Dr. Cam Simmons Canadian Hair Transplant Centre in Toronto, Ontario
Youve noticed the early signs of hair loss and
youre looking for options. Since a hair transplant is permenant you want someone you can trust
a leading expert in hair restoration surgery with a
stellar reputation for providing outstanding results, someone who puts your interests first.
Welcome to the Canadian Hair Transplant Centre in Toronto Ontario,
founded by Dr. Cam Simmons.
Since 1999, Dr. Simmons has been at the forefront of Hair
Transplant Surgery at the Canadian Hair Transplant Centre. With over 3,800 hair restoration
surgical procedures to his name, and an extensive background in family
and emergency medicine, he believes that a hair transplantation, when
performed by an experience doctor with precision and artistry, can do wonders for a
persons appearance, wellbeing and self esteem.
And he should know because he's not just the doctor, he's also a patient, Dr. Simmons would have been bald without his own surgical hair restoration intervention. So when he talks about the
difference the procedure can make, and how much hair restoration surgery has improved in the last decade, he speaks from his own personal experience.
Dr. Simmons is passionate about making sure that every hair transplant he performs leads to outstanding, undetectable results for his patients. To learn more about how we can help you with your hair loss challenges please feel free to call Gina, our friendly receptionist at 415-924-2482 for a free and discreet consultation, or use our contact page to arrange a personal consultation to learn about how our hair loss treatments can help you.
1. Why is Hair Important?
The psychological importance of hair is significant in many cultures worldwide1. Most of us have a personal or emotional connection to our hair and we appreciate that it can positively and negatively influence our appearance and quality of life.
It can be utilized as a means of social communication or to identify with a particular group or create a unique identity2. Socio-cultural studies have found that hair is important for recognition and determining whether another individual is physically attractive3. The state of our hair can respond to psycho-emotional stress4 and potentially even auditory (sound) stress5 suggesting a direct link between the brain and hair.
Unfortunately, those with alopecia (the medical term for visible hair loss) are at higher risk of developing depression and anxiety6. Certain cultural behaviours focus on hair and its loss as symbolic. For example military recruits are customarily “encouraged” to shave their heads, indicating removal of individuality as they assimilate with their new social group1. From a physiological viewpoint hair protects our scalp from potentially harmful ultraviolet rays, helps to retain body heat, and responds to biological signaling pathways7.
2. What is Pattern Baldness
Because hair supports our psychological and physiological well-being the importance of finding effective therapies for hair loss cannot be understated. There are several ways in which hair loss occurs, but for many affected individuals, male and female, androgenetic alopecia (AGA) is responsible. AGA is a polygenic disorder which predisposes the individual to gradual or progressive hair loss, diminished size of terminal hair follicles, decreased thickness of hair strands and shortening of hair growth cycles in affected areas8,9.
Individuals with this genetic condition will notice hair shedding (also termed effluvium) and less dense hair in specific locations on their scalp, usually at an early age (near puberty)7. For most males affected by AGA an androgen protein receptor is altered which changes the sensitivity of hair follicles to androgen, inhibiting growth7,10. Balding areas also contain more androgen receptors than nonbalding areas making them more genetically susceptible to AGA11. In addition, the enzyme 5α-reductase, which converts the hormone testosterone to dihydrotestosterone or DHT, is increased in AGA susceptible regions12.
There is no connection between lifestyle and this specific ailment, and it is not directly dangerous to physical health. It is essential for those beginning to notice consistent hair loss or receding hairlines to have an accurate diagnosis of cause prior to looking for treatment, as this depends on your specific situation and medical background. In addition, for many of the treatments detailed here it is imperative to begin as early as safely possible in order to increase the efficacy or usefulness of the therapy.
3. Finastride Propecia
One of the most commonly used non-surgical treatments of androgenetic alopecia is medication. Finasteride (the active ingredient in the brand Propecia) tackles the problem of hair loss by reducing the amount of DHT (dihydrotestosterone) in your bloodstream that causes miniaturization of the hair follicle and classical symptoms of alopecia.
