Intro SpaMedica Toronto has prepared this Guide for future and existing patients to gain insight into Hair Transplantation and FUE (Follicular Unit Extraction). In this Guide you will learn about hair loss and its causes, the hair growth cycle, modern methodologies and technology for hair restoration and more. Our clinic boasts the experience of a wonderful group of Hair Specialists led by Dr. Mulholland, one of the foremost experts in Hair Transplantation. His team includes Isaac, Lilybeth and Ana. Hair Transplant a lot safer and more efficient today than it was 20 years ago when Dr. Mulholland first opened his practice. Learn about modern technology and determine if Hair Restoration is for you. Common names for Hair Transplantation: Hair Restoration, Hair Replacement Surgery, Hair Growth Surgery 2
Table of Contents Hair Anatomy of Hair Hair Function Hair Growth Hair Loss Self Evaluation Statistics Myths Culture History Hair Restoration Journey Consultation Pre-Procedure Procedure Post-Procedure Donor Area Recipient Area Aesthetics FUE/FUT Artas/NeoGraft Considerations Candidates Medical Tourism Selecting the Best Clinic Women Hair Loss Brow Transplants Nonsurgical Nonsurgical Hair Restoration PRP The Details Timeline Cost FAQ Wrapping It All Up Summary About the Author About SpaMedica Hair Commitment Savings 3
Hair Anatomy of Hair Hair Function Hair Growth Hair Loss Self Evaluation Statistics Myths Culture History 4
The Anatomy of Hair The hair is one of the essential parts of the skin, providing warmth, protecting us from potentially harmful objects and it also contributes to our appearance and we all want to look good. The hair is considered a physically distinct feature known as a skin appendage. There are multiple appendages on our skin such as toenails, fingernails and sweat glands. Let s start with the skin your hair grows out of. providing the skin with durability and protection. This region also contains the subcutaneous glands and sweat glands. The subcutaneous fat and connective tissues, beneath the dermis, are a group of larger sensory nerve branches and blood vessels nourishing the skin with oxygen. Our skin is composed of three layers: epidermis, dermis, and subcutaneous fat and connective tissues. The epidermis is the outer layer of skin that is less than a millimeter in thickness, composed of dead skin cells that are constantly shedding and replacing itself. The dermis, located below the epidermis, is about two to three millimeter thick on the scalp, 5
The Anatomy of Hair Hair Follicles and Hair Shaft: Found in the upper part of the subcutaneous fat are the hair follicles which are three to four millimeter in length, containing one to four hair shafts. The hair shafts are composed of three layers: Cuticle is the outer layer of the hair, the part of the shaft that are visible to us with our naked eye. Cortex is the middle layer of the hair and provides the hair strength. It is composed of a protein called keratin. This protein is also found in the horns of rhinoceroses. Medulla is the innermost layer of the hair and only present in terminal hair follicles. Terminal hair is long, thick and dark compared to hairs that are vellus. During puberty, with the increase of androgenic hormone levels, the vellus hair will be replaced with terminal hair. The terminal hair is more common in men and found in regions such as the chest, arms, foot. Our scalps only contain terminal hair. 6
Hair s Function One of the more defining parts of a mammal is the hair on their body. Hair has many functions; among them is the hair in the nose that protects the lungs from inhaling harmful objects. The eyelashes protect harmful tiny objects coming in contact with the eye! Hair acts as an insulator, especially during the colder months, trapping the heat that is being expelled from the body. Hair also protects you from sun causing burns to the scalp! Among the helpful factors of hair, it is also cosmetic and important to men and women in defining their look. 7
Phases of Hair Growth The average amount of hair follicles on the scalp is about 100,000 to 150,000. In comparison, the human body contains over 5 million follicles. About 90% of the terminal hairs on the scalp are actively growing, meaning the hair is in its anagen phase. There are three phases in the hair growth cycle anagen, catagen and telogen. In the anagen phase, the hair is actively growing, lasting about 3-5 years. The hair grows about half an inch a month. A full length hair ranges from 18 to 30 inches. At the end of the anagen phase, the hair enters in a catagen state for approximately ten days. It is known as a transitional stage, in preparation of shedding the hair shafts grown in the anagen growth cycle. Following the catagen phase, is the telogen phase in which the hair shafts fall out. The follicles enter a dormant restive state for approximately three months before starting the process of re-growth again with the anagen phase. Each hair follicle has its own independent cycle, hence most of us will not have our hair fall out all at once. Hair loss occurs for various reasons such as a change in diet, metabolic changes, improper nutrition, physical causes and most commonly, aging. 8
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Understanding Hair Loss What is Hair Loss and How Does It Occur For most, hair loss or balding is a source of stress and frustration. The medical terminology for both is alopecia. There are varying types of alopecia and causes for it environmental and which happens due to various reasons such as environmental, physical or emotional causes. Alopecia There are several types of Alopecia, some being less severe than others Alopecia Areata The condition is generally known as spot baldness, with small patches of bald spot appearing in some or all areas of the body. Risk factors for the condition include family history, diabetes and other autoimmune diseases. There is no cure currently for Alopecia Areata. Doctors may administer drugs and topical creams to lessen the effect of Alopecia Areata. 10
