1. How much hair do I need?
2. What is hair transplantation?
3. What is the difference between density and fullness?
4. How do I know if I'm a good candidate for this?
5. Is it better to begin early?
6. Reasons for male pattern baldness?
7. How much hair do I have?
8. What is Follicular Unit Extraction?

1) How much hair do I need?

Dr. Sword will suggest how many grafts may be available for your first procedure (and subsequent procedures if you desire greater fullness). This will be based on your present loss pattern, what it may become in the future, and how much donor hair is available. People that have high donor density, tend to have follicular units usually containing multiple hairs, and people with low donor density tend to give a lot of hair units. If an individual has a very loose scalp, a larger donor strip can be removed while individuals with a tight scalp will have a smaller donor strip. When an individual has a relatively small amount of hair that can be moved, Dr. Sword will use his experience to distribute the available hair in ways that maximize the best coverage.

2) What is hair transplantation?

Even in the most extreme balding patterns a permanent "wreath" of hair exists on the sides and back of the head. This hair seems to be unaffected by the balding process. In multiple hair or follicular unit hair restoration, a strip of skin containing this permanent hair is removed from the back of the head. Because the skin of the scalp is flexible, the scalp can be stitched together again after the strip is removed. The hair follicles are then carefully removed from that piece of skin and placed in very small surgical sites made in the thinning/balding areas in the scalp. Once transplanted, this hair behaves as it is programmed to have and should grow naturally for the rest of your life, after a dormant period of 3-6 months.

3) What is the difference between density and fullness?

The word fullness rather than density more accurately describes the visual phenomenon in what we perceive as thick hair Vs thin hair. The concept of fullness is broader and more inclusive. Density, the number of hairs, (per centimeter), is only one of several factors that are responsible for the visual impression of hair that appears "thick". Other factors include hair shaft diameter, color, texture, and curl, which may be of equal or even greater importance than density in contributing to the visual appearance of a "full" head of hair.

4) How do I know if I'm a good candidate for this?

Most men in good general health are candidates for hair transplantation. Education is the key to ensure that the supply to demand ratio is equal to the patient's expectation. Understanding limitations to your individual traits and characteristics such as color and type (fine, medium, coarse) and pattern of thinning/balding are also important . Dr. Sword and the Patient  will help identify those together.

5) Is it better to begin early?

Surgical hair transplantation should not be used as a preventative measure. You should, however, begin thinking about it as an option when your degree of hair loss is unacceptable to you. If you are noticing some hair in the shower drain or on your pillow in the morning then it may be time to think about getting started. If there are no signs of hair loss, then you are one of the lucky ones (so far). Just keep your fingers crossed!

6) Reasons for male pattern baldness?

Male pattern baldness is genetic and can be inherited from either the mother or father or combination of both. Balding is triggered when dihydrotestosterone (DHT) molecules chemically bond with special receptor sites on hair follicle cells. This causes the hair follicle to weaken (miniaturize) and eventually to die. Once dead they can not be brought back to life again.

7) How much hair do I have?

The Norwood classifications were adapted to help determine typical loss patterns. Not all fit into these, but most do. There are 7 classes of hair loss in the main series and 5 variations of these called "A" series. Most men start to thin in the corners, and then some in the vertex, and over a long period of time at the top of the scalp. If you compare your hair loss pattern with the Norwood diagrams  Typical Loss Patterns, you can probably see the pattern you are in now.

8) What is Follicular Unit Extraction?

Follicular Unit Extraction, or FUE, is where hair is removed from the donor area in groups of 1-3 hairs by a 1mm punch. These are usually removed by hand, a highly repetitive and labor intensive procedure resulting in a transaction (loss) of 5% to 30% of the follicular (hair) because of the various directions of the hair as it leave the scalp. You cannot see the root as you push down on the skin. The skin tents inward and is distorted, pushing the root aside, thus risking damaging the root. Just push on your own skin and see.

The main advantage of the FUE, we are told, is the elimination of the linear donor scar which is usually only 1-2mm wide and easily hid by hair ¼" to ½" long. Although the individual scars of FUE are small, the cumulative scarring from hundreds to thousands of open wounds is significantly greater than from a linear incision often leading to see-through and moth-eaten appearance in the donor area. FUE also decreases the yield in future FUE sessions.

It is difficult to get more than 1,500 FUE in one session since you have to shave the entire back of the head. Patients with Norwood class 4, 5, 6, and 7 need 2,500 to 3,000 graphs, often more. It is best suited for patients with class 2 and 3 who want to keep their hair very short. What happens to these patients who loss more hair over time?

Because of the high transaction rate or loss of follicular units and the time consuming and tedious nature of the procedure there has been recent hype of using automation or robotics for the harvesting of donor hair. The first is ARTAS System or robotics’ selling for $200,000 and the other is the NeoGraft system, a hand held drill selling for $89,000. This cost is of course passed on to you.

I see FUE as an overhyped and underdeveloped technique that cannot match the "gold standard" set by modern follicular unit transplantation. It is being used as a marketing tool to get you in the door only for you find out it is double the cost of a microscopically dissected graph and that you are limited to only 500 to 1500 at a time.