Welcome to the New Zealand Hair Transplantation Institute™, collocated at Sapphire Appearance Medicine Clinic.

We are proud to be New Zealand’s first and only clinic with a Diplomate of the American Board of Hair Restoration Surgery (ABHRS), Dr. Garsing Wong. This prestigious certification demonstrates his proficiency in rigorous written and oral examinations, each independently validated to ensure safe, aesthetically sensitive hair restoration surgery. Dr. Wong is also the recipient of the James E. Arnold, M.D. Award, recognising the highest mark in the ABHRS written examination, reflecting his exceptional academic achievement.

Dr. Wong’s expertise is further recognised internationally. He serves as a Subject Matter Expert for the ABHRS and has been appointed Ambassador for Patient Safety by the International Society of Hair Restoration Surgery (ISHRS), advocating for highest standards of care in hair restoration surgery worldwide.

Expert, Locally-Based Doctors

All procedures are performed by New Zealand-born, locally trained surgeons who reside full-time in Auckland, ensuring personalised, hands-on care for every patient.

Joining Dr. Wong is Dr. Thomas Doo, also a University of Auckland graduate with qualifications in medicine, law, and accounting. Both doctors are Fellows of the Royal New Zealand College of Urgent Care and the Royal New Zealand College of General Practitioners, and hold full memberships with the International Society for Hair Restoration Surgery.

Advanced Techniques & Technology

We are the first clinic in New Zealand with TWO Trivellini FUE systems, a vacuum-assisted multiphasic technique representing the latest advances in hair transplantation technology. We also use Choi-type implanter devices (DHI/Direct Hair Implantation) for precise, natural-looking results.

Academic & Professional Leadership

Dr. Wong is an Honorary Senior Clinical Lecturer at the University of Auckland, training medical students in hair restoration and appearance medicine. He is a widely recognised examiner and mentor, with a career dedicated to advancing surgical standards, patient safety, and education globally.

Comprehensive, Safe Care

Hair transplantation is a safe and reliable method to restore hair, beard, moustache, or eyebrows when suitable donor hair is available. Our surgeons provide tailored advice, ongoing support, and post-operative care, combining cutting-edge technology with clinically proven methods.

Your Consultation

All consultations are conducted directly with your surgeon, providing personalised advice and a clear plan for your hair restoration journey.

Experience the expertise, recognition, and care you deserve. Contact us today to schedule your consultation:

nzhairtransplant@gmail.com

We’re Here For Your Hair™

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Our Hair Surgeons – Expertise You Can Trust

We are the first and only hair surgery clinic in New Zealand with a Diplomate of the American Board of Hair Restoration Surgery, Dr. Garsing Wong. We are also the only clinic in New Zealand offering Long Hair Transplantation, a highly specialised procedure requiring advanced skills.

Dr. Garsing Wong

A proud Auckland native and graduate of the University of Auckland, Dr. Wong is the first New Zealand doctor to earn Diplomate status from the American Board of Hair Restoration Surgery and the first Kiwi member of the World FUE Institute in Belgium. He is also a member of the International Society of Hair Restoration Surgery (ISHRS) and a Fellow of both the Royal New Zealand College of Urgent Care and the New Zealand Society of Cosmetic Medicine.

Dr. Wong has held leadership roles in Appearance Medicine and serves as an Honorary Senior Clinical Lecturer at the University of Auckland’s Department of General Practice and Primary Health Care, where he teaches and supervises medical students. He is also a respected examiner for the Royal New Zealand College of Urgent Care and the New Zealand Society of Cosmetic Medicine.

Dr. Thomas Doo

Dr. Doo, born in Auckland and a University of Auckland graduate, is qualified in medicine, law, and accounting. After attending Kings College in Otahuhu, he received a University Junior Scholarship to study medicine. Dr. Doo is a Fellow of both the Royal New Zealand College of General Practitioners and the Royal New Zealand College of Urgent Care, as well as a full member of the ISHRS and the World FUE Institute.

Alongside Dr. Wong, Dr. Doo was one of the first New Zealand-born and trained doctors to introduce permanent FUE (Follicular Unit Extraction) hair transplantation in New Zealand. He shares a deep commitment to delivering safe, natural, and permanent hair restoration results.

Languages

Our surgeons communicate fluently in English, Cantonese, Mandarin, and German, ensuring comfort and clarity for a diverse patient base.

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Long Hair FUE (Follicular Unit Extraction) is a safe and reliable method of hair transplantation for suitable candidates who wish to restore hair without shaving the donor or recipient areas.

We are the only clinic in New Zealand offering Long Hair FUE.

What does “Long Hair” mean?

“Long Hair” refers to the fact that no shaving is required prior to surgery. Hair is harvested from the donor area (usually the back of the scalp) while remaining long, using the Trivellini Long Hair Multiphasic FUE system with specialised punches.

Not all extracted hairs will remain long. The harvested hair may be trimmed before implantation to reduce tension on the follicles.

What should I expect after surgery?

Internationally, the term “Preview Long Hair Transplantation” is used to describe the visible appearance of transplanted hair immediately after surgery. As with all FUE procedures, transplanted hairs typically shed within 2–4 weeks, with regrowth beginning at approximately 3–4 months.

The transplanted hair retains the characteristics of the donor area and is considered permanent.

Are the results comparable to shaved FUE?

