HAIR TRANSPLANT FAQS
Chances are you’ve got a few questions on your mind about what to expect from hair transplantation. Scroll through the list of frequently asked questions to find out more about hair transplantation, the best hair loss products and other hair loss information. Since 1990, Dr. Craig Ziering has helped thousands of men and women treat their hair loss at his Los Angeles, Orange County, and Las Vegas area surgical centers. The procedures involved with hair transplants and other means of overcoming hair loss often lead to numerous questions, including:
HAIR TRANSPLANT FAQS
There are a number of causes of hair loss. Androgenetic Alopecia (AA) is the most common cause of hair loss in men and women. It is genetic and can be inherited from the mother or father. In AA, DHT (a testosterone derivative) attacks hair follicles, resulting in miniaturization and alopecia.
Hair loss is progressive throughout our lifetimes. In certain areas of the head, the cells around hair shafts have more 5-alpha reductase (the enzyme that makes DHT). As a result, these areas have more DHT and generally demonstrate greater loss.
Hair transplants, sometimes called hair grafts, can give you years back on your appearance. Balding hair needn’t be a concern any longer. The staff of Ziering Medical hasn’t quite invented the baldness cure, but we’ve certainly created beautiful heads of hair for our male and female clients.
There are 100,000 hairs on the average head of hair. Hair cycles between growth and resting phases. In the normal head, 100-150 hairs enter a resting phase and fall out every day. The vast majority will begin to grow back in three to four months. This should not create anxiety as it is a normal function and is not noticeable. In fact, your grafts will also cycle like all normal hair.
Hair loss medication alone may help your thinning hair, but let the experts at Ziering Medical help you make the decision that is right for your particular hair loss pattern.
Follicular Unit Transplantation (FUT) is a procedure where hair is transplanted exclusively in its naturally occurring groups of one to four hairs. These groups or follicular units are obtained through the microscopic dissection of skin tissue taken from the donor region of the scalp. Because Follicular Unit Transplantation reproduces the way hair grows naturally, results appear completely natural and are indistinguishable from one’s original hair.
In Follicular Unit Transplantation the hair for relocation is obtained by surgically excising a strip of hair bearing skin from the donor region of the scalp. The skin edges of this wound are then sutured closed and the result is typically a thin, fine line scar oriented horizontally across the back of the head. Follicular Unit Excision or FUE is a contemporary revival of an antiquated technique of obtaining donor hair in which a small circular cutting instrument is used to harvest follicular units one at a time from the donor area. Each harvest or excision creates a small circular scar and a transplant session creates a number of discontinuous, individual scars contrasting with the continuous linear scar of FUT. Short hair styles are well supported with either method of harvesting. Large session sizes are much more easily accomplished utilizing FUT technique and costs for FUE are often quadruple the cost of FUT on a per graft basis.
After arriving at one of our offices at your appointed time patients first finalize paperwork and payment with the patient advocate and next are photographed to document the preoperative condition. Next individuals are moved to the room where the transplant will be performed and there, patients are visited by the physician who again discusses with you the plan for your procedure. Next your donor region is prepared for the harvest. You are then administered a mild oral sedative to facilitate relaxation. Local anesthesia is next injected into the donor area. Now prepared for the donor harvest, patients are situated in a prone position upon the fully reclined surgical chair. The physician then excises the strip and sutures the wound closed. This step of the procedure takes about twenty minutes. Thereafter the staff begins the process of microscopically dissecting the strip into follicular units ready for transplant. The patient at this time is situated in the seated position for the remainder of the session. Anesthesia is again administered to top of the head next to prepare it for the steps of site creation and graft placement which follow. The physician performs the key step of creating the recipient sites for the grafts which determines their location, density and growth direction. Both steps of the dissecting and placing of the grafts by the technicians are overseen by the physician. Throughout the lengthy procedure patients are allowed to watch movies, listen to music or rest quietly. At the end of the transplant procedure a staff member will go over post-operative instructions with you. Patients are able to drive themselves home at the conclusion of the day although some opt to have a friend or family member drive them home.
Yes, proper use of follicular units will be detectable only under a microscope or to a trained professional. The only people who know will be those you tell.