The drug blocks activity of 5α-reductase which is responsible for converting testosterone into DHT. The efficacy of finasteride in reducing further hair loss and enhancing hair growth is well-established in men13,14. There is poor evidence that finasteride positively affects hair growth in women, partly because finasteride is classified as a teratogen (i.e. it can disturb the development of an embryo or fetus) thus not recommended for the majority of women15.
This medication is prescribed by a doctor and offered as an oral daily dose. Unfortunately it is not a permanent cure and must be taken continuously to see positive results. If treatment is stopped, any progress toward hair re-growth will halt and hair loss will resume as prior to treatment. Potentially detrimental side effects of this medication include sexual dysfunction and depression; however, the published reports are conflicting.
The second medication use to treat AGA is minoxidil. Minoxidil was accidentally discovered to positively influence hair growth when patients taking the drug for hypertension (high blood pressure) reported unwanted hair growth as a side effect16. Its molecular action for hypertension involves vasodilation or expansion of arteries to promote potassium channel use and decrease blood pressure. For the treatment of hair loss its function is likely mediated by increasing blood flow to the scalp via potassium channels opening, allowing growth factors already in the blood to more often reach the hair follicles to stimulate growth17.
The efficacy of this drug for hair growth is supported by many clinical research trials13. Minoxidil solution or foam is applied directly to the scalp 1-2 times daily as opposed to in oral form due to its ability to decrease blood pressure and increase water retention in normally healthy people. The treatment is simple and cost-effective, but therapy should be started in the early stages of AGA to be most effective and continuous use is necessary for long-term results.
The most concerning adverse effects of this topical therapy, especially the alcohol-based formulation, are contact dermatitis (redness and irritation in the specific location where the lotion/cream/foam contacts the skin) and abnormal hair growth in areas other than the scalp (also termed hypertrichosis). Allergic reactions may occur in response to ingredients in the solution, but rarely to the drug specifically18. With the foam formulation, application site reactions are less likely in the absence of the alcohol base. Noticeable hair shedding upon initial treatment is temporary as the dormant hair follicles “wake up”.
5. Low Level Laser Therapy (LLLT)
If medications are not suited to your lifestyle or health, there are non-drug non-surgical options that may be effective. In recent years lasers and light sources have been suggested for the treatment of hair loss based on observations of hair growth in mice exposed to certain wavelengths of light in a laboratory setting19.
The molecular basis for hair growth in response to light is not clearly established; it may be linked to increased blood flow, growth factors and a specific energy molecule that all stimulate the hair cycle20. The efficacy of low level laser therapy (LLLT) is not supported as well in the literature as finasteride or minoxidil, but the few published studies on the effectiveness of LLLT have reported statistically significant growth compared to placebo light devices21.
The treatment is painless and there are few adverse effects, but therapy requires several minutes spent under direct contact with the light source daily or weekly for several months in order to observe a noticeable difference. It is also unknown if these variables are dependent on the hair characteristics of the patient.
6. Platelet-rich Plasma (PRP)
Regenerative medicine is currently a booming field with many on-going clinical trials aiming to support its use in regenerating hair and skin. These treatment methods appeal to those who are averse to drugs and surgical options. One of the most recently well studied regenerative treatments for alopecia is platelet-rich plasma or PRP.
Because the treatment is prepared from the patient’s own source of platelets (i.e. a blood sample) immunogenic reactions are significantly reduced. Blood is removed from the patient, and platelets, along with specific molecules associated with them, are separated from the rest of the sample and concentrated to prepare the treatment.
After injection of PRP into the affected scalp areas, specific growth factors in the preparation are proposed to stimulate hair initiation and extension phases while promoting vascularization. The injection is relatively painless and the effects of a single treatment can last for up to several weeks.
7. Surgical Treatment of pattern Baldness
For some people who are already experiencing mild to severe progressive baldness, pharmacological treatments (i.e. finasteride or minoxidil) and/or other alternatives (platelet-rich plasma preparations) are not enough to induce sufficient hair growth to visibly improve their overall appearance or positively affect their quality of life. These individuals may benefit from hair transplantation because it creates a more permanent solution to hair loss with more dense hair in balding areas and it can be performed in the later stages of AGA. In a randomized controlled experiment, it was determined that those who underwent hair transplantation as a treatment for androgenetic alopecia were perceived as younger, more attractive, more successful and more approachable, compared to their appearance before the hair transplant, by unbiased observers22. In addition, hair transplantations are not as complicated or as unsafe as once perceived. There are many highly qualified surgeons with reputable track records of success in the field in many areas of the world including Canada. Before deciding if hair transplantation is the right decision for your specific condition it is important to speak to a hair transplant expert directly while self-educating yourself on all aspects of the procedure.
