Hair Loss Treatments

Overview: Turning Back The Clock

Hair transplants have been performed for more than 50 years and started a revolution; the effective treatment of hair loss. Naturalness improved with the development of grafts as small as a single hair, and today’s results are undetectable. Beginning with his own first hair transplant, more than 10 years ago, Dr. Elliott has seen tremendous evolution in his own techniques and in those of his colleagues.

Follicular Unit Grafts containing 1-4 hairs and dissected under the microscope, have given us the ability to deliver totally natural results. The next important development has been the technology of Multi-follicular Unit Grafts, which maximize density and volume. Dr. Elliott is a recognized expert with these grafts and has taught his techniques to other surgeons worldwide. Natural results. Fewer sessions. Greater density.

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How Do Transplants Work?

How do transplants work?

Hair follicles are taken from the permanent areas at the sides and back and placed into micro incisions in the areas of loss. These grafted follicles heal into place and then produce the same hair that you have at the sides and back. The hair is real, it is your own and it grows and looks like your other hair (because it really is your hair!).

How do I know if I am a candidate?

The most important factors are your goals. If they are realistic, transplants are an option for you. Since this is only superficial skin surgery, there are very few medical conditions that would make this procedure inadvisable. Dr. Elliott will review these with you.

Do I have to take medications to avoid graft rejection?

No, there is never rejection because the follicles are your body’s own tissue. They have just been moved to a new location on your scalp.

Hair transplants are permanent, right?

They are genetically programmed to last as long as they would at the back and sides. In typical AGA, this is life-long. Your surgeon must have the experience to judge where the permanent hair lies.

Will the hair be the same as my other hair?

Feel the hair at the back of your head. All of the characteristics of the hair, such as growth rate, texture, curl, when it will grey, etc., stay the same in its new location.

What if someone pulls out one of my transplanted hairs?

The follicle is still there and it will grow a new hair.

What can I do about my receding hairline?

Treatment with medication alone will not regrow your hairline. Hair transplantation is necessary. Transplants can restore a natural, more youthful hairline and put a stop to the appearance change that ongoing recession gives your face.

What can I do about a thin or bald spot at the back?

Hair transplantation is the most reliable route to restore the hair. Medications are important to stop further loss and may re-grow some hair or shrink the diameter of the bald spot in some patients.

Will the grafts grow anywhere you put them?

Yes, they will. Hair transplants may be used to treat the entire top area in AGA, and even into scars from injury or past surgery. It is also possible to graft hair to any other part of the body, such as the chest, beard, eyebrows and eyelashes.

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Do Hair Transplants Hurt?

Does it hurt?

Hair transplants should never be painful, but unfortunately, many are. Much of this depends on the doctor doing the procedure and each individual patient’s needs. If you have had a painful experience in the past, know that it can be different now.

It must hurt some, right?

Dr. Elliott knows how it feels to be the patient; he has had this done twice. The first one was a bit painful and he has never forgotten. He uses sedation, gentle technique and specially formulated anesthetic medications to make it painless. He personally makes sure you feel nothing during your transplant. His patients would all tell you that they felt no pain at all through the surgery.

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Hair Transplant Cost & Procedure

The costs range depending on the size of the area to be treated and technique used. FUT and Combination Grafting procedure costs range from $4000 to $10,500, depending on the size of the area to be grafted. Typical ranges for the following areas: corners of hairline $4000-$5500, frontal hairline zone $5000-$6500, front or back half $6000-$8500, entire top $8000-$10500. FUE transplants are charged on a per graft basis and can also be combined with FUT and MFUG methods. Book a free consult for an evaluation.

Is the cost of hair transplant procedures a Tax Deductible Medical Expense?

In Canada, elective medical procedures, including hair transplant surgery currently qualify as a medical expense under the Income Tax Act. To learn more, please consult with your accountant as amounts will vary according to income and personal status. (Residents from the U.S. and other Countries should consult their Tax Advisor as regulations do vary.)

Can women have hair transplants?

Absolutely. The surgery overall is similar, but designed differently due to the different pattern of loss in women. Your individual goals and options should be discussed with your hair loss treatment specialist.

But I don’t like the idea of having cosmetic surgery.

