Derm-It Trotter! Don't Swear About Skincare.
Feeling frustrated or overwhelmed with everything skin? Does the skinformation overload make you want to swear about skincare? Join Dr. Shannon C. Trotter, board certified dermatologist, as she talks with fellow dermatologists and colleagues in skincare to help separate fact from fiction and simplify the world of skin. After listening, you won’t swear about skincare anymore!
Derm-It Trotter! Don't Swear About Skincare.
Hair Today, More Tomorrow: Hair Transplants with Dr. Kopelman
Dr. Ross Kopelman, a hair transplant surgeon with offices in NYC and Palm Beach, gives a modern take on hair restoration, debunking myths and explaining what makes someone a good candidate. He stresses that medical therapy—not surgery—should be the first step in treating hair loss, with transplants as a supportive option once hair loss is stabilized.
Surprisingly, about 50% of his transplant patients are women, many seeking treatment for widening parts rather than receding hairlines. Techniques like FUT, which don’t require shaving large areas, often work well for them.
Dr. Kopelman also explains why young men with aggressive hair loss patterns may not be ideal candidates and breaks down the differences between FUE and FUT methods. The transplant process itself is a detailed, team-driven effort lasting 5–7 hours, focused on achieving natural-looking results.
Check out Dr. Kopelman's work, and more about him and his practice here: https://kopelmanhair.com
Welcome to Dermot Trotter Don't Swear About Skin Care where host Dr Shannon C Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skin care experts to separate fact from fiction and simplify skin care. Let's get started.
Speaker 2:Welcome to the Dermot Trotter Don't Swear About Skin Care podcast On today's show. I have a special guest here today, dr Ross Kopelman. He's a hair transplant surgeon at Kopelman Hair Restoration, with offices in New York City as well as Palm Beach, florida. He actually has a podcast as well that you need to check out the Hair Doctors and on that podcast he shares insights on hair loss and the latest trends in hair restoration and I've invited him to come on that podcast. He shares insights on hair loss and the latest trends in hair restoration and I've invited him to come on the podcast today to talk more about hair transplants because I know people have a lot of questions out there about it. So welcome to the podcast, ross.
Speaker 3:I'm very excited to be here and have this conversation about hair loss, which I you know. The reality is. Hair loss impacts most everyone.
Speaker 2:You're right. I think a lot of our listeners out there can relate to it. If not themselves, they know somebody and I think people talk about it more now and don't just accept it. You know, it doesn't necessarily have to be the reality, which is kind of exciting, and I know a lot of people you know might go to the dermatologist or their doctor and talk about hair loss treatment options that might involve, you know, putting things on the scalp or taking pills. But today I want to talk about kind of the next level and discuss a little bit more about hair transplants, because a lot of people are even wondering well, what type of hair transplants are there and even, am I a candidate for a hair transplant? So how would you answer that? If somebody comes to your office because maybe they are a good fit or maybe they aren't, how do you kind of address that with them to kind of get an idea of you know if they're going to be somebody you want to move forward with a hair transplant with?
Speaker 3:So it's a very interesting question because if you're someone who's starting to experience some form of hair loss, the first place you start is actually not with a hair transplant. It's with medical therapy. You start is actually not with a hair transplant, it's with medical therapy. In fact, my philosophy is that it's medical therapy paired with the hair transplant that ultimately gives the best result. So when I see a patient in my office, that patient could be male or female, and I think there's a misconception actually that hair transplants are only for men, and in fact I would argue that's not true. 50% of my patients are actually female.
Speaker 3:So that's the first place we have to start. We have to identify what is the root cause of your hair loss, because a hair transplant is not for everyone. The second thing we have to do is what medical therapy can we put you on? And then the third step and this is this is way down the field is are you a candidate for a hair transplant? We don't assume you're a candidate for a hair transplant the minute you walk into the office.
Speaker 2:So if somebody comes into the office and you're trying to decide if they're a hair transplant candidate, how do you make that assessment? What type of questions? Are you looking at their scalp or trying to identify the particular type of hair loss that they might have?
