Lately, there seems to be a fight going on, between those who oppose hair transplant technicians performing the extraction of FUE grafts and those who don’t. Let’s examine the pros and cons of each side, hopefully in a neutral and logical way.
Those who are against FUE hair transplant technicians, suggest that those technicians are inferior to a qualified doctor at performing the task. Many of the same people also suggest that using the FUE robot is acceptable however.
But this seems to be a flawed argument. There is no evidence to suggest that a medical qualification enables you to have better hand/eye coordination than someone not medical. And if so, then the robot must also be banned, since it isn’t qualified either.
Hair transplant goals
The goal is 100% perfectly intact grafts first and foremost. Because they’ll grow.
A second priority is having a very low transection rate i.e. damaging very few hairs that are left in the donor area, so that the remaining donor hair can still be used in the future.
Neither of these requirements depend on a medical degree but needs great skill and technique.
Lastly, over extraction must be avoided (see complaints made about many Turkish “Hair Mills” – later in the Dr Rogers complaints series). But even this can be taught and fundamentally, is down to the overseeing doctor to prevent this from happening. Indeed, if a doctor is happy to see this happening on their patient, he/she would be equally happy to cause it themselves if they are holding the punch. So blaming the technician is like shooting the messenger.
The additional theory is that using an FUE technician “allows” a doctor who is not educated and competent in hair transplantation, to perform hair transplant surgery. The so called “weekend hair transplanter.” But an intelligent, experienced and skilful FUE tech might help make the result better than if the unskilled doctor blunders about doing it themselves, unassisted. Modern hair transplantation is, after all, very much teamwork now.
The robot currently is not as good as a competent human at FUE, medically qualified or not. It doesn’t pass the three tests above but undoubtedly, the technology will improve and will become better than a human. As of now though, it isn’t and yet it still encourages those doctors with little experience or interest in hair transplantation, to add it to “their practice.”
So the logic of those against human FUE technicians but for the FUE robot seems perverse, yet this seems to be the position of the ISHRS even though many members don’t practice what they preach.
Using a competent FUE tech is no different from using an improved FUE robot – a tool to be used by the experienced hair transplant doctor to successfully transplant FUE hair grafts.
These opinions are based on discussions with doctors, hair techs and lay people. Undoubtedly, there are other viewpoints but what matters is a successful hair transplant.
Dr Rogers has started producing short videos to give patients basic information on a variety of subjects. Here is a taster:
“Today I’m going to talk to you about female hair loss
Female hair loss is a more complicated subject than male hair loss, which is generally straightforward genetic male pattern hair loss.
Female hair loss is most commonly genetic but there are quite a number of other conditions in women that can affect the hair quality
Classic genetic female pattern hair loss gives thinning of the hair in an oval pattern, on the front third of the scalp but retaining a strong hairline without recession.
However, some women are susceptible to thinning and receding of the temples, which makes it look like male pattern hair loss. And this is also genetic.
But it’s important to bear in mind that some hormonal conditions will produce a similar appearance too. And to add to confusion, there is some overlap between the causes.
So let’s talk about the other conditions causing female hair loss.
Hormones have powerful effects in the body, so it’s no surprise that they can affect hair quality.
The thyroid hormone, thyroxine, will affect hair quality, whether it’s underactive or overactive. It’s important to keep a steady thyroxine level
Oestrogens and testosterone.
Most people will be aware that women produce oestrogen which is the hormone for female characteristics. A deficiency in oestrogen will lead to poor hair quality which is in part responsible for the change in hair quality after the menopause which results in decreased oestrogen production.
Testosterone is also produced naturally in women in small quantities and that is normal. However, a high natural level in women who have the genetics for male pattern hair loss, will produce male pattern type hair loss – as in receding temples and thinning on the crow.
This overlaps with conditions such as Polycystic Ovary Syndrome where high testosterone levels will give increased body hair, acne and male pattern hair loss.