For those with androgenetic alopecia, the molecular mechanism of hair transplantation is based on the principle that hair follicles in the donor area (or “safe donor area”, SDA) deemed “permanent” will retain their “permanent” growth properties after they are transplanted to a new recipient location even if it is currently experiencing hair loss18. In this way transplanted hair will continue to grow despite its new location in a non-permanent site. All hair transplantations require at least two steps: harvesting or removal of living hair strands from one’s own head (or body) and implantation of these strands into a recipient location. In more detail, harvesting involves the removal of individual hair strands (termed follicles) or groups of hair strands (termed follicular units of 2-4 hair follicles) from a safe donor area (SDA) of your scalp where hairs are more dense and permanent (i.e. hair loss in this area is rare). This region corresponds to a horizontal strip on the back of your head, approximately where the back of a baseball cap would lie.
Two well-practiced harvesting techniques are follicular unit transplantation and follicular unit extraction. Follicular unit transplantation (FUT), strip surgery or strip harvesting has been the “tried and true” preference of hair transplant surgeons since its inception in 199523. Hair transplant surgeons are well-acquainted with the procedure and the possible complications. The method involves making incisions to the back of the head along the SDA to remove a piece of donor hair scalp. The process is accompanied by anesthetics to dull pain and rarely do complications arise as long as experienced and knowledgeable practitioners perform the entire procedure. The surgeon then sutures the resulting linear wound by at the edges of the incision. Technicians view the individual hair follicles or units using magnification and special lighting24. Surgical dissecting tools are used to dissect the hair follicles with precision. The other harvesting method of follicular unit extraction (FUE) does not involve excision of a strip and instead small (~1 mm) hollow metal tubes called punches are used to pierce the skin and tissue around a follicular unit to directly pull the hair(s) from the scalp. This process also uses local anesthetics so pain is masked. The resulting hair grafts from both procedures are then carefully implanted into tiny incisions in the recipient hair areas in an aesthetically pleasing manner using implantation tools. FUE surgeons who are well-practiced and knowledgeable about the procedure produce successful hair transplants similar to FUT.
Hair transplant surgeons will typically prefer one procedure over the other; however, most recognize the usefulness of both. Thus it is critical to understand the characteristics that define both options, since they can both be used for different situations. One way to do this is by examining the features of each procedure with certain categories from the viewpoint of the practitioner and the patient.
- Medical Risks – Both procedures risk infection of the scalp and hair follicles, such as folliculitis25,26. In rare instances, temporary numbness of the donor area may also occur after either procedure. A strip harvesting patient may have to rest longer compared after the procedure compared to an FUE patient. Temporary post-operative telogen effluvium, also known as hair shedding, caused by the physiological trauma of hair transplantation has been reported27.
- Scarring – There is a similar risk of scarring for both procedures. This is more obvious for FUT as the excision creates a linear scar along the back of the scalp. Depending on the healing nature of the patient and other factors such as the surgical technique used to close the wound this can appear quite striking, especially for those who choose to wear shorter hair. FUE scars are quite small and spread out over the donor area, so their appearance is hidden with long and short hairstyles.
- Donor Depletion – For a successful hair transplant, surgeons attempt to maximize hair restoration, and also minimize the amount of the hair removed from the safe donor area or SDA. Strips should be limited in size and location on the scalp, and individual FUE grafts should be limited in number and focused within the SDA to avoid this phenomenon. Patient circumstances may allow for deviations from this strategy with respect to FUE; however, a knowledgeable physician must base this on a long-term hair restoration strategy. In addition, multiple hair transplants can deplete the donor zone further so physicians must devise long-term plans based on patient needs and hair attributes when considering hair transplantation.
