It is estimated that 50 million men and approximately 30 million women suffer from male/female pattern baldness or thinning hair. In recent years, there have been many technological advances in hair restoration surgery and patients are realizing that they can remedy their baldness or hair loss by utilizing technology such as Neograft®. In this interview with Aesthetic Insider™, Joshua Kreithen, MD, a board-certified plastic surgeon with Holcomb-Kreithen Plastic Surgery in Sarasota, FL discusses this exciting breakthrough technology. According to Dr. Kreithen, NeoGraft® utilizes a technique called follicular unit extraction (FUE), in which natural groups of up to four hair follicles at a time are taken from an area of healthy hair (usually the back of the head), and strategically placed where the patient’s hair is missing or thinning. This technique produces results that look more natural compared to traditional procedures. FUE also makes NeoGraft® the least invasive transplantation procedure for hair restoration. To learn more, visit

What are the current options to treat hair loss?

As we age, some of the hair follicles on the head stop reproducing, leading to a typical baldness pattern. In many cases it’s minimal, but for some individuals it can be a significant amount of their hair, especially in specific areas of the scalp. Usually it’s purely an aesthetic issue as most people choose to get hair grafting or hair restoration performed so that they look and feel better about themselves.  A variety of treatment options are available for patients experiencing hair loss including light therapy (phototherapy, e.g. NeoLTS), medications [Propecia (men) and Minoxidil (women)], various serums and shampoos, platelet rich plasma scalp injections (see below), and hair restoration procedures [minimally invasive (e.g. NeoGraft) and surgical].  Minimally invasive and surgical hair transplantation is necessary for hair loss that does not respond adequately to conservative treatment options. At Holcomb-Kreithen Plastic Surgery Center, we use the NeoGraft system (although there are other brands and technology available for hair replacement including robotic treatments) in conjunction with conservative therapies to deliver the best results for each patient.

How were hair transplant procedures performed in the past?

In the past, as we do now, a doctor would take hair from an area of the scalp with an abundance of hair (generally the back of the head) and transplant it to where the hair loss has occurred. The difference now is the method of how the hair grafts are harvested. For large pattern baldness a doctor might have used a hair flap procedure requiring surgery and anesthesia. They would literally take an area of the scalp containing thousands of hairs, surgically create a scalp flap and transfer this hair bearing flap from its natural location (leaving it attached on one end to preserve blood supply) to the area where hair loss has occurred. While instantly effective, it could lead to various complications and require a lot of technical skill. Other methods still involve cutting out a piece of scalp from the back of the head, dissecting it into several hundred grafts, and surgically transplanting the many grafts into the desired location. Historically, this procedure often resulted in what looked like “doll’s hair” and patients were not always happy. Both of these procedures had the potential to leave behind obvious scarring.  Luckily, surgical advancements now provide far superior results with less risk and less downtime. The results are also far more natural in appearance.

What is NeoGraft and why did you select it for your practice?

I was trained in hair transplantation many years ago but elected not to go forward with it in my practice, because I didn’t feel that the effort and the risk were worth it. The results I saw were not that great (donor site scarring, etc.). Then a few years ago, when the NeoGraft technology debuted, I was really impressed with the natural results and the ease of the procedure for the patient, so I decided to give it a chance. Essentially, Neograft uses hand-held powered punch device that also uses suction to gently remove the hair follicle. Instead of having to cut out a strip in the back of the hair from ear to ear, we can now harvest several hundred grafts without an incision while also maintaining natural looking hair at the donor site. The device extracts donor hair in small natural groups of up to 4 hairs called follicular units from various parts of the back of the head. This process is called follicular unit extraction (FUE). With FUE, the donor site typically looks normal, even with larger amounts of grafts harvested (e.g., 1000 or more) although with larger amounts of hair, density at the donor site may be noticeably decreased.



Does the NeoGraft procedure look natural?

Yes. With the NeoGraft system, we place the hairs in what’s called an irregular pattern, so that it looks very natural. This may sound contradictory, but if you look at hair under a microscope you will see that it doesn’t grow in straight patterns. Therefore, it needs to be transplanted in a more irregular fashion to make it look natural. Artistically, this is a significant technological advancement in how hairs are placed using the natural hairline.


What is the recovery time?

It typically takes 3 to 6 months for those newly transplanted hair follicles to “wake up”, start growing, and create that full-hair effect.  Although, the downtime is minimal after the procedure and most of my patients are back to normal within 24 to 48 hours.

Does the hair regrow where you’ve taken out those follicles?

Well, the hair doesn’t regrow in the back of the head, but we leave enough hair follicle density, so it doesn’t look as though any hair has been removed.


Can you explain briefly how you move the follicles from the back to the front of the head?

Particularly for men, but for some women too, the hair follicle pattern looks like a vortex or hurricane swirl. If you look at the top of the head, there is a center point and the hair is growing in a spiral pattern. Because we know the angle of the hair growing from the scalp, we can make small incisions and place each hair follicle unit into them, leaving the hair to grow at the angle it would naturally. The density and angle of each hair follicle is perfect and looks absolutely natural.

