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 are received.

1. Follicular Unit Transplantation (FUT) is the gold standard method in doing hair restoration now.  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 in doing one vs. the other needs to be discussed with patient during the initial consultation.
2. Alopecia areata (AA) is an autoimmune and usually reversible condition that 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.  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 patient gets transplant in the balding area that hair is lost due to AA, there is a risk that patient lose transplanted hair with the same mechanism.

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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”.

Dear Dr. Mohebi:

Hello, my name is KT I am a chemistry student at Kwansei Gakuin University in Japan.
I found your email address on the ISHRS website. I am doing research on solving hair loss, and I wonder if you might be able to help me. I noticed on your website that you are working with hair loss, so it seems you have knowledge about these issues. I know you must be very busy, but I hope you do not mind if I ask you a question.

In your research and in your opinion, do you think that the biggest cause of hair loss is inheritance?
Thank you very much for your time and attention to my question. I hope to hear from you at your convenience, and I am grateful for your assistance with my research. Thank you once again, and have a nice day.

Sincerely,

KT
Kwansei Gakuin University
Japan

A:

You are right about inheritance and hair loss as male patterned baldness is concerned.  When you are a man (have testosterone) so your body can make DHT (dihydroxy testosterone) and are genetically prone to male patterned hair loss, you have two of the three sides of the balding triangle.  You only need the third side which is time to force the other two factors to work on your hair and cause miniaturization of hair and have them fall out.  Considering that men have testosterone, genetics become the most important factor in men who experience male patterned baldness.

Dear doctor,

I am a 38 old married woman from Bangalore. I have 2 children (13 years daughter and 9 years son) . I was having alopecia areata problem since I was 10 years old. But I used to get hair back in a year. Like this, hair was falling and getting back was happened 3-4 times. But hair was very lengthy and very beautiful when I got married. After that during second pregnancy I started loosing hair.

After delivery I lost all my hair and became bald including eyebrows, eyelashes and body hair.I was very lean. I took Allopathy medicines in kurnool(AP) like steroids. I got my hair back and became fat. I stopped the medicines gradually as per doctor’s advice. I lost my hair again after stopping medicines. After that I tried homeopathy(Bathra’s) and ayurvedic. No use by these. After that I have tried intra regional steriods(injections). I can see a few hair,but if I stop medicines, they started falling again.

1 year back I got affected with Chikun Gunya. I met rheumatologist in Bangalore. He again suggested some steroids(wysolone) and Azoran(immunosuppresents) for both severe leg pains and alopecia universalis. I have seen a very good progress and got hair back. But those new hairs are very soft and not strong. He reduced the dose of Wysolone(1/2 of 5 mg) and maintaining the azoran -50mg 3 tabs per day. After reducing wysolone again  I am getting so many bald patches.

I recently met my doctor and he again increased the dose of wysolone to 10 mg. I think this is neverending process. I have almost lost the hope and fed up with all these tests, treatments and side effects and unnecessary spending of money. I was very lean and my weight was 50 kgs at the time of second delivery.

Now I am 85 kgs.I am fighting with this desease  since 10 years. Presently I am using the medicines suggested by rhemotologist.I am having brittling nails and will get headache some times. Every 2 months once I will take blood and urine tests before consulting doctor. The reports are showing more ESR. No other problems for now. I have taken thyroid test and found hypothyroidism. Now taking thyroxin tablets for that.
Family background: My mother is having Diabetes and Thyroid problems.

Please suggest any permanent solution for my problem. Please help me out of this problem…..

Thanks

A:
Alopecia Areata or its more aggressive alopecia universalis, in which patients experience whole body hair loss, is an autoimmune disorder. Autoimmune reaction is an abnormal response from the immune system that attacks certain organs or cell lines and causes malfunction on that system.  In alopecia areata (AA), patients may have involvement of some other body organs such as thyroid disease or other appendages of skin such as nails and hair.

It seems like your alopecia areata was activated by pregnancy and led you to get alopecia universalis. A precipitating factor can be found in 15.1% of patients with alopecia areata and include major life events, febrile illnesses, drugs, pregnancy or trauma but no clear conclusions can be drawn. Despite these findings, most patients with alopecia areata do not report a triggering factor preceding episodes of hair loss.

