Frequently Asked Questions
Before you choose a hair restoration surgeon, give time to know if a properly trained and licensed physician will be responsible for your treatment and before you make a final commitment for hair restoration surgery, it’s a good idea to ask your hair restoration surgeon a lot of questions so you can have confidence in your decision.
Before you make a final commitment for hair restoration surgery, it’s a good idea to ask your hair restoration surgeon a lot of questions so you can have confidence in your decision.Start with the questions below
• What causes hair loss and what is common baldness?
There are many causes of hair loss such as stress, diseases, poor nutrition, poor immune system and injury. A certified dermatologist like, Dr. Arambulo has the knowledge and authority to give the proper evaluation and management of your hair loss problem.
The patterned hair loss called Androgenic Alopecia , is the most “ common baldness “ inherited hair loss problem affecting men more than women , is characterized by a process of progressive hair miniaturization , an eventual loss of hair follicles that are genetically susceptible .These type of hairs may continue to stay in the scalp however because they are thin and short the affected individuals appear to be bald.
Hormone dihydrotestosterone plays a central role in this process of miniaturization in men . It preferentially affects hair on the superior and anterior temporal areas of the scalp,whereas in women the cause is not clear, it more commonly presents a diffuse pattern in the crown,with or without sparing of the frontal fringe.
Male Adrogenic Alopecia is the type of hair loss consist of particular receptors found in hair roots that attract DHT (dihydrotestosterone), a by-product of testosterone, which causes hair follicles to minimize and shorten their lifespan, therefore the hair loss process begins.Men who start losing their hair at an early age tend to develop more extensive baldness. Hair on the front, above the temples, top of scalp and crown can all be DHT receptive, depending on your genetic coding.
For those who do not like surgery what is the nonsurgical treatment options of Androgenic Alopecia?
- DHT hair loss affects two in three men. While many other “solutions” and miracle shampoos promise their product blocks DHT, only two were approved by the FDA, that aid hair follicle growth and inhibit the formation of hormones responsible for hair loss.
• Topical Minoxidil solution : in 2% and 5% preparations are available that, when applied on the scalp, produce an increase in blood circulation to the hair follicles stimulating hair growth.
• Oral Finasteride : given only to men, is an oral medication that slows the progression of hair loss. Finasteride may also be prescribed in selected women with pattern hair loss. It is, however, necessary for patient to call for personal consultation appointment with Dr. Arambulo to know more about the benefits of Finasteride and understand the associated side effects of this medication .
- Low -Level Laser Therapy (LLLT) is a highly effective hair rejuvenation treatment process. LLLT increases cellular activity within the hair follicle, and promotes the proliferation of thick ,full and healthy hair.
- Platelet Rich Plasma (PRP) :Scalp surgeons from Brazil, Drs.Carlos O. Uebel, Porto Alegre reported that treating hair grafts with platelet-derived growth factors obtained from autologous platelet-rich plasma produced a significant increase in growth and density of transplanted follicular units.In addition ,PRP in hair transplantation promotes healing and hair growth and centered in three functional applications:1.To preserve and enhance hair follicle viability during and after hair transplantation;2.To promote and enhance tissue repair and healing after hair transplantation; and,3.To reinvigorate dormant hair follicles and stimulate new hair growth. John Kahen, MD Beverly Hills, California, USA Kahen MD reported a case of Androgenic Alopecia improvement on the crown and frontal areas 6 months after PRP treatment ; Forum 25 Sept,2015 ;Frequency of treatment and long-term guidelines still remain unclear, but PRP injections may be an attractive option for the treatment of androgenic alopecia.
.Although these medicines still don’t promise fast, permanent result and cost effectiveness ,the good news is ,hair transplantation is the other option treatment that only offers permanent solution to hair loss problem and the natural result will depend on Physician’s training, knowledge ,skills and with a well trained surgical team.
• What is involved in a hair transplant?
Hair transplantation involves transfer of patient’s existing hair from thick areas to the thinning or balding areas of the scalp.When these grafts are transferred to thinning areas of the scalp, they stay and last a lifetime. There are 2 techniques in hair transplant: Strip FUT and FUE procedure.
