Hair Transplant Blog Featuring John P. Cole, MD

Doctors Share Hair Transplant & Hair Loss Information

Hair Transplant Surgery Insider Blog by The untold side of hair loss and hair transplant surgery from industry insiders. Includes exclusive news and facts, top five and top 10 lists and reliable studies and findings.


If LeBron James really did have a hair transplant, it sounds as if he did plenty of research. Hair transplantation can have a profound affect on one’s appearance, so choosing the right surgeon and procedure to fit your needs is crucial. Follicular Unit Extraction (FUE) is the the most advanced form of hair transplant surgery available. Platelet rich plasma (PRP) is often applied during hair transplant procedures to aid in healing, promote donor recharging, and even improve the appearance of pre-existing hair follicles. Dr. Cole utilizes all of the latest treatment methods covered in this video, from advanced FUE to PRP.  The Capillus Laser Cap is even available for purchase through Cole Hair Transplant. As far as LeBron, watch this video and draw your own conclusion.

heart disease

According to the BMJ Open online journal, support has been found that can connect male baldness on the top (crown) area, known as the vertex, with an added risk for coronary heart disease. Hair loss in or around the hairline is not associated with this same risk.

Six studies were found to meet analysis criteria, and therefore, included in the report. The Hamilton Scale was used to determine the degree of baldness on men in these studies. The outcomes showed that 32% of those with tremendous balding had an increased risk of CHD compared to men of the same age without hair loss. The degree of vertex baldness was also associated with an increased risk of CHD. Minor vertex baldness, modest vertex baldness, and widespread vertex baldness have increased risks of 18%, 36%, and 48% according to the studies. Younger men were also found to have a higher heart disease risks associated with hair loss in the crown area compared to older males.

More research is needed to determine why vertex baldness is associated with an increased risk for heart disease. A few theories include insulin resistance, chronic inflammation, or increased testosterone sensitivity, both of which are connected to CHD. While thinning hair carries a much lower risk of heart disease than smoking or obesity, men suffering from hair loss in the vertex region should be aware of the potential elevated risk. Overall men’s health and a healthy lifestyle should be emphasized.


I’ve seen some of your posts on some hair loss forums talking about PRP and ACell. I just had this procedure done two weeks ago and have since then seen an increase in shedding. I saw that you wrote that you’ve never had this happen, although it has been reported. From what you have seen or heard, is this shedding temporary? I’m terrified that I’ve actually made the situation worse than it actually is. I’m 28 year old female who had some diffuse thinning in the frontal area of my scalp and had heard good things about PRP. I understand not all treatments work for everyone but is it possible that this loss I’m experiencing will be permanent?? I’m so worried. Any insight from you will be greatly appreciated.

There are many reasons for hair loss. After a procedure, one would most likely assume that it is due to the “shock” of the surgery. If this is the case, it should grow back over the next year with most of it resuming growing in the first 6 months. Another reason to loose hair is due to progressive androgenic alopecia. This sort of hair loss tends to occur in phases. One tends to sit on a plateau for a long time. Then suddenly, one falls off the edge of the cliff on the plateau. This results in tremendous hair loss that is not going to come back. This sort of hair loss is not due to the procedure. Rather, this sort of hair loss is genetic. It is rare for the procedure and the progressive hair loss to occur at the same time. It’s sort of like winning the lottery in terms of statistics, except we look forward to winning the lottery. We do not look forward to hair loss. Still the probability of timing a procedure with the turning on of your genetic clock is rare. Most likely you have “shock loss”, which is reversible. Remember, that shock loss begins about 2 weeks after a procedure and ends about 2 weeks later. Progressive hair loss will begin at any time and may occur after the 4th week. If you are more than 4 weeks out and your hair loss begins, it is probably progressive androgenic alopecia.

What percentage of patients respond to PRP and Acell injections and what is the optimal concentration of platelets and Acell. I am currently 55 years old.

I think you have summed up the current state of PRP/Acell perfectly. I began using PRP at a roughly 5X concentration in 2010 after visiting Joe Greco, who was the first I know of to report on the benefits of injecting ³activated² PRP using his Harvest system. Prior to my endeavor to use PRP, Joe reported that PRP could increase hair diameter. Although I did not feel his study was scientifically sound, I could rationalize this because I have seen perturbation, which is really a turn on of the inflammatory process, increase hair diameter. Although diameter increase following the natural inflammatory process was rare, it seemed plausible that magnifying the inflammatory process by concentrating platelets could amplify the natural inflammatory process and thus result in greater hair diameter increase.

Joe told me that he was getting a positive response in 75% of his patients. I cannot say what percent we are seeing primarily because I do not see all my patients back within a year¹s time simply because most live out of state.

What I can say is that some report improvement and some do not. Results typically last about one year. No one knows if a repeat injection given annually will continue to promote improved coverage. Some come back annually. Some responders do not.

When Joe told me that he was using an extracellular matrix as a scaffold to improve the release of growth factors, I theorized that we could add Acell to the PRP. I began at low concentrations of 1mg/cc, but have since increased to about 5 mg/cc. I¹m not sure that it adds any benefit. It may. It may not. Based on what I was doing, others began using Acell with PRP. Some use much higher concentrations of Acell today.