Some people don’t, but isn’t this different? Stopping your hair loss with medication is certainly different than having a nose job, and the aim of transplants is to restore what nature has taken away, not to be something you never were. The bottom line is that you won’t look fake or unnatural. This is you with more hair.

Can’t I just have a hair transplant and be done?

We would all like to just do one thing and never have to worry about hair loss again. It is important to remember that transplantation does not create new hair. It re-distributes AGA- resistant hair from the back and sides to the areas of loss. It does not slow or stop future loss in the non-transplanted hair. The hair that you have in future will always be the remaining original hair plus the transplanted hair.

Will I need more than one procedure?

Some patients will have one procedure and reach their goals. For most, future procedures will be needed for the best long-term result, replacing hair as more is lost and achieving more volume. Everyone is different, so tell your doctor what you want and together make a plan.

Should I have transplants now, or wait?

The right answer is different for everyone. What is urgent is stopping your loss with medical treatment. Chose a time to have hair transplants that is right for you. The downside of waiting is that you suffer through more hair loss before you do something permanent. Earlier transplantation means you never have to go bald.

What can I do if I can’t afford a transplant today?

With medication, you can slow or stop your hair loss. Then, plan for a transplant when it is right for you. At least you aren’t getting balder in the meantime.

How do I find the right hair transplant surgeon?

Although there are many physicians worldwide who perform a few hair transplants, only a fraction of them specialize in this procedure and in the medical treatment of hair loss. Choose someone you can trust to do a great job for you. Meet some of their patients. This is not an emergency. You can take the time to consult with different doctors and choose the one you feel is right for you. The International Society of Hair Restoration Surgery (ISHRS) is the largest educational organization of hair restoration physicians in the world. It is dedicated to physician and public education and can be a valuable resource for you and help you find a doctor.

Isn’t this a standard procedure? Shouldn’t it be the same wherever I have it done?

There are big differences. Many would say that this type of surgery is 10% surgical technique and 90% esthetic skill and judgment. You must see actual results before you decide. It’s the closest you can get to a test drive. Imagine two restaurants as an analogy. Both can get the same equipment, supplies, and produce. The food they serve should be exactly the same, right? Wrong. The skill, experience and effort put in by the people who make and serve the food are the difference. How good are they? How much do they care about what they do? A meal lasts for a moment in time. Your hair and its appearance are for life. Make the right decision.

What about the groups and companies that do hair transplants?

There are many groups that do excellent work. Remember that the doctor and medical team play a critical role in the results you will achieve. Know exactly who will be working on you.

What about training and qualifications?

Hair transplantation worldwide is done by physicians from several different medical backgrounds. Ask about attendance at conferences and training courses. The largest conference on hair restoration is held yearly by the International Society of Hair Restoration (ISHRS). Board Certification is offered through the American Board of Hair Restoration Surgery (ABHRS), an extra step that some physicians will achieve. Dr. Elliott is one of approximately 100 doctors world-wide that are board certified by the ABHRS. Click here to find out more about the ABHRS and what certification means.

How do I know what type of procedure is best for me?

There are many different grafting methods that can be used. What is most important is finding the right doctor, realizing that each will have a different approach, experience and skill level. Talk about the different procedure options. See some of that doctors patients. See their hair. Evaluate the results with your own eyes. Once you have looked around, you’ll know the difference between good and great.

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Procedure Options: Then and Now

Hair surgery, like any technology, has evolved dramatically from its origins 50 years ago. For the first three decades, large plugs were the only option. The late 1970’s brought about the scalp reduction, which faded from prominence by the early 1990’s. It still remains an important skill in repair surgery. It is during the last 15 years, though that perhaps the most significant evolution has occurred: the development of small, natural graft technology. Micro/Minigrafting was the first step forward from plugs. It uses single hair grafts (micrografts) and minigrafts, which were a fraction of the size of the old 30 hair plugs. The next technical development was follicular unit grafting, and then more recently multi-follicular-unit grafting.

What has changed in hair loss treatment compared to the past?

Better surgery and better medication. Hair restoration surgery has evolved the ability to give results that are natural, but also thicker, than ever before. This means that not only do you look like you never had transplants; you can also get a thicker result faster. With effective medications, most patients can also stop getting balder.

What are “plugs”?

When hair transplants were first done 15 or more years ago, large cylinder shaped grafts with up to 30 hairs in them were taken from the donor scalp and put into round holes in the thinning areas. When they grew, they gave a coarser, less natural look than the original hair. Modern transplants use grafts as small as a single hair and duplicate the appearance of the un-grafted hair.

