Coalition member Dr. Alan Feller has a long history of performing state of the art hair transplant procedures with excellent results. He also has a strong presence on our hair restoration forum helping to educate hair loss sufferers in the latest and greatest developments in hair restoration, including the popular follicular unit extraction (FUE) procedure.
Recently, we uploaded a collection of hair transplant video interviews with Dr. Feller on YouTube. To learn more about Dr. Feller, his experience, skill, and philosophy on patient care, visit “Hair Transplant Video Interviews with Dr. Alan Feller on YouTube“.
I’ve heard these terms used quite often, but what exactly is the difference between the Pre-Made Incision technique and the “Stick-and-Place” method? Is one better than the other?
For myself, the one big advantage of the stick-and-place method, which I take advantage of in certain unique cases, is the fact that it allows the hair transplant surgeon to make the SMALLEST possible incision to place the graft in. This is because, at the instant you withdraw the needle or slit blade, you are immediately placing the graft into the opening before any elastic recoil or shrinkage can occur at the site. The benefits of this fact are two: One, you do the least possible damage to the vascular system of the scalp because of the smaller sites, and two, you can place grafts closer together, because the sites are smaller and more will fit into a cubic centimeter than with a slightly larger site.
The big problem with stick-and-place is that it is not possible for the surgeon to personally perform the whole hair restoration operation due to the time factor (time the grafts are out of the body) and the fatigue/exhaustion factor. He would be there for 16 hours (till the wee hours of the morning) and a lot of the grafts wouldn’t survive because of the time out of the body. So this task has to be delegated or shared with one’s assistants.
Good day. I would like some information regarding the cost of FUE hair transplantation, any possible risks involved with this type of surgery, and where the best clinics are located. Also, I was advised that I might need around 2,550 grafts or hairs transplanted, but I can’t remember which term was used. What’s the difference exactly?
Follicular Unit Extraction (FUE) is a still a relatively new hair transplant procedure. Due to some of the inherent limitations of the technique at this point in time, performing an otherwise standard-sized megasession can be a somewhat risky venture. Safely transplanting 2,500 grafts would most likely take at least two days to accomplish, and could wind up costing twice as much as a FUT (Follicular Unit Transplantation). You should also become aware of the distinction between the proposed graft number and final hair count: the former will invariably be lower than the total amount of hairs moved, as naturally occurring follicular units are largely divided down and modified after dissection.
FUE is an extremely delicate, time-consuming process, so yield may be compromised if too much is being attempted too quickly. There is also some degree of scarring associated with the procedure. It won’t produce a linear strip scar, but tiny, feint “dots” may be visible upon close inspection. If an inexperienced hair transplant surgeon uses improper technique, especially with a punch tool greater than .9mm in diameter, the patient could end up with a “moth-eaten” look in the donor area reminiscent of plug extraction, which can potentially be worse than a strip scar. There are other physiological factors/obstacles that may come into play during FUE work, possibly more so than in a traditional strip surgery. Many prominent hair restoration physicians have emphasized the importance of overall scalp “cooperation”.
Finasteride (Propecia), an oral medication available by prescription only, has been introduced to the market in the past decade. Finasteride is approved only for use by men. Through scientific studies, it has been shown to regrow hair in some men and stop hair loss in an even higher percentage. Finasteride works by decreasing the formation of DHT, a hormone responsible in large for male pattern hair loss, while not reducing testosterone, the overall male hormone responsible for masculinity. Therefore, any side effects that may involve male sexual function are mild and occur in less than 2% of all patients.
Finasteride has been available for over 10 years and has been shown to be somewhat safe and effective. Finasteride (Propecia) works best for early and moderate hair loss, but it may also help patients with more advanced hair loss to preserve their remaining hair, and its use is suggested by hair restoration surgeons as an effective medication to slow down or reverse male pattern hair loss in many men. It is often used as a complimentary treatment for hair transplant patients.
Topical minoxidil (Rogaine) has been around for over 15 years and is helpful in slowing down hair loss, but less effective in helping new hair to grow. A higher concentration (5% solution) of minoxidil is now available for men and has been shown to be more effective than the 2% solution. 5% minoxidil solution is generally not recommended for use by women because it may stimulate the growth of facial hair, and also because at least one study suggests that it is not more effective than the 2% in females.
Recently, we edited and uploaded a collection of hair transplant video interviews on YouTube featuring Dr. Bernardino Arocha. To learn more about Dr. Arocha, his skill, experience, and philosophy on patient care, visit “Hair Transplant Video Interviews with Dr. Arocha” on YouTube.
