This below response from our Hair Loss Social Community and Discussion Forums was written by recommended hair restoration surgeon Dr. Ali Emre Karadeniz.

When repairing a bad hair transplant by removing poorly placed grafts along the hairline, is it best punch the grafts out or remove them with a laser?

Dr_Kardeniz_PhotoLaser hair removal for badly transplanted grafts at the hairline has not worked for my repair patients in the past and many other hair restoration surgeons that I know. These grafts contain multiple hairs at a high caliber and are very resistant to laser. Multiple laser sessions on previous patients have not given a satisfactory result. In addition, multiple sessions of laser removal causes some thermal damage resulting in scarring at the dermal layer.

I do not claim that follicular unit extraction (FUE) punching does not cause scarring at all. There is no ideal way of removing these hairs without accepting a trade off. We are just trying to get the best improvement with the least aesthetic problems left behind.

Dr. Ali Emre Karadeniz

David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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The following thorough response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “Gillenator”.

I have a simple question. I have a hair transplant booked at a well regarded clinic in California, but was told by the surgeon that he would have to leave at the break due to another obligation that day. He informed me that the procedure would be complete at that point and standard procedure is for the technicians to finish by themselves, doing the actual graft insertions. The only difference would be that he would not physically be in the office as well.

I would like to commit because it works with my schedule, but I have reservations paying a lot of money for a procedure where the surgeon is only there for half of the day.

doctorisoutWith follicular unit strip surgery (FUSS), the donor area where the strip is excised is indeed closed with sutures, staples, etc., immediately after the strip is taken and before the grafts are inserted. Possibly the doctor was telling you that the techs do all of the graft placement and after they are all placed, the procedure is pretty much completed.

Still, what I don’t like is that it is always possible that the patient may need more anesthesia before the procedure is finished and only a licensed physician should be administering anesthesia. That’s the law in the land.

This question, from a member of our Hair Loss Social Community and Discussion Forums, was answered by recommended hair transplant surgeon Dr. Mike Vories:

Doctor Vories, you recently discussed graft drying issues using the NeoGraft FUE machine. I was actually considering having work done at such a NeoGraft clinic and you have extensive experience using this tool – could you please elaborate? Was the yield too low or did you notice other issues versus a non-suction tool? And what about the positive air pressure – push – implanter pen from NeoGraft/Medicamat, when it comes to tight graft placement or angle control?

Dr_VorriesSuction can only damage follicular unit grafts. There is no reason to use suction besides speed. Once I reached a point where I could extract 2000 grafts in one day without suction, I stopped using the NeoGraft machine.

In my opinion, implanter pens should be used routinely with follicular unit extraction (FUE). These fragile grafts are very difficult to be hand placed without trauma. In fact, it is my belief that most of the discussion involving poor yield with FUE is due to placement of grafts, and not extraction.

The problem in using implanter pens is it puts the hair transplant surgeon back in the OR, and limits your practice to one hair restoration surgery per day.

Dr. Mike Vories
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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community.

This below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by Nicole, the SMP and Micro-Pigmentation Specialist for Coalition hair restoration surgeons Dr. Ron Shapiro and Dr. Paul Shapiro.

Hey Nicole, I wanted to ask your opinion on something. Since you have worked for a permanent scalp micropigmentation clinic, and now are the Temporary SMP specialist at Shapiro Medical Group, you probably have a unique perspective in that you are one of the few practitioners and specialists in the industry who has actually done both Temporary and Permanent SMP.

I know that your career now is the Temporary SMP, but do you feel that Permanent SMP is still a good viable option for men if they have it done at a reputable clinic? Or does it just depend on what the client is wanting, like maybe just wanting to see if SMP is for them or not?

smgI do feel like Permanent SMP can be a viable option if done by a reputable clinic! Temp SMP (tricopigmentation) is a great advancement in the permanent SMP procedure exactly for the reason you stated above – because it offers another option for patients.

I like to stay away from any permanent vs. temporary SMP debates because they both have their own lists of pro’s and con’s. Always, the most important thing first is “Do no harm” followed by “What is best for this patient?” Both are great procedures in the right hands but neither procedure is “the perfect solution” for every patient. It’s nice to be able to offer options.

This question, from a member of our Hair Loss Social Community and Discussion Forums, was answered by Dr. Jerry Cooley of Charlotte, NC who is a member of the Coalition of Independent Hair Restoration Physicians.

What is your opinion about the efficacy of taking Propecia (finasteride) twice weekly? For example, .5 mg twice weekly? In other words, does the efficacy of Propecia decrease significantly when the dose is lowered?

Dr-Cooly-portraitGood question. Dosing studies show that 0.5mg finasteride is almost but not quite as good as 1mg in suppressing DHT. I think everyone is different so some people will do well at this low dose.

They haven’t done large studies on hair loss with different dosages/dosing intervals so we have to base our opinions on how the drug is metabolized. We know that a single dose of finasteride reaches peak DHT lowering after 3 days and the DHT doesn’t come back to normal till after 7 days. So twice weekly dosing of 0.5mg will keep DHT suppressed significantly and inhibit hair loss for most people.

How does it compare to 1mg every day? No one knows but it might be 70% as good, just a guess, and a whole lot better than doing nothing. Over the years, I have had patients who have had side effects at 1mg daily who did not have side effects with lower/intermittent dosing and still seemed to benefit in terms of their hair.