Based on our experience, follicle survival and outcomes are comparable to fully shaved FUE procedures. However, harvesting long hair takes significantly longer, which limits the size of the area that can be treated in a single session. Larger areas may require staged procedures.

Cost considerations

Long Hair FUE is more time-intensive and therefore more expensive than shaved FUE. A personalised quote will be provided during your consultation.

Who is Long Hair FUE best suited for?

This technique is particularly suited to patients seeking a discreet procedure, allowing them to return to normal activities with minimal visible signs of surgery. Where appropriate, staged treatments may be performed at intervals of approximately four months.

To determine whether Long Hair FUE is suitable for you, a face-to-face consultation with your surgeon is required.

nzhairtransplant@gmail.com

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What Is Partial Shaved FUE?

Partial Shaved FUE (Follicular Unit Extraction) is a safe and reliable hair transplantation technique for suitable candidates who wish to avoid fully shaving their scalp while still achieving effective hair restoration.

This method involves shaving only a small, concealed section of the donor area, usually at the back or sides of the scalp, while leaving the surrounding hair unshaved to provide coverage.

What should I expect with Partial Shaved FUE?

During the procedure, follicular units are harvested from the shaved donor strip and transplanted into the areas of hair loss or thinning. As long as the surrounding donor hair is of adequate length, the donor site is well camouflaged within approximately one week after surgery.

In the recipient area, provided the existing hair is long enough, the transplanted area can usually be camouflaged within one day following surgery.

How does Partial Shaved FUE compare with fully shaved FUE?

Partial Shaved FUE offers similar surgical outcomes to fully shaved FUE in appropriately selected patients. However, it is more time-consuming and technically demanding, which limits the number of grafts that can be safely transplanted in a single session.

As a result, larger areas may require staged procedures.

What are the advantages of Partial Shaved FUE?

• Avoids complete head shaving

• Donor area typically concealed after one week

• Recipient area can be camouflaged within a day (if hair length allows)

• Allows earlier return to work and social activities

What are the limitations?

• Not suitable for very large transplant sessions

• Takes longer than fully shaved FUE

• Requires adequate hair length in both donor and recipient areas

• May require multiple procedures for extensive hair loss

Cost considerations

Partial Shaved FUE is more expensive than fully shaved FUE due to the additional time and technical demands. A personalised quote will be provided at your consultation. All quotes are valid for six months.

Am I suitable for Partial Shaved FUE?

Suitability depends on:

• The extent of hair loss

• Donor hair density and length

• Recipient area hair length

• Overall scalp health and expectations

A face-to-face consultation with your surgeon is required to determine whether Partial Shaved FUE is appropriate for you.

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What are the different FUE hair transplantation techniques?

At the New Zealand Hair Transplantation Institute™, we offer three Follicular Unit Extraction (FUE) techniques, selected based on your hair loss pattern, lifestyle needs, and suitability:

1. Fully Shaved FUE

2. Partial Shaved FUE

3. Long Hair FUE

All three techniques involve relocating your own hair follicles from a donor area to areas of hair loss.

What is Fully Shaved FUE?

Fully Shaved FUE requires the donor and recipient areas to be shaved short (approximately 0.5 mm). This allows optimal visualisation of follicles and enables the largest number of grafts to be transplanted safely in a single session.

Best suited for:

• Larger areas of hair loss

• Crown or extensive scalp thinning

• Patients seeking the most efficient procedure

Considerations:

• Visible shaving initially

• Hair regrowth occurs as per normal transplant timelines

What is Partial Shaved FUE?

Partial Shaved FUE involves shaving only a small, concealed donor area, while leaving surrounding hair unshaved to camouflage the site.

Best suited for:

• Patients wishing to avoid full scalp shaving

• Smaller to moderate transplant sessions

• Those wanting a quicker return to work

Considerations:

• Approximately 20% higher cost than fully shaved FUE

• Limited number of grafts per session

• Donor area typically concealed after one week

• Recipient area can often be camouflaged within one day, if hair length allows

What is Long Hair FUE?

Long Hair FUE involves no shaving at all of the donor or recipient areas. Hair follicles are harvested with hair intact, allowing immediate cosmetic camouflage.

Best suited for:

• Patients requiring maximum discretion

• Small, staged restoration areas

• Patients unable to shave for personal or professional reasons

Considerations:

• Technically complex and time-intensive

• Harvesting takes approximately three times longer than shaved FUE

• Limited graft numbers per session

• Higher cost than shaved techniques

• Multiple sessions may be required

Do all techniques give the same long-term results?

Yes. When appropriately selected, all three techniques provide comparable long-term outcomes, as the transplanted follicles retain the characteristics of the donor area. Initial shedding may occur within weeks, with regrowth typically beginning around four months.

Which technique is right for me?

The most suitable technique depends on:

• Extent and pattern of hair loss

• Donor hair availability

• Hair length in donor and recipient areas

• Lifestyle, work, and privacy considerations

A face-to-face consultation with your surgeon is required to determine the safest and most appropriate option for you.

Who performs the surgery?

All procedures are performed by New Zealand-born, locally trained, permanently domiciled hair surgeons in Auckland, who personally conduct every consultation and surgery.

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How do I book my consultation?

To book a consultation with the New Zealand Hair Transplantation Institute™, please contact our team by email or phone.