Types of Hair Loss Androgenic Alopecia Pattern Balding or Androgenic Alopecia is caused by hormones. In men, testosterone breaks into its derivative structure called dihydrotestosterone. The derivative structure is responsible for the thinning of hair follicles. Once very thin, the pockets that held the follicles are not able to contain them, eventually causing hair follicles to fall out. In females, it is not understood what the exact cause is, however general consensus boils down to aging, hormones and genetics. The hair loss in women occurs with thinning all over the head and typically the hairline doesn t recede. 11
Types of Hair Loss Alopecia Barbae Alopecia Barbae occurs on the facial area such as the beard and mustache. Potential signs of Alopecia Barbae is small patches of bald spots underneath your beard or on the sides. Alopecia Totalis or Universialis Patients that lose all the hair from their head with Alopecia Totalis or Universealis. Some patients even experience the loss of hair all over their body, including their eyebrows. 12
Types of Hair Loss Ciatrical Alopecia Ciatrical Alopecia is known as the scarring alopecia. When permanent scarring occurs, the hair will not experience any growth in the region. Burn patients may also experience Ciatrical Alopecia. Traction Alopecia Traction Alopecia is caused by the individual self, whether it is extreme pulling of the hair, ponytails, braiding, harsh hair products, etc. If found early enough, the condition can be reversed, however there is a possibility of permanent hair loss. 13
Types of Hair Loss Anagen Effluvium Hair loss caused by chemicals or drugs to treat cancer generally cause anagen effluvium. Hair loss can be gradual balding to patchiness. The condition is usually reversed six months following the stoppage of drug therapy. 14
Types of Hair Loss Telogen Effluvium Telogen Effluvium is hair lost by shock or stress. This condition typically subsides in most patients and can last anywhere from a few weeks to a few years, depending on the condition. In most cases the hair loss from Telogen Effluvium is temporary. Causes: Childbirth Drugs Change in diet Physical trauma Vaccination Chronic illnesses Weight loss Excessive amount of stress Medication If patients believe they fall under any of the hair loss conditions, they should have themselves checked by a doctor or hair specialists to be evaluated. 15
Where Are You now? Male-pattern hair loss can be broken into six classes, Norwood 1-6. Norwood 1 patients generally have a little temporal thinning and temporal recession. Norwood 2 through 4 patients have variable temporal recession and crown thinning. Norwood 4 through 6 patients start connecting the temporal and frontal thinning and recession with an expanding thinning of the crown until Norwood 6 Male-pattern hair loss arises, which results in complete baldness at the front, middle and back of the top of the scalp. Patients who fall under one of the stages of Malepattern hair loss from Norwood 1-6 are candidates for FUE and transplantation procedures using Artas and NeoGraft automated and robotic hair restoration techniques. 16
Hair Loss Statistics Everyone sheds hair, it is very normal. In fact, according to the American Academy of Dermatology, shedding between 50 and 100 hairs a day is fairly typical. If the body sheds more, it is medically classified as Telogen Effluvium. Hair shedding typically lasts only six to nine months, whereas hair loss potentially lasts forever. Hair loss can occur due to hereditary, drug therapy and poor hair products. In Canada: 1 in 8 respondents believes that hair loss is an obstacle to employment or promotions 1 person out of 4 believe that it s more difficult for a man who is losing his hair to have a romantic relationship 1 out of 4 Canadians with hair loss do not know who to ask for help 50% of men are affected by male pattern baldness (Androgenetic Alopecia) at some point in their lives, and 80% of men by age 70 (CDA) 40% of women show signs of female pattern baldness by age 50 (CDA) 17
Hair Loss Myths Unfortunately with media and old child tales, hair loss is vastly understood. With science and research, today we are able to assess the proper reasons why hair loss occurs among humans. Here are some common myths that people relate hair loss to: 19% of people associate wearing a hat with baldness. Wearing a hat does not contribute to hair loss. An unclean headwear can lead to infections however. 13% associate over-brushing hair with hair loss. While you may be able to pull out a few strands of hair, over brushing does not cause hair loss. 10% equate shampooing too much with baldness. Whether you shampoo your hair or not often, it does not have effect on your hair loss. The chemicals from the shampoo may potentially damage your hair, but it is not proven to cause permanent hair loss. No cure is available for balding this is not true; there are multiple treatments available to help stimulate growth. This guide will illustrate how modern Hair Transplant treatments have been effective in patients that experience balding and hair thinning. Some patients may experience short-term hair shedding from wearing a ball cap or shampooing, but unless you are pulling at your hair aggressively, it is rare for permanent hair loss to occur without natural aging and genetics. Confirm your doubts by consulting with a hair specialist if you have any questions or concerns. 18
Hair and Culture Hair has an important place in history and culture for both men and women. Long luscious hair was always a sign of femininity and beauty for women. During the World Wars, women who were not allowed to enter would cut their hair to secretly be enlisted. Such incidences include Maud Butler, a teenage girl from Hunter Valley, who was only 16 when she decided to dress up as a soldier. She was ultimately caught by the men of the army. Oddly enough it was neither her hair nor her feminine body that gave her away. It was her wretched black boots a suspicious officer discovered that gave her identity away. "It was these wretched black boots," Maud said. "I could kick these boots round the room for vexation. 19