Dr. Jerry Cooley

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. William Lindsey:

It’s been two weeks since my hair restoration surgery. Do you feel it is safe at this point, to take a dip in the ocean? How about pool water? Will the chlorine damage the grafts?

Dr_Lindsey_photo I swim a couple of miles a week and I have used various masks/goggles and I think just about all would apply undo stress to the donor area, possibly causing a wound separation. Additionally, the turning of the head from side to side will definitely stretch the donor area probably causing scar widening.

Having personally performed 2700 facelifts in addition to hair transplants I can absolutely say that wound stretching in the first few weeks after surgery is key to hypertrophic scar formation. I authored a paper back in 1995 on the treatment of hypertrophic scars and keloids in the Archives of Otolaryngology or the Archives of Facial Plastic Surgery discussing this further if anyone has interest.

A second issue is sun exposure on recently operated upon skin can permanently stain the scar line, or cause the recipient area to become hyperpigmented, requiring bleaching agents or chemical peels as treatments.

So to conclude, if you have had a hair transplant, ease off stretching of the scalp and direct sun exposure for 4-6 weeks.

Dr. William Lindsey – McLean, VA

This question, asked by a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Raymond Konior of Chicago, IL.

Can a man with severe hair loss and limited donor hair have a hair transplant in the front and use a hair system in the back in order to create the natural look of a full head of hair?

Dr_Konior_photoI primarily restrict this hair restoration approach to those men who are long term hair piece users and who expect to continue using a hair piece for their lifetime.

Although someone may commit to wearing a hair piece forever, surgical planning must take into consideration the reality of the patient eventually deciding to abandon his hair system. An important point relating to this is the relatively confined nature of the transplant zone that is created using the transplant/hair piece integration plan. Knowing that many hair piece users have an advanced pattern, the primary concerns of hair piece abandonment are future graft availability and the ability (or inability) of the hair transplant surgeon to restore the bald scalp to the patient’s satisfaction for density and coverage.

This below response from our Hair Loss Social Community and Discussion Forums was written by recommended hair restoration surgeon Dr. Ali Emre Karadeniz.

Do hair transplant surgeons maintain a record of the number of grafts transected during extraction and disclose this to the patient if asked?

Dr_Kardeniz_PhotoI don’t think that is practically possible. First of all, it requires significant effort and time during a procedure to calculate the estimated follicle transection rate. Thus it is not routinely calculated by most hair transplant surgeons and it is usually calculated for academic purposes.

Secondly, it is not clear yet what the follicle transection rate should be. I have listened to the follicular unit extraction (FUE) research committees suggestions at the ISHRS meeting, but there still are some unclear points. For instance, I pointed out that it is not adequate to only calculate the transected follicles within the grafts accumulated, but there are also some missing grafts (which should be counted as total transections) that are not possible to determine.

Third, as the transection rate mainly shows the expertise of the hair restoration physician, asking him to disclose it is like asking a company to disclose the weak sides of their product and is against the nature of marketing.

Dr. Ali Emre Karadeniz

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

This question comes from a member of our hair loss social community and discussion forums:

I saw an online ad for an “at home” dihydrotestosterone (DHT) test. The kit comes with a device that measures the level of DHT – the hormone responsible for male pattern baldness (androgenic alopecia) – in the blood and determines the severity of your hair loss. Do these at home DHT tests work?

DHTLike you said, DHT is the hormone responsible for male pattern hair loss or androgenic alopecia. It stands to reason that measuring the level of DHT in the blood would predict the nature of your hair loss.

However, I don’t think the home DHT tests are very well received. The information may be useful if you are trying to trend how your DHT level is dropping while using an anti-androgen medication like Propecia (finasteride). Otherwise, the level of DHT in your blood doesn’t really matter much; it’s more about whether or not your follicles are susceptible to it. If you have follicles primed to miniaturize when exposed to DHT (ie androgenic alopecia), they will likely shed whether the level is high or low. If your follicles don’t possess certain hormone receptors, they are resistant to the androgenic alopecia process and won’t shed – even if your DHT levels are high.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

This question comes from a member of our hair loss social community and discussion forums:

I’m suffering “brain fog” from Propecia (finasteride). Since starting the drug, I frequently “zone out” and have a difficult time thinking. However, it’s working for my hair loss and I don’t want to stop the medication. I’m wondering, can I take a medication to counter this side effect? I’ve heard “Adderall” is a drug for concentration. Can I take this for my Propecia brain fog?

adderall brainAdderall (amphetamine salts) is a stimulant used in the treatment attention deficient hyperactivity disorder (ADHD) and narcolepsy.

Most doctors avoid prescribing one drug to counter the side effects of another. This is especially true with potentially dangerous medications like amphetamines (ie Adderall). I understand the theory; finasteride is making you “foggy,” Adderall clears people up. Mix the Adderall with the Propecia and you’ll be back at baseline! Unfortunately, the two drugs work in very different ways; and it’s unlikely the two would really “balance” each other out.

Adderall isn’t targeted specifically for the brain either. It will work as an “upper” (stimulant) in a lot of different ways. This means racing heart, elevated blood pressure, anxious mood, et cetera. You may be better off talking to your doctor about lowering the finasteride dose or discontinuing the medication.

In fact, scheduling an appointment to discuss the situation with your doctor should be the first step. Remember, all medication changes should be thoroughly discussed with a personal physician familiar with your medical history.
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Blake Bloxham – formerly “Future_HT_Doc”

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