Hair Restoration Blog

Here are a series of very good questions on hair transplant with FUE (follicular unit extraction) and body hair transplant from a patient who did his homework and educated himself on his upcoming surgery.

Question 1: Do you have a pre op protocol for chest to scalp?

Answer: For FUE from chest I want to have a clean wet shave from the whole chest one week before the surgery day so in a week when we do harvest the grafts we only remove growing hairs (the ones that are in anagen phase). Scalp hair on the other hand, I don’t want it shaved at all and I will do my own clipping right before the procedure. We do FOX test for all new patients to determine their candidacy for FUE with a small number FUE harvesting under local anesthesia.

Question 2: How many grafts can you transplant per day and how many hours is a typical working day?

Answer: Just for you to get the idea of how long does a FUE hair transplant may take, the last two FUE that we did in US hair restoration office were 1500 grafts per day each. One of them took 9 and the other one 11 hours. In both surgeries we used scalp hair only.

Question 3: Are grafts that are extracted placed straight into the recipient incisions or are they checked under the microscope first?

Answer: All grafts need to be visualized under microscope to make sure they are intact (not transected). Most of them need to be trimmed too. We usually have to remove some of the upper layers of skin and a little of extra fat around the grafts for them to be in the ideal size for transplant.

I will post the rest of this Q and A series in next few days.

Q:

I am a 45 year old woman. My dermatologist told me that I have male patterned baldness. I am also diagnosed with Iron deficiency anemia. Can Iron deficiency in women cause hair loss in male patterned baldness and if so, can treatment of iron deficiency help reversing balding process?

A:

Iron deficiency with or without overt anemia can intensify the rate of hair loss in women with either male or female patterned hair loss. If Iron deficiency is the only cause of your hair loss and you are not genetically prone to anemia, hair loss can be reversible. However in many situations, patients are genetically predisposed to patterned hair loss and Iron deficiency has only accelerated the hair loss process. Accelerated hair loss in women who are genetically predisposed to patterned hair loss may not be reversible by just correcting the Iron deficiency. You need to see a good hair specialist to confirm the type of your hair loss and plan the proper treatment method including hair transplant surgery.

Hair transplant cost is one of the questions that we have answered many times in this blog and we still receive it from our patients. The quality of hair transplant surgery have been improving within the last few decades with the use of stereotactic microscopes and advanced methods of handling and maintaining the hair grafts. However, not every hair transplant clinic could have kept up and adopted the new technology.

Cost of hair transplant surgery varies from clinic to clinic and from surgeon to surgeon. You may find a wide variety in hair transplant costs. Many clinics that offer cheap hair transplants are not committed to the quality of service. They hire inexperienced hair transplant staff. Some of the hair restoration surgery clinics do not use microscope and are not scientifically in line with the advanced techniques that are available today. Some clinics are run by technicians and doctor is only involved in a small portion of the procedure.

Hair transplant costs are generally calculated as per hair graft basis. Hair transplantation with exclusive follicular unit transplant could cost $3 to $10 per each graft (average for exclusive follicular unit transplantation). That is the cost of hair transplants with strip techniques of FUT or follicular unit transplant and the price of the FUE (follicular unit extraction) hair transplant is higher. Affordable hair transplant could be found in high-quality hair restoration clinics too. They may not be able to lower the cost of surgeries to $2 per graft (as you may see in some hair transplant offices) because of the fact that having an experienced surgical team and skillful surgeon cost more than that.

As I said, you can find low cost hair transplant centers that still offer quality hair restoration surgeries. Some of them are very skillful and offer individual services unlike the big chain hair transplant centers. The big chain hair transplant centers have a variation in their services due to different surgeons and staff. I have seen a diversity of results from some of those clinics. The variation is generally seen due to difficulty keeping the same standard in different offices. Most patients with a previous surgery in the chain clinics who have a repeat surgery at Los Angeles Hair Transplant center of US Hair Restoration are critical of the lack of personal attention and individual care in those clinics.

In conclusion, although the cost of hair transplant surgery is an important factor, it should not be the sole factor in choosing a hair transplant clinic. I always encourage my patients to educate themselves on the most advanced techniques of hair restoration surgery. Internet is a great source of information. We have a useful collection of hair loss and hair restoration articles in our web site. I also answer the patient’s hair restoration questions in hair restoration blog on a daily basis.

My recommendation is to shop around for the best value hair restoration surgery and not for the cheapest one. Think about it as a lifetime investment. Good or bad you will see your hair every day for the rest of your life.

