Surgical Hair Restoration of the Frontal Hairline

Robert Barretto (FUE Surgery 2105 grafts-Actual Patient of Dr.Ken Williams)

Hair loss is inevitable, and many men in their 30’s and 40’s can expect to lose their frontal hair in the few years ahead. Men already experiencing a premature aging to their appearance because of the loss of the frontal hairline (FHL), readily recognize the deficit of this critical landmark as the hallmark of an older or less youthful appearance.  But help is here in the form of surgical hair restoration, where hair is taken from the back of your head and transplanted to the balding areas of the scalp.

Recreating the FHL is one of the most common surgical procedures performed. The design and restoration of the FHL is intended to reframe the face and restore a youthful appearance. The surgical goal for this part of the face is for the casual observer to view the frontal hairline ascend into the mid scalp with a cosmeticly appealing density. The FHL is considered the area of the scalp most looked at during casual conversations, or more importantly in pictures.


There are two techniques used by hair restoration surgeons to transplant hair from one denser region of the scalp to less dense area.  These two techniques are known as Follicular Unit Extraction (FUE) and the Strip. There are advantages and disadvantages to each of these procedures and patients need to be aware of the differences. After understanding the differences in the surgical techniques, patients then need to find a competent hair surgeon  who can assist in the final decision making process.

“Surgical frontal hair restoration using the FUE technique is the most desired type of hair surgery. FUE  surgery gives a natural look and is minimally invasive.” Dr. Ken Williams


Many plastic surgeons, cosmetic surgeons, med spa owners, and even non-physicians such as aestheticians who own skin clinics,  advertise they perform hair surgery. The reality is there are many charlatans in the hair surgical field who have no business being in hair restoration surgery.  There are hair surgeons in private practice who have not obtained regular continuing education and training to be competent hair surgeons. Or even worse, as is documented in medical literature, these physicians purchased a hair transplant device without having any training and hire hair technicians to perform the entire hair surgery. Patients need to ask the question who actually performs the hair restoration procedure as well as the training and expertise of the physician. 


After deciding on the best hair surgeon and the ideal surgical technique for you as a patient, the next hair design decision involves determining the FHL placement. This is typically the distance from the glabella (the region of the forhead between the eyes) to the FHL.  The priority should be to recreate this height so it is age appropriate, and that it takes into consideration the progressive nature of hair loss and natural aging process.

Many patients believe they need the same placement of the FHL they once possessed during high school or college.  Although the request may be sincere, a low placement of the FHL will look unnatural, and should be avoided at all costs. The problem with too youthful of a placement of the FHL is it fails to give a natural appearance, and it requires more hair grafts. Thus, more grafts used to create a low lying FHL will deplete the donor site of follicles potentially needed at subsequent surgeries.

The second surgical decision to make is what should be the shape of the FHL look like. Some patients have a natural bell shape to their FHL while other possess a more rounded appearance. The bell curved hairline is for patients with a narrower head and where temporal hair loss is prominent. The bell shape also conserves valuable grafts because of a smaller surface area.  A round design is typically used for patients with a wider head and more stable temporal hair.

fhl design

(Illustration from HairTransplant 360- Sam Lam, M.D.)

The good news is hope is available for balding men and women with hair restorative surgery.   But according to Irvine, California hair restoration surgeon,  Dr. Ken Williams,  “The most important decision once you recognize you need surgery, is stabilization of any future hair loss with a consistent medical treatment program.”  He adds, “Laser therapy, Rogaine, a DHT inhibitor like finasteride are key components to any future hair surgery.”

For men and women suffering from hair loss, or are interested in hair restoration surgery, call Dr. Ken Williams and his staff for a personal and professional consultation. The Orange County Hair Restoration center, is conveniently located in the beautiful city of Irvine, California, adjacent to the Newport and Laguna Beach coasts. Our office number is 949-333-2999

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Confidence Is Having the Look and Hair on Your Scalp-New Rogaine face Bill Rancic interviewed Bill Rancic about being the new ambassador for Rogaine, and how your appearance can make or break your career.

You’ve checked your resume six times. You know why you’re a good fit for the position. But are you armed with confidence? Bill Rancic, the very first candidate Donald Trump hired eight years ago on The Apprentice , has gone on as a successful entrepreneur, reality TV star, and motivational speaker. His main theme is making an impression goes beyond what you look like on paper. “Confidence is critical,” the 41-year old says. “When you’re confident enough to be yourself, that’s when you’ll get the job.”

