What should I expect from my consultation?

During your consultation, you will learn about the surgery, its limitations and risks, and discuss your needs and concerns. This will help Dr. Nabil Fakih understand your expectations and determine whether they realistically can be achieved. Dr. Nabil Fakih will carefully examine your hair to assess it to determine what type of procedure would best maximize your result.

After your consultation we will take photographs for your medical record and we will discuss the surgery fees and scheduling dates. Prices can be discussed during your consultation. You should come to the consultation prepared to discuss your medical history. You should provide any relevant information from your health doctors. Also provide information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries and medications that you currently take. It is important for you to provide complete information.

How does hair transplantation work?

Some of the hairs on your head are genetically resistant to balding patterns, and these hairs are often selected to be donor hair follicles. Your physician will locate the area of the donor hair and determine where the restoration site will be. The donor tissue is prepared for surgery, and the follicles are harvested.

The grafted hair follicles are placed onto the scalp using patterns that imitate a natural hair growth pattern. This procedure is generally performed using local anesthesia, and very minimal pain is felt during this process. After the procedure, your own donated hair will begin to grow to produce a natural look on your scalp.

Am I eligible for a hair transplant?

You can achieve the full head of hair that you are seeking in numerous ways, but one of the most effective ways is through hair transplants. There are three main factors that help your physician determine whether you are eligible for a hair transplant procedure, they include:

• Your age - If you are too young, you may not be eligible. As you age, you will naturally lose density in your hair, and the results of a hair loss procedure can be significantly diminished as you naturally lose existing hair in the future.

• The size of the area to be treated - For most individuals, the area of hair that needs to be transplanted and the size of the donor hair area should be small enough that any transplantation will look natural.

• Condition of your scalp - Besides hair loss, an otherwise healthy scalp is recommended to ensure that optimum results are achieved. Eczema or other pre-existing conditions can decrease the effectiveness of the hair transplant procedure.

Follicular Unit Transplanting (FUT) / Follicular Unit Strip (FUS)

Over the past decade the desire shared by both patients and physicians to achieve a natural-appearing cosmetic improvement in hair density and aesthetic facial framing led to the advent of micrografting, or Follicluar Unit Transplantation (FUT). By isolating the critical microscopic components within a hair follicle that are required for continuous regeneration of the hair, large “hair plugs” gave way to more refined, healthy micrografts, also known as follicular units (FUs). As a result, fine hair grafts containing a single FU can be safely transplanted into hair-bearing areas. The number of patients benefitting from this approach to surgery, in turn, has expanded to include women and younger men in the early stages of male pattern baldness (MPB).

The advantages of this advanced FUT technique are fourfold:

1. Less damage to any existing hair in the recipient area.

2. Less post-operative redness.

3. Micrografts grow slightly faster than traditional types of grafts.

4. Micrografts produce no clumping or plugginess.

The micrografts or FU are obtained in the following manner.

Donor Strip: Hair within the donor area (generally less than 1/2 inch wide and 5-10 inches long) is initially clipped to a length of about 2mm. Once the patient’s donor region is completely numb, a narrow “strip” of hair-bearing scalp is removed (any previous scar is also taken out at this stage). A single suture is used to repair the donor area and, with surrounding hair falling over the stitch, the area is immediately and effectively concealed. Afterwards, our patient’s scars are nearly imperceptible (averaging just under 1mm in width). 

Micrograft creation: Under microscopic visualization, tissue from the donor region is divided into a variety of graft sizes. From this delicate process, the finest single-haired grafts are generated to produce a natural appearance and multi-haired grafts are generated to achieve hair thickness. While each of the grafts created are unique, they are all referred to as micrografts.

A micrograft, or FU, refers to a graft that has retained the natural groupings of hair as seen on the surface of the scalp. Generally, FUs grow one-to-four-haired follicles. While there is variation with age, the majority of FUs naturally occur in two-or-three-haired clusters. In the early years of FUT, various factors contributed to the sub-optimal survival rates of transplanted grafts. Neither the optimal graft trimming technique, nor the ideal graft-to-recipient-site sizing had been clarified. In addition, instrumentation used for graft preparation still required further improvement in order to achieve current levels of transplanted graft viability.

Follicular Unit Extraction (FUE)

Using this technique, each individual follicular unit (FU) is carefully created directly from the scalp, rather than from a strip of donor tissue that has been removed from the scalp (See FUT). The FU are excised from the scalp using a small, sharp cylindrical punch (generally 0.8mm to 1mm in diameter) which incises the skin surface around each hair follicle before they are carefully teased out manually with forceps.