Email (preferred): nzhairtransplant@gmail.com

Phone: 09 360 1250

Our clinic is located within Sapphire Appearance Medicine Clinic, Auckland.

Consultation types

We offer both video consultations and face-to-face consultations.

A face-to-face consultation is recommended to allow a thorough examination of your scalp and donor hair. However, video consultations are available for patients who are unable to attend our Auckland clinic initially.

Please note that a face-to-face consultation is required before any surgery can be booked, as this is essential for accurate assessment, treatment planning, and informed consent.

A standard consultation fee applies and must be paid in advance to confirm your appointment.

Clinic hours

• Monday–Thursday: 10:00am – 5:00pm

• Friday: 10:00am – 6:00pm

• Closed on public holidays

Quotes and planning

Any quote provided is tailored to your individual hair loss pattern and is valid for six months, as your hair condition may change over time.

All consultations are conducted directly with your surgeon, ensuring personalised assessment and appropriate medical advice.

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To help us provide you with the most accurate assessment and appropriate advice, we recommend the following preparation before your consultation:

• Family hair history: Please be familiar with patterns of hair loss in your family, including siblings, parents, and—if known—both paternal and maternal grandparents.

• Previous treatments: Bring a list of any medications, supplements, topical products, or procedures you have used for hair loss, including how long and how often each was used.

• Patient history form: Prior to your appointment, you will be emailed a patient history form by our team. Completing this in advance will help ensure a smooth and efficient consultation.

• Relevant medical tests: If available, please bring copies of any blood test results from the past 12 months, as these may assist in identifying medical causes of hair loss.

Providing this information allows your surgeon to better understand your individual situation and tailor recommendations specifically to your needs.

If you have any questions before your appointment, our team is happy to assist.

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How much does hair transplantation cost?

The cost of hair transplantation varies between individuals and depends on several factors, including:

• The area being treated (scalp, beard, moustache, eyebrows, or other body areas)

• The technique used (fully shaved FUE, partial shaved FUE, or long hair FUE)

• The size of the area being restored

• The number of follicular units required

• Donor hair availability and quality

• Your long-term expectations and treatment goals

As a general guide, hair transplantation procedures start from approximately $5,700, depending on the area treated and the technique required. An individualised quote can only be provided after a consultation with your surgeon.

ACC (Accident Compensation Corporation) considerations

In certain circumstances, ACC may contribute to the cost of hair transplantation when hair loss results from an accident, trauma, or medical treatment–related injury.

Eligibility for ACC support is determined solely by ACC. Patients must:

• Register a claim with their general practitioner

• Obtain ACC approval prior to surgery

Until ACC approval is confirmed in writing, all consultation and surgical fees remain the responsibility of the patient.

Understanding long-term planning and cost

Hair loss is an ongoing process, influenced by genetics, age, and the underlying cause of hair loss.

An apt analogy is to think of your hair as a bucket of water with a leak. Hair transplantation involves redistributing water (hair) from one area to another, but the leak may persist. This limits the total amount of hair available over a lifetime and means that careful, long-term planning is essential.

The most common form of hair loss in men—androgenetic hair loss—may continue to progress and often stabilises later in life. For this reason, your surgeon will consider not only your current hair loss, but also your likely future pattern of hair loss, to achieve a natural-looking result that remains appropriate over time.

Why a consultation is essential

During your consultation, your surgeon will:

• Assess your hair loss pattern and donor hair reserves

• Discuss medically appropriate treatments to help slow further hair loss

• Clarify realistic expectations and long-term outcomes

• Recommend the most suitable technique for your situation

Only after this comprehensive assessment can a safe, ethical treatment plan—and accurate cost—be determined.

To help make hair restoration more accessible, we provide information about Nova Medical Finance, New Zealand’s specialist medical finance provider. Applications are simple via their online form, and normal lending criteria apply. Please note that we are independent of Nova Medical Finance and provide this information purely as a potential option.

For more information about the costs and frequently asked questions, you can visit the Nova Medical Finance FAQ page

https://www.novamedical.co.nz/faqs

To apply for medical finance, you can follow the application link at: https://www.novamedical.co.nz/apply

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Do I Need to Shave My Hair?

Whether or not you need to shave depends on the type of FUE procedure you choose and the area being treated—scalp, beard, moustache, or eyebrows.

1. Standard (Fully Shaved) FUE: A number zero haircut across the donor area is required. This allows optimal access for harvesting follicles and ensures the best surgical outcome. This is the most time-efficient and cost-effective approach.

2. Partial Shave FUE: Only the donor area is trimmed, leaving the recipient area long. This is ideal if you want to camouflage the transplanted area immediately, while keeping most of your hair length intact. The donor area will be fully healed and hidden within a week.

3. Long Hair FUE (Preview Long Hair Transplantation): No shaving is required at all. Your hair is harvested and transplanted while maintaining length, allowing you to continue your daily activities without visible signs of surgery. This method is available for scalp, beard, moustache, and eyebrow transplantation. Please note that the procedure takes longer and the fee is generally double that of the fully shaved FUE. If you choose this option, avoid cutting your hair for at least three months prior to surgery.

By offering these three FUE techniques, we provide flexibility to suit your style preferences, treatment area, and budget. During your consultation, our experienced surgeons will discuss which approach is most suitable for your specific hair loss pattern, donor availability, and long-term goals.