There is good news, however, in the field of genetics. Although we may be predisposed to hair loss, there are areas on the scalp where the hair is genetically programmed never to fall out. These are the hair follicles on the back and lower sides of the head that are not affected by DHT. When these grafts are transplanted to the front, crown, and top of scalp, they retain their resistance to DHT hair loss and last a lifetime. Most donor areas contain ample hair to fill in the bald or thinning areas leaving no perceptible change from where they were taken. The transplanted donor hair does not know it is in a different place and will continue to grow throughout your life. It is your own natural, healthy hair to style anyway you choose.
What are my surgical options? What is difference between FUT (strip) and FUE?
It is important to know that both FUT (strip) and FUE results in scars. There is no such thing as “scarless” surgery in hair transplantation. The ISHRS is concerned about false and exaggerated advertising claims related to hair restoration surgery such as “scarless surgery” or the claim that the surgery can be completely performed by a machine. The fact is that any incision whether by machine or hand that enters the skin beyond the most superficial of depths causes a scar to form, and there is currently no machine capable of automatically performing all the aspects of the hair restoration surgery. Available technology can only assistant trained surgeons performing hair restoration surgery.
What is FUE technique?
FUE is the major advancement in hair transplant surgery.
Below are further questions to ask the FUE physician provider to known does the procedure with skills and efficiency ( https://youtu.be/KixuDpZIliY ). At AHRC ,we have photos and videos to show that only Dr. Arambulo does the the critical parts of FUE procedure and going to FUE page you can read her answers to questions below
What is you choice of machine and why do you choose it?
Who is your mentor in FUE?
What is the maximum number of FUE grafts you harvest in one session?
How do you honestly document the FUE grafts harvested?
I understand the physician dissect the individual follicular units, do you have video that shows the really you physician’s does FUE with skills and efficiency?
• Will my hair transplant results look completely natural?
Hair transplantation, when done correctly, can be so natural that even your hair stylist will not know that you have had it done. But the skill and techniques of hair transplant surgeons does vary widely, as do their end results. Dr. Arambulo and her well trained surgical team observe every detail involve in hair restoration surgery. Click to watch AHRC team work https://youtu.be/KSuIwQDoCEQ ) and the results ( https://youtu.be/CeOwcCKTAX4 )
How long does a hair transplant procedure take?
AHRC performs 1,500 to 3500 grafts /session in an out patient basis. The length of the procedure depends on patients scalp characteristics and number of grafts to place . The procedure usually lasts from 5-12 hours. Most patients will arrive in the morning and will have their procedure completed by late afternoon. This will be explained further on your first visit.
• Does the hair transplant procedure hurt?
Patients are given local anesthesia in the donor and recipient areas. Most patients find that once the anesthesia is given , they feel no pain or discomfort during the surgery. Most patients are pleasantly surprised by how minimal the discomfort from the surgical procedure is. During the procedure AHRC patients pain assessment is minimal: rate of 1-3 from the score of 1-10 is from anaesthesia infiltration. A “Gate Theory” during anaesthesia infiltration is applied to further decrease the mild discomfort associated with it. Most patients watch movies,listen to music or nap during the procedure.After surgery patients will typically feel mild discomfort and numbness or no discomfort at all .
- How many grafts/hairs will I need?
The amount of grafts you will need ultimately depends on your degree of hair loss present , projected future hair loss pattern, and on how full you desire your hair to be..On line consultation will help us provide you ,the initial assessment of number of grafts to place for coverage but the first personal consultation with Dr. Arambulo can best provide you with more accurate estimate number of grafts to place after proper assessment and evaluation of your donor reserve
• What is the recovery/healing time?
With todays very refined micro hair transplantation procedure ,the incisions are very small and less invasive than past procedures. This results in more rapid healing. Most patients feel fine within a day or two following surgery, although some temporary numbness and mild soreness can be expected for several days following surgery but this is almost none now in our experience because of improved anesthesia and post operative care. Take home medications ,written and video post operative instructions will be provided for the utmost care of transplanted hair.
