Hair Loss specialist Dr Amiya prasad performs hair transplant surgery on patients seeking to treat Androgenetic Alopecia (genetic male pattern hair loss). As a Board Certified Cosmetic and Oculofacial Plastic Surgeon, Dr. Prasad helps patients who’ve lost their hair with hair transplants using methods including FUT or FUE.
In addition, Dr Prasad uses his unique TrichoStem® Hair Regeneration system in combination with hair transplantation to improve the healing time, reduce the loss of hair grafts, and thicken existing thinning hair. This method is not used in traditional hair transplantation. If you’re interested in restoring your hair, learn more here and contact us to see if you’re the right candidate.
Hair transplant is a cosmetic procedure performed on men and women who have significant hair loss, thinning hair, or bald spots where hair no longer grows. Generally, the procedure consists of moving hair that is genetically resistant to thinning from a small area at the back of the head (donor area) to the recipient area at the front of the scalp. It’s generally recommended to concentrate the transplanted hair to the front of the scalp to help frame your face.
There are two main types of hair transplant processes used today which differ in how donor hair is extracted from a back of the scalp. The method of placement of the hair grafts is essentially the same depending on the preference of the surgeon. The method of harvesting does have an effect on hair graft survival. Either transplant method can be used to harvest the same number of hair grafts, but the procedures differ in the quality of hair grafts harvested and the longevity of graft survival.
In men, hair loss and baldness are most commonly due to genetic factors (a tendency passed on in families) and tend to increase with age. Male pattern baldness, in which the hairline gradually recedes to expose more and more of the forehead, is the most common form of hair loss in men.
Men may also experience a gradual thinning of hair at the crown or very top of the head. For women, the causes of hair loss is more commonly associated with hormonal changes after menopause and usually manifests as thinning of hair throughout the entire head.
According to the International Society of Hair Restoration Surgery , 35 million men and 21 million women are experiencing hair loss in the United States. An estimated 80,000 men get a hair transplant each year. Hair transplantation surgery can also be done to replace hair loss due to burns, injury, or diseases of the scalp.
Hair grows naturally in the scalp in small groups of hair called follicular units. Each follicular unit can have 1-4 hairs averaging about 2.2 hairs. A single transplant session can range from 2000-4000 hairs, depending on an individual’s donor hair density.
In comparison, at the peak of hair health in the early teens, a person has about 100,000 hairs. Hair loss is typically first noticed when 50% of hair has already been lost. A hair transplant operation moves a small percentage of total hair which is a limitation of any hair transplant surgery.
Depending on your current level of hair loss, various hair restoration techniques can be used to treat your condition.
It is important to understand that a hair transplant, regardless of the technique or technology used, is a procedure that is strictly limited by the rate of your hair loss progression and the amount of hair you have in your donor area.
It’s important when considering a hair transplant that you should also consider stabilizing the progression of your hair loss. If your hair is thinning significantly, a hair transplant is not advised since your hair will continue to thin, and the multiple transplants needed to keep up with your loss will deplete your donor area. TrichoStem® Hair Regeneration is the preferred option for men and women with thinning hair. The best candidate for a hair transplant is someone who desires hair in an area that has had long standing hair loss, and whose hair loss has been stabilized.
The right candidates for hair transplantation have the following characteristics:
Although hair transplantation is a safe procedure, some risks do exist which need to be understood. It is important to inform your physician about any medications currently being taken and about previous allergic reactions to drugs or anesthetic agents. Patients with blood clotting disorders also need to inform their physician about their condition before the procedure is performed.
Typically, a narrow strip of skin from the back of the scalp is removed containing genetically resistant to thinning hair follicles. Within the strip are naturally-occurring groups of hair follicles called Follicular Units, which are meticulously dissected under microscopes into 1-4 hair follicular units.
The follicular units are then precisely implanted into the bald areas in the front and top of the head. In some cases, Follicular Unit Extraction (FUE Hair Transplantation) may be used but it requires that the patient have the sides and back of the scalp shaved in order to harvest the grafts before hair transplantation.
At specific times during the procedure, Dr. Prasad uses his Hair Regeneration method to the donor area, and to areas of the scalp where hair has been transplanted.
The combination of wound healing technology using platelet-rich plasma (PRP) and ACell’s extracellular matrix (ECM) help heal the donor area where the strip of skin was removed, and improve the healing and survival of transplanted hairs on the scalp.
