The NeoGraft System
The NeoGraft System uses the Follicular Unit Extraction (FUE) method with suction assist. The FUE method removes individual follicular units from the scalp in their naturally occurring groupings of about 1-4 hairs and are then placed in the areas of the scalp where balding has occurred. The end result is a natural looking hairline with no linear scar and a quick recovery time.
The NeoGraft punctures the outer scalp to 1/3 its depth (3mm) which frequently results in imperceptable scars when a punch less than 1mm is used. (.9mm recommended)
Follicular Unit Extraction
Lifetime total ability to extract grafts with this method is probably around 4000-5000 grafts. With the strip method, a 2500-3000 graft strip can be taken out on one or two occasions, each time removing the previous scar so only one scar of 1-4 mm width results. This scar is always covered by a curtain of hair hanging over it so it is not apparent.
After two strip sessions, it is best to switch to FUE .In the FUE method, using the suction-assisted .9 mm punch, 1000-2000 grafts can be harvested from a full donor at least once. Depending on the thickness of the hair, an additional 2500 can be harvested at a later date. If the patient has very fine or thin hair, this is not an option. If too much hair is taken out by FUE in a patient that has thin hair, the donor will develop a thinned appearance. A full Class 6 bald person requires 6000 to 8000 grafts to fully transplant his head. With the new Double Mega Procedure method, this can be accomplished by one strip graft of 2500 to 3000 grafts, followed by a micro FUE .85 procedure done at about two weeks later with an additional 2500 grafts, giving about 5000 grafts over a period of two and one-half weeks. As the years go by and a person with this transplant requires some additional hair around the back, this can be obtained by the FUE method down the road. Evaluation for Follicular Unit Transplantation (FUT)
In evaluating a person for follicular unit extraction, it is necessary to make sure there is sufficient density in the donor that no change will be observed when removing 2000 to 2500 micro FUE .9mm grafts. FUE may also be used on very thick body hair when scalp hair is very limited. New “Double Mega” FUE Procedure Using a newly developed technique, the Double Mega Procedure, we are able to transplant 5000+ grafts – enough to cover almost all cases of baldness – in just three weeks.
3000 grafts by strip with Exparel (two-week anesthesia)
Sutures out at two weeks.
Next week, 2000+ grafts by micro FUE (.9mm) above and below strip scar – and scar filled. Also Exparel.
For patients who have had one to three prior strip procedures, the best choice for a touch up is NeoGraft FUE .9mm above and below the old scar line. In most cases, hairs can also be placed into the old scar line.
The newly developed Hybrid Hair Transplant uses the robot plus NeoGraft to harvest 5000 grafts in the same day, completing the transplant without the usual delays.
Treatment Protocols to Stimulate Thinning or Transplanted Hair and to Optimize Hormones
STEM CELLS AND PRP FOR HAIR RESTORATION
AND HAIR GROWTH IMPROVEMENT
PRP has been used for some years to improve the thickness of hair after hair transplant, reduce shedding, reverse miniaturization of hairs that occurs for several years in male and female pattern hair loss, and generally enhance the overall recovery after a hair transplant.
In men and particularly women with fine miniaturization and thinning hair, a series of PRP treatments at one-month intervals, usually three, followed by a booster treatment at one year, can have amazing hair thickening effects.
Mesenchymal stem cells, which have just recently become available, can be added to the PRP for an incredible boost in hair growth. In this situation, a hair may be expected to grow at approximately one month after a transplant, or 1-2 months after a treatment of stem cells and PRP. In this case, usually one treatment is sufficient, although a second may be necessary at the 6-12-month level.
Stem cell/PRP treatments are available at the Pacific Hair Institute offices in Costa Mesa, Beverly Hills and La Qunita.
The doctors at Pacific Hair Institute sometimes also add ACELL to further quicken the growth of transplanted hairs or miniaturized hairs. For more information, contact the office for an in-person consultation.