• Will people know I had a hair transplant?
Immediately following surgery, a patients recipient area is typically pink with scabs forming around the micro or tiny incisions. These thousands of tiny incisions will heal rapidly within 24 hours with scabs falling off after ten to fourteen days. During the first few days after the surgery a persons hair transplants will be noticeable, if there is no previous hair to mask these temporary scabs. However, most patients feel comfortable being in public without wearing a hat within 5 to 7 days following surgery. Once the transplanted hair grows out the results should look entirely natural, even under close examination.
In strip procedure , the donor back hair is kept long to cover the linear incision, however , in FUE procedure with design plan of more than 800 grafts, full shaving of the scalp is required to facilitate harvest . This FUE scalp preparation below should be acceptable to patients who prefer FUE technique
• Where will the surgery take place?
Majority of our procedures are done at our centre , the Asian Hair Restoration Center (AHRC) in Ortigas . Our centre is designed to provide the spacious , best stress –free, friendly environment and patient has a choice of a more private by appointment personal consultation and treatments . However, patient has an option to undergo the procedure at The Medical City Wellness and Aesthetic Centre. This will be explained to you further on your initial consultation.
Providing good service and satisfaction is what we aim for our patients ,thus, appointment is very important to us. We schedule the appropriate amount of time to explain to patients the details involve in the hair transplant procedure. Please arrive on time for our hair transplant surgeon and surgical team would want to spend time with you as much as possible to address all your concerns. Your initial visit is important, before making a decision, you need to meet the hair transplant surgeon and the surgical team to understand the details involve in the procedure teamwork.
The procedure is safe and simple in the hands of the experienced staff. The staff recommends that a friend or loved one drive you home after the procedure or the AHRC can assist you in hotel and transportation reservations.
In most cases, patients will leave the office with surgical cap provided or patients own baseball cap or bandana (scarf) to hide the graft implanted area for the first few days.
• When will my newly transplanted hair start to grow?
Normally it takes between four to six months following surgery before the transplanted hair follicles begin to grow new hair. However ,we noted early growth as two months after surgery with the use of Platelet Rich Plasma.The transplanted hair grows in very thin initially and gradually grows thicker and fuller over time. After one year ,patient’s transplanted hair will be fully mature and will continue to grow for a life time
• When can I go back to work?
Depending on the type of procedure you have done and the type of work you do, it is often possible to go back to work the next day. Dr. Arambulo will discuss this details with you and address this concern and other concerns during the initial consultation.
• Are hair transplants expensive?
Despite the initial cost of the procedure, hair transplantation can be less expensive than an artificial hairpiece over the long run. Considering the quality of our work and that the results are permanent, most people consider hair transplant , a good investment in their future happiness.
• Will I need more than one procedure?
That will depend on the extent of your hair loss and the number of grafts per surgery session. The number of the sessions will depend on the
1) area of scalp treated
2) the number and size of grafts used
3) the density which the patient desires and
4) the individual scalp characteristics of the patient.
Dr.Arambulo will discuss with you different design plan options during consultation.
• What is the largest number of hair grafts I can have transplanted at one time?
To ensure the best possible results from the procedure ,Dr. Arambulo has developed a training system to produce a bigger team of competent medical and surgical assistants, and combined with the atmosphere of team spirit comprise the core ingredients to a successful procedure. The AHRC training system has increased the teams surgical quality and efficiency. Currently AHRC well trained surgical team made it possible for thousands of grafts to be implanted in a single session. The largest number of grafts AHRC surgical team can implant at one time may vary between 2,500 and 4000 by Strip FUT method and 1500-2500 by FUE technique. With difficult scalp characteristics, though rare, two days consecutive days FUE procedure might be possible.
• What does the healing process involve?
Although there may be some redness and swelling for a few days following your procedure, it is usually not very noticeable. Existing hair, if possible, may be combed over the grafted area to hide them while they are healing.
