World Health Organization

Do you feel that staples or sutures are better for closing of the donor area after hair transplant surgery.  Which one produces a better scar?

This hair loss question was answered by Dr. William Lindsey of Reston, VA who is one of our recommended hair restoration physicians.

I see this question a lot on the hair loss forum and have put my 2 cents in a few times.  To summarize, I don’t think there is any difference between sutures and staples if placed with the same amount of skill.

I place staples about 25% of the time and it really depends on how the skin comes together for me. The hair restoration patient who is shown in this hair transplant photo album was listening to my assistant and me discussing this very topic. In the last 8 years I conservatively guess that I have placed 300,000 sutures; so I am very comfortable sewing. If there is any tension on the scalp after deep closure I do sutures. On the other hand, I think staples are more comfortable for the patient during that initial 10 days, and if the scalp comes together easily I will use staples for patient comfort. But if I have to trade a bit of comfort for a worse potential scar in my hands, I will suture and explain it to the patient.

Good question.

William Lindsey, M.D.

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

This insightful hair loss information was posted on our hair restoration forum by Dr. Jerry Cooley of Charlotte, NC who is a member of the Coalition of Independent Hair Restoration Physicians.

Propecia is approved by the US FDA for once a day use for hair loss. This does not mean it is the best dosage, only the one that was studied and approved. The average serum “half-life” of finasteride 1mg is about 5 hours in young men and 8 hours in older men. This does not mean that half of the medicine is out of your body in that time period though. The finasteride molecule is distributed throughout the body where it binds to the type II 5-alpha-reductase enzyme, thereby inhibiting conversion of testosterone to dihydrotesterone (DHT). Serum DHT is reduced about 65%, and less DHT means less balding. But several studies show that a single dose of finasteride suppresses serum DHT for 7 days or more (Eur J Drug Metab Pharmacokinet. 1991 Jan-Mar;16(1):15-21, J Clin Endocrinol Metab. 1990 Apr;70(4):1136-41, Prostate. 1989;14(1):45-53). So the finasteride is leaving the bloodstream, entering the tissue throughout the body, and binding to the type II 5AR (5-alpha-reductase) enzyme, resulting in long lasting DHT suppression.

I do not “recommend” my patients take finasteride daily, every other day, twice weekly, etc. Rather I feel it is my duty as their doctor to advise them of the known facts about this medication. Most of my hair loss patients choose to take it on a Mon-Wed-Fri schedule, which is rational from my point of view. Many of my younger patients take it daily ‘just to be sure’ while my older patients are happy to take it two or three times a week. There are no clinical studies showing that less than daily dosing is as effective to treat baldness as daily dosing and for obvious financial reasons, the pharmaceutical company making finasteride has no incentive to fund such a study.

I hope this information is helpful. It is up to each patient to make an informed decision about which dosage is right for them. 

Dr. Jerry Cooley

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Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog

Who's the greenest actor in Hollywood?

Certainly there's uber-enviro Ed Begley Jr., who has his own green reality TV show (Living with Ed), and whose greenness is so notorious that an episode of The Simpsons had him driving a car powered by his sense of self-satisfaction.

Don't count out Arnold Schwarzenegger, the Governator, who as California's head has ensure the state remains No. 1 in the nation when it comes to tackling climate change — though he hasn't shaken his Hummer habit.

And of course there's Leonardo DiCaprio, who proves conclusively that, contrary to what many conservatives think, Earth-friendly habits needn't preclude you from a rich lifestyle of award-winning film performances and rampant supermodel-dating.

But the greenest of them all may be a name that's less known: Hart Bochner. Bochner co-stars in the USA Network drama The Starter Wife, featuring Will and Grace alumna Debra Messing. (To Americans of my generation, however, Bochner will always be known for directing the classic early 1990s college comedy PCU, which proved Jeremy Piven's comedy chops long before he swaggered onto the set of Entourage.) What makes Bochner different from his celebrity peers is that he's willing to do the anonymous, behind-the-scenes work to make the industry more environmentally friendly. "It can't just be about messages," says Bochner. "It has to be about deeds as well."

By its nature, film and TV production isn't always the greenest undertaking in the world. Sets are built quickly and dismantled just as fast, with little regard for the long-term environmental impact. Productions can be energy intensive, especially when shooting on location. And actors, no matter how green they claim to be on Entertainment Tonight, are accustomed to a certain level of luxury that carries a certain carbon footprint.

Bochner and his colleagues at the Environmental Media Association (EMA), where he's been a board member since 2000, are working to change that. He started by creating the EMA Green Seal, which is a badge of approval for productions that follow environmentally friendly practices. "You hit the targets and you get the stamp of approval," says Bochner, who in his own career as a filmmaker helped ban the use of luan, a rainforest mahogany wood, often harvested in threatened Indonesia, in favor of more sustainable materials. "We want to make this the norm."

