Welcome to Premier Hair Solutions- Your Hair Preservation and Restoration Education Center.

The cycle of hair growth and loss seems like a simple process, but it is surprisingly complex and is composed of four distinct phases. These stages of hair growth have been extensively researched to better understand how hair grows and what might be done to prevent or treat premature hair loss.

The first three phases — anagen, catagen, and telogen — cover the growth and maturation of hair and the activity of the hair follicles that produce individual hairs. During the final, or exogen, phase, “old” hair sheds, though usually, a new hair is getting ready to take its place. Each phase has its own timeline, which can be affected by age, nutrition, and overall health. Fortunately, there are multiple options to intervene along the way to help ensure that your hair follows a healthy growth cycle. 

The stages of hair growth begin with the Anagen phase. This is the longest phase, lasting about 3 to 5 years for the hairs on your head, though for some people a single hair could continue growing for 7 or more years.  Average growth rate is 1 – 1.25cm per 28 days.

Fortunately, the anagen phase differs with different types of hair. For example, the anagen phase for eyebrow hairs and pubic hairs is much shorter than the phase for your scalp hairs.

During the anagen phase, your hair follicles are growing and adding keratin to their hair shafts that will continue to grow until they’re cut or until they reach the end of their lifespan and fall out. At any time, 80-90% of the hairs on your head are in the anagen phase.

The Catagen phase starts when the anagen phase ends and tends to last about 10 days or so. During this phase, the hair follicles shrink, and hair growth slows. The hair also separates from the bottom of the hair follicle yet remains in place during its final days of growing.

Only about 5 percent of the hairs on your head are in the catagen phase at any given time.

The Telogen phase typically lasts around 3 months. An estimated 10 to 15% of your scalp hairs are in this phase.

Hairs don’t grow during the telogen phase, but they don’t usually fall out either. The telogen phase is also when new hairs start to form in follicles that have just released hairs during the catagen phase.

 The Exogen phase is essentially an extension or a part of the telogen stage of hair growth. During the exogen phase, the hair shaft is shed from the scalp, often helped along by washing and brushing. Losing 50 to 100 hairs per day during the exogen phase is normal. 

During the exogen phase, which can last about 2 to 5 months, new hairs are growing in the follicles as old hairs fall away.

Each hair follicular unit has a pre-determined number of life cycles before it undergoes programmed cell death or apoptosis. Once this occurs, the follicle is dead and cannot be regenerated.  Therefore, it is very important to slow down the speed at which the hair follicle goes through its natural life cycle to reduce the rate of hair loss. To do so, we must find and treat the underlying cause. The cause for male patterned hair loss is usually due to DHT. Female patterned hair loss can also be related to DHT but can also have multiple other causes and factors which affect hair loss. 

Using a gardening analogy, DHT is like a poison that kills your plants. There are multiple treatment options to reduce the effects of DHT. These are divided into medications that reduce DHT levels via inhibiting the conversion of Testosterone to DHT (Finasteride and Dutasteride). This class of medications targets the Alpha 5-reductase enzymes (class I and II).

  Finasteride is currently FDA approved for the treatment of male patterned hair loss and prostate enlargement. Dutasteride is currently FDA approved for prostate enlargement, but it is approved in many other countries for hair loss. These medications have been studied extensively and have been used for many decades. There has been a lot of media attention regarding the incidence of sexual side effects that are possible with these medications, including a rare condition called post-finasteride syndrome where the sexual side effects are present long-term. This has led to many patients not willing to try these medications especially younger men. Also, these medications are not indicated for women of child-bearing age.  

We also have medications that act like fertilizers to stimulate hair growth like Minoxidil. Minoxidil is used primarily as blood pressure medication that for some unknown mechanism triggers hair growth. Minoxidil has been FDA approved as a topical treatment for both male and female patterned hair loss as Rogaine. Different formulations and strengths are used for men and women. Unfortunately, approximately 1/3 of patients lack an enzyme in the scalp that is required to convert minoxidil into its active form. Therefore, 1/3 of people will not respond to topical minoxidil. More recently, there has been increasing use of oral Minoxidil at very low doses with very promising results and relatively low incidence of side effects. 

There has been a lot of interest in the development of topical compounds of these medications in the hope to minimize the systemic absorption and, therefore, minimize the risk of side effects.  

Unfortunately, approximately 1/3 of patients lack an enzyme in the scalp that is required to convert minoxidil into its active form. Therefore, 1/3 of people will not respond to topical minoxidil. More recently, there has been increasing use of oral Minoxidil at very low doses with very promising results and relatively low incidence of side effects.  We will discuss all of the options with you in detail and come up with the best treatment plan. 