Wear confidence—literally 
Is your interview outfit something you feel comfortable and powerful in? Or is it the same suit you wore when you were fresh out of school and about 70 trips to Wendy’s thinner? “Whether you want to admit it or not, people begin to judge you the minute you walk in the door,” says Rancic, who has a hands-on role in the hiring process of his various ventures. “When I’m interviewing someone, I want to make sure that he thought enough to take care of himself—to dress appropriately and to groom himself properly. If he wasn’t willing to do that for the interview, how will he act when he’s working for me?”

Make good grooming a habit
When you sit across from the boss at a table, he’ll be looking at you from the neck up, so make sure you’re feeling assured. Rancic’s secret weapon? Rogaine. “When you lose your hair, it has an impact on confidence and your overall self-esteem whether it affects your career or your love life,” he says. He’s been a Rogaine consumer for years and admits he was shocked with his hair loss comparing before and after photos.


One in four men suffer from hereditary hair loss, so Rancic knows he’s not alone. In his latest role as Rogaine’s “Growth Coach,” he’ll offer advice to men through social media outlets on how to take control of hair loss. Whether you’re hitting the gym to keep your belly in check or loading up on anti-aging products to delay wrinkles, tackle the issue head on instead of running from it. “No one even needs to know what you’re doing,” he says, adding that he’s not the least bit embarrassed to use Men’s Rogaine Unscented Foam. “It’s like a styling mousse. You use it once in the morning and once at night, and it becomes a habit like brushing your teeth.”

Be open to change
In his transient life—he and his wife, Giuliana of E! News, live in Chicago and LA to suit both of their careers.  “Since getting married, it (life) has changed significantly,” he says, laughing. “Oh my God, I was not a good dresser. I’d wear flip-flops and jeans. I guess that’s not cool.” Giuliani helped him with the little things—like introducing him to pocket squares for a simple way to upgrade a smart outfit and wearing proper footwear. (She’s right—flip-flops away from the beach really aren’t cool.) And Giuliana isn’t the only one who thinks change is a good thing. She also has him hooked on after-shave balm (“It tightens up my skin.”), blow-drying his hair (“My hair used to be really flat. It takes like two extra minutes.”), and anti-aging serum. Rancic doesn’t look like a guy who spends too much time grooming—he just looks good.

“I shouldn’t be saying this,” he says. “My buddies in Chicago are going to read this and I’m going to lose my ‘Man Card.’” See that full head of hair, though? Man card is intact.

The Costs, Pros & Cons To Hair Loss Treatments

Hair-Loss-in-menAndrogenetic alopecia (AGA), or male pattern baldness, is the most common form of hair loss. It’s inherited from either one or both parents and is caused by the hormone Dihydrotestosterone (DHT), which shuts down hair follicle growth. Men with this pattern baldness tend to have the classic “horseshoe” appearance of the scalp; women usually have thinning hair concentrated on the center part or diffuse loss on their entire scalp.

There are many causes for hair loss such as medical illness (diabetes, lupus, hyperthyroidism, and hypothyroidism), medications (antidepressant, beta-blocker, and cholesterol reducer), physical/emotional stress, chemical dyes, and even wearing tight braids/ponytails (Traction Alopecia),and over-styling of the hair.

Here are a few pros and cons of FDA approved hair loss treatments:

Finasteride-DHT Inhibitor

According to clinical studies, this medication, sold as Propecia, was most successful with patients. It’s primarily prescribed for men because it can cause serious birth defects in women.  Women of child bearing years may be prescribed Propecia, but special precautions must be implemented to prevent pregnancy because of teratogenic side effects in male infants. The cost is around $60 to 80 per month depending on the pharmacy.

imagesPros: In clinical trials in which men with pattern baldness took 1 milligram per day for two years, new hair grew in 66 percent of patients. In 83 percent, hair loss was stopped.

images copyCons: Side effects are infrequent but may include decreased libido, impotence and depression. These symptoms typically disappear if the medicine is stopped. Patients should commit to it for at least six (6) months of therapy before evaluating treatment effectiveness. If the patient stops taking the medication   any hair gained or maintained through the therapy will be lost.


