FAQs

HOW SHOULD I CHOOSE MY HAIR TRANSPLANT SURGEON?

Firstly, DO NOT base your decision on anything you read on the internet. The internet can be a wonderful source of information, but can also be very misleading and/or function as an advertising tool for a particular doctor. Ask your primary care doctor, dermatologist, plastic surgeon, hair stylist, and friends. Speak to people who have seen the actual results from the particular surgeon (and not just those specially chosen by the doctor as "good examples"). Go meet the hair transplant surgeon in consultation in person if at all possible - different doctors may have an approach or style that matches more or less closely to your needs. Ask to see photos of their work and ask how they are specifically trained in this field: hair transplant surgery requires very specialized training and is not "officially" part of most residency programs. A fellowship and/or American Board of Hair Restoration Certification are the best available means to ensure the doctor is qualified. This is a very important decision which will have permanent consequences for your life, so take time, meet several doctors for whom you received recommendations and meet more if necessary until you find the right match for you.

DOES THE HAIR TRANSPLANT ALWAYS "WORK"?

Yes. When a hair transplant is performed carefully and with attention to detail, the surgery increases the density of hair in the area treated. Hair is removed from the permanent donor area and moved to an area with hair loss. The transplanted hair will behave in this new region, as it would have in its original location. To be clear, this hair is "relatively permanent" in that it will gradually thin as a person ages, but will not disappear completely. Thus, the effects of the hair transplant are long lasting.

Of course, there are situations that can result in an unsuccessful transplant: poor planning by the surgeon with respect to the blood supply and density of sites, poor dissection technique by technicians, sub-optimal storage of the grafts outside the body and/or traumatic graft placement. Modern transplant surgery utilizes very small grafts, which are especially vulnerable. Therefore it is particulaly important to be certain that the surgeon performing the hair transplant is well-trained and has a similarly excellent staff of technicians, who have the training and time to prepare and place the grafts with the utmost care.

HOW MANY "GRAFTS" DO I NEED? WHAT ARE MEGASESSIONS?

More is not always better - and in fact it may sometimes be worse. It is natural for patients to want to have as many grafts transplanted in one surgery as possible, however it is important that the pros and cons be carefully weighed. For purposes of this discussion, megasession will be defined as a surgery in which more than 2800 FU are transplanted (the definition varies greatly within the field). A detailed discussion of this topic can be found in many articles, however a brief summary may help to clarify some of the issues. The advantages of megasessions potentially include 1) greater area of alopecia covered 2) possibly higher density achieved 3) fewer number of total surgeries. The disadvantages may include 1) larger strip harvest is more likely to lead to closure of the wound under tension and thus a wider donor area scar 2) greater time outside the body and hence potentially lower survival 3) a prolonged surgery and the concomittant exhaustion may increase error by the technicians or surgeon, leading again to decreased hair survival 4) greater injury to the blood supply with the large number of incisions in a relatively small area, once again threatening hair survival.

Each surgeon and each patient has to decide whether the potential risks of megasessions are worth the benefits. Dr. Robin Unger does not promise a certain number of grafts per surgery, rather an approximate number is estimated after assessing the density and laxity of the donor area and deciding upon the surgical plan for the recipient area. The grafts may include follicular units consisting of 1-5 hairs, or double follicular units containing 4-8 hairs in appropriate patients. Average surgeries in female patients consist of 1000-2000 FU, while male patients with their longer and denser donor areas average 1800-2200. Dr. Unger believes that the blood supply in the recipient area becomes a significant concern if greater than 3000 sites are created in one surgery: this corresponds to approximately 12 feet of incisions in a very concentrated area (presuming the sites are approximately 1mm size).

ARE WOMEN GOOD CANDIDATES FOR HAIR TRNASPLANT SURGERY?

Female hair transplantation is an excpetionally successful procedure if the treatment area is carefully chosen and the technique is meticulous. Approximately 40% of Dr. Robin Unger's practice consists of female patients - and the impact on their life is of great significance. Female hair loss is very distressing, regardless of the age at which it occurs, and unfortunately there are few options available that will actually re-grow hair. The hair transplant is performed in the area which will produce the greatest cosmetic benefit, and the grafts are placed between the pre-existing hairs. Great care is taken to protect this native hair and in a recent survey, her patients reported that the increase in density met or exceeded their expectations in 97% after one surgery. For more information please see the description under general procedural details

WHAT CAN BE DONE TO MINIMIZE ANY SCAR IN THE DONOR AREA?