Female Patterned Hair loss can be due to many different causes including nutritional, hormonal, autoimmune conditions, and life stressors or illness. Therefore, this requires a much more detailed investigation to determine the cause. For more information, click on the link below. 

In women, we also use Spironolactone, which is commonly used as a diuretic, at low doses for its anti-androgenic effects. 

Plaletel-Rich Plasma or PRP has been used for decades to stimulate hair growth. This procedure uses the patient's own stem cells and growth factors already produced by platelets. A needle is inserted into a vein to obtain blood which is then spun down in a centrifuge to separate blood cells and plasma. The platelet-rich plasma is then re-injected into the scalp, delivering the stem cells and growth factors to the hair follicle and stimulating growth. 

More recently, there has been a lot of research and development of bio-identical growth factors from different sources for the same purpose. We offer this procedure using plant-based serums and growth factors, which are consistent in quality, using our Aquafirme XS device with De/Rive serum to exfoliate the scalp, improve blood flow to the hair follicles, and deliver the growth factors to the hair follicles using ultrasound and low-level laser therapy to push the growth factors from the scalp to the hair follicles. This device has been researched extensively and approved by the FDA. 

Laser hair caps, also known as low-level laser treatment (LLLT) devices, are designed to prevent or reverse hair loss. They work by emitting red light that is thought to stimulate hair growth by speeding up cell division. LLLT may also encourage hair follicle stem cells to produce new strands. The treatment is FDA-approved for both men and women who are experiencing thinning. However, the specific mechanism of how it works is not fully understood. It’s believed that the light therapy has anti-inflammatory properties that reduce the number of damaged cells in the scalp, which could prevent those harmful cells from causing hair loss.

Research has shown that laser caps can be effective in treating male pattern hair loss and female pattern hair loss, especially when other forms of therapy have proved unsuccessful. However, they do not directly help you grow hair in advanced balding areas.

The current protocol is to use these devices three times a week for 20 minutes per session. Most brands recommend 30 minutes of use every day to see results and claim that visible hair growth happens somewhere between 6 and 12 months. It’s important to note that while these devices are generally considered safe and have no known side effects. Please note that individual results may vary, and effectiveness can depend on various factors, including the stage of hair loss and adherence to the treatment protocol.  There are many different products available online and we encourage each patient to research them individually to see which option works best. 

The surgical treatments for male and female pattern hair loss have evolved substantially since their inception and currently both have excellent short- and long-term results when the most appropriate method is employed in the right individual.  The two procedures are the Linear Strip Excision (LSE) also known as Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). During the Consultation with Dr. Fernandez-Tatum, both techniques will be thoroughly discussed, including the pros and cons of each technique and the rationale for choosing the most appropriate technique for each individual.  Depending on the extent of baldness, more than one procedure may be necessary to achieve the desired result. There is a limited amount of donor hair  available for transplantation from the Safe Donor Area. This area is located in the back of the head and these hair follicles are genetically different and much more resistant to DHT and balding.

The Linear Strip Excision (LSE) or Follicular Unit Transplantation Procedure (FUT) is performed under a combination of moderate sedation and local anesthesia. Follicular grafts are typically taken from the back and sides of the head in the Safe Donor Area (areas of the scalp that are more resistant to genetic hair loss). 

The patient is placed face down on the procedure table and sedation is administered with oral and IV medications. The patient is monitored throughout the procedure. The donor scalp is first anesthetized with local anesthesia. Then, Dr Fernandez-Tatum surgically removes a strip of the scalp which contains the Follicular Units (FU) that will be transplanted taking great care not to damage the underlying blood vessels and nerves. The skin is closed in a tension-free fashion with non-absorbable suture leaving a small linear scar which is typically hidden by the surrounding hair and unnoticeable long term especially if the hair is kept longer than a #3 guard. The sutures will be typically removed 2-3 weeks after the procedure either in our office or by your own provider. The strip of scalp is then dissected under stereoscopic dissecting microscopes by experienced assistants, first into slivers (similar to cutting a loaf of bread into slices) and then each sliver is further dissected into individual Follicular units, which are separated into groups according to the number of hairs in each follicular unit (typically between 1-4 hairs per FU). All grafts are placed in a holding solution containing special vitamins and nutrients that keep the follicular units well preserved before they are transplanted. 