Even more admirable is his attempt to get Hollywood to believe that the hybrid Toyota Prius was as hot as a Ferrari. Bochner explains: "We just tried to position the Prius as the new sexy thing. It wasn't easy — making driving a smaller, more economic car hip was a task. So I'd just ask my friends, 'Do you love your children?' That was the linchpin in convincing them. I told them, 'The decision is yours, but the nation is watching what you want to do.'"

It's hard to take Hollywood's greens altogether seriously — gee, if only we could all afford to shell out $22,000 for a shiny new hybrid — but Bochner's got a point: The nation does watch Hollywood. The TV and film industry tends to be on the cutting edge of social change, from civil rights to the war in Iraq, and that's true when it comes to the environmental as well. From films like An Inconvenient Truth to high-profile attempts at carbon-neutrality (by the FOX drama, 24, last year), Hollywood is working to set the bar higher, bit by bit — who cares if it feels pretty good about itself in the process? And more importantly, bit by bit, Hollywood is changing social norms. Ideally, someday being green won't be cool anymore — it will just be boring old convention.

The nursing director of our operating room had been out of work a lot, gone for two and three weeks at a time, four or five times over the course of a year. There had been enough good reasons: terrible sickness, a number of tragic family problems.

She always seemed to have enough to do when she was at work, but the funny thing was — noted by the 40 or so people who worked in the OR with her — that nothing really changed when she wasn't there. The schedule got done, supplies were ordered, patients had their surgeries and left. When the director retired, the question of replacing her came up. Most of the doctors and nurses agreed: "There's no difference whether she's here or not, and we could sure use the money for more nurses in the rooms." The hospital administration had a different opinion — namely, "Of course we need to fill her post," while offering no real reason why. So we hired another nursing director. She doesn't take much time off and, fortunately, has become useful enough to be missed when she does.

I started musing about this last week, when John McCain dramatically suspended his campaign to return to Washington to do his real job — being a United States Senator. What other job allows you to not show up for work for months at a time without getting in trouble? In Obama's case it's been over a year now since he's worked, but he still gets paid to be Senator. What kind of employer cuts workers that much slack? And what kind of administrative mess must we have in the Senate for there to be no discernible loss of function in the absence of its chief administrators?

As doctors who treat injured folk, we love the self-employed — they'll barely take the afternoon off to have surgery, and one way or another, manage to get back to work that week to keep the business going, get the mortgage paid and feed the family. Even among the salaried folks, we do see a good percentage who take sick-time fairly and responsibly. What a glaring contrast they are to the corporate or government employee whose minor injury keeps him out — but paid — for months at a time. Months during which we are forced to fill out ever more ridiculous disability forms every two weeks.

Docs are routinely called in to adjudicate these matters — to tell the patient that he or she is cured and has to go back to work — when companies want their employees back. But the sad truth is that within our medico-legal system, any doc would be a fool, and a soon-to-be bankrupt fool, if he thinks he can force a patient to return to work against his will.

And, so, we propose to all the companies flailing in this soon-to-be bankrupt economy a "take-away test" to figure out which of your employees you really need. Simply give each worker a nice long vacation — paid, of course (it will be a cost-saver in the long run). Then sit back and see what happens. If your business output suffers and important things go undone, get that employee back. Your company clearly needs him or her. If, on the other hand, you find no discernable fall-off in business, you know what to do: Give him a raise — he's probably a member of the U.S. Senate or the head of a major financial institution. He might throw some fat contracts, or at least a great mortgage, up your way.

Either way, you'll be saving doctors a lot of unnecessary paperwork.

Dr. Scott Haig is an Assistant Clinical Professor of Orthopedic Surgery at Columbia University College of Physicians and Surgeons. He has a private practice in the New York City area.

In our hair loss forum community, we spend a lot of time discussing hair transplant surgeons who perform only the best work. And though these physicians deserve the online accolades they receive, the experience and hard work of the medical technicians and office staff plays a significant role in the success of the surgery.

These “unsung heroes” are largely responsible for regularly performing the important but tedious tasks of carefully trimming follicular unit grafts under microscopes and placing delicate grafts into recipient sites without damaging them.

Each member of the hair restoration surgical team must be on their game in order for the hair transplant procedure to be a success. One technician improperly trimming or placing grafts could amount to a significant amount of wasted follicles and a much lower hair growth yield.

Surgeons are often more publicly recognized because they are ultimately responsible for the work of the entire surgical team and the end result. However, each member of the hair restoration team plays a significant role in the final outcome of the surgery. Large ultra refined hair transplant megasessions are only possible today because quality surgeons employ a large and experienced staff who can handle grafts quickly, accurately, and safely.

Kudos to the dedicated medical technicians and office assistants who work hard alongside elite surgeons to ensure the end result is as good as it gets.

Bill - aka Falceros
Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center
View my Hair Loss Weblog