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Archive for the ‘Hair Transplant’ Category

What can be done about beards?

September 15th, 2017 | General Info, Hair Transplant, Treatments

Tormund Giantsbane - Game of Thrones

In today’s society having a full and lush beard is becoming more and more of a fashion statement for men.  While some men are born with thick facial manes, others require treatment to aid in thickening up their beards.

Not all men are lucky like actor Kristofer Hivju (photo), more popularly known as Tormund from the HBO hit show, Game of Thrones (most of the staff at the Groot DermaSurgery Centre are very big fans of Game of Thrones).

Dr. Thomas Nakatsui, a board certified Dermatologist and hair transplant specialists, has been performing hair transplants for over 18 years.  The exact reasons why men come in for a beard transplant vary.

Some men want to increase thickness, while some men have suffered some form of trauma that caused an area to scar, therefore leaving a portion of facial hair missing.

As with any hair transplant, artistry plays a major role in how the end result turns out.  Hair transplants need to look natural and undetectable in appearance.  Old forms of hair transplants, “plug transplants”, have yielded unnatural and very detectable results.

Having undetectable results is even more paramount whenever dealing with the face as it is always front and center.  Any irregularities can be easily spotted.

To address this issue, Dr. Nakatsui follows the patient’s natural flow, angle, and direction of their beard.  If hairs are placed in any strange angle, it will become very apparent that a hair transplant was performed once the hairs have grown in.

The size of the graft is important as well.  A graft is a natural grouping of hairs that come in 1, 2, or 3 hair bundles.  Dr. Nakatsui typically utilizes the grafts with one hair when it comes to beard hairs.

Beard hair transplants can be a great tool to help thicken up a beard.  One thing to consider before having a beard hair transplant is that the donor hair, which is usually taken from the back of the scalp, may have different texture and/or colour than the recipient bearded area.

Once the transplanted hairs are placed, it will hold the same characteristics as the area where it was taken from.  If there is a significant difference between the donor hair at the back of your scalp and your beard hair, it can potentially become visible and unnatural.

The beautiful thing with a beard hair transplant if it is done correctly is that it now gives the individual the choice whether or not they want to grow a beard or be clean shaven.

Because of the incredibly small incisions that Dr. Nakatsui makes during the procedure, a patient can be cleanly shaven and have no trace of scarring to the area.


For more information regarding hair transplants, please visit


Sudden and exaggerated hair loss? You may have Telogen Effluvium.

August 5th, 2017 | Conditions, Hair Transplant

Telogen Effluvium

(Scalp Hair Thinning Due to a Shift in the Hair Cycle)

The sudden loss of exaggerated amounts of scalp hair is quite a common complaint, particularly in women.  This shift in the hair cycle, creating a hair loss pattern called “telogen effluvium”, usually occurs suddenly.  This is not associated with isolated bald patches of the scalp, or with excessive crusting or infections of the hair follicles.  It may “unmask” male/female pattern hair loss, revealing thinning on the top of the scalp.  In these cases, treatment is required for both problems.


When a scalp hair begins to grow in each individual hair follicle, it remains in the “growth phase” (anagen phase) for approximately three years.  This average growth phase for the scalp hair creates hair that will grow to approximately mid-back level.  Some people have a longer growth phase and can grow their hair until they can almost stand on it, while others with a shorter cycle, can grow their hair no longer than shoulder length.  This is an individual genetic variation.

After the growth phase, the individual hair follicles, independent of each other, convert into a “resting phase” (telogen phase), and remain in this dormant stage for approximately three months.  During this time, a new hair is suddenly stimulated to grow, which eventually “pushes out” the old hairs as you comb, brush, and wash your hair.  You will see these hairs coming out all of the time.  This resting hair has the typical white tip on the scalp-end of the hair.  This white tip is not the root, but indicates that this hair was in the resting phase, and that another hair is replacing it in the same follicle.  In the normal hair cycle, approximately 85% of hairs are in the growth phase at any one time and 15% are in the resting phase.  With this ration, it has been calculated that the average person will lose 100 hairs per day.  If you do not shampoo every day, you will notice that on the days you do shampoo, you will lose an exaggerated number of hairs.  This is normal.


The hair cycle and the growth phase of your hair have nothing to do with having a tight scalp or a lack of blood flow to the scalp.  The tightness of your scalp is genetically determined, and has nothing to do with “circulation”.

Telogen effluvium is not associated with frequent shampooing.  In fact, the healthiest scalps and hair that I see are the patients who shampoo daily.

The length of hair does not affect the growth rate.


It is important to remember that after the triggering event that causes a shift in the hair cycle, it takes up to three months before the hair loss is noticed.  Due to this delay, it is important to look back at least three months prior to the onset of your hair loss.  Following are some of the common causes of telogen effluvium:

Pregnancy and Delivery – 8-12 weeks after the delivery of a child a scalp hair loss often occurs that can be quite frightening.  This is temporary, and the hair cycle will re-establish itself.