Hair and Culture During World War I, shaving was required for the proper fitting of gas masks and personal hygiene. It was during World War II men going to battle were universally required to have shorter hair on top. It was not too long ago, Generals were serving in the Civil War of America with full hair and facial hair. Ambrose Burnside, a Union Army general in the American Civil War fashioned unusual facial hair, with his sideburns connecting to his mustache. Many areas in Asia adopted shorter hair in the 17 th century, especially in the Chinese and Islamic cultures. Today, hair is seen as fashionable and a form of self expression. 20
The History of Hair Transplants The history of Hair Transplant dates back prior to World War 2. It all started with a Japanese doctor, Dr. Okuda, was performing hair transplant on the eyebrows of trauma patients. In 1952, Dr. Norman Orentreich conducted the first modern hair transplant at his practice in New York. By the year 1961, he had already performed the procedure on 200 patients. While at New York University Skin and Cancer Hospital, Dr. Norman studied skin grafts and hair follicles. He came to the conclusion it was surgically possible to take hair from donor sites and transplanting them on the recipient site where it would grow healthily and last a long while. Dr. Norman s introduced the principle of Donor Dominance illustrating bald resistant hairs from the back of the head maintained its characteristics irrespective to where the hair was implanted. Meaning, as long as the hair follicle from the donor site was healthy, it will continue its intrinsic qualities wherever it is implanted. 21
The History of Hair Transplants In the 90s, strip grafting became the popular choice of Hair Transplant surgery. This involved the removal of a strip of skin from the back of the scalp; the hair follicles were removed from the strip and implanting onto the desired site. The downfall of the strip grafting method was that it often left linear scarring on the back of the scalp. Many patients did not prefer this method and were hesitant about hair transplant. FUE became the preferred choice of Hair Transplant in the mid 2000 s. It is still the most desirable choice of procedure for patients. New robotic and computerized systems such as the ARTAS and NeoGraft help evolve Hair Transplant by reducing the sight of scars and reducing the margin of error. In the next section, you will learn more about FUE. 22
Hair Restoration Journey FUE/FUT Artas/NeoGraft Candidates Consultation Pre-Procedure Procedure Post-Procedure Donor Area Recipient Area Aesthetics Considerations Medical Tourism Selecting the Best Clinic 23
Options There are two primary techniques for hair transplantation currently in use. The FUE (Follicular Unit Extraction) and the FUT (Follicular Unit Transplantation) methods. They differ primarily in the way hair follicles are extracted from the donor area. The FUT process involves removing a small strip of tissue from the back of the head, from which the donor hair follicles will be extracted. The hair follicles are harvested from the strip by a skilled clinical team before being individually transplanted to the recipient areas. In most cases, and especially cases of advanced hair loss, FUT is the preferred method because it allows the physician to fully utilize the scalp area to deliver results consistent with patient expectations. FUT typically allows for the greatest number of grafts to be transplanted in a single session. FUE is a non-linear scarring hair harvest technique where the individual hair bulb and the shaft that share the root are harvested using high tech methods that do not leave a linear strip graft scar. This is one of the biggest improvements of modern day Hair Transplant versus the previous gold standard of strip grafting. 24
Options 25
FUE Over FUT Why Dr M and SpaMedica s hair specialists prefer FUE over FUT: The FUE does not leave any linear scarring. With the FUE system such as the ARTAS and NeoGraft, it only leaves small unnoticeable marks at the site of hair extraction. These are small circular marks with a 1mm diameter or less. Faster healing. Patients can expect to heal quicker with minimal pain. Patients boast little downtime. Expected healing time is three to seven days. The FUE systems are more precise and efficient than the FUT. The Artas for example, calculates where to extract the hair follicles, optimizing the hair to look as full as possible while removing hair units. In strip grafting there is a higher potential for human error. 26
NeoGraft What is NeoGraft? NeoGraft is a new device which facilitates the automated harvesting of follicles during an FUE-type hair transplant, dramatically improving the accuracy and speed over previously-used manual extraction instruments. The surgeon or technician will select the proper angle, depth and rotatory punch speed for most patients. NeoGraft has the advantage in previously harvested scalps and, so for secondary hair transplantation NeoGraft is the best. 27
Artas Robotic What is Artas Robtoic? Artas is an Automated Robotic follicular unit harvesting system, that like NeoGraft automates the process of FUE harvest. The depth and angle of the hairs to be harvested is set and the high tech Robot does the rest. Artas Robotic Hair Restoration is good for certain hair types, anatomy and first time FUE harvests. 28
Good Candidates for FUE Good candidates for FUE hair restoration are those individuals that desire no linear scar at the back of their scalp and have either genetic hair loss or a post-traumatic hair loss. They have realistic goals about the amount of hair and density that can be achieved with hair restoration and transplantation procedures. Good candidates realize that it takes at least 9 months to a year to see changes before considering a second procedure. 29
Consultation Process During the consultation, you will get to meet the hair technicians. They will thoroughly guide you through the process and expectations. In the consultation, you should ask questions and address concerns you have for the procedure and your health. The surgeon will want to know any medications, allergies and health conditions that may interfere with the procedure. Be completely honest with your surgeon as this will be in your best interest. The Hair Technicians will examine your scalp and evaluate the best site to remove the hair follicles from (the donor site). Your Hair Technician will also identify the best area to implant the hair follicles. Be prepared to review your medical history, including any previous surgeries. 30