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Is a Hair Transplant Painful?

At the New Zealand Hair Transplantation Institute™, the comfort and well-being of our patients are our top priorities. Hair transplantation is performed under local anaesthesia, which may cause a brief stinging sensation when applied, but this ensures the area becomes fully numb, minimising pain during the procedure.

We provide additional support by offering an oral sedative to help you relax and stay comfortable throughout your treatment. Pain relief is available as needed, and our dedicated staff continuously monitor your vital signs to ensure your safety and comfort.

Please be aware that the sedative for the operation is lorazepam, which is detectable in your bloodstream for up to five days post intake. If you are driving and you are stopped by the police who require you to be drug tested, then the lorazepam may be detectable. This will result in an infringement notice which will result in a court appearance. To avoid this, we would recommend that you arrange independent transport for five days after any administration of any sedative.

Our hair surgeons are highly trained, permanently based in Auckland, and are Fellows of the Royal New Zealand College of Urgent Care, the Royal New Zealand College of General Practitioners, and the New Zealand Society of Cosmetic Medicine. They are also full members of the International Society of Hair Restoration Surgery and the World FUE Institute, ensuring that your procedure is carried out with the utmost expertise and care.

Most patients report only mild discomfort, if any, and find the procedure very tolerable. Whether you are having a scalp, beard, moustache, or eyebrow transplant, our goal is to make your experience as comfortable and pain-free as possible.

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Day 0: On the day of your hair transplant, the procedure typically begins early in the morning, around 8 am, depending on the size and location of the transplant. The surgery itself can last several hours. After the procedure, our experienced kiwi hair surgeons will provide detailed instructions on how to care for the grafts until your follow-up appointment, during which your transplanted hairs will be examined. You will be prescribed pain medication and, if necessary, antibiotics to support your postoperative recovery. It is important to note that you must wear a shirt that buttons up from the front from the day of surgery and for the next week.

Days 1 – 5: The first two weeks following the hair transplant are crucial for the healing process. Our kiwi hair surgeons will give you specific instructions on how to care for your newly transplanted hairs. During this period, you may experience swelling on the forehead and at the back of your head (donor area). The skin in these areas may also appear red, but this redness typically diminishes within the first week or two. Any tenderness in the donor area usually subsides within a few days. It is recommended to keep the area dry for one week after the surgery.

Days 6 – 10: Swelling should no longer be present, and any remaining redness should be faint or completely gone. As the area continues to heal, you may experience slight itching, which can be managed with over-the-counter antihistamines like loratadine(eg Lora Tabs) or cetirizine(eg Zista). During this time, our doctors will instruct you to gently remove the "crusts" that form around the transplanted hairs. This can be done by thoroughly soaking the grafts and gently rubbing them with your fingers one week after the surgery. By day 10, all the crusts should have disappeared.

Week 2 – 4: At this stage, the transplanted hairs will start to shed, and by the end of the third or fourth week, most of them will have fallen out. It is normal for the transplanted hairs to go through a shedding process before new hair begins to grow. Any remaining hairs can be actively removed as they may obstruct the growth of the new hair from the transplanted stem cells. This shedding phase is a natural part of the healing process.

End of Month 1 – Month 2: The transplanted hair follicles have entered the resting phase of their cycle. The length of this resting phase can vary before the hairs start to grow again. At this stage, your appearance will be similar to how it was before the surgery in terms of hair volume. You will also have the freedom to style and color your hair as desired. This phase has been referred to by some as the "ugly duckling" phase.

Months 2 – 4: The new transplanted hairs will start to emerge, although they may initially appear thin. The timing of hair growth can vary among patients, with some experiencing early growth and others seeing it later. During this period, most of your native hair will also begin to grow back (if you chose the standard fully shaved hair FUE option). The donor area will continue to heal, and any redness in that area will gradually fade.

Months 5 – 9: Hair growth becomes more noticeable during this stage. The emerging hairs may still be thinner, but as time progresses, many of the transplanted hairs will gain thickness and texture.

1 Year: You will attend for your follow-up appointment with New Zealand Hair Transplantation Institute to assess your progress. By this point, you can expect to see approximately 80% of the growth from your transplanted hairs. Most of the hairs will have emerged from the scalp, and you may notice a slight curvature to them, which is a result of micro-scarring.

2 Years: At this stage, you will be able to fully appreciate the final appearance from your hair transplant. While some patients achieve their desired results within the first year, for others, it may take longer for the transplanted hairs to fully emerge and reach their optimal density and thickness. As the transplanted hair continues to grow longer, it will contribute to a fuller appearance, as the increased length adds volume within the transplanted areas. It's important to keep in mind that doubling the length of your hair equates to doubling its density. Patience is key during this period as you witness the transformative effects of the hair transplant procedure.

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Aftercare is an essential part of the hair transplant process, and we provide a comprehensive post-surgical pack to support your recovery. This pack includes pain relief medication, a neck cushion to protect the transplanted area, Avene Thermal Spring Water spray to care for your new hair, and dressing materials (for the standard fully shaved FUE - No dressings are required for the LONG hair FUE as the surgery is largely no visible). Additionally, our doctors will provide you with their cell phone number, which is monitored around the clock, ensuring that you can reach out with any post operative questions or concerns.

As part of our commitment to your care, follow-up appointments are included in the cost of the surgery. Our hair surgeons will routinely see you after surgery at specific intervals, after surgery and including one week, one month, six months, and one year post-operatively. Please note that the first post-operative visit is compulsory face to face visit and will take place on the next business day. If you wish to schedule a follow-up outside of our normal business hours by mutual agreement, an additional surcharge of $240 will apply.

During the initial week after the procedure, we recommend keeping the transplanted area dry. After one week, you can gently wash the area twice daily. The crusting in the area typically comes off naturally within this time frame with the assistance of gentle washing. Although surgical procedures are never completely scarless, the extraction site generally heals after one week, and it becomes difficult to detect where the hair has been extracted once fully healed.

It is important to note that all the transplanted hair will naturally fall out starting from about a week after the surgery. This is a normal and encouraged part of the process. Your new permanent hair will start to grow back after four months, and you can expect to see approximately 80% of your final result after one year.

Sometimes the initially regrown hair may appear slightly kinky, but in most cases, this corrects itself by the second year post-op.

Continuing the prescribed medications, such as finasteride, and restarting topical Minoxidil one week after surgery is crucial. This helps reduce the possibility of "shock loss" and enhances your final result.

Rest assured that our hair surgeons are New Zealand-born, comprehensively trained, and live in Auckland. They are readily available throughout the entire process to provide you with exceptional care and support.

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The amount of time off work following the hair transplantation procedure is a personal choice. However, there are some guidelines to consider:

For those undergoing LONG hair FUE, you may return to work the day after the procedure without anyone suspecting that you have undergone a hair transplantation procedure. NO TIME off is needed! We are the only hair surgeons in New Zealand who offer LONG hair transplantation.

For the standard fully SHAVED FUE, most patients feel comfortable returning to work one week after the procedure. By this time, the donor area (where the hair has been taken from) has typically healed.

Hair Transplantation is a SAFE and RELIABLE method to restore your hairloss if you have suitable donor hair.

If there are no unforeseen complications, you will be able to wear a hat or hair covering after two weeks.

Please keep in mind that the grafted area may still be noticeable for several weeks. It is important to note that all the newly transplanted hair will start falling out after 1-2 weeks. However, you can expect your new permanent hair to begin regrowing three to four months after the transplantation.

If you opt for the standard fully SHAVED FUE option, it is worth noting that other patients who are interested in hair transplants may recognise that you have had the hair transplantation surgery. They may spontaneously approach you to ask about your experience.

Ultimately, the decision of when to return to work depends on your personal comfort level and the nature of your job.

Accurate at the time of plublication 9th July 2023

The origins of modern surgical hair restoration can be traced back to Japan. In 1939, Dr. Okuda, a Japanese dermatologist, made significant advancements in the field by describing his pioneering work on burn patients. He utilised a punch tool to extract skin containing hair follicles, which were then transplanted into slightly smaller holes. Building upon Okuda's technique, Dr. Tamura, another Japanese dermatologist, further refined the procedure in 1943. He focused on replacing lost pubic hair in female patients by using smaller grafts consisting of one to three hairs. Dr. Tamura employed an elliptical incision to extract donor tissue and carefully dissected each individual graft. Remarkably, Dr. Tamura's approach closely resembled the later-developed techniques of follicular unit transplantation (FUT or Strip Surgery with the linear scar). However, it is worth noting that both Okuda and Tamura's techniques primarily addressed traumatic alopecia and not male pattern baldness.

In 1952, a significant breakthrough in hair restoration occurred when Dr. Norman Orentreich of New York performed the first documented hair transplant on a patient with male pattern baldness. Despite facing resistance from his colleagues, Dr. Orentreich published his findings in 1959 and introduced the concept of "donor dominance." His research demonstrated that hair from the sides and back of the scalp was mostly resistant to balding, leading to the development of hair transplants for male pattern baldness (androgenetic alopecia). Dr. Orentreich generously shared his knowledge, teaching numerous physicians and laying the foundation for modern clinical hair transplants. During the 1960s and 1970s, the primary technique used was Dr. Orentreich's punch technique, involving 4-mm punches with 20 to 30 hairs each. However, this approach had limitations in creating a natural appearance. Many patients ended up with an unnatural "dolls head/Chucky" look, and the large punches left the donor area with a scarred chessboard appearance.

In the 1980s to mid-1990s, there was a push to improve the naturalness of hair transplants by utilising smaller grafts. Early attempts involved using 2-mm grafts, but they often resulted in high graft transection rates(that is the foolicels are destroyed during harvesting) and poor growth. Techniques like cutting 4-mm plugs into smaller "split" and "quarter-grafts" showed some success, but they still had a "pluggy/Chucky" appearance. Other methods involved cutting smaller one to three hair grafts, known as micrografts, and using them to soften harsh hairlines. However, these techniques didn't gain widespread adoption.

A significant advancement came with strip harvesting, where multiple thin strips were taken from the donor area and dissected into smaller grafts of different sizes. This method reduced scarring (the chess board like scarring) compared to the previous punch technique. The trend of using smaller grafts continued, leading to the introduction of "mega sessions" in the 1990s. Surgeons like Uebel from Brazil and the Moser Clinic from Vienna performed sessions of over 1,000 grafts using exclusively one to four hair grafts. This approach garnered attention and further advanced the field. In 1993, the International Society of Hair Restoration Surgery (ISHRS) was established, providing a platform for sharing information and techniques among professionals.

Flaps and scalp reductions were once popular alternatives to hair restoration but fell out of favour as the naturalness and coverage achieved with small grafts improved. These procedures are now primarily used for repairing major scalp defects caused by trauma or congenital abnormalities.

The next major advancement in hair transplantation came with the shift from simple micrografts to more refined follicular unit (FU) grafts. This shift began in 1984 when Dr Headington recognised that hair grows in natural groupings called follicular units consisting of one to four hairs. Physicians started using microscopic magnification to dissect grafts while preserving these natural groupings. Dr. Bobby Limmer from Texas was among the pioneers of this technique, and Dr. David Seeger from Canada actively promoted and taught it. In 1995, Drs. Bernstein and Rassman published the first paper defining follicular unit transplantation (FUT or Strip Surgery) and explaining its benefits and characteristics.

FUT/Strip Surgery initially faced resistance within the established hair transplant community. It was a laborious and time-consuming procedure that required additional staff, but surgical assistants were hesitant to adopt the use of microscopes. The primary concerns revolved around graft survival and the ability to consistently achieve satisfactory density. However, by the year 2000, the procedure gained widespread acceptance as it consistently yielded positive outcomes. The internet played a significant role in spreading awareness and generating increased patient demand, ultimately establishing FUT/Strip Surgery as the gold standard in hair transplantation. Some even referred to it as the "logical endpoint" of hair transplant development, albeit prematurely, unaware of the future advancements that awaited.

Follicular Unit Excision (FUE - what we offer at New Zealand Hair Transplantation Institute), which emerged in 1998, was driven by the desire to avoid the linear donor scar that occasionally posed a problem for FUT/Strip Surgery patients. Both FUE and FUT/Strip Surgery employ follicular unit grafts; however, in FUE, individual grafts are meticulously harvested one by one using small micropunches.

The pioneering surgeon who initially described the harvesting approach for FUE was Dr. Masumi Inaba from Japan. In 1988. However, it was Dr. Ray Woods from Australia who further developed and popularised this technique as "scarless surgery" during the 1990s. Dr. Woods referred to it as the "Woods technique" rather than FUE. He was also the first to demonstrate that body hair could successfully grow when transplanted to the scalp. However, Dr. Woods chose to keep his methodology a secret. It was not until 2002 that Drs. Rassman and Bernstein published the first comprehensive report on FUE in the medical literature titled "Follicular unit extraction: minimally invasive surgery for hair transplantation." In their article, they discussed the inherent challenges associated with performing FUE using a manual sharp punch.

Early FUE techniques faced skepticism and were slow to gain acceptance within the general hair transplant community for various reasons. Firstly, FUT was already achieving impressive results, and although linear scars could be a concern, they were usually thin and easily concealed even with short hair. In contrast, early FUE, with its sharp blind extraction of individual grafts, proved technically difficult and challenging to learn. FUE was time-consuming and frustrating, allowing only small numbers of grafts to be extracted at a time.

Another criticism arose from the realisation that FUE could also lead to visible scarring in the form of multiple small white dots at the extraction sites. However, a few forward-thinking physicians believed in the potential of FUE if the issues could be addressed. Working independently, they made significant improvements in instrumentation and techniques over the following decade. These advancements included better punches and tools for limited depth scoring, motorised devices for faster and easier extractions with rotation, oscillation, and vibrational dissection modes, the concept of blunt dissection techniques for deeper dissection, the use of smaller punches to minimise "spotty scarring," and the ability to utilise body hair as a donor source in patients with limited donor supply.

By 2015, an ISHRS (the International Society of Hair Restoration Surgery) census revealed that FUE accounted for over 50% of all hair transplant procedures, compared to just 10% in 2009. New Zealand Hair Transplantation Institute recognise the value of FUE and have wholly incorporated it into their practice.

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Hair Restoration Surgeons continue to debate the difference in the "ultimate" number of grafts that can be obtained "over the life" of a patient by doing FUE exclusively versus offering both FUT/Strip Surgery and FUE in combination.

The quality and survival of grafts are comparable between FUE and FUT/Strip Surgery, the potential variation in the total number of grafts achievable over a patient's lifetime remains uncertain.

It is worth noting that both techniques can typically provide around 6,000 grafts, which is sufficient for the majority of patients. Therefore, both FUT/Strip Surgery and FUE can effectively meet the needs of a significant number of individuals seeking hair transplantation.

However, there are important questions that still need to be answered. For instance, what about patients who require larger numbers of grafts? What percentage of patients fall into this category, and how can they be identified?

Ultimately, a patient's final coverage in the future will be determined by their total donor supply.

At New Zealand Hair Transplantation Institute, we are mindful of these issues, and will advise our patients in an ethical and conservative fashion to give you the best long term outcome.

11th June 2023

Hair transplantation is similar to organ transplantation in terms of our body's natural defense mechanisms. Our immune system is designed to recognise what belongs in our body and what is foreign. As a result, using hair from someone else, even if they are an identical twin, would likely lead to the rejection of the transplanted hair.

