April 15, 2025 • 23 mins
Dr. Ross Kopelman, a hair transplant surgeon with offices in NYC and Palm Beach, gives a modern take on hair restoration, debunking myths and explaining what makes someone a good candidate. He stresses that medical therapy—not surgery—should be the first step in treating hair loss, with transplants as a supportive option once hair loss is stabilized.
Surprisingly, about 50% of his transplant patients are women, many seeking treatment for widening parts rather than receding hairlines. Techniques like FUT, which don’t require shaving large areas, often work well for them.
Dr. Kopelman also explains why young men with aggressive hair loss patterns may not be ideal candidates and breaks down the differences between FUE and FUT methods. The transplant process itself is a detailed, team-driven effort lasting 5–7 hours, focused on achieving natural-looking results.
Check out Dr. Kopelman's work, and more about him and his practice here: https://kopelmanhair.com
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Episode Transcript
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Speaker 1 (00:00):
Welcome to Dermot Trotter Don't Swear About Skin
Care where host Dr Shannon CTrotter, a board-certified
dermatologist, sits down withfellow dermatologists and skin
care experts to separate factfrom fiction and simplify skin
care.
Let's get started.
Speaker 2 (00:19):
Welcome to the Dermot Trotter Don't Swear About Skin
Care podcast On today's show.
I have a special guest heretoday, dr Ross Kopelman.
He's a hair transplant surgeonat Kopelman Hair Restoration,
with offices in New York City aswell as Palm Beach, florida.
He actually has a podcast aswell that you need to check out
the Hair Doctors and on thatpodcast he shares insights on
(00:42):
hair loss and the latest trendsin hair restoration and I've
invited him to come on thatpodcast.
He shares insights on hair lossand the latest trends in hair
restoration and I've invited himto come on the podcast today to
talk more about hairtransplants because I know
people have a lot of questionsout there about it.
So welcome to the podcast, ross.
Speaker 3 (00:55):
I'm very excited to be here and have this
conversation about hair loss,which I you know.
The reality is.
Hair loss impacts most everyone.
Speaker 2 (01:02):
You're right.
I think a lot of our listenersout there can relate to it.
If not themselves, they knowsomebody and I think people talk
about it more now and don'tjust accept it.
You know, it doesn'tnecessarily have to be the
reality, which is kind ofexciting, and I know a lot of
people you know might go to thedermatologist or their doctor
and talk about hair losstreatment options that might
(01:22):
involve, you know, puttingthings on the scalp or taking
pills.
But today I want to talk aboutkind of the next level and
discuss a little bit more abouthair transplants, because a lot
of people are even wonderingwell, what type of hair
transplants are there and even,am I a candidate for a hair
transplant?
So how would you answer that?
If somebody comes to youroffice because maybe they are a
(01:43):
good fit or maybe they aren't,how do you kind of address that
with them to kind of get an ideaof you know if they're going to
be somebody you want to moveforward with a hair transplant
with?
Speaker 3 (01:51):
So it's a very interesting question because if
you're someone who's starting toexperience some form of hair
loss, the first place you startis actually not with a hair
transplant.
It's with medical therapy.
You start is actually not witha hair transplant, it's with
medical therapy.
In fact, my philosophy is thatit's medical therapy paired with
the hair transplant thatultimately gives the best result
(02:14):
.
So when I see a patient in myoffice, that patient could be
male or female, and I thinkthere's a misconception actually
that hair transplants are onlyfor men, and in fact I would
argue that's not true.
50% of my patients are actuallyfemale.
So that's the first place wehave to start.
We have to identify what is theroot cause of your hair loss,
(02:38):
because a hair transplant is notfor everyone.
The second thing we have to dois what medical therapy can we
put you on?
And then the third step andthis is this is way down the
field is are you a candidate fora hair transplant?
We don't assume you're acandidate for a hair transplant
the minute you walk into theoffice.
Speaker 2 (03:00):
So if somebody comes into the office and you're
trying to decide if they're ahair transplant candidate, how
do you make that assessment?
What type of questions?
Are you looking at their scalpor trying to identify the
particular type of hair lossthat they might have?
Speaker 3 (03:12):
Absolutely.
So we have to see do they havea scarring alopecia?
Do they have a non-scarringalopecia?
Is there an underlying medicalreason why they are experiencing
hair loss?
Because if they fall into oneof those categories for instance
, if it's a medical reason why aparticular person has hair loss
(03:33):
maybe it's a thyroid conditionWell, in that case we have to
address the thyroid issue beforewe even think about a hair
transplant.
Additionally, if they have ascarring alopecia or a hair loss
condition, that has somethingto do with an autoimmune
underlying issue, that has to beaddressed, and so in some cases
we have to biopsy the scalp.
(03:55):
Very frequently I see women whoare postmenopausal who have a
condition known as FFA frontalfibrosis and alopecia and those
women are not ideal candidatesto have hair transplants unless
their condition is stabilized.
So we have to be very cautiousbecause there's a lot of people
that are they're running to.
(04:16):
They think the hair transplantis the solution, but really you
have to really address what'sunder the roof, and that is
critical because not everyone isa candidate to move forward
with surgery.
Speaker 2 (04:31):
So somebody has you know, you mentioned kind of
scarring, non-scarring, form ofhair loss.
Say you go in, you take a lookat them, you make the diagnosis
just looking at them, or maybe abiopsy, and, for example, if we
talk about people that maybehave scarring forms of hair loss
, if you're able to stabilizethat condition where they don't
appear to be having any moreloss, is that somebody that
(04:53):
could qualify or benefit from ahair transplant?
