Physicians divide hair loss, or balding, into scarring or non-scarring alopecia. Scarring alopecia includes a variety of diseases that cause patchy hair loss due to internal disease or trauma, or certain straightening agents. Stress can also cause hair thinning in a generalized way in all areas of the scalp. Only one type of hair loss will produce a distinctive pattern of loss in men and women. This is called male and female pattern baldness and is a genetic disorder. This disorder is primarily caused by the affects of dihydrotestosterone or DHT on the hair follicle. Men, and even women, have a certain amount of male hormone in their bodies, which is broken down by the enzyme 5 alpha-reductase, into DHT.

In women, the effects of DHT on the hair follicles causes a slow thinning of the hair on top of the head over many years. The hormonal mechanisms for female pattern baldness, however, involve more than DHT and are still under investigation. This produces the Ludwig patterns 1, 2, and 3. Loss of estrogen after menopause adds to this effect. In rare cases, women may have diffuse thinning all over the scalp, rather than pattern baldness. Diffuse thinning is generally not treatable with hair transplantation, while female pattern loss usually is.

In men, distinct and progressive pattern baldness usually starts in the 20's, 30's, or 40's and continues briskly for eight to fifteen years. After that it slows down, but continues on a gradual and progressive course for life. Again, as in females, the result of the interaction of DHT with the hair follicles is the main cause for pattern baldness. Since men have considerably more DHT, we presume this is the reason for the more rapid progression.

In both male and female pattern baldness, there is a gradual miniaturization of the hairs produced by affected follicles until they eventually stop growing and fall out. This is why a person's hair will feel finer for several years before actual baldness occurs. In pattern baldness, the hair around the sides and back is immune to the effects of DHT. This hair is also immune to DHT, if it is moved to another area on the scalp. It is this concept of donor dominance that makes hair transplantation permanent. Only follicles from the permanent band of hair around the sides and back are used for transplantation.

Steps of The Procedure

Hair transplantation is a minor surgical procedure confined to the skin. It is performed under local anesthesia and is a safe procedure with few complications. With the introduction of the CompuMed Wand (pictured to the left), patients are administered local anesthesia in a nearly imperceptible process. Designed by dentists to alleviate the negative stigma associated with needle injections, the CompuMed Wand is a computer controlled delivery system that the Elliott & True physicians employ to offer their patients the maximum comfort while administering anesthesia. Patients are given a small dose of oral Valium prior to surgery for its calming effect. It also counteracts the agitation some patients have from xylocaine/epinephrine. Patients should feel absolutely nothing during the procedure. Local anesthesia, when properly done, is 100% effective.

Donor Harvesting

Once the anesthesia is administered, the first surgical portion of the procedure is donor harvesting. A strip of hair bearing scalp is removed from the sides and back of the head. The area is then sutured with a two-layer closure, which will result in a very fine scar hidden under the remaining donor hair. The scar is virtually undetectable using this two-layer closure technique. Because of the elasticity of the scalp, this process may be repeated in subsequent procedures. Each time a procedure is done, the scar from the previous procedure is removed so that at the end of a treatment course there is only one fine scar in the donor area. The scar is completely hidden under the remaining hair.

Preparing the donor area

Suturing of the donor area

The healed donor area

Graft Production

Once harvested, the strip is then microscopically dissected into the naturally occurring bundles of follicles, or follicular units. These tiny grafts of skin contain units of 1-4 hairs. The natural architecture of the average donor area is ¼ single follicular units, ½ double follicular units, and ¼ 3-4 hair follicular units. The microscopic dissection process is performed by specially trained registered nurses and surgical technicians. By keeping follicular units intact, we assure optimal growth rates.
Microscopically dissecting follicular units.	Extreme close-up of microscopically dissecting follicular units.
Dr. Elliott creating receptor sites.

Receptor Sites

The receptor sites are the tiny incisions in which the follicular units will be placed. The sites are created with a fine surgical needle. The receptor sites are truly the artistic portion of the procedure. Design nuances such as direction of hair growth and angle, hairline shape, and crown whorl are determined in this stage of the procedure. This layout will mimic the look of nature. The photo below on the left illustrates our technique compared with outdated methods (center and right).

Pinpoint

Slit

Punch

Graft Placement

The tiny follicular unit grafts are placed into the receptor sites by the surgical team of specially trained registered nurses and surgical technicians. The follicular units are preserved in saline under the ideal temperature conditions during the placement process. This practice assures the survival of the grafts and optimal growth rates. Once the grafts have been placed, the doctor will check to see if the grafts are all at the right level and look just right. A hair dryer is then used to blow cool air on the grafts, which will form a natural adhesion and set the grafts in place. Bandages are not necessary, and the patient will wear a baseball cap for the trip home. The patient will then return the next day for a check up appointment, and then in 10-14 days for the suture removal appointment. Follow up visits are recommended every three months for the first year after treatment.

Procedure on Day of Surgery

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Elliott & True
Phone: 1-800-990-HAIR (4247)
FAX: 1-949-263-2733
Email: Info@elliotttrue.com