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A Procedure Step by Step

Posted February, 02/03/2010 - 14:11 PM
Question:

Determining Donor Density Via Photos

Answer:

The density of your donor hairs is the key factor for many patients- especially females- for determining the number of grafts I can transplant, as well as predicting the degree of improvement you can expect from a transplant.  The best photos you can send are those of the back of your head, with you parting your hair along a horizontal line along the line of the top of your ears and holding up that hair which is above the part line.  That will allow me to better assess the quality of your donor hairs.

In addition, a live webcam consultation, such as by Skype, can be quite valuable.

Posted by Jeffrey S. Epstein, MD, FACS

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Posted January, 01/03/2010 - 15:11 PM
Question:

Scalp Sensation Post Procedure and Chosing the Right Hair Transplant Surgeon

Answer:

I want to first start out by saying how I appreciate blogs like this on this website. To take this further, I've recently made one of the worst decisions ever by having a hair procedure done in one of those hair transplant franchise companies (in California).  The biggest problem has been their lack of customer service and communication.  I am very disappointed by the lack of care they would provide.  I had the procedure done 2 months ago and I still feel confused with many of the processes that have happened and what to expect in the near future.  I am in no way affiliated with these doctors here but already, I highly recommend them.  As proof from the blogs and other actions, they seem to be more concerned and helpful to the patients, which I find highly valuable during the recovery of the procedure.  I'm thankful there are good doctors like these around

As I'm currently lost in many things about my recent procedure, one of the things that have gotten me nervous is this sensation I feel on my scalp.  I've been going through some shock loss, particularly in the frontal part of the scalp.  Sometimes, whenever I move that particular frontal area of the scalp (such as, when I yawn or look up) I would feel this tightness.  Actually, it feels like I'm being poked by those grafts that are placed.  My hunch is that this sensation is felt because the grafts have been densely packed and my scalp is just recovering from all those grafts being placed in there.  I hope this symptom is normal and will go away soon.  Is anyone aware of this?

It is far too early to even begin to assess your final results Charles, and the sensations you describe are likely to improve with time.

Your experience highlights why it is so critical for prospective patients to do a lot of homework before choosing a surgeon.  This includes not just determining if the doctor is recommended by a legitimate hair site such as baldtruthtalk.com, but also seeing a lot of before and after photos and even meeting with patients who have had the procedure.

Posted by Jeffrey S. Epstein, MD, FACS

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Posted December, 12/28/2009 - 11:34 AM
Question:

Hair Transplants Can Yield Very Natural Results

Answer:

I also under went hair transplants and you won't believe that now i have beautiful hairs. I suffered hair loss since i was 20. I have taken medicines and other treatments. But nothing was helpful so finally i decided to go for hair transplant. Now i enjoy others compliment for such nice hairs.

That is wonderful news to hear.  Hair transplants, when performed properly, can create impressive results.

Posted by Jeffrey S. Epstein, MD, FACS

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Posted November, 11/10/2009 - 10:25 AM
Question:

Suffering from male pattern baldness and chemo for breast CA is a little hard to take.  Since the doctors say I'll be around long time I'd just as soon do it with hair. 

I'll be on Doxil long-term.  Infusion is once every four weeks.  Drug supposedly stays in the body for three weeks.  So, 1)  is it possible to have hair restoration surgery during the week the Doxil is supposed to be out of my system; or, 2) if there was a break in treatment, how long a period would be required for surgery to take place, given recovery times.

Answer:

You’re welcome Nancy.

Any chemotherapy drug can induce hair loss, and may occasionally impair the regrowth of transplanted hairs.  However, if having a transplant is a major priority, I wouldn’t hesitate to recommend a transplant procedure, as long as you understand the less reliable rate of growth.

Posted by Jeffrey S. Epstein, MD, FACS

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Posted October, 10/21/2009 - 18:36 PM
Question:

I am trying to schedule a hair transplant during my vacation time toward the end of the year and I was wondering how long after the hair transplant do I have to wait to go out in the sun without my head being covered? Would it be more than two weeks?

Answer:

I get this question several times a week. Probably because I live and practice medicine in Florida. In the past I have always told patients not to allow any direct sun exposure to the scalp until they can look in the mirror and not see any redness or discoloration from the procedure. Any time you expose already abnormally pigmented skin to direct sunlight you taking a risk that permanent changes will occur. Meaning there is a chance that there could be some degree of permanent redness. However, I now suggest to patients that they wait an additional 1-2 months to insure that the pigment of the skin immediately surrounding the newly grafted tissue will respond in a similar fashion to the adjacent tissue.

Posted by Jeffrey S. Epstein, MD, FACS

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Posted October, 10/21/2009 - 15:01 PM
Question:

Hair Loss After Significant Weight Loss

Answer:

Am from India.... i have lost my hair( infront side of head)  due to sudden hair fall. The backround is like i have not taken the proper foods 8months back to reduce  my weight. I had reduced my body weight but i have lost my hair... Hence please let me know  what is prodcedure for the hair transplant.

I usually recommend that after sudden hair loss due to some type of shock to the system i.e weight loss or dietary changes  that the patient wait a good 12 months before undergoing any type of hair transplant procedure.   During this time, it is best to take nutritional supplements like biotin, use minoxidil, and consider laser light therapy. 

Posted by Jeffrey S. Epstein, MD, FACS

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Posted October, 10/21/2009 - 14:24 PM
Question:

How effective is low level laser light therapy?