Speaker 3 (04:56):
So that's a great question.
So patient has alopecia areata,which is an autoimmune hair
loss condition.
What we could do and this alsoapplies to women who have FFA,
frontal fibrosis and alopecia wemight do a test run so we might
take out a couple, maybe ahundred follicles from the back
of the scalp, and that's by theway.
(05:16):
When we perform hairtransplants which I'm sure we'll
discuss we take care from theback, and there's a reason for
that.
And when we transplant theminto these individuals who have
scarring alopecias, we have tosee if those follicles are going
to actually take.
It's better to do that approachthan transplant a thousand
(05:36):
follicles and have a failure,and so we have to be very
cautious in terms of how wemanage those individuals who
have scarring alopeciaspecifically.
Speaker 2 (05:47):
Interesting.
So, like you talked about, it'skind of that test drive
approach.
You know, you do thattransplant on a few.
See if it maybe takes, inparticular for those scarring
forms of hair loss, which aredefinitely more challenging to
treat, even medically speakingas well, and then for the people
that have maybe non-scarringforms maybe they have, you know
(06:18):
what people like to call, youknow, hereditary form of hair
loss, or androgenetic orage-related thinning of the hair
or, as you mentioned, alopeciaareata.
Speaker 3 (06:22):
These forms of hair loss that aren't scarring do
they tend to respond better thanto a hair transplant.
Yeah, so you know, if you comein and you have androgenetic
alopecia, well what does thatmean, first and foremost?
Well, that means there'sprobably a genetic component for
why you have hair loss to start, and then there's a major.
There's a hormone that's amajor contributor to hair loss
and that's known as DHTdihydrotestosterone.
And what we know is thatthere's areas of the scalp where
(06:42):
the hair is more sensitive toDHT.
So, for instance, in thehairline, the mid part, but not
in the back of the scalp.
The hair from the back of thescalp is less sensitive to this
hormone known as DHT, and that'swhy we can transplant it to the
front.
So, if you're a male patient,you come into the office, you
have recession of your temporalrecession, recession of your
(07:07):
temporal areas, or you've lostsome of your hairline, or even
your mid scalp, even your crown,and, yes, you potentially are a
candidate, as long as, again,you don't have an underlying
medical reason for the hair lossor a scarring alopecia.
For women, I tend to seewidening parts as the
(07:29):
predominant issue in femalepattern baldness, and those
women are also great candidatesfor hair transplants.
However, if you're someone whocomes in and you have something
known as DUPAA this is diffusehair loss that kind of globally
impacts your entire scalp wehave to be very, very cautious
(07:52):
because in those particularpatients, even their donor area,
even their donor areas areimpacted.
So that's why it's critical,before we even explore a hair
transplant, medical therapyshould be started a few months
before, because we want to primethe hair, especially in the
donor area, because it makes theextraction much more effective.
Speaker 2 (08:14):
So kind of talking about.
You know, we talked about somepotential candidates like just
out of the gate who would yousay really just isn't a good
candidate for a hair transplant.
Speaker 3 (08:23):
Okay.
So who is not a good candidate?
This is a I love this question,because who is the typical
patient that wants a prettyaggressive hair transplant?
I would argue that that's ayoung male in their mid to early
thirties.
Those individuals who have,we'll call it, a Norwood three
(08:47):
to four pattern and that's thisis a scale that we use to kind
of assess where they are intheir hair loss journey are not
good candidates.
Why?
Because if they're having thattype of hair loss at such a
young age, well, their hair lossis going to progressively get
worse.
(09:07):
So one of the things that wethink about as hair surgeons or
even as dermatologists treatinghair because most of hair loss
is treated by dermatologists wehave to think about where is
that hair loss going to be 10years from now, 20 years from
(09:28):
now, 30 years from now?
And so we have to be very, verycautious with young men.
Very cautious with young men.
They want to look youthful,they want a hair transplant
because maybe emotionally, todate there's a lot of reasons
why people want hair transplants, but for these young men in
(09:50):
particular, it can be verydistressing.
They're at the beginning oftheir careers, they want to look
youthful, and so we have to becautious, and I always tell my
young male patients that it'scritically important you start
on medical therapy and we can'teven think about having you do a
hair transplant until I seethat your hair loss is stable
(10:11):
for at least a year.
Speaker 2 (10:13):
And that's something that I constantly have
conversations with patientsabout, because there's a lot of
young men that do reach out toour office and I have to turn
them away from having a hairtransplant that group that's
(10:37):
more commonly affected, or kindof that typical person that
comes in that thinks thisprobably is going to be the
solution for them, Yet, like youmentioned, probably not the
best option for them, especiallyif they're going to have
progression over time.
So it sounds like you knowsomebody just thinking okay, is
hair transplant?
For me, One, it's identifying,as you mentioned, the type of
hair loss.
Two, if it's scarring ornon-scarring.
And if it's scarring ornon-scarring, you want to have
(10:57):
appropriate medical managementwhere you're not really seeing
progression, and then, of course, eliminating any underlying
issues that might be a source ofthe hair loss or contributing
cause to it, like you mentioned,like the thyroid not behaving
appropriately, and maybe it'soveractive or underactive, or
maybe they have nutritionaldeficiencies, things like that,
that you need to supplement, ormaybe they have nutritional
deficiencies, things like thatthat you need to supplement.
