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Hair Loss Questions

Why Choose Dr. Swinehart?
Why Does Hair Transplantation Work?
What Is State Of The Art?
How Is Hair Transplantation Performed?
How Many Sessions Are Required?

Dr. Swinehart


Why choose Dr. Swinehart for my hair restoration surgery?

I am a perfectionist. I take pride in my work, and perform each procedure and operation with the skill, care, and patience that I would wish to receive for my family or myself. Our staff is highly trained and experienced, with professional staff always in attendance in the operating room. I will suggest the procedure which I feel will benefit you the most - or, I will recommend alternative options if I feel that you are not a candidate for my skills. For a review of my credentials, please examine the biography. I love my work, and will look forward to helping you to the best of my ability!


James M. Swinehart M.D. is a board-certified dermatologist, and has been in private practice in Denver since 1979. He was born is Seattle, Washington, and grew up in Fresno, California, where he was valedictorian of his high school class. He next attended the University of California at Berkeley with a major in chemistry.

At Creighton University School of medicine, he ranked third in his class of 85, graduating Cum Laude (with honors) as a member of Alpha Omega Alpha, the national medical honor society. During his residency at the University of Colorado, Dr. Swinehart received his specialty training, and was Chief Resident in Dermatology in 1977-1978. He now serves as Assistant Clinical Professor of Dermatology at the University of Colorado Health Sciences Center.

Professional societies currently include: American Academy of Dermatology; Colorado Dermatologic Society (President 1992), Colorado Society for Dermatologic Surgery (founder and President 1987-1988), and currently Secretary), and International Society for Hair Restoration Surgery, (1993-present).

Dr. Swinehart has published several articles concerning hair and scalp surgery, of which his latest is a renowned book : "Color Atlas of Hair Restoration Surgery." (Appleton and Lange, 1995).  He has also written two chapters in the upcoming 4th edition of "Hair Transplantation" by Dr. Walter Unger.

Dr. Swinehart has been performing hair transplants and scalp surgery for 28 years. 


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Why does hair transplantation work?

Each and every hair on your scalp possesses its own genetic "program" that determines how long it will live before it is permanently lost. Many of your hairs in front or on top may have been "programmed" to die by the time you are 30 or 40, whereas nearly all of the "healthy" hair on the lower back and sides of your scalp may likely last for 80 or 90 years.

The "genetic program" of these hair follicles can be transferred by transplantation, generating hair in previously bald areas that will last a lifetime. In other words, the balding areas do not represent "bad soil" or "diseased scalp", but rather areas that can accept healthy permanent grafts from the donor area. Japanese surgeons actually pioneered hair transplantation in the 1930's - thus, we have a 70-year history of successful hair replacement surgery.

Which Procedure is the best for me?

Every individual is unique: no two patterns of hair are the same. And, for each situation, one or more treatment alternatives may exist:

Some factors influencing the method of hair restoration:

* Age, as well as date of onset, and speed of progression of hair loss

* Family history

* Size and height of donor area, compared to present (and future anticipated) size of bald area

*Hair coarseness (donor vs. recipient)

*Hair color (donor vs. recipient) contrasted with skin color

*Hair curl or waviness,

*Hair density, both in donor and recipient areas

*Looseness (laxity) of your scalp

*Location of original hair line, compared to anticipated location of mature hairline

*Other factors which may be discussed by your surgeon

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What is the current state of the art in hair restoration surgery?

Follicular unit grafting has revolutionized our approach to many forms of hair loss. With his method, many hundreds, or even thousands, of your tiny living grafts ("follicular units") containing only one, two, three or four hairs are inserted in closely spaced fashion (as close as 1/16" apart) over the entirety of your bald and thinning areas. These micrografts, which approximate the one to three hairs which naturally originate from each of your original follicles, result in a very natural, aesthetic appearance. Randomly-spaced single hairs can create an especially pleasing, feathered hairline.

