You’ve Got Questions. Dr. Pistone’s Got The Answers.
Before you select a hair transplantation surgeon, be sure you’ve asked all of the necessary questions and received definitive answers. Always insist on reviewing “Before & After photos” and be sure to clarify that the surgeon showing them actually performed the procedures shown. Also, ask to speak personally with other patients. Ask for a list of at least 10-20 references. If the surgeon can’t provide them, be concerned. Do not make a rash decision. Do your homework.
The most common cause of hair loss is androgenic alopecia – male and female pattern baldness. The contributing factors are genetics and hormones. Hairs located in the front and crown of the scalp are genetically programmed to miniturize in response to hair follicle's growing sensitivity to the hormone dihydrotestosterone or DHT. The hair becomes finer and finer, until it becomes practically invisible to the human eye and eventually falls out.
The only limitation is the number of DHT - resistant follicles available in the donor area. We all have a fixed amount of genetically sound hair; therefore, my priorities focus on the survival and growth of every possible graft and to use the donor hair judiciously so that the hair transplant will stand the test of time.
If this is the case, we will determine which areas are most critical to be restored and what overall looks are achievable. When we mutually agree on a look that is both achievable and compliments the shape of your face, we will then and only then proceed. If you are not a good candidate, we will tell you so. In some extreme situations a newer technique called Follicular Unit Extraction can be used, where donor hair can be taken from other parts of the body such as the back, chest and legs.
There are three noteworthy innovations that have revolutionized the process of hair transplantation. The first is transplanting natural groupings of follicular units of one-to-four hairs each. The second is the dissection of the donor strip into follicular units under the high-powered magnification of a Stereo-microscope. The third is removal of the donor follicles by follicular unit extraction (FUE) in certain cases(i.e. Neograft, SmartGraft, S.A.F.E. System, etc)
Hair grows in natural groups of one, two, three and four hairs, enfolded in a fibrous sheath. These natural groups are called follicular units. When I perform a hair transplant, I imitate nature using single hair units on the hairline and units of two, three and four hairs moving from front to back. Follicular units are the key to achieving a completely natural look and to the high survival rate of the transplanted grafts. Some clinics may dissect the follicular units of two, three and four natural hair groups into single hair grafts and then transplant them. Supported by a published study in the Dermatologic Surgery journal, this process, often referred to as single hair micrografting, actually contradicts the natural grouping of hair and produces less natural and very thin results.
Some clinics will dissect the natural hair groups of two, three and four hairs into single hair micrografts solely for monetary purposes. For example, a clinic may dissect a natural follicular unit comprising of four hairs into four single hair micrografts and charge the patient for four grafts instead of one. I often use the metaphor of a pizza in explaining this less than scrupulous practice. Would you pay more for a 15-inch pie cut into twelve pieces than the
exact same pie cut into eight? I often warn: buyers beware. The total number of hairs transplanted and the way they are artistically angled is far more important than the number of grafts.
In a word, results. The Stereo-microscope enables me,via high-powered magnification, to precisely dissect the natural follicular units of one, two, three and four hairs from the donor strip. The precision of dissection that the Stereo-microscope affords virtually eliminates trauma to any of the follicular units resulting in an almost 95+% survival and growth rate. If a surgeon attempts to dissect using minimal or no magnification, he runs the risk of transection and the destruction of donor hair – our most precious commodity. An additional benefit of dissecting follicular units under the magnification of a Stereo-microscope is that it provides me with the ability to trim excess tissue from the hair follicle. Therefore, each unit to be transplanted is actually smaller. Smaller transplants mean that I can make smaller recipient incisions in the scalp, which enables me to artistically place the grafts closer together producing greater density.