Hair loss surgery is not what it used to be. Microscopic Follicular Unit Grafting as performed by Dr. Ziering and staff, has reached new heights of artistic and scientific perfection. “Natural” is by far the most common reaction we hear about our work.
We work very hard to meet the needs of our patients. However, there are some patients that have unrealistic goals or do not understand how a transplant is going to look once it grows in. Our surgeons have a lot of experience designing hairlines that look natural according to age, race, and gender. More importantly, they understand how they will look once they have grown in. We enjoy working with our hair loss patients on the custom surgical plan, but if a patient insists on something that our surgeon believes would be cosmetically inappropriate, then the surgeon has the right not to perform the procedure.
Unlike the unnatural looking hair plugs of old, Ziering Medical specializes in creating natural looking hairlines. The best way to see what your hairline might look like is through a consultation with a professional from Ziering Medical.
Transplanted hair does tend to have a slight wave, but if your donor hair is straight, it will not become curly. Medical hair loss therapy as practiced by Dr. Ziering and staff is not to be confused with laser hair loss treatment. We are extracting hairs from your donor area and creating natural looking results through follicular unit grafting.
Yes. Light hair on light skin has minimal contrast and results in a very natural look. Dark, thick hair on light skin is the most surgically challenging. This is true when dealing with either men’s or women’s hair loss. Curly or wavy hair can also give the appearance of greater density. When styling, it is better to part the hair to one side. This will create a layering effect and the appearance of greater density.
Although the cosmetic benefit can be dramatic a hair transplant by nature involves the relocation of hair that is redistributed within the transplant zone in a density that is less that nature’s original density. As such the goal of literally replacing all the hair that is absent from an area is usually impossible unless the involved area is quite small. Fortunately the appearance of full or at least substantial coverage can be obtained by the introduction of a smaller number of hairs into the affected area(s) provided they are artistically arranged to create an optimal cosmetic effect. Ziering Medical has the technological proficiency to provide density [hairs per unit area] on par with industry leaders and is unsurpassed in the even more important area of creative artistry.
This is always a difficult question to answer. Density is a function of hair shaft thickness and number of hairs. One thousand thin hairs do not appear as dense as one thousand thick hairs. Your surgeon can help you understand this concept. The appearance of thickness or density will depend on how you style your hair, how much existing hair you have, how much hair you continue to lose, and how big the area is that you wish to transplant into.
Completely bald patients need to understand that, when they had full heads of hair, there were about 60,000 hairs on the portion of the head into which we usually transplant and about 30,000 hairs when they began to notice they were thinning. If you transplant 2,500 follicular units, you will get about 6,000 hairs. If you spread these out over the entire head, you can imagine that it will not look as thick as when you had 60,000 hairs over the same area. Having said that, the results of this type of procedure can make a dramatic and positive impact on one’s appearance.
Everyone is different but on average the new hair will begin to emerge from the surface of the scalp at the four month mark following surgery. The range within individuals is from two to six months and is not easily predictable. A man or women with prior transplantation – particularly that done in the intermediate or remote past will not experience growth until later. A postoperative evaluation is scheduled at five months at which time the expectation is the visualization of early new transplant growth. Abundant growth and consequent cosmetic coverage is not anticipated until the nine-month mark following the procedure. By the year anniversary of the work most all of the transplanted hair has begun growing. Over the ensuing six to twelve months the individual hair shafts thicken to a fully mature state and this contributes significantly to the overall appearance of the transplant.
*individual result may vary
Hair length entering a procedure should be sufficiently long in the donor area (½” or longer) to allow hair from above the donor incision to drape down and cover the sutured area upon completion of the transplant. Shorter cuts are allowed provided the patient is willing to have the surgical wound on display for the ten days the sutures are in place. Hair length within the recipient zone can be cut to the patient’s preferred length. Shorter lengths make the work of managing the hair during the procedure easier and longer styles offer greater ease of concealing the worksite for the week or so that there is visible evidence of the procedure.
The transplanted hairs will last and grow forever. This is the result of harvesting follicular units from the permanent zone of hair in the back and sides of the scalp. This hair is genetically different than the hair on the top of the head and within the crown that is affected by the hormone DHT [the culprit in male hair loss responsible for miniaturization of the hair and eventual baldness]. When these ‘protected’ follicular units are transplanted they maintain their original immunity and thus grow as they would have within the donor area. This phenomenon is termed ‘donor dominance’ and though not entirely understood from a histochemical standpoint is the well established foundation for hair transplantation that is now time tested over nearly fifty years.