In 2012 I began using the Angel system to make PRP primarily because I wanted a 6X concentration of PRP and I wanted a low white cell count. The white cells increase the risk of post surgery swelling. I also wanted a 1x concentration for a topical spray to promote healing and prevent infection due to the high white cell count in the 1x topical spray. Later I told Dr. Cooley about the Angel system and he adopted it.

I have some positive results by photograph and some more interesting positive responses using cross sectional trichometry, which is a measure of the surface area of 4 sq cm of hair. Carlos Puig is currently doing a study evaluating the response of females to PRP and ACell injections. So Šstay tuned for those results.

At your age of 55, a hair transplant is probably ok, but I never encourage anyone who is comfortable with nothing or with medical therapy to do a surgical procedure.

What I can tell you about PRP and Acell is that there is no formula that works in all patients. I tell patients who don¹t respond that there is no need to do a second treatment. When someone does respond, I tell that person it may be worthwhile to do another treatment. I believe that most who spin their own PRP inexpensively probably are making a 1x concentration that most likely has a very limited benefit. The cost of PRP is really due to the equipment you have to buy to spin the PRP.

I think you have hit the nail on the head. What we need is some controlled trials. I would love to see this happen in the next year. In the mean time, stay tuned and wait for more specific protocols.

Bariatric Weight Loss Surgery And Hair Loss

My mother had esophageal band surgery a couple of years ago due to her excessive weight problem. Following this she has noted progressive hair loss and a change in her personality. I’ve read that band surgery and stomach stapling can cause hair loss. Is this true?

Bariatric (Weight Loss) Surgery: Metabolic, nutritional, psychological and physiological Consequences Bariatric or weight loss surgeries have become commonplace in the USA and in other countries, in part due to an ever increasing incidence of obesity in the context of a societal standard of beauty that emphasizes a thin, shapely physique. Lobbying by various organizations, as well as medical studies detailing the present and future consequences of untreated obesity, has led to insurance coverage for these surgeries, which were previously deemed “cosmetic”. This article will detail some of the physical and mental aspects of the often rapid weight loss which occurs after bariatric surgery.
The bariatric surgery community utilizes a number of procedures to promote rapid and hopefully permanent weight loss. Some of the earlier methods have been abandoned or modified due to unacceptable morbidity in the post-operative period, both immediate and long-term. Currently used techniques most often decrease absorption of calories or promote early satiety (feeling of fullness), or some combination of the two.


Unfortunately, the decreased absorption of calories is accompanied by decreased absorption of macro- and micro-nutrients. This often leads to nutritional deficiencies of varying degrees of severity. Sometimes these deficiencies may go undetected for some time, until they have had a profound effect on the patient. Many of these deficiencies can be very difficult to treat (refractory) once established. They may cause significant derangement in the patient’s physical, mental and emotional health.

Nutritional deficiencies associated with bariatric surgery:
Multiple vitamin deficiencies: D, A, B12, B1
Multiple mineral deficiencies: iron, magnesium, calcium, zinc
Macronutrient deficiencies: protein, fatty acid, caloric
The endocrine system may also be deranged; hyperparathyroidism may occur, secondary to vitamin deficiencies, and this condition may cause multiple physical and mental/emotional disorders. This may lead to new micro nutrient disorders, or exacerbate those which have already resulted form the surgery. All of these factors together may set the stage for multiple, interrelated metabolic conditions that may have an overwhelming effect on the patient after bariatric surgery.
In addition to the physiological issues detailed above, mental and emotional distress or overt illness may also occur subsequent to these procedures. This may range from mild depression to full-blown psychosis. The etiology of these symptoms is only partially clear. Some may be due to radical, sudden changes in body image. Others manifestations may be due to metabolic derangements such as magnesium deficiency, hyperparathyroidism, and/or various B vitamin deficiencies. Unfortunately, authorities say that the psychological effects of bariatric surgery have yet to be as fully elucidated at the physiological ones have been.
Another major issue in the post-operative period has to do with the cause of the obesity itself. It is widely believed that many overeaters use food for “self-soothing”, in other words, it calms their anxieties, cures boredom, temporarily alleviates depression (but worsens it in the long run), may act as a substitute for caring relationships and love interests, and generally supports the individual emotionally. When the ability to eat is radically curtailed, this whole quasi-“relationship” the person has with foods is interrupted, sometimes with disastrous consequences. This is one of the many reasons that bariatric surgeons must screen the population of patients so strictly, and this is also one of the reasons that psychotherapy before and after such procedures is seen as mandatory. It is of interest that current studies reveal a substantial percentage of these patients eventually regain much or all of the weight they initially lost, despite the “permanent” nature of the surgery.
Hair loss is another very common consequence of bariatric surgery, and of course can exacerbate the psychological problems the patient may develop. The germinal cells found in the bulb at the base of the hair follicle are among the most rapidly dividing cells in the body. This is one reason that hair is so sensitive to any stressors experienced by the human organism.
It is well known that people may experience an effluvium, or shedding, under the influence of myriad stressors. These can be physiological or psychological, and the hair loss may be permanent or temporary. Bariatric surgery may be an overwhelming stressor, and even in the most optimal cases, it is a major perturbation to the body as well as the mind.