Experience, skill, artistry, and ethics in conjunction with the use of the Stereo-microscope in the process of follicular unit transplantation distinguishes my practice. I perform only one hair transplantation procedure at a time and refuse to use an “assembly line” approach where several surgical patients are juggled at one time. Once I begin a procedure, the patient has my undivided attention. This would seem obvious, but is actually more of an anomaly than the
norm. I also am personally involved in every phase, every step of your hair transplantation procedure. I do not believe that it is in your best interest, or mine, for a technician, qualified or not, to be directing a procedure.
No, absolutely not. Do not wait. The current techniques that I practice allow me to insert donor hairs between your existing hairs, leaving them undisturbed while restoring density to your scalp. The successive placement of many of these grafts over several procedures can usually prevent the appearance of baldness in some patients who have remaining, but thinning hair, stay one step ahead of the onset of baldness.
The number of procedures and the number of grafts varies from individual to individual. I would recommend a free consultation where I’ll be able to examine and determine the appropriate course of action. The key factors in determining the number of grafts necessary to achieve a patient’s desired density are:
A. Your current hair density in the balding area. Remember that this existing hair is likely to be DHT-sensitive as well, resulting in additional hair loss as you age. It is always prudent to save some donor hair for this potential eventuality.
B. The density in the donor area, as well as the hair thickness, curl and color all contribute significantly to your final result.
C. In my experience, most patients who come to me require between 1-2 procedures over a lifetime, depending on the size of the bald/balding area and the ultimate density they would like to achieve. Additional procedures could be performed when and if their existing hair continues to thin.
Yes. I am able, in almost all cases, to reverse the misfortunes of a bad hair transplant. The cornrow look or unsightly flaps along the frontal hairline can now be corrected in order to achieve a much more natural hairline. I am able to repair even those patients with abnormally low hairlines from earlier transplants. I remove the plugs, dissect them under the Stereo-microscope and then re-transplant them.
I believe that while there are numerous qualities a hair transplant surgeon should possess, the most critical are:
A. Formal training. Training must take place under the strict guidance of a residency program or a fellowship and result in Board Certification under the auspicies of the American Board of Medical Specialties, and Board Certification in Hair Restoration is certainly desirable. Double-board certification in a primary specialty, such as Dermatology, and Hair Restoration Surgery is the most desirable and such surgeons should receive higher consideration, in my opinion.
B. Technical skill. Modern hair transplantation requires the mastery of a plethora of technical skills, which are only achieved over time. I have performed more than 20,000 procedures and have been refining my surgical techniques for more than 30 years.
C. Artistry. Recreating a hairline not only takes great surgical skill and experience, but also an intrinsic sense of artistry. I pride myself on restoring hairlines that are virtually undetectable. I recreate soft and natural hairlines paying meticulous attention to fullness, density, texture, and the angle and placement of each individual hair.
D. Ethics. I live my life and run my practice under the guidance of one rule, the Golden Rule – do unto others as you would have others do unto you. My commitment to you is the skillful blending of artistry and medical training, coupled with personal attention – always.
My patients say that they only feel slight pressure during the procedure. Most of the time, they are absorbed in a movie or napping anyway. Recovery is usually speedy. The majority of my patients are back to their normal activities within a week.
If this is the case, we will determine which areas are most critical to be restored and what overall looks are achievable. When we mutually agree on a look that is both achievable and compliments the shape of your face, we will then and only then proceed. If you are not a good candidate, we will tell you so. In some extreme situations a technique called Follicular Unit Extraction can be used, where donor hair can be taken from other parts of the body such as the back, chest and legs, however body hair does not appear as natural as scalp hair. If you are not a candidate for the procedure we will tell you so.
In the midst of all the marketing and new technology, we sometimes forget that Hippocrates gave doctors his best advice in the famous "Hippocratic Oath," recited by all medical doctors all over the world at their graduation ceremony. He admonishes us to "do no harm" and to pass on our knowledge and experience to the next generation of physicians, as well as other noteworthy advice. Personally, I like to keep this in my office and read it from time to time. I have trained doctors as far away as Turkey and Columbia in my effort to uphold this oath and will continue to do so as long as I am able.