This topical product is manufactured in strengths of 2% (the only version approved for women) and 5%, which also comes in a foam. Sold under the brand name Rogaine or generically, versions sell for as little as $10 per month. Minoxidil works best on patients whose hair loss is recent.

imagesPros: In a study cited in the journal ACP Medicine, even the 2 percent solution was shown to produce visible hair growth in about one-third of patients and fine-hair growth in another third.

images copyCons: In the same study, minoxidil was ineffective in one-third of patients. Results might not be visible for 4 to 12 months, and like Finasteride (Propecia) any benefits are lost when you stop applying the product. Side effects include dry, itchy, or irritated scalp and increased facial hair.

Hair Transplant Surgery & Costs

If you want to regain a natural youthful hairline and medical therapy does not work,  or your hair loss is too advance, you will most likely require hair restoration surgery.  Modern hair surgery uses your own natural hair grafts which are moved from the back of the scalp, to the top or front part of your head. There are two surgery techniques used in hair surgery- FUE and Strip. The average cost per graft for the  STRIP technique is $4-8,  and $ 8- 12 for FUE.  The average hair transplant requires 1500 to 2,000 grafts for mild hair loss. Depending on the severity of the hair loss, multiple procedures may be required with over 6000 to 8000 grafts harvested necessary to achieve the proper cosmetic outcome.

imagesPros: If you find a skilled and experienced hair transplant surgeon, and the transplant is successful, you will end up with a youthful appearance of your hair.

images copyCons: Rarely does a surgical hair transplant fail in the hands of an experienced hair surgeon. Make sure the surgeon is an active member of the ISHRS and that they actually perform the hair surgery. Some doctors lack the training and skills to perform FUE surgery. So what these doctors do is to hire hair technicians do perform the surgery, and shake your hand and leave the operating room. Not ethical or legal behavior.

pic-patient-testimonial-6mo-postHair transplant surgeon at OC Hair Restoration of Irvine, California , Dr. Ken Williams, specializes in FUE hair restoration technique. He also not only helps patients struggling with hair loss, but he also speaks to his patients from personal experience. Dr Williams is an advocate for a daily treatment program to treat hair loss.

Williams states, “Daily treatment is key.  The use of a DHT blocker, like Propecia, and topical application of minoxidil will stop further loss and maintain current hair density.” He adds, “I use Rogaine 5% foam in the morning when I am in a hurry to get to work because it acts like a muse and holds the hair in place in the morning. For the evening dose,  I use the liquid Minoxidil from Costco because it is four ($4) dollars a bottle. I take a DHT inhibitor once a day, and I use the Laser Cap (low-level laser therapy) every other day. I have an aggressive approach to a daily treatment program because I had FUE hair restoration surgery, and I don’t want to be bald ever again.”


PRP Female Hair Loss Study-Enrolling Patients


PRP Female Hair Loss Study-Enrolling Patients

Dr Ken L. Williams of the Irvine Institute of Medicine and Cosmetic Surgery-OC Hair Restoration is enrolling female patients suffering from hair loss in a medical research study. The study is designed to evaluate the effect(s) of Platelet Rich Plasma (PRP) therapy on women with Female Pattern Hair Loss (FPHL). The medical study is university based and privately financially supported by the International Society Hair Restoration Surgery (ISHRS) and medical partners.


The term, FPHL, has emerged as the preferred medical term for hair loss in women. As opposed to the primary male hair loss diagnosis-Androgenetic Alopecia, FPHL is caused by multiple etiologies, and treatment options are considered more complicated. Hair loss in women negatively impacts women more than men with impaired social function, decrease self-esteem, and loss of confidence. In many cases, a accurate clinical diagnosis can be made and the hair loss condition treated medically or surgically.



The eligibility criteria are: 1) Female gender, 2) At least 18 years old, and 3) Ludwig II FPHL diagnosed by history, physical examination, and either biopsy or strong family history of female pattern hair loss as defined by two or more female relatives known to have a familiar Ludwig pattern of hair loss, without known disease.


The study has been approved by the Office of Human Research Protections at the University of Houston to evaluate the effect of PRP upon the growth of the hair follicle. It is financially supported by a small grant from the ISHRS and is designed by Baylor University hair surgeon and principal investigator, Dr. Carlos Puig. In addition to Drs. Puig and Williams, also participating in the multisite study are Dr. Robert Reese from Edina, Minnesota; and Dr. Matt Leavitt of Maitland, Florida.



