February 3rd, 2009 John Frank M.D.
Just a quick blog about the three largest hair transplant companies. All very good companies. Medical Hair Restoration and Bosley are owned by the same group and essentially offer the same services.
Hair Club built itself through hairpieces and wigs and is now performing hair transplants. I was one of the original surgeons who actually instructed them how to perform transplants. They are owned by Regis Corporation, one of the world’s largest hair salon groups.
My biggest criticism of the big three is the transplant atmosphere-it’s more like an assembly line. I would know, I was employed for several years. Fortunately, as an individual practicioner, I’m able to practice in a small, one-on-one environment. When it comes to medicine and surgery, I think that is very important.
Also, they employ a full-time sales staff. There is nothing wrong with non medical personel assisting clients in getting accurate information, however, the consultation is too important, and expectations about your case must be discussed with the actual doctor, in advance of the procedure.
So, I think that is a quick, fair assessment.
More later…
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January 30th, 2009 John Frank M.D.
Check out the new website. Now we will strive to add as much useful and objective, helpful information as possible regarding hair loss, hair transplants, women’s hair loss and all of the relative factors.
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September 24th, 2008 John Frank M.D.
But are you really pulling your hair out?
You may be doing this and not even realize it. Doctors are well aware of a condition called Trichotillomania. In fact, over 1 million people in the US may actually be suffering from this condition.
But does this lead to long term hair loss?
Pulling the hair repeatedly can damage the hair shafts themselves, causing them to break. More damaging though, is the repeated damage that the traction has on the root itself, and the follicle. This can lead to severe damage and permanent hair loss. Ouch!
Treatments may involve some behavior modification or perhaps even medication. So, if you have areas of your scalp or elsewhere that are showing some thinning, it’s best to get some professional analysis and advice. Just watch out for the charlatans or people with no medical or professional background claiming they know something about you, your scalp, and your hair.
Photo-micrograph of broken hair shaf
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September 24th, 2008 John Frank M.D.
Relatively recent scientific research shows that DHT is not the only factor causing hair androgenic alopecia. Several inflammatory mediators and cell receptors are also involved and the scientific community is actively researching these areas. For instance, besides DHT, what is occurring at the cellular level that is actually causing the miniaturization and programmed cell death of hair follicles?
How closely linked is nerve growth factor (NGF) ? What is the association of follicular inflammation which promotes catagen? Does stress induce substance P-mediated inflammation and subsequently telogen effluvium? And TGF-beta2 is also known to induce catagen in human hair follicles as well.
What does this all mean?
Simply put, there are many unknown reactions which occur at the microscopic level which contribute to hair loss and many of the causes are unknown. Many however are pointing towards inflammation-and treating the microscopic inflammation should have some benefit in reversing the hair loss process.
More to follow….
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September 9th, 2008 John Frank M.D.
What can be done to minimize or eliminate a hair transplant donor scar?
I am frequently confronted with this question. The first issue is to not be in a situation to create a wide scar in the first place. The most common cause of a noticeable donor scar is having multiple procedures done from the same donor area.
Some surgeons may tell you that if or when somebody has a second procedure, the first scar is removed. Unfortunately, that is really misleading because in most cases, the second scar will create a permanent scar that is wider than the first scar. It may look good for a few months, but over time, as the wound matures, the dermis will stretch-back and a wide scar will result.
So in my opinion, it is far better to harvest donor hair from an area either above or below the first procedure. Two fine lines are much easier to conceal than one wide line without hair. I have had one hair transplant procedure and if I choose to have a second procedure, I will certainly request that it’s performed from a completely separate area.
So what can be done about it? Really, not much unfortunately. For limited areas, some doctors may try to transplant hair directly into the scar effectively, but for truly wide scars, you are not going to get a lot of bang for the buck on that one.
Other procedures are available, including scalp expansion or some special plastic surgery flaps, however, each person and each donor area would need evaluation.
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September 2nd, 2008 John Frank M.D.
Since the end of standard grafting and mini-grafting, and the advent of micrografting, hair transplant surgeons have steadily been conquering the challenge of the dreaded “pluggy” hairline, aka “dolls hair look”.
Previously, when hair transplant was in it’s former stages, it was remarkable and amazing simply to have hair growing on bald scalp. These were the standard plugs and it was the standard of care. As the years progressed however, this was not good enough and hair surgeons aimed to overcome the pluggy look.
In the 1990’s as doctors started using microscopes and triming micrografts, the grafts finally started to become smaller and the problem with “plugs” was finally being conquered. The state of the art became micrografting, smaller and smaller. The concept of “follicular units” was introduced and was a refinement. While there were still some doctors on the fringe who were still using big punches and hadn’t adopted micrografting, most hair surgeons began using smaller and smaller grafts, as well as smaller instruments for making the recipient sites.
The challenge of the pluggy hairline was solved, only to be replaced, in my opinion by a new challenge, density.
Density was difficult to measure, however many clients would have one or two procedures and wish they could have been receiving more density. They were less concerned about walking around having somebody notice they’re grafts, but more anxious about density. Unfortunately, during this time (and up until this day), the hair surgeons seemed to be on a different quest, trying to get smaller and smaller grafts. Naturally, certain individuals (dark hair, fair complexion) will benefit from the smallest grafts in the hairline. However, most people are best served by a combination of graft sizes. And practically speaking, when it comes to graft survival, slightly larger grafts have a survival advantage (less of a risk to injure with crushing and drying). And in large cases, it is always a challenge for placing all smaller grafts and preventing graft trauma.
