Hair Transplant Blog - The Knudsen Clinic

Category: Hair Restoration

Who Is Performing Your Hair Transplant?

Posted on 07 Mar, 2017

In recent years there has been an explosion of “low cost” hair transplant clinics offering large procedures at very low cost. This is partly the result of “cosmetic medical tourism” in low-cost countries but also due to unscrupulous business people entering the field and minimising, if not eliminating, the role of the doctor.

Stories abound of people travelling overseas and only briefly seeing the doctor for the administration of the local anaesthetic prior to the procedure. The doctor is then never seen again!

What this means is that the whole procedure is carried out by “surgical assistants” whose training or qualifications are never stated. Indeed, most of these assistants have no nursing background and may be performing illegal actions by cutting the patient’s skin. In addition, to save cost, there are clinics that have multiple patients being operated on in the same room! This is highly unsafe as cross contamination is highly likely. As well, some of the results coming from these clinics are very poor in both design and execution.

The International Society of Hair Restoration Surgery (www.ishrs.org) has taken the lead role in publicising the dangers posed by this non-medical model of rogue clinics and the authorities are starting to act in some jurisdictions with criminal charges being brought against clinic owners allowing illegal performance of hair transplantation by non-medical personnel in their clinics.

The ideal model, which is practised in the Knudsen Clinics, is to have both the consultation and the surgical procedure performed by the doctor. Only the doctor is allowed to cut the skin. Only the doctor is allowed to make the surgical plan. The assistants are there to assist the doctor. Even the ARTAS robot is controlled by the doctor in our Sydney Clinic.

One of the reasons the cosmetic tourist model exists is because patients confuse the difference between a product (the hair transplant) and the service (the performance of the hair transplant). The result is going to depend upon the skill of the doctor (and his assistants). Make sure a doctor is going to be the person performing the hair transplant.

What is Platelet Rich Plasma (PRP)?

Posted on 11 May, 2016

There has been a lot of publicity in recent times about a possible new treatment for hair loss (of any cause) that is called Platelet Rich Plasma (PRP). This is argued to be a “stimulation” therapy for hair loss. The theory is that the multiple skin growth factors that live inside platelets (the blood cells responsible for clotting) can be utilised to stimulate hair by “cracking open” the platelets after the patient’s own blood has been centrifuged (spun down). These growth factors are then re-injected into the scalp in areas of thinning hair.

The idea has been around for a while but the evidence for hair stimulation has not been strong. We do know that PRP is helpful with wound healing but it is less clear which thinning patients might benefit. One of the problems is that the technique has no stringent set of rules and different centrifuges produce different results. Current research is directed at assessing whether higher concentrations of growth factors produce a stronger stimulating effect on weakened hairs.

Another possible line of research involves combing PRP with an extracellular matrix product that acts as a scaffold to assist the effect of the growth factors. Further research is needed in this area.

At best, current evidence is inconclusive that PRP is as effective as other stimulatory products such as minoxidil or techniques such as low level laser therapy.

Hair Loss Treatment with Generics?

Posted on 03 Mar, 2015

Are generic prescription drugs as effective for the treatment of hair loss as the original ones?

 

In recent years generic versions of finasteride and minoxidil have come into the marketplace. Generics appear when the patent period (typically 15 years) expires for the original company that process/markets a new drug. They are often made in the same facility as the original drug but are generally made by a respected manufacturer in a certified facility. It is worth noting that purchasing generics from overseas manufacturers does not always offer this protection.

 

The attractive feature of generics is their price as it is usually significantly lower. This reflects the fact that they did not do the original research which is very expensive. Generally speaking, the generics are well produced with equivalent effectiveness compared to the original. Compounding chemists also make variations on original products but the addition of other ingredients is not necessarily helpful.

 

Many minoxidil hair loss treatment lotions add ingredients such as azelaic acid and retinoic acid. There is NO evidence this increases the effectiveness of minoxidil. Indeed, there is NO evidence that any strength of minoxidil greater than 5% adds to effectiveness.

Hair Loss Treatment Confusion

Posted on 10 Nov, 2014

Much confusion surrounds the difference between topical hair loss products (applied directly to the scalp) and internal products (taken by mouth). They both can be effective in managing hair loss but are NOT equivalent when trying to block the male hormone DHT.

