What causes hair loss? Multiple causes include: genetics; hormone imbalances such as taking testosterone, thyroid dysfunction, menopause; tight braids (very common), tight pony tails and any hair style that constantly pulls on the hair.

General anesthesia, certain medications and chemotherapy can also cause alopecia.

What is the best transplant method? For the past 25 years, the best method is transplanting with follicular units. This means 1-millimeter grafts each with one to four hairs. This can be done by removing a strip of hair from the back of the scalp or removing small punch-like individual grafts (FUE).

These methods replaced the first hair transplants which had unnatural looking “plugs.”

Which is the best type of graft? The advantage of the punch-like grafts is no linear scar in the back of the head, so once healed, one cannot tell that a hair transplant has been performed. However, much of the scalp in the back must be shaved, and is noticeable for about seven to 10 days until the hair starts growing back.

The advantage of the strip method is that it’s faster. It’s important for grafts to be re-inserted and blood supply reestablished as soon as possible for healthier follicles. Also, with thin donor site hair, more grafts can be taken. There is no shaved area noticeable in the donor site.

The disadvantages are that sutures must be removed in 10 to 12 days, and there is a fine linear scar, noticeable with very short hair. Thus, the technique must be individualized.

Most women prefer the strip to avoid the shaved donor site. People with very short hair usually prefer the FUE, e.g. NeoGraft, with no visible scar.

Will a patient need another hair transplant? The transplanted hair can last a lifetime; however, the original hair in the balding area might continue falling out.

During the initial consultation, the doctor must advise the patient if the donor site is suitable for a second procedure, should more hair loss occur. Not everyone will be a candidate for a hair transplant or an additional procedure, and this must be carefully assessed by the hair transplant specialist.

What is the recovery time for a hair transplant? Generally, a week is necessary before routine shampooing can be done. The procedure is done under local anesthesia with oral medications to relax the patient during the procedure if desired.

Post-procedure pain is generally minimal. Patients might have headaches and swelling of the forehead if the grafts are placed in the hairline. Ice packs and mild analgesics are recommended.

When does the hair start growing? The first grafts start growing hair at three months. Maximum density is at 18 months, although at five to six months the hair growth is significant.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com