In contrast, older or obsolete methods of hair transplantation practiced in the 1960's and 1970's nearly always resulted in a "clumped" or "bristle brush" appearance. The "Barbie Doll" appearance of hair transplant plugs (round grafts containing generally 9-10 or more hairs) is unfortunately nearly always quite conspicuous, and worse, permanent. During the 1980's minigrafts (smaller clumps containing 5-8 hairs) were an improvement, but only served to generate smaller "clumps". Indeed, approximately 1 out of 4 cases at our hair restoration surgery center involve the repair and/or hairline camouflage of these "plugs" or "minigrafts" placed at other clinics. Even more unfortunately, at some locations, these larger grafts are still utilized.


Unsightly "Barbie Doll" hairline from hair transplant surgeon who still uses round "plugs"

The benefit from follicular unit micrografting, versus plugs or minigrafts, can be visualized by viewing a group of tree trunks: even though the cross sectional area of each tree is large, one can clearly see space between the trees. In contrast, the tiny branches of a hedge, with a much smaller total cross sectional area, still create a much more dense visual barrier.


29 year-old male with receding hairline


Same patient, after only one session of 1-hair and 2-hair micrografts. Can you tell the difference between the grafts and his natural hair?

Why wait until you are completely bald?

The insertion of micrografts between your existing hairs, leaving them undisturbed, can systematically restore density to your scalp hair. Thus the grafted hairs may compensate for the loss of your natural hair. The successive placement of many of these micrografts over several sessions can even prevent the appearance of baldness in selected patients with remaining, but thinning, hair.


Marked thinning, on crown, in patient in 50's


Same patient, after 2 "hair-thickening" sessions of micrografts. An additional session would be add even more density


21 year-old white male with anterior crown thinning with very strong family history of baldness. This patient did not want to wait until he was completely bald


Same patient, after 3 "fill in" micrografting sessions with a beautiful result. Note that a mature hair line has been anticipated in preparation for the appearance that would be desirable during the patients middle-aged years

What about hair loss in females?

Most women, of course, never lose all of their hair, but in some instances the hair on top of the scalp can get quite thin. Heredity, hormonal situations, menopause, and certain medications can result in considerable hair loss. In these instances, in women with an intact hairline, the placement of micrografts between the existing follicles can restore a good deal of density to the crown of the scalp.

Improperly performed face lift surgery may permanently damage hair follicles along the temples and sideburns: browlifts (forehead lifts) may move the hairline back to an unacceptably high location, and scars along the hairline may be quite visible when the hair is parted or when the wind blows. In these instances, a new hairline must be created with 1-hair and 2-hair micrografts or follicular units. Of course, a normal, dense donor area must be present on the sides and back of your scalp in order for the surgeon to perform successful hair replacement.

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How is hair transplantation performed?

We perform all procedures in an operating room fully equipped with monitoring equipment, emergency supplies, and sterile instruments. Prior to the procedure, photographs will be taken and the surgeon will carefully trace your hairline with your approval. Then, once an IV line has been started, you will be given relaxing and pain medications, usually by mouth.


The essence of extensive micrografting: a small strip from the donor area is dissected and cross dissected into micrografts containing 1-4 hairs each

How are the grafts taken and inserted?

Once you are completely numb, a small strip (usually approximately 3/8" wide) containing healthy donor hair will be taken from the back or side of your scalp. This area, after closure with stitches or staples, and later resulting in a linear scar, will be hidden by your downward combed hair in back

This strip is then meticulously dissected, under magnification, into groups of micrografts and follicular units containing 1, 2, 3, and 4 hairs each. In some cases, the top (epithelium) of each graft may be removed, although it usually is left intact.

Simultaneously, the physician first divides the scalp into "zones" to receive the various sizes and types of grafts. He then creates the hundreds of tiny needle-holes or slits in exacting fashion in your recipient (balding) region. Care is taken to orient the transplanted hairs in the same angle and direction as that possessed by your original hair. The needle holes are smaller and more closely spaced along your hairline, and are situated between your existing scalp hair on the front and crown of your scalp. 


The various sizes of micrografts are carefully matched to dilators (if used) and special needles; These micrografts are then inserted into "zones" of single-hair micrografts (in front) followed by 2-hair and 3-hair micrografts, with 4-hair micrografts placed into the crown for density.

In patients who are quite bald, or who desire repair/camouflage of older plugs, small "microholes" of bald scalp or scar tissue may be removed prior to graft insertion.