Women suffer from autoimmune conditions more frequently than men and this includes, alopecia areata, frontal fibrosing alopecia, thyroiditis etc
It’s quite common for women to be careful with their diets either for health reasons, ethical reasons like Veganism or simply to control their weight.
Hair is continuously growing, therefore requires a continuous source of high quality nutrition, particularly iron, B12, folate and fatty acids. All of these are found in the typical Western red meat and vegetables diet but extra care does need to be taken if other diets are followed.
If you are deficient in nutrition, then hair quality (and nails) will soon become poorer – finer, brittle, slower growing hair.
If there are obvious causes, such as iron deficiency, then this first needs treating. And to restore normal levels of iron, it can take 12 months of iron supplements.
Likewise if there are hormonal disturbances, then these need to be treated first but it can take 12 months or more to show improvement in hair quality.
Various medications can help, as well as supplements. But a full range of blood tests should be taken first.
SMP (scalp micropigmentation) can help improve the apparent density of the hair and reduce the “see through” look.
Lastly, women can also have very successful hair transplants.”
Dr Rogers hair transplant complaints blog is where Dr Rogers will be writing his views and reviews about a number of his pet complaints regarding the hair transplant speciality. The complaints that will be under Dr Rogers under investigation will include:
Dr Rogers hair transplant complaints list of blogs to come:
FUE technicians performing the hair extraction process vs doctors – click here
Turkish hair transplant clinic results, including over harvesting
Hair forums and secret salesmen who review their own and rival’s clinics
Unnatural hairlines and unnatural corn row hair graft implantation
Results, especially density and naturalness
Respecting that both FUE and FUT (strip) have their place in offering the best hair transplant results to each patient
The commercialisation and corporate mentality taking over the hair transplant speciality instead of the one to one approach favoured by Dr Rogers
All these opinions will be his own and are general, not specific to any one doctor or clinic but are his observations from his 22 years experience. First article coming soon…
Turkey Hair Transplant Clinic on BBC TV and website was something of a promotional advert for Turkish hair transplant clinics but didn’t show the reality of many of the so called “hair mills.”
They focussed on the cost and didn’t explore the fact that many patients have a poor experience there. We have personally seen patients coming back from Turkey with dreadful results and like Greg Williams, would caution those considering travelling abroad for cosmetic treatment. Hair transplant surgery is not to be undertaken lightly (Robbie Williams please note!) and patients should consider more than just cost.
GDPR rules are coming into force in May 2018 – that is General Digital Processing Regulations and these will affect the way businesses intereact with their customers. In short, it covers how we use any data we obtain from you. Full disclaimers and information will be posted elsewhere on this site but essentially:
Our lawful basis for your data is to process your request (and consent) for us to assist providing you with hair loss information and treatment. Our purpose is to use your data to be able to contact you via telephone, post or email communication regarding those services.
Our medical records are paper based and we do not store personal details digitally, except name, address, DOB, payments/invoicing etc to assist administration in contractual applications with you.
We do not supply third parties with your information. You can ask for us to remove your consent to use your details i.e. for direct marketing.
Full version below:
Westminster Clinic Ltd is committed to protecting and respecting your privacy.
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In the usual course of our business, we may disclose your personal data (to the extent necessary) to certain third-party organisations that we use to support the delivery of my services.
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The law gives you certain rights in respect of the personal data that we hold about you. In addition to your right to stop marketing, detailed above, below is a short overview of the most commonly-used rights. It is not an exhaustive statement of the law.
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If you want to exercise your rights in respect of your personal data, the best way to do so is to contact us by email or to write to us for the attention of the data protection officer at the address mentioned above.
Prince William haircut news – HRH has clearly accepted his hair loss, detailed in many photos in newspapers in the UK and around the world.
Nothing wrong with that, although he could have been more proactive about 10-15 years and benefitted from drugs such as Propecia or a hair transplantation. All eyes will now be on Prince Harry (or perhaps Meghan Markle) and whether he’ll do anything about his crown thinning…
The Trust me I’m a Doctor BBC TV show, which was on recently, had a 5 minute segment about balding men. Presented by a nearly bald doctor, it very briefly explained some of the choices. Generally it was accurate and helpful, mentioning Finasteride and Minoxidil, hair transplants and alternative medicine. It could easily have been a longer piece and it suggested that Minoxidil worked by blood flow, which is incorrect. However, at least it was fair and neutral and not jokey, unlike many TV shows.
Transgrafts in hair transplant terminology, means performing a high quality, densely packed hairline transplant – either FUE or FUT (strip) Only to the hairline zone. This can be seen more easily in the photo below, showing an initial session.
This then leaves space for a made to measure hairpiece to sit behind the transplants and then the transplanted hair brushed backwards over the hairpiece. The advantage of this is that the transplants hide the edge of the hairpiece, which otherwise can be a giveaway if the hair isn’t styled forward to cover it.
This transgraft technique is best used for patients who are happy with long term hairpieces but desire the ability to have more of a “quiff” hairstyle. eg.
Punchgrafts are the old fashioned method of hair transplants but in essence, very similar to FUE hair transplants.
Essentially the difference is that the punches used (sharp hollow metal tubes) are 4mm across instead of the very small 0.8, 0.9 punches we use now.. They do not give natural results: the difference is clear in the photos
However, it is an important subject, so it’s good that at least it is getting taken seriously.
“For some people it may be the stuff of nightmares, but baldness isn’t just a male problem. Loose Women panellist Nadia Sawalha has posted an emotional video talking about losing her hair at the age of 52. But what is female baldness?
The TV presenter admitted her trademark curls were fake and that she was going through the perimenopause, which is the start of the menopause.
She revealed a doctor told her she had the balding gene.”
The news agency, Reuters, reports a trial from the John Hopkins School of Medicine in Baltimore, whether “hair transplants make men look more attractive” or not?
(Reuters Health) – Balding men who seek to look better or younger by undergoing hair transplants are on the right course, a small new study suggests.
People shown before-and-after pictures of hair transplant recipients rated men with more locks as looking more attractive and younger, researchers found. People also thought the men looked more successful and approachable after the procedure.
“In an attempt to get objective opinions on men’s appearances before and after the procedure, Dr Ishii and her colleagues asked 122 volunteers – 58 men and 64 women – to view 13 pairs of images. Seven pairs showed men before and after having had a hair transplant; the other six pairs were of men who didn’t have a hair transplant or any other significant cosmetic procedures between the two photographs.
The participants were asked to rate each image on age, attractiveness, successfulness and approachability.
The reviewers thought the men who’d had hair transplants looked about four years younger in their “after” photos. They also thought the men looked more attractive, successful and approachable after their procedures.
“It showed there were measurable improvements on measures that are meaningful to the patients,” she said.”
Hair cell jab could restore lost hearing, reports the Daily Mail.
Dr Robert Langer of MIT, explains how this breakthrough successfully regrew crucial inner ear hair cells in the laboratory. A drug combination helped create 60 times the number of hair cells than previously achieved. Although the hair cells are not the same as scalp hair cells, there will be biological similarities which could lead on to the “Holy Grail” of hair multiplication or even cloning.
James Nesbitt relates in a recent BBC interview, how having a hair transplant has really helped him keep working, getting more varied roles that he probably wouldn’t have got otherwise.
The Cold Feet, Murphy’s Law and Lucky Man actor, has gone on record to say how much having a couple of hair transplants has boosted his self confidence and attracting leading roles he may not have been chosen for.
Safety of Finasteride (Propecia) has been a hot topic for many patients, especially in the past few years. Although extremely rare, a label of PFS (post finasteride syndrome) was tagged onto various vague symptoms, mainly of a sexual nature but also including mood swings and depression. These are well known but uncommon and a recent study offers very strong evidence that these side effects are in fact, just as common in the general public who aren’t taking these drugs.
As reported in The British Medical Journal, September 2016, a group of 72,000 men who were taking Finasteride (Propecia) for prostate hyperplasia or male pattern (androgenic) alopecia, concludes there is no significant increased risk compared to those not taking the drugs.
Dr Rogers was asked to comment about five years ago, for a newspaper article regarding hair loss and exercise. At the time. there was a limited amount of information but further studies have been done since and there is now increased clarity about how exercise affects hair loss.
The take home message is that relatively short bursts of high intensity exercise, such as HIIT and weightlifting, bodybuilding etc, can significantly increase levels of natural anabolic and androgenic hormones in men and women. The principal one of course, is testosterone which is metabolised to DHT (dihydrotestosterone) well proven to cause hair loss.
Low intensity but prolonged aerobic cardio exercise, such as long distance running, reduces the levels of testosterone. It makes sense when looking at the physiques of marathon runners vs 100m sprinters.
Finally, as an aside, couch potatoes who become obese, may experience less hair loss. Fat cells metabolise testosterone into estrogen, so reducing the amount of DHT.
This update is about female genetic hair loss – for other causes of female hair loss, please click here:
It has always been assumed until recently, that female pattern hair loss is a distinct genetic pattern of hair loss, inherited differently to men and not treatable with male medications. Hair transplants did help of course but it would be better still if further hair loss could be prevented.
However, at the ISHRS conference in Las Vegas, Dr Rogers attended a number of specialist lectures demonstrating a change in thinking about female pattern hair loss:
Essentially, there is more and more clinical, experimental and genetic evidence to suggest that male, androgenic pattern hair loss is the root cause of female pattern also. There is still a lot to elucidate yet as it is unclear why male pattern hair loss looks different to female pattern hair loss. Additionally, some men exhibit a female type pattern of hair loss and some women a male type of hair loss.
There have been a number of trials treating women with medications but they were inconclusive or contradictory. However, since the trials have increased the prescribed doses, it seems more women do respond to these hair loss drugs. It’s very specialised but includes:
spironolactone and cyproterone acetate
Finasteride and Dutasteride
and a few more esoteric drugs as well. As can be seen, they are hormonally acting drugs, unlike Minoxidil
In addition stem cell treatments have also shown promise.
At the ISHRS Las Vegas conference, an interesting lecture suggested that from their case studies, there is additional benefit from combining Propecia and Avodart (Finasteride and Dutasteride respectively).
Specifically, those patients that had some response (i.e. it slowed hair loss but didn’t stop it or regrow hair) and those that previously had good regrowth of hair from Finasteride (but after five years noticed some deterioration again) did get improvement by adding just one 0.5mg capsule of Dutasteride once weekly whilst continuing their existing Finasteride dose.
This is interesting because it does demonstrate crossover benefits whilst keeping the dose very low, probably helped by the fact that Dutasteride has a long half life and adds just enough extra DHT suppression synergistically, to regain hair. It correlates with the known effect that for some men, the Finasteride effects do wane after five years – clearly lowering DHT is effective but some patients do need lower levels than others to completely stop the process.
We shall be recommending patients consider this option as it is a very cost effective treatment, especially now prices for Finasteride and Dutasteride have come down.
Dr Rogers was guest speaker at this year’s prestigious SKN conference 2016, presenting “the history, techniques and state of the art hair transplantation” to approximately 150 delegates attending the all day event.
There were many questions from the practitioners regarding hair transplants. Although now popular in the press, detailed knowledge of hair transplant surgery is less well known, even amongst other healthcare professionals. But Dr Rogers soon enlightened them and it was a very well received presentation.
To recap, modern hair transplants were actually invented in the 1930’s by Dr Okuda in Japan. A dermatologist, he researched transplanting hair in bald men to see if it worked. It did! He soon improved the technique to cover all aspects of a natural cosmetic result.
Excellent team. I’m thrilled with the results from my first hair transplant. Looking forward to seeing how my hair thickens after this second visit. Thank you for all your hard work. I really enjoyed the day.