NONSURGICAL HAIR TRANSPLANT
Pacific Hair Institute protocol for nonsurgical hair transplanting, which means the stimulation and improvement in hair growth without use of a traditional hair transplant, is as follows:
1. Having a sufficient level of thyroid free T3 is critical to good hair growth. The normal range of free T3 in most laboratories is 2.2 to 4.2. Best hair growth is found at the upper end of that range around 4.2 and even up to 5.0. The problem is that when we are young, our thyroid gland makes plenty of T4, otherwise known as thyroxine. Thyroxine is an inactive form of thyroid hormone. Thyroxine or T4 is converted in the tissues of our body into T3, which is the active form. This is best measured by measuring the free T3 (that means that the amount of T3 is not bound to proteins in the blood). As we age, the ability to convert the T4 to T3 in our tissues falls off, so that by middle age or later, many of us are at a free T3 range around 2.2 to 2.5. This correlates with the symptoms of low thyroid including diminished hair growth, diminished nail growth, thinning of the outer third of the eyebrows, being colder than other people around you, less energy, and the like. For more information on this, see the Pacific Longevity Institute website. Thus, the protocol to stimulate hair growth, particularly in those of middle age or later, requires an evaluation and blood tests to see what level of free T3 is present, and then thyroid tablets in order to get it up to the proper level, preferably around 5.0.
2. Do a HairCheck machine evaluation initially, and then annually thereafter. The HairCheck is a machine that measures overall hair density, and so is a way to quantify the effects of this protocol on a person’s thinning hair.
3. Minoxidil 2.5 mg tablet daily. This is a replacement for Rogaine twice a day and much easier to utilize. No one knows the exact effect of Minoxidil, but it is stimulatory to hair growth.
4. Theradome Medical-Grade Laser, worn 30 minutes every other day. The Theradome is a laser which contains sufficient power in its diodes to penetrate the scalp down to the level of the hair follicle. The hair follicle lies on the underside of the skin. Most of the laser cap devices have red diodes, which do not penetrate to the correct depth.
5. Ketoconazole and/or Head & Shoulders Shampoo daily. Pacific Hair Institute recommends alternating these. This takes away the issue of hair itching and scaling.
6. It is important for hair growth that a person’s iron level be sufficient. This can be measured by a lab test, and then your physician can suggest the correct iron supplement, which usually has to be taken without any calcium in your food, to get your ferritin level to the correct and sufficient amount.
7. Three treatments of PRP at 6-week intervals, followed by one at 12 months. This is generally found to stimulate hair growth nicely. In addition, the recent availability of near fetal stem cells makes the combination with PRP in the first of the three treatments mentioned, may generally provide a vastly better response than PRP alone, and may well result in growth in 2-4 weeks.
8. For women, blood tests should be done to determine the testosterone and Estradiol levels, particularly if postmenopausal, and then pellets used to treat the deficiency of testosterone and Estradiol. Testosterone is the most plentiful hormone in a woman’s body, more than estrogen, and therefore important to hair growth. Please see the paper by Dr. Rebecca Glaser on the Pacific Hair Institute main website, which will describe her findings which show that a woman’s testosterone level up to around 100 to 150, will result in better hair growth than without any testosterone supplementation.
9. For men, testosterone pellets are usually indicated and required. These pellets are in much higher doses than that used for women. In either case, pellets need to be replaced every four months or so.
10. In addition to the above, a sufficient level of the following vitamins is important for best hair growth;
a Vitamin D3 5000-10,000 units daily.
b GNC Ultra-Mega vitamins or the equivalent which contain almost all vitamins and minerals required.
c Biotin 6000 units daily.
d Omega 3 capsule 2000-4000 mg daily.
e Iodine supplementation.
f Vitamin K2 of at least 500 mcg daily.
g DIM of at least 2100 mg daily.
Microblading is a form of semi-Permanent Makeup that provides a means to partially or fully camouflage missing eyebrow hair with the appearance of simulated hair using fine deposits of cosmetic tattoo pigments.
