Dr. Gregory Keller

Welcome To Keller Plastic Surgery

 The Keller Hair Master™️

Hair Master™️ hair transplantation produces the optimum results that a blend of artistry, dense packing, and the use of modern hair grafting techniques can render. With over 25 years of hair transplant experience, Dr. Gregory Keller utilizes the latest hair transplant techniques, in addition to innovative procedures and effective treatments regarding hair loss in both men and women. Discover why our patients trust Keller Plastic Surgery with their hair loss and transplant services.

Hair Transplant Procedures

Hair transplant procedures are highly effective (close to 100% successful) and have advanced significantly from the days of reductions, flaps, and large hair plugs.  Today’s hair transplants are natural, effective and can be performed without scarring under local anesthesia.  They are “not your father’s hair transplants”.  They involve a natural alternative to going bald or losing hair.  Hair transplants are usually permanent and involve the moving of genetically permanent hair along the back of the scalp to the balding areas.  

The Need for Hair Transplantation

Hair loss affects two out of three men, and one in five women.  Some people begin to lose hair in their twenties.

Hair Transplantation: An Artistic Endeavor

Hair transplantation is an artistic endeavor as well as a technical expertise.  Combining artistry with technical expertise is our formula for producing a natural “out of the shower” appearance.  Because Dr. Keller performs plastic surgery in the forehead and scalp, he, like Leonardo DaVinci, knows and uses the anatomy of your scalps natural hair distribution to reconstruct the anterior hairline points, the “apex” of the natural hairline recession points, and the hairline in the temple.  

He defined this natural anatomy and published it in the hair journal, through a thorough study of the anatomy of hair as related to the scalp and muscles.  This natural anatomic approach to reconstructing your hairline avoids the odd looks (such as the “mohawk look”)  that are seen after other hair transplants.  It gives you a natural “out of the shower” appearance that goes undetected.

“Would do it again… absolutely” – David (Actual Patient)

Male Pattern Baldness

Most hair loss in men is due to the syndrome of “male pattern baldness”.  This is mostly genetic in nature. While there are other causes of hair loss in men (such as the “patchy hair loss” of alopecia areata), 90% of hair loss in males is genetic male pattern hair loss (or MPL).  

Hair thinning occurs throughout life, but pattern baldness in males may occur early in life, prior to andropause (male menopause). Often pattern baldness and hair thinning can recur when a man takes testosterone supplements. 

Heredity (genetic factors) is the major factor for hair loss in men.  Though other forms of hair loss occur, baldness usually occurs in a pattern area (often with a recession of hair at the temples, top of the head and crown. 

This hair loss is the result of the effect of a breakdown product of testosterone, di-hydro testosterone (or DHT). DHT’s effects on the hair cell mitochondria (and the hair cell RNA and DNA)  are responsible for the destruction of the hair follicle.  Only genetically susceptible hair follicle cells are affected by DHT.  Mostly these are on the crown, the top of the head, and in the temple areas.  The hair left in the “fringe” (the back and sides) of the scalp is not susceptible to DHT and, when transplanted to the bald area survives, just as it would if were in the fringe. 

Male pattern baldness often occurs early in men, prior to andropause (male menopause) when male testosterone decreases.  If DHT inhibitors (Propecia/finasteride) are given early, the hair loss can sometimes be reversed.

Most testosterone is bound to plasma proteins and cannot get into the hair follicles.  Free testosterone (testosterone not bound to plasma proteins) can enter into the hair follicle cells and is converted into dihydrotestosterone by an enzyme, 5-alpha reductase (5AR).  In genetically susceptible hair cells, toxic proteins are formed that ultimately damage the hair follicle.

When this occurs, the hair becomes progressively thinner, and grows shorter.  It becomes a “sapling” rather than a “tree”.  This process is called “miniaturization” of both the hair follicle and hair shaft.  Over a variable period of time, the hair cannot be regenerated and is lost. Illustration from my brochure.