 

DHT is produced in both hair follicle and the liver. If a topical product is aimed at the scalp hair follicle it will likely be less effective than oral blocking as the liver supplies DHT directly to the follicle via the blood. This is why finasteride needs to be taken orally to give the best effect.

 

In men with male pattern balding the oral use of blockers (e.g. finasteride) has proven to be far superior to the use of topical stimulants (e.g. minoxidil or laser). That said they can be successfully used together to produce even better results as they act in different areas.

 

For male pattern balding, effective therapy begins with a medical doctor

Dr Knudsen receives Manfred Lucas Award

Posted on 29 Oct, 2014

Hair Transplant Surgeon ASHRS Awards

Dr Knudsen has been honoured to receive The International Society of Hair Restoration Surgery (ISHRS) highest privilege, The Manfred Lucas Award.
Dr Knudsen has been recognised for distinction in the field of hair restoration surgery and sharing his skills and knowledge on hair loss and for his commitment to the highest ethical standards throughout his career as a hair transplant surgeon. Read more.

Hair and Now

Posted on 10 Oct, 2013

There has been a lot of publicity in recent times about a possible new treatment for hair loss (of any cause) that is called Platelet Rich Plasma (PRP). This is argued to be a “stimulation” therapy for hair loss. The theory is that the multiple skin growth factors that live inside platelets (the blood cells responsible for clotting) can be utilised to stimulate hair by “cracking open” the platelets after the patient’s own blood has been centrifuged (spun down). These growth factors are then re-injected into the scalp in areas of thinning hair.

 

The idea has been around for a while but the evidence for hair stimulation has not been strong. We do know that PRP is helpful with wound healing but it is less clear which thinning patients might benefit. One of the problems is that the technique has no stringent set of rules and different centrifuges produce different results. Current research is directed at assessing whether higher concentrations of growth factors produce a stronger stimulating effect on weakened hairs.

 

Another possible line of research involves combing PRP with an extracellular matrix product that acts as a scaffold to assist the effect of the growth factors. Further research is needed in this area.

 

At best, current evidence is inconclusive that PRP is as effective as other stimulatory products such as minoxidil or techniques such as low level laser therapy.

Finasteride and Prostate Cancer

Posted on 09 Sep, 2013

A long-running study of men in the USA with enlarged non-cancerous prostates (benign prostatic hyperplasia – BPH) using finasteride previously reported a 25% reduction in overall numbers of patients developing prostate cancer. However, there was some debate about whether the prostate cancers detected in users of finasteride were of the more aggressive variety. A recent analysis of this study showed that finasteride users had lower levels of the prostate cancer screening test PSA (prostate specific antigen) which led to more accurate diagnosis of those patients actually suffering cancer rather than just an enlarged prostate. In addition, the smaller prostates made tumour detection easier by biopsy.

 

Overall, men taking finasteride were 30% less likely to be diagnosed with prostate cancer and 43% less likely to get a diagnosis of low-grade cancer (slow growing). In addition, survival rates were not changed in patients taking finasteride compared to those not on finasteride.This is very reassuring news to patients taking finasteride for hair loss as these prostate effects are beneficial rather than harmful and will likely result in less unnecessary surgical treatment of prostate enlargement in future. We can reassure patients talking finasteride that there are no harmful long-term effects on the prostate from treating their hair loss.

Natural Ingredients for Hair Loss

Posted on 21 Jul, 2013

I frequently get asked the question: Are there any “natural” products I can use for my hair loss? The answer is – it depends upon the cause of the hair loss.

 

For example, if the hair loss is related to iron deficiency anaemia, then foods with high iron content or iron tablets could help. Biotin (Vitamin H) deficiency has been correlated with hair loss but it is a very unusual cause in the general population. Vitamin H, Vitamin B6 and zinc are all essential nutrients for healthy hair but are not necessarily involved in a particular persons hair loss, so supplementing them may not be effective.