- Transaction Rates – When hair follicles or groups of follicles termed follicular units are excised from the scalp, they are called grafts. Graft excision requires expert surgical skill. In either procedure, accidental cutting of the hair shaft can lead to grafts that are essentially wasted, as they are unlikely to survive after being implanted in the recipient donor site. Hair transplant surgeons aim for low transaction rates, a measure of how many extracted grafts are accidentally cut. Strip transaction rates are typically lower than FUE because the technicians can remove hair follicles from the donor strip without the limitations of it being attached to the patient. They use three-dimensional microscopes, specific lighting and surgical tools to select and excise grafts, allowing for enhanced accuracy.
- Grafts – Hair transplant experts usually agree that the number of grafts per comparable sessions of these two harvesting procedures is greater with strip surgery, although this is based on several variables. There are also different physical properties belonging to grafts from strip surgery and FUE. It is not known if these differences affect their survival and growth in the recipient site. Grafts excised from the strip contain more tissue around the follicles compared to grafts punched from the scalp. In practice, grafts excised from FUE must be handled delicately as they are susceptible to dehydration and breakage due to lack of supporting tissue.
- Donor Area Shaving – Strip surgery can be performed on a patient with any length of hair. Only the area marked for strip excision must be shaved. FUE often requires full shaving of the head, particularly if an extensive transplant is scheduled. A technique called the unshaven method provides an option to those patients wanting to keep their hair long but choose the FUE procedure. Only sections where FUE is to be performed are shaved while the remainder of the hair is kept long.
- Combination strip/FUE – For a large amount of grafts (i.e. for a situation where the patient has severe hair loss and extended bald areas), a combination of strip and FUE may benefit situation. As the technique suggests, strip surgery is performed in addition to FUE on either side of the strip. This procedure can maximize the number of grafts produced per comparable session; however, you will need to find an experienced surgeon who can perform this technique well as it has its own challenges.
- FUE Considerations – The FUE procedure has its own challenges and benefits. FUE can be used to supply donor hair from non-scalp regions such as beard and torso hair, which is particularly useful for those with diminished donor hair. FUE is also best to repair unsuccessful hair transplants or other hair restoration procedures. It can also be used to strategically camouflage scars, including strip scars. The challenges of FUE are largely due to lack of knowledge and talent of the practitioner and incorrect selection or use of specific FUE instruments. It should also be noted that FUE is a difficult technique to learn and can be demanding of the expert’s time and physical ability.
8. Hair Transplant Self Evaluation
9. Medical References
- Cash TF. The psychosocial consequences of androgenetic alopecia: a review of the research literature. British Journal of Dermatology. 1999 Sep 1;141(3):398–405.
- Morris D. Bodywatching: a Field Guide to the Human Species. New York: Crown; 1985.
- Terry RI. Further evidence on components of facial attractiveness. Percept Mot Skills. 1977;45:130.
- Katsarou-Katsari A, Singh LK, Theoharides TC. Alopecia areata and affected skin CRH receptor upregulation induced by acute emotional stress. Dermatology (Basel). 2001;203(2):157–61.
- Arck PC, Handjiski B, Peters EMJ, Peter AS, Hagen E, Fischer A, et al. Stress inhibits hair growth in mice by induction of premature catagen development and deleterious perifollicular inflammatory events via neuropeptide substance P-dependent pathways. Am J Pathol. 2003 Mar;162(3):803–14.
- Williamson D, Gonzalez M, Finlay AY. The effect of hair loss on quality of life. J Eur Acad Dermatol Venereol. 2001 Mar;15(2):137–9.
- Wolff H, Fischer TW, Blume-Peytavi U. The Diagnosis and Treatment of Hair and Scalp Diseases. Dtsch Arztebl Int. 2016 May;113(21):377–86.
- Blume-Peytavi U, Blumeyer A, Tosti A, Finner A, Marmol V, Trakatelli M, et al. S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents. Br J Dermatol. 2011 Jan;164(1):5–15.
- Birch MP, Messenger AG. Genetic factors predispose to balding and non-balding in men. Eur J Dermatol. 2001 Aug;11(4):309–14.
- Heilmann S, Brockschmidt FF, Hillmer AM, Hanneken S, Eigelshoven S, Ludwig KU, et al. Evidence for a polygenic contribution to androgenetic alopecia. Br J Dermatol. 2013 Oct;169(4):927–30.