This technique is a process that may be used to improve or create eyebrow definition, to cover gaps of lost hair, to extend the eyebrows, or may be used as a full reconstruction if the brows have little or no hair. Each microblading stroke is applied individually, allowing the tattoo artist/beauty therapist to control the shape, color and density of the completed eyebrows.
The treatment begins with developing the desired shape, then using individual tattoo strokes or ‘feathers’ in the area to plot the shape and style requested. The color choice is patient-specific and is mixed using a natural selection of micropigments to complement hair color and skin tone.
Scalp pigmentation is a series of tiny dots tattooed onto the scalp between existing hairs. This treatment is used to cover up areas of the scalp that are easily seen due to thinning hair or scarring.
Scalp micropigmentation is also the process of replicating the appearance of shaved hair. When placed by a skilled technician, the recipient appears to have a full head of hair, shaved to a very short length.
Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP) treatment for hair regrowth is an in-office, non-surgical procedure completed in about an hour.
Platelets from the patients blood are extracted and condensed, then injected into the areas of the scalp needing stimulation. PRP contains growth factors and cytokines that have been shown to be responsible for stimulating and enhancing hair follicle function.
Two excellent candidates for PRP treatment for hair loss are patients with areas of “weak quality” hair growth on the scalp, where functioning hair follicles can still be observed, and patients with small areas of alopecia areata. These patients appear to have the greatest success with PRP.
According to published reports, PRP tends to improve hair caliber and hair growth for about four to six weeks, requiring treatments as often as every other month. However, by combining ECM or Extracellular Matrix (like ACell) patients achieve a stronger and longer hair growth result of about a year before another treatment is necessary.
It takes six to twelve months to see results. There is no activity restriction after a PRP treatment. Patients may shower/shampoo/ condition their hair normally just 24 hours after the treatment and resume normal daily and athletic activities. Use of topical hair growth treatments like Minoxidil 82M or similar can resume the next day. Laser therapy treatments can also be resumed the next day.
After the area of concern is identified, evaluated and measured, standardized medical photos are taken. Special gentle and sterile techniques and equipment are used to separate and concentrate the platelets and plasma from a small sample of peripheral blood. A small sample of the blood and PRP is tested in a hematology analyzer to measure and document the improved platelet concentration. PRP contains growth factors and cytokines that have been shown to be responsible for stimulating and enhancing hair follicle function. The PRP may be combined with ECM or Extracellular Matrix (like ACell or BioD) for a stronger and longer hair growth result. The scalp is prepared with antiseptic solution and anesthetic (a “ring block,” not simply local anesthetic gel) is used to completely numb the scalp for a 100% painless procedure. Small injections of the PRP deliver the powerful platelet-derived growth factors into the skin at the level of the weak follicles.
It’s best to measure improvements in Hair Mass Index using HairCheck months before the results are visible to the naked eye. Increases in Hair Mass Index using the HairCheck device predict how much visual improvement the patient is likely to see in the months to come. It takes six to twelve months to judge the results of PRP visually in the mirror or with standardized photos. Measurements are taken every three months, so the plateau phase of improvement can be tracked. When Hair Mass Index starts to decline, the patient’s next PRP is planned. With the exception of alopecia areata, the average hereditary hair loss patient can expect to need PRP with ECM on an annual basis.
Surgical Hair Transplant Procedures
What is a Hair Transplant?
Hair transplants are minor dermatologic surgical procedures in which hair follicles are transferred from the permanent and thick donor area around the sides and back of the head to areas of thinning or balding generally found on the front, top, and crown of the head, as well as eyebrows, beard areas, and sometimes even chest. In rare cases, even body hair can be used as donor, if it is very thick and luxurious in areas such as the chest.
