Beyond Hair Plugs: Modern Surgical Options For Hair Loss in Men
When medical treatments for hair loss fail to bring satisfactory results, some men turn to surgical treatments like hair transplantation ...

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Robert V. Cattani MD, David R. Marks MD, Michael L. Reed MD


When medical treatments for hair loss fail to bring satisfactory results, some men turn to surgical treatments like hair transplantation and scalp reduction. Such procedures have come a long way since the days of big hair plugs, often yielding remarkably natural results. Our panel of experts will walk you through the various options, and discuss video footage of a hair transplant. Topics will include:

  • Microsurgery
  • Scalp reduction
  • Flaps

Webcast Transcript

DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. Here's a depressing thought. 50% of us men, that's 50%, will suffer hair loss by the time we're 50 years old. The good news is, there are many surgical treatments available. Which one is the right one for you? We have two guests joining us today to help us decide. The first is Dr. Michael Reed. He's Assistant Professor of Clinical Dermatology at NYU Medical Center and he directs their hair transplant program. Welcome.


DAVID R. MARKS, MD: Next to him is Dr. Robert Cattani. He's one of the founders of the American Board of Hair Restoration Surgery and he practices in New York. Welcome.

ROBERT V. CATTANI, MD: Thank you very much, David.

DAVID R. MARKS, MD: Dr. Cattani, it used to be that when you saw a man on the street who had a hair transplant you knew it. Nowadays you can't really tell. Why the difference?

ROBERT V. CATTANI, MD: I think that's a good starting point for the audience there. Hair restoration began in 1958 and I think for the first 35 years we were almost offering apologies for some of the work we were doing because we were transplanting very large grafts. We all know the names. Cornrow, dolls hair, take offense, my god they're awful. That was the only thing we had. Then because of medicine and the wonderful progress we're able to make, we decide that maybe less is more. We started to take down the size of the grafts. From ten and 12 hairs down to five, four, three and two and sometimes one hair.

We learned that men seek two things in hair restoration. One, they want maximal naturalness, and two, they want minimal detectability. Lastly, maximal naturalness doesn't have to mean maximal hairiness. It's OK not to have a full head of hair.

DAVID R. MARKS, MD: You had some picture to demonstrate the differences, correct?

MICHAEL L. REED, MD: Yes, I think this is the image that a lot of people have in their mind of going back to the 70s and 60s. You see people who had incomplete or poor work and this is the so-called old giant plug graft, the dolls hair look. That's been totally replaced by much smaller grafts. This is just one session or these tiny grafts have been put in. The knowledge that is the basis for this new work is shown here. A kind of breakthrough in understanding the anatomy of how mother nature creates density, is to understand something called the follicular unit which is a natural, anatomical clustering of hair follicles. They go in little clusterings where you can have anywhere from one up to five or six hair follicles all together surrounded by a little fibrous tissue compartment. We've taken this concept of the follicular unit and now we have what's called follicular unit grafting where we can take grafts which have one follicular unit, with one, two or three hairs, to construct a natural frontal hair line just like mother nature. Behind it we can use the same type of grafts or a little bit larger grafts to create the density, so that when hair grows in you see hair and no longer see scalp. So we can get results that are natural in the front and dense in the back, and we can do it in as little as one session in a lot of patients.

DAVID R. MARKS, MD: One session?

ROBERT V. CATTANI, MD: As little as one session, yes. Although if a person looks real close at themselves in the mirror and not just in casual circumstances, to rebuild a frontal zone may take two and even three in some individuals depending on the hair color and texture and the skin color.

DAVID R. MARKS, MD: OK. We're going to go to some video here. Take a look at this scalp.

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