Q:

I have two questions:

1. Have you heard of a post surgery shampoo called Procyte Graftcyte? It contains aloe ver a and a copper peptide micronutrient that is supposed to aid in quicker healing of the scalp.
2. Also, at how many days do you feel that the grafts are secure and cannot be dislodged? It is now day three and I have begun to wash my head by just patting the shampoo lightly onto my scalp and then pouring a cup of water over the head to rinse it. I am not standing directly under the shower for fear that the grafts may be dislodged.

Thank you very much for your time.

Best regards,

Patient’s name

A:

1. Procyte Graftcyte is a product that is recommended by some hair transplant surgeons. Its ingredients are: Water, Disodium Cocoamphodiacetate, Sodium Laureth Sulfate, Aloe Vera Gel, Cocamidopropyl Betaine, Citric Acid, Diazolidinyl Urea, Methylparaben, Fragrance, Copper Tripeptide-1, Propylparaben and FD&C Blue. There is not a significant evidence to support the beneficial effect of any of these components on transplanted grafts. I myself use and recommend baby shampoo for the first few days that is inert and has the minimum irritating agents. I don’t do not have any problem with my patients using Graftcyte.
2. I answered to your question of hair wash after hair transplant before, but our policy at US Hair Restoration is: Gentle hair wash for 4 days as instructed without any rubbing twice a day and after that back to washing hair routinely. Scalp scab can be seen after hair transplant surgery that could potentially hurt the growth of the grafts. During your after hair transplant care, you should not try to remove scabs by pulling them off. You can eliminate the scabs by increasing the frequency of washing your hair to twice or three times a day or even more.You are right about not letting forceful water from the shower directly hit the transplanted area. I recommend pouring water gently for the first four days and then back to showering at least at day five.

Have a great weekend,

Dr. Mohebi

Central centrifugal cicatricial alopecia or CCCA is one of the less common causes of hair loss. This medical condition, which characterizes with circular balding, mainly on the top (vertex and crown) which can be expanding and only leave a rim or hair around the scalp with total baldness in the more central areas in extreme cases (see picture).

The causes of this type of balding are now quite known. This disease used to be called with different names such as hot comb alopecia, follicular degeneration syndrome, pseudopelade in African Americans and central elliptical pseudopelade in Caucasians. Microscopic evaluation of the hair loss areas shows evidences of inflammation in the area of disease activity, chronic and rapidly progressive skin changes with eventual complete baldness in some part of the scalp with its unique pattern.

This hair loss condition could be started with the evidences of skin inflammation (redness and itching), but this phase might be temporary and patient may not have any signs or symptoms other than hair loss with its specific pattern.

Treatment of this condition could be challenging. Treatment with medications is generally not successful in prevention of the hair loss and to reverse the process. Hair transplant could be an option, but it could not be done in the acute phase of the disease. Hair transplant for Central centrifugal cicatricial alopecia might be considered when the active phase is over and when the inflammation is completely subsided. I would like to do a small test hair transplant before committing to the actual hair transplant surgery to be assured of the survival of the hair grafts.

Q:

I had a hair transplant two days ago and would like to use Bromelain to aid in reducing inflammation. I have heard that bromelain interferes with fibrin which holds the grafts in place. Do you know if this is true or not?

A:

Bromelain is a combination of some enzymes that are naturally found in the pineapple juice and stalk. One of the uses of Bromelain is for its improving effects on swelling, bruising and irritation of skin after surgical procedures and injuries. You are right about the fiblinolytic (dissolving fibrin) effect of Bromelain and for the same reason you should not use it on the transplanted areas of your head. Microscopic clots that initially form around the transplanted grafts are necessary to seal the follicular grafts in place within the first few days after surgery, when grafts are still fragile and can get dislodged.

There are some medications that can improve your swelling and redness after the surgery such as steroids that are proven safe for the growth of hair grafts. You need to ask your hair transplant surgeon about what to use to decrease the swelling and redness after hair transplant surgery.

Q:

Thanks for the serious information.

I hope they find the hair cloning or something that generates hair follicles in a near future. My question is if this cloned hair would fall or if it is going to be like the donor hair that doesn´´t fall because of it imunnity to dht. I would aprecciatte your answer.

A:

This is a great question and unfortunately we still don’t have a clear answer to it. The problem is most research projects on this topic have been limited in terms of numbers and long term follow up. Intercytex is a biotechnology company that probably has the most promising project on hair multiplication at this point. They have done some studies and finished phase I of a hair multiplication study. Unfortunately the details of their research have not been announced quite clearly. However they announced that they will release some more information in September of 2008. Let’s wait and hope that they clarify some of those issues and answer the questions like yours on the quality and durability of multiplied hair.

