About Dr Walker
Dr Walker has completed extensive training in hair restoration surgery at the Saifi Hair Transplant Clinic and American Hair Transplant Center in Poland.
He received one-on-one training with Dr Marwan Saifi, an experienced hair transplant surgeon, Diplomate of the American Board of Hair Restoration Surgery, Fellow of the International Society of Hair Restoration Surgery and Fellowship Training Programme Director.
Dr Walker has been trained in both FUE and FUT techniques of hair transplant surgery and specialises in the newer technique of FUE.
Dr Walker is attending the International Society of Hair Restoration World Congress and World Live Surgery Workshop as a resident physician and he has completed the CRLAB Live Trichology and CNC Workshop at their academy centre in Poland.
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Frequently Asked Questions
There are many factors that can cause hair loss, but 95% of the time the cause is heredity (androgenic alopecia). Men and women can both inherit the hair loss gene from either parent, or both. The factors that can contribute to the onset of hair loss include your age, the genetic susceptibility to lose hair and the presence of the male hormone called Dihydrotestosterone.
Other causes of hair loss include thyroid disease, iron deficiency, scalp disease, high fever, hormone imbalance, diabetes, autoimmune disease, recent surgery, recent childbirth, stress and trauma. Many drugs can also cause hair loss.
It is completely normal to lose around 100 hairs every day, and once lost, they will regrow several months later. But when the level of hair loss is higher than the level of hairs growing back, hair loss becomes visibly evident.
Eventually, hair growth stops altogether. The exact cause for this type of hair loss is unknown, but it is related to the production of the hormone dihydrotestosterone (DHT). Treatments that inhibit production of DHT are sometimes effective in slowing or stopping hair loss due to androgenic alopecia. Though male pattern baldness is often treatable, other forms of hair loss either cannot be treated or they resolve themselves on their own. Telogen effluvium, for example, is a temporary form of hair loss typically induced by severe stress. Once the stressor has been removed, many people grow their hair back.
Alopecia Areata, an autoimmune condition, is another story. Scientists aren’t sure what triggers the immune system to begin attacking the hair follicles, but it is thought to be a combination of internal and external factors. For some people, oral or topical treatments work to reduce hair loss, but autoimmune conditions like this can never be fully cured.
Male and female hair loss patterns tend to progress differently and therefore require different treatment strategies. Typical male pattern hair loss begins with frontal recession which progresses to the mid zone and crown, whereas females typically present with diffuse thinning. It is therefore important to have a thorough consultation and examination to individualise the treatment strategy.
It is important to understand that there is no cure for androgenic alopecia and no treatment will completely reverse the process. Having said that there are a number of treatment options available. The response to treatment is quite variable and some people will not respond to particular treatments.
Broadly speaking these options include camouflage methods (including hair pieces or hair systems, scalp micropigmentation amongst others), medication (as well as medical devices such as laser) or surgery. There are two TGA approved medication options available in Australia: topical minoxidil (commonly used like a shampoo) and an oral tablet called finasteride. There are advantages and disadvantages to both, for instance finasteride can cause sexual dysfunction in men and should not be used by women of child bearing age. For this reason, it is important to have a thorough consultation with your doctor before considering medical options. There are a number of alternative treatments available on the market, such as supplements, lotions or shampoos, low level light therapy (such as laser combs) and PRP (platelet rich plasma) which have a variable evidence base of how effective they are in the treatment of hair loss. Many people opt for a combination of treatment approaches, often in conjunction with a hair transplant procedure.
This drug was initially introduced as a treatment for high blood pressure, but people who took it noticed that they were growing hair in places where they had lost it. Research studies confirmed that minoxidil applied directly to the scalp could stimulate hair growth. As a result of the studies, the TGA originally approved over-the-counter 2% minoxidil to treat hair loss. Since then a 5% solution has also become available for when a stronger solution is indicated.