Speaker 3:Absolutely. So we have to see do they have a scarring alopecia? Do they have a non-scarring alopecia? Is there an underlying medical reason why they are experiencing hair loss? Because if they fall into one of those categories for instance, if it's a medical reason why a particular person has hair loss maybe it's a thyroid condition Well, in that case we have to address the thyroid issue before we even think about a hair transplant.
Speaker 3:Additionally, if they have a scarring alopecia or a hair loss condition, that has something to do with an autoimmune underlying issue, that has to be addressed, and so in some cases we have to biopsy the scalp. Very frequently I see women who are postmenopausal who have a condition known as FFA frontal fibrosis and alopecia and those women are not ideal candidates to have hair transplants unless their condition is stabilized. So we have to be very cautious because there's a lot of people that are they're running to. They think the hair transplant is the solution, but really you have to really address what's under the roof, and that is critical because not everyone is a candidate to move forward with surgery.
Speaker 2:So somebody has you know, you mentioned kind of scarring, non-scarring, form of hair loss. Say you go in, you take a look at them, you make the diagnosis just looking at them, or maybe a biopsy, and, for example, if we talk about people that maybe have scarring forms of hair loss, if you're able to stabilize that condition where they don't appear to be having any more loss, is that somebody that could qualify or benefit from a hair transplant?
Speaker 3:So that's a great question. So patient has alopecia areata, which is an autoimmune hair loss condition. What we could do and this also applies to women who have FFA, frontal fibrosis and alopecia we might do a test run so we might take out a couple, maybe a hundred follicles from the back of the scalp, and that's by the way. When we perform hair transplants which I'm sure we'll discuss we take care from the back, and there's a reason for that. And when we transplant them into these individuals who have scarring alopecias, we have to see if those follicles are going to actually take. It's better to do that approach than transplant a thousand follicles and have a failure, and so we have to be very cautious in terms of how we manage those individuals who have scarring alopecia specifically.
Speaker 2:Interesting. So, like you talked about, it's kind of that test drive approach. You know, you do that transplant on a few. See if it maybe takes, in particular for those scarring forms of hair loss, which are definitely more challenging to treat, even medically speaking as well, and then for the people that have maybe non-scarring forms maybe they have, you know what people like to call, you know, hereditary form of hair loss, or androgenetic or age-related thinning of the hair or, as you mentioned, alopecia areata.
Speaker 3:These forms of hair loss that aren't scarring do they tend to respond better than to a hair transplant. Yeah, so you know, if you come in and you have androgenetic alopecia, well what does that mean, first and foremost? Well, that means there's probably a genetic component for why you have hair loss to start, and then there's a major. There's a hormone that's a major contributor to hair loss and that's known as DHT dihydrotestosterone. And what we know is that there's areas of the scalp where the hair is more sensitive to DHT. So, for instance, in the hairline, the mid part, but not in the back of the scalp. The hair from the back of the scalp is less sensitive to this hormone known as DHT, and that's why we can transplant it to the front.
Speaker 3:So, if you're a male patient, you come into the office, you have recession of your temporal recession, recession of your temporal areas, or you've lost some of your hairline, or even your mid scalp, even your crown, and, yes, you potentially are a candidate, as long as, again, you don't have an underlying medical reason for the hair loss or a scarring alopecia. For women, I tend to see widening parts as the predominant issue in female pattern baldness, and those women are also great candidates for hair transplants. However, if you're someone who comes in and you have something known as DUPAA this is diffuse hair loss that kind of globally impacts your entire scalp we have to be very, very cautious because in those particular patients, even their donor area, even their donor areas are impacted. So that's why it's critical, before we even explore a hair transplant, medical therapy should be started a few months before, because we want to prime the hair, especially in the donor area, because it makes the extraction much more effective.