In theory, it would be possible to use hair from another individual by taking strong immunosuppressive medication, similar to what is used for organ transplant recipients. However, since hair transplantation is an elective cosmetic procedure, it is ethically inappropriate to prescribe immunosuppressive medication, as it would compromise the overall functioning of your immune system and there is no guarantee that your body would still reject the hair from another donor.

If you have any further questions or concerns, we recommend consulting with our experienced hair transplantation specialists during your consultation.

11th June 2023

After undergoing hair transplantation to address male pattern baldness, it is highly recommended to take scientifically proven medication such as Propecia/Finasteride or Dutasteride to prevent further hair loss.

Considering the considerable investment of time and money involved in the procedure, maximizing the results becomes crucial, and medication can significantly contribute to that.

In the case of hair loss resulting from trauma, the need for medication will be evaluated on an individual basis. The specific circumstances and requirements will be taken into account to determine the appropriate course of action.

For patients with hair loss caused by autoimmune conditions, it is absolutely essential to continue taking the prescribed medications to effectively manage and treat the underlying illness. These medications play a vital role in the overall treatment plan and should not be discontinued without consulting with your relevant specialist.

11th June 2023

The duration of medication for AGA/male pattern baldness is based on your personal priorities. Once you reach a point where hair loss no longer bothers you and you are unconcerned about further hair loss, you may consider discontinuing the medication.

Clinical studies have indicated that male pattern baldness tends to stabilize around the age of 65. Therefore, it could be a reasonable consideration to stop the medication when you reach this age.

However, it is crucial to note that if you have any autoimmune conditions, it is imperative to continue taking your medications as prescribed by your specialist. The management of autoimmune conditions may differ from the approach taken for male pattern baldness.

11th June 2023

While body hair transplantation is possible, it's important to consider a few factors.

Firstly, the best results are typically achieved when using hair from the same area where the transplantation is desired. This ensures a more natural appearance, as transplanted hair retains the characteristics of the donor site. For example, if pubic hair is transplanted, it will continue to grow and look like pubic hair.

Another consideration is that scalp hair tends to be the most ideal for transplantation due to its unique characteristics. Scalp hair has a longer "anagen" phase, which means it grows faster, up to 2cm per month and for longer that other hair on your body. However, when scalp hair is placed in other areas of the body, this rapid growth may become noticeable. Therefore, it's important to trim and manage the transplanted hair accordingly if it's placed in areas such as eyebrows, beard, or the pubic region.

Ultimately, the choice of hair for transplantation depends on individual preferences, goals, and the expert advice of your trained Kiwi hair surgeons. A thorough consultation with our doctors will provide you a more personalised guidance on the suitability of body hair transplantation for specific areas of concern.

11th June 2023

As far as we know, the most important function of scalp hair today is its role in social relationships. Well-groomed hair is an asset in our personal lives, in our jobs, and in helping us feel good about ourselves. Less important today is the role of hair in protecting the scalp against physical injury, heat loss in winter and damage from solar radiation in summer—we have headgear for this kind of protection. Of the approximately five million hair follicles on the human body, 100,000 to 150,000 are on the scalp when the scalp is unaffected by hair loss. The number of scalp hair follicles is linked to hair color: the greatest number of scalp hair follicles is found in blonds, fewer in brunettes, and the least number in people with red hair. The Hair Growth Cycle The normal growth rate of scalp hair is one-fourth to one-half inch per month. Hair growth has a cyclic pattern that can be affected by a number of genetic, disease, medication or other factors to cause hair loss. Hair is formed in the hair follicle and grows out of the follicle in a continuous cyclic pattern of growth and rest.

There are three phases in the hair growth cycle:

• Anagen—growth phase, 2 to 8 years;

• Catagen—degeneration phase, 2 to 4 weeks; and,

• Telogen—resting phase, 2 to 4 months.

During anagen the follicle actively grows hair. During catagen the follicle is almost entirely degraded. During telogen the follicle rests prior to re-initiation of an anagen phase and the growth of a new hair shaft. As the new hair shaft emerges it pushes out the prior “dead” hair shaft, and the old hair is shed. About 50 to 100 telogen hairs are normally shed every day; these are the hairs we find in our comb, brush and shower drain. About 10 percent of scalp hair follicles are normally in telogen phase at any

Excerpts copied from International Society of Hair Restoration Surgery, www.ISHRS.org, © 2004.

The hormones called androgens are important control factors in hair growth and in inherited male and female patterns of hair loss. The androgen hormone testosterone and its metabolite dihydrotestosterone (DHT) are the key control factors:

• Testosterone is a key control factor in the growth of beard, underarm and pubic hair.

• Scalp hair growth is not under androgen control, but scalp hair loss is associated with presence of DHT in male and female pattern hair loss. DHT plus the presence and activity of hair loss gene(s) are the key factors underlying male and female pattern hair loss.

Excerpts copied from International Society of Hair Restoration Surgery, www.ISHRS.org, © 2004.

Male and female pattern hair loss is called androgenetic alopecia (AGA) because both androgens (andro) and genes (genetic) are involved.

Alopecia is a medical term for hair loss. Androgenetic alopecia (AGA) “runs in families”. It is an inherited condition associated with a gene (or genes). Both the testosterone metabolite DHT (Di hydrotestosterone which occurs when your testosterone is broken down) and the gene for hair loss must be present for AGA to occur.

