Dr. Sidle has a particular interest in hair loss and hair restoration that was sparked during an intensive year of training spent under the guidance of Sheldon Kabaker, M.D., a world famous hair transplant surgeon.
What causes male pattern baldness?
Male pattern baldness (androgenetic alopecia) occurs when there is shortening of the natural hair growth cycle. This shortening causes growing hairs to become miniaturized. The combined effect of the increased number of miniaturized hairs and decreased number of normal thick hairs results in a noticeable thinning of your hair. This process occurs due to the action of the hormone dihydrotestosterone (DHT) in patients who are genetically predisposed to male pattern baldness. In someone who is predisposed to male pattern baldness, this condition is typically progressive throughout adult life.
What can be done to treat male pattern baldness?
The last couple of decades have seen significant advances in the management of male and female hair loss. There are medications that help reverse or prevent hair loss. Additionally, surgical techniques have improved to provide a more natural result than earlier efforts that often resulted in a “doll’s hair” or “corn row” appearance. New techniques and regular use of magnification during surgery are employed to create hair grafts of the smallest possible size that still retain the natural characteristics of hair growth and development. Dr. Sidle performs Follicular Unit Grafting, which is currently the gold standard in hair transplant procedures.
Prior to considering surgery to treat baldness, many patients pursue medical treatment. Medical treatment aims to prevent further hair loss and may reverse hair loss to some degree. The use of medications may also be a useful adjunct to surgery. Medications that are commonly used to treat hair loss include Propecia® (finasteride) and Rogaine® (minoxidil). If you would like more information on available medical treatments, Dr. Sidle and his staff can provide recommendations for doctors in the Chicago area that specialize in medical treatment of hair loss.
Surgical Hair Transplantation: Follicular Unit Grafting
In recent years, significant changes have occurred in the way many surgeons perform hair transplants. Our clinic and others have adopted the use of the dissecting microscope to create hair grafts of the smallest possible size that still retain the natural characteristics of hair growth.
By “natural characteristics of hair growth”, we mean the pattern of hair follicles as they grow out from the skin. If one looks at the scalp with a 5-10x power of magnification, it is evident that hairs grow out of the skin in small groups of one, two, three, and four hairs. The human scalp averages one follicular unit per 1mm2, and each unit contains an average of 2.2 hairs. Therefore, a strip of scalp 1 centimeter wide and 10 centimeters long would be expected to contain 1000 follicular units or 2,200 hairs.
When we perform hair transplantation, we mimic natural hair growth patterns by surgically moving hair in its naturally-occurring follicular units. In some situations, just one grafting session may achieve optimal results; however, in patients with more severe or widespread hair thinning, two or three grafting sessions may be required to achieve the best possible result.
By transplanting the finest possible intact follicular units, Dr. Sidle is able to significantly improve the fullness and thickness of your hair while still maintaining a natural appearance. However, it is important to emphasize that the density of the transplanted hair will still be somewhat less than that of your hair before you started balding.
What should I expect on the day of surgery?
Many clinics perform this surgery under only local anesthesia – shots to numb the area that are given while the patient is awake. This allows the patient to be fully alert throughout the procedure and able to drive him- or herself home afterward. In our clinic, we offer oral or IV sedation to patients so that they remain sleepy and largely unaware through a good portion of the procedure. Because the procedure may last between 3-6 hours, most of our patients prefer to receive some degree of sedation to relieve any anxiety they have and keep them comfortable during the procedure. However, if they wish to drive themselves home or take public transportation without assistance after the procedure, we do offer the option to receive local anesthesia alone. In either scenario, the operation is painless once the scalp is anesthetized.
What can I expect after surgery?
Postoperatively, we often put a dressing on the back of the head to collect any drainage that may occur. This is usually removed the day after the procedure. Often, we do not put a dressing on the top of the head; however, you may be instructed to place moist dressings on the scalp, which are changed every 2-3 hours. Alternatively, you may be instructed to intermittently spray the top of your head to keep your new grafts moist. Using one of these techniques seems to decrease the amount of crusting and sometimes causes the hair to grow a bit more rapidly.