Your thyroid disease could be part of the same autoimmune disorder that affected your hair and skin.  Eight percent of people with alopecia areata have thyroid disease; this is higher than the incidence of thyroid disease in the general population which is 2%. Despite the correlation between alopecia areata and thyroid disease, treating the thyroid disease does not generally remedy the alopecia areata.

The outcome of alopecia areata is unpredictable. Some people lose hair in only small patches. Others may have more extensive involvement like you. Alopecia capitis or alopecia totalis is the loss of 100% of your scalp hair and alopecia universalis is the loss of 100% of body hair. These last two conditions are rare and more difficult to treat. In the majority of patients with smaller involvements of alopecia areata, the hair will re-grow completely within about 1 year without any treatment.

More serious involvements need to be closely followed by a dermatologist or a rheumatologist. Treatment might not be permanent and complete.  If immunal-suppressive treatments are being used, close monitoring to the treatment and correcting the course of treatment based on the initial response is the key to the following treatments.

“Formation of Hair Structures Suitable for Implantation” is the title of a newly published article from Intercytex. Hair multiplication, also known as hair cloning, has been discussed in our Hair Restoration Blog in many of our past posts and has been the subject of many studies in the past. Intercytex is one of the companies that have been reporting some progress in different levels of the study and have reported that they have finished phase II and are starting phase III of this study.

Their studies have shown that hair multiplication by hair culturing has been successful in animals and it is now being studied on humans. The following article tries to elucidate the process of hair multiplication on laboratory animals that have already been released.

The aim of the study was “to develop a construct through which implanted follicular cells will efficiently cause hair regeneration for the treatment of androgenetic alopecia.” They used follicular dermal and epidermal cells isolated from embryonic mouse skin which were formed into aggregates.

The aggregates were incubated in lab in culture for five to seven days and then implanted inside the skin into athymic mice, which does not have the capability of rejecting foreign tissue. They observed that during culturing, mixed cell aggregates developed into hair-like structures, termed “proto-hairs.” Proto-hairs contained structures that resembled normal hair components, such as dermal papillae, hair matrix and rudimentary hair shafts.

When implanted into mouse skin, they developed further into mature hair follicles capable of prolonged growth. The authors concluded that mixed aggregates of murine follicular cells have the ability to develop while in culture into proto-hairs that retain the ability to fully develop into hair follicles after implantation.

Proto-hairs from human hair stem cells could provide a convenient and practical means by which follicular cells could be implanted for efficient hair regeneration to treat hair loss. Although the study does not add to what we knew before, it elucidates the process of work for the other scientists who follow on the progress of hair multiplication (cloning) research.

We at US Hair Restoration California offices follow the progress of hair multiplication studies closely.  We are also involved in some hair multiplication studies and the results will be released when completed.

Last month I had an interesting patient who had one sided hair loss. He was visiting me for treatment of his male patterned hair loss and eyebrow hair loss. He also had patchy hair loss on the back of his donor area of scalp that had been bothering him for a long time. His eyebrow hair loss was more pronounced on one side. During his examination, he was pointing out his hair eyebrow hair loss which was more prominent on one side. During the examination of the other parts of his body, I noticed hair loss on one side of his body that was quite distinguished primarily on his legs and eyebrows.

Unilateral balding, or one sided hair loss, is rarely reported in medical literature.  There is a report of a rare medical syndrome in which patients experienced alopecia as part of the presentation of the syndrome. The condition is called Satoyoshi syndrome in which patients may have a slowly progressive disorder of unknown etiology with a poor long-term prognosis.

The syndrome consists of the following clinical features: (1) painful, intermittent muscle spasms; (2) alopecia or hair loss; (3) diarrhea; and (4) skeletal abnormalities. The reported age of onset is typically less than 20 years of age, but three adult onset cases have also been reported. There has been only one sided report of Satoyoshi syndrome so far.  Our patient did not recall the other manifestations of his condition in the past, but did have one sided hair loss on his eyebrow and lower extremities.

Good morning, Dr. Mohebi.  I wanted to update you on my doctor’s visit.  All lab results, including the ones you suggested, are normal.  I have noticed a decrease in hair loss over the past few days, but it is still occurring.  Is there a possibility that stress would cause hair loss for 2.5 months?  I was wondering what my next step should be.  Is there other medicinal treatments besides Rogaine?  Also, I read that pregnant women should not use Rogaine.  Is this true?  I was planning to have a child within the next couple of years.  Your expertise is greatly appreciated.