In general, FUE involves no suturing as well as less post-operative discomfort. But it has mostly gained popularity amongst those who often wish to wear their hair less than 2mm in length because – unlike the classical “strip” technique – it does not leave a linear scar in the donor area of a patient’s scalp. To accomplish this, FU removal is ideally performed in a random distribution within the safe donor region. After a single session or even multiple sessions of FUE, hair in the donor area appears to be slightly less dense than previously, but only upon close inspection.

One of the major potential drawbacks of FUE is the possible extraction of grafts that contain hair that is more likely to be lost over time. This potential problem stems from the mutual desire of both the physician and the patient to maximize the yield of transplanted FU in a single session. In general, the greater the number of FU transplanted using FUE, the more likely the session may include fewer permanent hairs and more temporary hairs that are destined to thin and ultimately disappear. Because increasing the yield of hair follicle harvesting during FUE requires selection of follicles from within a larger distribution of scalp donor area, a number of FU may be harvested from outside of the safe donor region. This zone is the region in which hair follicles will generally remain throughout a patient’s lifetime. When transplanted, hair follicles will continue to grow as long as they would have in their original location. Therefore, for a long-lasting correction of hair loss, it is imperative to transplant only FU that will remain throughout a patient’s lifetime.

The patients who benefit from FUE, are patients who want to have no linear scars at any time and who do not have the requisite scalp laxity for effective donor strip extraction should opt for FUE. As the amount of tension required to close the scalp after a strip has been excised increases, the likelihood of a wider than average scar also grows. On the other hand, scalp laxity does not significantly impact the cosmetic recovery of the scalp after an FUE harvest.

Another group benefiting from FUE is the population of patients who have pre-existing scarring. Using this advanced technique to transplant FU directly into a scar, it is possible to camouflage or eliminate even a fine linear scar resulting from a prior surgery. For this reason as well as the aforementioned advantage of transplanting the largest percentage of permanent hairs via FUT, many surgeons believe that a combination of FUT (single donor strip harvesting) followed by an FUE session is optimal to achieve the largest number of safe, long-term FU from the donor area while minimizing or eliminating any resultant scarring. 

What to avoid before surgery?

It is vitally important to avoid all blood thinning medications/supplements for 2 weeks prior to surgery. This includes any aspirin or aspirin-containing products as well as any anti-inflammatories such as ibuprofen or naproxen (including Motrin, Aleve and Advil). It is generally fine to be take Tylenol (Acetaminophen). Avoid supplements such as Vitamin E including multi vitamins, omega 3 fatty acids such as fish oil and flax seed oil. All of these medications can contribute to bleeding problems following surgery and can increase the amount of bruising. It would be useful to bring a list of any prescribed medications to your pre-op assessment. If you are a smoker, try and stop for the amount of time as outlined in each procedure as it can reduce the chances of complications.

Recovery

To help improve the healing process, patients are given the option of wearing a turban-like bandage overnight. They are issued three types of pain medication to tailor their analgesia. The following morning patients return for a gentle hair wash and bandage removal. Sutures are typically removed 8 to 10 days post-operatively either in our office or (if the patient has traveled a great distance to have the surgery with our practice) at their local qualified physician’s office.

Hair Growth

Contributing to the naturalness of the results is the gradual manner in which the transplanted hairs grow. Generally, patients will begin to see fine vellus hairs (like “peach fuzz”) growing three to four months after the follicles are initially placed. After six months, patients will have an idea of the results. However, it is not until 9-12 months post-operatively when the patient will appreciate full growth

PRP (Patelet Rich Plasma Therapy)

At Fakih Hospital, we have been performing PRP therapy as a proactive therapeutic option for male and female patients experiencing hair loss. PRP is an exciting non-surgical therapeutic option for patients who require stimulation of hair growth for hair loss conditions. Recent scientific research and technology provides the medical community with new understandings of wound and tissue healing. As a result of these scientific studies, we recognize PRP is an all-natural autologous medical procedure performed in physicians offices for scalp, skin, and hair stimulation.  While studies are slowing being published in the medical literature on the success of PRP, the hair restoration community remains cautious about making claims for hair restoration using exclusively PRP. In a recent study published in Dermatologic Surgery, physicians in Korea published data supporting the clinical application of PRP in hair restoration. A we encourage it and prescribe PRP therapy as a compliment to a nonsurgical approach for those patients who are not eligible for surgery or who want to delay hair restoration surgery. As a non-surgical treatment option, we recommend PRP therapy along with Minoxidil and DHT blockers or for those patients who can not tolerate or have side effects with these medications. It is recommended for all patients who do Hair Transplant to proceed with PRP Treatment to support the hair transplant. 

How does PRP works?