Male pattern hair loss is genetic in nature and can begin as early as the second decade of life. Increasing numbers of men are affected as they age so that by age 50 approximately 50% of men have appreciable hair loss. Medical therapy designed to ward off future hair loss can begin as early as a young man reaches maturity and begins to exhibit early signs of hair loss. Ziering Medical’s philosophy emphasizes establishing contact early with patients experiencing or destined to experience hair loss so that educational efforts can begin to establish a thorough understanding of the nature of hair loss and medical and surgical options for managing this condition. Surgical intervention can begin early provided the patient understands the importance of concomitant medical therapy and the implications of early intervention in a condition that is often progressive over many decades of time. Again Ziering’s physicians are experts in assessing the future evolution of male pattern balding and designing a restoration program to optimize one’s appearance today as well as tomorrow.
The simple answer is that it would be difficult to get a good closure at the site of incision.
Hair loss in men is a confidence killer for many. You can stop thinning hair and male baldness, getting your confidence back and living the life you used to live.
This is not only a frequently asked question, it is a common fear for most prospective hair transplant patients. After they have completed their procedures, they are surprised at how comfortable they were throughout the procedure. At Ziering Medical, we have a highly qualified RN who administers your anesthesia very slowly to provide optimal comfort for your personal needs. Dr. Ziering believes that having a hair restoration procedure is the beginning of a new life and the entire process should not be a painful one.
No. Fine hair transplants with the same success as any other type of hair. The nature of fine hair is such that the coverage it affords is comparably less than thick hair. The appearance is none-the-less natural and familiar to the individual as his or her original hair type.
As many factors come to bear in assessing an individual’s candidacy for hair restoration, the answer to this question can only be determined with by a physician well versed in the surgical management of hair loss. Not everyone with hair loss is a candidate for hair transplantation though the vast majority of men and a small majority of women are fair to excellent candidates. The physician staff at Ziering Medical will provide any interested part with a thorough examination to analyze your type and degree of hair loss. At the conclusion of this complimentary consultation advice will be provided outlining medical and surgical options.
Most men and women in good general health are candidates for hair transplantation. In order to accurately determine one’s candidacy [ based upon degree of hair loss and hair type ], a complimentary private consultation with a Ziering Medical physician is recommended. During a consultation the physician performs a thorough examination of your scalp and hair to determine donor density, scalp laxity and the requirements for restoration. This determination takes into account one’s individual hair characteristics such as color, texture, and the presence or absence of curl to develop the right plan for your hair restoration procedure.
No. Your body would reject someone else’s hair just like a heart or kidney transplant.
Dr. Ziering explains this more in-depth in this video, also found on our Dr. Ziering on Television page.
Hair growth information and free private consultation await you.
Hair can most certainly be transplanted into skin affected by scarring – either that resulting from surgical trauma or other injury. Some adjustments are made when transplanting scarred areas such as decreasing the density of grafts placed per session. However repeat sessions are possible and often density values resulting in significant coverage and camouflage can be achieved.
The amount of hair needed for an average large session is well within the safe limits of what can be removed provided that the surgery is done properly. It is the experience and judgment of the surgeon that will ensure that the amount of hair that is harvested from the donor area is safe and appropriate for the planned session.
The scalp will regain most of its original laxity through the process of skin remodeling following a hair transplant. The majority of this occurs within the first 6 to 8 months following a procedure. Scalp flexibility or laxity varies from individual to individual and this difference to an extent dictates the amount of hair that can be removed from the donor area over time. If an individual possesses a tight scalp the maximum harvest or yield is less than someone with a very flexible scalp [ for a comparable density of hair ]. Even with multiple procedures patients rarely report lingering tightness unless their history includes scalp reductions or lift procedures.
Yes. Graft survival and growth following transplantation is limited by tissue oxygenation, not blood supply as is commonly perceived. Today’s most refined technology of microscopic follicular unit transplantation allows oxygen to easily diffuse to the small one to four hair grafts contained within the follicular units. The blood supply of the scalp is among the richest in the entire body which enables it to support the growth of large numbers of grafts provided that they are small in size. Ziering Medical performs exclusively follicular unit transplantation which ensures optimally small graft size.
