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™

8th February 2026

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.

8th February 2026

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

We are the only clinic in New Zealand to offer LONG hair transplantation since May 2022.

We are the first and only hair surgery clinic in New Zealand to have a Diplomate of the American Board of Hair Restoration Surgery, namely Dr Garsing Wong.

Introducing (Preview) Long Hair Transplantation, an innovative technique that eliminates the need for shaving during the procedure. Whether it's the donor area (back of your scalp) or the recipient area (where you desire hair transplantation), our skilled team employs the Trivellini LONG Hair Multiphasic machine with specialised punches to harvest your hair.

The term "LONG hair" refers to the fact that no shaving at all, is required. Not all of the extracted hairs will remain long. Approximately 60-90% of the hair can retain its length, which can be trimmed to a shorter length before implantation to minimise any strain on the hair follicles once transplanted.

Overseas hair transplant surgeons have coined the term "Preview Long Hair Transplantation" to highlight the natural shedding of transplanted hair two to four weeks after the procedure, followed by regrowth around four months later. Rest assured, the transplanted hairs maintain the characteristics of the donor area—no thinning or shedding—ensuring long-lasting results.

Based on our experience, the loss of follicles in Long Hair Transplantation is comparable to that observed in our shaved hair FUE patients. It's important to note that harvesting long hair takes approximately five times longer than the shaved hair procedure, which limits the area that can be covered in a single session. For larger areas, multiple discreet treatments using this method may be required.

Please be aware that the Long Hair Transplantation procedure carries a higher cost compared to the shaved hair technique. A detailed quote will be provided during your consultation.

The significant advantage of Long Hair Transplantation is its ability to offer a discreet hair transplant, allowing you to continue your daily activities with minimal evidence of having undergone a procedure. Additionally, if a larger area requires coverage, regular transplantations can be scheduled every four months.

Experience the benefits of Long Hair Transplantation and achieve a natural-looking, seamless hair restoration without anyone knowing.

Contact us today to schedule your consultation and explore the possibilities of this groundbreaking technique.

nzhairtransplant@gmail.com

Accurate at the time of publication 23rd December 2023.

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

We are the first and only hair surgery clinic in New Zealand to have a Diplomate of the American Board of Hair Restoration Surgery, namely Dr Garsing Wong.

Follicular Unit Extraction/Excision (FUE) is a hair transplantation technique that involves harvesting individual follicular units from the scalp. These units can consist of a single hair or multiple hairs. On average, there are approximately 2.6 hairs per follicular unit. So, if you require 400 FUE, it would be equivalent to 1000 hairs.

The term "grafts" can sometimes be confusing because in Follicular Unit Transplantation (FUT), where a strip of scalp is removed and individual hairs are dissected from that strip, then multiple hairs in a single follicular unit may to divided into individual grafts, and some places overseas interchange the term grafts with hairs. Therefore, 1000 "grafts" at one clinic could be equivalent to 400 FUE grafts at New Zealand Hair Transplantation Institute if each hair within a follicle is separated into an individual hair or graft.

FUT and FUE refer to the method of harvesting your hair & is not related to how your hair is placed in you.

We are the only clinic in New Zealand to perform & offer two options for FUE: fully shaved traditional FUE and (Preview) LONG hair FUE, which requires no shaving at all. Both methods follow the same post-operative path. All transplanted hairs will naturally fall out over time & the final result will not be fully visible for about a year.

The significant advantage of LONG hair FUE transplantation is its virtually undetectable appearance after the procedure. In fact, most of our patients have returned to work the very next day following the surgery. With LONG hair FUE, you require meticulous harvesting which takes significantly longer compared to the fully shaved FUE option hence for larger areas, repeated procedures may be required every four months, or you can opt for the fully shaved option.

Some centers overseas refer to LONG hair FUE as "preview FUE" because it gives you an idea of your final results immediately after the surgery. However, please be aware that you will still experience the "ugly duckling" stage where the transplanted hairs naturally fall out, starting from the first week after transplantation.

We are committed to providing you with comprehensive information and guiding you through the hair transplantation process. If you have any further questions or concerns, please don't hesitate to consult with our experienced team during your consultation.

Accurate when published on 23rd December 2023.

