WARNING: Anyone with an MD can do any cosmetic procedure in the United States without further certification or regulations. They can buy a laser and open shop, or they can start doing hair transplants. They can even make their own certification board that certifies them. Make sure you know which certification boards are the most prestigeous, rather than being WOWed by their long list. Many doctors still use outdated, barbaric procedures just because they cost less than micro grafts and can get the cheap customers, but the procedures are fast enough they can make more money with less work and less skill. Some even post in these forums trying to send people their way. Run the other way if you hear "mini", "slot", "plug", or "flap", 180 or "scalp reduction"; these will leave you looking like a freak. Many of these victims post on this board frequently. Only micro grafts look natural, and half the micrograft docs mess them up sometimes too.
First stop your hairloss before getting hair transplants, or you will be constantly getting more and will run out eventually and have an unusual looking patch of transplanted hair surrounded by bald skin. This forum discusses many topicals for slowing hair loss, but typically you can't stop it without finasteride, and need at least 6 months to see if you are responding. If you are 20 years old and seriously balding, you may want to wait 2-3 years on finasteride to see if it will stop your hair loss (see Timing section, below, if you are thinking of looking good now and not worrying about later. hair transplant may take years to get the density you want.)
There are two acceptable types of follicle harvesting:
1. Follicular Unit Extraction (aka FUE and other acronyms. Includes Body Hair Transplants BHT)
2. Strip (has other names, but they take a strip and cut it into individual follicular units)
Here are some rules for picking a surgeon:
1. They only do micrografts, which are individual follicular units of 1-2 or sometimes 3 hairs.
2. They only do one patient at a time, and not more than 8 or 10 hours per day. If there is only one doctor, there should be only one surgery room.
3. If they are doing strip, they must have about 3 technicians for procedures around 1000 grafts, and 5-6 or more for procedures of 2000 grafts or more.
4. The blades must be small: less than 1mm for FUE punches. Some docs use 25 gauge needles for FUE. For Strip recipient areas, the blade width should be about 1.2 mm or less.
5. Prices for Strip procedures range from $3 to $9 per graft from Strip procedures, though most people agree the $9 ones are way over priced. Pick based on doctor skill, not price. FUE usually costs more, ranging from $5.5 to $15 per graft. Overseas prices can be much lower, but pick the doctor based on skill. It is hard to know for sure how many grafts a doctor really put in.
6. Ask them to mail you many close up before and after pictures in a brochure that details their procedure and technology used. Compare the brochures of many doctors, and post questions on forums like this one. Watch out for low post count members who may be doctors in disguise.
7. If it is a strip procedure, the doctor must use internal sutures.
8. Beware of doctors that do more than 20-30 follicular units per square centimeter (cm2): Some of them are really skilled and can do it just fine. But the higher the density, often the lower the survival rate. So unless you are sure of the doctor's skill, and your genetics, it is often wiser to do lower density procedures. Some doctors are very good though.
Expectations:
1. Hair transplants do not increase the number of hairs you have. They just move hairs around more evenly.
2. If you lost a lot of hair, you can't have dense locks everywhere. If you are at least NW4, or even 3, you will need a lot of grafts, maybe 4000+, to get moderate density, unless you avoid a NW1. If you are NW5-7, you will need to accept a thinner density, or just use a LOT of grafts. It varies on your head size, where you want to fill, etc. While you will look better, most 20 year olds will probably not be happy with the density after they've had 6 months to compare themselves to other 20 year olds after the grafts finish growing out. You can get high density though if you have smaller areas to fill in.
3. Strip scars can be invisible under hair, or be 1/4 inch wide, or be wider if the scalp tention was too high. Lengths vary from 3 inches to over 10 inches depending on the width of the Strip and how much hair was taken and the density. It typically takes 1/2 long hair to hide most Strip scars.
4. FUE scars depend on the punch size, and their color depends on your genetics and sun avoidance while healing.
5. Many doctors will tell you that 40-50 follicular units per cm2 looks just like full density. This simply is not true. It may have the look of hair, instead of obvious individual hair, but will still look like 40-50% density. In some lightings it will look fuller. This density will be OK for older men, or young men who just want to frame their face and don't mind being a big thin. But most guys wanting to look their very best will want at least 60 grafts per cm2, and will not have enough donor hair to achieve that.