Human blood contains mesenchymal stem cells, and autologous blood products that contain essential and specific growth factors that assist in tissue regeneration and healing. Published medical literature from Europe and the United States confirms the safety and use of PRP therapy. It has been used a medial adjunct therapy for over two decades for skin and wound healing. PRP therapy has established itself to be effective as a medical treatment modality in the specialty fields of oral surgery, neurosurgery, plastic and cosmetic surgery, sports medicine and orthopedics. It has been used extensively in these specialties for the last twenty years with generally positive outcomes and success. In the field of hair restoration, evidence supports PRP therapy as a promising treatment option to promote hair growth. No claim can be made of its efficacy. While PRP is in the early stages of scientific research in hair restoration, PRP is not meant to replace current FDA approved therapies such as DHT blockers and Minoxidil. But it is a promising non-surgical therapeutic option for those patients with hair loss.

What should I expect from my consultation?

During your consultation, you will learn about the PRP, its limitations and risks, and discuss your needs and concerns. Dr. Nabil Fakih will carefully examine your hair and determine what type of procedure would best maximize your result.

After your consultation we will take photographs for your medical record and we will discuss the surgery fees and scheduling dates. Prices can be discussed during your consultation. You should come to the consultation prepared to discuss your medical history. You should provide any relevant information from your health doctors. Also provide information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries and medications that you currently take. It is important for you to provide complete information.

How the procedure is performed?

Blood is drawn in our office as though you are having routine blood testing at your primary care physician’s office. Through a simple blood draw (between 80 - 100 ml of blood, equivalent to 10-18 bottles of blood) from an individual into a sterile tube and is placed in a centrifuge and spun in order to separate the blood from the growth factors and platelets. We ensures a lot of PRP in comparison with others colleagues who they withdraw 1-2 tubes only. We use a closed sterile system and the platelets are concentrated to 3X the normal blood values. The system eliminates granulocytes which hurts tissue regeneration and wound healing. An anesthesia block is given to nerves of the scalp so the patient does not feel any pain. The highly concentrated platelet rich plasma (PRP) is then injected into the scalp. The patient’s hair is then washed and the patient may drive home without any assistance. PRP contains many growth factors that stimulate the hair follicle’s growth. PRP can be used preoperatively, intraoperatively, or post operatively. Some patient’s chose to have PRP performed every three (3) to four (4) months as early data suggests regular or semiannual PRP treatments that may stimulate hair growth. PRP is a potential emerging non-surgical based therapy for natural hair follicle stimulation for thinning hair. We offer to do it with Local Anesthesia or with Sedation (by our certified anesthesiologist doctor). We can offer the treatment combined with Vitamins mesotherapy that contains essential vitamins for hair regrowth as biotin and stem cells booster.

The Science about PRP

PRP contains special cells called Platelets, that can theoretically cause growth of the hair follicles by stimulating the stem cells and other cells in the microenvironment of the hair follicle. These special Platelet cells promote healing, accelerates the rate and degree of tissue healing and regeneration, responds to injury, and formation of new cellular growth. The primary purpose of using PRP in hair restoration is to stimulate inactive or newly implanted hair follicles into an active growth phase. Inside the Platelets are many intracellular structures such as glycogen, lysosomes and alpha granules. These granules within the PRP contain clotting and growth factors that are eventually released during the healing and repair process.

 PRP specific cells that causes hair growth include:

 • Platelet-Derived Growth Factor (PDGF)—promotes blood vessel growth, cell replication, skin formation;

 • Transforming Growth-Factor-Beta (TGF-b)—promotes growth of matrix between cells, bone metabolism;

 • Vascular Endothelial Growth Factor (VEGF)—promotes blood vessel formation;

 • Epidermal Growth Factor (EGF)—promotes cell growth and differentiation, blood vessel formation, collagen formation;

 • Fibroblast Growth Factor-2 (FGF-2)—promotes growth of specialized cells and blood vessel formation; and,

 • Insulin Like Growth Factor - (IGF)—a regulator of normal physiology in nearly every type of cell in the body

PRP therapy offers the opportunity for hair growth for those patients who are not candidates for surgery or those patients wanting a more aggressive nonsurgical approach to treatment. For our surgical patients PRP therapy is performed at the same day as the hair restoration surgery or before for a ideal preparation. Whether you are looking for additional hair stimulation, or are looking to have hair surgery with the addition of PRP. Results will vary from patient to patients.

Who should not have PRP Procedure?

Medical diagnosis such as platelet dysfunction syndromes, thrombocytopenias, hypofibrinogenaemia, hemodynamic instability, sepsis, acute and chronic Infections, chronic liver disease, anti-coagulation therapy, chronic skin diseases or cancer, metabolic and systemic disorders.