Ken Williams, DO, FISHRS

This is a good question and the answer is based upon the medical literature. Currently there is no research indicating a positive response from micro needling versus subcutaneous injection of PRP into scalp. Obviously the time frame of PRP injections is important because you don't want to be injecting autogolous cells into the scalp immediately after surgery.  That would potentially decrease graft survival. One study published by Carlos Ubell in 2006 suggested  greater graft survival after hair surgery when grafts are bathed in PRP.  A comprehensive review by the ISHRS PRP committee revealed,  PRP  is not only is safe and tolerable, but the efficacy is also recognized. 

Good afternoon.

Many factors come into play when figuring out the cost of a hair transplant procedure.  Most offices charge a per graft fee with the fees ranging anywhere from $4-$14 per grafts depending on the harvesting technique., i.e., FUE versus strip.   The fee range is also based on the office location, number of grafts, complexity of the case and physician experience. Another factor of surgical fee differences is the illegal practice of non-physicians harvesting and performing hair surgery. Many U.S. based plastic surgeons have a non-physician or technician performing the surgical procedure.    

There are also add-on fees that some offices charge. Some facilities charge an extra fee to add Platelet Rich Plasma (PRP) therapy to the procedure. While some offices also charge more for holding solutions and chilling devices to decrease tissue ischemic changes to grafts after they are harvested.  My office performs PRP and we chill our grafts while using Hypothermasol and ATP to increase graft survival.

I empathize with patients who have limited budgets or who are trying to get the best per graft price.  However, when it comes to your physical and aesthetic appearance, I would advise against decisions totally based on finances.   The old adage “you get what you pay for” or “penny wise and pound foolish” comes to mind for patients that choose their hair restoration physician based solely on price per graft. Important factors to keep in mind when choosing your hair restoration facility:

1.           Do you feel comfortable with your physician and the office?

2.          Is a physician performing your procedure or is a technician performing the surgery?

3.          Is your physician a board certified hair surgeon?

4.          Is the hair surgeon a member in good standing with the International Society of Hair Restoration?

5.          What is the experience level of your physician?

6.         What is the holding solution for your grafts? Are the grafts chilled to insure graft survival?

7.          Is Platelet Rich Plasma (PRP) therapy included in the surgical fee?

Good morning.

Great question. There is no clinical difference in hair growth after a procedure is performed with either STRIP or FUE donor harvesting.  After transplantation, the hair follicle falls out at about 2-4 weeks.  It may take between 6 to 12 months after the procedure before the transplanted hair follicles grows. Results will vary from one patient to another, and it may take up to to 18 months for the hair follicle to grow.

Patients may begin Low Laser Light Therapy immediately after surgery and restart Rogain in 2-4 weeks after healing of the scalp. I recommend to continue to use DHT inhibiters like Finasteride immediately before and after surgery.  I advocate to patients High Density Platelet Rich Plasma (HD-PRP) for regenerative treatment to stimulate the follicles that are dormant, or to stimulate hair follicles that remain in an extended Telogen rest phase.

Follicular Unit Extraction (FUE) is an excellent technique to reduce the visibility of and conceal a donor linear strip scar. FUE devices like ARTAS and NeoGraft do not contribute to cosmetic outcome of any hair surgery.  Many patients are unaware that a FUE device does not make a hair restoration procedure better than another device. There are other great FUE harvesting devices that may be better then the two mentioned.  It is always the physician’s aesthetic eye, skill, and experience; and not a FUE device that ultimately determines the patient’s cosmetic outcome.

Performing hair restoration surgery requires proper training and knowledge. Many surgeons perform hair surgery without proper training, or they don’t perform the surgery and illegally delegate the procedure to hair technicians. This is a felony. A board certified hair restoration surgeon is the ideal and ethical choice to perform hair transplant surgery and they abide by high ethical standards and best practices. Board certified physicians from the American Board of Hair Restoration Surgery have passed a written and oral exam demonstrating their knowledge and expertise in performing hair surgery.  

I use a punch grafting technique to excise as much scar as I can. I also combine this with Scalp Micropiogmentation (SMP). A hand held motorized FUE device and a 0.8 mm circular round sharp punch are used to punch into the scar and remove scar tissue. The scar tissue is removed and FUE grafts are then placed into the created punch wounds. This technique provides a natural appearance and better coverage may be achieved. The procedure may need to be retreated depending upon graft survival. 

Hello Sir,

Here is a simple response. To this excellent question.

HD-PRP is a recent hair restoration therapy that was first described by Dr. Carlos Ubell of Brazil in the medical literature; it has gained popularity as a regenerative treatment for Androgenetic Alopecia and Female Pattern Hair Loss. Scalp trauma, introducing tumescence fluid or Lidocaine into the scalp, or even stress can cause a hair follicle to go from its anagen phase of the hair growth cycle to the Telogen phase.  It is not uncommon.  It is referred to by many as “shock loss.”   It may occur 1-2 weeks after a single treatment with High Density Platelet Rich Plasma (HD-PRP) treatment, or any procedure that causes trauma to scalp.

To extend the conversation on HD-PRP, over 15 published studies on the success of HD-PRP are found in the medical literature.  Evidence supports HD-PRP therapy as a promising treatment option to promote hair growth.

While HD-PRP is in the early stages of scientific research in hair restoration, PRP is not meant to replace current FDA approved therapies such as DHT blockers and Minoxidil. Plateletts contain specific growth factors that assist in tissue regeneration and healing. Published medical literature from Europe and the United States confirms the safety of HD-PRP therapy. It has been used a medial adjunct therapy for over two decades for skin and wound healing.

Finally, not all PRP treatments are the same. Some PRP systems only concentrate platelets to 2-3 times baseline values.  The platelet density is required to be 5 X the baseline platelet value to be effective. Our office certifies platelet concentration by in office CBC counts.