 

That said, products like Provillus that contain them, and saw palmetto, are not going to harm anyone suffering from hair loss. The unfortunate assumption is that these “natural” remedies, essential for healthy hair, are helpful in the commonest forms of hair loss in men and women: male pattern baldness and female pattern hair loss. There is NO evidence that these nutrients are involved in these conditions and therefore NO evidence they assist in balding or female pattern thinning.

Shaving your hair makes it grow back stronger.

Posted on 24 Jun, 2013

Not true. As your hair grows it becomes subject to environmental damage (wind, sunlight, washing and combing or scratching). The result of this is that the tips of the hairs become tapered over time. If the tip of the hair frays you get a “split end”.

When you shave hairs and feel the stubble coming back, these hairs have not suffered environmental damage and feel quite “thick”.

They are just normal hairs without damage.

Most common Hair loss consultation questions

Posted on 07 Jun, 2013

The six most common asked questions in a hair loss consultation

1. Do hair transplants work?
YES, YOU CANNOT REJECT YOUR OWN HAIR. THEY GROW NORMALLY AND REMAIN HEALTHY IF PROPERLY SELECTED.

2. What supplements do I need to take to stop my hair falling?
NONE. NONE ARE PROVEN TO WORK.

3. Are there any side-effects with the medication?
SIDE EFFFECTS ARE DOSE DEPENDENT SO, USUALLY, THERE ARE NOT ANY.

4. Will my hair completely regrow back from medication alone?
USUALLY NO BUT IT MAY IMPROVE.

5. How long do I have to take the medication for?
AS LONG AS YOU WANT TO KEEP YOUR HAIR.

6. Have you had anything done yourself?
NO BUT I DO NOT SUFFER FROM HAIR LOSS BUT I AM TRYING LOW POWER LASER THERAPY TO IMPROVE DENSITY

If you have more questions you would like answered about hair loss and how we could help with a solution to your hair loss, please book a hair loss consultation.

The ongoing Finasteride debate

Posted on 03 Dec, 2012

Recently an international conference heard an in-depth panel discussion about Finasteride and sexual side-effects. It was again emphasized that Finasteride is a safe medication, side-effects were largely dose-related and disappeared upon stopping the medication. It was felt that recently media reports about the incidence and severity of side-effects was significantly overstated and that it remained the medication of choice for treating male pattern hair loss. In my hands, side effects are quite uncommon and only a small intermittent dose of Finasteride is required to achieve long-term stability of the hair loss in most balding men.

New Medication to treat pattern hair loss

Posted on 26 Nov, 2012

The recent Annual meeting of the International Society of Hair restoration Surgery saw discussion of upcoming medications to treat male pattern hair loss. In particular we were intrigued to understand that different versions of prostaglandins (chemicals involved in inflammation) have opposite effects on hair growth! Some prostaglandins have recently been shown to inhibit hair growth, whereas others are well known to stimulate hair growth. Perhaps the most exciting part of the research is that some medications currently being developed to treat asthma via inhibiting specific prostaglandins could have an unexpected benefit in stimulating hair regrowth in balding males. These new compounds are still a couple of years away but may turn out to be the next generation of medicines that positively affect balding.

Latest hair loss information

Posted on 18 May, 2012

I just recently came back from the Asian Association of Hair Restoration Surgery Annual Meeting in Seoul – Korea. The meeting was well attended with 250 surgeons there to find out the most up to date information concerning hair loss treatments.

 

Of particular interest to me were the talks referencing the influence of the recipient site on the growth rate of the transplanted hair. Original research was performed in Korea more than 10 years ago and showed the surprising result that, contrary to our initial belief, the body site where the transplanted hair is placed influences and changes the future growth rate of the hair.

 

The relevance of this result is that hairs in different areas of the body grow at different rates. When using scalp hair to reconstruct eyebrows the transplanted hairs initially grow at the scalp hair rate (three times faster than the eyebrow rate of growth). This means that the new transplanted eyebrow hairs need to be trimmed regularly because they grow much longer and quicker.

 

Over time the surrounding eyebrow skin influences the transplanted hairs and they slow down a lot to more match the growth of normal eyebrow hairs. More interestingly, if the transplanted hairs are removed from the eyebrow and then re-transplanted in to the scalp again, they begin to speed up their growth rate again! Simply amazing!