Clearly, minoxidil is not a miracle drug. While it can produce some new growth of fine hair in some — not all — it cannot restore the full density of the lost hair. It’s not a quick fix either. You will not see results until you use the drug for at least two months. The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. If minoxidil works for you, you’ll need to keep using it to maintain those results. If you stop, you will start to lose hair again.
Some people find that the minoxidil solution leaves a deposit that dries and irritates their scalp. This irritation, called contact dermatitis, is probably caused not by the minoxidil itself, but rather by the alcohol that is included to facilitate drying.
Side effects and concerns: Minoxidil is safe, but it can have unpleasant side effects even apart from the alcohol-related skin irritation. Sometimes the new hair differs in colour and texture from surrounding hair. Another risk is hypertrichosis — excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more likely with the stronger 5% solution.) Because the patent on Rogaine (the brand-name version of minoxidil) has expired, many generic products are available. They all contain the same amount of minoxidil, but some include additional ingredients, such as herbal extracts, which might trigger allergic reactions.
Finasteride is a TGA-approved medication for the treatment of hair loss in men. Also sold under the brand name Propecia®, finasteride belongs to a class of drugs known as 5-alpha-reductase inhibitors. It works by preventing testosterone from breaking down into DHT, the hormone that is thought to cause male pattern baldness. It is a prescription only medication. Available in tablet form, finasteride is designed for long-term use. You may not see any significant results until you have been taking the product continuously for a few months. Men who have used finasteride to treat hair loss have reported an increase in the number of hairs, as well as improvement in hair quality. Keep in mind that finasteride only works if you keep taking it. If you stop using finasteride, the hair you have regrown will eventually fall out.
Though the instance of side effects in men taking finasteride is relatively low, all drugs come with a risk of side effects and it is important to know the potential risks before taking finasteride. Men taking finasteride have reported experiencing rashes, breast tenderness and enlargement, depression, anxiety, problems with ejaculation, testicular pain, neurological problems like mental fogginess and sexual side effects like erectile dysfunction, decreased libido and lower ejaculate volume levels. It is recommended that NSAID medication (such as ibuprofen) be avoided while taking finasteride, as there could be an increased occurrence of sexual dysfunction when the two are mixed.
It is worth noting that these side effects generally disappear once you stop using the medication. It is also worth noting, however, that in rare cases, men who experienced side effects while taking finasteride continued to experience them even after stopping treatment. Although low, there is also an increased risk of getting a more serious form of prostate cancer, called high-grade prostate cancer. Finally, men who have chronic liver disease should not take finasteride.
Platelet Rich Plasma, also known as PRP, is a relatively new addition to the list of hair loss treatments. The theory is this that platelets store growth factors to help stimulate wound healing and tissue growth where it is needed. Blood contains platelets in varying concentrations. If you take a patient’s own platelets and re-inject them into an area that needs healing and growth, the body’s own mechanisms will improve the regeneration of the tissue. PRP injections have been verifiably used to help the growth and healing of slow growing tissues like bones and teeth. Early experiments in its use with hair have been mixed however. Most studies have concentrated on using PRP injections to possibly help the growth of the native hair (and possibly the grafts if surgery was done) in the areas of hair loss and thinning. What these studies have shown so far is that the treatments do not help hair to re-grow on a completely bald head, so the earlier a treatment is started the better. Higher concentrations of platelets, more frequent injections, and possibly activating the platelets or causing micro-injuries to the scalp may also provide better results. No study has been conclusive, however, and many variations within the research make it difficult to compare and draw conclusions.
Since this use of PRP is not yet fully tested, it is impossible to know how much of an effect it would have in an individual case. That being said, it is a patient’s own “blood product,” and thus not likely to be detrimental. It is useful to remember that like most treatments, some patients have great results and others have results that are not as significant. A standard treatment regimen has not yet been developed with most practitioners advocating treatment schedules that range from monthly to every three months. Also, like all medical hair treatments it may require ongoing maintenance treatments. Whichever treatment frequency is used, at least 6 months are needed to see results. It is a very simple procedure which involves taking a blood sample, spinning the sample in a machine to separate the platelets and growth factors which are then injected into the scalp.