Consultation Process Questions to ask your surgeon Who will be performing the procedure? How many years of experience do you have in Hair Transplant and FUE? What should be my expectations? May I see before and after pictures of Hair Transplant patients? Are there any health conditions I should notify you about that may complicate the surgery? What are the potential risks that I should be aware of? What payment options are available for me? Do not shy away from asking the questions that will benefit you in making your decision on getting the Hair Transplant. Create open communication with your surgeon. 31
Pre-Procedure To ensure a successful procedure, you will be required to follow some pre-procedure instructions: Your Hair Technician will provide you guidelines to follow. Here are some basic courses of action you will have to take ahead of your surgery: 1. Do not drink alcohol three days prior to surgery. Drinking alcohol has been proven to slow down the healing and weakening the immune system. 2. Do not smoke at least two to three days prior to surgery. Smoking inhibits your healing process and your surgeon may elect to cancel your procedure if there are any causes for concern. Complications with the anesthesia can potentially arise if the patient is a smoker. 3. Certain medications and vitamins will need to be stopped for a couple weeks. Discuss with your Hair Technician which of your medications are appropriate to take and which should be stopped. 4. Avoid blood thinners and anti-depressants. If these are required and vital to your health, discuss with a doctor and surgeon. 5. Protect your head from the Sun to avoid Sunburn. This will make hair extraction difficult on your scalp. 6. Unless specified differently, do not drink or eat after midnight, including water and gum. 32
Pre-Procedure Every individual is unique, your Hair Technician and Surgeon will carefully plan out your preoperative and post-operative guidelines specific to your health and condition. Be sure to ask the following questions in the lead up to your surgery: 1. What tests should I have done prior to the procedure? 2. Which of my medications will need to be stopped ahead of the surgery? 3. When do I need to stop eating and drinking? 4. Will a blood test need to be taken? 5. Inform your Hair Technician and Surgeon about your medication and drug history, family health problems, recent surgeries, and how often you smoke and drink alcohol. 33
Procedure The first technique deploys the robotic and automated Artas hair transplantation system. Toronto FUE hair transplantation patients benefit from this high-tech robotic hair restoration harvest using the Artas Robot. The Artas Robot uses very precise computer generated programs and algorithms to ensure the most accurate and precise harvests of individual follicular units. After being programmed, the Robot is able to send a tiny rotatory punch in the scalp and core out and extract the desired follicular units. The Artas Robot s parameters are set to precisely match the angle and depths of your follicular Units. For the Artas Robotic hair restoration procedure, patients must shave the scalp region fairly short, somewhat less than a number one blade, and the size of this patch of shaved hair, where the FUEs are harvested from, depends on the number of follicular units and hairs the patient needs. Using very sophisticated computer-driven algorithms, the robot extracts all the larger four, three and large two-hair follicular units, using the robotic, rotatory extraction technology. The robotic system and the on-board computer also plan the density of the extraction very evenly, so that no area of the occipital and temporal donor sites at the back and side of your scalp is overharvested or thin looking. 34
Procedure For women suffering from Female-pattern hair loss who undergo Artas or NeoGraft the hair at the back of the head that is just above the shaven patch, can fall back down over the shaven patch and completely camouflage the donor site while the hair stubble surrounding the follicular unit extraction site grows out to hide the donor punch holes, which are barely visible to the naked eye by 4-7 days. 35
Procedure In the same session, patients will benefit from another high tech FUE hair transplantation technology called NeoGraft. The hair technicians will deploy the NeoGraft automated FUE hair transplantation system immediately after the Artas robot. NeoGraft also uses an automated rotatory punch and FUE extraction system. The NeoGraft has slightly more human control than the Artas robot, and allows the use of extremely small.8 and.9-millimetre diameter punches for the harvest of the very small single-hair and double-hair follicular units that are very important to create the most natural frontal hair lines. By using a combination of the Artas robotic FUE hair transplantation system and the NeoGraft automated FUE transplantation system, your hair restoration program affords you a donor site, with the least possible degree of transections, smallest amount of linear scarring at the back of the head and highest possible graft take rate available on the market. Before After 36
Post-Procedure Depending on the type of procedure, your surgeon will suggest a certain treatment plan. Your treatment will depend on a few variables: How intensive was your hair treatment and how many grafts were needed Type of anesthesia and care needed How sensitive your scalp is Your health condition and any possible resistance to medications Your surgeon and hair technicians will outline your post-hair transplant treatment for you. It is important you follow their instructions for the quickest and safest recovery and the best possible outcome. 37
