Can I have Hair Transplant Surgery in the Front Area of my Balding Scalp Even Though I Still Have a lot of Hair?

Hello, My hair started thinning approximately 2 years ago. I take Propecia (finasteride) which has helped, but I am conscious of the hair loss I am experiencing at the front of my head. Is it possible to have a hair transplant while still having a considerable amount of hair left?  Many thanks.

Yes, it is possible to have a surgery in the frontal area of your balding scalp even if you have a good amount of remaining hair. 

A qualified hair restoration physician will have to take into consideration factors such as:

  • Your age
  • Your current level of balding
  • Whether or not you are taking any nonsurgical treatments to prevent further baldness such as Propecia (finasteride) or Rogaine (minoxidil)
  • How many follicular unit grafts you will need in a single hair replacement session
  • Working with you to formulate a long term strategy in the event you lose more hair. 

Developing a long term hair restoration plan is highly critical as hair loss is unpredictable and progressive.  Propecia and Rogaine may not work forever, which means subsequent surgical procedures may be necessary.

I recommend consulting with at least 3 high quality hair transplant surgeons and using our hair loss forum as a tool to see what their patients are saying.

Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Visit to Dr. Kabaker in Oakland, California

Pat with Dr KabakerDr. Kabaker has been recommended on the Hair Transplant Network for several years. View his profile - on the Hair Transplant Network.

Dr. Sheldon Kabaker is renowned among hair restoration physicians for his superb surgical skill, which he developed and refined over the past thirty years.

During my visit he and his staff performed a small session of 1,100 grafts into a patient’s crown area. Dr. Kabaker removed the donor strip using a single bladed knife and then did a double layer closure so that the internal sutures would reduce tension on the skin level external sutures. He believes this produces a minimal donor scar. He then used a 19 gauge needle to create graft incisions of about 0.9 millimeters in size.

In addition to the quality follicular unit grafting that he performs, Dr. Kabaker has developed a reputation for being an expert at female hairline lowering, below is an example.

Lowering female hair lineThis can be a cost effective surgical solution for women who have naturally high hairline that they want lowered. Many women feel that the high hairline makes them look masculine or older.This is not due to hair loss but rather their heredity.

Although transplanting hair to recreate a lower hairline is an option, such transplantation normally requires multiple sessions to create a hairline that is sufficiently dense.

Dr. Kabaker’s hairline lowering surgery lowers a person’s hairline in one session. This out patient surgical hairline procedure involves excising excess tissue immediately below the existing hairline and then moving the hairline forward and down. He uses a trychophytic closure so that the hair will grow up and through the scar thus hiding the incision/scar. This procedure can also be combined with a brow-lift to give the patient additional benefits.

The complete visit details and images are on our Hair Restoration Forum.

Laser Therapy Hair Loss Treatment - A Researcher’s Point of View

This insightful hair loss article was written by hair restoration forum member “HLBD”.  Below he shares with us a piece of what he has learned in researching real hair restoration solutions for his hair loss condition.  I know that there is a lot of skepticism towards laser hair treatment on our hair loss forum and my view – although I’m not endorsing or supporting the use of any low level laser therapy (LLLT) product – is equally unpopular simply because I believe, from a scientific standpoint, there is not enough evidence to validate nor dismiss claims of effectiveness and so I refuse to outright condemn laser therapy as a treatment until further investigation is done. History of Laser Therapy for Hair Loss: In 1967, shortly after the first working laser was invented, a researcher named Endre Mester with the Semmelweis University of Budapest developed a theory that exposure to cold laser light would, eventually, lead to cancer – he theorized that melanoma (a malignant form of skin cancer) was likely to form from exposure to these cold laser light bands, similarly to exposure to UV radiation emitted by the sun. To test his theory, he shaved a group of mice and trapped some of them in a cage with constant cold laser light exposure and left the other half as a control group. To his surprise, the light didn’t cause cancer in any of his animal subjects; however, the mice that were exposed to the laser light grew back their shaved fur much faster than the control group. Mester named his discovery laser or photo (light) biostimulation as he theorized that, somehow, the laser light had stimulated the hair cells into an excited state of hair growth. Simply knowing this, however, is not enough for us to assume that laser hair treatment would be a satisfactory treatment for male pattern baldness (MPB). The first problem is that animal studies are notoriously unreliable. Secondly, mice do not suffer from MPB. Finally, just about anything can make a mouse grow hair. Problems with Validating Laser Therapy as a Hair Loss Treatment For the validation side of the argument, there are plenty of problems:
  • Most of the pictures presented to provide “evidence” are circumstantial (submitted by users of the therapeutic products) and are often taken under different conditions – head positions different from ‘before’ and ‘after’ photos, different lighting, different hairstyles or colors, and/or no visible change.
  • The FDA “approval” was not actual approval – the permission to market and clearing of the Hairmax laser comb was given as conjunction approval based on the device’s similarity to other previously cleared devices. Furthermore, though many internet sites selling low level laser therapy combs and brushes attempt to mislead customers into believing that the FDA approves and cleared all LLLT devices, the FDA does not approve or permit the marketing of any therapy enabled by a device, but the device itself – this is the reason I can’t just start making pacemakers and selling them online, saying that ‘the FDA approves of electrocardiopulmonary regulation.’ The most important factor in approval, marketing permission, or clearing of any medical device, according to the FDA’s medical device division is the manufacturing of said devices; the device must follow GMP (good manufacturing procedure): a set of standards established to insure health and safety of the products manufactured).
  • There is no evidence as to how LLLT therapy works, if it does work.