What is a scalp reduction (a.k.a. alopecia reduction)?

This is a procedure where an area on the top of the scalp is removed and the scalp from the sides pulled up and closed together. Originally developed to remove areas that were bald or thin, it has been largely replaced by transplants. It remains an important surgical skill in some patients, particularly those needing repair surgery like scar removal or revision.

What is a “flap”?

It is a surgical procedure where a long strip or flap of hair-bearing scalp is raised up from the back and sides of the donor area, turned, and surgically put down into the area of loss, usually the hairline. The flap remains attached to the original scalp in the temple so it continues to receive blood flow. There are only a very small number of men who would want this procedure or are good candidates for it. Dr. Elliott does not perform flap surgery, but has helped many patients who have needed correction of some aspect of the flap.

We have talked about scalp reduction, and I realize that transplants are usually the first option. Are there different types?

Yes, there are. The two major surgical approaches in modern hair restoration are follicular unit transplants (FUT) and FUT in combination with multi-follicular-unit grafting (MFUG). Each has advantages and disadvantages and some patients will be a better candidate for one approach or the other. In addition, there is now another option for donor harvesting; Follicular Unit Extraction (FUE), for situations where strip harvesting is not possible or desired. Dr. Elliott is expert in all these approaches and will be able to advise you on which best suits your goals and hair and skin type.

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What is follicular unit transplantation (FUT)?

It is a transplant technique using grafts containing 1-4 hair groupings. It is the most common technique in modern hair restoration. Because the grafts are small and average 2.1-2.3 hairs, large numbers of grafts are needed to move the thousands of hair that most patients want. It is one of the fundamental procedures in modern hair restoration. Like all surgery, results vary depending on the skill of the medical team.

What is the difference between FUT and MFUG?

FUT uses grafts containing 1-4 hairs. Hair grows in these groupings in the scalp and when separated, become follicular unit grafts. Multi-follicular-unit grafts (MFUG) combine 2 or 3 of the groupings into each graft, still with a natural configuration. In some patients this allows more hair to be transplanted into an area in each procedure and reduces cost. MFUGs are never used for some areas, like the hairline, and are always combined with FUT. Like all surgery, results vary depending on the skill of the medical team. MFUG transplanting is technically difficult, and not performed by most transplant physicians. Dr. Elliott is expert in both methods and can combine the two, or use FUT only to get you where you need to go.

I only want what will look natural.

Of course in expert hands, your hair transplant procedure will give you natural results.

If FUT is the most popular, why bother with MFUG?

To get more coverage and hair volume. When you are considering hair transplants, Dr. Elliott recommends keeping two goals in mind: naturalness and coverage. Unnatural transplants can be worse than being bald and are why Dr. Elliott spends so much time and effort on repair for patients who are in this situation. Coverage means having enough hair and this is really a matter of how much hair gets moved into an area. The ideal is a natural result with great coverage. For many patients, multi-unit grafting moves more hair per procedure, giving increased coverage, without losing the natural appearance. The key is realizing which procedure design is best for each patient and their goals.

Can you get good coverage with FUT?

Of course, but because the grafts each contain less hair, it takes a lot more grafts to move any amount of hair. Decide how much hair you need and which approach will work for you. Dr. Elliott commonly transplants 6000 or more hairs per procedure with MFUG. This would require nearly 3000 follicular units. FUT procedures of 3000 grafts or more are available, but at increased cost relative to combination grafting procedures. Patients who are good candidates for combination grafting may choose to use some MFUGs as part of their plan.

Most of the reading and research I have done suggests that FUT is the way to go.

It is the most common method in use today and is the most heavily advertised. It is a wonderful technique. Just realize that there are advantages and disadvantages to each approach. Dr. Elliott can do either procedure for you or a combination of both. You owe yourself the time to see someone who has had MFUG and FUT transplantation from an expert and make the comparison. Decide for yourself. That’s the great thing about having a choice.

Sounds a little confusing. How do I decide what type of procedure is right for me?

You don’t have to decide how to do the surgery. That’s your doctors job. Most doctors will not offer both these options, but you should do the “due diligence”. Your job is to find the right doctor for you. Talk about this together. Ask questions and listen to the pros and cons of each procedure.