Timing:
1. Depending on your scalp, your genetics, the doctor, and the density, your follicles may start growing out in 2-6 months, or sometimes right away if the density is low enough (13 per cm2 grow out right away on me). Some people's scalp blood vessels will not be able to support more transplants for at least a year after a procedure.
2. If you do your second procedure less than 7 months after your first, you take the risk of them not growing out ever, even if it is a small risk (happened to me. Lost 1500 grafts)
Some doctors will do huge sessions of 60+ follicular units per square centimeter. I can't say for sure, but at least there are rumors that the survival rates of high density transfers, especially with FUE, are much lower than 20- densities from Strip.
3. When they first grow out, they will be thin. They thicken, and more grow out, until a max at 2 years. If you have grafts again before then, there is a possibility a doctor will put a new graft on top of an old one that is not yet out, killing that one. If you want to get your money's worth, and not waste your limited donor hair, you may have to take 2-5 years building up density. Many guys get good results even when rushing, but it is a choice and risk you must consider.
Recovery:
1. Different docs use different meds during surgery, which can make some people nautious, and other feel fine. I drove home after mine, but most people get a ride and stay home for a while. I went to work the next day.
2. Recovery from FUE is supposed to be much easier than from strip.
3. With strip, you get stitches removed in 2 weeks. The stitches itch until then. This can be done at a local hospital.
4. You must be very careful washing the recipient area the first 2 weeks.
5. Unless you take the pain meds they give you for 2 weeks after the Strip surgery, the pain from donor area can make you feel like you have a bad headache for that time period.
6. It takes 6 months for a strip procedure to fully heal so that you can exercise any way you want. The internal sutures dissolve in 3 months. You an do light exercise before then, but must be careful not to pull it. Some people say you can exercise sooner than that, but they are the ones with 1/4 inch scars on the back of their heads. If you want yours to be 1/8 inch or less, you need to keep your nose up as much as possible those 6 months to keep the tension off the skin in the back of your head. If you point your nose down, you will feel it back there. During sleep is the trickiest part.
If you have a huge area to cover, and not a lot of money, and high expectations, you would be wise to look into hair pieces. The technology nowadays is really good. Not perfect, but undetectable except under the most rigorous circumstances. Look into places like http://www.finalhair.com, http://www.coolpiece.com, http://www.toplace.com, http://www.hatsoffhair.com, and others. First look in the hair piece forum and ask questions.
BHT Body Hair Transplants:
1. I heard only a hand full of surgeons can do BHT well. But that number will probably increase.
2. BHT is where they move follicles from your legs, chest, arms, etc to your head. Results will vary. Body hair typically is more curly, and thinner, than head hair, and the color might not match. But if you lost a lot of hair, you kind of get to start a new style. It will be a curly style though, which maybe can be straightened regularly.
3. Many people consider it a last resort, but I plan to do it to fill in my donor scar and other areas that I always keep 1/2 inch long or less, where the curl will not be as noticeable.
4. Body hair transplants usually cost less than scalp hair FUE, probably because of market demand, not difficulty. You may need 2-3x as many transplants to get the same density as FUE.
5. To avoid discolored scaring, keep the donor area out of the sun until it is fully healed. Many people will have off color anyway, but usually not too noticeably off. This is why scalp FUE is preferable, since slightly mis-colored small dots are hidden by hair. If you are getting the hair from your beard, it may be hard to keep that out of the sun unless you work inside, especially during the healing process since sun block might affect healing.
6. Beard hair is typically too thick to match scalp hair.
7. Some people use scalp FUE to do their hair line, and then use BHT to put body hair in the holes the scalp hair was taken from so their scalp donor hair is not thinned too much.
8. If you have a lot of body hair, and it is course, you may be able to go from NW7 back to NW1, but your hair might have a bit of an afro look to it. Some people even call it a pubic look. But if you straighten it and dye it, it could be a lot better than being bald. Such surgeries may total over $70,000.