(11:19):
So once somebody's to a periodof stability, typically with
having non-scarring or scarringhair loss, they might be a good
potential candidate.
Would that be a good summary ofsomebody who's out there maybe
thinking is this right?
Speaker 3 (11:29):
for me.
That's true that you didsummarize it, but I do want to
go back to one point, which is,yes, these young men might be
upset that they can't go for ahair transplant, but they're
very appreciative because theyrecognize that I am acting as an
advocate to protect them.
There's, unfortunately, atremendous amount of marketing
(11:51):
in this industry to get youngpeople to fly internationally
for medical tourism to dotransplants when they should not
do transplants and they'redangling really inexpensive
prices in front of their eyes.
The reality is this is asurgical procedure and you have
to really have a long-term kindof perspective.
(12:12):
So it's critically important asdermatologists, as hair
surgeons, that we advocate andwe put our patients' well-being
ahead of kind of maybe our ownkind of drive to get another
hair transplant case.
So I think that that's thething that I've learned the most
(12:32):
about from my patients thatI've turned away from having
hair transplants.
They're still very appreciative.
They're still very much mypatients because they're on
medical therapy and they feellike I'm their advocate.
Speaker 2 (12:46):
It's a really important point.
I appreciate you bringing thatup because you're right, it's
very emotional.
You know hair loss and peopleare willing often to spend
anything or almost do anythingand people are making
recommendations.
You know healthcareprofessionals where it's not
appropriate.
So it's great you know that wecan step in and be that advocate
for the patient as well.
And if they're coming to youroffice and, you know, say this
(13:07):
is somebody that you look at andfeel like, okay, yeah, hair
transplant, you're a goodcandidate.
What are the different types ofhair transplants and when do
you recommend maybe one over theother?
Speaker 3 (13:18):
Okay.
So if we're talking about amale patient who's on the
younger end, in that case it'stypically strengthening the
hairline.
Okay, because we don't want toaddress the crown if they do
have any crown involvementbecause we don't know how that
hair loss is going to progress.
So typically with younger menwe do smaller cases.
(13:40):
We don't want to be tooaggressive.
We don't want to do what'scalled a giga session, which is
more than four to 5,000 grafts.
If you're a male and you're inyour late forties, fifties and
sixties, your hair loss has kindof slowed down.
As long as you're on some formof medical therapy, I feel
confident to move forward, to domore aggressive extractions of
(14:03):
taking hair out from the back ofthe scalp.
And then for female patients wehave a little more laxity.
You can be in your 20s and your30s, your 40s and your 50s, and
women are a little morecomplicated than men because
there are other underlyingissues there's pregnancy,
there's menopause, but we can bea little more aggressive.
(14:24):
For instance, I do have femalepatients who are in their late
20s, early 30s.
They want to strengthen theirmid parts or they want to bring
their hairline down a little bit.
We don't have to worry aboutthe same things that we have to
worry about with with younger,with younger male male patients.
Now, the other thing that weshould talk about is the two
(14:46):
different approaches toperforming hair transplants.
There's the FUE approach, whichis follicular unit extraction,
where individual hair folliclesare removed, typically from the
back of the scalp, and thenthere's FUT, which is
essentially taking a linearstrip from the back of the scalp
and then suturing that up.
(15:07):
And what's interesting and youmight find this fascinating is
that strip, 10 years ago, wasthe dominant approach to
performing hair transplants inthe United States and around the
world, and now 75% plus of hairtransplants are performed with
the FUE approach, the follicularunit extraction approach.
And so many would argue thatFUT is a dying art, and I
(15:33):
actually am in the camp that FUTis as important as FUE in terms
of taking hair from the back ofthe scalp.
When we perform hair transplants, we use both approaches on both
male and female patients.
An FUE approach is ideal for amale who has really kind of like
a thin military cut.
They don't want to see anylinear.
(15:54):
We don't want to see any linearscars in the back of the scalp.
They like to wear their hairshort, so that's an ideal
approach.
But for someone like myself Ihave longer hair I would feel
comfortable performing an FUT ona male patient with a similar
hairstyle.
Now, there's a slew of otherhair surgeons that feel
(16:14):
comfortable performing FUE onwomen other hair surgeons that
feel comfortable performing FUEon women.
Now, when we perform hairtransplants on women, we
typically need anywhere from2,000 to 3,000 hair grafts, and
you can imagine that's a widewindow of hair that has to be
shaved on the back of the scalp.
And I don't know, dr Trotter,right, I want to make sure I'm
saying your last name correctly,dr Trotter, right, I want to
(16:35):
make sure I'm saying your lastname correctly how long it took
you to grow your hair to thelength it is today?
Probably took a couple of years.
I don't know how many womenwant to shave the entire back of
their scalps, right?
So I'm in the camp that, forwomen, FUT should be the
dominant approach to performinghair transplants, and in fact, I
(16:58):
would also argue that thequality of the grafts that we
get from the back of the scalpare better.
With FUT we get lesstransections.
This is where the hairfollicles will be ruined,
because with the FUE approach.
We have to use special devicesto remove hair follicles, and we
don't always pull them outcorrectly.
There's actually typically atransection rate of anywhere
(17:20):
from 6% to 10%, depending uponthe quality of your skill sets,
and so I'm in the camp of tryingto kind of maintain FUT
techniques in the United States,because I do not believe that
it should be a dying art.