LLLT (Low Level Light/Laser Therapy) has long been used in hair restoration. There are TGA approved devices (such as laser combs) available which use laser energy to penetrate the hair and scalp. Such devices are thought to improve scalp circulation and improve the length and thickness of miniaturised hair. Theoretical physiological mechanisms include an improvement in blood microcirculation to the follicle, increased nutrient availability to the follicle, increased oxygen uptake and decreased inflammation. Such devices are generally quick and simple to use.
Most patients can potentially benefit from hair transplantation depending on a number of factors. However, some patients will benefit more than others. Age is an important factor to consider, as this corresponds to the current level of hair loss. It is arguably the most significant factor in the projection of future hair loss and whether or not medication or surgery might be the best and most appropriate modality of treatment. While patients who undergo a transplant will have permanent transplanted hair, it is still very important to remember that transplantation will not alter the natural physiology of your hair or your specific genetic pattern. Native hair (that is, the non-transplanted hair) will have a continued tendency to fall out over time. At Skin Rejuvenate, we will look at a future plan for projected hair loss and this might include, for some patients, the use of medication, post-surgery, as a means of supporting the life expectancy of the non-transplanted hair. In essence, medication can be used to resuscitate the dying hairs (aka miniaturising hairs) while surgery is used to fill in the areas where hair-loss has already occurred. As one ages, one tends to have more ‘gaps’ which will, at some stage, join together to form what we would term ‘baldness.’
A hair transplant is an outpatient procedure that involves transplanting the hair follicles from one part of the head (or body), known as the donor site, to the balding part of the head (or body), known as the recipient site. Although hair transplantations are typically used to treat androgenic alopecia, they can also be used to fill in scars caused by accidents or surgery.
The terminology can be confusing. Generally speaking there are two methods of harvesting donor hair (transplanting the donor hair in the recipient area is generally done in the same way, regardless of the means of donor hair harvesting).
Traditionally, the two methods were termed FUE (Follicular Unit Extraction) and FUT-Strip (Follicular Unit Transplantation – Strip) which have been recognised as confusing terms. There is a proposal to rename the two methods FUE (Follicular Unit Excision) and the Linear Strip Excision as better descriptors of the two surgical techniques.
At Skin Rejuvenate we specialise in the newer technique of FUE.
The only difference in the two treatments is the way in which the hair is extracted from the back of the scalp. The implantation process is the same. FUT or strip procedure requires the harvesting of a strip of scalp from the donor area. The strip is placed under a microscope and divided into grafts containing 1 or 2 hairs. Some patients experience more post-operative pain following the strip method. Follicular unit excision (FUE) is a process that utilises a small punch tool that removes hairs from the donor sites. The tool removes grafts that contain either 1 or 2 hairs. FUE procedures use a much larger donor area than strip procedures, but the recovery time is relatively quick. Both procedures insert 1 or 2 hairs at a time into tiny incisions. Some patients find that the incision sites for strip procedures are somewhat larger and more noticeable than that of FUE procedures. Both procedures require incisions that are less than 1 millimetre in diameter. FUE is an advanced and sophisticated hair transplant procedure. In FUE, follicles containing 1-4 hairs are removed individually from the donor site (usually on the sides and back of the head) and artfully transplanted into thinning or balding areas on the head. The individual extraction of the donor hair leaves hardly visible scarring as opposed to the old strip-surgery method.
The transplanted hairs that are moved are indeed permanent. The hairs that are extracted and then replanted are not prone to hair-loss and thus, will not fall out.
However, the native hairs that exist in the part of the head that is thinning will continue to fall out. It is important for patients to have an on-going relationship with the clinic. Hair loss can be managed over a period of time, making adjustments as the pattern of hair loss continues, replacing lost hair with transplanted hair in a subtle process which can transform the path that your hair loss would otherwise appear to take.
Some patients elect to take medication to prolong the life of the native hair. Others are comfortable with the thought that if they wish to have increased density in the future then they can plan for subsequent transplants with Skin Rejuvenate. All of these factors can be discussed in consultation and a treatment plan drawn up. This will be a flexible and collaborative plan which will take account of future patterns of individual hair loss. An important part of this process is discussing realistic expectations, particularly in the younger patient.
Possibly. For some patients, one transplant will be adequate. If the patient only wants to have one transplant, then the clinic can work to ensure the coverage and density of the hair in the particularly problematic areas of concern. These areas of concern will vary from patient to patient. Each patient will have a unique constellation of concerns about their hair-loss and the consultation process at Skin Rejuvenate will take careful consideration of these unique issues. It will generally be the case, however, that if only one surgery is required, that surgery will be rather larger to account for future hair loss. A sufficient number of grafts will be needed for an optimal outcome. A staged approach can be easily managed with the FUE technique which naturally lends itself to this process.
We are only redistributing your existing permanent hair to your thin or bald areas. We are not creating new hair. Having said that, in expert hands the limited donor hair available can be used to create the illusion of a lot more hair in people with significant hair loss. In extensive baldness, the most important achievement will be to restore frontal scalp hair and the hairline to create a frame around the face (rather than using precious grafts in areas such as the crown which will have less of a visual impact). This will improve how you look to yourself and to others.
Scarring is naturally a concern for most patients. They will wish to avoid conspicuousness when the hair is wet, when they are at the hairdressers or when they have to have a close, short cut e.g. if they work/holiday in a hot environment. Modern technology and micro surgery mean that we can use microscopic cylindrical extraction blades to remove an individual hair follicle – or indeed part of a hair follicle. This is carried out at a very high magnification level thus leaving a very, very small hole where the hair once was. Any circular hole then contracts to form an even smaller ‘scar’. As there are naturally pale areas of scalp between scalp hair, it may not visible to others even with a very short haircut. In many cases, one is able to shave the head completely and see minimal scarring, but this cannot be guaranteed. This is in contrast to the earlier strip method of hair removal which can indeed leave a visible scar by virtue of the continuous uninterrupted nature of the scar. In addition, FUE techniques, are an effective method of treating and disguising visible scarring that has arisen from a previous strip transplant technique.
A number of key things make this extremely unlikely. The grafts, if placed correctly, are not recognisable as grafts, even on close inspection. In patients who have surgery before they go significantly bald, they will have their own hair – and this will be added to and augmented by the surgery. Hair transplantation can be done gradually and in a bespoke fashion and there will be an on-going relationship with the patient. This process also makes it very unlikely that there will be a point at which people can notice that a hair transplantation has happened. It will effect a subtle change, over time, and, for this reason, can be undetectable.
The vast majority of patients find that hair transplant procedures are extremely successful. The team will help patients maintain realistic expectations, which is the key to avoiding disappointment. It is impossible to create a thick, full head of hair in an individual who has experienced a large area of balding. Realistic expectations and following the guidelines of the surgical team should ensure a successful hair transplant experience.
There are a number of disadvantages to hair transplant surgeries. It is important that all patients weigh the risks of hair transplant procedures against the benefits. Ultimately, there is minimal medical risk associated with the surgeries. This means that while disadvantages do exist, they are generally not negative enough for patients to not go ahead with the procedures. However, an important part of the process is a thorough discussion of the risks and benefits of what is ultimately a non-essential surgical procedure.
Bleeding or Infection: Patients who follow the advice and recommendations of the surgical team are unlikely to experience either of these medical risks. However, if an infection or excess bleeding does occur, simple treatment options are available.