Donor Area Most patients are able to return to work in 7-12 days, depending upon the nature of their job. Thus, if you are a male and you wear your hair fairly short, it is important to schedule a vacation of ten to twelve days following your transplantation session until you return back to work. If you are a male with male-pattern hair loss that wears their hair relatively long at the front and temporal areas of their scalp, or a female with long but thinning hair at the front and very long hair at the back, generally one can return to work within 7 days. 38
Recipient Area Freshly grafted temporal recipient site on day 3. The patient has enough temporal hair that the scabs and stubble from the transplant can be hidden 39
Hair Transplant Aesthetics In addition to the technical skill required to perform hair transplants, an artistic eye is needed. To ensure proper aesthetics, the surgeon and hair technician will focus on: 1. Proper selection of donor sites 2. Graft size 3. Design of the hairline and placement of the recipient sites Note: Some doctors create the same standard hairline on every patient. This is less than ideal. Natural hairlines vary from one individual to another. Few natural hairlines are symmetrical, so your hair transplant team should not focus on creating a symmetrical hair line. Ethnicity comes into play there are definitely patterns of hairline structure for groups descending from different areas. Be active in the discussion about your hair line and ensure that it is not placed too low. The only recourse when the hair line is placed too low is surgically removing the transplanted hair. 40
Hair Transplant Aesthetics Understanding the characteristics of hair in different ethnic groups is an important part of the process. African hair tends to be very curly. This makes African hair produce some of the best results in hair transplantation. However it does require precision and extreme care to avoid damage to the curved follicles. 41
Hair Transplant Aesthetics Most Asian hair is black, coarse and straight, making this hair type the most difficult, especially when the skin is fair. Very small grafts seem to work best. Light/Fair haired Caucasians with a low contrast between hair and skin tones typically see great results. Using only naturally occurring individual follicular units produces natural results with all hair and skin types. Your team also has to look at how the hair grows. It grows in different directions in different parts of the scalp. Hair in back of the head grows backward and downward; hair in the front and top grows forward; hair on the sides of the head grows away from the middle of the head. The place where they meet in the crown is reflected in the "cowlick." The surgeon will analyze YOUR natural growth patterns and hairstyle preferences to craft the best transplant outcome for you. 42
Hair Transplant Aesthetics The Bottom Line: Your transplant, whether it is to increase fullness or improve the hairline, is not just about the amount of hair moved or the number of grafts. The surgical process requires the design of your transplant, factoring in all of the elements: 1. Current balding pattern 2. Projected hair loss 3. Hair density 4. Hair and skin color 5. Thickness of each hair shaft 6. Hair character: straight, wavy, or wiry 7. Scalp laxity Some of you are better hair transplant candidates (more hair, better color, thicker hair shafts, wavier hair) than others. Discuss this with your surgeon at your consult. 43
Hair Transplantation Considerations Patients should start considering Hair Transplantations if: Have receding hairline Have bald patches Have hair thinning Have a family history of hair loss The Hair Loss is not occurring due to chemotherapy or stress If you are noticing a good amount of hair being lost over a period of several weeks or months, it might be time to schedule an appointment to have you hair follicles examined. 44
Medical Tourism Medical Tourism is seeking cosmetic procedures in foreign counties. Our Hair Technicians advise not to have procedures done abroad due to complications and potential health problems that may arise. Some potential complications: Not being familiar with the country s law and qualifications required for medical practices in foreign country Communication with doctors and nurses is a potential problem. Not having a medical staff that is fluent in your language can create misunderstandings and impact your recovery and care. Potential of counterfeit drugs or low quality medicine is still an issue in some foreign countries. Often times, the cost of traveling and getting the procedure done equals to or exceeds the cost of surgery in your home country. Patients also do not enjoy their vacation as much as they anticipate due to the nature of downtime following surgery. 45
By getting the Hair Transplant done locally, patients have the benefit of visiting their clinic to report any health problems and complications. Many clinics will not operate or consult on patients who have gotten their procedure done abroad when they require additional surgeries. It is a big liability on the surgeons to perform surgeries on patients who have been operated on by an unqualified and uncertified doctors and technicians. It is strongly advised to consider speaking to your family physician before considering going abroad. 46
How to Select the Best Clinic Here are three things you should look for when finding the best hair clinic and specialists: COMFORT: Find a hair specialist that you are completely comfortable with. Interview the hair transplant specialists around your area and get a feel for their personality. Are you able to discuss important health matters with them and is the conversation interactive? Do you feel heard and understood? RESOURCES: Ask the specialist what resources they have for your research and what kind of after-care they provide. You must have a specialist that is able to have your health as a number one priority especially post-op. EXPERIENCE: Ask the specialist about their experience and ask for their before and after pictures. This gives you a fair idea of the work the specialist has performed in the past and their credibility. 47
Women Hair Loss Brow Transplants 48
