Hair Restoration

Hair loss treatments can address specific concerns about the appearance of the hair on your scalp due to a condition called androgenic alopecia. There are three general categories of hair loss treatments for androgenic alopecia, each of which may or may not benefit you. It is important to first undergo an evaluation by a dermatologist to determine whether there are alternative causes to your hair loss, such as thyroid problems, vitamin deficiencies, infections, auto-immune conditions, or psychiatric illnesses. Seek not only a fellowship-trained but also a double board-certified facial plastic surgeon to help determine whether – and which – hair loss treatment is appropriate for your concerns once alternative causes have been ruled out. Medications are Often the First Treatments Used for Hair Loss Medical treatment is often the first treatment tried for hair loss and is an important adjunct to surgical and non-surgical procedures. The two most frequently administered medications for hair loss are finasteride and minoxidil. Finasteride, which is available in oral and topical form, is generally prescribed to men only. Finasteride is an FDA-approved medication and an anti-androgen, meaning, it blocks the action of an enzyme called 5-alpha-reductase, which normally converts testosterone to other hormones that can cause hair loss. Finasteride is commonly prescribed for prostate enlargement. However, a much lower dose can be prescribed for hair loss. The topical form is less widely used but is sometimes combined with topical minoxidil. Minoxidil in topical form is an FDA-approved treatment for hair loss. Unlike finasteride, it is commonly prescribed to women and men. There are multiple potential mechanisms for the function of minoxidil in treating hair loss. It is important to note that, while finasteride and minoxidil can be effective treatments for hair loss, their effects last only if they are taken continuously. Hair is often lost again when these medications are discontinued. There are also many treatments being marked for hair loss that are not FDA-approved. Most are regulated as nutritional supplements, which have significantly lower standards for effectiveness, safety, and consistency in formulation. For example, saw palmetto is a common ingredient in these products for men due to the limited evidence that it may function similarly to finasteride. As with any medication, it is important to have a detailed discussion with your provider about the potential benefits, risks, and alternatives to the use of the medications and nutritional supplements above. Non-Surgical Procedures for Hair Loss Can be Useful Adjunctive Treatments One of the most popular and well-known non-surgical treatments for hair loss is platelet-rich-plasma (PRP). PRP, which is isolated from the patient's own blood drawn the day of the treatment, is a concentration of platelets whose effects are "activated" when injected around the hair follicles in the patient's scalp. Platelets release multiple signaling molecules that can help dormant hair start growing again. There is also evidence that PRP can improve the thickness of hair in some cases. Both men and women receive this treatment. It is typically administered once monthly for three sessions followed by a fourth session approximately six to eight months after the first. Treatments can be repeated every six to twelve months. Like hair restoration surgery, it typically takes a few months to notices the effects of this treatment. This treatment can be performed while taking medications and/or with hair restoration surgery to enhance the effects of treatment. PRP may benefit younger individuals who have less hair loss (e.g., mild-to-moderate) and/or who are not ready for hair restoration surgery. Other injectable treatment options include products such as exosomes. Exosomes are membrane-bound structures that carry different materials, including proteins and mRNA. There have been some promising studies performed in cultures in a lab, but no good human studies performed to demonstrate the effectiveness of exosomes in the treatment of hair loss. Another non-surgical treatment option is low-level light therapy. This involves the placement of a device over the scalp that emits red or near-infrared light. It requires multiple treatment sessions. It can also function as an adjunct to other treatments (e.g., PRP, hair restoration surgery, medications). The mechanism by which it can help treat hair loss is unclear and the evidence for its effectiveness is incomplete. However, like exosomes, it does show promise. Surgical Procedures for Hair Loss are the Most Definitive Treatment for Hair Loss Hair restoration surgery has advanced far beyond the unsightly – and obviously unnatural – "plugs" many people still associate with it. This is because techniques, technology, and our understanding of anatomy have improved greatly over the past twenty to twenty-five years. We have learned how to safely and effectively isolate miniscule groupings of hair follicles, called follicular units, and transplant them to other areas of the scalp to provide natural results for patients. Much of the marketing behind hair restoration surgery is based on the device offered to perform this procedure. However, that is not the best way to explain hair restoration surgery to patients. There are effectively two methods of surgical hair restoration surgery. Both operate on the understanding that hair follicles respond differently to their chemical environment on different areas of the scalp. There are some areas of the scalp where even individuals losing their hair tend to keep it, specifically over the ears extending to the back of the lower area of the head and nape. These hair follicles tend not to go dormant and disappear with the hormone-related changes that lead to androgenic