Non-Surgical Restorative Hair Protocol

Treatment Protocol to Stimulate Thinning or Transplanted Hair and to Optimize Hormones

  1. PRP – Three treatments at 6-week intervals then annually.
  2. Check Thyroid Free T3 initially, then annually, to make sure it is at top of normal range. Also, take iodine solution to supplement thyroid. Try to get free-T3 slightly super normal (i.e. 5.0).
  3. Do Hair Check initially, annually thereafter.
  4. Theadome Medical Grade Laser, 30 minutes, alternate days.
  5. Ketaconazole Shampoo 3 times/week, Head and Shoulders other days.

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.

arrow-leftThe Treatment

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. Electronic, mechanical microneedling is performed, after which residual PRP is rubbed on the microneedled area. A session of Low Level Laser Therapy is performed before the patient leaves the office.

arrow-leftTracking Results

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.

arrow-leftThe NeoGraft System

The NeoGraft System uses the Follicular Unit Extraction (FUE) method because of the vast benefits this less invasive technique offers. The FUE method removes individual hair follicles 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.

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arrow-leftFollicular Unit Extraction

Some patients prefer the alternative form of donor retrieval in which single follicular units are extracted by either manual punch, power punch, a robot, or neograft machine individually. Instead of having a very fine-line sutured scar in the donor area, in this method the result is a series of very small white-dot scars in the donor area. For this method to work, the donor area has to be entirely shaved and then the grafts extracted one at a time. In general, 1000-2000 grafts are the most that can usually be extracted at one time. Lifetime total ability to extract grafts with this method is probably around 4000 to at most 5000 grafts on a very large head. Doctors charge more per graft for this method (because it is extremely tedious and makes the day very long). With the strip method, a 2500-3000 graft strip can be taken out on one to three 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 .85 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)

Evaluation for Follicular Unit Extraction (FUE): 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 .85 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 two weeks.

• 3000 grafts by strip with Exparel (two-week anesthesia)
• Sutures out at two weeks.
• Next day, 2000+ grafts by micro FUE (.85mm) 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 micro FUE .85mm above and below the old scar line. In most cases, hairs can also be placed into the old scar line.

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.

Eyebrow Restoration

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.

Microblading: the secret to bold, beautiful brows for men & women

Scalp Micropigmentation: A series of tiny dots that are tattooed onto the scalp between hairs.

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 three 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.

Two principal factors contribute to how young you look and feel:

• Your genetics
• Your level of hormones still
functioning in your body

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.

CASE STUDIES

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.

Procedures, Testimonials and Case Studies

Locations

BEVERLY HILLS

1125 S. Beverly Drive, Suite 410
Los Angeles,CA 90035
(310) 914-4000 • FAX (310) 274-3931

NEWPORT BEACH

3140 Redhill Ave, Suite 260
Costa Mesa,CA 92626
(949) 263-0800 • FAX (657) 304-0084

SAN FRANCISCO

500 Sutter Street, Suite 510
San Francisco,CA 94102
(415) 986-1866

PALM SPRINGS

3001 E. Tahquitz Canyon Way,Suite 108
Palm Springs, CA 92262
(760) 320-4292• FAX (760) 322-9475

Feel that confidence again.