Hair Restoration Blog

Q:

I am a 30 now and I have been losing my hair since I was 18. I started taking finasteride last year and seen great result only after taking it for only a few months. I think I may have been experiencing some side effects.  The thing is I noticed that it might have affected my erection and it takes me longer to get an erection. I know when you know you are taking a medication that has to do with your male hormone it may automatically affect your sex function negatively. So I do not know whether it is mental or real. I don’t want to stop Propecia if it is safe to continue it.

A:
You have been experiencing erectile dysfunction recently while taking Propecia (finasteride) for a year. Erectile dysfunction has been evaluated in patients who have been taking Propecia.  The incidence of erectile dysfunction is reported to be 1.3% of men who were on Propecia for one year.

The rate of erectile dysfunction was reported 0.7% among the patients who only took placebo. You can test this side effect of Propecia by stopping it for at least two weeks and see if you still have erectile dysfunction. If the erectile dysfunction goes away by discontinuing Propecia after two weeks, your problem might be a real side effect of finasteride. If you still want to continue taking Propecia despite experiencing erectile dysfunction, you may try a lower dose that can still help your hair growth without giving you any negative effects to your sexual function.

Happy New Year! Last year was a year of great accomplishments for our group, and I have a lot to share with you in this blog. We are proud to be able to continue our research in hair loss and hair restoration and be active at the medical meetings at an international level.  I am also proud that our articles were published on Hair Transplant Forum, the most prestigious journal of hair restoration surgery.

Two of our articles, Psychology of Hair Transplants and How to assess scalp laxity, were published on this journal as their cover article within the last year.  I have to appreciate Dr. William Rassman, Medical Director of the New Hair Institute, who coauthored me on those articles and also Dr. Jae Pack who helped us with the technical aspect of our invention: Laxometer.

I presented a lecture on Psycho-social impacts of hair restoration surgery on men at an annual meeting of the International Society of Hair Restoration Surgery (ISHRS), which is the most important event in the hair restoration society.  One of the medical equipment companies is working on producing the Laxometer, which was invented a year ago and was perfected within the last year.  Laxometer is a device that can help hair transplant surgeons to increase their precision in harvesting hair and making hair transplant a safer procedure for patients.

Beside our achievements in hair restoration, we have expanded our Medical Spa to be able to provide many more cosmetic needs of our patients under one roof.  Our hair restoration offices in Encino, Beverly Hills and Orange County facilitated the access of the patients to our services for residents or Southern California.  We also provided great travel packages for the patients who traveled from other states or other Countries to take advantage of our quality services.  I have to thank Niki and Rey and other medical assistants for coordinating this process and making our procedures as smooth and pleasant as possible.

Last year has been a financially challenging year for America and many other countries.  We at US Hair Restoration succeeded at reducing rates of our procedures while maintaining our high standards.  We also offered a variety of low rates and 0% interest finances for qualified patients to make our hair transplant procedures more affordable.

I am glad that I found many new friends last year, people who I personally admire for their willingness to become a better person inside and out.  I appreciate my colleagues for referring their patients and friends to us and our previous patients who could not stop bragging about their new look after the procedures that they had with us.

Have a great Holiday,
Parsa Mohebi, MD
Medical Director
US Hair Restoration and Medical Spa

Trichotillomania and Hair Transplant - Broken hair shafts are visible in microscopic evaluation of scalp

Trichotillomania (TTM) [Greek: tricho (hair), till (to pull), and mania], also called trich, is hair loss due to an impulse control disorder distinguished by the repeated urge to pull out hair of scalp, body, eyelashes, eyebrows, facial hair, nose hair or pubic hair.  Trichotillomania may result in noticeable bald spots or hairless patches.

Trichotillomania is more common during the first two decades of life with female predominance; however it could be seen in both sexes and all ages. Trichotillomania may resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual’s teenage years, but may happen at any age. Depression or stress can trigger the trich. Due to social implications, the disorder is often unreported and it is difficult to predict accurately prevalence of Trichotillomania.  It is stated that 2.5 million people in the U.S. may have TTM, with a 1% prevalence rate.

Patients with trichotillomania may live relatively normal lives.  TTM may not be known by the patients and in fact most patients deny any manipulation of the hair.  An additional psychological effect can be low self-esteem, often associated with being rejected by peers and the fear of socializing due to appearance and negative attention they may receive.  Trichotillomania can be effectively treated by habit reversal training along with a variety of psychiatric medications based on the underlying disorder.

