Thinning Hair

Dear Mark - From your photos, you appear to be an excellent candidate for a hair transplant procedure - well defined hair loss pattern, nice colored and good density donor hair, and you are older than 30 years old. My recommendation would a procedure of 1900 to 2200 or so grafts to work primarily in the frontal half of the scalp, reinforcing the receded and thinning hairline, filling in the frontotemporal recessions and anterior central scalp to significantly increase density, and if desired, placing an additional 500 or so grafts (assuming they are available in the donor area) to provide some coverage in the crown. For the back half of the scalp, including the crown, I would suggest you consider going on Propecia to slow down or stop the progression of hair loss.

Posted by Jeffrey Epstein, MD, FACS

A variety of specialists perform hair transplantation - for most doctors, it represents only a portion of their practice, not the majority.  With the demands of today’s most modern techniques - assuming you are seeking the most natural appearing results - it requires a full or near full-devotion to performing hair transplants. This means typically that the doctor performs at least 3 to 5 of these procedures every week, and has a full time staff to assist him.
As far as the type of specialty the doctor has - usually dermatologists are well versed in the basic techniques, while plastic surgeons who do specialize in this procedure can be expected to bring a more aesthetic approach, given their years of experience with cosmetic surgery.
The most important criteria, however, is to find a doctor whose work looks natural. You should be able to view tens, if not hundreds, of the doctor’s own before and after photos, with results that you would be proud to have as your own. For most of my patients, the internet is the best referral source - not only can the doctor’s own website be viewed, but many patients share their experiences and photos on one of several community websites that contain forums.

Absolutely - your hair can be dyed as soon as 3 weeks after your procedure. Remember, once performed, your hairs will continue to grow just like your own original hairs, and can be treated in whatever way you wish.

Please feel free to send some photos for me to evaluate, and I welcome any questions you may have.

Posted by Jeffrey S. Epstein, MD, FACS

Up until the early to mid 1990s, scalp flaps, when performed properly by qualified surgeons, were reasonable procedures to perform on select individuals - given the less than perfect aesthetic results of micro/minigrafting procedures. Personally, I stopped performing these complex surgical procedures in 1995, after limiting them to only select patients.
Today, it is possible to significantly address and repair the major aesthetic problems that result from scalp flaps. The abnormally solid hairline can be softened. The donor site scarring can be repaired with grafting and/or with scar repairs. The rounded off frontotemporal recessions can be made more receded. As a surgeon who was trained in this procedure, I am able to understand the  dynamics of these surgeries, and repair them to their greatest degree.

Posted by Jeffrey S. Epstein, MD, FACS

Absolutely - your hair can be dyed as soon as 3 weeks after your procedure. Remember, once performed, your hairs will continue to grow just like your own original hairs, and can be treated in whatever way you wish.

Please feel free to send some photos for me to evaluate, and I welcome any questions you may have.

Posted by Jeffrey S. Epstein, MD, FACS

Yes, it can, to some degree, but most effectively if your donor area (back of the scalp) is somewhat thicker in density and the transplanted hairs are concentrated into certain areas - most commonly the frontal region and partline - to provide the most cosmetic benefit.
I see many female patients who have been told by other hair transplant surgeons that nothing can be done for them, yet in many of these cases the reality is that a procedure can improve their hair loss situation - perhaps not as dramatically as they would want, but it is a definite improvement.

Posted by Jeffrey S. Epstein, MD, FACS

Yes, it can, to some degree, but most effectively if your donor area (back of the scalp) is somewhat thicker in density and the transplanted hairs are concentrated into certain areas - most commonly the frontal region and partline - to provide the most cosmetic benefit.
I see many female patients who have been told by other hair transplant surgeons that nothing can be done for them, yet in many of these cases the reality is that a procedure can improve their hair loss situation - perhaps not as dramatically as they would want, but it is a definite improvement.

Please feel free to send some photos for me to evaluate.

Posted by Jeffrey S. Epstein, MD, FACS

The reality is, most individuals can be successfully transplanted using their own existing hairs, in sufficient quantities, to create significant improvement in the treatment of hair loss. The average male patient presents with over 8000 donor grafts total (over 16,000 hairs) - a significant number that can allow for two procedures of 2600-plus grafts, then subsequent smaller procedures. 
However, given the amount of reparative work I perform, I do see individuals who, because of excessive scarring and/or inefficient transplanting techniques, have a serious deficiency of an adequate amount of hair for transplanting. While these individuals can be helped even with conservative procedures, they strike me as those who would benefit most from cloning techniques of the future that could provide much larger - potentially unlimited - numbers of donor hairs or cells to initiate the growth of new hairs.

Posted by Jeffrey S. Epstein, MD, FACS

Dear Elvonna - I 
The big challenge in your situation is the quality of your donor hairs - if you have a good density in the back of your scalp, I could anticipate a more impressive result. The other consideration is that, in women of color, there can be a lower percentage of hair growth, resulting in less coverage. The only way to assess the exact amount of hair growth you are likely to experience is to perform a test procedure of say 40 grafts, then waiting 6 months to see how things grow.
The alternative is to proceed with a procedure of 1300 to 1400 or so grafts, filling in both temple areas (500 grafts per side) and placing the remaining 400 or so grafts along the hairline to provide increased density and  perhaps bring it down/forward a bit.  In addition, a second procedure may be desired in the future to provide more density.

I welcome your thoughts.

Posted by Jeffrey S. Epstein, MD, FACS

Yes, we can put you in touch with several patients who live in the UK.
 
I have a number of questions I would love to discuss with you if possible; do you take calls from prospective patients? (If this is difficult due to your other commitments I am happy for us to correspond via email until I come to New York for my procedure). 

By all means, please feel free to call me this afternoon on my cell phone or tomorrow in my office. 
 
In terms of my concerns I am wondering about the following:
 
1. Can I have FUE rather than strip method please?
This is not something typically performed on women, due to several reasons: Women tend to have already a low donor density and a high need for as many hairs as possible; and women have no trouble concealing whatever scars are present, typically scars that are 2 mm in width or narrower. You can read much more about FUE versus strip/fug procedures in the attachment.

2. Can this procedure be done with my hair long?
(Shoulder length) as long as you would like it.

3. Will there be any shock loss in the adjacent areas?
I feel that with the experience I have in working with women that I have developed techniques for minimizing any shock hair loss, while maximizing the numbers of hairs that can be placed between existing hairs. That being said, there is always a risk of some shock hair loss, but this has happened in only a very very small number of patients of mine, and none in the past 4 years since I further refined my technique.

4. Will I have any small scars or marks in the recipient site (hairline)?
None

5. How long will it take for the scabs and the redness in the recipient site to completely disappear?
Typically 7 to 8 days for all crusts and most pinkness, but this can sometimes take 10 to 12 days - but you will have no trouble concealing the crusts in as soon as 3 days after the procedure.

6. Will I have small bald spots at the donor site (back of the head) or will you be taking individual strands from all over my head?
Only a fine line donor site scar.

7. Can I get reasonable density with one procedure?
Some of this depends upon the exact thickness or density of your donor area, but you should have a nice cosmetic improvement.

8. What is the estimated cost?
(Rough guide) I really need to have Roxy answer this question as she will provide you with a more accurate estimate of fees.

Sincerely,
Jeff Epstein, MD