Do MFUGs really look good?

Meet some patients and see how their hair looks. You be the judge. Dr. Elliott has lectured internationally to hair surgeons about MFUG and has been invited to bring his patients to each ISHRS (International Society of Hair Restoration Surgery) conference since 2001 as examples of the possibilities of this technique.

What is new in Dr. Elliott’s practice?

His unique approach to MFUG has attracted attention from the ISHRS (International Society of Hair Restoration Surgery) and the ESHRS (European Society of Hair Restoration Surgery) and he has been an invited lecturer at the annual scientific conferences of each. Now, in 2004, Dr. Elliott is the only hair restoration physician in Alberta to offer both Microscopic FUT and MFUG. His experience in these two procedures has resulted in the new “one surgery, two pass” innovation. In this new approach, proven FUT and MFUG technology is combined. Dr. Elliott selects individual areas to graft with both MFUGs and FUT, combining the advantages of each. This adds yet another dimension to Dr. Elliott’s practice and another choice for the patient.

The Trichophytic donor closure represents a major improvement in donor scar visibility. Already scars have been typically difficult to even find, but with this new innovation, in most patients they are nearly invisible.

FUE has added an entirely new dimension to Dr. Elliott’s practice, making transplants reality for many patients who were not candidates in the past.

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Follicular Unit Extraction

What is FUE?

FUE (follicular unit extraction) is a new technique for harvesting follicular unit grafts from the scalp, or other body areas for use in hair transplantation. It has been performed in hair transplantation for more than five years. Recent improvements in instrumentation have enabled improvement in the quality of the grafts produced to the extent that they are now comparable with microscopically dissected follicular unit grafts.

What makes FUE different from other hair transplant techniques?

The difference lies in the matter of graft harvesting. In FUE, there is no linear excision of skin. No scalpel is used and there are no stitches. The follicles are “extracted”, rather than cut, from the skin. The skin heals quickly in the space where the follicles were, without visible scarring, and the grafts are transplanted in the usual manner to the thinning areas on top.

What are the advantages of FUE?

Some patients prefer not to choose strip excision, out of concerns of discomfort, the appearance of the linear scar, the desire to avoid stitches, or the desire to wear a very short hairstyle in future (where a linear donor scar could potentially be visible). Some patients just don’t like the idea of an incision in their skin and opt for FUE instead. In addition, there are some patients with quite tight scalps, in who strip excision possibilities are limited due to the scalp’s remaining ability to stretch. FUE is not dependant on scalp stretch, and so is just as feasible in those with tight scalps.

Patients who have had this done report no pain in the donor area and quicker healing.

What new possibilities does this technique offer?

Any hair on the body can be transplanted to the scalp to thicken what is already there. With strip harvesting, there is always a linear scar remaining making most non-scalp donor areas impossible to conceal. Harvesting hair with a strip from the center of the chest, as an example, leaves a scar similar to that of coronary bypass surgery. FUT leaves small micro-dot scars, rather than a visible linear scar, and has become the preferred technique for body hair transplants.

Some situations require only a very small number of grafts and again, FUE is often preferred, rather than a strip.

Is FUT “no-scar” hair transplant surgery?

No, it isn’t. Any time the skin is cut, it’s only way to heal is through the formation of a scar. FUT leaves individual “micro-dot” scars that are undetectable in the vast majority of patients, but they are still scars. It’s just that they are less noticeable to the eye than a scar that is a line. FUE scars in most patients are tough to even find.

What is the scarring like from strip harvesting?

This has recently gone through an evolution with the development of the Trichophytic closure technique. In the hands of an experienced hair surgeon, traditional strip harvesting will leave a 1-2mm wide scar in 90-95% of patients. Trichophytic closure produces an even narrower scar with hairs that actually grow through the scar, further hiding it. In practical terms, this means that in Dr. Elliott’s experience, 95% of patients will never be bothered by the appearance of their donor scar, and need not choose FUE based on donor scar appearance. These patients would tell you that their hair stylist has trouble finding it.

What is the disadvantage of FUE?

This procedure has been in use in hair transplantation for several years now. When first conceived, the rate of damage to the follicles during the extraction process was unacceptably high, in Dr. Elliott’s opinion. Further development in technique and instrumentation followed and the quality of the grafts improved to become comparable to what can be achieved through modern microscopic methods.