 

Another benefit from this research is that it proves that certain body hair can successfully be used to replace lost hair in the scalp and over time these body hairs will resemble natural scalp hairs in their appearance and the hair regrowth rate. Despite these compelling results, body hairs should only be considered as a last resort when there aren’t any more usable scalp hairs available to use as donor hairs.

Hairloss Treatment Medication

Posted on 16 Mar, 2012

A large amount of internet and media interest has recently focused on claims of persistent sexual side-effects long after discontinuing the use of Propecia (finasteride) hairloss medication. A study published by Irwig in 2011 suggested the occurrence a high incidence of long-term sexual side effects in some Propecia users. It should however be noted that this study was not a study of Propecia users in the general population, but a sample of men already claiming to have long-term side effects.

While not wishing to cast doubt on these patient claims, I do find them somewhat surprising. In over 14 years of prescribing Propecia/Proscar, to well over 4000 of my patients, I have no reported case of permanent sexual side-effects. Those few patients who reported these side-effects recovered fully after stopping taking the medication. In most cases recovery occurred within 4 weeks, in a couple of cases it was about 2-3 months until full recovery. A couple of recently published medical studies from Japan and Italy support the previously published lower incidence of side-effects and the long term effectiveness of Propecia. The Japanese study by Sato followed 3177 men for 3 years and the Italian study by Rossi followed 113 men for 10 years. In both studies, over 80% of patients show long-term growth and stability on the medication without any significant side-effects.

Another factor,  largely unknown, is that the frequency of sexual side-effects depends upon the dose used. In my hands, I have consistently recommended a dosing of a 1 mg tablet three times a week for the last fourteen years. This is because Propecia lasts much longer than 1 day in your system. In fact, the enzyme is blocked for up to 1 month! This means that you can maintain the effectiveness of Propecia without having to use it every day. The other great benefit is that, the frequency of sexual, or other, side effects drops dramatically if you only take the tablet every 2-3 days.

I believe that my frequency of patient sexual side effects is approximately 1 per 200 patients on 3 tablets per week and even less frequent on 2 tablets per week. All my patients have fully recovered after stopping therapy. Some who could not tolerate 3 tablets per week were able to be re-introduced to 2 tablets per week without any side effects.

With regards to altered mood (depression) whilst on Propecia, I have seen this in a handful of patients. It occurred quickly after starting the medication and resolved quickly on stopping the Propecia tablets. In summary, Propecia remains a very effective and also very safe treatment for male pattern hairloss. It has demonstrated clear superiority compared to other treatments for hairloss and side effects can be significantly reduced with adjusted or lower doses.

Finasteride Side Effects

Posted on 19 Jan, 2012

Recently an international conference heard an in-depth panel discussion about Finasteride and sexual side-effects. It was again emphasized that Finasteride is a safe medication, side-effects were largely dose-related and disappeared upon stopping the medication. It was felt that recently media reports about the incidence and severity of side-effects was significantly overstated and that it remained the medication of choice for treating male pattern hair loss. In my hands, side effects are quite uncommon and only a small intermittent dose of Finasteride is required to achieve long-term stability of the hair loss in most balding men.

Combating Hair Loss for Men and Women with Low Powered Laser Devices

Posted on 20 May, 2011

There has been a lot of interest in low powered laser devices and their effect on hair loss. Recent research suggests that it has a stimulatory effect on hair follicles. This could be an effective secondary (i.e. additional) treatment for hair loss in patients who are balding or thinning. It certainly also may be effective in seasonal increased hair shedding (a moult).

However, the delivery system and amount of laser exposure is critical to the chances of success. A new device called the Lasercap,  applies 224 laser lights continuously to the scalp in the comfort of your own home. It uses rechargeable batteries, can be worn under a cap or hat and can be used at your convenience. Suggested dosage schedules is 15-30 minutes every second day.

The major advantage of this device, compared to hand held devices, is that the correct energy level is continuously applied to the scalp. Hand held laser devices only apply energy for a very short period of time if used to the manufacturer’s instructions.  If you would like to know more about this additional treatment for hair loss, please call our Sydney Hair Loss Clinic on 1800 685 399.  The Lasercap can also be ordered directly from our Sydney Clinic.