We usually do the first shampoo after 24 hours at our center but for busy patients may do the shampoo gently and carefully. We will show you video and provide take home copy of video to guide you on how to take care of the transplanted grafts.
Two types of donor sutures are to be removed after 5 and 14 days after the procedure by our staff ,or ,your choice of local licensed physician for patients who dont have time to follow up . The provided post operative video instructions will guide you and the local physician on suture removal.
• Why does the transplanted hair have to fall out?
It is perfectly normal for the newly implanted hairs to fall out during the healing process. Understand that by being transplanted, they have gone into a sort of shock or trauma which moves them (ahead of schedule) into the resting phase of the 3 stage Hair Growth cycle. All of this is completely normal and you should not worry as the dermal papilla of the hair root is firmly implanted in your scalp and will regrow again. In some rare cases, the newly implanted hairs will scab as they heal – but not fall out within the next few weeks following your surgery. Sometimes, the hair stays in place, but this happens only rarely.
• How long does it take for the new hair to grow?
Although some patients notice hair growth after 2 months but in majority of patients , 4 to 6 months on average. Patients will notice their fine new hair growing in, slowly at first and not all at the same time. Hair grows at the rate of 1 cm to 1/2 inch per month and despite the claims of some products, there is no vitamin or herbal treatment that can cause your hair to grow faster. Just be patient and keep in mind that for some hair transplant patients, waiting 8 to 12 months is necessary to observe its maximum growth and hair will look very natural. You may style and trim it the way you like. No stylist or barber would notice the difference.
• Are the results permanent?
Since the hair follicles that are transplanted to the balding areas are genetically resistant to going bald, they will continue to grow for a life time – just as if they had been left in the bald resistant donor area.
• Will my new hair look natural?
Hair transplant technicians today (worldwide) use various techniques that transfer one to five hairs maximum (per graft) from the donor area to the recipient area. Dr. Arambulo together with AHRC well trained surgical team are updated and follows every details in these techniques,so that your new hair will look and feel natural and no one will know the difference unless you tell them.Watch our surgical team video.
• Will I have a scar and what will it look like?
The AHRC assess the donor area properly and observes the right technique in strip harvest method for grafts. This strip is taken from the back or sides of your head. The donor area is then sutured back together employing the trichophytic closure technique.Our hair transplant specialist Dr. Arambulo is highly experienced at removing donor strips and makes every attempt possible to minimize the scar that will remain. We have observed unnoticeable linear scars from our patients with the current trichophytic technique..For patients who do not like linear scarring on the back ,FUE technique is the best for you.
• Will I be able to drive home after the surgery?
Like most types of out-patient surgery, you are not allowed to drive home immediately after your surgery. In addition to the local anesthesia, patients are given a mild oral sedative to help them relax, prior to their procedure. Patients who want to leave immediately after the surgery should bring someone with them. AHRC will assist you arrange transportation back to your hotel. You have a choice of our private driver or UBER to bring you to our centre and back to the hotel.
• How long do I have to wait until I have another procedure?
It is also important that you come for follow up so we can asses the growth yield from every procedure. Because it can take 6 to 12 months for your new hair grafts to grow in, you need to wait that long before you can have another procedure.
• After using Propecia® (finasteride) for a prolonged period, would cessation of use of the drug result in the same sudden rapid hair loss off all hairs that would have been lost without the use of the drug, like suddenly stopping use of Rogaine® (minoxidil)?
The hair would be lost until the point where an individual would have been without treatment. However, the hair loss is not sudden and will take several months to a year after stopping the medication.
• Can I use Propecia (finasteride) or Rogaine (minoxidil) after my surgery?
Both finasteride and minoxidil are treatments for hair loss that have been reported to be successful in growing new hair. Minoxidil has a 1 in 3 success rate for crown hair growth in men and finasteride reports a 2 in 3 success rate for new hair growth on the crown region. Even though finasteride may not work for all men, it is generally accepted as a treatment to stop further hair loss. If your goal is just to keep the hair you have without losing more, and getting new hair growth with hair grafts, finasteride is an excellent co-treatment option along with hair transplants. Any new hair growth that finasteride can provide should be considered a bonus but please bear in mind that these FDA approved medications only offer temporary result that once discontinued,the hair affected by hormones DHT will fall out.
