, you will come into our office, take some medication that will help you relax, and basically just sit in a comfortable chair, watching movies, reading, or listening to music while we do the procedure.  We always offer you breakfast and lunch too.  Most patients state that the whole process is as easy or easier than a visit to their dentist.

Q: Do you do eyebrow or beard restoration surgeries?

Absolutely.  The process for these surgeries is very similar to typical male pattern baldness.  Over the past several years, there has been an increasing demand in women who want thicker, longer eyebrows.  Oftentimes, this is due to chronic over- plucking of eyebrows.  Other times, it is due to diseases that cause eyebrows to thin.  For men, many seek thicker or more defined beards.  Again, the process is the same.  We craft the line of the beard, and with the patient’s input, transplant hair to give a thicker, fuller beard or moustache.

Q: Can women have hair restoration surgeries?

Women can definitely have hair restoration surgeries, although the process of determining if women are good candidates for surgery can be a little bit more complicated than it can for men.

Nonetheless, if a woman suffers from hair loss, she should at least seek the time to have a free consultation.  I have many female patients who are happy with their transplanted hair.  It can make all the difference in self-image.