A high fever (from any cause) is a common initiator of a shift in the hair cycle from the growth phase to the resting phase, the growth phase will return to normal.

Ingestion of various anticoagulants (blood thinners) can affect the hair cycle.

Birth control pills can initiate a shift in the hair cycle, either while the patient is on them or once the patient has stopped the pills.  The same type of hair loss can be experienced as with the birth of a child.

Emotions – some patients have a very sensitive hair cycle and emotionally disturbing experiences can shift the hair cycle, creating an exaggerated hair loss.

Anemia, particularly iron deficiency anemia, can influence the hair cycle in a negative way.

Any severe, systemic illness can create a shift in the hair cycle.

Hypo- or hyperthyroidism can create telogen effluvium.

Diets – any crash diet program can create a shift in the hair cycle (the HCG weight control program often influences the hair cycle).


Correct the precipitating cause if it is ongoing.

Avoid aggressive combing, brushing, and back-combing of your hair.

Do not “over use” the hair dryer.

Use mild shampoos

It is important to have serum iron and iron binding capacity laboratory tests done, as there are significant number of patients who have low tissue iron levels who will not regain the growth phase of the hair without iron replacement.

It is very important to remember that once the hair cycle has shifted, it takes months for the hair cycle to re-establish itself, even in patients where the cause of the hair loss is easily determined and eliminated.  Few patients never quite regain the volume of hair they had before the shift occurred. If you feel that your hair loss has gone past the preventative stage, you may need a hair loss treatment that is more intensive and more personalized to your particular issue. Thankfully there are plenty of options available in today’s market.

Zinc (Usually in the form of Stress Tabs with zinc and copper, 1 pill twice daily) and Rogaine lotion (1 ml twice daily to thin hair areas, is often helpful but may require many months of therapy).

As with any medical treatments, it is always important to check with your family doctor or dermatologist to see if any of the above medications or treatment regimens is right for you. For more information, please visit our dedicated hair transplant website at

Dr. Thomas Nakatsui is the medical director of the Groot DermaSurgery Centre, a certified non-hospital surgical facility. Dr. Nakatsui is a dermatologist that specialises in ultra-refined hair transplantation, using the lateral slit technique. He is a Fellow of the Royal College of Physicians and Surgeons of Canada and is board certified in both the United States and Canada. He completed his medical training and residency in Dermatology at the University Of Alberta and received additional training at several Centres of Excellence including Harvard, the Johns Hopkins Medical Centre, the Massachusetts General Hospital, and the Mayo Clinic.

The Art of Hair Restoration Surgery

July 7th, 2016 | Hair Transplant

The Art of Hair Restoration Surgery

Hair transplant surgeries have become one of the most popular cosmetic procedures for men and a large number of women.  Much of what happens before, during, and after a hair transplant surgery is uncertain for many curious people.  Here is what the typical process for hair restoration surgeries look like from consultation to 1 year after the surgery with Dr. Nakatsui.

Complimentary Comprehensive Consultation

A prospective patient will come in to our clinic for a complimentary consultation with Dr. Nakatsui.  During this consultation, Dr. Nakatsui will obtain a thorough history of the individual.  When did the hair loss begin, what types of treatments they have tried in the past, and what is their family history for hair loss are among a few of the typical questions asked.

Dr. Nakatsui then performs a thorough examination of the scalp to determine if there are any other medical factors that may contribute to the hair loss such as Alopecia Areata or Lichen Planopilaris.  These are conditions in which the body attacks its own hair and because of that, hair transplantation into these areas is not recommended.  Dr. Nakatsui then assesses the patient’s situation and expectations and determines if the individual is a good candidate for hair restoration surgery.

Candidacy for hair restoration surgery is multifactorial.  First, Dr. Nakatsui will assess if there is enough donor hair for the required areas.  Is there enough supply for the demand?  Donor hair taken from the back of the scalp is the best hair for transplantation and we have to think of that hair as a limited resource; there is only so much that Dr. Nakatsui can take from this resource.  Candidacy goes beyond the initial consultation as well.  Dr. Nakatsui will not only take into consideration if there is enough donor supply for the demand for today, but also for next year, 10 years down the road.

Unfortunately, hair loss in men and women may be progressive and can continue for many years after a hair transplant.  Technically, the transplanted hairs are permanent and should never fall out, so that leaves the pre-existing non-transplanted hairs.  These hairs have the potential to fall out in the future.  Dr. Nakatsui takes these factors into account and tries to determine if there will be sufficient supply to meet the demands of the future.

The most important factor for candidacy is always patient expectations.  The goal of hair transplant surgeries, and any cosmetic surgery, is improvement not perfection.  Since the transplanted hairs are technically permanent, they will be with you when you are 70-80 years old.  It is important to understand that having a low hair-line similar to your 18-year-old self may have an unnatural appearance not only today, but when you are 70 years old.