Answer:

Over the past several years, studies have confirmed the efficacy of LLLT, especially as provided with a multi-diode hood device (such as the Revage system).  Anecdotally as well, we have a number of patients, both men and women, who have reported very positive outcomes from the LLLT, including thickening of existing hair and decrease of hair loss. For this reason, we do recommend LLLT as a stand-alone treatment for most women and some men with diffuse pattern thinning, as well as adjunctive with a transplant procedure to help accelerate healing and the regrowth of transplanted hairs

Posted by Jeffrey S. Epstein, MD, FACS

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Posted August, 08/27/2009 - 17:24 PM
Question:

Hello Doctor, 

I would like to know if you can give me some urgent advice. I have just had a hair transplant and I am going to have a check up for breast cancer. I would like to know, would the transplant area grow back after chemotherapy or would I need to have another hair transplant??

Thanks for your time.

Answer:

Paula,
Hair loss that occurs with cancer treatment is usually caused by certain forms of chemotherapy, or radiation given to the skull region (usually because of brain involvement).  Any hair loss would expose the donor site scar and cause the transplanted hairs to fall out.

With regrowth of the scalp hairs, the transplanted hairs would regrow as well.

Hope that helps.

Posted by Jeffrey S. Epstein, MD, FACS

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Posted August, 08/23/2009 - 11:58 AM
Question:

Questions about the Miami Social (Bravo) Episode and General Questions about a Hair Transplant Procedure

Answer:

Question #1:  Dr. Epstein, I and my friends all watched your performance on Bravo TV--and we all watched with great interest. 

Neither of us had ever seen a reality TV show before.  I know you will be busy responding to fan mail, but we had many questions:

1.  Will the transplanted hair fall out (does it actually grow back?). 

YES, IT FALLS OUT AFTER 3 WEEKS OR SO, THEN STARTS TO REGROW IN 3 TO 4 MONTHS, WHERE IT WILL CONTINUE TO DO SO FOR A LIFETIME

2.  How long do these treatments last--are they dependent on the necessary blood flow problems that might have given rise to the hair loss in the first instance? 

PERMANENT.  BALDNESS IS NOT DUE TO ALTERED BLOOD FLOW-  IT IS A GENETIC PROCESS WHERE HAIRS IN CERTAIN PARTS OF THE SCALP (THE AREAS OF MALE PATTERN HAIR LOSS) ARE GENETICALLY PRONE TO THE EFFECTS OF A BREAKDOWN PRODUCT OF TESTOSTERONE CALLED DIHYDROTESTOSTERONE (DHT).  THE HAIRS FROM THE DONOR AREA (TYPICALLY THE BACK AND SIDES OF THE SCALP) ARE DIFFERENT GENETICALLY, AND THUS DO NOT FALL OUT.  TRANSPLANTED TO THE AREAS OF THE BALDNESS, THESE DONOR HAIRS WILL CONTINUE TO GROW.

3.  It seemed that the patient left your office wearing a bandana but the scalp looked as if it was still bleeding slightly.  Is that because of the procedure was not actually performed in real time--he didn't leave soon after the procedure was finished? 

BY THE TIME THE PATIENTS LEAVE THE OFFICE AFTER A 4 TO 6 HOUR TYPICAL PROCEDURE, THERE IS LITTLE IF ANY BLEEDING EXCEPT FOR SOMETIMES FROM THE DONOR AREA.

5.  Do you and your staff normally perform these procedures without wearing masks or, again, was that because it was more aesthetically interesting to watch the unmasked master perform his magic?

THE INCIDENCE OF INFECTION WITH TRANSPLANT PROCEDURES IS VIRTUALLY NIL.

UNLIKE MANY OTHER TRANSPLANT DOCTORS, WE ACTUALLY PERFORM THESE PROCEDURES USING STERILE TECHNIQUE.  HOWEVER, I DO NOT REQUIRE MASKS, FOR THEY DO NOTHING TO REDUCE THE ALREADY MINIMAL RISK OF INFECTION.

6.  The woman seemed to walk into the surgical room while the procedure was underway?  Is that usual, or again, a conceit of reality TV? 

REALITY TV.  THE PROCEDURE WAS ALREADY OVER AND THE CAMERAS CONTINUED

FILMING.

7.  Did you know that she was going to essentially come on to you while you were performing surgery?  Is there some kind of a script going on the entire way?  For instance, surely you must have known in the first segment that the patient was going to consent to having the procedure done. 

NOTHING WAS SCRIPTED FOR THE MOST PART.  I DID KNOW THAT MICHAEL WAS GOING TO HAVE HIS PROCEDURE (HE'S BEEN A FRIEND OF MINE FOR SEVERAL YEARS) BUT WE DID HAVE A REAL CONSULTATION.

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Posted August, 08/17/2009 - 12:49 PM
Question:

Hello, I've already had an in person consultation with Dr. Epstein back in December. I was wondering if he will be using PRP in the near future? If not will Dr. Charles be using it? Thank you, Dan

Answer:

Dan-  I have, along with Dr. Charles, been using PRP as a routine part of my transplant procedures for the past 2 months.  While results are still too early to determine the efficacy, the use of PRP has several likely advantages:  as a graft storage solution it likely enhances the percentage of take of the grafts;  injected into, as well as applied a post-procedure healing gel onto the areas of transplants it likely also further enhances the rate of hair growth as well as accelerates healing; applied to the donor site it likely improves healing and leaves a finer line scar;  and lastly, as a stand alone treatment it seems to reverse the hair loss process, making finer vellus hairs thicker and lighter hairs that have lost their pigment darker.

Our fee is quite reasonable for the PRP, essentially covering the cost of the procedure.

It would be a pleasure to discuss this further with you.

Posted by Jeffrey S. Epstein, MD, FACS

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