No, a transplant will not prevent further loss. We consider this when planning a surgery. You can decrease the rate at which you lose hair by taking adjunctive medical therapy, which may include other hair loss prevention products.
All the hair loss information you need, customized to your particular hair loss pattern, can be quickly obtained by filling out our private consultation form.
Yes, you can, but it should be clipped on and not attached with glue or another adhesive. Tape can be used in the front, but only so long as it is lower than the level of the grafts and will not interfere with the transplanted hair.
There are a variety of ways to transition out of a hairpiece, and we can help you work through these scenarios.
Today’s hair restoration surgery is a low risk and very safe procedure and complications of any form are a rarity. Infection is virtually unheard of provided one adheres to postoperative instructions. An adverse or allergic reaction to the local anesthesia is possible through practically never encountered. Ingrown hairs can occur when the hair first begins to emerge from the scalp. These are a minor nuisance and will resolve completely. Postoperatively patients experience transient numbness in the donor region which abates within weeks. This is a normal consequence of the procedure. Swelling involving the forehead and in extreme instances the whole of the face can occur following a hair transplant; particularly one focused upon the hairline or the front of the head. If swelling occurs it begins the day following the surgery and resolves within the first five days postoperatively in most instances.
The scalp is sufficiently recuperated to allow a second procedure generally by the six month mark following the previous surgery. The hair from the prior procedure has begun to grow at this point but has not yet reached full maturity. Therefore, if one is deliberating the need for an additional procedure, waiting until the year anniversary of the last procedure is generally advocated. Conversely if an individual knows confidently that they desire additional density or coverage, a second or repeat surgery can be scheduled as early as six months following the last procedure.
Medical training and education can be very confusing to people outside of the medical profession. There are DOs, MDs, and a variety of board certifications. For those of you who aren’t sure what all of that means, here is how it works.
There are only two degrees of medicine in the United States of America that give an individual the right to apply for a state license (each state administers its own license) to practice surgery (cut and suture) or prescribe FDA and DEA regulated medications without supervision. These are the “allopathic” MD (medical doctor) degree and the “osteopathic” DO (doctor of osteopathic medicine) degree. Any individual who graduates from one of these four-year programs has earned the title “doctor” of medicine (as opposed to history or chemistry).
It is exceedingly rare for new doctors to begin practicing medicine right out of medical school. 99% of new doctors enter into a residency to learn a specific field of medicine (dermatology, emergency medicine, plastic surgery, etc.). Residencies are at least three years in length and can be as long as seven years. The goal of the residency is to prepare a doctor to practice his or her specialty and to pass the “board” examination for that specialty. Successfully completing a residency entitles a physician to sit for a specialty board and, if he or she passes, become “board certified.”
Beyond the residency, doctors wishing to “sub-specialize” can receive additional training in a “fellowship.” A fellowship is highly specific field of study. There are fellowships in sports medicine, hand surgery, hair transplantation, toxicology, invasive cardiology, etc. Fellowships are important because they allow physicians to focus their time exclusively on a concentrated field of medicine and typically teach physicians to perform a limited number of procedures very well. This is especially important in hair transplantation, which is often minimally covered or excluded altogether from residencies. Even plastic surgery and dermatology residencies do not generally require their surgeons to have performed or ever to have seen one hair transplantation.
At Ziering Medical, we believe that physicians who have dedicated a year of their lives to a fellowship focusing exclusively on hair transplantation (hair grafts) and hair loss will have a better understanding of the artistic and surgical intricacies of hair transplantation. As part of our commitment to quality, all of the surgeons at Ziering Medical have completed a residency and are board certified in that specialty. In addition, they have all completed a minimum one-year fellowship in hair transplantation surgery and are board certified or eligible to take the board exam offered by the American Board of Hair Restoration Surgery. Every Ziering Medical surgeon has a minimum of eight years of medical and surgical education with at least a one-year fellowship specifically in hair transplantation.