Hair transplant surgeries can take several hours to perform as it is very detailed and tedious work.  Similar to a master watch maker crafting a beautiful watch, Dr. Nakatsui skilfully and painstakingly performs surgery that will ultimately yield incredible results.

Surgery Day

The big day is finally here and there is excitement in the air!  Patients arrive at 8:00 in the morning and is shown around our clinic.  Dr. Nakatsui speaks with the patient going through all the ins and outs of the procedure.  Dr. Nakatsui then plots out exactly where he will be transplanting and ensures that both patient and Dr. Nakatsui are happy with the recipient areas.

The patient is prepped and ensured the donor and recipient areas are clean and sterile.  At this time, the patient is laying face down in a comfortable massage table and Dr. Nakatsui at this will use local anaesthetic to numb up the donor site.  If the patient is having the follicular unit transplant (strip technique), then Dr. Nakatsui and his surgical team slowly and carefully remove the donor site hair.  Once that is complete, he then closes the donor site with surgical staples.

If a follicular unit extraction (FUE – individual) surgery is performed, Dr Nakatsui will trim the donor site hair very short.  Local anaesthetic is used once again to numb up the area, then using a tool called the SAFE machine, Dr. Nakatsui manually extracts every individual hair one by one.

Hair Transplant GraftsOnce the removal of the donor hair, Dr. Nakatsui then anaesthetizes the recipient areas.  He then makes tiny incisions into the recipient areas.  Dr. Nakatsui’s team of technicians carefully and skilfully trim and dissect every individual graft.  A graft is a bundle of 1, 2, or 3 hairs.  Once all of the incisions are made, Dr. Nakatsui, his team, and the patient break for a quick lunch provided by Dr. Nakatsui.

In the afternoon, the hair transplant technicians then reinsert every individual graft.  Dr. Nakatsui and his team will utilize all grafts and painstakingly insert one graft at a time.  The incisions that Dr. Nakatsui made are in very specific angles and direction and, ultimately, when the grafts are reinserted into the scalp, they must be inserted at the exact same angle as the incision.

Once completed, Dr. Nakatsui and his team go over post operative instructions and a care package is given to the patient.

Post Treatment

Typical things to expect post surgery include swelling to the forehead, redness, irritation, itching.  Antibiotics are given to prevent infection.  Dr. Nakatsui recommends rest/no strenuous activity for at least 10-14 days post surgery, which includes time off from work.  The transplanted areas will appear as if the patient had bad sunburn.  Any strong physical exertion could potentially eject the grafts within the first week after the surgery or any physical trauma to the recipient sites can cause grafts to eject.

Three week after the surgery, typically the visible portion of hair falls out at this time.  Because the follicle is dormant beneath the skin, it will take approximately 3 months for little sprouts to appear.  It will, however, take 12-14 months to see the full 100% effect of the result.

The hair transplant surgery and outcome is a game of patience.  The day of surgery is a long day for both patient and surgical team.  As with anything worth the wait, time is needed to see the full result, but it is worth it. For more information, please visit our dedicated hair transplant site at

Patient 3cPatient 13a


What is involved in a Hair Transplant Surgery?

June 7th, 2016 | Hair Transplant

Hair Transplant Grafts

Hair transplant surgeries have been around for many decades.  Through technological advancement and improved techniques, hair transplant results have become both very natural and undetectable.  Historically, hair transplant surgeries have been associated with the word “plugs” or “doll hair” and those terms are not far from the truth.  Early iterations of the hair transplant surgery yielded unnatural results that were easily detected.  Large clumps of hair that looked like “plugs” were inserted into the scalp and had very large spacing in-between each graft.  The end result looked very much like a dolls head of hair.



Dr. Thomas Nakatsui, a board certified dermatologist, trained extensively with Dr. Jerry Wong under the most advanced technique of Hair Restoration surgery.  Dr. Nakatsui has been performing Hair Transplant surgeries for more than 18 years and his technique involves taking the very basic units of hair called grafts (seen in the photo above).  Each graft contains 1, 2, or 3 hairs.  The older plug technique typically had 5, 8, sometimes 10 hairs in a single graft.  Because Dr. Nakatsui uses the very basic units of hair, the grafts are incredible small, between 0.6-1.0mm in size.

The above photo shows a group of grafts placed in a saline filled sterile Petri dish placed on top of an ice pack wrapped in sterile tin foil.  Each graft is incredibly small as you can see.  Hair transplant surgeries require patience as they are typically a lengthy day for Dr. Nakatsui, his team, and the patient.  However, the only way to achieve amazing results is to perform this tedious process.   Our job is not difficult, we’re splitting hairs! For more information regarding hair loss/hair transplant surgery, please visit

Hair Transplant Before and After