I have recently seen a male patient with male patterned baldness in our Los Angeles hair transplant clinic who has previously undergone a hair transplant surgery in another hair transplant clinic about a year before with over 500 grafts on his crown area.  The result of the surgery that should have been completed at the time of our consult was very disappointing both to the patient and to us.  I performed a microscopic evaluation of the scalp in both the frontal and crown area.  I noticed broken hair at both frontal native hair area and crown area, which was evidence of manipulation of the hair.

Patient denied any hair pulling, but had disclosed having experienced a nervous breakdown recently.  However, he did not deny that he had been too conscious about newly implanted hair follicles after his hair transplant that might have forced him pulling most of his transplanted hair grafts.

I recommended a psychological evaluation and treatment of any underlying disorder and we decided to re-evaluate him in a few months after his psychological treatment.  I won’t recommend a hair transplant until he shows no evidence of trichotillomania for a considerable period of time.  I have previously treated a patient who has had hair loss due to trichotillomania at childhood with hair transplant, but was treated completely with no evidence of pulling hair for a long period of time.

Bakersfield, California: US Hair Restoration hair transplant clinic is soon to start its activity at the city of Bakersfield in California.  Previously in this blog we went over the article “Surgeon Restores Patients’ Hair, Self-Confidence” that was recently published in the the Beverly Hills Courier.  In the article Dr. Parsa Mohebi, medical director of US Hair Restoration discusses the modern hair transplant techniques and the innovation that a perfect hair restoration is made of with the most natural results possible.

US Hair Restoration announced the opening of its hair restoration clinic in the city of Bakersfield, CA to serve Southern California, particularly the northern cities of Los Angeles such as Sacramento and Fresno and north of the San Fernando Valley.  US Hair Restoration hair transplant clinics are also accessible and being used by the residents of Las Vegas, Nevada and Phoenix, Arizona.

From Beverly Hills Courier magazine:

We all know that nothing looks better than a full head of hair, and one of the best people to provide it is Dr. Parsa Mohebi, medical director of US Hair Restoration.

Dr. Mohebi specializes in several hair-transplant procedures:

• Follicular Unit Transplant (FUT) is the gold standard of hair-transplant surgery, Mohebi said, giving very natural results. A strip of donor scalp is removed and the follicles are prepared under microscopes and distributed in the bald area in the natural direction and orientation.
• Follicular Unit Extraction (FUE), also called non-invasive hair-restoration surgery, uses special biopsy devices to extract individual follicular units without having to remove a strip of skin; so there is no linear scar.

“Not everyone needs FUE or follicular unit extractions hair transplant” Mohebi says. “But people who want to shave their head in the future for any reason may consider FUE because there is no visible evidence of surgery on the back of their head. There’s nothing to suture, and the small dot wounds are not detectable a few days after surgery”.

Since the newly placed follicles are so fragile, patients return the next day to get their hair washed professionally, given special shampoo and taught how to take care of their hair at home. “After five days, no special care is needed,” Mohebi said.

Ten days after the surgery, patients return to have the donor site checked and staples removed for those who had them. Hair starts growing after three months, and is long enough to style and comb after ten to twelve months. The third follow up is at 10 months after the procedure.Continuing to pioneer in the field, Dr. Mohebi is the inventor of the Laxometer, a device to measure the laxity or mobility of the scalp. Laxity of the scalp is key in determining the size of the donor strip so that enough can be removed for bigger cases, and the wound can be closed without too much tension and the scaring will be minimal.

US Hair Restoration has Southern California Clinics in Encino, California, Orange County, Beverly Hills and now Bakersfield.  US Hair Restoration also offers hair transplant services in Dubai, United Arab Emirates (UAE). To help people stay abreast of all that’s happening in the field of hair restoration, and to answer questions (he’s heard from Europe and China) Dr. Mohebi maintains the hair restoration blog to answer your hair loss and hair transplant questions.

Q:
Dear sir,

I am 43 year old and I have lost my hair in top portion of my head. so I want to get advice from you that which one will be suitable for me either plantation or restoration

A:

I’m guessing you are asking about Medical Hair Restoration vs. Hair Transplant in your condition. If so, it needs to be evaluated by a hair transplant surgeon through a microscopic miniaturization study. If your hair loss is limited to your crown area and you have significant miniaturization in that area, then you might be a good candidate for medical treatment with finasteride or minoxidil. You may be able to see drastic changes within a year. However, if your hair loss evaluation is completed and you don’t have much miniaturized hair on the crown area, medical treatment of hair loss is not going to help you much and I recommend hair transplantation assuming that you have healthy donor hair.

Dear Dr Parsa Mohebi,

I have been experiencing male pattern baldness for some years now. Initially used Rogaine, it worked at first but now no longer respond to it. Next used Propecia, but had to stop due to side effects. Lasercomb failed too. I am currently saving up and considering getting a hair transplant maybe in 4 years time. I’ll have enough money by then.

