Founder Andrew Kashian recently sat down with Leo to talk all things hair loss.
For years, if you were suffering from hair loss, you had but two options – neither of them great. Go full bald or dust off that toupee. From John Wayne to Ted Danson to even the original Bond, men who wanted to feel like they had full heads of hair had to go about town with a rug on their head, never diving into a pool and hoping it stayed attached in a convertible. Then came plugs – a very painful procedure that never looked right and often left some pretty nasty scarring. But now times have changed.
Andrew Kashian is the founder of Solve Clinics, a leading hair transplant and skin restoration clinic in Chicago that provides transparent, personalized, and high-quality care at an affordable price.
We sat down with Kashian to discuss hair loss, why it happens, the myths and lies about it, and how modern medicine and technology have made the procedure painless, the results realistic, and the cost very affordable.
YOU CAN FINALLY BLAME YOUR PARENTS!
(Editor’s note: DHT, also known as dihydrotestosterone, is an androgen which helps give males their male characteristics. It is linked to the hormone testosterone.)
“Men lose their hair because of genetics. It’s a release of something called DHT. Follicles are genetically coded and each follicle of hair has DHT receptors. There’s no lineage to a mother’s father or anything like that. Hair loss is just like every other feature on your body. It’s a total crapshoot of whatever genetics you get from your parents. Stress in your life and other things can help push that sooner, but at its foundation, it’s what you’ve been either cursed or gifted with genetically. Women are biologically different and don’t have as much DHT, so that’s why there’s not as much baldness running through women’s genetics.”
FORGET THE FLUFF
“Shampoos and conditioners, anything over the counter, none of it is going to save your hair. It helps with hair health and healthy hair will give the appearance of growth, but it’s not preventing the loss. The only way you’re going to stop hair loss is with prescription medicine or with treatments. Everything else is just fluff.
Like anything in aging, hair loss is progressive. Our bodies are slowly degenerating and dying with time. That’s just a part of life, and hair is one of those things. Most men are going to lose most, if not all, of their hair by the time they’re in their 60s, 70s, or 80s. But there are tools in place that can help you extend the life of that hair. What we can do is a treatment like a PRP injection (a plasma injection). It’s used in a lot of medicine whether it’s for facials, torn ligaments, hair loss, erectile dysfunction, all sorts of things. And there’s also a medication called Finasteride. It’s a drug that blocks the receptor that kicks hairs out. So instead of that hair all falling out in five years, we can slow it down and it might take 20 years. So, it’s all about extension, not lifetime preservation.
Finasteride comes in two forms. It comes in an oral pill form and a topical or liquid form. The oral is stronger, but it does come with the chance of side effects. Now, the pharmaceutical companies that make this drug will say only 1% of the population experiences a side effect, but we don’t think that’s true. We’re seeing closer to about 10-15% of our patients experiencing a decrease in libido as a result of Finasteride. Now the good news is it’s an FDA cleared drug. It’s super safe. If you do experience those side effects, you go off it and with time it’ll completely go away. Option number two, which is relatively new, is topical Finasteride which doesn’t have any side effects. It’s not as effective as oral Finasteride but it still works very well. We usually recommend patients start with the pill version. If they start to feel the side effects, we switch them over to the topical.”
“FUE stands for Follicular Unit Extraction. If you look really closely at your hairline and look at the hole that the hairs are going into, sometimes those holes have multiple hairs coming out. These holes form a single follicle or a single graft. So, a graft can have as little as one hair to as many as five. The old method was called strip method, where you would literally cut out a roll of grafts of hair and then suture that skin together. It was a brutal procedure. Some people are still doing it today. And you end up getting that scar running across the back of your head.
But in the last six or seven years, follicular unit extraction was invented where we use this microscopic tool that has a rotating blade in a circle, almost like a syringe tip. And that blade is just large enough to get around the width of a single graft of hair and cut the base of the skin. So now suddenly, instead of doing four massive incisions with a huge suture and long recovery time, we’re doing anywhere between a 0.7 to 1.0 millimeter incision per graft that’s removed. The beauty of this is the recovery time is really fast and the scar tissue is minimal. Once your hair grows back, you really don’t see it at all, so it’s super, super discrete.