Treatments for hair loss can be medical or transplantation can be utilized.  There are three FDA cleared medical treatments for hair loss: finasteride, minoxidil, and low power red light phototherapy.  

Minoxidil is a vasodilator and an opener of potassium channels.  It is an antihypertensive agent, and, in clinical trials, it was found to cause hypertrichosis (increased hair growth), for which it went into clinical trials.  It seems to be more effective in the crown area and for women.  Its mechanism of action is unknown.

Finasteride is an inhibitor of 5 alpha reductase (5AR), the enzyme that breaks down testosterone to form DHT. Given early, Finasteride can reduce DHT production and stop the progressive miniaturization of the hair.  If miniaturization is reversed early enough, vellus hairs can again become healthy.  

However, testosterone can also be converted to DHT in the blood circulation independent of 5AR and enter the hair follicle.  In these instances, finasteride may not be effective. Finasteride has well known complications (though a recent article in JAMA showed that these are infrequent) and it should not be begun without a discussion with your doctor and PSA testing.

Phototherapy for stopping or reducing hair loss with red laser light is also called “heliotherapy”.  The use of red visible laser light every other day seems to increase blood supply to the scalp and stimulate the mitochondria of the hair cell.  

Other forms of medical treatment are currently experimental.  Prior to initiating these, it is important to discuss your options with a physician.  

Hair loss can also be caused by medication reactions, and other metabolic and disease problems.  Consultation and work up is required.  Some of these are listed below.

• Nutritional imbalance or deficiency
• Extreme dieting
• Excessive intake of vitamin A
• Traction alopecia, caused by tightly pulled hairstyles
• Excessive stress
• Extreme illness
• Major surgery
• Shock
• Medications
• Anemia
• Testosterone or Steroid Supplementation
• Thyroid dysfunction

Other causes of hair loss in men and women are disease and immunologic problems.  These often result in hair loss that occurs in unusual patterns and can involve the skin.

Hair Transplantation

Hair shafts naturally emerge from the skin as units (called “follicular units”).  These units can have a single hair, or from 2 to 5 hairs.  Modern hair transplantation extracts these units from the back or sides of the head, which is genetically relatively resistant to pattern hair loss (donor area) and moves them to the balding areas of the scalp (recipient area).  Once in the recipient area, they remain genetically resistant to balding, as they would in their original home donor area.  

The hair follicles in these units belong together, have a blood supply in common, and “talk” to each other.  When transplanted into small needle size “slits” in the balding recipient area, they appear natural, as if they belong there.  

There are two modern hair restoration methods that most hair transplant surgeons use: Follicular Unit Extractions (FUE), and Follicular Unit Transplant (FUT).  These methods avoid the “hair plug” look of older hair transplant methods and the scars and pain of hair flaps and scalp reductions.  

Follicular Unit Extraction (FUE) is the most common method in use today.  A small (8 or 9 mm) punch is used to extract the follicular unit.  This small of a punch avoids “dimple” scars, and is really no larger than a needle.  The follicular unit is then extracted from the skin, and placed in a patterned slit in the donor area. While there are different machines for FUE, and even robots, the chief consideration is the quality of the graft removed, and how well it “takes” in the recipient area.

The advantage of FUE is that the donor area heals quickly without a noticeable scar.  There is comparatively little pain from this procedure, performed under local anesthesia.  The disadvantage of the procedure is that extremely large numbers of grafts cannot be obtained at one sitting (2500-3500 only, depending on the donor area).  Also, a large area of the donor scalp has to be shaved.

Follicular Unit Transplant (FUT) removes a strip of skin from the back or sides of the head, usually under local anesthesia.  Under a microscope, the individual follicular units are separated, and transplanted into slits in the donor area.  

The advantage of this technique is that the donor area of the scalp does not need to be shaved.  Depending on the laxity of the scalp and the density of the donor area, large numbers of grafts can be obtained (often 5000 follicular units or more), and the number of transplant sessions in a large area of baldness can be reduced.  The disadvantage is that there is a scar that is left inside the hairline.  For this reason, patients that might desire to wear their hair very short or shaved are not good candidates for the FUT procedure.