Once this evolution occurred, Dr. Elliott was confident in offering this method to his patients. Currently, the disadvantages of FUE are time and cost. This process is 3 or 4 times more time-consuming than FUT (follicular unit transplantation) with strip harvesting. In FUT, the strip is dissected into grafts by skilled technicians under the microscope. In FUE each graft is extracted by Dr. Elliott one at a time, but this is preferred by some patients. This means that to move the same number of grafts takes much longer. This raises the costs involved when compared to strip harvesting.

Dr. Elliott will explain the advantages and disadvantages of FUT, combination grafting with MUGs and FUs, and FUE relative to your situation, goals and concerns. You can choose the method that you prefer.

Why did Dr. Elliott decide to offer this procedure in his practice if it is so time consuming?

Dr. Elliott is committed to excellence in all aspects of hair loss treatment. He is an invited speaker at international hair surgery conferences and a world-recognized master of Multi-Unit Grafting. He believes that there is a solution to any hair loss problem and saw the advantages of FUE for some problems and some patients. When he was satisfied that the technique had evolved to be able to provide these advantages without sacrificing graft quality, it had passed his personal test.

Dr. Elliott knows that for some patients, strip harvesting is not technically feasible, or unappealing. FUE offers these patients the opportunity to deal with their hair loss through transplantation and enhance their personal appearance and confidence.

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What Will the Procedure Be Like?

The hair transplant procedure is done in the office surgical room under local anesthetic. You don’t need to be “put under” with a general anaesthetic. This means that you are awake, but the scalp involved is totally numb. You don’t feel any part of the surgery. Dr. Elliott gives each patient a sedative medication before the surgery, so you will probably sleep for the first hour, or so. The area that receives the grafts is called the recipient area and the donor area is where the follicles are taken from. Both are planned out in advance. The donor area is removed and the scalp on both sides closed back together with stitches. The hair at the back of your head covers the stitches, so nobody will ever see them.

While the doctor makes the tiny incisions, one for each graft, in the recipient area the donor tissue is dissected into grafts according to the surgical plan. Dr. Elliott makes all of the incisions and personally monitors all aspects of the procedure. The grafts are then implanted one at a time. Once all the grafts are in place, the surgical team double-checks everything until they are totally satisfied. Your hair is cleansed, dried and styled. No bandage is needed and you can leave wearing a hat. Dr. Elliott then reviews your procedure with you, explains post-operative instructions, gives you medications to take home in case you have discomfort and his phone number in case you have questions. He also takes your number and calls you that evening.

What do I do this whole time?

The surgical chair is like a Dentist’s chair. It’s comfortable. Most patients nap, watch a movie or listen to music. If you are hungry or thirsty, you can eat and drink. If you need to get up and stretch, you can. If you have questions, they answer them. In short, the team does whatever they need to do to ensure you comfort.

Do you have to shave my head?

No. Although some clinics insist on this, Dr. Elliott and his team will work through existing hair to place the grafts. This makes it much easier to conceal afterwards.

Am I going to have pain that night?

Dr. Elliott’s patients will tell you they either had none, or just had to take a little pain medication to stay comfortable. Remember, Dr. Elliott has had this done. He does everything that can be done to prevent pain, both during the surgery and with the special long-acting anaesthetics that he uses. If you have pain, you’ve got pills to take for it. If you still have a problem, he is always available.

What happens the next day?

The following day, you come back to the office and the team washes your hair, and the grafted area. Dr. Elliott checks everything and answers any questions you may have. You are shown what to do and what not to do to take care of everything.

What happens then?

During the first week, you may notice that some of the grafts form a slight “crust” on the surface. This is normal and these will gradually come off as you wash your hair. Some of the crusts will have a couple of short pieces of hair in them. This is not the graft being lost, simply the release of the little hair fibre that the graft contained.

VWhat about swelling in the forehead?

This happens sometimes after the procedure starting at 36-48 hours and lasting 2-4 days. It does not interfere with the success of your surgery, or how your hair will look. Through technical evolution, Dr. Elliott has eliminated bruising or blackening around the eyes after the procedure.

What happens to the existing hair after the grafts are put into an area?