When performing a strip harvest, the surgeon needs to be certain to close without tension, bring the edges of skin together so they perfectly meet, and instruct the patient regarding post-operative care. Dr. Unger uses both "standard" and trichophytic closures. The latter provides the least visible scar, however there are some patients in whom a standard closure is preferable in the first surgeries. The scars are usually 1mm or less. FUE is an alternative approach discussed fully in the section on the donor harvest.

WHEN IS THE RIGHT TIME TO START WITH HAIR TRANSPLANT SURGERY?

Anwers to this question vary significantly between surgeons. Dr. Unger believes the patient is usually the best one to decide, and does not adhere to any doctrine limiting the age or stage of hair loss. The amount of existing hair is not important provided the hair transplant surgeon has the skill necessary to prevent permanent injury to this hair. Some individuals want to be very pro-active and either have an aversion to or have failed medical therapy: they may still have a significant amount of native hair but never want to go through a "bald" period. The patient may have hair loss unnoticeable except to themselves, or may have severe loss which has bothered them for quite a while. Other patients come to the decision to have surgery after all other attempts to address their hair loss have failed. The important caveat to clarify is that the surgeon must have a surgical plan which addresses current and future concerns - this is especially important when young patients are treated; the doctor needs to help the patient take a long-term view of their hair loss.

HOW MUCH "RECOVERY" TIME DOES THE PATIENT NEED TO PLAN FOR?

Patients having this surgery for the first time should ideally take 7-10 days away from work and social activities if they want to keep the procedure confidential. In most cases, this amount of time is actually more than necessary. However, if you have planned to return to work after 3-4 days and you happen to be one of the patients with more swelling or bruising than the average patient, it can become a very akward situation. Usually, the first surgery is a good indicator of future healing, thus your schedule can be adjusted for subsequent surgeries. Obviously, patients with more pre-existing hair and those working posterior to the frontal hair line will have an easier time camouflaging the area during the post-operative period. A PDF of Dr. Unger's post-operative directions is available on this website, and it may help answer further questions (although these are not uniformly followed by all doctors in the field).

HOW MANY SURGERIES WILL BE REQUIRED?

This is one of the questions which can only be answered after a thorough examination with a hair restoration surgeon. The number of surgeries that will be required over the patient's lifetime depends upon the age of onset of hair loss, the family history, and any underlying conditions. With respect to male patients, it also depends upon the surgeon philosophy with respect to treating only current areas of hair loss versus treatment of future areas of loss simultaneously. Therefore, one surgeon may say only one surgery is necessary: meaning the central region of frontal and midscalp hair loss can be treated in one surgery. In the future, that patient will undoubtably require a second surgery to treat areas which will develop with age. The benefit of this approach is that the patient's immediate concerns are addressed. The drawback is that if the patient is unable to return in a timely fashion to treat evolving areas of loss, he will be left with a pattern of distribution of hair that does not occur in nature. Alternatively, a hair restoration surgeon may believe it preferable to complete the frontal area (current and future areas of hair loss) and subsequently repeat a similar process in the midscalp. This approach is beneficial because the patient is never left with an unnatural distribution of hair, and if for some reason is unable to return, he will not have a "strip" of hair down the middle with bald alleys on either side.

The approach to female hair transplanting is significantly different. The goal is to thicken the most cosmetically significant areas of hair loss in the first surgery. In general, one surgery is usually sufficient to achieve this, provided the surgeon carefully chooses this area and transplants a sufficient amount of hair without injuring the pre-existing hair. Occasionally, there are two very distinct areas of thinning that concern the patien (such as the frontal region and the crown). These patients will then require two surgeries. The transplanted hair lasts much longer than the original hair in the treated region. As more of the pre-existing hair is lost gradually over time, the patient may want a subsequent procedure in the future. The vast majority of Dr. Unger's female patients have had only one or two surgeries to achieve (or exceed) the results they desired.