This female hair loss study is supported by Cytomedix, the manufacturer of the Autologel  system that creates the wound healing and hair stimulating properties from PRP. The research is a multi-site study consisting of hair loss specialists located in the northeast, south, and western regions of the United States. The study is prospective, double blinded, and placebo controlled to increase scientific validity and reduce physician bias. The official title of the research is Pilot Study On The Effect of Autologel Platelet Rich Plasma Injections On Hair Growth In Patients With Female Pattern Hair Loss.



There is no cost to eligible patients and no reimbursement is available for enrolling in the study. If the study demonstrates a significant difference between the placebo and study group, all patients in the placebo group will receive without charge PRP therapy to induce hair growth.



If you are interested in participating in this medical study, and if you have been under the care of a dermatologist or hair loss specialist, you may be eligible to participate in this hair loss study. Your contact is Jackie Kusinsky at or call (949) 333-2999.

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NFL Football Great Wes Welker Talks FUE Hair Surgery

Walker footballNFL great and wide receiver for the Denver Broncos, Wes Welker, went public today helping  his hair surgeon, Dr. Robert Leonard, promote public awareness of hair loss surgical restoration.

The story began almost a year ago when Walker underwent hair transplant surgery in New England with a procedure called Follicular Unit Extraction (FUE). FUE is a surgical hair procedure that is a relatively newer surgical technique compared to the traditional Strip method of hair transplantation that leaves a donor linear scar. Using this surgical technique, patients are able to use their own natural hair and transplant it to areas of baldness in men and women.

The surgical procedure is an advance surgical procedure that requires excellent hand-eye skills and much patience.


Using the FUE surgical technique, individual hair follicles are removed “one-by-one” from the back of the scalp, and relocated to balding areas of the scalp. The procedure is performed under local anesthetic with optional light sedation if requested. The entire procedure for a large 2000 graft case typically takes 12 hours to perform. Hair survival rates approach 90-95%, and after waiting nine to twelve months, patient experience their own hair follicles emerging on previous bald areas of the  scalp.


There are only a handful of surgeons that actually perform FUE hair surgery. There is a growing concern among veteran hair transplant surgeons in the International Society of Hair Restoration Surgery (ISHRS), that new physicians entering the hair restoration field are hiring non-physicians to perform the entire hair transplant surgery. With little or no experience, physicians are allowing technicians to perform surgery.

Irvine hair restoration surgeon, Dr. Ken Williams, expresses his concerns, ” Technicians are not trained to monitor patients under sedation, give anesthesia, remove human tissue, or create the hair design.” Williams adds, “there are many surgeons who have purchased a FUE device, called NeoGraft, and are not following standard hair transplant practices. They allow technicians to perform the entire surgery and they are hurting patients.”

OC Hair Restoration Center is located in Irvine, California. The principle hair surgeon is Dr. Ken Williams, a leading FUE surgeon in the Western United States and whose hair surgical practice is primarily FUE based. He enthusiastically promotes FUE  “as a great procedure for younger men and athletes who want a shorter post-operative down time and who want to wear their hair short.  There is no donor linear scar with the procedure.”

For a consultation call (949) 333-2999 or visit our website at

FUE Hair Transplantation-Challenges for surgeons

Derm SurgRecent Publication on FUE Hair Surgery-Dermatologic Surgery

Hair surgery techniques to redistribute hair to areas of alopecia include scalp reduction surgery; scalp and rotation flaps, advancement flaps, and free flaps; FUT by strip harvesting; and FUT by the follicular unit extraction (FUE) technique. The more aggressive hair surgical techniques such as flaps and scalp reduction are largely abandoned for cosmetic cases, but are used primarily in reconstructive surgerical cases from trauma and infection. The most common surgical method for hair transplantation is FUT either by the Strip technqiue or by FUE.

With the recent worldwide  interest of hair transplantation using FUE, many hair surgeons, plastic surgeons, dermatologists, and medical spa physicians are jumping on board. The introduction of this surgical technique into cosmetic practices is accelerated by certain FUE device manufacturers promoting a “turnkey” model for increasing the surgeons income.

But with the recent increase in physician training in FUE,  and an increase in consumer interest, new and different  challenges in the hair restoration field have emerged. The primary controversy is physicians with no formal training with this newer hair transplantation technique, and even worse physicians without any training or experience in hair transplantation; are contracting with non-physicians or hair technicians to perform the entire FUE surgical hair transplantation.


Irvine based hair transplant surgeon, Dr. Ken Williams, recently published in Dermatologic Surgery an article on this subject is entitiled: Current  Practices and Controversies in Cosmetic Hair Restoration.