In the long term, it behaves just as it would if you not had transplants. Hopefully, you are using medical treatment so you won’t lose it. It is important that you realize that you may shed some of this hair in the first 3-4 weeks after the transplant. This is because some of those follicles will go into the telogen resting phase and shed their hairs. That hair will re-grow after a month or two unless it was almost shut down from AGA. Yet another reason to take Finasteride.

How can I minimize this shedding?

Start Finasteride, ideally in combination with Minoxidil, at least a month prior to your transplant. The hair most vulnerable to shedding is hair that is withering from AGA. Get it into better shape before your transplant with medical treatment.

When does the hair start to grow?

The grafted follicles shed their hairs and rest for a few weeks. At 12-16 weeks after the transplant, the first growth appears. This gradually thickens over the next 4-6 months. This means a gradual improvement in your hair, rather than something everyone will notice.

How do I know everything is fine afterwards?

Your follow-up appointments are made for 8 days (stitch removal), 3 months, 7 months and one year. At each of these visits, Dr. Elliott checks on your hair and takes digital photos to track your progress. He personally monitors the results of each surgery and each patient’s satisfaction. Anytime you have questions, you can call or see Dr. Elliott.

What about donor area scars?

Skilled surgeons know how to minimize scars from surgery. The donor scar in skilled hands will be a line 1-2mm wide in 95% of patients. The Trichophytic closure also causes hair to grow right through the scar, making it invisible in most patients. These patients find they can cut their hair as short as they want and still cover the scar. Five percent of patients will form a slightly wider scar due to the nature of their skin. This does not mean they can’t have transplants, just that they may need hair length of 1-2 inches in the donor area. With FUE, the scars are multiple micro-dot scars that are not visible.

What about scars where the grafts are inserted?

If the surgery is done expertly, there are no visible scars where the grafts are put. The scalp could be shaved and nothing seen.

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Questions You Could (and Should) Ask

It is not easy to be a patient and trust someone to do this for you. Dr. Elliott understands. He has been a patient and had transplants too.

How did you learn to do this procedure?

What has the doctor done to keep up-to-date?

How much experience do you have?

What can I expect as a patient?

What about attending hair surgery conferences?

These conferences are an important way to continually improve.

Do you teach others these techniques?

Doctors who are leaders in the field will be asked to teach others.

Do you write medical articles on hair surgery?

How much of my surgery will be done by assistants and how much by the doctor?

Most patients prefer to have the doctor there for the whole surgery, rather than just part of it.

What priority do you place on stopping my hair loss with medication?

We have discussed the importance of this.

Is hair loss a small or large part of your practice?

As in most things in life, you get better if you devote more of your time and energy to one area.

Can I see before/after photos from the top view?

This view is the one that shows how much coverage has been achieved and should always be available.

Who is the Doctor represented by these before and after photos?

It is important to know who created the results that are being presented to you.

What are the risks or complications of doing this?

Be fully informed. Complications are less common in experienced, skilled hands, but are still a possibility.

What happens if I have a problem or questions?

What about follow-up after the surgery?

How many procedures to reach my goals?

What will you do for me so this doesn’t hurt?

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Surgical Complications

Complications can occur after any form of surgery, though in hair transplantation they are fewer and less serious than other forms of esthetic surgery. Dr. Elliott believes that you should be aware of the possibilities, but also that you can help minimize your risk by choosing a skilled doctor and being an active participant in your care.

The reality is that in expert hands, complications are very rare, and can be treated. Meticulous attention to detail and skill make a difference. Your choice of doctor makes a difference.

Infection:The risk of a minor infection is 1:200. Dr. Elliott has never seen a serious infection in any of his patients. Treatment is with antibiotics.

Problem donor scarring: This was more common with older surgical techniques. Today this is rarely seen in skilled surgical hands. The main reasons are over-aggressive donor tissue removal or suturing the scalp too tightly. Skilled and experienced hair surgeons can explain how to avoid this. Treatment is by scar revision, or grafting into the scar.

Recipient area scars that are visible: Common in the past, the techniques now exist to avoid this and depend on the skill and experience of the surgeon. Grafts placed too deeply in the scalp may form “pitting”, where the hair exists out of a depressed “pit” in the scalp, rather than from smooth scalp. Dr. Elliott will explain how this is avoided and has techniques to correct this if you have experienced this with procedures done elsewhere.