Speaker 2 (17:42):
And you mentioned just kind of the process there
where you're talking about likegraphs and pulling things out.
You know, for some of ourlisteners they might not even be
familiar with kind of what thatmeans.
Can you briefly describe sortof that process then for the
transplant, just to kind of geta feel, what does the graph mean
, or more than one graph, likeyou mentioned, or pulling that
out and literally what is theact of transplantation Like?
(18:02):
What does that actually meansurgically?
Speaker 3 (18:11):
if you were explaining it to a patient.
Yeah, so hair follicular unitsokay, they come in units, okay,
and the units could be one, one,one hair follicle, twos, threes
or fours.
It's they're like littlebatches.
Think about, like like when you, when you're planting flowers,
sometimes there's, sometimesthere's one flower that sprouted
, sometimes there's two kind ofpackaged together and we don't
really know when we're, whenwe're taking out a strip or
(18:32):
extracting with the FUE approach, are we going to get ones, are
we going to get twos, are wegoing to get threes?
And so that is.
That's the the basics in termsof what's happening in the back
of the scalp, and then what'sthe other?
The other thing that's criticalis how we design the hairline,
or how we design how we implantthis hair not only into the
(18:53):
hairline but into the mid scalp,into the crown.
Typically, we like to use onehair follicles in the front
because they're fine as a finestto the front of our scalp, and
then we do behind that, we havesome twos, and then there's a
fineness to the front of ourscalp, and then we do behind
that, we have some twos, andthen there's a disbursement of
twos and threes.
Now, when the hair comes outfrom the back of the scalp.
You have hair technicians whotake these hair follicles and
(19:18):
they cut them underneathmicroscopes, because sometimes
you get twos or threes and youneed more ones.
So they kind of slice them up,they clean them up, and I think
one of the things that I want toemphasize is that when a hair
transplant is performed, it's ateam effort.
Okay, this is not a surgerysimply performed and solely
(19:40):
performed by a hair surgeonmyself.
It really involves a nurse andpossibly two or three hair
technicians.
It's a multiple hour procedure.
It takes anywhere from five toseven hours to complete these
procedures, and it doesn'tmatter if it's a small, medium
or large case.
These cases take an exorbitantamount of time because there's
(20:04):
so many different steps involved.
These cases take an exorbitantamount of time because there's
so many different steps involved.
The other thing that we have tobe very cautious of is how we
anesthetize the front of thescalp, the back of the scalp.
We have to be very sensitive tomaking sure that there's no
lidocaine toxicity or anycomplications during surgery.
So it's vitally important thatyou go to a, a hair surgeon, who
(20:27):
has tremendous amount ofexperience managing, you know,
complications and overseeingthese procedures because it
these are long, long, very longcases and you don't want
anything to go wrong.
Speaker 2 (20:44):
And the last like minute or two, cause we've
already kind of sailed through.
It's kind of crazy time wise.
What other tips would yourecommend?
And we'll definitely have tomaybe bring you back on to talk
more detail about hairtransplants.
But what other tips do yourecommend as people just kind of
be aware of if they're thinkingif a hair transplant might be
right for them?
Speaker 3 (21:02):
could you rephrase that question?
Speaker 2 (21:04):
yeah, just just if somebody's thinking about you
know, doing a hair transplant,what sort of like tips or things
would you recommend them startthinking about, if it's the
right choice for them, you know,thinking about the type of hair
loss or maybe where they shouldgo I know you mentioned the
credentials were important whattype of risk complications would
they have to worry about?
You know, what type of adviceor tips would you give to
(21:25):
somebody maybe consideringhaving a hair transplant?
Speaker 3 (21:29):
That's a wonderful question.
So, 100%, you have to do yourresearch.
What does that mean?
That means go to Google, learnabout what the whole process
looks like.
You don't have to know thesurgical, all the surgical
minutiae, but understand thefundamentals of the difference
between FUE and FUT, which wediscussed, understand how this
(21:52):
is a team-based approach.
Do your research about whichclinics you're going to.
Read patient reviews Always agreat idea to actually speak to
patients who've gone through theprocess of having a hair
transplant so you can getfirsthand kind of knowledge
about that surgeon, what theirresults are like.
Make sure to look at before andafter photos and, you know, just
(22:15):
make sure that again, the firstthing you have to do is go to a
surgeon who's not just going tosell you a hair transplant but
who is going to be committed totreating you for a very long
period of time.
Because when you go for a hairtransplant, that is not the end
(22:36):
of your journey.
This is really a lifelongcommitment to maintaining your
hair and that involves medicaltherapy.
So you really want to go to apractice that's committed to
taking care of you very long.
You want to make sure to go toa practice that has a commitment
to kind of be there along thisentire journey with you.
Speaker 2 (22:55):
Great advice, great advice.
Well, thank you so much, ross,for coming on giving us this
little taste, if you will, abouthair transplants For our
listeners.
If they want to find you, doyou mind sharing where they can
locate you online and more aboutyour podcast?
Speaker 3 (23:07):
Yeah, this was.
This was a tremendous amount offun, uh, so if you want to
connect with me, I actually havea YouTube channel.
Uh, it's called Dr Copelman.
I talk about hair on a weeklybasis.
I also have a podcast calledthe hair doctors and if you want
to connect with me on Instagram, it's Dr Ross, and I do answer
all of my DMs.
So I'm looking forward tohelping you on your hair loss
(23:29):
and I want to thank you so muchfor allowing me this opportunity
to be on your podcast.
