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Hair Transplant

Hair Loss Specialist in New York

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.

What is hair transplant?

Hair transplantation surgery illustration

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.

before and 12 months after hair transplant and hair regeneration - male patient top of the head view
before and 12 months after hair transplant and hair regeneration - male patient top of the head view

Hair Loss Causes

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.

stages of Hair loss process illustration

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 Transplant by Numbers

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.

older man with hair loss problem model

Who is a Good Candidate for Hair Transplant?

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:

  1. Good health
  2. Enough hair in the donor area
  3. Male. Females can have transplants, but typically females are not good candidates because female pattern hair loss is more diffuse. When hair is diffuse, placing hair grafts close to native hair puts the native hair at risk of loss.
  4. 30-years-old or older. People who experience hair loss in their late teens and 20s usually have rapid hair loss, so hair grafts can’t match the amount of hair continually being lost. 

Stages of Hair Loss

hair loss stages of men illustration

How to prepare for hair transplant surgery?

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.

Dr. Amiya Prasad performing hair regeneration
Dr. Prasad’s Unique Treatment to Improve Hair Transplants and Stop Further Loss

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.

Hair transplantation methods : FUE vs FUT

FUT vs FUE hair transplant

Follicular Unit Transplant (FUT):

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.

microscope image of thinning hair

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.

FUE ( Follicular Unit Extraction) – Avoiding the Strip Incision

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.

before and after Hair Transplant surgery

Follicular Unit Extraction (FUE)  Disadvantages:

  1. With FUEs, follicular units are extracted using tools and punches that can retrieve the hair shaft, but may cut the root beneath the skin (since you can’t see through the skin). The loss or damage of the root (dermal papilla) known as transection. As much as 30% of hair grafts in an FUE can be damaged at the root, resulting in grafts that don’t take, die, or just don’t grow.
  2. Less quality grafts – since the FUE doesn’t yield as many grafts in the true genetically resistant donor area as the FUT. A significant number of FUE grafts have to be harvested from outside the narrow genetically resistant zone of hair. Harvesting grafts from outside the donor area means that these hairs are not genetically resistant and more prone to hair thinning and loss.
  3. Higher incidence of broken grafts – Extracting hair grafts in an FUE procedure is riskier to the graft than during an FUT procedure. Follicular units can be carefully extracted in the strip method since the skin is no longer attached to the body, preserving the all important root, or dermal papilla.
  4. Longer procedure – the FUE is a longer hair surgery procedure than the FUT. FUT extractions are faster since the strip of hair is removed and hair grafts are prepared by technicians. In the FUE, the patient experiences each individual extraction  which is a long and uncomfortable process compared to FUT. In fact, FUE surgery can take twice as long as an FUT.
Garden city- Prasad Cosmetic office

Hair Transplant Recovery Time, Aftercare, and Healing

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.