Commonly referred to as the “strip method”, follicular unit transplant (FUT) is the more traditional hair transplant method. All hair restoration surgeons will agree that even if it is an older method, it yields more viable hair grafts than the newer and more technologically “advanced” follicular unit extraction (FUE) method.
The FUT procedure involves surgical removal of the strip of skin that holds hairs that are genetically resistant to thinning (the donor area). The strip is then placed under a microscope so follicular units can be harvested.
Since the FUT only takes hairs from the safe donor area, the FUT does have a higher survival rate of grafts when compared to the follicular unit extraction (FUE) method, which takes some hairs from outside the safe donor area which are prone to hair thinning.
In addition, it’s well known that 30% or more of FUE grafts are transected (even with advanced “technology”). “Transected” means that the dermal papilla (or root) is cut away from the graft. This is comparable to planting a tree without the root.
Survival of each follicular unit is dependent on preserving the soft, fatty tissue at the base of the hair that contains the root called the dermal papilla. After graft harvesting, the follicular units are placed on desired areas of the scalp using an implanting tool such as the Choi Implanter.
FUT is the Preferred Hair Transplant Procedure at Prasad Hair Restoration
The FUT is the preferred transplant procedure of Prasad Hair Restoration because it yields better quality grafts, has less incidence of graft damage (known as transection), and because the strip scar at the back of the head can potentially heal with minimal scarring using Dr. Prasad’s advanced wound healing techniques and cosmetic surgery closure.
Follicular unit extraction (FUE) transplantation is considered a more “modern” hair transplant procedure assisted with technologies promoted as superior to “old” FUT methods. The FUE was conceived as a way to avoid the strip scar of FUT procedures.
The FUE extracts follicular units individually from the back of the scalp to avoid the larger FUT donor area scar. However, the FUE method trades off smaller scars in place of the one long extraction scar (which can now have enhanced healing with regenerative medicine technology).
The FUE is a procedure that can be done manually with a hair graft punch, and also robotically with the ARTAS FUE robot. The robot selects the best hairs for extraction faster than a human identifying the best hairs to extract.
Once grafts are harvested, hairs are implanted in the same or similar manner as done with the FUT procedure. FUE technology may imply that it is a superior hair transplant method, but technology does not change the size of the donor area, or the amount of available and viable hair grafts.
Follicular Unit Extraction (FUE) Disadvantages:
Prior to your hair transplant surgery, you’ll be provided instructions about your aftercare and recovery. It’s important you provide your doctor and medical team all information about your health, current medications, smoking and alcohol history, allergies and previous surgeries and dental procedures. Medications may be prescribed for you as part of your aftercare.
If you’re undergoing FUT surgery, allow your hair length in the back to grow at least to 1 inch so the hair can cover your hair transplant scar. Hair transplant recovery in the first few days is managed by limiting strenuous activity and resting with your head elevated when you sleep or relaxing.
You’ll be instructed on how to minimize the hair transplant scar in the donor area and how to manage the hair transplant scabs where the hair grafts were placed. You will be seen in about 1 to 2 weeks for examination, suture removal and examination of your hair transplant scar in the back of the scalp and the appearance of the hair grafts.
Most people are able to return to work after 1 to 2 weeks depending on the type of surgery you undergo and the type of work you do.
The Hair Regeneration treatment was developed by Dr. Amiya Prasad to thicken existing hair and prevent progressive hair loss. This treatment involves injections which clinically appear to apply the wound-healing properties of an extracellular matrix by ACell, platelet-rich plasma and vitamin D which result in thickening of thinning hair.
The Hair Regeneration treatment can be used as a replacement for hair transplantation in younger patients by stopping hair loss progression early on and thickening already thinning hair.
This hair loss treatment can also be used to improve graft survival in hair transplants and stop further hair loss (based on approximately 5 years of data – additional injection may be necessary to optimize and maintain results).
The Hair Regeneration treatment has seen success in over 99% of men and women treated for pattern hair loss over the last 7 years, and results have been shown to last 2-5 years, and beyond.