Dr. Craig Ziering is board certified in dermatology by the American Osteopathic Board of Dermatology, and in hair transplantation surgery by the American Board of Hair Restoration Surgery. In addition, he has over 15 years of hair transplantation surgery experience. He is widely acknowledged as one of the most innovative and accomplished hair transplantation and hair loss experts in Southern California, Nevada, Utah, or anywhere else in the United States.
Is a hair transplant or hair graft right for you? Ziering Medical could have the answer you’re looking for. Visit our private consultation form and get started toward a more confident, self-assured life.
Most certainly. The blades offer the Ziering Medical surgeon the ability to precisely locate and create each recipient site opening. They are custom designed with a diamond shaped tip to allow for better graft fit. This refined instrumentation allows for the recipient sites to be made as close together as possible which correlates with a greater density of transplanted hair. The use of these smaller blades also results in cumulatively less trauma to the scalp and individually faster site healing.
The Ziering Whorl is a hair growth classification scheme recognized and named by Dr. Ziering following a focused study to gain full understanding of hair growth and behavior with the crown region of the scalp. Ziering’s physicians are interested and well versed in the management of crown hair loss and when appropriate use the understanding of the whorl brought by Dr. Ziering’s research to recreate nature’s pattern in this area of the head.
Yes they can. We at Ziering Medical specialize in a whole variety of facial hair aesthetics including eyebrows, eyelashes, mustaches, sideburns, and goatees. However, one must keep in mind that the donor hair is still the posterior scalp hair. It will grow as scalp hair does which will make trimming/grooming of the transplanted hair essential.
Many hair transplant patients are maintaining a schedule of routine facial injections. If you are currently using Botox or plan to start using Botox to minimize wrinkles and fine lines on your forehead, we recommend that you have your injections done 2 weeks prior to your hair transplant or you wait until 2 weeks after your hair transplant procedure. If you are having an eyebrow transplant, then we recommend the same time frame for injections planned to reduce around your eyes. Facial fillers in the lower face are not affected by hair transplant surgery, so they may be scheduled at your convenience. However if you are having under eye fillers, it is best to wait to have those injections after your hair transplant procedure and not until any or all your post hair transplant swelling and bruising is completely gone, or you may have the injections 2 weeks prior to your hair transplant procedure.
For the first week following the procedure the transplanted zone displays small crusts associated with the creation of the receptor site incisions and a variable degree of erythema [redness] depending on one’s skin type. Swelling of the forehead is a potential consequence of a hair transplant; particularly one focused upon the hairline and frontal aspect of the head. By the time a week or so passes the transplanted patient’s appearance normalizes. The sutures placed inconspicuously in the donor region are removed on the 10th day following the transplant. The transplanted hair frequently responds to the act of relocation by entering the dormant or resting stage of the hair growth cycle. When a hair enters this stage the hair shaft breaks off and is shed leaving the follicle residing beneath the skin alive and well. From this resting follicle a new hair shaft will grow in 3 to 4 months. The hair then continues to participate in the natural cycle of hair growth for several years alternating with ‘rest periods’ of several months length.
Occasionally following a hair transplant the emerging hair exhibits characteristics dissimilar to one’s native hair e.g. excessive curl. It is felt that this uncommon and temporary phenomenon is related to collagen activity in the skin surrounding the grafted hair its impact on the hair’s attributes as the hair emerges from the skin’s surface. The usual outcome in this scenario is the normalization of hair characteristics over the ensuing twelve months. Dry hair is felt to be cause by excessively tight trimming of the follicular units during the graft preparation stage and the inadvertent removal of the sebaceous glands surrounding the hair follicle. These glands provide a lubricating action to the surface of the hair and skin and their absence can create dry hair. Proper attention to detail during the process of graft preparation eliminates this also temporary post-operative effect.
Every day following the procedure the transplanted grafts become more secure in the scalp. Graft attrition or loss should be only 1 %. Hair shedding is a different entity than graft loss and is expected following a transplant session. If a graft is lost it is almost invariable associated with some sort of trauma to the head and accompanied by bleeding.
Any medical treatment for hair loss carries with it some slight risk factors. Shock occurs in a very small percentage of recipients of hair transplantations. Shock can occur when placing grafted hair between growing hair. Trauma from the procedure can cause some additional hair shedding. The strong hairs will grow back, while the weak hairs that were destined to fall out may or may not return.