Thank you
A:

Thanks for the update,

Stress can definitely increase the speed of hair loss. In women who are not genetically prone to balding, stress can only force hair follicles to enter the resting phase (telogen). In this case, the hair follicle is in its resting phase, but is capable of growing another hair in a few weeks. However if you are prone to typical women hair loss or female patterned alopecia the loss of hair due to stress can be irreversible.

At this time there is no other FDA approved medication that can be used for treatment of female hair loss and, unfortunately, pregnant women cannot take Rogaine because of its effects on the fetus. On a more positive note, there are some hormonal changes during pregnancy that can potentially protect vulnerable hair and might be able to compensate for Rogaine withdrawal to some degrees in women who stop using Rogaine during pregnancy as well.

Respected sir,

I am XX from India, age 23 male. My problems are that I don’t have complete baldness problem. like before my hair growth was very good nice curly hair thick hair and I don’t have genetic hair baldness because my father age is 51 he has got normal hair .my problems is that the growth, thickness, hair fall and like more hair I hope u understand  this thing r missing . One more reason is that I have tension .well I don’t used more shampoo or any chemical but some time I used hair gel and that also I stop .so please tell what the cure or any vitamins  please help me out .

A:

Hi there,

Age 23 is the time that most people with male pattern hair loss start seeing some degrees of baldness. You did also mention that your father is not bald. Although it could be related to men’s hair loss in its typical form or male patterned alopecia is a genetic condition, many people may not find baldness in their immediate relatives. In other words, the gene expression for hair loss may skip some generations. A small group of men with hair loss may suffer from other types of hair loss such as alopecia areata, cicatricial alopecia or other rare balding conditions.

You need to see a good hair specialist who can examine your hair and come up with an accurate diagnosis for your hair loss condition before you can start on any hair loss medication or treatment. I generally spend around one hour with every new patient to evaluate the hair loss and to come up with a proper treatment plan in our California hair transplant centers. Most shampoos, conditioners, lotions or vitamins that are extensively marketed for hair loss do not really help stop the hair loss or re-grow hair. If you have male patterned baldness, there are some medications that can stop your hair loss. You may as well need a hair transplant to restore the hair that cannot be restored by means of medical treatment.

This is another article from Dr. Mohebi that is recently published on the cover of the Hair Transplant Forum International: the journal of the International Society of Hair Restoration Surgery.

The laxometer was invented by Dr. Parsa Mohebi two years ago. Laxometer is a device that is used to measure the mobility of scalp skin, which is a crucial piece of information for hair transplant surgeons before hair restoration surgery with strip method.

Evaluation of scalp laxity prior to hair transplant procedures has been a clinical subjective evaluation that varies with each surgeon and each visit. Hair transplant surgeons have been traditionally assessing the laxity of the scalp with manual palpation of the donor area and by moving the scalp horizontally or vertically, estimating the scalp movement against the occipital bone.

Measurements have been recorded with subjective term such as very loose, moderately loose, average, moderately tight, and severely tight. With the use of the laxometer we are provided a more precise metric for use in hair transplant surgery.  You can read the full article “How to assess scalp laxity” on US Hair Restoration Website.

Hello,

I underwent surgery in mid-October and remember well the directive to keep the sun off my head. My question is whether I can use a tanning bed without damage or threat of damage to the transplant area if a use a bandana.

You have had your hair transplant for about two weeks now and you were wondering whether or not a tanning bed can damage your newly transplanted hair implants. What we generally recommend to our patients after hair transplant surgery at US Hair Restoration is to avoid sun exposure to the transplanted areas of the head for at least 6 months after their hair transplants. Sun exposure can slow down or stop the growth of normal, existing hair or even damage the hair follicles. The same issue may be seen with newly transplanted hair after a hair restoration surgery. Sunlight has many different components besides the visible light including ultra violet and infra red lights. We do not know for sure which components are more responsible for hair follicle damage but for this reason I prefer to treat tanning beds the same way. If you can cover your head completely to block the exposure to the light, I do not think that you have to avoid tanning beds.