The gene for hair loss makes scalp hair follicles extraordinarily sensitive to DHT, and this sensitivity eventually causes hair follicles to (1) stop producing hair, or (2) produce only miniaturized “peach fuzz” hair(called vellus hair). The amount of DHT does not need to be greater than normal for AGA to occur; it is the presence of the gene for AGA that causes DHT to halt growth in hair follicles. Patterns of inheritance of the hair-loss gene can be unpredictable for the average person. Having a father or uncle with AGA makes it probable—but not certain—that AGA will occur in a son or daughter. Physician hair restoration specialists are familiar with the genetics of AGA and can usually counsel a patient regarding the onset and progression of male or female pattern hair loss.

Excerpts copied from International Society of Hair Restoration Surgery, www.ISHRS.org, © 2004.

Androgenetic alopecia (AGA), also known as male pattern hair loss, is one of the most common conditions affecting men. In the United States, 35 million to 40 million men are affected by AGA. In some men AGA progresses to baldness over most of the scalp. Degrees of hair loss range from this most severe form of AGA to the least noticeable loss of hair in the front temporal area above the eyebrows. Loss of hair in the front temporal area is usually the first place where hair is lost in male AGA; in some men the loss stops there and never progresses while in other men hair loss continues into other areas of the scalp. Progression of hair loss is rapid in some men, slower in others.

A physician hair restoration specialist can often predict the final appearance of hair loss based upon the rapidity of onset and progression.

Male AGA occurs in an array of patterns illustrated in the Norwood-Hamilton Scale. The Norwood-Hamilton Scale is used by physician hair restoration specialists in assessing hair loss and in planning hair loss treatment. No matter how severe the hair loss, hair is never lost at the back or sides of the head or on the nape of the neck. These regions are under different genetic control from the gene(s) that affect hair follicles at the front and top of the head. This “preserved” hair at the back and sides of the head is a reservoir of healthy follicles that can be harvested and transplanted to scalp areas where hair has been lost.

Excerpts copied from International Society of Hair Restoration Surgery, www.ISHRS.org, © 2004.

Androgenetic alopecia (AGA) occurs in women as well as in men. In women, AGA is defined as female pattern hair loss.

The patterns of AGA in women are significantly different from the AGA patterns in men. The typical appearance of female pattern hair loss is diffuse thinning of hair over the top of the scalp.

The Ludwig Classification illustrates female pattern hair loss in increasing degrees of severity from Grade I and Grade III. Female pattern hair loss can begin at any age from teen-age through middle age. There may not be an obvious hereditary association; whereas a man with AGA usually has close male relatives with AGA, no such family pattern may be apparent for women.

While AGA is the most common cause of permanent hair loss in women (about 50 percent of women over age 40 have some degree of female pattern hair loss), it is by no means the only cause. Non-AGA causes of hair loss are more frequent in women than in men; some of these causes are discussed in the next section. Women more than men are also likely to have temporary hair loss that may occur separately or together with female pattern hair loss. Two common causes of temporary hair loss in women are the hormonal changes associated with pregnancy and untreated hypothyroidism. A woman who is worried about loss of scalp hair should consult a physician hair restoration specialist for evaluation and diagnosis. Female hair loss can usually be successfully treated after a diagnosis is established.

Excerpts copied from International Society of Hair Restoration Surgery, www.ISHRS.org, © 2004.

While androgenetic alopecia (AGA) is the most common cause of hair loss in both men and women, hair loss can also be due to a number of other conditions. These conditions may not be recognized until they are diagnosed by a physician hair restoration specialist.

Successful treatment is dependent on correct diagnosis. Some of the most important of these non-AGA causes of hair loss:

• Alopecia areata—a possibly autoimmune disorder that causes patchy hair loss ranging from diffuse thinning to extensive areas of baldness with islands of retained hair.

• Scarring alopecia—hair loss due to scarring of the scalp. A common cause of scarring alopecia is persistent tight braiding or corn-rowing of scalp hair. Over a period of time scarring may destroy hair follicles and result in permanent hair loss. More severe scarring alopecia may be caused by physical cutting-rippingtearing injury to scalp skin or burn injury. • Telogen effluvium—a relatively common type of hair loss caused when a large percentage of scalp hair follicles are shifted into “shedding” phase. An underlying cause may be hormonal, nutritional, or drug-associated.

• Loose-anagen syndrome—a condition that occurs primarily in fair-haired persons. Scalp hair sits loosely in hair follicles and is easily extracted by normal combing or brushing. In some cases the condition appears during childhood and improves in later life.

• Triangular alopecia—a loss of hair in the frontal area of the scalp that sometimes begins in childhood. Hair loss may be complete in the frontal area or a few hairs may remain. The frontal hair loss can look similar to early-stage AGA. The cause of triangular alopecia is not known but it can be successfully treated.

• Trichotillomania—compulsive hair plucking. The condition ranges from idly plucking hair while reading or watching TV to ritualistic plucking of hair in specific patterns. Over time, trichotillomania can cause scarring alopecia and permanent hair loss. Hair loss due to trichotillomania usually cannot be successfully treated until underlying psychological or emotional conditions are treated successfully.

• Scalp infections—bacteria, fungi and viruses can invade and damage hair follicles, causing hair loss. The infection must be diagnosed and treated before hair restoration can be undertaken.

Excerpts copied from International Society of Hair Restoration Surgery, www.ISHRS.org, © 2004.