In his paper, Williams “raises concern for the future viability, practice, and art of hair restoration surgery. The concept of physicians with outdated, minimal, or even no knowledge of hair restoration to allow nonphysicians (hair technicians) to perform hair surgery from start to finish is unethical and potentially criminal. In the view of many surgeons in the hair restoration specialty,it is inappropriate to advocate these “new” hair technician responsibilities.”

Even the worldwide medical society of hair surgeons, the International Society of Hair Restoration Surgery , has decided to establish best practices and standards by stating donor harvesting and expanding the duties of hair technicians is a “serious disservice to the patient.”

Todays medical literature reveals ample science-based evidence of the efficacy and reliable clinical outcomes of hair restoration surgery through the last few decades with Strip and FUE surgical techniques. Modern day hair transplantation began in the fifties using a now outdated technique where a 4mm circular manual punch removed  large pieces of scalp tissue containing numerous hair follicles causing an unnatural look. Today,  individual follicular units are removed and transplanted with motorized or robotic devices with a punch the size of the tip of a pen-1mm, and all patients can enjoy restoration of their hairlines with their own natural hairline.

Before Hair Surgery-Norwood 5-6

Before Hair Surgery-Norwood 5-6

After FUE Surgery

After FUE Surgery

Testosterone Replacement Therapy Linked to Hair Loss

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A recent study released in the May issue of The Journal of Sexual Medicine revealed the compliance rate for taking Testosterone Replacement therapy (TRT) is low in hypogonadal males. The study showed that by six (6) months of therapy only 35 % of male patients had continued on their medication. At twelve (12) months, the adherence rate had dropped to 15.4%. So what did we learn from this study ? Men are bad when it comes to taking medication.

Those numbers don’t surprise physicians who engage in hair loss and hair restoration procedures and treatments. Patients who fail to take physician prescribed medications, such as DHT blockers and TRT is a common problem.  Patients that have purchased and used illegal anabolic substances from nutrition sports stores are even more difficult to treat.  These patients often times present, unknowingly, with clinical findings of Anabolic Steroid abuse. Hair loss patients using anabolic steroids can also present with side effects including fatigued, erectile dysfunction,  poor libido, and low sex drive.

For the average medical doctor, the suspicion of underlying illegal anabolic steroid (AS) use as a cause for the patient’s subjective complaints often goes undetected. In patients who are no longer cycling on AS,  the development of  Anabolic Steroid Induced Hypogonadism (ASIH) is common unless the patient goes on another cycle of AS.

bald bb6Doctors often miss the correct diagnosis because they fail to ask the right questions, or patients are too embarrassed to offer this medical information during their office visit. The situation is only made worse because of inadequate training and knowledge of physicians in treating patients with ASIH from anabolic steroid use.

Most practicing physicians don’t understand  anabolic steroid use or the use of testosterone because physicians are taught early in medical school and residency to avoid these trouble causing and drug abusing patients. It is critical that patients be given direct instructions by healthcare providers about the serious side effects of steroid use.

Only a handful of physicians are engaged in evaluating the endocrine functions of their patients, and an even lesser amount of physicians have any idea of the side effects associated with steroid or non-physician prescribed testosterone. These side effects include hair loss, testicular atrophy, gynecomastia, lipid and liver abnormalities, and an increase in red blood cells called polycythemia.

Hair loss occurs for men and women who use testosterone or anabolic steroids because of the increase chemical conversion in the body of Testosterone to another hormone called, Dihydrotestosterone (DHT). During the metabolism or breakdown of  Testosterone, a equivalent increase in conversion to DHT occurs. This hormone has been known for over three(3) to four (4) decades to cause hair loss.

So what should a hair loss patient do when they have taken non-physician prescribed steroids?  Hair Restoration surgeon, Dr. Ken Williams of the Irvine Institute of Medicine and Cosmetic Surgery, states, “ Being honest with your doctor and obtaining medical care by a physician who is familiar with treating hair loss patients with hypogonadal symptoms is paramount.”

Williams adds,  “It is vital to have a comprehensive physical and endocrine evaluation. Baseline blood tests such as a PSA, Testosterone, CBC, and DHT are critical.  Routine office visits in time will eventually reestablish normal hormone levels, libido, and stabilize hair loss.

Patients with a history of steroid use and who suffer from hair loss can call Dr. Williams at his office at 949-333-2999 for a medical consultation and evaluation.