It was really a pleasurespeaking to you.
Speaker 2 (23:36):
Well, thank you so much as well, and stay tuned for
the next episode of DermotTrotter.
Don't swear about skincare.
Speaker 1 (23:44):
Thanks for listening to Dermot Trotter.
For more about skincare, visitDermotTrottercom.
Don't forget to subscribe,leave a review and share this
podcast with anyone who needs alittle skincare sanity.
Until next time, stay skinsmart.
Welcome to Dermot Trotter Don't Swear About Skin
Care where host Dr Shannon CTrotter, a board-certified
dermatologist, sits down withfellow dermatologists and skin
care experts to separate factfrom fiction and simplify skin
care.
Let's get started.
Speaker 2 (00:19):
Welcome to the Dermot Trotter Don't Swear About Skin
Care podcast On today's show.
I have a special guest heretoday, dr Ross Kopelman.
He's a hair transplant surgeonat Kopelman Hair Restoration,
with offices in New York City aswell as Palm Beach, florida.
He actually has a podcast aswell that you need to check out
the Hair Doctors and on thatpodcast he shares insights on
(00:42):
hair loss and the latest trendsin hair restoration and I've
invited him to come on thatpodcast.
He shares insights on hair lossand the latest trends in hair
restoration and I've invited himto come on the podcast today to
talk more about hairtransplants because I know
people have a lot of questionsout there about it.
So welcome to the podcast, ross.
Speaker 3 (00:55):
I'm very excited to be here and have this
conversation about hair loss,which I you know.
The reality is.
Hair loss impacts most everyone.
Speaker 2 (01:02):
You're right.
I think a lot of our listenersout there can relate to it.
If not themselves, they knowsomebody and I think people talk
about it more now and don'tjust accept it.
You know, it doesn'tnecessarily have to be the
reality, which is kind ofexciting, and I know a lot of
people you know might go to thedermatologist or their doctor
and talk about hair losstreatment options that might
(01:22):
involve, you know, puttingthings on the scalp or taking
pills.
But today I want to talk aboutkind of the next level and
discuss a little bit more abouthair transplants, because a lot
of people are even wonderingwell, what type of hair
transplants are there and even,am I a candidate for a hair
transplant?
So how would you answer that?
If somebody comes to youroffice because maybe they are a
(01:43):
good fit or maybe they aren't,how do you kind of address that
with them to kind of get an ideaof you know if they're going to
be somebody you want to moveforward with a hair transplant
with?
Speaker 3 (01:51):
So it's a very interesting question because if
you're someone who's starting toexperience some form of hair
loss, the first place you startis actually not with a hair
transplant.
It's with medical therapy.
You start is actually not witha hair transplant, it's with
medical therapy.
In fact, my philosophy is thatit's medical therapy paired with
the hair transplant thatultimately gives the best result
(02:14):
.
So when I see a patient in myoffice, that patient could be
male or female, and I thinkthere's a misconception actually
that hair transplants are onlyfor men, and in fact I would
argue that's not true.
50% of my patients are actuallyfemale.
So that's the first place wehave to start.
We have to identify what is theroot cause of your hair loss,
(02:38):
because a hair transplant is notfor everyone.
The second thing we have to dois what medical therapy can we
put you on?
And then the third step andthis is this is way down the
field is are you a candidate fora hair transplant?
We don't assume you're acandidate for a hair transplant
the minute you walk into theoffice.
Speaker 2 (03:00):
So if somebody comes into the office and you're
trying to decide if they're ahair transplant candidate, how
do you make that assessment?
What type of questions?
Are you looking at their scalpor trying to identify the
particular type of hair lossthat they might have?
Speaker 3 (03:12):
Absolutely.
So we have to see do they havea scarring alopecia?
Do they have a non-scarringalopecia?
Is there an underlying medicalreason why they are experiencing
hair loss?
Because if they fall into oneof those categories for instance
, if it's a medical reason why aparticular person has hair loss
(03:33):
maybe it's a thyroid conditionWell, in that case we have to
address the thyroid issue beforewe even think about a hair
transplant.
Additionally, if they have ascarring alopecia or a hair loss
condition, that has somethingto do with an autoimmune
underlying issue, that has to beaddressed, and so in some cases
we have to biopsy the scalp.
(03:55):
Very frequently I see women whoare postmenopausal who have a
condition known as FFA frontalfibrosis and alopecia and those
women are not ideal candidatesto have hair transplants unless
their condition is stabilized.
So we have to be very cautiousbecause there's a lot of people
that are they're running to.
(04:16):
They think the hair transplantis the solution, but really you
have to really address what'sunder the roof, and that is
critical because not everyone isa candidate to move forward
with surgery.
Speaker 2 (04:31):
So somebody has you know, you mentioned kind of
scarring, non-scarring, form ofhair loss.
Say you go in, you take a lookat them, you make the diagnosis
just looking at them, or maybe abiopsy, and, for example, if we
talk about people that maybehave scarring forms of hair loss
, if you're able to stabilizethat condition where they don't
appear to be having any moreloss, is that somebody that
(04:53):
could qualify or benefit from ahair transplant?
Speaker 3 (04:56):
So that's a great question.
So patient has alopecia areata,which is an autoimmune hair
loss condition.
What we could do and this alsoapplies to women who have FFA,
frontal fibrosis and alopecia wemight do a test run so we might
take out a couple, maybe ahundred follicles from the back
of the scalp, and that's by theway.