Once the strip has been harvested, the patient is then placed in a seated position for the rest of the procedure. The recipient scalp is also anesthetized with local anesthesia, and we begin transplanting them individually according to the number of hairs in each follicular unit into the recipient scalp, meticulously placing each graft to create a natural appearance that blends into surrounding hair pattern. This procedure can take between 4-8 hours depending on the number of grafts required to treat the areas of hair loss. The patient is maintained comfortable throughout the procedure with additional sedation and anesthesia as needed. Patients typically sleep or watch movies during the procedure and can get up and go to the bathroom as needed. Also, the patient will be provided lunch during the procedure.  

  Follicular Unit Extraction (FUE) is completed under local anesthesia and moderate sedation. Follicular grafts are typically taken from the back and sides of the head in the Safe Donor Area (areas of the scalp that are more resistant to genetic hair loss). However, beard hair can also be used in some cases where the patient has exhausted the supply of scalp donor hair. 

The donor scalp or beard is typically shaved and thoroughly anesthetized ensuring patients are comfortable throughout the procedure. We then use a small handheld punch device that removes individual follicular units, each containing 1-4 strands of hair. The punch device extracts the entire hair follicle, including its underlying root system, in order for the graft to survive the transplantation process and be able to regrow in its new location. 

All grafts are placed in a holding solution containing special vitamins and nutrients that keep the follicular units well preserved before they are transplanted. All grafts are also inspected under a stereomicroscope to ensure that every graft is intact and of the highest quality to ensure maximum hair growth and restoration. Once a safe and appropriate number of grafts have been harvested, we anesthetize the recipient scalp with local anesthesia and begin transplanting them individually into the recipient areas of the scalp, meticulously placing each graft to create a natural appearance that blends into surrounding hair pattern. 

The FUE procedure can span between 2-8 hours, depending on the number of grafts necessary to achieve the patient’s desired results. It is of the greatest importance to avoid over-harvesting of grafts as this can lead to a cosmetically undesirable appearance of the back of the scalp or obtaining grafts from outside the safe donor area which can lead to loss of these grafts in the future.   

After a FUE transplant, the scalp will be red, swollen, and tender for a few days. Patients are instructed to take great care not to touch their scalps to avoid dislodging the transplanted grafts. It takes approximately 7 days for the grafts to be completely incorporated into the scalp. Most of the effects after the procedure resolve within the first week. Scabs will form over the donor and recipient sites, and these should not be disturbed. The scabs will fall off over time as the scalp heals. Patients are instructed to sleep with their head elevated for the first few nights to minimize swelling. FUE is a relatively minor procedure, and most patients feel relatively normal the next day. However, like any surgical procedure, significant care should be taken over the first few days to ensure the best possible results. It is recommended that patients take a few days off (2-3 days) from work to allow the scalp to heal and recover before resuming normal daily activities and schedules. 

   This is the most important decision: determining which procedure is the best option for each individual at this time.  There are many different variables to consider when making this decision including the degree of balding, the density and quality of the donor hair, patient's age, underlying cause of balding and treatment, the desired cosmetic result, previous procedures, and hair cut style. These complex factors have to be carefully considered and we must always be thinking and planning ahead.  Hair transplantation is NOT a cure for baldness in the sense that it does not treat the underlying cause. Hair transplantation without medical therapy and routine follow-up and surveillance has a risk of poor long-term results due to progression of the balding process in the non-transplanted hair. 

 Compared to Linear Strip Excision (LSE) or follicular unit transplantation (FUT), the FUE procedure leaves less noticeable scarring in the donor areas. However, both Linear Strip excision (LSE or FUT) and FUE methods are very effective hair transplant surgeries to restore a fuller head of hair.  However, the number of grafts that can be safely obtained from the safe donor area is significantly lower for FUE compared to FUT. It is of the greatest importance to avoid over-harvesting of grafts with FUE as this can lead to a cosmetically undesirable appearance of the back of the scalp or obtaining grafts from outside the safe donor area which can lead to loss of these grafts in the future. 

Patients who have had several strip procedures may not have sufficient scalp laxity or donor hair available and therefore are only able to have FUE. In patients who wear their hair very short (1-2 guard), the scar from LSE may be noticeable and may be a better candidate for FUE.  In the rare instance where the LSE scar is noticeable, FUE can be performed to put hair directly into and around the scar to hide its appearance. 

It is also vitally important that the patient's expectations are realistic and achievable. The available donor hair is a precious and limited resource. If the extent of baldness is severe, it may be impossible to achieve both complete coverage of the bald area with a normal appearing density. 

These are just some examples to illustrate the complexity of this decision process which we will go through together at length before we proceed with any procedure. Hair transplantation is a long-term investment and commitment.