The medical term for ‘hair shock’ is telogen effluvium. This entity is an event in which a population of one’s native hairs synchronously enter the dormant or resting stage of the hair growth cycle and are shed. A number of situations can precipitate telogen effluvium inclusive of a hair transplant. The impact on one’s appearance if he or she experiences ‘hair shock’ is usually not cosmetically significant, though on occasion the temporary loss can present an additional styling challenge to someone already contending with less hair than they are comfortable with. All competent hair transplant surgeons are aware of this potential consequence of a hair transplant and attempt to minimize it’s occurrence through careful recipient site creation and avoidance of injuring the native hair in the region. Ziering Medical’s extremely small instrumentation further minimizes the risk of this event. The fate of a hair involved in ‘hair shock is related directly to its state of health. If the affected hair was genetically coded to live for an extended period of time then the hair will return as actively growing hair in about three month’s time. If conversely the involved hair was approaching the end of its natural life cycle, then the possibility exists that the transplant procedure may prematurely end this hair’s existence.
In general the higher the percentage of mininiaturized hair one has and the more rapid the pace of one’s hair loss, the greater the risk of telogen effluvium shedding from surgery. Patients with longstanding and stable patterns of hair loss are less likely to be affected by ‘hair shock’.
As soon as possible in most instances. If you are planning to have a hair restoration procedure within four to six weeks on your consultation, you can wait to begin it use after your transplant. If you plan to wait several months to years before having the procedure it should be started immediately as it is the long term continuous use of adjunctive medical therapy which optimizes results.
Yes there is a difference. GraftcyteTM contains a patented copper-peptide, tri-amino acid formula that accelerates the healing of the donor and recipient areas by about two to three days in comparison to the salt water soaks. We do recommend that it be purchased to help with the healing process.
You will bathe the next day and wash your hair at that time. We will give you specific instructions on the day of your procedure as to how to care for your hair in the post-operative period. In short, the transplanted zone is washed by gently pouring a mild shampoo and water mix over the head and similarly rinsing is accomplished by carefully hand pouring water over the transplanted zone. The remainder of your scalp inclusive of the sutured donor region can and should be washed in a normal fashion on a daily basis following the transplant. Hair can be either air dried, gently patted dry with a towel or dried with a hair dryer on a cool setting.
We recommend that you wait five to six weeks after the procedure before coloring or dying your hair. Hair can be colored within the week leading up to the procedure.
You can have your hair cut or styled one week after the sutures are removed from the donor area. The sutures are typically removed ten days following the transplant.
Ziering Medical will provide you with a complete list of all activities that should be avoided in the post-operative period. Strenuous physical activity inclusive of vigorous aerobic exercise and power weight training should not be performed until two weeks following the procedure. After the sutures are removed at ten days one can slowly begin to reintroduce an exercise regiment beginning with cardio and slowing adding back weight training. Early excessive movement and particularly stain on the healing donor wound can increase the likelihood of a widened donor scar. Ideally one should reduce their activity profile and ensure adequate rest during the week immediately following the surgery.
We recommend taking at least taking three days off from work following the procedure. Thereafter it becomes a question of one’s comfort level in terms of appearance as to the time frame of returning to the workplace. As residual erythema [ redness ] typically lingers for five or six days following the procedure, many individuals take off a full week from work. In instances where a hat can be worn, detectability is concealed immediately.
We instruct you to sleep in a reclined position at about a forty-five degree angle. If you have a recliner at home this is an ideal sleeping device for the first several nights following the procedure. Alternatively, utilizing two or three pillows in bed accomplishes the objective.
Education is a big part of the hair replacement process. That’s why we have compiled a list of common questions and answers for you to review in relation to hair transplants and hair loss. Our Southern California, Nevada and Utah offices feature knowledgeable, helpful staff who would be pleased to answer any other questions you might have. We want you to fully understand your hair replacement options and to feel comfortable when working with Dr. Ziering and the staff at Ziering Medical.
Take some time to read through these questions. If your hair loss questions aren’t answered here, please feel free to contact Ziering Medical for additional information. It would be our pleasure to help you better understand the details of hair replacement and the methods that would work best for your specific hair loss circumstances.