The hair is then patiently inserted under magnification with a jeweler's forceps, by the staff, until your scalp recipient area has been blanketed with micrografts. All grafts are carefully inspected and readjusted, if necessary, at the conclusion of the operation. No stitches are necessary in this recipient area - the body's own "glue" from the clotting process keeps the grafts in place.

After application of a sterile dressing, you will be discharged from the operating room. You generally will receive a phone call that afternoon and that evening, and you will be seen the next day for a dressing change and examination of your transplant.

This second dressing can be removed on the second day (48 hours), followed by a light shampoo. On the third postoperative day, following shampooing and hair styling, many patients can return to work. The stitches in the donor area are usually removed in 10-12 days. Tiny pinpoint crusts are generally present for 2 weeks; small red dots may delineate the graft sites for a month or so. Occasionally, a small "pore" may be present at the site of the graft insertion.

Immediately after the operation, the grafts usually go into the "resting state". The transplanted hair then starts to appear in approximately 2-4 months, growing at a rate of approximately 1/2 inch per month after that. Thus, it will take a number of months to see the growth from any one session.


33 year-old white male with deeply receding temples

Same patient, after two sessions of 1-hair, 2-hair and 3-hair micrografts displaying a beautiful, natural result

Risks and complications

If the surgeon could anticipate untoward effects, he would, of course, never perform the surgery. However, with hair restoration surgery, most of the adverse events are of a cosmetic, or aesthetic, nature. The patient must bear in mind the fact that cosmetic surgery of any type is never perfect. The patient should hope for improvement, of course, but cannot expect to recreate the perfect hairline and full head of dense hair that he or she possessed at age 16. As previously mentioned, even the best series of micrograft procedures produces a "naturally thin" appearance. One session will add noticeable, though sparse, coverage.

Other relative risks or side effects include post operative swelling, discomfort and nausea; these can be treated with special medications. The postoperative appearance of the recipient area, though temporary, may cause a problem for those in the public eye; this can be covered by hair styling, hair additions, or camouflage cosmetics. The donor scars can be covered by downward combing of the hair. Tiny pores or pits may occasionally result from micrografts where the hair exits the skin. Patients with dark hair and light skin pose a more difficult challenge, as well, since there is a strong contrast between skin and hair color. Rarely, a defective donor area may lead to poor growth of, or future loss of, grafts. Other risks can be discussed during the consultation and are covered in detail in the consent form.

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How many sessions are required?


How dense will it be?


In each surgical session, the grafts are inserted in-between existing hairs or previously placed micrografts, yielding considerably increased hair density after 4 sessions

Follicular units can generally be situated no closer than 1/16 inch from each other; closer packing would cause "popping" (extrusion) of adjacent grafts, and could interrupt the blood supply. However, normal human hairs are located much closer together than this. Thus, 3, 4, or even 5 sessions will be required to fill in these "spaces". The timing of these sessions depends, of course, on the rate of progression of loss of remaining natural hair and the needs of each patient. In general, however, sessions are spaced at least a minimum of 3 months apart in order to allow the new grafts, and blood supply, to become established.

It is important to realize that a dense result cannot be achieved with one session of follicular units. Even 3 or 4 sessions, on a fairly bald scalp, will ideally result in a "naturally thin" appearance.

The final result, under the best of circumstances (dense, coarse donor hair, with considerable remaining scalp hair) may approach your hair's original density. This is balanced, however, by the much more natural appearance of the tiny hair grafts.

What future innovations are in the works?

Hair follicle cloning is an exciting concept that is still in the developmental stages but shows some promise. Other possible future innovations may include automatic devices to create the microholes, perform exacting dissections, and to automate the graft implantation process. Your surgeon will inform you of these advances as they are perfected.


The gradual increase in density from micrograft sessions 1, 2, 3, and 4 is evident


41 year-old white male with one of the most difficult challenges in hair replacement surgery: coarse, straight. dark hair contrasting with light skin


Same patient, after 1 micrograft session


Same patient, after 3 extensive micrografting sessions


Same patient, after 4th session of micrografts: note natural hairline combined with considerably increased density in anterior crown

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