Types of Hair Restoration Procedures

Watch the video below as Dr. Josh Crose gives advice and tips on finding the right physician for your potential procedure. 

Fortunately, there are several treatments available for people at this time in medicine.   Most of these treatments are minimally invasive and affordable. Medicines such as finasteride and minoxidil have been used for years to slow, stop, and even regrow hair.  Low-Level Laser Therapy provides convenience.  Non-surgical injections such as PRP and Mesenchymal Stem Cell Exosomes offer regenerative options that help your body rapidly grow hair.  Hair Transplantation moves hair from one part of the scalp or body to another where there is less hair and has advanced significantly in the last 15 years.  Hair loss can be a thing of the past by combining medicines, non-surgical treatments, as well as surgical interventions but making the correct choice is very important and requires professional guidance.

Medicines such as finasteride (Propecia), and minoxidil (Rogaine) have traditionally been used for treating hair loss.  New formulations of the older medicines are now available that make them easier to use and even reduce some of the unwanted side effects.  Topical forms of finasteride as well as oral use of minoxidil can provide great alternatives to previous options.  Careful use of these or other medicines such as spironolactone is commonly used in women.  Herbal supplements such as Nutrafol help address many of the different stress and nutrient causes of hair loss too.

Injections such as PRP, PRF, PRP with Acell, Stem Cells, and Exosomes are commonly used to help hair growth.  Each treatment has its advantages and disadvantages.  These treatments should be performed by a physician, nurse practitioner, or physician’s assistant and if they are performed by a nurse, the doctor should be present to supervise the procedure.  They are listed in order of increasing potency here.  The advantage to these treatments is that they can help patients grow their existing hair back fuller and thicker, but they do not grow “new” hair.  This is a common misconception.  But if there is miniaturized hair or vellus hair, these regenerative medicine approaches can possibly “wake” them up and turn them into thick terminal hairs.  Of note, Mesenchymal Stem Cell Exosomes are the newest and most potent of the above methods with current research studies seaming to show only one treatment needed to date.  These methods usually take about one hour to perform and have minimal to no downtime afterward.

Low-Level Light Therapy is a form of photobiomodulation that can help restart the growth of hair.  Using a near-infrared wavelength and lower intensity of energy, LLLT can increase the metabolism of hair follicles and cause them to grow faster.  There is evidence that this works and companies such as Capillus and iRestore among others provide various easy to wear and use devices.  The key with this method of hair restoration is consistency in use and not to overuse them too as this will make your follicles tired and decrease their ability to grow as well.  This is called overstimulation.

Dr. Joshua Crose uses the WAW by Devroye Instruments to perform his hand-held harvesting which uses a uniquely specialized cutting punch.  It is shaped like a trumpet at the tip and cuts away from the hair follicle.  This is important as it protects the hairs and hair follicles while providing much needed surrounding tissue to help the survival of the hair grafts.  He uses this instrument in every one of his cases, even his ARTAS iX Robotic cases to help feather in the edges of the harvest area.

The patient arrives at 7:00 AM. The patient and I will sit down and go over consent forms and I will take vital signs and perform a small preoperative exam. Then preoperative pictures are taken for appropriate documentation of the transformation process. After the photos, I carefully draw and measure the hairline and double and triple check with the patient to make sure they are satisfied with the shape, location, and dimension of the hairline. I also explain that HAIRLINES are not LINES! Yes, a line is not natural and is merely a guideline as I will place hair grafts behind and in front of this line randomly to provide a natural variation to reproduce the new hairline.

After the hairline drawing has been completed, the patient is directed to my surgical suite. The hair is trimmed to 1.2-1.5 mm in length in the back donor area where we will extract the hair. If the patient agrees to have Robotic site making or Robotic hair implantation then the top of the scalp will also be shaved to 1.5-2.0 mm in length, otherwise, it can be left longer for manual site making per patient wishes. Regardless, the majority of patients will ultimately need to shave and/or trim much of their hair to aid the transplantation process and to appropriately visualize all of the existing hairs and follicles. This allows us to avoid damaging your hairs on the top of the head when we make new hair follicle sites.

Next, blood is drawn for PRP and sedation is offered to the patient (ie. valium, ativan, xanax). This helps the patient relax and make the day go by faster.

Depending on the size of the case and quality and quantity of donor hair that the patient has, I will make a decision to start with harvesting the hair follicles or making the new hair follicle sites first. If we are uncertain as to the ability to safely get all the hair needed to cover the desired areas of the patient, then I will start with hair follicle harvesting first. If the patient has plenty of donor hairs with good quality, then I will start with site making first. Regardless, the area that is to be worked on first will be numbed up with local anesthesia. I provide ProNox gas if desired to the patients as it helps reduce pain while we inject the lidocaine and marcaine.

After the patient has received an area nerve block to prevent any pain, the FUE extraction process can begin. We position the patient in the surgical chair and commence hair extraction.  Some physicians may leave the room or not perform this step, but it is my obligation as a Hair Surgeon to be present and run the surgical process myself. ANY DOCTOR NOT PERFORMING THE HARVESTING HIMSELF IS BREAKING THE LAW.  Throughout the hair follicle harvesting process, the patient may take breaks and stretch or use the restroom if desired but it will lengthen the day. This stage can last 2 hours up to 5 hours depending on the number of FUE grafts to be harvested.

After harvesting, the patient takes a lunch break provided by Capitis Medical & Aesthetics as part of the entire experience. This is usually no more than 30-40 minutes before we bring the patient back into the surgical suite and perform an area nerve block on the next region.

Site making is a critical part of the process and also is performed by myself.  Site making is where the art of design comes in with location and determines the hair growth direction.  This Step MUST BE PERFORMED by the PHYSICIAN TOO!  The hairline, temples, and crown/vertex are always performed manually as these areas require a careful eye for pattern creation and randomization to create natural and artistically appealing hair design.  This step can take 1-2 hours.

After the hairs have been extracted from the scalp and been cleaned up by my technicians under a microscope and all of the hair sites created, my technicians carefully place the grafts into their new homes. Just prior to the placement of the grafts, I inject the PRP into the scalp to assist with graft healing and to provide additional hair growth to the existing follicles. I then assist with placement and coordinate the exact areas that certain types of hair follicles should be placed to maximize the coverage and provide the most natural looking hair.

The patient is comfortably reclined and watching TV during this step which is a nice way to complete the day as many times this step can take 1-3 hours as a part of an 8-12 hour day. Up to 3 people will be placing the hair grafts into the scalp at a time to expedite the process but this depends on the size of the case. I am present and reinforcing anesthesia and help with placement but will come and go from the Surgical Suite at this point in the day.

When the last graft is placed, we carefully bandage your head and start providing you with detailed instructions about aftercare and what to expect. I proved a second copy of post-operative instructions and some medicines that help with recovery. I also send you home with a spray bottle of lipolized ATP that helps feed your newly transplanted hair as they try to reestablish a new vascular supply. This promotes survival and recovery and reduces shock effect to the new hair follicles. Finally, the patient is released and a follow up appointment is scheduled within the first 4 days.