- Hibberts NA, Howell AE, Randall VA. Balding hair follicle dermal papilla cells contain higher levels of androgen receptors than those from non-balding scalp. J Endocrinol. 1998 Jan;156(1):59–65.
- Crabtree JS, Kilbourne EJ, Peano BJ, Chippari S, Kenney T, McNally C, et al. A mouse model of androgenetic alopecia. Endocrinology. 2010 May;151(5):2373–80.
- Gupta AK, Charrette A. The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride. J Dermatolog Treat. 2014 Apr;25(2):156–61.
- Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G. Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review. Arch Dermatol. 2010 Oct;146(10):1141–50.
- Bowman CJ, Barlow NJ, Turner KJ, Wallace DG, Foster PMD. Effects of in utero exposure to finasteride on androgen-dependent reproductive development in the male rat. Toxicol Sci. 2003 Aug;74(2):393–406.
- Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. Journal of the American Academy of Dermatology. 2008 Oct;59(4):547–66.
- Rossi A, Cantisani C, Melis L, Iorio A, Scali E, Calvieri S. Minoxidil use in dermatology, side effects and recent patents. Recent Pat Inflamm Allergy Drug Discov. 2012 May;6(2):130–6.
- Kelly Y, Blanco A, Tosti A. Androgenetic Alopecia: An Update of Treatment Options. Drugs. 2016;76(14):1349–64.
- Khidhir KG, Woodward DF, Farjo NP, Farjo BK, Tang ES, Wang JW, et al. The prostamide-related glaucoma therapy, bimatoprost, offers a novel approach for treating scalp alopecias. The FASEB Journal. 2013 Feb;27(2):557–67.
- Oron U, Ilic S, DeTaboada L, Streeter J. Ga-As (808-nm) laser irradiation enhances ATP production in human neuronal cells in culture. Photomedicine and Laser Surgery. 2007;25:180–2.
- Afifi L, Maranda EL, Zarei M, Delcanto GM, Falto-Aizpurua L, Kluijfhout WP, et al. Low-level laser therapy as a treatment for androgenetic alopecia. Lasers in Surgery and Medicine. 2017;49(1):27–39.
- Bater KL, Ishii M, Joseph A, Su P, Nellis J, Ishii LE. Perception of Hair Transplant for Androgenetic Alopecia. JAMA Facial Plast Surg. 2016 Aug 25;
- Bernstein RM, Rassman WR. Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatologic Surgery. 1997 Sep 1;23(9):771–84.
- Parsley WM. Follicular Unit Instrumentation. In: Haber RS, Stough DB, editors. Hair Transplantation. Elsevier Saunders; 2006. p. 105.
- True RH. Strip versus FUE Considerations. In: Lam SM, Williams KL, editors. Hair Transplant 360: Volume 4: Follicular Unit Extraction. Jaypee Brothers Medical Publishers (P) Ltd; 2015. p. 121–31.
- Lam SM. Complications in Hair Restoration. Facial Plastic Surgery Clinics of North America. 2013 Nov 1;21(4):675–80.
- Loh S-H, Lew B-L, Sim W-Y. Localized Telogen Effluvium Following Hair Transplantation. Ann Dermatol. 2018 Apr;30(2):214–7.
Meet your doctor
Dr. Cam Simmons, founder and medical director of the Canadian Hair Transplant Centre in Toronto, has performed more than 3,800 hair replacement procedures since 1999. He is a recommended physician in the Hair Transplant Network and is the only recommended physician in Toronto in the Independent Coalition of Hair Restoration Physicians.
Dr. Cam Simmons
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Dr. Cam Simmons is a recommended physician
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Canadian Hair Transplant Centre proudly provides Hair
Transplant and Surgical Hair Restoration services to the
following great Ontario cities:
Ajax, Barrie, Belleville, Bolton, Bracebridge, Brampton,
Burlington, Cobourg, Gravehurst, Grimsby, Guelph, Hamilton,
Kingston, Kitchener, London, Markham, Milton, Mississauga,
Niagara Falls, North Bay, Oakville, Orillia, Oshawa, Pickering,
Richmond Hill, St. Catharines, Stoney Creek, Sudbury, Thornhill,
Trenton, Vaughan, Waterloo, and Whitby.
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