Hi. I was just wondering about something: Is there any particular kind of hat I can wear while applying Rogaine?
Just to clarify, there is no practical, recommended way to apply Rogaine (minoxidil) while you are wearing a hat. I suppose it might be remotely possible to treat the area through the open space above the adjuster in the back of a baseball cap, but this would be time consuming and counterproductive.
Consumer medical information for the original formula advised users to wait at least an hour after using Rogaine before putting a hat on; however, Rogaine Foam is absorbed into the scalp more quickly. Many users consider this to be the superior method for topically treating thinning hair.
In my opinion, as long as the area has completely dried and no residue remains, you’re free to wear your cap or apply other hair care products in moderation such as gel or hairspray after minoxidil. Using a blow dryer on a light, cool setting (never hot) can speed up the drying process without causing breakage or inducing further hair loss. For more information, I suggest you visit the company’s official site and browse through the Q & A section.
I recently emailed several of my pictures to a highly recommended hair restoration center and am quite disappointed with their response. They basically told me that I’m not a hair transplant candidate at this time based on my photos and age, but didn’t really bother to elaborate. I’m certainly no expert, but how can anyone make this decision without seeing me in person? I feel like I got brushed off.
Due to the increasingly high demand for online consultations, many of the leading worldwide hair transplant clinics become inundated with emails from prospective candidates, and therefore might not always be able to offer in-depth responses to every patient query. If you are dissatisfied with their reply, I encourage you to schedule an in-person consultation with the hair restoration physician.
Remember, although online evaluations can be a very practical solution for long-distance candidates who might be interested in booking a procedure, they can never truly substitute for a proper, in-office assessment, particularly for patients with indistinct hair loss patterns or ill-defined expectations. If traveling to the hair restoration clinic isn’t a feasible option, I suggest you try to resubmit clear, non-flash pictures of your hair that effectively expose any perceived problem areas, and also take a brief moment to really articulate your concerns and goals. Lack of proper photos and general miscommunication may explain the initial response.
I’m approaching the 3 month mark after hair transplant surgery and I’m starting to get some pimples in the receipeint area. My question is if i pop them will it hurt the grafts? I know that they say at 10 days you would have to surgically remove the follicular units and that you cannot lose them, but what damage can popping the pimples do?
If you are getting more than a couple of pimples at a time, please contact your hair restoration doctor. Pimples don’t usually affect the final results but they can be a nuisance. There are some simple measures that your doctor can recommend to reduce the number of pimples you get. These could include such things as warm salt-water soaks, topical antibiotics or other lotions, or oral antibiotics (like acne medications for teenagers.) The treatment your hair loss doctor will choose would depend on the severity of the pimples.
I would recommend against squeezing any pimples. If they break inwards instead of outwards you could get inflammation and scarring under the skin. Big or painful pimples can be punctured with a sterilized needle to release the pressure but you should follow your own doctor’s recommendations.
Ironically the pimples tend to be at their worst before the transplanted hair has grown enough to hide them. Hopefully your pimples will disappear and you will see some good hair growth soon.
If people with male pattern baldness (MPB) have hair follicles that are sensitive to DHT, then why is it that they don’t lose their hair right away in their twenties but rather much later in their life? I presume that DHT gradually lowers when we get older? So why do some hair loss sufferers start going bald in their thirties or even forties?
In men, except in unusual circumstances, hair loss is all genes and luck, or lack thereof.
I recall from some source or another, that male hair loss affects 10% of the population per decade. Thus, 40% of guys in their 40’s have significant hair loss. My “eyeballing” of people walking around the mall or at a recent football game suggests that is probably reasonably accurate.
So then the issue is what do you do about it. My consultations always offer 4 choices.
Do nothing. You won’t die from hair loss.
Wear a hairpiece when needed. We have done quite a few fellows who wore hairpieces and either were able to get rid of them, or wear a smaller hairpiece after surgical hair restoration.
3. Medical therapy works for many folks but has its own pros and cons.
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For myself, the one big advantage of the stick-and-place method, which I take advantage of in certain unique cases, is the fact that it allows the hair transplant surgeon to make the SMALLEST possible incision to place the graft in. This is because, at the instant you withdraw the needle or slit blade, you are immediately placing the graft into the opening before any elastic recoil or shrinkage can occur at the site. The benefits of this fact are two: One, you do the least possible damage to the vascular system of the scalp because of the smaller sites, and two, you can place grafts closer together, because the sites are smaller and more will fit into a cubic centimeter than with a slightly larger site.
In men, except in unusual circumstances, hair loss is all genes and luck, or lack thereof.