9. When body hair is tranplanted to the scalp, it stays in its growth phase longer than usual, but still does not grow as long or thick as scalp hair. Nizoral's growth stimulating should lengthen it mroe than it's androgen receptor blocking shortens it. Many people use minoxidil, and some former NW7's decide to no longer use propecia since it may keep body hair from being as thick as possible and they don't think their sides can get worse.
First stop your hairloss before getting hair transplants, or you will be constantly getting more and will run out eventually and have an unusual looking patch of transplanted hair surrounded by bald skin. This forum discusses many topicals for slowing hair loss, but typically you can't stop it without finasteride, and need at least 6 months to see if you are responding. If you are 20 years old and seriously balding, you may want to wait 2-3 years on finasteride to see if it will stop your hair loss (see Timing section, below, if you are thinking of looking good now and not worrying about later. hair transplant may take years to get the density you want.)
There are two acceptable types of follicle harvesting:
1. Follicular Unit Extraction (aka FUE and other acronyms. Includes Body Hair Transplants BHT)
2. Strip (has other names, but they take a strip and cut it into individual follicular units)
Here are some rules for picking a surgeon:
1. They only do micrografts, which are individual follicular units of 1-2 or sometimes 3 hairs.
2. They only do one patient at a time, and not more than 8 or 10 hours per day. If there is only one doctor, there should be only one surgery room.
3. If they are doing strip, they must have about 3 technicians for procedures around 1000 grafts, and 5-6 or more for procedures of 2000 grafts or more.
4. The blades must be small: less than 1mm for FUE punches. Some docs use 25 gauge needles for FUE. For Strip recipient areas, the blade width should be about 1.2 mm or less.
5. Prices for Strip procedures range from $3 to $9 per graft from Strip procedures, though most people agree the $9 ones are way over priced. Pick based on doctor skill, not price. FUE usually costs more, ranging from $5.5 to $15 per graft. Overseas prices can be much lower, but pick the doctor based on skill. It is hard to know for sure how many grafts a doctor really put in.
6. Ask them to mail you many close up before and after pictures in a brochure that details their procedure and technology used. Compare the brochures of many doctors, and post questions on forums like this one. Watch out for low post count members who may be doctors in disguise.
7. If it is a strip procedure, the doctor must use internal sutures.
8. Beware of doctors that do more than 20-30 follicular units per square centimeter (cm2): Some of them are really skilled and can do it just fine. But the higher the density, often the lower the survival rate. So unless you are sure of the doctor's skill, and your genetics, it is often wiser to do lower density procedures. Some doctors are very good though.
Expectations:
1. Hair transplants do not increase the number of hairs you have. They just move hairs around more evenly.
2. If you lost a lot of hair, you can't have dense locks everywhere. If you are at least NW4, or even 3, you will need a lot of grafts, maybe 4000+, to get moderate density, unless you avoid a NW1. If you are NW5-7, you will need to accept a thinner density, or just use a LOT of grafts. It varies on your head size, where you want to fill, etc. While you will look better, most 20 year olds will probably not be happy with the density after they've had 6 months to compare themselves to other 20 year olds after the grafts finish growing out. You can get high density though if you have smaller areas to fill in.
3. Strip scars can be invisible under hair, or be 1/4 inch wide, or be wider if the scalp tention was too high. Lengths vary from 3 inches to over 10 inches depending on the width of the Strip and how much hair was taken and the density. It typically takes 1/2 long hair to hide most Strip scars.
4. FUE scars depend on the punch size, and their color depends on your genetics and sun avoidance while healing.
5. Many doctors will tell you that 40-50 follicular units per cm2 looks just like full density. This simply is not true. It may have the look of hair, instead of obvious individual hair, but will still look like 40-50% density. In some lightings it will look fuller. This density will be OK for older men, or young men who just want to frame their face and don't mind being a big thin. But most guys wanting to look their very best will want at least 60 grafts per cm2, and will not have enough donor hair to achieve that.
Timing:
1. Depending on your scalp, your genetics, the doctor, and the density, your follicles may start growing out in 2-6 months, or sometimes right away if the density is low enough (13 per cm2 grow out right away on me). Some people's scalp blood vessels will not be able to support more transplants for at least a year after a procedure.