Speaker 2:So kind of talking about. You know, we talked about some potential candidates like just out of the gate who would you say really just isn't a good candidate for a hair transplant.
Speaker 3:Okay. So who is not a good candidate? This is a I love this question, because who is the typical patient that wants a pretty aggressive hair transplant? I would argue that that's a young male in their mid to early thirties. Those individuals who have, we'll call it, a Norwood three to four pattern and that's this is a scale that we use to kind of assess where they are in their hair loss journey are not good candidates. Why? Because if they're having that type of hair loss at such a young age, well, their hair loss is going to progressively get worse.
Speaker 3:So one of the things that we think about as hair surgeons or even as dermatologists treating hair because most of hair loss is treated by dermatologists we have to think about where is that hair loss going to be 10 years from now, 20 years from now, 30 years from now? And so we have to be very, very cautious with young men. Very cautious with young men. They want to look youthful, they want a hair transplant because maybe emotionally, to date there's a lot of reasons why people want hair transplants, but for these young men in particular, it can be very distressing. They're at the beginning of their careers, they want to look youthful, and so we have to be cautious, and I always tell my young male patients that it's critically important you start on medical therapy and we can't even think about having you do a hair transplant until I see that your hair loss is stable for at least a year.
Speaker 2:And that's something that I constantly have conversations with patients about, because there's a lot of young men that do reach out to our office and I have to turn them away from having a hair transplant that group that's more commonly affected, or kind of that typical person that comes in that thinks this probably is going to be the solution for them, Yet, like you mentioned, probably not the best option for them, especially if they're going to have progression over time.
Speaker 2:So it sounds like you know somebody just thinking okay, is hair transplant? For me, One, it's identifying, as you mentioned, the type of hair loss. Two, if it's scarring or non-scarring. And if it's scarring or non-scarring, you want to have appropriate medical management where you're not really seeing progression, and then, of course, eliminating any underlying issues that might be a source of the hair loss or contributing cause to it, like you mentioned, like the thyroid not behaving appropriately, and maybe it's overactive or underactive, or maybe they have nutritional deficiencies, things like that, that you need to supplement, or maybe they have nutritional deficiencies, things like that that you need to supplement. So once somebody's to a period of stability, typically with having non-scarring or scarring hair loss, they might be a good potential candidate. Would that be a good summary of somebody who's out there maybe thinking is this right?
Speaker 3:for me. That's true that you did summarize it, but I do want to go back to one point, which is, yes, these young men might be upset that they can't go for a hair transplant, but they're very appreciative because they recognize that I am acting as an advocate to protect them. There's, unfortunately, a tremendous amount of marketing in this industry to get young people to fly internationally for medical tourism to do transplants when they should not do transplants and they're dangling really inexpensive prices in front of their eyes. The reality is this is a surgical procedure and you have to really have a long-term kind of perspective. So it's critically important as dermatologists, as hair surgeons, that we advocate and we put our patients' well-being ahead of kind of maybe our own kind of drive to get another hair transplant case. So I think that that's the thing that I've learned the most about from my patients that I've turned away from having hair transplants. They're still very appreciative. They're still very much my patients because they're on medical therapy and they feel like I'm their advocate.
Speaker 2:It's a really important point. I appreciate you bringing that up because you're right, it's very emotional. You know hair loss and people are willing often to spend anything or almost do anything and people are making recommendations. You know healthcare professionals where it's not appropriate. So it's great you know that we can step in and be that advocate for the patient as well. And if they're coming to your office and, you know, say this is somebody that you look at and feel like, okay, yeah, hair transplant, you're a good candidate. What are the different types of hair transplants and when do you recommend maybe one over the other?