• How do I find an excellent hair restoration surgeon?
The most important decision in restoring your hair is the physician you choose. Dr. Arambulo is the first and only Filipino Diplomate of American Board of Hair Restoration Surgery. The skill, talent, and experience of hair restoration physicians vary widely, as do the end results. Dr. Arambulo performs herself both methods:Strip FUT and Follicular Unit Extraction (FUE) with higher skills and knowledge.Who you choose will determine how natural and full your new hair will be for the rest of your life. In addition , the Asian Hair Restoration surgical team are well trained,enthusiastic and dedicated to excellence.
Actual photos and videos of our full procedure will be shown on your initial visit to help you understand that our physician hair restoration specialist , Dr. Arambulo does not delegate but does herself the major and critical part of the procedure ,in both strip FUT and FUE procedures. If you have further questions ,please email us or call for personal consultation appointment.
Attending scientific conferences and workshops, is an indication of her commitment and advanced training and most of all being invited to speak on hair transplant procedure here and abroad, is , an indication that she strongly supports the Mission and Vision of International Society of Hair Restoration Surgery applying it as the guiding principles in hair transplant practice:“ To achieve excellence in patient outcomes by promoting member education, international collegiality ,research ,ethics and public awareness”.
The Physician’s Experience : The gallery of before and after photo are results of her own work and matches with her years of practice. Beware of physicians who use photos of other physician as their own or copy photos of other physicians. Its good to know that before and after website photos used in the website are patients who are willing to be references for the Dr. Arambulo , you can request to talk with them about their experience with us.
The Manner in Which the Physician Practices : A call for initial consultation to visit the clinic will help you know about the environment in which Dr. Arambulo practices; to know more about her which is likely to result to a good patient/physician relationship founded upon trust based on your knowledge of her training, experience and competence. As a a certified dermatologist , she has the authority to evaluate you hair loss concern and willing to spend time with you , to give you the different treatment options that will work best for your hair loss problem . In addition ,an initial visit to the clinic will help you know more the Asian Hair Restoration office staff helpfulness and willingness to answer your other concerns. Our video post operative instructions are also something to show you the importance of a well trained surgical team observing the surgical details important to achieve the best aesthetic result form the difficult hair transplant procedure
Thank you very much for your patience and time reading these FAQ . Please call for personal consultation to understand hair transplant procedure further
During the procedure:
• Hair transplant is considered a minor surgical procedure..Patients will be awake and place under local anesthesia only, often accompanied with premedication for mild sedation and relaxation.You may wish to bring movie videos or we have a selection of DVDs to watch during placement of grafts part of the procedure.
• Patients can expect to go home the same day after the procedure
• Procedure may take 5-12 hours depending on the patients number of grafts plan and scalp characterisitics.
Day 1 post op:
Patients may have some oozing and discomfort but it is tolerable. Take home oral pain relievers and antibiotics will be provided .
Day 3 post op:
Patients may have some swelling in the forehead but with our patients the experience is so minimal to none.However, this can be avoided if you follow the post procedure instructions provided carefully. In addition the tumescent solution used has an anti-inflammatory medicines to avoid this problem. It is normal to find scabs on the recipient areas .
Day 4-7 post op:
Scabs will start to fall off within two weeks and is considered normal.
Patients follow up schedules:
• 24 hours after : 1st shampoo at the center , as much as possible
• 5 -7 days after : removal of sutures at the center or by your local doctor
• 14 days after , optional for patients who want removal of remaining absorbable sutures
• However, if patient can not come for follow up, an absorbable sutures are used . In addition, we provide out patients , written and video post operative instructions to guide patients take care of the transplanted after surgery.Thank you very much for your patience and time reading these FAQ . Please call for personal consultation appointment to understand whether the surgical or nonsurgical option is for you..