alopecia. It is these hair follicles that are isolated and transplanted to areas of the scalp where hair is lost. One approach to hair restoration surgery is follicular strip harvesting and transplantation, also called FUT. This procedure involves the removal of a thin strip of skin from the back of the head with the hair follicles intact followed by careful closure of this site so the surrounding hair can grow over the incision as it heals. This is usually the best initial approach – though there are always exceptions – to hair restoration surgery, because it can provide the largest concentration of follicles from the smallest harvested area. The follicles also tend to be healthier, less traumatized and, therefore, more likely to survive and grow. The other approach is typically associated with the frequently marketed devices. Called Follicular Unit Extraction, or FUE, it differs from FUT in that a drilling device is used to isolate and extract individual follicular units rather than a strip with many follicular units. The harvested sites need to be spread evenly and randomly throughout a predefined area of the scalp. There are many different devices and many different drill shapes and sizes available for this procedure. FUE can be a good initial option if a patient wears their hair very short. Otherwise, it usually serves as an adjunct to FUT. For example, FUE can be used to harvest additional follicular units as needed if the FUT procedure falls short of the goal number of hair follicles. FUE can also be used for follow-up procedures when fewer follicular units are required. It is important to note that the density of hair follicles available for an FUT procedure drops dramatically when the strip is harvested in areas where FUE has been performed. That it is why FUT is usually the best first option. A commonly held concern among patients is the appearance of the hair follicle harvest site after surgery. There is a misconception that FUT can result in abnormal scarring and FUE cannot. FUT harvest sites are closed in multiple layers to minimize tension on the site. Hair is left in place around the surgical site to grow over it. As a result, few patients have noticeable scars after surgery. FUE results in small, pinpoint incisions that, if distributed properly, are generally minimally visible as well. The procedure does not end with the harvest of hair follicles. The surgeon then determines the location, angle, and pitch the hair follicles will be placed on the scalp by creating "wells" in which the follicular units can be placed. A team of technicians isolates the follicular units and places them in these wells. This team is essential to the success of any hair restoration surgical procedure. The design of the hairline and the appropriate distribution and position of each follicular unit requires intense concentration, skill, and an artistic eye. Medications such as topical minoxidil and non-surgical procedures including PRP and low-level light therapy are often incorporated into the procedure as adjunct treatments. Like PRP, it takes months before these transplanted follicular units start growing hair. In fact, it usually takes one year before the final results are evident. More than one session is often required to achieve ideal results. In fact, the International Society for Hair Restoration Surgery (ISHRS) surveys their members each year to learn more about hair restoration practice patterns. The 2021 statistics cited the average number of hair restoration surgery sessions required to achieve the ideal result was 1.4. A second session is more more likely required when there is little-to-no hair in the the area of the scalp transplanted, as demonstrated by the image of the patient below. The patient below is six months out from FUT hair restoration surgery. He is expected to experience additional improvements in the appearance of his hair for at least six more months. A second FUT procedure was planned prior to his first surgery for one year after his first. The goal of his first FUT procedure was to establish his hairline as well as establish density at the center of his scalp. The goal of the second FUT procedure is to increase the density of his hair in the area that was previously transplanted and to build out hair in his temples. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about hair loss. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

Follicular units, which are composed of one or more hair follicles (usually up to four) and important support structures for the hair generating follicles, are removed from a donor site in the back of the scalp and transferred to areas of hair loss during hair restoration surgery. One important factor, among many, to a successful hair restoration surgery procedure is the survival of these grafts between their removal from the donor site and implantation in the recipient site. As a result, extensive research has been conducted to determine the ideal solution to maintain these follicular unit grafts. However, there is no perfect graft solution. We at Harmon Facial Plastic Surgery feel our graft solution provides the best support to the follicular units prior to their transplantation based on the best-available scientific evidence. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Grafts are Stored in a Specialized, Chilled Solution Solutions surrounding cells can contain a concentration of electrolytes lower, the same as, or higher than the internal composition of the cells themselves. This affects the shift of fluid between the outside to inside the cells. Solutions such as saline and Plasmalyte are often used to preserve hair follicles. We at Harmon Facial Plastic Surgery use chilled Hypothermosol. Hypothermosol models the interior of the cells in hair follicles. This allows hair follicles to survive for hours off the scalp. Chilled solutions are especially important in reducing the oxygen demand of the follicular units and, therefore, the energy requirements of the grafts when they are outside of the body. This solution is more expensive than the alternatives. We feel our patients deserve this. ATP is Energy Added to the Solution The addition of energy in the form of the molecule ATP can extend the survival of grafts in the chilled Hypothermosol solution from hours to days based on research. Again, this is an added expense. However, it is worth it to provide the best result possible for our patients. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us