Most patients can wash their hair gently two days after surgery. On the second day after surgery, they can gently shampoo their hair. Then, on the third day, patients can often resume their normal hairstyling methods. The stitches or staples used for closure in the back of the head are removed in 10-14 days.
What are the possible side effects of the surgery?
There are a few problems and complications that may occur following hair transplant procedures. The most commonly seen problems include swelling of the forehead, which can occur during the first week after surgery, and small pimples that may form at a few of the graft sites during the first three or four months after the procedure.
We employ certain measures during surgery to decrease the risk of swelling, so it generally is only seen in about one of every eight patients. The swelling, if it occurs, goes away spontaneously. If small pimples or cysts arise, these are treated by opening or “unroofing” them in clinic. We carefully evaluate patients at their scheduled follow-up visits to ensure that any problems that may exist are identified and handled in an expeditious manner. If you have any concerns after your procedure, we are always available to answer questions via email or phone call, or we can schedule an additional follow-up visit if necessary. Very rarely, wound infection may occur, which is treated with antibiotics.
A relatively common occurrence after large sessions of grafts is temporary fallout from previous grafts or from some of the thinning, balding hair. Due to changes in circulation that occur from the many graft insertion points in the scalp, some hairs are shocked. By “shocked”, we mean that the blood supply is temporarily diminished, causing the hair to go through a premature hair growth cycle in which some hair initially falls out but subsequently grows back.
If this happens, do not be alarmed. The previously transplanted hairs will all grow back, along with the newly transplanted hairs. It should be emphasized that hairs, when they are transplanted, take an average of three months before new growth appears above the surface of the skin. Some hairs may take up to nine months to become visible. Small crusts and hairs that are in the grafts when they are inserted usually fall out within the first three weeks, but this phenomenon and minor shedding of other hairs is no cause for concern.
“Doll’s Hair Appearance
In the early days of hair grafting, this procedure was done with larger grafts, a technique that has been essentially abandoned for the smaller grafts that Dr. Sidle uses. The previously used larger grafts, sometimes referred to as “plugs”, often resulted in a “corn row” or “doll’s hair” appearance. This was due to the large, prominent grafts standing out in tufts by themselves. By microscopically dividing the donor hair into very tiny grafts, we spread the hair around more diffusely. Using state-of-the-art Follicular Unit Transplantation technique avoids the “doll’s hair” appearance and provides a much more natural and aesthetically-pleasing result.
Why choose Dr. Sidle for hair transplantation?
Judgment, experience, and, perhaps most importantly, artistic talent of the surgeon are essential in order to obtain the optimal result for each individual patient. There exists a great variety of balding patterns, hair textures, densities, colors, and scalp laxity, all of which are factors that require certain considerations in surgical planning to get the best possible result. Dr. Sidle emphasizes that hair transplantation is not an assembly-line, one-size-fits-all type of procedure. He does not employ a patient counselor in his practice, as he believes it is the responsibility of the surgeon himself to examine and counsel the patient appropriately, discussing with the patient his plan for achieving the best possible outcome.
When performing large sessions of hair transplants, it is necessary to have a team of physicians, nurses, and technicians who can do the labor-intensive tasks of cutting the donor hair under microscopes into thousands of tiny grafts and then inserting them into the carefully designed puncture sites the surgeon creates on the scalp. In our clinic, we have up to five assistants working each case, often alternating assistants to decrease the fatigue factor. The skill and experience of these assistants are crucial to efficient and successful modern-day hair grafting.
Experience Matters. As a board-certified Facial Plastic Surgeon at Northwestern with expertise in the hair, face, and neck, Dr. Sidle can provide you with an individualized plan to achieve your goal of having a fuller, more youthful appearing hairline. Call our office for a one-on-one consultation.
Additional Information from the International Society of Hair Restoration
- International Society of Hair Restoration homepage
- Common Questions About Hair Loss and Hair Restoration
- Follicular Unit Transplant & Extraction
All post-operative instructions can be found on the Patient Resources page.