Speaker 3:Okay. So if we're talking about a male patient who's on the younger end, in that case it's typically strengthening the hairline. Okay, because we don't want to address the crown if they do have any crown involvement because we don't know how that hair loss is going to progress. So typically with younger men we do smaller cases. We don't want to be too aggressive. We don't want to do what's called a giga session, which is more than four to 5,000 grafts. If you're a male and you're in your late forties, fifties and sixties, your hair loss has kind of slowed down. As long as you're on some form of medical therapy, I feel confident to move forward, to do more aggressive extractions of taking hair out from the back of the scalp. And then for female patients we have a little more laxity. You can be in your 20s and your 30s, your 40s and your 50s, and women are a little more complicated than men because there are other underlying issues there's pregnancy, there's menopause, but we can be a little more aggressive. For instance, I do have female patients who are in their late 20s, early 30s. They want to strengthen their mid parts or they want to bring their hairline down a little bit. We don't have to worry about the same things that we have to worry about with with younger, with younger male male patients. Now, the other thing that we should talk about is the two different approaches to performing hair transplants. There's the FUE approach, which is follicular unit extraction, where individual hair follicles are removed, typically from the back of the scalp, and then there's FUT, which is essentially taking a linear strip from the back of the scalp and then suturing that up. And what's interesting and you might find this fascinating is that strip, 10 years ago, was the dominant approach to performing hair transplants in the United States and around the world, and now 75% plus of hair transplants are performed with the FUE approach, the follicular unit extraction approach. And so many would argue that FUT is a dying art, and I actually am in the camp that FUT is as important as FUE in terms of taking hair from the back of the scalp.
Speaker 3:When we perform hair transplants, we use both approaches on both male and female patients. An FUE approach is ideal for a male who has really kind of like a thin military cut. They don't want to see any linear. We don't want to see any linear scars in the back of the scalp. They like to wear their hair short, so that's an ideal approach. But for someone like myself I have longer hair I would feel comfortable performing an FUT on a male patient with a similar hairstyle. Now, there's a slew of other hair surgeons that feel comfortable performing FUE on women other hair surgeons that feel comfortable performing FUE on women.
Speaker 3:Now, when we perform hair transplants on women, we typically need anywhere from 2,000 to 3,000 hair grafts, and you can imagine that's a wide window of hair that has to be shaved on the back of the scalp. And I don't know, dr Trotter, right, I want to make sure I'm saying your last name correctly, dr Trotter, right, I want to make sure I'm saying your last name correctly how long it took you to grow your hair to the length it is today? Probably took a couple of years. I don't know how many women want to shave the entire back of their scalps, right?
Speaker 3:So I'm in the camp that, for women, FUT should be the dominant approach to performing hair transplants, and in fact, I would also argue that the quality of the grafts that we get from the back of the scalp are better. With FUT we get less transections. This is where the hair follicles will be ruined, because with the FUE approach. We have to use special devices to remove hair follicles, and we don't always pull them out correctly. There's actually typically a transection rate of anywhere from 6% to 10%, depending upon the quality of your skill sets, and so I'm in the camp of trying to kind of maintain FUT techniques in the United States, because I do not believe that it should be a dying art.
Speaker 2:And you mentioned just kind of the process there where you're talking about like graphs and pulling things out. You know, for some of our listeners they might not even be familiar with kind of what that means. Can you briefly describe sort of that process then for the transplant, just to kind of get a feel, what does the graph mean, or more than one graph, like you mentioned, or pulling that out and literally what is the act of transplantation Like? What does that actually mean surgically?
Speaker 3:if you were explaining it to a patient. Yeah, so hair follicular units okay, they come in units, okay, and the units could be one, one, one hair follicle, twos, threes or fours. It's they're like little batches. Think about, like like when you, when you're planting flowers, sometimes there's, sometimes there's one flower that sprouted, sometimes there's two kind of packaged together and we don't really know when we're, when we're taking out a strip or extracting with the FUE approach, are we going to get ones, are we going to get twos, are we going to get threes? And so that is. That's the the basics in terms of what's happening in the back of the scalp, and then what's the other? The other thing that's critical is how we design the hairline, or how we design how we implant this hair not only into the hairline but into the mid scalp, into the crown. Typically, we like to use one hair follicles in the front because they're fine as a finest to the front of our scalp, and then we do behind that, we have some twos, and then there's a fineness to the front of our scalp, and then we do behind that, we have some twos, and then there's a disbursement of twos and threes. Now, when the hair comes out from the back of the scalp. You have hair technicians who take these hair follicles and they cut them underneath microscopes, because sometimes you get twos or threes and you need more ones. So they kind of slice them up, they clean them up, and I think one of the things that I want to emphasize is that when a hair transplant is performed, it's a team effort.