Problems with Dismissing Laser Therapy as a Hair Loss Treatment

On the dismissal side, there are also some issues:

  • Most opponents of the laser therapy for hair regrowth offer no scientific evidence to back their claims that the devices are ineffective. One physician has mentioned time and time again that these devices do not work because they do not concur with “common sense”. Speaking as a former member of both high school and college debate teams, this argument won’t win any debates. I can’t show anyone common sense. I can’t point to common sense on a chart and, although I’ve known many people with sense, I can say with all certainty that it is not a “common” trait – then again, I do a lot of work on the internet these days. True men of science cannot afford the luxury of “common sense”.
  • Although most of the information is circumstantial, there is a lot of it and some of it is quite convincing. I recall watching a news segment of a young camera man who agreed on the spot to try an laser hair treatment therapy at a local clinic on which the news agency was reporting and, if there was no trickery involved, the young man’s progress was well documented and impressive. He started out maybe a level 3 on the norwood scale and regressed back to a norwood level 2 or 1.

The point is that there is not really enough evidence one way or another to determine whether LLLT is an effective treatment for baldness and most respected proponents only recommend its use in conjunction with other treatments.

The debate does put me in mind of a device that once came through our lab for independent validation study. Before I tell you what the device was, perhaps I should tell you that many researchers and assistants did crack some jokes as the device was a “penis stretcher” or penis traction device. Long story short, the results of our studies did indeed prove that the device did work as its manufacturer claimed (men gained between one and three inches in length over a year period). Its claim was actually scientifically sound as most of the body’s tissues are remarkably elastic and do respond to traction. Some of the sites marketing the devices are, however, misleading.

The devices work by causing microscopic rips in the tissue at the cellular level. This prompts the cells to divide and heal the breach with more tissue. This will, with time, engorge and enlarge the tissues to which traction is applied. Although most of these sites claim that the procedure is similar to neck stretching that is done by some remote tribes, it is actually closer to ear stretching that has been popular recently in urban cultures.

Still, despite our study and numerous others contracted to validate the penis traction device makers’ claims and their successful outcomes, many opponents claimed and still state that there is no way the devices could work. Much like the naysayers above, none of these people could provide any reasoning as to why they believed the devices would not work. Also, like the laser therapy devices, many among the opponents were and are medical professionals who also have no evidence or logic to support their opinions. In my book, an uninformed and unaware opinion fails by its very nature to be a professional opinion.

Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Concerned about a Chest Growth by Taking Propecia

I am considering taking Propecia for my hair loss, and I am worried about the chest growth due to this medication.  Would you please tell me more about it?

I can’t say I’ve ever heard about a “chest growth” by using Propecia (finasteride) as a hair loss treatment.  Where have you heard of this?  Just a general caution: be careful also not to believe everything you read as there is a lot of false information out there.  For solid information on medication for treating baldness, consult with a dermatologist or hair restoration physician who can answer all your questions.

A list of Propecia’s potential side effects can also be found at www.propecia.com

Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Does Wearing a Hat or Hair Piece Cause Hair Loss or Negatively Impact Hair Growth?

Is there any evidence to suggest that wearing a hat or covering the head day in day out over a long period of time (years for example) may lead to premature hair loss?. Also is there any evidence that suggests taking glucosomine supplements can lead to baldness, or is this just a load of old cobblers?

This question was posed by a hair loss sufferer on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.

I would agree that hats do not have a negative effect on hair growth, either your natural hair or follicular unit grafts that have been transplanted.

The only thing that goes on the head that I do know can have a negative impact on some patients is wearing a hairpiece. Over the years, I would say that approximately 15-20% of my alopecia wig wearing hair restoration patients have had slight to moderate diminishment of growth compared to my normal non-hairpiece-wearing patients. A few years ago I had a discussion about this with some other very experienced doctors, including Dr. Bobby Limmer and Walter Unger, and they had noted this also in their practices. Their recommendation to me at the time, which I have followed, is to not have a hairpiece worn during the week after a procedure, and then to have the patient have the hairpiece off as much as possible, wearing it only for essentials such as work and social engagements - but wearing a ballcap around the house or nothing on the head. I have noticed a slight improvement since switching to this policy, but still see an occasional patient with diminished hair regrowth.

The reason for this is not fully understood. Most feel it has to do with a close “shuffling” of the piece on the newly implanted grafts, perhaps somehow preventing them from “taking root.” Increased temperature or bacteria present would be other wild guesses that probably don’t apply.

Most of us have people who wear motorcycle helmets, ski helmets, and hard hats not wear their headware for at least 7-10 days after hair transplant surgery.

Mike Beehner, M.D.

Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog