Until recently, most patients requiring treatment had to undergo invasive strip surgery (removing part of the scalp during an operation). As a result of the obvious physical limitations of this invasive procedure, many were allowed to go almost totally bald before they could be treated. A lot of these newer techniques have been perfected in Dublin. Rejuvenate Magazine spoke with Dr. Patrick Treacy about the option of the new H+ method of hair transplantation.

First, why do we actually lose our hair?

1 Follicular Unit Transplantation (FUT) is a hair restoration procedure where hair is transplanted exclusively in its naturally occurring groups of 1-4 hairs. These groups, or follicular units, are obtained through the microscopic dissection of tissue taken from a single donor strip or extracted directly from the donor area.

Tell us more about androgenetic alopecia?

Which is the best hair restoration method?

You mentioned genes. How do they play a role in hair loss?

It was previously believed that baldness was inherited from the maternal grandfather. While there is some basis for this belief, it is now known that both parents contribute to their offspring’s likelihood of hair loss. Large studies in 2005 and 2007 showed the importance of the maternal line in the inheritance of male pattern baldness. German researchers called the main ‘balding’ gene, ‘ARG’ or the androgen receptor gene. The presence or absence of a specific variant in this gene is related to baldness.

How common is this condition?

The H+ technique has been perfected in Dublin. It essentially is a minimally invasive method of hair restoration which avoids the need for any scalpels or stitching to be required at any point during the procedure. Single hair follicles are extracted one by one from the donor area (back of the head) and re-implanted with the unique patented device; therefore a strip of donor skin is not required to be removed from the back of the head. Many doctors, including myself, consider this to be the most advanced method of transplanting hair.

With evolving techniques like the newer single hair follicle extraction technique, follicles are extracted one by one from the donor area (back of the head) and re-implanted with the unique patented devices. The H+ method is based on the use of genetic testing as a means of screening, the use of growth factors, 633nm light for fibroblast stimulation and the use of quality control during the hair transplant procedures. The hair transplant doctor needs only a single surgical assistant to help him during the follicle hair transplants. The procedure also ensures maximum care to the grafts. The hair transplant doctor can decide upon the exact number of grafts to be removed while he is removing them one-by-one.

Certainly yes, the H+ technique uses a genetic test for male pattern hair loss, which reports the presence or absence of a specific variation in the androgen receptor gene. A positive test result means that a man has the high risk genetic variation. Men who test positive have approximately a 70% chance of going bald. This means the H+ genetic test can predict a patients risk for hair loss or thinning.

What are the present medical treatments presently available?

Propecia lowers the dihydrotestosterone on the scalp and also in the serum of treated patients. Clinical trials have shown it to be effective in preventing further hair loss and increasing hair counts to the point of cosmetically appreciable results. Interestingly, hair loss on the temples is not improved. Side effects are rare, less than 1%, and patients must remain on the drug indefinitely since the benefit may be lost after discontinuation.

Tell me something about hair transplantation?

Hair transplantation is a surgical technique that involves moving sections of skin containing hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to a bald scalp. However, it is also used to restore eye lashes, eye brows, beard hair and to fill in scars caused by accidents and surgery such as face lifts and previous hair transplants.

When did hair transplantation actually begin?

The numbers of sessions being one or more is aided by the use of genetic programming and special camera densitometry equipment to see under the skin and fully inform the patient of his or her total available donor hair. In each session, the follicles are inserted between existing hairs or previously placed hairs and generally placed up to 1mm apart.

What is the cost of the H+ technique? .

It is thought that these hairs were also subject to poor oxygenation by a “donuting” effect as the punch size was too big. We must remember that the follicles also take a curved path through the skin and there was an unacceptable rate of transection (about 30%) during the punching technique. In the 1980s, Uebel in Brazil popularized using large numbers of small grafts, while in the United States Rassman began using thousands of “micrografts” in a single session.

Can you explain the ‘minigrafts’ and micrografts technique?

The punch technique continued during the 1960′s, although the size of the punch was reduced in order to improve the survival of the hairs in the central part of the graft. For the next pedriod, surgeons worked on transplanting smaller grafts, but results were only minimally successful, with 2-4 mm “plugs” leading to results that were often “pluggy” and unnatural and was referred to as a “doll’s head” or “corn-row” look.

What is the most popular technique?

During the past few years, follicular unit transplant grafts (FUT) have become popular due to a more natural effect. Follicular units were first described in the medical literature by Headington in 1984. Follicular Unit Transplantation has its roots in the single-strip harvesting method and microscopic graft dissection technique developed by Dr. Bobby Limmer in the late 1980s and published in 1994. In 1995, Bernstein and Rassman published the first paper on “Follicular Unit Transplantation,” where hair is transplanted exclusively in naturally occurring groups of 1-4 hairs.

What do you mean by the ‘strip’ technique?

The strip method is really an invasive surgical procedure requiring the attendance of a plastic surgeon and general anaesthesia. During the procedure, a long strip of scalp, approximately 20- 25 cm in length and 1 cm to 2.5 cm in width of hair-bearing skin is removed from the donor area using a scalpel, cutting through nerves and major blood vessels of the scalp. The donor area is then sutured (stitched) closed and approximately 30 days are required for full healing. In order to avoid stretching of the donor scar, two layers of donor stitches must be used and left in the skin for at least two weeks.

Are there any problems with the strip technique?

This is invasive surgery and the patient may sometimes develop scarring or neurological problems of sensation in the back of the head post procedure. Another primary disadvantage of strip extraction is that the patient must wait nine months for the area to heal fully before considering or being able to undergo a second procedure and the patient must have sufficient elasticity in the donor site before the surgeon can safely harvest another strip. Besides the long donor area permanent scar, there is also a possibility to be left with permanent suture scars, stretch back tension scars, keloid scars, or staple scars, even if the procedure goes perfectly.

What is the best hair method of transplant treatment?

The patient can develop scarring or neurological problems of sensation in the back of the head post procedure. Another disadvantage of strip extraction is that the patient has to wait nine months for the area to heal fully before considering or being able to undergo a second procedure

What is the best hair transplant treatment?

Over the past few years unit follicular hair transplant has emerged as the most reliable hair transplant procedure of hair transplantation surgery.

What is the best hair transplant method?

My feeling is that the final result is very operator related.

In your opinion which is the best method?

The H+ technique has been perfected in Dublin. It essentially is a minimally invasive method of hair restoration which avoids the need for any scalpels or stitching to be required at any point during the procedure. Single hair follicles are extracted one by one from the donor area (back of the head) and re-implanted with the unique patented device; therefore a strip of donor skin is not required to be removed from the back of the head. Many doctors, including myself, consider this to be the most advanced method of transplanting hair. With evolving techniques like the newer single hair follicle extraction technique, follicles are extracted one by one from the donor area (back of the head) and re-implanted with the unique patented devices. The H+ method is based on the use of genetic testing as a means of screening, the use of growth factors, 633nm light for fibroblast stimulation and the use of quality control during the hair transplant procedures. The hair transplant doctor needs only a single surgical assistant to help him during the follicle hair transplants. The procedure also ensures maximum care to the grafts. The hair transplant doctor can decide upon the exact number of grafts to be removed while he is removing them one-by-one.

What is the H+ transplant method?

One advantage of the H- transplant procedure is that it allows the hair transplant surgeon to extract as many grafts as is actually needed and on average, we usually extract and place 3,000-5,000 hairs per day.

Tell me about the advantages of the H+ method?

There is also no waiting period between H+ procedures and hair from all over the body can be used. Body hair follicular grafts have shown growth patterns similar to head hair with no difference in texture but are usually used for enhancing the density in the posterior region of the scalp rather than the hair line.

How many sessions are required for the H+ method?

It really depends on the size of the balding area, donor yield and the goal of the patient. In order to achieve a greater density, I would suggest starting treatment early and plan at least two or three sessions over the next six or seven years, so in effect you never really become bald.

What price is the H+ technique?

About 3 per follicle