To transplant hair requires an artistic knowledge of the anatomy of the hair bearing scalp.  The hairline that we create is not really a “line”, but a pattern in the scalp.  For the front line, there are three key points: the apex on each side, the frontal point, and the temporal point.  All of these have ideal anatomic points and zones.  

The ideal frontal point, according to DaVinci, is located so that the area from between the eyebrows (the glabella) to the beginning of the hairline is approximately 1/3 of the facial measurement.  Generally, this point lies in a transition zone as the forehead starts to angle backward and is about 7 to 8 cm above the brow.  

Because we have, for other plastic surgery, observed the anatomy of the bone beneath the area where the hair begins to thin in the temple area (temporo-parietal recession), we know that the ideal apex is where two suture lines of the scalp come together.  We feel this as a small divot in the bone in the temporal area.

When we feel the temple, we can feel where the soft muscle meets the bone.  As we start from the top of that area and trace our fingers downward, we feel the eye socket and our fingers stop above the eyebrow.  That is the temporal point of our hair.

Recreating the ideal hair zone is not always possible.  There may not be enough donor hair, or the patient may not wish to do enough grafts.  The patient may have an asymmetrical face.  Compensating for these and other problems requires a great deal of experience and artistic ability.

There are a lot more aspects to the artistic creation of your new hair.  We know them.

Our hair transplant experience spans over 25 years with follicular unit grafts, and over 42 years of hair transplant experience.  We know the hair bearing scalp anatomy from the inside out.  You can trust our skill and expertise.

Other causes of hair loss in men and women are disease and immunologic problems.  These often result in hair loss that occurs in unusual patterns and can involve the skin.

Women’s Hair Loss

Hair loss in women generally begins later than in men.  If it does begin earlier, it has the potential to be severe.  The causes of hair loss in women can be genetic (50% of cases) or metabolic.  

Genetic problems in women are, as in men, due to the conversion of testosterone to dihydrotestosterone (DHT) by the enzyme 5-alpha reductase (5AR).  Women have less testosterone than men, so the hair loss usually occurs over a longer period of time.  There is also literature to support that womens’ hair follicles are more susceptible to DHT than mens’.

The hair loss is marked by a shortened anagen (active hair growing phase) and a prolonged telogen (resting hair phase where the hair shaft falls out) phase.  The hairs become shorter and have decreased diameter, as the follicle “miniaturizes”.  These hairs are termed “vellus hairs”.   Eventually, these hairs no longer grow. 

Hair loss in women begins in the front, mid-scalp, part line, and crown.  Hair loss at this point is Stage 1 Ludwig’s hair loss.  Stage II is a progression to more pronounced thinning in the Stage I areas, but in addition, the frontal and temporal hairline starts thinning, as well.  Stage III hair loss is a more extensive thinning of the Stage I areas with the frontal and temporal areas becoming very thin.

Minoxidil 2% is the only FDA approved treatment for hair loss in women.  

Metabolic Loss

Metabolic hair loss in women may occur more quickly than genetic hair loss.  A classic example is the hair loss that occurs in menopause.  The growth cycle in these hairs is interrupted with more hairs remaining in telogen than normal.  The result is hair thinning, often in the temple areas.  The causes of metabolic hair loss are numerous.  Some are listed below. 

• Nutritional imbalance or deficiency
• Extreme dieting
• Excessive intake of vitamin A
• Traction alopecia, caused by tightly pulled hairstyles or the use of hair extensions
• Excessive stress
• Pregnancy
• Menopause
• Extreme illness
• Major surgery
• Shock
• Anemia
• Medications, including contraceptives, antidepressants, beta blockers, non-steroidal anti-inflammatories and chemotherapy drugs
• Polycystic ovarian syndrome
• Hormonal imbalances
• Thyroid dysfunction

Other causes of hair loss in men and women are disease and immunologic problems.  These often result in hair loss that occurs in unusual patterns and can involve the skin.

Learn about other procedures offered by Dr. Gregory Keller.