2. If you do your second procedure less than 7 months after your first, you take the risk of them not growing out ever, even if it is a small risk (happened to me. Lost 1500 grafts)
Some doctors will do huge sessions of 60+ follicular units per square centimeter. I can't say for sure, but at least there are rumors that the survival rates of high density transfers, especially with FUE, are much lower than 20- densities from Strip.
3. When they first grow out, they will be thin. They thicken, and more grow out, until a max at 2 years. If you have grafts again before then, there is a possibility a doctor will put a new graft on top of an old one that is not yet out, killing that one. If you want to get your money's worth, and not waste your limited donor hair, you may have to take 2-5 years building up density. Many guys get good results even when rushing, but it is a choice and risk you must consider.
Recovery:
1. Different docs use different meds during surgery, which can make some people nautious, and other feel fine. I drove home after mine, but most people get a ride and stay home for a while. I went to work the next day.
2. Recovery from FUE is supposed to be much easier than from strip.
3. With strip, you get stitches removed in 2 weeks. The stitches itch until then. This can be done at a local hospital.
4. You must be very careful washing the recipient area the first 2 weeks.
5. Unless you take the pain meds they give you for 2 weeks after the Strip surgery, the pain from donor area can make you feel like you have a bad headache for that time period.
6. It takes 6 months for a strip procedure to fully heal so that you can exercise any way you want. The internal sutures dissolve in 3 months. You an do light exercise before then, but must be careful not to pull it. Some people say you can exercise sooner than that, but they are the ones with 1/4 inch scars on the back of their heads. If you want yours to be 1/8 inch or less, you need to keep your nose up as much as possible those 6 months to keep the tension off the skin in the back of your head. If you point your nose down, you will feel it back there. During sleep is the trickiest part.
If you have a huge area to cover, and not a lot of money, and high expectations, you would be wise to look into hair pieces. The technology nowadays is really good. Not perfect, but undetectable except under the most rigorous circumstances. Look into places like http://www.finalhair.com, http://www.coolpiece.com, http://www.toplace.com, http://www.hatsoffhair.com, and others. First look in the hair piece forum and ask questions.
BHT Body Hair Transplants:
1. I heard only a hand full of surgeons can do BHT well. But that number will probably increase.
2. BHT is where they move follicles from your legs, chest, arms, etc to your head. Results will vary. Body hair typically is more curly, and thinner, than head hair, and the color might not match. But if you lost a lot of hair, you kind of get to start a new style. It will be a curly style though, which maybe can be straightened regularly.
3. Many people consider it a last resort, but I plan to do it to fill in my donor scar and other areas that I always keep 1/2 inch long or less, where the curl will not be as noticeable.
4. Body hair transplants usually cost less than scalp hair FUE, probably because of market demand, not difficulty. You may need 2-3x as many transplants to get the same density as FUE.
5. To avoid discolored scaring, keep the donor area out of the sun until it is fully healed. Many people will have off color anyway, but usually not too noticeably off. This is why scalp FUE is preferable, since slightly mis-colored small dots are hidden by hair. If you are getting the hair from your beard, it may be hard to keep that out of the sun unless you work inside, especially during the healing process since sun block might affect healing.
6. Beard hair is typically too thick to match scalp hair.
7. Some people use scalp FUE to do their hair line, and then use BHT to put body hair in the holes the scalp hair was taken from so their scalp donor hair is not thinned too much.
8. If you have a lot of body hair, and it is course, you may be able to go from NW7 back to NW1, but your hair might have a bit of an afro look to it. Some people even call it a pubic look. But if you straighten it and dye it, it could be a lot better than being bald. Such surgeries may total over $70,000.
9. When body hair is tranplanted to the scalp, it stays in its growth phase longer than usual, but still does not grow as long or thick as scalp hair. Nizoral's growth stimulating should lengthen it mroe than it's androgen receptor blocking shortens it. Many people use minoxidil, and some former NW7's decide to no longer use propecia since it may keep body hair from being as thick as possible and they don't think their sides can get worse.