To schedule an appointment with our experienced kiwi doctors, please reach out to our friendly staff at the New Zealand Hair Transplantation Institute, located within Sapphire Appearance Medicine Clinic. We have dedicated office hours to assist you, operating on Mondays to Thursdays from 10am to 5pm, and Fridays from 10am to 7.00pm. Please keep in mind that a standard consultation fee is applicable, and this fee must be paid in advance prior to booking your consultation.

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

We are the first and only hair surgery clinic in New Zealand to have a Diplomate of the American Board of Hair Restoration Surgery, namely Dr Garsing Wong.

For most initial consultations, we offer the convenience of video consultations, which are suitable in most cases. However, for a more accurate quote, comprehensive planning and prior to booking any surgery, a face-to-face consultation is obligatory. It's important to note that any quote provided is valid for six months as your hair situation may change over time.

To contact us and schedule your appointment, we prefer that you reach out to us via email. You can email us at nzhairtransplant@gmail.com. Alternatively, you can also contact us by phone at 09 360 1250.

Our team is dedicated to providing you with exceptional service and personalised care throughout your hair transplantation journey. Don't hesitate to get in touch with us to begin your transformation.

23rd December 2023

In order to provide the best possible care, it is beneficial to have a comprehensive understanding of your family's hair history. This includes information about hair loss patterns in all family members, including siblings, as well as both sides of your family (paternal and maternal), and even grandparents if available.

When attending your appointment, please come prepared with a list of all the various products and medications you have used to address your hair loss. Include details such as the duration and frequency of use for each product.

Prior to your consultation with the hair surgeon, you will be required to complete a patient history form. Our friendly staff will email you the form in advance, allowing you to fill it out prior to your appointment for a smoother process.

Additionally, it would be helpful if you could bring any blood test results that you have obtained within the past year.

By providing these details and information, we can better assess your individual situation and tailor our treatment recommendations to your specific needs. If you have any further questions or require clarification, please do not hesitate to contact us.

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

We are the first and only hair surgery clinic in New Zealand to have a Diplomate of the American Board of Hair Restoration Surgery, namely Dr Garsing Wong.

23rd December 2023

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

The decision regarding the appropriate treatment for your hair loss will depend on your desired goals and how they align with the predicted natural outcome of your hair as you age.

The cost of prescription-only medications can vary depending on the pharmacy you choose. For repeat prescriptions, you have the option to obtain them from your family doctor or through NZ Hair. If you choose the latter, we will send the repeat prescription directly to your preferred pharmacy. Please note that there is a fee for this service.

The cost of hair transplantation will depend on the surface area that requires coverage, whether you prefer total discretion with the LONG hair FUE vs the standard fully shaved FUE, as well as the availability of a healthy donor site. Our minimum offering for the standard fully shaved hair transplantation is 400 Follicular Unit Transplantation, which is equivalent to an average of 1000 hairs and costs $5700. Please be aware that there may be a surcharge if the procedure is scheduled outside of our normal business hours or if you choose to pay by credit card.

We are the only hair surgeons in New Zealand who offer the LONG Hair transplantation since May 2022.

We are the first and only hair surgery clinic in New Zealand to have a Diplomate of the American Board of Hair Restoration Surgery, namely Dr Garsing Wong.

The surgical cost includes a comprehensive preoperative assessment and an aftercare pack, along with five follow-up consultations (video link consultations are available) to ensure the best possible hair transplant results. It's important to note that 400 FUE will only cover a total area of approximately 10cm2. For individuals with frontal temporal regions similar to those in patients classified as Hamilton Norwood II, a better result can be achieved with 900 standard fully shaved FUE, which corresponds to 2340 hairs & costs $12,825. An accurate quote will be provided after a thorough consultation with our dedicated hair surgeon/doctors, who are New Zealand born and trained and available in Auckland 24/7.

It's crucial to understand that hair loss is an ongoing process influenced by various factors, including the underlying cause & your genetics. An apt analogy is to think of your hair as a bucket of water with a leak. Hair transplantation involves moving water (hair) from one area to another, but the leak may persist, limiting the amount of available water (hair). The most common form of hair loss in men is androgenetic hair loss, which typically stabilises after the age of 65. Therefore, we need to consider your future outcome to provide you with a realistic-looking result that will stand the test of time.