Speaker 3:Okay, this is not a surgery simply performed and solely performed by a hair surgeon myself. It really involves a nurse and possibly two or three hair technicians. It's a multiple hour procedure. It takes anywhere from five to seven hours to complete these procedures, and it doesn't matter if it's a small, medium or large case. These cases take an exorbitant amount of time because there's so many different steps involved. These cases take an exorbitant amount of time because there's so many different steps involved. The other thing that we have to be very cautious of is how we anesthetize the front of the scalp, the back of the scalp. We have to be very sensitive to making sure that there's no lidocaine toxicity or any complications during surgery. So it's vitally important that you go to a, a hair surgeon, who has tremendous amount of experience managing, you know, complications and overseeing these procedures because it these are long, long, very long cases and you don't want anything to go wrong.
Speaker 2:And the last like minute or two, cause we've already kind of sailed through. It's kind of crazy time wise. What other tips would you recommend? And we'll definitely have to maybe bring you back on to talk more detail about hair transplants. But what other tips do you recommend as people just kind of be aware of if they're thinking if a hair transplant might be right for them?
Speaker 3:could you rephrase that question?
Speaker 2:yeah, just just if somebody's thinking about you know, doing a hair transplant, what sort of like tips or things would you recommend them start thinking about, if it's the right choice for them, you know, thinking about the type of hair loss or maybe where they should go I know you mentioned the credentials were important what type of risk complications would they have to worry about? You know, what type of advice or tips would you give to somebody maybe considering having a hair transplant?
Speaker 3:That's a wonderful question. So, 100%, you have to do your research. What does that mean? That means go to Google, learn about what the whole process looks like. You don't have to know the surgical, all the surgical minutiae, but understand the fundamentals of the difference between FUE and FUT, which we discussed, understand how this is a team-based approach. Do your research about which clinics you're going to. Read patient reviews Always a great idea to actually speak to patients who've gone through the process of having a hair transplant so you can get firsthand kind of knowledge about that surgeon, what their results are like.
Speaker 3:Make sure to look at before and after photos and, you know, just make sure that again, the first thing you have to do is go to a surgeon who's not just going to sell you a hair transplant but who is going to be committed to treating you for a very long period of time. Because when you go for a hair transplant, that is not the end of your journey. This is really a lifelong commitment to maintaining your hair and that involves medical therapy. So you really want to go to a practice that's committed to taking care of you very long. You want to make sure to go to a practice that has a commitment to kind of be there along this entire journey with you.
Speaker 2:Great advice, great advice. Well, thank you so much, ross, for coming on giving us this little taste, if you will, about hair transplants For our listeners. If they want to find you, do you mind sharing where they can locate you online and more about your podcast?
Speaker 3:Yeah, this was. This was a tremendous amount of fun, uh, so if you want to connect with me, I actually have a YouTube channel. Uh, it's called Dr Copelman. I talk about hair on a weekly basis. I also have a podcast called the hair doctors and if you want to connect with me on Instagram, it's Dr Ross, and I do answer all of my DMs. So I'm looking forward to helping you on your hair loss and I want to thank you so much for allowing me this opportunity to be on your podcast. It was really a pleasure speaking to you.
Speaker 2:Well, thank you so much as well, and stay tuned for the next episode of Dermot Trotter. Don't swear about skincare.
Speaker 1:Thanks for listening to Dermot Trotter. For more about skincare, visit DermotTrottercom. Don't forget to subscribe, leave a review and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.
