Before reading about the Bald Truth, you need to forget everything you have learned about hair transplants. If you are considering getting a hair transplant, like any other medical procedure, you need to have an open mind. This, along with working with your surgeon and using your own best judgment, can help make the decision that is right for you. The following areas will guide you on what you need to know before considering getting a hair transplant:


What are the Pros and Cons of Charging by Graft Number or Donor Size?

Charging by Graft Number
Pro: Although it is easy to compare the graft price between clinics, it should not be assumed that one-hair grafts and four-hair grafts have the same value.
1. There is a conflict of interest: when the price is tied to the number of grafts, the clinic may have a tendency to cut more grafts even with the same donor size.
2. It encourages doctors to use all Single Follicular Units (SFU)—the smallest size graft. But for some patients, this is not in their best interest.

Nowadays, SFU is being cut skinnier and skinner. Ten years ago, medical reports showed that fatty grafts produce 15-33% more hair than skinnier grafts. The denser the packing, the skinnier the grafts. But there is no conclusive evidence on this idea. Some surgeons have decided to cut even skinnier and have come up with the very skinny graft named “Extra Thin FU”. Several years ago a female hair transplant surgeon from Arizona was asked to deliver a minimum of 3,000 grafts to qualify to join the Extra Thin FU Dense Packing Club. After years of experience and analyzing the results, she changed to the bi-follicular unit. Steven C. Chang, MD respects her courage—as using the bi-follicular unit is the way he has been performing surgeries for more than 27 years. His practice has been criticized for an obsolete technique, but insists that it is in the best interest of the patients.

3. There is no incentive for the surgeon to consider other graft sizes to see if they will increase the growth rate. In the study “Do paired grafts survive as well as intact FU grafts?” published in Hair Transplant Forum International (2012), Michael Beehner, MD concluded that the bi-follicular unit has better regrowth rate and hair quality than SFU—in other words, the graft with more tissue around the hair has a better growth rate.
4. There is competition for more graft numbers (or more dense packing), instead of paying attention to the hair number.
5. There is no way to cut the exact pre-determined graft number; there are either too many or not enough hairs (hair density is different all over the donor site some clinics cut by follicular unit—not by size. The size of a follicular unit varies).
6. There are not enough grafts. To achieve the promised number of grafts, the surgeon needs to cut smaller grafts, even if it is not in the patient’s best interest.
7. There are extra grafts. When the graft number is more than the amount agreed upon, some clinics charge for extra grafts. This is unfair because it’s not the patient’s fault.

Charging by Donor Size

1. It is possible to cut the pre-determined donor size precisely.
2. There is no conflict of interest: it is easier for surgeons to make decisions based on the patient’s best interest, not the clinic’s financial interest.
3. There is no pressure to achieve a certain graft number. The clinic can cut the graft size in the patient’s best interest.
4. The patient and surgeon agree on the exact fee before surgery.
5. It is easy to compare results—using the relative density, not the graft number
6. It is possible to use a mixed size of graft to have the best results without worrying about not having enough graft numbers.

It is more difficult for patients to compare prices between clinics because almost 95% of hair transplant clinics use the graft number system.

What happens during hair transplantation?
For men, baldness can be taken as a sign of old age, unattractiveness, and infertility. Although none of these signs may be true, clinical studies have shown that hair loss is a cause of low self-esteem and low self-confidence in men. About 70% of men and 50% of women experience some degree of hair loss in their lifetime. Causes of hair loss come from several factors, but mostly from these three — genes, hormones, and age.

In the past, men have gone to desperate measures in trying to cover up their hair loss. Hair restoration has vastly improved in recent years. Among the several options used for hair restoration now, hair transplantation is emerging as the most effective treatment for baldness.

On average, a person sheds and regrows about 50 – 100 hairs a day. A mix of emotional turmoil, medication, poor nutrition, and illness may cause excessive daily shedding. However, these factors are often temporary, and hair growth should continue once these factors have ended. Around 70% of American men and 50% of American woman will experience some sort of hair loss during their lifetime. Researchers have shown that around 80% of bald men are preoccupied about their hair loss, and men who begin to lose their hair in their early twenties are more likely to suffer from extremely low self-esteem. Permanent hair loss comes from hair follicles that become thinner and weaker. Male patterned baldness is scientifically called Androgenetic Alopecia, which is caused by genes, hormones, and age.

Hair transplantation is a minor outpatient surgery that simply relocates existing hair follicles from the donor site to the balding area. The procedure first begins with the surgeon removing a donor strip from the donor site, which is often located on the back or side of the scalp. During the procedure, local anesthesia is administered to relieve any discomfort. Our doctor will remove a strip of skin from the donor area and close the opening with self-absorbable sutures. The donor strip is further cut into 3 sizes of grafts — the micro graft, the single follicular unit, and the modified follicular unit. The single hair follicular unit has 1 hair; single follicular unit has about 2 hairs; and the modified follicular unit has 2 to 4 hairs. The surgical technicians then isolate individual hair follicles from the donor strip, and implant them to the graft region. The grafts are inserted into pre-cut micro and mini slits that are strategically designed to aesthetically improve the density of your existing hair, lower the hairline, and fill in balding areas. For more information about the hair transplant procedure, please go to our Online Consultation.