Donor area numbness above the scar: This is normal for a couple weeks after the surgery, but if the nerve under the scalp is cut during surgery it will be long lasting or permanent. This will not interfere with graft growth but can be avoided through specific surgical technique. Dr. Elliott endured numbness on the back of his head for a year after his first transplant. He then developed specific techniques to preserve these nerves. The risk in his practice is approximately 1 in 500 patients. Leaving the nerve intact also means less pain.

Ingrown hairs: These are like any ingrown hair on the scalp and are essentially a pimple. You may get a few when the grafts start growing at 3 months. They go away just like a pimple and don’t harm the hair.

Unnatural hair direction or growth: This is controlled by the surgeon when the tiny incisions are made and the grafts implanted. Problems are avoided by having the necessary expertise and creative ability. As in anything creative, skills vary.

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Hair Repair – Correcting Old Problems, Avoiding New Ones

What makes a transplant look unnatural?

This can be due to a variety of problems. A hairline may be poorly designed, placed too low or too high, or grafts that are too large and catch the eye. The list goes on and on. If people notice something, it’s not completely natural. Skill and attention to detail create something that will go unnoticed by others, but that you will value for a lifetime.

Why should this ever happen?

Hair restoration surgery takes a lot of skill, judgment, and attention to detail. In the case of plugs from years past, that was simply the technology of the day. Today we have the ability to produce natural results, but the surgeon must have those skills. Find a skilled surgeon who uses advanced techniques and rest assured. You will get a great result.

Can an un-natural transplant be fixed?

Yes! An experienced hair surgeon with a creative approach and a broad range of surgical techniques will be able to repair and improve nearly anything. Dr. Elliott believes there is a solution to any problem. This is why 30% of the patients who come to see him are seeking to improve results from surgery done elsewhere. Dr. Elliott is the creator, editor and contributing author to the column “Hair Repair” in Hair Transplant Forum International (the official publication of the ISHRS ). This column deals with exactly these sorts of problems. He has given lectures to doctors from all over the world about these techniques.

Transplants are permanent. If they look unnatural, how can anything be done?

This takes special surgical and creative skill. Grafts must sometimes be removed and at other times can be “blended in” by placing micrografts around them. If grafts need to be removed, the follicles can be re-transplanted back into more suitable areas. Tell your hair surgeon what bothers you about the appearance of the old transplants. A surgeon with the right set of skills and experience will understand and know what to do.

How do you go about fixing this sort of problem?

The first step is to explain to Dr. Elliott what you see as the problem. For example, “my hairline looks unnatural and catches people’s eye”. Dr. Elliott will explain where the problems lie and what the choices are to solve them. Creativity and advanced surgical skills are needed here.

What corrective techniques does Dr. Elliott perform?

In the last 8 years, Dr. Elliott has developed many surgical skills needed to fix any problem. Hairline re-contouring, graft removal and re-transplantation, softening techniques, scar revision, and frontal and lateral brow lifts are all part of his practice.

My hairline is all plugs from 15 years ago. What can I do?

First of all, know that you are not alone. Like most experienced hair surgeons, Dr. Elliott has seen this many times. Many men in this situation have been stuck with wearing a hat or hairpiece to hide these grafts. Others are okay with their hair combed forward, until the wind lifts it up and the plugs show. After such a bad experience in the past, it is difficult to believe that there is hope. There is. Dr. Elliott believes any problem can be improved and will show you how it can be done with todays technology.

What about transplants that look natural, but are just too thin and sparse?

Natural but thin and sparse is what we were all trying to get away from by having transplants in the first place. Remember the two goals: naturalness AND coverage. Bald is natural but without coverage. Hair pieces give 100% coverage, but aren’t natural. Neither one is what you want. You should know before you start what it is going to take. In Dr. Elliott’s experience, restoring the front (what you see in the mirror) ideally takes 8,000-12,000 hairs (depending on the person). If you are starting from bald and have a session of 1500 follicular units, you would get about 3,300 hairs. That means one session with FUT will not be enough for most people. You will never wish you had less hair, but this would sure leave you wishing for more.

How do I avoid these problems?

You need a good doctor with the skills to do the surgery, but you also need accurate information about your options and what is involved in achieving your goals. Find someone who will help you in the long run. Hair loss is a long-term problem, isn’t it?

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Dr. Vance Elliot