Hair Transplant and hair regeneration before and 12 months after recovery Time
Hair Transplant and hair regeneration before and 12 months after recovery Time
What is healing like after a hair transplant? Hair transplant surgery is a pretty extensive procedure which can take much of a full day to perform an example is called FUT or follicular unit transplantation also known as strip surgery since a strip of hair-bearing skin is harvested from the back of the scalp for the purpose of obtaining hair grafts to be implanted typically in the front of the scalp another method is called FUE or follicular unit extraction where instead of harvesting a strip of skin individual grafts are harvested with circular blades called punches many people with hair loss believe that their only option is to have a hair transplant and they are concerned about specific issues such as the healing process as well as the amount of hair growth to expect afterwards I’ll discuss some concepts related to healing and how we help people in our practice who are considering having a hair transplant or have already had one I’m Dr Amiya Prasad I’m a Diplomate of the American Board of Cosmetic Surgery and a Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in practice in New York City and Long Island for over 25 years I’ve performed surgical hair transplants throughout my career as I mentioned earlier hair transplant surgery is a long procedure unfortunately the hard reality of hair transplant surgery is that there can be a significantly high percentage of hairs transplanted that don’t grow resulting in frustration for the patient and the surgeon to address this and other challenges in 2011 I used a wound healing material called extracellular matrix by the company ACell to enhance graft survival and donor area healing we observed that a year later that hair grafts and the donor area benefited from the application of extracellular matrix in addition even of greater significance was that native hair that was not transplanted had increased in number and grew in thicker inspired by this remarkable event I worked over several years to create a non-surgical treatment for male and female pattern hair loss called TrichoStem Hair Regeneration over the many years of helping people from around the world with TrichoStem Hair Regeneration we’ve helped many people before and after their surgical hair transplants with our system interestingly we’ve helped many people whose hair transplants were performed many years ago actually improved their appearance with regrowth of transplanted hairs which appeared to have stopped growing so let’s take a step back before discussing how to help healing after a hair transplant and ask a simple question and that question is is this the best time for you to undergo a hair transplant timing is very important since the number of grafts regardless of technique is fairly limited even if you were to have several surgeries in my practice I find that most people considering a hair transplant have thinning hair as such there is a strong argument for maximizing your scalp coverage with a non-surgical treatment before having a hair transplant simply stated every hair that naturally grows in and is thicker is a hair that doesn’t have to be transplanted many of my patients considering hair transplant are younger and are very motivated to have surgery I explained to them that I see many people who have had multiple surgeries when they were young and as they got older and lost their existing native hair their transplanted hair didn’t look very good and they had very little scalp coverage it’s simply logical to see how much of your existing hair can be optimized before having surgery i also see a lot of people who come into me after they recently had a hair transplant typically they’ve had an FUE procedure and they’re looking online for information about the possibility of losing hair grafts after surgery and how to deal with scabs generally speaking after 48 to 72 hours grafts are well situated and are not likely to dislodge this doesn’t mean that they will necessarily grow basic hygiene regimens are usually part of the post-operative care but separately in terms of helping people optimize their hair transplant results we have helped a lot of people soon after they had surgery with TrichoStem Hair Regeneration the rationale behind the strategy is that our treatment can potentially optimize the environment for hair graft healing as well as reactivate native hairs to grow and thinning hairs to thicken this can be significant benefit since FUE procedures yield can be limited due to graft transection during harvesting and challenges with graft survival specific to FUE surgery as mentioned earlier we see a lot of people who have had hair transplants years ago and even decades ago many of these people cannot undergo any more transplantation and have lost most if not all of their native hair this leaves them with very sparse looking transplanted hair I’ve helped many of these people with TrichoStem Hair Regeneration it’s been my observation that a lot of transplanted hairs seem to stop growing yet the hair follicle is still viable which is evident after regrowth post or after TrichoStem Hair Regeneration treatment we effectively established in 2011 that hair transplant healing can be enhanced with regenerative technology since that time we’ve established a new way to approach hair loss without surgery in addition to helping people who’ve recently or not so recently undergone hair transplant surgery hair transplant surgery has limitations in spite of many new techniques introduced the donor area can only yield so many grafts healing can be optimized after surgery but in my opinion hair loss management is more than getting a hair transplant and hoping for the best whether you plan to or already have had a hair transplant I find that developing a strategy which leverages the benefits of our non-surgical treatment with TrichoStem Hair Regeneration and other medical management options we’re able to help our patients look their best for the long term I hope you found this information helpful and thank you for your question

Hair Transplant Alternative: Trichostem for Hair Regeneration

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.

hair regeneration before and after treatment top of the head view
hair regeneration before and after treatment top of the head view

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 Transplant Limitations

Male head crown with hair loss
  • Limited amount of genetically resistant hair in the donor area

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.

  • Hair transplants do not stop hair thinning

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.

  • Inadequate density of transplanted hair

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.

Treatments to Maximize Hair Transplant Results

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.