I don’t care who is the surgeon or who the technicians are, the problems with oozing, popping and patient discomfort will always exist. I have been refining the anesthesia techniques (both local, tumescent and sedation) and have made tremendous progress and have shared this with several other surgeons. While I think Dr. Wong’s recent study with dense packing for lateral slits is very interesting, it still was studied on a limited area and more work needs to be done before this technique is considered standard of care.
You must also understand the pricing policies as well. Most commonly, doctors use a fee-per-graft policy. Unfortunately, this may have a bias for surgeons to use smaller grafts in order to be able to charge more money. Sure, I am aware that some doctors have conversion factors and different pricing methods, but we in the scientific community must be aware of this dynamic as well and not allow financial factors to influence our techniques. Also, we must not be lured by the bravado that comes with creating the smallest and smallest instruments and grafts-this is also not natural.
Ultimately, each patient is an individual and the care should be customized. It behooves any hair surgeon to be aware of all the different techniques and have them available to provide the best results.
Best,
Dr. John Frank
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August 4th, 2008 John Frank M.D.
Welcome back to my hair transplant blog. I am compelled to share with you a case we recently did. This gentleman (who happens to be an excellent dentist and good friend) has been experiencing hair loss for much of his adult life. He has tried all sorts of alternatives and medicines. The hair you see is mostly transplanted.
In this photo you are able to get a sense for the design from the prior work done. Notice the very narrow pattern of the hair line. It’s obviously thin as well, however, without transplants he would be essentially shiny on top.
We fluffed his hair up a bit for the photo. But on close-up of the hairline, you’ll be able to notice the old style hair plugs. The correct terminology is “standard grafts”.
So, it’s quite obvious he has a couple of issues to improve. Both the design, as well as the “pluggy” look.
One additional challenge I had with him was being able to find suitable donor. Considering that most of the hair visible on top of his head were transplants, the donor may have been a challenge for most surgeons.
In fact, I was able to harvest 1800 grafts in an attempt to both bridge the top with the sides, as well as soften the standard plugs, with follicular unit grafts. This was done within the last two months-stay tuned, will have some more photos when the hair grows in more!
Can’t wait to show you.
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July 23rd, 2008 John Frank M.D.
Many hair piece wearers decide to have hair transplant and may be the most satisfied of all patients. One important caveat exists though; they must be properly educated about the potential final outcomes. They should not expect to have the same density of a hairpiece. However the added long term convenience factor outweighs the density issue. The cost and time also favors a hair transplant versus the ongoing time and expense of servicing a hair piece.
Before
I have found that the men inquiring about hair transplants are so eager to have something different than the hairpiece they are usually content knowing they won’t achieve the same density. You may hear them comment that their hairpiece is unnaturally thick and they welcome a more natural, “thinning” appearing. This eagerness may be a double-edged sword though because they may overlook the realities of the outcomes. Some may not be psychologically prepared for the day when they remove the system.
After
On the other hand we have found this to be an especially uplifting experience for those who approach this “cold-turkey”. For others, it may be very difficult and exemplifies the deep psycho-emotional attachment many men have with the hairpiece. Putting off the transition only prolongs this bridge, which must be crossed. The more difficult cases usually require a second or third procedure before they feel they have obtained density, which will allow them to remove the system.
Transitioning from Hair Piece to Hair Transplant
There are some maneuvers, which may help them to minimize the transition: most important is to have their stylist thin down the system while the transplanted hair grows to a sufficient density. By the time the hair has grown in, the hairpiece has already been pruned so the contrast is minimal. They also may choose to grow a moustache, beard or other facial hair during this period and when the day comes to remove the hairpiece and face the public they shave the facial hair creating a decoy.
They should also bear in mind a few things during the immediate healing and growth phase of the transplants. Many surgeons will prohibit them from wearing the hair system at all for one week following the transplant.
This may be very difficult for some people and we feel this restriction should not be something that eliminates the option to have transplants. People should be informed that the system might harm the grafts during the healing phase so they should limit the time they wear it. If they must wear the system during the day then they should try to allow for some “breathing room” when they come home in the evening. They should also be fitted with clip attachments and should never be attaching the system with the same adhesive they may be accustomed to. And typically we inform people that it may take up to one entire year before they see final results however in hair piece wearers we have found that it actually may take up to 18 months.
Expected Results of Hair Transplants
Of course, the expected result still follows the same patterns of any other hair transplant. Many factors influence results including hair color, scalp complexion, hair curl and extent of loss.
We have also obtained excellent early results from areas where the hairpiece stylists may have shaved the hair beneath in order to obtain a closer fit and this hair should grow back at the same time as the transplants yielding additional density or some “icing on the cake”.
One may also commonly see small areas of permanent allopecia in different areas from where the hairpiece was attached as well as the halo pattern of hair loss around the fringes. These areas are successfully transplanted as well.
It may be helpful for prospective patients to be able to converse with others who have made that transition and we will attempt to facilitate this contact. While it may be difficult to obtain an equivalent density, a properly informed patient usually will find the comfort and naturalness of hair transplantation far outweighs the inconvenience of a hairpiece.
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