What’s an alternative treatment to surgical hair transplants?
when you go online and search for a solution for hair loss
you are often flooded and then stalked by
ads from hair transplant clinics for a long time a certain percentage of
people were resigned to pursue a hair transplant because
there was no other alternative fortunately as a byproduct of my trying
to improve the outcomes of my hair transplant surgeries i developed
a non-surgical alternative to hair
transplant which has been very successful for over
10 years i’ll discuss my perspective on this
alternative approach which can for most of my patients
actually exceed the results of hair transplantation
I’m Dr Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive
surgeon I’ve been in practice in New York City
and Long Island for over 25 years for many years
hair transplant surgery was amongst the most popular procedures
i performed in my practice as a cosmetic surgeon i was
used to a high rate of satisfaction for my facial and
body cosmetic procedures and at the same time i was
frustrated with getting consistent results
and having comparable satisfaction with hair
transplant surgery the two areas that i wanted to focus attention on was to
optimize hair graft survival so the yield would improve
and to get better healing of the donor area
where the strips of hair bearing skin was harvested
in an effort to achieve this i applied extracellular matrix by ACell
with prp at the time of surgery i recognized that in addition to
improved graft yield and donor area healing
that thinning hair became thicker i focused my attention and resources to
determine how to optimally dose and deliver this
material for different types of hair loss for
both men and women this work took many years and
ultimately i was able to achieve consistent results for both men and
women with androgenetic alopecia and created
TrichoStem Hair Regeneration with only one to two treatment sessions
we’ve been helping people from around the world improve their
appearance and their confidence with over 99 percent success
many of my patients who were considering hair transplant surgery
prior did not feel that they needed surgery after
having TrichoStem Hair Regeneration treatment
there is no question that TrichoStem Hair Regeneration
is now the industry benchmark for ACell and prp treatments which seem to
appear on mass many years after we developed
our treatment i often see people who professionally speaking were not ideal
candidates for hair transplant surgery and yet they
underwent not just one but several
hair transplant procedures these patients perceived that their
only option was to undergo hair transplant surgery
unfortunately they fell victim to the aggressive salesmanship of hair
transplant factories both in this country
and for considerably lower cost internationally there are two groups of
people who in my opinion with limited exception should not have
hair transplant surgery one group is men in their 20s and the
other is women who typically have a diffuse
hair thinning pattern when estimating the
incidence of hair loss in men we use a general rule of thumb
called the Rule of Decades for example if you are in your 20s about 20 percent
of your contemporaries have hair loss while 80 percent don’t if you’re in your
50s you are probably aware that 50 or more of your contemporaries have hair
loss essentially the age of onset and the
rate of hair loss needs to be factored when considering a
treatment strategy that involves hair transplant surgery the source
for hair for transplantation is the limited
donor area in the back of the scalp a younger man who undergoes hair
transplant will continue to lose hair at a much
faster rate by the nature of their type of hair loss
in comparison to a middle-aged man with the same level of hair loss this
means that the donor area will run out sooner if the transplantation is
performed repeatedly to keep up with the ongoing hair loss
it’s also important to understand that the aesthetic expectations
are different for a younger man in comparison to a middle aged man
this means that regardless of the amount of surgery performed on a younger man
who is suffering from moderate to advanced hair loss
it is unlikely that they will achieve density and coverage
comparable to the 80 percent of their peer group
unfortunately a lot of men who choose to have
several transplants beginning in their 20s
often regret having had these surgeries when they are in their
mid to late 30s this is because they continue to
lose their hair and the remaining hair they have
is transplanted hair she doesn’t have good density and
doesn’t look very natural i treat a lot of women with hair loss in my practice
this type of hair loss is referred to as female pattern hair loss
and is also called androgenetic alopecia this type of hair loss is characterized
by diffuse thinning with no areas of smooth
non-hair-bearing skin hair transplant surgery has the potential of making hair
loss in women worse because of the loss of
existing hairs as a consequence of trauma caused by the
incisions made for implanting hair grafts the term
for this is often called collateral damage
this is why i generally don’t recommend hair transplant for most of my female
pattern hair loss patients for these two groups of hair loss
patients a hair transplant alternative is
really necessary as i stated earlier the TrichoStem Hair Regeneration treatment
can be administered without the risks of exhausting the
donor hair and causing collateral hair loss i also
want to make clear that trichostem hair regeneration is not
just about the injection treatment but rather it’s about a treatment strategy
when i meet a patient i develop a customized treatment plan with
modalities to optimize hair growth these modalities
can include pharmaceuticals topicals nutritional
supplementation and hormonal therapy TrichoStem Hair Regeneration increases
the number of visible hairs on the scalp by reactivating hair that is not growing
and thickening thinning hair resulting in significant
improvement of scalp coverage this phenomena is very important to
consider when you understand the technical limitations
of hair transplant surgery your existing native hair even when it’s thinning
can be as dense as 50 hairs per square centimeter
when you undergo hair transplantation you can only get about 20 hairs per
square centimeter this is because the ability of the skin
to heal with multiple incisions for hair grafts
is limited by the structural integrity of your skin
