Doctors on Hair Loss & Hair Transplant surgery.

Are many hairs transected as the surgeon makes extractions on the donor during hair transplantation?

Good question. The answer is that it varies wildly from surgeon to surgeon and clinic to clinic. We take great pride in having achieved some of the lowest transection rates in the hair transplant world.

Our transection rates with CIT are averaging less than 3% which is very low compared to the industry as a whole. Some published papers on FUE and other single graft harvesting techniques cite transection rates as high as 50 to 70% from their own clinics! This is a travesty, and should be mentioned only to be condemned. .

Single blade strip surgery has average initial transection rates (in our hands) of about 2%; again, it is all over the map depending upon the experience and expertise of the surgeon, and at least for strip, upon the experience and expertise of the surgical staff. One of the most important variables is the surgical technician staff; after the strip is harvested, the tissue is processed by these technicians. Their transection rates can range from 5% up to as much as 50% of the grafts, and is dependent on their training and skill. This is why quality control in a hair transplant practice is so very important (but unfortunately is not the norm by any means). In our practice, CIT has a lower transection rate (<3%) than strip; in strip cases, our technicians’ transection rates, plus the transection during harvest, averages 5%. So for us, even this relatively low strip transection exceeds our even lower CIT transection!
Remember that the training and expertise of hair transplant surgeons runs the gamut, from beginners with virtually no experience to speak of, to veterans with thousands of cases and thousands of quality results under their belts. However, there is one other factor that comes into play, which is standards. A physician may have years of experience, but set the standards in his practice very low. In this situation, sloppy work and poor technique, combined with minimal staff oversight and quality control, may produce high transection rates and other conditions that lead to mediocre results at best, and cosmetic disasters at worst.

We are proud of the high quality and dedication to excellence that we are known for!

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I’m a woman over 40 and was diagnosed with androgenetic alopecia ten years ago. My 16 year old is losing her hair. I took her to the derm and was told that it is stress related. The doctor said that she did not see the genetic pattern. My daughter is losing her hair on the sides above the temple and also in her part. Isn’t this genetic pattern? I don’t know if I buy the whole stress theory. The doctor spent 5 minutes with us and ran her fingers through my daughters hair. Can stress hair loss mimic androgenetic?

There might be a stress component, but it is not a common cause of hair loss except with alopecia areata, which tends to be well circumscribed and circular in shape. There are different kinds of stress. There is mental stress and there is physical stress such as a severe illness or significant trauma. Physical stress can produce a global form of hair loss.
The fact that mom has the diagnosis of AA increases the chance of the daughter having a similar problem, however at 16, she is a bit young for that. Other possibilities are polycystic ovary syndrome; one would expect other signs of androgen excess with this (facial hair, acne, increased body hair, etc). The sides of the scalp are not a common area for androgen excess to present itself. Female pattern loss can involve the sides of the scalp however.
I am unsure what is meant by “above the ear”. If the loss is in the fronto-temporal recess, it could be androgenetic alopecia; if it is on the sides (parietal), that is unlikely and it may be a diffuse patterned or unpatterned alopecia.
The loss through the area of the “part” may indicate a Ludwig pattern of AA, which is a more typical “female” pattern, as opposed to the “male” pattern of temporal recession and loss of the hairline.
A thorough workup with a physician specializing in hair loss would be your best option at this point. You should look for any changes in density or hair diameter. You could follow this up with a biopsy properly performed. Make certain to perform some lab tests to look for anemia, androgen excess, iron deficiency, or a thyroid dysfunction.

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My reason for writing to you is over the past 8 to 9 months I have noticed an “excessive thinning” of my hair. My hair has also been dried out and brittle. I am a natural dark haired individual and do bleach my hair. I have been doing so for over 20 years with no negative affect.
I moved to south Georgia in September - into an older home, which has well water. I immediately noticed the texture of my hair changing. It became much drier and hard to style. I was told it might be because of the well water and the pH of the water.
What is your opinion? Are there any tests I can do on the well water? Would that cause hair loss? Is there any other tests to perform that might indicate something bad or missing in the water that would be so negative on my hair.