(05:16):
When we perform hairtransplants which I'm sure we'll
discuss we take care from theback, and there's a reason for
that.
And when we transplant theminto these individuals who have
scarring alopecias, we have tosee if those follicles are going
to actually take.
It's better to do that approachthan transplant a thousand
(05:36):
follicles and have a failure,and so we have to be very
cautious in terms of how wemanage those individuals who
have scarring alopeciaspecifically.
Speaker 2 (05:47):
Interesting.
So, like you talked about, it'skind of that test drive
approach.
You know, you do thattransplant on a few.
See if it maybe takes, inparticular for those scarring
forms of hair loss, which aredefinitely more challenging to
treat, even medically speakingas well, and then for the people
that have maybe non-scarringforms maybe they have, you know
(06:18):
what people like to call, youknow, hereditary form of hair
loss, or androgenetic orage-related thinning of the hair
or, as you mentioned, alopeciaareata.
Speaker 3 (06:22):
These forms of hair loss that aren't scarring do
they tend to respond better thanto a hair transplant.
Yeah, so you know, if you comein and you have androgenetic
alopecia, well what does thatmean, first and foremost?
Well, that means there'sprobably a genetic component for
why you have hair loss to start, and then there's a major.
There's a hormone that's amajor contributor to hair loss
and that's known as DHTdihydrotestosterone.
And what we know is thatthere's areas of the scalp where
(06:42):
the hair is more sensitive toDHT.
So, for instance, in thehairline, the mid part, but not
in the back of the scalp.
The hair from the back of thescalp is less sensitive to this
hormone known as DHT, and that'swhy we can transplant it to the
front.
So, if you're a male patient,you come into the office, you
have recession of your temporalrecession, recession of your
(07:07):
temporal areas, or you've lostsome of your hairline, or even
your mid scalp, even your crown,and, yes, you potentially are a
candidate, as long as, again,you don't have an underlying
medical reason for the hair lossor a scarring alopecia.
For women, I tend to seewidening parts as the
(07:29):
predominant issue in femalepattern baldness, and those
women are also great candidatesfor hair transplants.
However, if you're someone whocomes in and you have something
known as DUPAA this is diffusehair loss that kind of globally
impacts your entire scalp wehave to be very, very cautious
(07:52):
because in those particularpatients, even their donor area,
even their donor areas areimpacted.
So that's why it's critical,before we even explore a hair
transplant, medical therapyshould be started a few months
before, because we want to primethe hair, especially in the
donor area, because it makes theextraction much more effective.
Speaker 2 (08:14):
So kind of talking about.
You know, we talked about somepotential candidates like just
out of the gate who would yousay really just isn't a good
candidate for a hair transplant.
Speaker 3 (08:23):
Okay.
So who is not a good candidate?
This is a I love this question,because who is the typical
patient that wants a prettyaggressive hair transplant?
I would argue that that's ayoung male in their mid to early
thirties.
Those individuals who have,we'll call it, a Norwood three
(08:47):
to four pattern and that's thisis a scale that we use to kind
of assess where they are intheir hair loss journey are not
good candidates.
Why?
Because if they're having thattype of hair loss at such a
young age, well, their hair lossis going to progressively get
worse.
(09:07):
So one of the things that wethink about as hair surgeons or
even as dermatologists treatinghair because most of hair loss
is treated by dermatologists wehave to think about where is
that hair loss going to be 10years from now, 20 years from
(09:28):
now, 30 years from now?
And so we have to be very, verycautious with young men.
Very cautious with young men.
They want to look youthful,they want a hair transplant
because maybe emotionally, todate there's a lot of reasons
why people want hair transplants, but for these young men in
(09:50):
particular, it can be verydistressing.
They're at the beginning oftheir careers, they want to look
youthful, and so we have to becautious, and I always tell my
young male patients that it'scritically important you start
on medical therapy and we can'teven think about having you do a
hair transplant until I seethat your hair loss is stable
(10:11):
for at least a year.
Speaker 2 (10:13):
And that's something that I constantly have
conversations with patientsabout, because there's a lot of
young men that do reach out toour office and I have to turn
them away from having a hairtransplant that group that's
(10:37):
more commonly affected, or kindof that typical person that
comes in that thinks thisprobably is going to be the
solution for them, Yet, like youmentioned, probably not the
best option for them, especiallyif they're going to have
progression over time.
So it sounds like you knowsomebody just thinking okay, is
hair transplant?
For me, One, it's identifying,as you mentioned, the type of
hair loss.
Two, if it's scarring ornon-scarring.
And if it's scarring ornon-scarring, you want to have
(10:57):
appropriate medical managementwhere you're not really seeing
progression, and then, of course, eliminating any underlying
issues that might be a source ofthe hair loss or contributing
cause to it, like you mentioned,like the thyroid not behaving
appropriately, and maybe it'soveractive or underactive, or
maybe they have nutritionaldeficiencies, things like that,
that you need to supplement, ormaybe they have nutritional
deficiencies, things like thatthat you need to supplement.
(11:19):
So once somebody's to a periodof stability, typically with
having non-scarring or scarringhair loss, they might be a good
potential candidate.
Would that be a good summary ofsomebody who's out there maybe
thinking is this right?
Speaker 3 (11:29):
for me.
That's true that you didsummarize it, but I do want to
go back to one point, which is,yes, these young men might be
upset that they can't go for ahair transplant, but they're
very appreciative because theyrecognize that I am acting as an
advocate to protect them.