Female Hair Loss Female-pattern hair loss generally does not progress to full-scalp baldness, but, rather a generalized and often embarrassing thinness. Follicular Unit Extraction (FUE) hair restoration and transplantation techniques for females are very successful, using the NeoGraft and Artas automated and robotic techniques. A patch of scalp is shaved and the Artas robotic and NeoGraft automated FU extraction system is deployed to extract the necessary number of follicular units to help fill in and create a more dense front and middle of the scalp. At the end of the procedure, the long hair at the back will cover the donor site until the shaved patch grows out. 49
Female Hair Loss Female Hair Loss Female hair loss occurs due to a variety of reasons: genetics, hormonal, environment and medical conditions. The main causes for female hair loss include: sudden weight loss, anemia, thyroid problems, stress, trauma, hormonal changes, among others. At every clinic, there are female clients seeking hair transplant. Women are encouraged to seek a hair specialist s opinion if they are noticing receding hairlines. Women that are experiencing hair loss for unknown reasons other than simple aging and genetics may be good candidates for FUE and Hair Transplant. 50
Eyebrow Hair Transplant For Women The eyebrows are a distinguishing and important facial feature. Through the years we ve seen various eyebrow trends, however the importance of getting them right never wanes. Think Brook Shields how many women emulated her thick, lush brows? Getting the right shape is important to framing your eyes. There is an increasing number of women (and some men) that are dealing with eyebrow loss. Eyebrow hair loss occurs as a result of several factors, such as: Natural thinning due to the aging or heredity Plucking especially over-grooming Medication or radiation/chemo Metabolic conditions like diabetes or thyroid imbalance 51
Eyebrow Hair Transplant For Women There are many products out there that allow you to draw or paint brows on and many women love them. However many women don t like doing the work to create the brows everyday and they feel the drawn in brows may not appear as natural. Eyebrow Hair Transplants are a permanent solution that allows women to create the brow they want. It is a very popular procedure for females at our surgical practice. Many women lack the density and outline they desire. During your consultation, your surgeon will evaluate your goals and expected outcome for the shape, symmetry and form of your brows. Procedural time is between two to five hours, depending on the complexity and amount of hair grafts required. The most common area for the grafts is the scalp; however there may be other options. This is discussed during your consultation. 52
Eyebrow Hair Transplant For Women Local anesthetic is applied in the donor site and the hair follicles are meticulously removed with the FUE systems (ARTAS and NeoGraft) and then grafted. The hair grafts will be carefully placed with precision by a hair technician or surgeon in the destined eyebrow pockets. Recovery is expected to be a week. Small crusting will be visible around the hair, lasting one to two weeks. You will be advised not to touch the area. The surgeon will demonstrate how to wash the crusting during showers - precautions and gentle care must be taken. There will be pinkish spots around the grafts which will fade over the course of a few weeks. Bruising and swelling may be apparent. 53
Eyebrow Hair Transplant For Women Pain and discomfort are manageable with prescribed pain medication. Stay out of the sunlight, as it will interfere with your recovery. Wearing a ball cap and sunglasses are advised to allow the eyebrows to properly heal and grow. After a few weeks, the redness from the swelling will go down, and you will see the beautifully crafted eyebrows. The hair will carry the same growth properties from the donor site, thus, if your hair regularly grows thick in your donor site, expect it to grow the same on your eyebrows. Strenuous activities should be avoided for at least a week. It is very important that you follow the postoperative recovery plan laid out by your surgeon to reduce swelling and potential complications and to give you the beautifully crafted and artistic designed eyebrows. 54
Nonsurgical Options Nonsurgical Hair Restoration PRP 55
Nonsurgical Hair Restoration Nonsurgical options such as minoxidil topical vasodilator (Rogaine), oral pills called Propecia (testosterone blockade), laser light scalp therapy and topical nutrient shampoos may be beneficial and are an option to surgery. Dr. Mulholland feels Artas and NeoGraft Hair transplantation is often the best approach for most hair restoration patients. Another popular treatment is the Platelet-Rich Plasma (PRP). The PRP is obtained by taking blood from the arms and centrifuging it into useful components. The centrifuge removes the red blood cells and separates the useful components for Hair Restoration. These components include stem cells that are topically applied to the scalp. Note: Nonsurgical Hair Restoration is beneficial to some patients, but not everyone. It depends on the severity of hair loss and the goals. Our suggestion is to have a consultation and review by a hair technician to properly evaluate your condition and outline the best procedures for you. 56
PRP In recent media, Platelet Rich Plasma has become a popular phenomenon after its widespread use by famous athletes and celebrities Kobe Bryant, Kim Kardashian, Angelina Jolie and Tiger Woods who have praised its effects and amazing stimulating properties. Scientific research has shown our blood has special growth factors that are responsible for healing and rejuvenating tissue. This helps with wound repair and healing and also with growth which can enhance cosmetic procedures. Platelet Rich Plasma is derived from our blood which is centrifuged to separate the red blood cells and plasma. The plasma contains growth factors, stem cells and a high platelet concentration. The platelets are the components in the body that help with clotting. 57 New discovery shows PRP is an exciting nonsurgical option and effective treatment for hair restoration. The PRP solution is injected into the scalp.