In a one day session, how much coverage can you give to the front of the head? Is it significant coverage?

It depends on the extent of hair loss that the patient has, but 2500 grafts, the maximum amount for a one day session, should cover and fill in the front of the scalp and recreate the frontal hairline. For people with a large amount of hair loss, it might take a second session, but the majority of patients I see can obtain a great result with up to 2500 grafts.


Can you explain the platelet rich plasma (PRP) treatment for hair restoration?

This is additional therapy that we use with hair grafting. We also use it in combination with other plastic surgery procedures too. PRP is a procedure where we remove a small amount of blood from the patient and then use a device that separates out and concentrates the platelets. This “platelet rich” plasma has a much higher concentration of platelets per unit volume than ordinary blood. The platelets are activated upon injection into the desired tissue location. The activated platelets release growth factors that stimulate the hair follicles to grow more quickly, with a higher rate of success, and with added vibrancy. For example, in a normal NeoGraft procedure we expect to retain approximately 80% of the transplanted hairs. If we add in the PRP treatment, we generally see that 90% to 95% of those hairs become vibrant and make it to the full growth cycle.  PRP injections can also reactivate dormant hair follicles and increase the quality of the hair that grows (thicker) out from stimulated hair follicles. So it’s just something extra that we can do to boost the success rate and deliver even better results for our patients.

What is the difference of NeoGraft and some of the other restoration procedures that are available?

The NeoGraft is not a robot although the technology is very elegant. Basically, we’re using a very tiny powered punch device with attached vacuum that allows us to suction out the hair follicles in a very gentle way, keep them alive, and then transplant them to the back of the scalp. The technology is sound, works fantastic, is reasonably economical to perform, and gives great results. I’ve been waiting a long time for something like this to come out because, as I said earlier, the traditional way was to remove a strip of hair from the back of the scalp which leaves a linear scar. Now, we can avoid the previous issues with linear donor site scars.


What is the NeoLTS Light System you use?

It’s a low-energy light treatment called phototherapy. It works at the cell and molecular levels to stimulate healing and hair growth. Like PRP, we use it after the procedure to stimulate the newly transplanted follicles. It helps the follicles to wake up more quickly, leading to vibrancy and healthy hair. During the 20 minute treatment, a sense of scalp warming occurs but there is no pain, wound creation, or downtime.

Is the hair the same texture and color as before?

Yes, when the hair grows back it is almost identical to the hair in the follicles when they were harvested. It’s really a nice result as the hair in the back of the head is often the thickest most vibrant hair so essentially wherever we place it, the front of the hairline or the top of the head, it’s typically thick, healthy, vibrant hair and gives the patient a really great result.

Who is the ideal candidate for hair restoration?

The most common patient that we see is an older male patient with male pattern baldness. In terms of who is a candidate for hair restoration, healthy male individuals and also women, with thinning hair are great candidates. I’d say those are the two most common patients we see — middle-aged to older gentlemen with male pattern baldness and middle-aged to older women with some hair thinning.

About Holcomb – Kreithen Plastic Surgery and MedSpa

With their main office located in beautiful downtown Sarasota, and services also available at locations in Lakewood Ranch and Tampa, Holcomb – Kreithen Plastic Surgery and H|K MedSpa offers a comprehensive range of aesthetic surgical and non-surgical treatments that enhance the lives of men and women. The AAAASF-accredited facility includes a private outpatient ambulatory surgical center.  The founding physicians of the practice include J. David Holcomb, M.D. (Facial Plastic and Cosmetic Laser Surgeon) and Joshua Kreithen, M.D. (Breast and Body Contouring Specialist).  Dr. Kriston J. Kent, MD (Facial Plastic Surgeon) recently joined the practice’s Tampa division.

Holcomb – Kreithen Plastic Surgery is renowned for its expertise in facial plastic surgery, plastic surgery of the breasts and body and cosmetic laser surgery. Additional core areas of focus within H|K MedSpa include non- and minimally-invasive body contouring, facial aesthetics, medical hair restoration, laser skin rejuvenation and medical skin care.  With its comprehensive range of services and dedicated staff the practice has developed a reputation as one of the most advanced centers in Florida.  Receipt of the Allergan “Black Diamond Award” is an objective benchmark for the practice’ success, ranking it among the top 1% of practices in the entire country providing Botox Cosmetic, Juvederm (including Voluma) injectable gel, Latisse, Natrelle breast implants and SkinMedica skin care.

The Holcomb – Kreithen Plastic Surgery and MedSpa staff is comprised of an extraordinary group of professionals whose primary goal is to safely empower individuals to reach their full potential. They are committed to always treating patients and each other with kindness, compassion and dignity. For more information, visit



To listen to the interview with Dr. Kreithen CLICK HERE!



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