Is treatment still needed after a hair transplant? For many years during consultations for hair loss treatment I found that a lot of my patients with male pattern hair loss were under the impression that the most definitive solution for their hair loss was a surgical hair transplant hair transplantation regardless of the method used is the transplantation of genetically resistant hairs from the back of the scalp to the front of the scalp while hair transplant surgery does put hair in areas with little or no hair it does not change the continuous progression of hair loss afterwards i’ll discuss why having a hair loss treatment strategy is very important especially after a hair transplant 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 throughout much of my career hair transplant surgery was a significant part of my practice in an effort to improve the outcomes about 10 years ago i started using a wound healing material called Acellular matrix to improve the healing process in the donor area and to improve the survival rate of the hair grafts we observed that a year later thinning hair that wasn’t transplanted became thicker this discovery inspired me to come up with a system to treat hair loss the challenge was to come up with a predictable treatment protocol for customization in order to meet the unique needs for each type of patient i developed a system where i factored in key variables such as age gender age of onset of hair loss and severity of hair loss to customized treatments that will work best for your profile this treatment can be used for men and women who’ve previously had a hair transplant our treatment for hair loss which i trademarked TrichoStem Hair Regeneration has also been very successful as an alternative to hair transplant surgery as a pioneer of this new treatment for over the past 10 years i’ve helped a wide range of people who came from around the world with scalp coverage improving in over 99 of patients it’s clear why TrichoStem Hair Regeneration stands as the benchmark to compare any other ACell plus PRP treatment for hair loss that interestingly appeared so many years after we started hair transplants are marketed and perceived by consumers as a solution for genetic pattern hair loss the reality is that hair transplant alone does not treat progression of genetic pattern hair loss at all the characteristic progressive hair thinning will continue after surgery for example when you see a person who had an obvious hair transplant where you see the so-called plugs of hair that are growing in isolation they’re often labeled as having had a bad transplant in reality they didn’t start out that way they actually probably looked pretty good for a few years after their transplant surgery however with time only the grafted hairs that are genetically resistant to hair thinning remained while hair thinning continued and the native thinning hairs eventually disappeared this is one of the main reasons why i discourage men in their 20s to undergo hair transplant even with multiple transplant surgeries rapid hair thinning will leave the coverage sparse and looking unnatural not only will they not look like the same as contemporaries who don’t have hair loss but as they get older and reach their mid 30s the residual grafted hair will have poor density look artificial in my experience a lot of people who choose to undergo a hair transplant as a solution for their cosmetic concerns are frustrated by the limited results of their surgery invariably they end up having a second transplant where they are further frustrated so they find another surgeon to do their third transplant in the end regardless of the number of surgeries they had they find themselves in a situation where they’ve spent a lot of money undergone a lot of pain and recovery and no longer have any more hair left to harvest for further transplantation this is not a good position to be in unlike other cosmetic surgical procedures like eyelid surgery facelift surgery or breast implant surgery there is much greater variance in the outcomes of hair transplant surgery in the marketplace the advertising does not reflect the actual reality of hair transplant outcomes in my opinion the problems arise due to patient selection the setting of unrealistic expectations and basic issues regarding blood supply bleeding and scar tissue oftentimes the patient who has undergone two transplants had the second transplant done by the same surgeon who did their first transplant however there was no difference in how the surgeon approached the second procedure consequently the yield from the second transplant is not only less than anticipated but there is often further hair loss due to the trauma to native existing hairs and poor graft survival when it comes to patients who have had hair transplant surgery before coming to see us they essentially fall into three basic situations one an individual who had hair transplant several years prior and is looking to avoid having to do a second hair transplant while they’re experiencing hair loss progression two an individual who has in the past three months had a hair transplant and wants to optimize their healing and growth of their existing native hair three an individual who has had two or more hair transplants over several years and is noticing the quality of their transplanted hair is diminishing in addition to worsening of their scalp coverage due to natural progression in order to understand how we manage these patients we should first briefly cover how TrichoStem Hair Regeneration treatment is used for people who have never had a hair transplant and are experiencing androgenetic alopecia or genetic pattern hair loss the TrichoStem Hair Regeneration treatment has over a 99 success rate for men and women experiencing genetic pattern hair loss the success is defined as visual improvement in hair thickness and scalp coverage with TrichoStem Hair Regeneration we are essentially reactivating hair that is not growing because of a prolonged resting phase where thickening hair that was thinning and increasing the longevity of the hair growth cycle one of the advantages of TrichoStem Hair Regeneration over hair transplant surgery is that native hair grows much closer together than what can be achieved even with multiple hair transplant surgeries further by thickening thinning native hair and stimulating hair growth trichostem hair regeneration treatment can achieve better scalp coverage than not just one but two hair transplant surgeries for many of our patients typically we treat each patient with a two-year plan where we do two separate treatments approximately 18 to 24 months apart and we expect sustainable benefits in the range of three to five years or even more additional medical management including dht blockers nutritional and medical therapy may be indicated depending on the category you’re in we see our patients every three to six months and review results with them to show how they are progressing over time for patients who have had hair transplant surgery it appears that our TrichoStem Hair Regeneration system provides an optimal environment to help both their hair grafts and their native hairs i have the unique perspective of performing hair transplant surgery for many years and developing a significant non-surgical treatment for genetic pattern hair loss with all of this clinical experience in my opinion you can optimize your appearance with non-surgical options and delay if not avoid further hair transplantation in the near future regardless of the type of hair transplant you’ve had or plan to have your genetic pattern hair loss will continue to progress although hair transplant surgery has a potential role for improving appearance particularly for men with frontal hair loss it’s important to recognize that a strategy for the long term is critical to avoid regret and frustration I hope you found this information helpful thank you for your question

Finasteride Oral Medication

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 Topical Application

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.

Hair transplant Q&A

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.

Hairs transplanted from the true donor zone, once healed and growing should continue to grow for the rest of your life. Unfortunately, without additional treatment, existing hair (native hair) will continue to thin and eventually disappear.

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.

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