Hair restoration surgery, which includes follicular strip (FUS) and follicular unit extraction (FUE) procedures, is an excellent option to treat the most common cause of hair loss in men and women, called androgenic alopecia. The pattern of hair loss in men and women with androgenic alopecia differs, though the cause is similar. Here at Harmon Facial Plastic Surgery in Cincinnati, Ohio both FUS and FUE hair restoration surgery is performed for both men and women with concerns about hair loss. However, there are multiple causes of hair loss for which hair restoration surgery would not be a good treatment option. The examples below are not all-inclusive but present a wide range of potential diagnoses. It is essential that any individual for whom you have a concern about any of these diagnoses should be evaluated by a dermatologist prior to considering hair restoration surgery. Seek a fellowship-trained, double board-certified facial plastic surgeon if you have concerns about your hair and feel hair restoration treatments may be a good option. Inflammatory Causes to Hair Loss Would Not be Appropriate for Hair Restoration Surgery Two types of inflammatory causes to hair loss will be discussed below. They are distinguished by the fact that one family of diseases causes scarring of the scalp while the other does not. The family of diseases that fall under cicatricial, or scarring, alopecia result in hair loss due to permanent destruction of the hair follicle. Examination of the scalp demonstrates a complete loss of hair follicles as well as scar tissue. The cause is inflammation caused by one or more types of inflammatory cells. One example is called lichen planopilaris. It is more common in women and most commonly develops in your 40s and 50s. Patients typically experience an intensely itchy scalp associated with hair shedding. It typically affects the central scalp. When you look closely at the hair on the scalp you see scaling and redness at the base of the hairs at the location of the follicles. A second example is called frontal fibrosing alopecia. It was first discovered in post-menopausal women who were experiencing recession of their frontal hairline and temples. Unlike lichen planopilaris, itching is typically not associated with this disease. The skin where the hair is lost appears smooth and shiny, though the edge of the hairline that remains demonstrates inflammatory changes. Eyebrow hair is typically lost as well. A third example is central centrifugal cicatricial alopecia. This disease affects primarily adult females of African descent. The hair loss pattern typically starts in the center of the scalp and spreads radially, leaving just a few scattered hairs in its wake. The affected skin is smooth and soft. There are other inflammatory processes that result in hair loss without scarring of the scalp skin. One example is the autoimmune condition called alopecia areata. Unlike the above conditions, alopecia areata demonstrates waxing and waning - rather than progressive - symptoms and is reversible. It affects men and women equally and in a wide age range. Alopecia areata appears as small, well-defined patches without other symptoms that can expand or contract in size. A telltale sign of this disease on exam is the demonstration of what are called "exclamation mark" hairs, which appear to expand in width from base to tip. The patient's nails also sometimes develop an abnormal texture. Whether the inflammatory cause of hair loss is scarring or not, neither are generally appropriate for hair restoration surgery. These conditions should be evaluated and treated by a dermatologist. Infectious Causes to Hair Loss Would Not be Appropriate for Hair Restoration Surgery There are multiple infections that can cause hair loss. Though less common now, syphilis is one example of an infection that can cause hair loss. A more common infectious cause is tinea capitis, also known as ringworm. Tinea capitis is a fungal infection of the scalp than results in scaly, swollen, draining skin with associated hair loss. As expected, the exam usually strongly suggests an infection. These individuals are not good candidates for hair restoration surgery. Instead, they should be treated promptly by a physician specialized in the treatment of such infections. Hair Loss Related to Mental Health Would Not be Appropriate for Hair Restoration Surgery There is an impulse disorder in the family of conditions related to obsessive compulsive disorder called trichotillomania where patients chronically pull hair from their scalp. These individuals sometimes present to hair restoration surgeons concerned about hair loss. The symptoms typically start in late childhood but can persist into adulthood. Among the signs to look out for are hair loss that demonstrates a bizarre geometric pattern as well as evidence of recent bleeding from the scalp with hair removal. These patients are best evaluated and treated by a mental health professional for their symptoms. Hair restoration surgery is not appropriate for these individuals. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us References Blume-Peytavi U, Tosti A, Whiting DA, Trueb R, eds. Hair Growth and Disorders. Springer Publishing; 2008.