There's, unfortunately, atremendous amount of marketing
(11:51):
in this industry to get youngpeople to fly internationally
for medical tourism to dotransplants when they should not
do transplants and they'redangling really inexpensive
prices in front of their eyes.
The reality is this is asurgical procedure and you have
to really have a long-term kindof perspective.
(12:12):
So it's critically important asdermatologists, as hair
surgeons, that we advocate andwe put our patients' well-being
ahead of kind of maybe our ownkind of drive to get another
hair transplant case.
So I think that that's thething that I've learned the most
(12:32):
about from my patients thatI've turned away from having
hair transplants.
They're still very appreciative.
They're still very much mypatients because they're on
medical therapy and they feellike I'm their advocate.
Speaker 2 (12:46):
It's a really important point.
I appreciate you bringing thatup because you're right, it's
very emotional.
You know hair loss and peopleare willing often to spend
anything or almost do anythingand people are making
recommendations.
You know healthcareprofessionals where it's not
appropriate.
So it's great you know that wecan step in and be that advocate
for the patient as well.
And if they're coming to youroffice and, you know, say this
(13:07):
is somebody that you look at andfeel like, okay, yeah, hair
transplant, you're a goodcandidate.
What are the different types ofhair transplants and when do
you recommend maybe one over theother?
Speaker 3 (13:18):
Okay.
So if we're talking about amale patient who's on the
younger end, in that case it'stypically strengthening the
hairline.
Okay, because we don't want toaddress the crown if they do
have any crown involvementbecause we don't know how that
hair loss is going to progress.
So typically with younger menwe do smaller cases.
(13:40):
We don't want to be tooaggressive.
We don't want to do what'scalled a giga session, which is
more than four to 5,000 grafts.
If you're a male and you're inyour late forties, fifties and
sixties, your hair loss has kindof slowed down.
As long as you're on some formof medical therapy, I feel
confident to move forward, to domore aggressive extractions of
(14:03):
taking hair out from the back ofthe scalp.
And then for female patients wehave a little more laxity.
You can be in your 20s and your30s, your 40s and your 50s, and
women are a little morecomplicated than men because
there are other underlyingissues there's pregnancy,
there's menopause, but we can bea little more aggressive.
(14:24):
For instance, I do have femalepatients who are in their late
20s, early 30s.
They want to strengthen theirmid parts or they want to bring
their hairline down a little bit.
We don't have to worry aboutthe same things that we have to
worry about with with younger,with younger male male patients.
Now, the other thing that weshould talk about is the two
(14:46):
different approaches toperforming hair transplants.
There's the FUE approach, whichis follicular unit extraction,
where individual hair folliclesare removed, typically from the
back of the scalp, and thenthere's FUT, which is
essentially taking a linearstrip from the back of the scalp
and then suturing that up.
(15:07):
And what's interesting and youmight find this fascinating is
that strip, 10 years ago, wasthe dominant approach to
performing hair transplants inthe United States and around the
world, and now 75% plus of hairtransplants are performed with
the FUE approach, the follicularunit extraction approach.
And so many would argue thatFUT is a dying art, and I
(15:33):
actually am in the camp that FUTis as important as FUE in terms
of taking hair from the back ofthe scalp.
When we perform hair transplants, we use both approaches on both
male and female patients.
An FUE approach is ideal for amale who has really kind of like
a thin military cut.
They don't want to see anylinear.
(15:54):
We don't want to see any linearscars in the back of the scalp.
They like to wear their hairshort, so that's an ideal
approach.
But for someone like myself Ihave longer hair I would feel
comfortable performing an FUT ona male patient with a similar
hairstyle.
Now, there's a slew of otherhair surgeons that feel
(16:14):
comfortable performing FUE onwomen other hair surgeons that
feel comfortable performing FUEon women.
Now, when we perform hairtransplants on women, we
typically need anywhere from2,000 to 3,000 hair grafts, and
you can imagine that's a widewindow of hair that has to be
shaved on the back of the scalp.
And I don't know, dr Trotter,right, I want to make sure I'm
saying your last name correctly,dr Trotter, right, I want to
(16:35):
make sure I'm saying your lastname correctly how long it took
you to grow your hair to thelength it is today?
Probably took a couple of years.
I don't know how many womenwant to shave the entire back of
their scalps, right?
So I'm in the camp that, forwomen, FUT should be the
dominant approach to performinghair transplants, and in fact, I
(16:58):
would also argue that thequality of the grafts that we
get from the back of the scalpare better.
With FUT we get lesstransections.
This is where the hairfollicles will be ruined,
because with the FUE approach.
We have to use special devicesto remove hair follicles, and we
don't always pull them outcorrectly.
There's actually typically atransection rate of anywhere
(17:20):
from 6% to 10%, depending uponthe quality of your skill sets,
and so I'm in the camp of tryingto kind of maintain FUT
techniques in the United States,because I do not believe that
it should be a dying art.
Speaker 2 (17:42):
And you mentioned just kind of the process there
where you're talking about likegraphs and pulling things out.
You know, for some of ourlisteners they might not even be
familiar with kind of what thatmeans.
Can you briefly describe sortof that process then for the
transplant, just to kind of geta feel, what does the graph mean
, or more than one graph, likeyou mentioned, or pulling that
out and literally what is theact of transplantation Like?
(18:02):
What does that actually meansurgically?
Speaker 3 (18:11):
if you were explaining it to a patient.