PRP The recommended frequency for the PRP is once a month for a period of four months. After four sessions, maintenance is required once every three months to keep the hair rejuvenated. PRP is a safe treatment and has very little known side effects. Patients are generally safe from reactions since the PRP is from a patient s own blood. Minor pain, bleeding and redness may appear while the injection is being applied. Mild headaches and scalp tightening is experienced by some patients, but this only lasts one to two days. PRP is not effective or recommended for patients who have a history of heavy smoking, alcohol or drug use. Patients who have been diagnosed with cancer, excessive bleeding, infections and other chronic diseases will be advised not to seek the PRP treatment. If you are wondering about your candidacy for PRP, you should consult with a doctor or surgeon. Advanced hair loss will require Hair Transplantation; the PRP used as a conjunctive treatment with the NeoGraft and ARTAS enhances the effectiveness of the procedure. 58
Details Timeline Cost FAQ 59
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Costs The costs will vary from clinic to clinic. The price will be dependent on how many hair follicles will need to be grafted and area of extraction/implantation. Typically you will see costs around $5000 +HST for 500 FUE grafts. The cost includes fees charged by the doctor, the surgical supplies, anesthesia, medications, laboratory tests, and outpatient hospital charges. Typically it does not include any overnight care. Most insurance plans do not cover the cost of the hair transplants. Financing options are often available. Should complications occur, additional surgery or other treatments will be necessary. Typically the surgeon will not charge a surgical fee for any revision surgery, but facility and anesthesia fees/taxes will apply. 61
Frequently Asked Questions Is hair transplantation suitable for both male and females? Yes, both men and women benefit from FUE Hair Transplant. It is a minimally invasive procedure and suitable for patients seeking to grow hair with transplantation. How to determine if I am a good candidate for Hair Transplant? Your best bet is to visit a Hair Loss Clinic. If you are located in Toronto or the Greater Toronto Area, SpaMedica has an amazing team of Hair Technicians led by nationally renowned cosmetic surgeon, Dr. Stephen Mulholland. Your one-on-one consultation will provide you better insights on the procedure and fully determine whether you are suitable candidate for Hair Transplant and FUE. How short should my hair be before the procedure? Our Hair Technicians recommend you go with the buzz cut in the donor area. If your donor hair is long enough, harvesting using the FUE can be done by shaving small areas which can be covered by your other, existing hair. For maximum benefit, the buzz cut is the preferable choice for your Hair Technicians. Are the final transplanted results any different with FUE than those achieved with linear harvesting (Strip Grafting)? Results are similar. FUE procedures, by default, yield grafts that contain mainly one, two, three, or four follicles called follicular units. Linear harvests, which are then microscopically dissected by a team into grafts of one, two or three follicles, would also yield similar follicular-unit grafts. 62
Frequently Asked Questions How much hair can I lose? Shedding is a normal occurrence in both men and women due to the aging process. Most people carry 100,000 hairs on their head and lose 100 to 125 hair strands per day. If hair loss exceeds more than 125 hairs a day, or if patients start to notice more and more hair falling out every day (let s get real, who has the time to count) are advised to seek a consultation with a Hair Technician. How long does it take to recover and heal? Recovery time for modern hair transplant with the Artas and NeoGraft is much less compared to traditional strip grafting method. No surgical incisions or stitches are required following the surgery. You can return to your normal daily routine within a couple days. Your Hair Technician will walk you through the recovery process and how to care for your scalp following the surgery. Rigorous activities however should be avoided for at least one to two weeks. Should I cut my hair before treatment? Discuss with your Hair Technician on how they would prefer your hair to be cut. Most prefer the donor site to be buzzed, making it easier to extract the hair follicles. Will people know I have had a hair transplant procedure? Not unless you tell them or have them examine your scalp up close! Most people will not notice you having gotten hair transplant. Your donor follicles will be extracted carefully and artistically to leave noticeable signs. 63