There multiple reasons people loose their hair. With female hair loss the causes may include hormonal problems. One should consider a thyroid problem. This could be due to an elevated thyroid or a low thyroid function. A change in medications might stimulate hair loss in women with female pattern loss and this should be considered too. One would generally see female pattern loss prior to age 62 if this were the cause.

I think you should consider the well water as a possible cause. There are numerous heavy metals present in well water and you can absorb heavy metals through the skin or through ingestion. There would include thallium, arsenic, mercury, copper, cadmium, or bismuth. A half gram of bundled hairs kept in their normal orientation (tops toward the top) sent to the National Medical Services in Willow Grove, PA can evaluate your hair for arsenic.
A low pH can sometimes cause copper in the pipes to precipitate out into the water and this can result in an accumulation of toxic levels of copper in your system.

You could have your physician work you up for heavy metal exposure. Blood levels, urine levels, and hair levels will generally tell you if you have been exposed to heavy metals. Often times you will have neurological findings or symptoms with heavy metal exposure.

Lab tests in addition to a heavy metal analysis include thyroid function tests, a CBC and ferritin level to evaluate you for iron deficient anemia, a dihydroepiandrosterone level to check you for elevated male hormones, a testosterone level, a FSH and LH. If the work up comes back negative, you could consider a properly performed biopsy. The dermatology department at the Medical College of Georgia in Augusta could perform most of this work up.

Heavy metal poisoning produces a characteristic form of anagen hair loss. A dermatologist should be able to assess you for any particular hair shaft abnormalities. Heavy metals were often found in pesticides and herbicides that could have found their way to your well water.

Of course hair coloring can make your hair brittle and cause breakage. This could be a factor currently and might result from a change in salons who use different chemicals or leave the agents on for a long period of time.

I usually see progressive female pattern loss begin after pregnancy or in the 40s to 50s. I do not see it begin in 62 year old women typically. Often times there is a family history, which means your mother would have exhibited these symptoms. Medications high in progesterone can stimulate hair loss in women prone to this form of hair loss. Any therapy would be directed at the cause. Therefore, it is best to determine the cause first. I think most of this work up can be done closer to your home. If it comes down to a biopsy, it probably is better for me to take, but I’d get the lab work up first.

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I’m told by various strip physicians that the strip scar is a thin as a pencil mark. Is this true?

This is completely dishonest. The average strip scar is 2 to 3 mm wide and it can stretch from ear to ear. If you plan to cut your hair short, this can be a problem for you as it is obviously a man made scar. It is an obvious sign that you had a hair transplant. No one wants anyone to know they’ve had a hair transplant, however. No one wants anyone to know they had hair loss or that they ever considered hair restoration surgery. Even shorter hair styles can expose the strip hair transplant scar. Frequently we are told that a hair cut of a number 3 or shorter exposes the strip scar form a strip hair transplant.

There is a new fallacy you are hearing from strip surgeons, as well. They claim that their new trichophytic closure technique produces pencil thin scars that are invisible. We’ve seen 5mm wide scars produced by this technique. Five millimeters is ¼ inch wide. It is a huge gap with no hair in it. When the trichophytic closure works, it rarely works in the rear of the scalp. You will not see an advantage along the sides of the scalp usually. Furthermore, the tighter you make the scalp by performing successive strip procedures, the more likely it is that your scar will widen and stretch out. Furthermore, these strip scars can turn whiter than the surrounding skin or bright pink. This produces further contrast to the scars should they be exposed by a short hair cut or by a medical illness that causes thinning or loss of your hair.

One other problem you will never hear about from your strip surgeon is that strip procedure causes irreversible changes in your donor area hair growth angles. A strip is nothing more than a scalp reduction in the donor area. It alters hair growth angles for the rest of your life.

There is no reason to have a strip procedure. It really is up to the patient to demand the alternative, which is far better. Patients should begin to demand CIT, which is an advancement over our older FIT procedure. There is CIT and no quite CIT. Many physicians will tell you they perform FUE. This FUE procedure does not meet the quality of CIT. CIT is a proprietary procedure with quality instrumentation. Only CIT has proven results day in and day out with all types of hair including wiry, kinky hair seen in men of African decent.

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