and the limitations of blood supply if you place too many grafts
the skin falls apart and the hair grafts simply don’t survive
it’s for this reason that many patients who have had hair transplant surgery
are dissatisfied with how unnatural their grafts appear
in terms of density and they are resigned to undergo another
surgery hoping to improve their density this means they are paying twice and
further depleting their donor area regardless of whether you’re undergoing
FUT or FUE surgery the donor area is a
limited supply of hair grafts in order to achieve
density that looks natural you need a lot more than the number of grafts you
can maximally harvest from the back of the scalp it’s simply a
surface area mismatch the top of the scalp is a lot larger
than the limited area of hair bearing skin that is genetically
resistant to hair loss by increasing the number of hairs and
thickening existing thinning hairs which are naturally at a
much higher density than can be achieved with a hair
transplant hair regeneration can achieve very
effective coverage without surgery although the marketing
of hair transplants seems so alluring
essentially hair transplantation is moving hair from one
location to another unfortunately there is a
certain percentage sometimes as high as 90 percent of hairs
which don’t survive being moved from one location to another
further as mentioned earlier collateral damage to existing hairs
in the recipient area results in significant loss
of potential density and coverage in spite of transplantation
the popular procedure of follicular unit extraction or
fue has what’s known as a transection rate
transection means that when the hair graft is harvested
a certain percentage typically 30 percent of hairs
do not have the root or follicle necessary for growth when
implanted this means that 30 of the grafts are not going to grow in
addition there is a percentage of grafts that are intact
which don’t survive i see so many patients every week who have had
three hair transplants and are frustrated and disheartened by this type
of experience since they’re no longer able to have any
more surgery they need a new approach to their
situation typically i find that i can help them
improve the appearance of their hair grafts
as well as the few native hairs remaining
with TrichoStem Hair Regeneration in fact i’ve helped many people with old
hair transplants by not only improving the quality of
their transplanted hair but also by reactivating hair that was
transplanted and simply not growing it’s important to understand that hair
transplant surgery is very traumatic to the scalp if you just
think about a surgery where you have 1500 to 2500 stabs on the scalp
you can imagine how there can be vascular compromise and scar tissue
resulting in a sub-optimal environment for hair growth
by using acellular matrix and platelet-rich plasma
i believe i’m creating a better environment
by optimizing blood supply and recruiting your adult stem cells
into the deeper layers of skin where the hair follicles are
it’s important to recognize that particularly with procedures like
fue hair is being harvested from areas outside the true permanent zone
this means that these grafts are subject to thinning
just like the hairs that have been lost from the top of the scalp
after all this does it mean that there’s never a situation where a hair
transplant would be indicated of course not
there are cases of advanced hair loss particularly
frontal hair loss where there are no more
viable hair follicles to treat non-surgically
typically the same patient who would benefit from transplantation to the
frontal area also has some hair in the mid scalp
and behind in the crown recalling that hair transplant is still
very limited by the number of hairs that can
be successfully transplanted in the
limitations of achieving natural density a strategy can be employed where optimal
coverage can be achieved maximally before the patient undergoes
hair transplant surgery as has been seen
by looking at celebrities who had obvious hair transplants which everyone
identifies as such it’s important to recognize
that the frontal hairline is defined by natural density
with the transition behind the hairline as opposed to isolated grafts in a line
comparable to a picket fence so the strategy that i recommend
is to undergo TrichoStem Hair Regeneration
first to maximize coverage before undergoing hair transplantation
simply stated every hair that we are able to
regrow and improve scalp coverage allows the hair transplant surgeon
to focus the limited number of grafts to smaller surface areas we’ve also helped
many patients who underwent hair transplant and then discovered
trichostem hair regeneration while they were online
i found that patients who have undergone hair transplant surgery can
benefit in terms of optimizing the hair graft growth as well as
their native hair growth i often joke with them that at the one year point
after surgery the surgeon who performed their transplant
will want to take credit for how good they look because of the improved
density achieved with TrichoStem Hair
Regeneration that’s okay with me in conclusion
although the marketing of hair transplant surgery creates the
perception that the only way to address significant
hair loss is to have a hair transplant we have
proven for over 10 years that a non-surgical treatment such as
TrichoStem Hair Regeneration can not only be comparable but actually
yield results that exceed not only one but two hair transplant surgeries
in a marketplace driven by transaction and profit
there’s often little attention paid to the long term consequences
of any aesthetic intervention whether it’s a laser treatment
cosmetic surgery or hair transplant a patient with hair loss is different
and compared to a patient who is interested in trying botox
for the first time hair loss has a significant
emotional impact and i feel that people who
come to me with hair loss need an honest opinion and a treatment strategy
not a transaction
I hope you found this information helpful
thank you for your question
Hair that is genetically resilient to hair loss only grows in a limited area at the back of the head. Any hair taken above or below this area is vulnerable to hair loss after a transplant or as part of progressive hair loss. Given this scenario, it is easy to see the limitations of having to harvest hair from a small area in order to cover a much larger area of baldness at the front of the scalp and the crown.