Our team is dedicated to providing you with exceptional service and personalised care throughout your hair transplantation journey. Starting your hair loss journey now is important to prevent further loss and take proactive steps towards preserving your hair. Don't hesitate to get in touch with us to begin your transformation.

nzhairtransplant@gmail.com

Accurate as of the 23rd July 2024

Please note that hair transplantation is an elective cosmetic procedure, catering to personal preferences rather than medical necessity.

With that in mind, we offer the following financing option to make the procedure more accessible to our patients:

Nova Medical Finance: Nova Medical Finance is New Zealand's sole specialist medical finance company. Applying for medical finance is a straightforward process through their user-friendly online application form. Please be aware that normal lending criteria will apply. 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

We would like to clarify that we are completely independent of Nova Medical Finance. While we do provide information about their services as a potential financing option for our patients, it is important to note that we are not affiliated with Nova Medical Finance in any way. Our goal is to provide you with a range of options to make the procedure more accessible, and Nova Medical Finance is just one of the possibilities. We encourage you to explore all available financing options and choose the one that best suits your individual needs and preferences. If you have any questions or concerns regarding financing, our team is here to provide guidance and assistance throughout the process.

We are the first and only hair surgery clinic in New Zealand to have a Diplomate of the American Board of Hair Restoration Surgery, namely Dr Garsing Wong.

23rd December 2023

You will NOT need to shave your head if you prefer to have the LONG hair FUE procedure, however the fee is double that of the fully shaved hair procedure.

We understand that maintaining your desired hairstyle is important to you, and we offer different options to accommodate your preferences.

For standard FUE (Follicular Unit Extraction), a stylish number zero cut all over the head is required. This helps to ensure optimal access to the donor area and facilitates the transplantation process. However, we also offer an alternative called LONG Hair FUE transplantation, where you do not need to cut your hair at all. This innovative technique allows for hair transplantation without shaving the head, providing a more discreet option for those who wish to maintain their current hairstyle throughout the procedure.

If you are considering the LONG hair option, please do not cut your hair for at least three months before your surgery.

By offering both standard fully shaved FUE and LONG Hair FUE transplantation, we aim to cater to individual preferences and provide flexibility in the hair transplant process. Our experienced hair surgeons will discuss these options directly with you during your consultation to determine the best approach based on your specific needs, goals and budget.

We are the first and only hair surgery clinic in New Zealand to have a Diplomate of the American Board of Hair Restoration Surgery, namely Dr Garsing Wong. In addition, Dr Wong is the first Kiwi to be a member of the World FUE Institute in Belgium. Dr. Wong's accomplishments extend to his membership with the International Society of Hair Restoration Surgery and his impressive medical background, including former chairmanship of the Royal New Zealand College of Urgent Care, as well as leadership roles in the field of Appearance Medicine.

13th January 2024

The comfort and well-being of our patients during the procedure are of utmost importance to us. While we understand that some aspects of the process may cause slight discomfort, we take several measures to ensure your comfort throughout the entire journey.

To begin with, the administration of local anesthesia, although it may cause a mild stinging sensation initially, is necessary to ensure the targeted area becomes numb, thereby minimising any pain or discomfort during the procedure.

For longer procedures, we place an intravenous (IV) line, allowing us to keep you properly hydrated and administer medications that help alleviate anxiety and will make your feel relaxed. You will be given pain relief medications as needed, ensuring your comfort throughout the entire procedure.

Furthermore, our dedicated staff members are constantly monitoring your well-being using advanced vital signs monitoring equipment. This allows us to closely observe your vital signs and respond promptly to any potential concerns, prioritising your comfort and safety throughout the entire process.

It is important to note that our doctors are highly qualified, extensively trained, and permanently based in Auckland. They are all Fellows of the Royal New Zealand College of Urgent Care, Fellows of the Royal New Zealand College of General Practitioners, and Fellows of the New Zealand Society of Cosmetic Medicine as well as members of the International Society for Hair Restoration Surgery and the World FUE Institute. With their comprehensive expertise and experience, you can rest assured that you are in the capable hands of professionals who are dedicated to providing the highest level of care and ensuring your comfort throughout the procedure.

Your well-being and comfort are our top priorities, and our kiwi trained hair surgeons are committed to making your experience as pleasant and pain-free as possible.

11th June 2023

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.

11th June 2023

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.

11th June 2023

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.

11th June 2023

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.