1. Q. What is hair replacement surgery, and are the results really permanent?

A. Yes, happily, they really are. Hair transplant procedures rely on the genetics of hair growth. For the vast majority of people who lose their hair, a sizable portion of hair never falls out. This hair, usually above the ears and around the back of the head, is genetically encoded to grow throughout life. It is this permanently growing hair that serves as the "donor" region for hair follicles (roots) that are removed and transplanted to a thinning or bald area.

Results vary, but in most cases it is possible to get complete coverage in one or two surgical sittings of three to five hours each. Typically, the hair continues to grow independently the rest of the person's life.

2. Q. Does hair replacement surgery work for everybody or does your age or how much hair you have make a difference?

A. Contrary to popular opinion, hair loss can be a problem for both sexes and for people of almost any age. Hair transplants have been performed on men and women from 17 to 90 years old. For the procedure to be performed, some remaining hair is necessary, but that's rarely a problem, as very few people are completely bald.

All types of hair loss except one (alopecia areata) respond well to transplant surgery. People with that disorder (an autoimmune disease) can find help through cortisone injections.

3. Q. Does hair replacement surgery hurt or cause scarring?

A. There is no pain during surgery and no scarring on the top of the scalp afterwards when the operation is performed by a qualified, experienced physician. A patient has little to no down time and can return to work the following day.

One's choice of physician is very important here. If a surgeon is poorly trained or uses outdated procedures, it can cause pain, scarring, "doll's head hair" (where hair grows out of little holes in clusters) and other unfortunate consequences.

4. Q. Do hair transplants produce natural-looking hair?

A. The answer is a resounding "yes" with one caveat: the physician must be knowledgeable. A skilled doctor can design a new hairline, fill bald or thinning spots, and provide very good coverage in a minimum of sittings (usually one or two).

Using the latest breakthrough procedures, surgeons implant one to three hair follicles per insertion, creating natural-looking hair and avoiding the weird "doll's head hair" that was typical of hair plugs and transplants in years past. Unfortunately, some doctors today still create doll's head hair, and it's difficult to tell the good physicians from the poor ones merely by asking questions. Both good and bad "talk the talk" with impressive terminology. Only the good "walk the walk."

5. Q. How do I find a doctor I can trust to do the procedure?

First, avoid hair transplant companies (chain franchises that specialize in sales and hire doctors from outside to come in and do their surgeries). Such clinics provide disappointing experiences and even horror stories.

The only way to really tell if your doctor knows his business is to talk to many satisfied customers and to observe a transplant surgery for yourself. Does the doctor do hair transplants every day? If not, find a different doctor. Physicians who do three or four hair replacements a month are not qualified experts and should never be trusted to do a good job.

Any doctor who pushes gimmicks and gadgets along with or instead of a hair transplant procedure also should not be trusted.