The main problem of hair transplantation is that they do not actually treat the progression of hair loss, since they do not directly address the hormones or other cellular signals that affect hair growth. It is important to understand that hair loss does not occur suddenly.
Rather, hair progressively grows thinner each time hair sheds and enters the growing phase. Hair grows in cycles and with every cycle, hair continues to miniaturize, until it eventually disappears.
Most hair loss sufferers ideally want to achieve natural-looking hair density and coverage in a single session when undergoing a hair transplant. This is an unrealistic expectation, since only a limited amount of hair can be safely and effectively transplanted per square centimeter of the scalp.
Keep in mind that each transplanted hair comes with the entire follicular unit, including the dermal papilla and other soft tissue. These need enough space and blood and nutrient supply in order to grow, therefore, crowding grafts together is not a wise option. Native hairs may also be subjected to trauma during a hair transplant, which can also affect hair density.
There are known ways in order to maximize the result of an hair transplant surgery, which consist of medical therapy and regenerative medicine or adult stem cell based treatment.
Finasteride (or Propecia) prevents the enzyme 5-alpha reductase from converting testosterone to dihydrotestosterone (DHT), which affects DHT sensitive hairs in some men. Consistent use of finasteride can help in slowing down hair loss; however, finasteride has been known not to work on all men. There is also an increasing concern of its long-term sexual side effects, which is one reason that many men are refusing to take finasteride. Finasteride must be taken daily for efficacy.
Minoxidil (or Rogaine/Regaine) is a liquid or foam treatment that can be used by both men and women. Minoxidil works by prolonging the anagen (growing) phase of hair and suspending the telogen (shedding and resting) phase. Minoxidil does not thicken hair, nor does it actually stop hair thinning, rather, more hair is retained on the scalp, giving greater density and hair coverage. Minoxidil must be used regularly to sustain effectiveness, although not everyone responds to it as a treatment.
The term “hair plugs” refers to a perception many people have of individuals they see and identify as having had a hair transplant. In the past, this perception was related to the large size of hair grafts in otherwise bald scalp.
This perception with modern hair transplant is typically due to existing hair thinning and disappearing, leaving behind the hair grafts. This loss of density causes the grafts to look more obvious. Therefore, it is important to stabilize hair loss so native hair doesn’t thin and disappear, leaving behind isolated hair grafts.
Most of the time, when people seek out a hair transplant, they are not informed that there is a high likelihood that they will need more sessions in order to achieve satisfactory results. The most common reasons for multiple hair transplant procedures are due to the following:
A patient’s existing natural hair will continue to thin out until they are lost, leaving behind only the transplanted hairs. If a patient does not have another hair transplant to address the added hair loss, they will be at risk for the “pluggy look”.
Transplanted hair that remains are genetically resistant to the effects of DHT that cause hair thinning and loss. However, native hair is still prone to hair thinning and can be lost years after the transplant was performed.
The donor area itself is limited because only 1500-4000 grafts can be harvested safely in one transplant session. To ensure that the hair grafts survive and grow, only a limited number of hairs can be transplanted so the donor area can heal before having another procedure.
The safe donor area of hair genetically resistant to hair thinning is very limited.
In our experience, the cost of hair transplant has become commoditized in a cost per graft model. This makes people believe that all hair transplants are the same. This is not true. We believe that the best approach is to place the maximal number of hairs from a donor area while at the same time create a minimal scar in the donor area.
Every patient has different variables which affect the number of hairs available for transplantation. A proper examination by the operating surgeon (not a “consultant”) is critical for you to understand what your results will most likely be. Making the right choice is critical. Your donor area is limited. You need to maximize your odds for the best result for you.