Most bald men have hair on the back of their heads because that hair is genetically different from the hair on the top of our head. That hair is actually genetically resistant to balding. So when you transplant the hair from the back of the head to the top, it’s really a permanent fix instead of a temporary fix. It’s a full recovery. So when someone looks at the back of your head where those hairs were removed, our goal is that there’s no indication that anything has been done there. The goal for a successful surgery is not just hair growth, but for the hair to grow in and for no one to know that a transplant was even performed.”
WHILE YOU WERE SLEEPING
“The procedure takes one day. Patients arrive at 7:15 and we shave the back of the head down because hairs can’t be long for the tool to fit around. The first half of the surgery is the extraction, so the patients are face-down. The area is completely numb, all local anesthesia, and every single graft is individually cut and extracted. About 90% of our patients fall asleep during the surgery, and that is a testament to how comfortable it is, because they’re bored, not because we’ve doped them out! It’s because they’re sitting there for five or six hours. It’s a very tedious surgery and requires a large team. We usually have about seven medical staffers working on a single patient at a time.
Average surgery size depends on the patient, could be as small as 1000 grafts, and the max we do is about 2200 grafts. We assume the average graft is three hairs, so you’re looking at anywhere between 3000 hairs to upwards of 6000 or 7000 hairs.
By noon, that portion is done. After that, those hairs are observed underneath a microscope to make sure that they’re 100% healthy and alive, that there’s no transections, which is like nicks or cuts in the hair. If they are confirmed alive, they’re trimmed to the appropriate length and prepared for the transplantation to the new location. The placement of hair density depends on the location and part of that transplantation process in the second half of the surgery is where to put the grafts in. It’s an art form. A natural aesthetic is something that’s always difficult to attain. And trying to replicate what your body naturally produces is one of the most difficult things to do in medicine.”
“The first two days are the most crucial for recovery, that’s when the body is healing the most. Visual healing – where you can go out in public without wearing a hat and without any sort of scabbing or redness – typically takes about 10 to 14 days.
Usually after the first month, you go back to the way you were before and it doesn’t look like anything was done; the thinness is still there, the area addressed is still bald. But then, the next 12 months begins the slow process of growing. The first three months, you start to get infant growth, little-teeny hairs starting to poke through. Month six, you start to see a majority of those transplanted hairs coming through. And then between month six and month 12, you go to full density. So, the full final dense result takes a full year.
The downside is it takes time. The upside is the slow progression is almost a way of easing the results into acceptance for other people.”
SOMETIMES YOU GOTTA EMBRACE THE BALD
“When someone is fully bald and they have no hair from hairline to mid-scalp, you have to have a lot of donor hair. And if that area is too thin, then the possibility of doing a transplant and getting good density in the front is unlikely. It actually looks worse than if they were just to shave their hair short.
We believe in brutal honesty and transparency. I would rather tell the patient, ‘Hey, you’re going to end up spending a lot of money and it’s not going to give you an outcome that you’re happy with,’ than take their money, do the surgery and have them be disappointed.
Our approach with first time patients is not to try to convince them or sell them. We don’t believe in that here. When patients come in or reach out to us, whether it be virtually, in person, or whatever, we consult you for free. And our goal is to receive pictures from you and then spend time on the phone or in person explaining what’s going on. This is what you’re experiencing. Here are your options. Here are the caveats with those options. And then the more you learn about your body and what you’re going through and the options available, the better you’re going to be able to make that decision for the next step, and the easier and more comfortable that step will be.
Another unique thing about our clinics is we have fully transparent fixed costs. We charge $5 per graft. That is inclusive of everything, taxes, post-care, medication, surgical fees, follow up fees, all of it is looped in. And you can pay for that upfront or we have interest-free monthly payment plans. Our goal is a fixed fair rate that’s all-inclusive of everything. If you’re out-of-state, that cost actually includes transportation to our clinic here in Chicago with housing and then transportation back. No increase there either.
Our pricing is designed intentionally to be accessible. The average transplant on the west coast or the northeast runs anywhere between $15,000 to $30,000. The most expensive surgery would ever be here is around $10,000 and that’s for the largest surgery possible. We are able to keep prices low and still be hyper-profitable. We’re building the largest hair-loss clinic in the entire country in downtown Chicago right now. Don’t overpay for something just because a fancy doctor’s flexing their degrees and trying to convince you. There’s a reason that doctor has four Ferraris parked in his garage.”