Nerve Damage: Nerve damage is most common in surgeries which remove a portion of the scalp (such as FUT), however some temporary numbness can also be experienced following an FUE procedure.
Scarring is another potential disadvantage of hair transplant procedures. Although scarring is usually minimal, there is always the chance of improper healing or noticeable scars. The scars associated with FUE procedures are small dots or bumps at follicular insertion sites. Procedures usually result in thin scars at the follicular insertion sites and a 1 millimetre scar at the donor site. These scars are generally difficult to detect, but may become visible if patients choose to shave the hair very short.
Hair Loss can be experienced after transplant surgeries in the rarest of cases. Sometimes this is simply shedding, which means that the hair will grow back in a month or two. It is possible, however, for a percentage of transplanted hairs to die and fall out.
The risks associated with transplant procedures are extremely low, approximately 2%-10% of transplanted hairs do not survive the procedure.
Decreased sensitivity is another possible side effect within the first few months after surgery. Most patients regain full sensation in the scalp within one year of the surgery.
Patients may also experience crusting around the grafted follicles. This is completely normal and the crusts will fall off on their own around a week after surgery. It is important that patients refrain from picking at the crusted area. Picking could result in the removal of grafts.
No. At the very worst, there may be some minor discomfort whilst the skin is being frozen with a local anaesthetic – great care is taken to ensure a comfortable surgery. Many of our patients take naps whilst the procedure is being carried out! Following surgery, because it is an FUE procedure, there are no stitches in the skin and thus no tension on the skin. Importantly, there are no sutures to be removed.
Local anaesthesia. Oral sedation is usually used which contributes to a pleasant patient experience.
This depends on the size of the surgery, but it can take around 8 hours. We will ensure you have frequent breaks during the procedure to make the process as comfortable as possible.
For the first few days after the surgery there can be some bruising at the front of the scalp, and, for this reason, some patients may choose to take several days off work. But, in general, the primary limitation and return to work is largely a social discretion. As the procedure carries minimal discomfort and there are no stitches to remove, patients will be physically able to do everything they normally do (within reason!) the day following surgery. Vigorous exercise would not be recommended for approximately a 2 week period afterwards. Aftercare will be discussed in detail during your consultation.
While the root of the hair follicle will survive, the hair shaft, that is, the visible element on the surface of the skin WILL fall out approximately three weeks after surgery. But the important part of the transplant remains, beneath the surface of the skin, growing to form the new hair. The patient should see the beginnings of new follicle hair growth around six months after surgery. Crucially, the hair grows back gradually, as opposed to all at once. This gradual re-growth over time allows for the naturalisation of appearance and is one of the main reasons why your hair transplantation may not be noticed by others. Many patients report that people observe they look younger, thinner or even happier – but they do not appreciate why this change has actually happened! The full extent of the results of a hair transplant can be seen at around the 12 month point.
The follicles that are transplanted during the surgical procedure will last for the lifetime of the patient. These hairs are genetically resistant to balding, which means they will not fall out. Some patients, however, may not experience hair growth for up to sixth months following the hair transplant procedures. Additionally, some patients may experience initial hair loss due to the transplantation process. These hairs will grow back in 2-6 months. Once the hair begins to grow normally, it will continue to do so for the patient’s lifetime.
It is best not to shave your hair short as the surgeon will trim the area he needs to use for the transplant procedure.
Patients may begin or continue taking minoxidil about five days following the surgery. Finasteride can usually be taken before, after, and during the surgical procedure. If you are utilising other hair restoration methods, the continued use of these will be discussed during your consultation.
No. There is no need for bandages after modern hair transplantation. A small dressing may be applied to the back of the head where the hairs have been taken from. This may be required to stay on for up to 24 hours. We advise this is removed the morning following surgery but can be worn a little longer for 24 hours from discharge but should be removed at the 24 hour stage.
We will explain during your consultation and following your procedure as well as provide written post-operative instructions to ensure the best possible outcome from your hair transplant procedure.