Hair transplantation has a high success rate as long as you have enough donor hair. This procedure does not have any long term or major side effects. Taking the medication that we provide after the procedure can prevent possible complications such as infection and swelling.

The procedure generally takes about 3 to 5 hours depending on the number of grafts. There will be a fine scar on the donor area that you can easily cover up with the surrounding hair. Patients usually feel little or no pain, and can return to work the very next day. There is no additional care needed on the transplanted hair; just treat it like your ordinary hair, because it is your own hair! The transplanted hair will start to grow in 3 to 6 months, and will have the same strength, color, texture, length, and life span as your hair from your donor area.

Within 6 months of the procedure, the transplanted hair can be groomed and combed in any fashion you like. By doing a hair transplant now, you can replace your hair as it begins to thin and bald.

Are all hair transplant clinics the same?
Searching for a hair transplant clinic is no easy task and it’s almost impossible to compare clinics to see which surgeon does a better job. Because many websites use similar wording, information can look the same. When comparing clinics, make sure to ask if they can provide:

Different angles in the “before and after” photographs
Is a picture worth more than a thousand words? This is not the case when looking at photographs from hair transplant websites. Looking at “before and after” photographs can be confusing. Have you heard of the saying “looks can be deceiving”? This is truly the case when comparing photographs because photos taken at different angles with different hair styles can make the results look better than they actually are.

The face-to-face view gives the best result. Many clinics prefer to show this view and state the graft number. But providing the graft number is not enough. Most of the time, there is no mention of how large of an area of hair was grafted from and transplanted to.
The head-down view always shows a very thin impression.
A center part vs. a side part can show big differences in appearance. Ninety-five percent of men experience greatest hair thinning at the top and the center of the head. Although women experience hair loss less frequently than men, hair style is important in trying to achieve the look of a fuller head of hair.
Different hair cuts can show variations in how full the hair looks.
A shaved head in a “before” photograph can show dramatic results after hair transplant in an “after” photograph.
Many patients are taking the hair regrowth medication Propecia (finasteride), which can have a huge impact on the result of a hair transplant that may make the hair look fuller, but most clinics don’t even mention if the patient is taking it or not. I

If regrowth medication is recommended

Keep in mind that not everyone has the same type of hair. There are variations in hair density, hair quality and color of skin/hair, so even the same clinic can show different results for different patients. Don’t be afraid to ask questions so you can use your best judgment.

The more density in one session the better?
One of the most common questions hair transplant surgeons hear is, “How many grafts can you transplant into one square centimeter”? Some people use this question as a tool in helping to decipher the surgeon’s skill level. They feel that the higher the number of grafts squeezed in equals the higher the skill level of the surgeon. Is this true? Yes and no.

Yes: The most important thing for a hair transplant is to get the best result from the highest density of grafts. In order to gain a higher density of grafts, the surgeon needs to be able to cut the graft smaller. The smaller the grafts that are cut, the more density the surgeon can create.
No: Deciding the graft density depends on several different factors including patient age, nutrition level, health condition, history, transplant size, surgery duration and graft size, etc… No one knows what the highest density of grafts should be in order to give the best result. Today’s research only provides graft density for one square centimeter. However, hair transplants cover more than just one square centimeter. Surgeons need to take into consideration the patient as an individual and estimate.
For over 27 years, Steven C. Chang, MD uses a higher density approach for small areas with younger patients. For older patients with more area to cover, he uses a more conservative approach to keep the density adequate and within a safe range. He always works in the best interest of his patients.

Our Surgeon’s Perspective?
Come visit hair transplant surgeon Steven C. Chang, MD. With over 27 years of experience, he feels that diagnosis for hair loss is straight-forward with simple choices for treatment including Rogaine, Propecia and hair transplant surgery. There are four steps to hair transplant surgery:

Donor harvesting
Recipient site location

One-hundred percent of dissection and implantation are done by technicians. Some states in the US even allow technicians to do slit making. (California is an exception).
Although surgeons perform donor harvesting, a surgeon’s main job is to train a skilled surgical team, choose the right surgical method and create marketing opportunities.

If the surgeon is sick on the day of surgery, he can be replaced with minimal impact to the surgery result, but if all technicians are absent, then surgery has to be cancelled. It’s possible to find surgeons to remove the donor strips, but dissection and implantation take an extremely long time to learn.

Why come to us?

We have an excellent surgical team that has worked together for more than 20 years.
Our mixed size grafts have much better regrowth rate than the popular single follicular unit.
We give you the estimate based on measurement on your bald area, not only by visual estimate.
Our surgery is nearly painless, even during local injections.