Female Hair Loss and Transplantation
Hair Transplantation– Female Pattern Hair Loss
If there is sufficient donor hair on the back of the head, women can be transplanted one to three times in the area of thinning to recover decent density. Sometimes the thinning goes over the sides and back of the head so that there is insufficient donor hair to do all of it. Generally, in these cases, if one starts at the hairline and transplants back to the apex (or highest point of the head), a drastic improvement in appearance will be had by adding several thousand hairs to the top of the head. It is not necessary or possible to transplant the entire thinning area in many women.
We have been seeing ever more females with hair loss in the office. Usually this is a typical female-pattern hair loss, although occasionally there is a scarring alopecia or alopecia areata. The FUE method is normally best here.
Females with female-pattern hair loss, in about 50-70% of cases, have sufficient donor hair to transplant the top of their hairline, rebuild the hairline, and obtain a good result. For many years, we have done this by doing two procedures about 3-6 months apart. There is usually a temporary loss of the miniaturized fine hair in the thinning and balding areas on ladies, so rather than go through that twice, it is better to put the procedures closer together. We use a little bit less density in terms of grafts per square centimeter in ladies who still have a reasonable amount of hair in their balding area. This will reduce the hair shock after the first procedure.
Also of note, there are some women who have a diffuse thinning of their donor area, as well as all the rest of their head, plus a slight female pattern. These people are said to have diffuse pattern alopecia and, while the cause is unknown, they are not good candidates for hair transplantation because of the thinning in the donor area. Thus an experienced physician needs to examine the donor area to determine whether or not they are candidates. Recent evidence suggests low-dose testosterone and thyroid may help immensely.
History of Hair Transplantation
The history of hair transplantation began in 1931 in France, where French surgeon Passot moved some hair from a thicker area to a bald area, creating what is thought to be the first hair transplant. In 1939, Japanese hair researcher, Dr. Okuda published his results in a Japanese medical journal regarding his technique of inserting small hair-bearing grafts into needle-stick recipients to fill in defects in eyebrows. His work was lost during WWII. In 1956, Dr. Norman Orentreich re-invented the modern hair transplant while doing research into skin grafts.
Eyebrows are one of the most important defining characteristics of the face. Often you don’t even realize the full impact that eyebrows make until you see a person without them. With a hair transplantation, it is now possible to restore natural looking eyebrows that will last a lifetime..
Anti-Aging to Look and Feel Younger
Hormone replacement is one of the principal cornerstones of anti-aging therapy. For women, pellets containing bio-identical estradiol hormone are placed under the skin every four months to maintain proper estrogen levels. This is always supplemented by progesterone pills which are taken under the tongue daily. For men and women, testosterone pellets under the skin are the cornerstone of therapy. Women need a testosterone level of about 100 to 150 units for best overall body function, strength, sexual drive, and hair growth. Men need a level of about 1000-1200 units. These levels are protective for Altzheimers and heart disease.
Two principal factors contribute to how young you look and feel:
Your level of hormones still functioning in your body
For detailed information on the effects of hormones, visit:
Pacific Longevity Institute
Human Hair: Growth Cycle, Where Hairs Form at 3 Months.
Resting or telogen phase generally lasts about three months. When hairs are transplanted in a hair transplantation procedure, the small hairs in the hair grafts (which are about 1-2 mm long), will generally fall out within the first two weeks following the transplant. Those hair follicles then go into the resting or telogen phase for about three months. At the end of three months, the hairs will grow out.
NOTE: The telogen (resting) phase of a hair follicle is about three months – that’s why hair transplants grow at about three months.
Anatomy of the Hair Follicle and Follicular Unit
The hair follicle is a complex but small organ, which contains nerve fibers and blood vessels around the actual hair follicle. About 80% of hair follicles are paired. The rest are either singles, triples or an occasional quad. These clusters are called follicular units because they share a common blood and nerve supply. When doing hair transplantation and dissecting the donor area, it is important not to cut these follicular units apart because this generally results in miniaturized transplanted hairs rather than the full-sized hairs that are desired.