Yeah, so hair follicular unitsokay, they come in units, okay,
and the units could be one, one,one hair follicle, twos, threes
or fours.
It's they're like littlebatches.
Think about, like like when you, when you're planting flowers,
sometimes there's, sometimesthere's one flower that sprouted
, sometimes there's two kind ofpackaged together and we don't
really know when we're, whenwe're taking out a strip or
(18:32):
extracting with the FUE approach, are we going to get ones, are
we going to get twos, are wegoing to get threes?
And so that is.
That's the the basics in termsof what's happening in the back
of the scalp, and then what'sthe other?
The other thing that's criticalis how we design the hairline,
or how we design how we implantthis hair not only into the
(18:53):
hairline but into the mid scalp,into the crown.
Typically, we like to use onehair follicles in the front
because they're fine as a finestto the front of our scalp, and
then we do behind that, we havesome twos, and then there's a
fineness to the front of ourscalp, and then we do behind
that, we have some twos, andthen there's a disbursement of
twos and threes.
Now, when the hair comes outfrom the back of the scalp.
You have hair technicians whotake these hair follicles and
(19:18):
they cut them underneathmicroscopes, because sometimes
you get twos or threes and youneed more ones.
So they kind of slice them up,they clean them up, and I think
one of the things that I want toemphasize is that when a hair
transplant is performed, it's ateam effort.
Okay, this is not a surgerysimply performed and solely
(19:40):
performed by a hair surgeonmyself.
It really involves a nurse andpossibly two or three hair
technicians.
It's a multiple hour procedure.
It takes anywhere from five toseven hours to complete these
procedures, and it doesn'tmatter if it's a small, medium
or large case.
These cases take an exorbitantamount of time because there's
(20:04):
so many different steps involved.
These cases take an exorbitantamount of time because there's
so many different steps involved.
The other thing that we have tobe very cautious of is how we
anesthetize the front of thescalp, the back of the scalp.
We have to be very sensitive tomaking sure that there's no
lidocaine toxicity or anycomplications during surgery.
So it's vitally important thatyou go to a, a hair surgeon, who
(20:27):
has tremendous amount ofexperience managing, you know,
complications and overseeingthese procedures because it
these are long, long, very longcases and you don't want
anything to go wrong.
Speaker 2 (20:44):
And the last like minute or two, cause we've
already kind of sailed through.
It's kind of crazy time wise.
What other tips would yourecommend?
And we'll definitely have tomaybe bring you back on to talk
more detail about hairtransplants.
But what other tips do yourecommend as people just kind of
be aware of if they're thinkingif a hair transplant might be
right for them?
Speaker 3 (21:02):
could you rephrase that question?
Speaker 2 (21:04):
yeah, just just if somebody's thinking about you
know, doing a hair transplant,what sort of like tips or things
would you recommend them startthinking about, if it's the
right choice for them, you know,thinking about the type of hair
loss or maybe where they shouldgo I know you mentioned the
credentials were important whattype of risk complications would
they have to worry about?
You know, what type of adviceor tips would you give to
(21:25):
somebody maybe consideringhaving a hair transplant?
Speaker 3 (21:29):
That's a wonderful question.
So, 100%, you have to do yourresearch.
What does that mean?
That means go to Google, learnabout what the whole process
looks like.
You don't have to know thesurgical, all the surgical
minutiae, but understand thefundamentals of the difference
between FUE and FUT, which wediscussed, understand how this
(21:52):
is a team-based approach.
Do your research about whichclinics you're going to.
Read patient reviews Always agreat idea to actually speak to
patients who've gone through theprocess of having a hair
transplant so you can getfirsthand kind of knowledge
about that surgeon, what theirresults are like.
Make sure to look at before andafter photos and, you know, just
(22:15):
make sure that again, the firstthing you have to do is go to a
surgeon who's not just going tosell you a hair transplant but
who is going to be committed totreating you for a very long
period of time.
Because when you go for a hairtransplant, that is not the end
(22:36):
of your journey.
This is really a lifelongcommitment to maintaining your
hair and that involves medicaltherapy.
So you really want to go to apractice that's committed to
taking care of you very long.
You want to make sure to go toa practice that has a commitment
to kind of be there along thisentire journey with you.
Speaker 2 (22:55):
Great advice, great advice.
Well, thank you so much, ross,for coming on giving us this
little taste, if you will, abouthair transplants For our
listeners.
If they want to find you, doyou mind sharing where they can
locate you online and more aboutyour podcast?
Speaker 3 (23:07):
Yeah, this was.
This was a tremendous amount offun, uh, so if you want to
connect with me, I actually havea YouTube channel.
Uh, it's called Dr Copelman.
I talk about hair on a weeklybasis.
I also have a podcast calledthe hair doctors and if you want
to connect with me on Instagram, it's Dr Ross, and I do answer
all of my DMs.
So I'm looking forward tohelping you on your hair loss
(23:29):
and I want to thank you so muchfor allowing me this opportunity
to be on your podcast.
It was really a pleasurespeaking to you.
Speaker 2 (23:36):
Well, thank you so much as well, and stay tuned for
the next episode of DermotTrotter.
Don't swear about skincare.
Speaker 1 (23:44):
Thanks for listening to Dermot Trotter.
For more about skincare, visitDermotTrottercom.
Don't forget to subscribe,leave a review and share this
podcast with anyone who needs alittle skincare sanity.
Until next time, stay skinsmart.
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