Frequently Asked Questions Will there be visible scarring in the donor area? The FUE leaves small rounded scars in the extraction site. The scarring however are barely noticeable unless the head is completely razor shaven. You can enjoy a buzz cut even at the lowest clipper setting without visible scarring. One of the biggest benefits of the FUE compared to strip grafting is patients will not have linear scarring. Does the Procedure hurt? There is virtually no pain during the procedure since anesthesia will be applied on the scalp. Mild discomfort may be experienced while the anesthesia is injected to the scalp. Following the surgery, discomfort will be experienced but it is very manageable with prescription drugs. Minor swelling does occur in some patients, this will subside in one to three days. Are Procedure results permanent? Your hair will last as long as the hair follicle is healthy. It is difficult to claim the results are permanent as everyone is biologically susceptible to aging and hair loss at some point in their life. Your Hair Technician will ensure that the hair follicles that are taken from the donor site will be healthy and long lasting, with no signs of pattern hair loss characteristics. Do your diligence in choosing an experienced Hair Technician. 64
Frequently Asked Questions How long does the Procedure take? The length of the procedure varies as it depends on the amount of hair follicles that needs to be grafted and implanted. The estimated time by the number of grafts: 1000 to 1500: 4-6 hours 1500 to 2500: 5-7 hours 2500 to 3000: 6-8 hours Your Hair Technician may prefer you to come in for a second Hair Transplant session if you require more than 3000 grafts. How is the Procedure different than Hair Plugs? Old fashioned hair plugs included the harvesting of large patches of hair that resulted in an awkward and unnatural appearance once implanted. In the ARTAS Robotic Procedure, hairs are harvested in their natural groupings and then transplanted individually by your experienced technician. Individual transplantation provides you with the look you desire, including a great looking hairline and a fuller looking head of hair. 65
Frequently Asked Questions When will my new hair start to grow? Hair growth following the Hair Transplant will occur in three stages: Dormant Stage (0-4 months) The old hair will fall out of the follicle in the new region with little to no growth visible. Emergent Stage (4-8 months) Hair will start to gradually appear. Nearly 80% of the new hair should be seen at the eight month mark. Maturation (8-12 months) The hair starts to thicken. Patients will see their final form 12 to 15 months from the surgical date. After a year, you can fully enjoy natural looking hair you like your younger self. 66
Wrapping It All Up Summary About the Author About SpaMedica Hair Commitment Savings 67
Summary Do your research and pick a surgeon and technicians that are skilled in the precision science of the transplant but also in the artistic planning. Understand all your options and schedule a consultation to help you make your final decision. It is important to realize you have options and should not settle for hair loss that makes you self conscious or unhappy. 68
About the Author Dr. Mulholland is one of Canada s leading cosmetic plastic surgeons and an internationally-recognized specialist in cosmetic plastic surgery of the face and body. For 20 years, Dr. Mulholland has continued to have one of the most successful and recognized aesthetic plastic surgery practices in Canada. SpaMedica is nestled in the heart of Toronto s fashionable Yorkville district at its iconic location at 66 Avenue Road. At our clinic, we offer you a variety of programs and treatments, from nonsurgical to surgical hair restoration. Dr. M shares his live surgical techniques and results with the interested viewers of CityLine, Breakfast Television, ET Canada, ETalk, Global, City, CBC and CTV news. Dr. Mulholland and wife Ann Kaplan Mulholland starred on Real Housewives of Toronto. Dr. Mulholland is Canada s foremost expert on both automated and Robotic FUE transplantation techniques (ARTAS and NeoGraft). He and his team have over 30 years of experience and have performed over a million grafts. 69
About SpaMedica SpaMedica is the brainchild of Dr. Mulholland and is celebrating 20 years of helping patients reach their aesthetic goals. Our Hair Specialists Isaac and Lilybeth are our Hair Technicians; with the assistance of Dr. Mulholland, they have mastered the art of automated and robotic systems for FUE. Together they have grafted over a million hair follicles. They are perhaps the best duo of Hair Technicians in Toronto, bring comfort, excellent results and satisfactions to our patients. 70
SpaMedica s Hair Commitment SpaMedica has delivered the highest quality service, in a safe and comfortable environment, with the best outcomes for 20 years. We are committed to your satisfaction, your comfort and to delivering the expected outcomes. Hair Growth Commitment: Our FUE Hair Growth Commitment (excepted in situations where a pre-existing medical condition will impact results) ensures that we will replace non-growing transplant grafts with a session at no charge. Your Consultation: During your consultation, Dr. Mulholland and his highly skilled SpaMedica team will review your expectations and clearly define the expected outcome from your procedure. Additionally, you will learn: Reasons for your Hair Loss What FUE is How many grafts you require Pre and post surgical plan The time required for one session How many sessions shall be required Patient Rights: As a valued SpaMedica patient, it is your right to experience quality customer service and our adherence to guidelines outlined here. Your safety is our first priority, with your comfort and satisfaction a very close second. 71
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