There’s one thing I’m really curious about. Would you happen to know anything about Revivogen from www.revivogen.com. It’s a topical lotion combined with shampoo/conditioner that was invented by Doctor Alex Khadavi, MD, a US Board-certified dermatologist. I have a question below which I hope you can answer and shed light on.

All I just want to know before trying the product and applying the lotion to my scalp is for my “safety” concerns. If this product was developed by a dermatologist is it okay to allow myself to test it out even if it may not grow/and or stop hair loss but at least I can be rest assured it won’t cause allergic reactions on the localized surface of my scalp. Although I don’t have sensitive scalp skin, some of the things I’m scared of are like more hair loss(worse than pre-treatment) or cause unknown severe harm like scalp dermatitis/acne/burn/swolleness, stain my scalp permanently orange etc.(I’ve probably just exaggerated every side effect.May or may not true!). This is what I mean by safety. What’s the worse a topical solution like Revivogen could do to my scalp anyway? Any potential risks? Are the ingredients mentioned on the website even safe on humans?
Finally, do you believe it is safe enough and whether its worth a try for me to test out what appears to be a very safe and sound consumer product and hopefully not a scam? There’s nothing else on the market and I’m really desperate too to give it a go.

Please do feel free to take your time and answer me whenever you can. Your comments and recommendations would be very appreciated. Thanks.

Kind regards,
-

A:

It seems like you tried everything for your hair loss, but stopped them all due to either side effects or inefficiency. You are now exploring other options before you can get a hair transplant surgery. You are not alone and there are many other young men who are going through the same path.

First of all, I really like to know what kinds of side effects you experienced with finasteride (Propecia), because finasteride is an effective hair loss medication, although it has been blamed unfairly for many side effects. I put most my patients at our Los Angeles and Orange County Hair Restoration Clinics who have significant miniaturization on finasteride. Finasteride can help prevent further hair loss. Some of your hair loss might be irreversible by medication and you may need hair restoration surgery, but at least you can stop further hair loss by the time that you can restore your hair surgically. Revivogen® is a hair loss product with some natural compounds that mainly inhibit 5-Alpha-Reductase. 5-Alpha-Reductase is the enzyme that converts testosterone to dihydroxytestostrone (DHT). Prevention of DHT production can slow down hair loss in male pattern baldness.

One of the components of Revivogen is Saw Palmetto Extract, which is a DHT blocker and is used systemically for prevention of both hair loss and prostate enlargement. The efficacy of its topical product is not studied as extensively in large human experiments. Other components include a variety of fatty acids like: Gamma Linolenic acid (GLA), Alpha Linolenic acid (ALA), Linoleic Acid and Oleic Acid without strong human research on their absorption from skin level as well as their efficacy on human hair growth. Other components such as Azaleic acid, Vitamin B, Zinc, Beta-Sitosterol and Procyanidin Oligomers have shown some effects on the DHT production in labs, but the extensive studies to compare their effect with more researched medical treatments for hair loss is lacking.

The absorption level of the ingredients of Revivogen® from human scalp skin is not studied as extensively as well. I personally have not heard anything about any serious side effects of Revivogen, but I would rather have more information about long term studies, which are published in peer reviewed medical journals, before I can recommend the product to my patients. There are many hair loss products out there, which are safe, but you do not have a life time to go around and try them all to find out whether they have any effect on your hair or not.

You need to establish a good relationship with a good hair specialist that you can trust. He or she should be able to document the level of your current hair loss and miniaturization of hair and can come up with a master plan, which includes medication treatment, surgery and even cosmetic alterations that can make your hair look better. Side effects of the medications that you tried before need to be re-evaluated closely by your doctor.

You don’t want to deprive yourself from effective, FDA approved hair loss medications that their safety and efficacy are confirmed in scientific studies and instead start looking around to see what else is in the market. If you have no alternatives, your doctor may have some suggestions for your individual condition to preserve whatever hair you have with a product with minimal side effects.

Q:

I was diagnosed with Alopecia and lost pretty much all of my hair during pregnancy. My son is now 5 months old and my hair has grown back. All but one spot. I can hide it but I would love for one day not to have to hide it.

A:

Dear Mo,

You have experienced extensive alopecia (I am assuming that you mean alopecia areata) and now only after a few months got your hair back except for a small patch. This is a pretty good recovery for a condition that could have had a much worse outcome. My suggestion to you is to hang in there. It is very likely that you can grow the rest of your hair back without any treatment. If your hair loss is due to alopecia areata, a hair transplant can not help your condition.  You need to be seen and examined by a hair specialist or a dermatologist to best confirm the diagnosis.

Best of luck to you.

Dr. Mohebi,

These eyebrows deserve your attention!

It is Friday evening and we are finishing a large FUE (follicular unit extraction) case in our Encino, California hair transplant clinic.  I was going over my letters and I found this picture that was sent from one of my patients. My patient has such a great sense of humor. He recently had an eyebrow hair transplant procedure with us.  I found this letter amusing and I wanted to share it with the readers of our hair restoration blog.

Q:

Dear Dr. Mohebi,

Hello, I am really interested in doing hair transplant by you, as my friends in California highly recommended you. I wonder if you can please help me with this questions:

1. Which method would you recommend, FUT or FIT?
2. I have had Alopecia areata in the past in back part of my head. It happened several times, last time 3 years ago. I wonder how it will affect my chance for doing hair transplant. I really appreciate if you can please answer me in details.

Thank you so much for your attention and time.

Sincerely,
S T

A:

Thanks for you interest in our hair restoration services.  I will answer your questions in the order they were received:

1. Follicular Unit Transplantation (FUT) is the gold standard method in doing hair restoration. FUT is done in two methods 1. strip technique and 2. Follicular unit extraction (FUE, also called FIT).  It has to do with your goals in hair restoration and you can read more about advantages and disadvantages of FUE in my hair restoration blog.  Planning on doing one vs. the other needs to be discussed with the patient during the initial consultation.
2. Alopecia areata (AA) is an autoimmune disorder and usually a reversible condition in which a patient loses hair in a patchy fashion.  It affects transplanted hair the same as normal hair.  I generally make sure that patients don’t have active AA before proceeding with hair transplant.  A physical examination is extremely important in differentiating between male patterned baldness and diffuse alopecia areata (a rare type of alopecia areata).  In undiagnosed cases of alopecia areata, if a patient gets a transplant in the balding area that hair is lost due to AA, there is a risk that patient will lose the transplanted hair with the same mechanism.

Today, I was following the trend that people usually search online for “hair transplant”.  I noticed hair transplant cost, hair transplant costs, cost of hair transplant are among the most popular phrasess that are used in online search by people who are trying to educate themselves on hair restoration and what is involved including the cost of hair transplatn or hair restoration cost or costs in a hair restoration procedure.  There are many people who try to get the best value their mony can buy and some people are cheap shopping.  I don’t mind finding the chipest product when I am shopping for the same brand that I usually buy at a dicounted rate.  However, when it comes to the cost of hair restoration, I don’t recommend finding a hair transplant surgeon merely based on the price of hair restorations.

Affordable hair transplant surgeries or other promotional phrases such as discounted hair transplants, $1 per hair, low cost hair transplants could be found everywhere, however when it comes to hair transplant, it should be more of a value shopping rather than price shopping.  Remember that you are buying something that is going to stay with you for the rest of your life.

I perform quite a few hair transplant repair procedures every months.  Some of the patients who go through reapire srugery are the ones who had their hair transplantation years ago, before the era of follicular unit transplants, but unforturantely a large nubmer of these patients had their hair restoration surgeries in the last few years.  They either never received the number of grafts that they were promised and end up with less than optimal coverage due to technical problems or got problem with the artistic design of the hairline or issues with distribution of the hair on the balding area.

Among hair transplatn surgeons some charge more due the name, brand and the location.  You have probably seen the signs that says Beverly Hills Hair Trasnplatn Surgeon.  Some of the older hair transplatn doctors could not keep up with the new techniques, they do not participate in scientific meetings for hair restoration surgery and are simply not aware of what is the gold standard in hair transplantation.  Having said that, I do now some of the the pioneers in hair restoration that are always ahead of their time and are involved in hair transpalnt research and development.  One good example is Dr. William Rassman whom I had previlage of working with closely.  He is capable of providing quality hair restorations utilizing the new techniques while using his years of experience in the field of hair restoration.

In conclusion, it all comes to the patients who need to realize what he is getting is a procedure that produces permanent changes and they better off doing it right the first time and don’t risk getting a less than optimal hair restoration with lesss than best cosmetic appearance.  The procedures that will need repair hair transplant in the future.  Whether you are in Los angeles or elsewhere, you need to do your homework to find the best hair transplant surgeon and even after that know what kind of questions to ask from your hair transplant doctor.

Hair transpalnt cost is importatnt and is a determinig factor for some people, but you should not make your decision based on the cost and affordability in your hair transplant surgeon search.  That is why I deliberately avoided explaining about hair transplant cost in Southern California hair transplant centers of US Hair Restoration in this article, which is titled “hair transplant cost in Los Angeles”.