Best,

Dr. Mohebi

Autologous Hair Regeneration - ICX-TRC (Intercytex)

ICX-TRC is an autologous hair regeneration system. ICX-TRC project is an ongoing research program that uses a suspension of human dermal papilla cells (one of the stem cells of the hair follicle which is involved in the growth and cycling of hair follicles. The system is claimed to be used for the treatment of male and female patterned baldness. The intention of ICX-TRC is to provide a technique to restore hair in patients who do not have adequate supply of donor hair on scalp for the hair transplant process and maybe for everyone with baldness.

Both types of patterned hair loss have significant genetic influence. It was claimed that with the ICX-TRC procedure, the process of hair restoration would be less problematic than conventional hair transplants. The proposed idea is to remove a few normal hair follicles from the donor area and harvest their active cells called dermal papilla (DP). These active cells are cultured and multiplied by different techniques and eventually the multiplied cells from this culturing process could be used to produce multiple hair follicles. The goal is to grow the hair follicles that are produced with this method while keeping the original characteristics of donor hair.

The cultured cells are supposed to be injected to the bald areas of skin. Interaction between the DP cells and normal epithelial cells in the skin can potentially generate new hair follicles under a certain circumstances. The process of culturing the DP cells and getting the new cells may last around three weeks.

Intra-dermal injections of new DP cells in the scalp could be done under local anesthesia with the current techniques of hair transplantation. It is claimed that some sort of hair growth could be seen after 3 months. However the condition and characteristics of the new hairs have not completely elucidated.

ICX-TRC clinical trial

Every new medication or medical technique needs to be examined closely through a systematic process for evaluating its effectiveness and safety. Intercytex has announced that they have finished their phase I (for safety and tolerability of the system) on volunteer patients and it has been successful. It means that the procedures did not have a serious or lethal side effects, at least in short term.

They also announced that they started phase II in Manchester to optimize the delivery of the DP cells and to refine their techniques, which is completed as well. They have obtained hair and measured the growth by shaving and taking photos of the transplanted area with cultured DP cells. On the phase II of the study they used 19 volunteer. They describe few different techniques that were used including pre-stimulation of the skin before injection of the cultured cells. Unfortunately, there is not much information available on the technique and methodology of the studies.

Here is what is stated in Intercytex web site for the result of the phase 2 of this experiment:

• Eleven subjects have now passed the 24-week time point since treatment and specialized image analysis at this time point showed
• Of the group of six patients without stimulation of the scalp, three had an increased hair count and two had a reduced hair count; one has been lost to follow-up
• Of the five subjects with pre-treatment scalp stimulation, all had increased hair count at 12 weeks and the three who were evaluable at 24 weeks all had an increased hair count at that time point

They are still looking for the 24 week data on all subjects in September 2008. At that time if it is all promising we should expect to see the phase III started on a larger group of patients who try this treatment for a longer period of time (years) to rule out any long term complications.

Intercytex is also claimed that they are working on an automated device that can facilitate the injections of cultured grafts, which could be used for the transplantation of cultured hair cells.

Conclusions:

1. The progress of Intercytex research and the released results are not quite clear yet
2. The safety of this system has not yet evaluated for long term potential side effects of cultured human cells such as increased risk of cancer or other dermatologic or systemic abnormalities
3. If proven safe and effective after completion of the phase III, we should have an estimate of the cost for this procedure. It is unclear whether or not this is going to be affordable and something that could be used for everyone or it should be reserved for patients with special needs.

We will follow the progress of ICX-TRC project along with other similar projects on hair stem cell and hair multiplication studies and keep our readers posted.

Q:

Hey doc!

How’s it going? I hope all is well. I have two things on my mind. One is a question: the Murad shampoo directs users to use the shampoo daily.. do you think i is okay to use that shampoo daily? The reason why I am asking is because of the chemical content in shampoo, it is usually recommended to shampoo every other day or so.

A:

I answered another question about Murad shampoo “Murad Shampoo for hair loss” before. I don’t believe that DHT blockers especially in the form of shampoo can be absorbed from the skin to affect the hair growth compared with systemic DHT blockers i.e. finasteride pill. I don’t think that daily use of the shampoo can hurt your hair either, unless it is specifically prohibited by the manufacturer.

Q:

Next week will be the second month I have used proscar, and to be honest, the shedding has only lessened a little. I would say it is better than before. Do you think I will see more observable results by the end of summer perhaps?

By the way, after looking at numerous propecia experiments, I think that some of the results could be misleading. Now, I mean this in a good way. It is possible that the success rate could be higher if the experimentation would be more controlled. The reason why I am saying this is because there are not many parameters that are being analyzed within the experiments. It is also important to see people’s “daily actions” to see the possible reasons why proscar/propecia might not work for them. Even though the mechanism mostly occurs internally, there are external factors that could play a pivotal role.

Thank you! Hope you have a good week.

A:

Hair shedding is not always a sign of hair loss. In fact the real bad hair loss that leads to balding in male pattern hair loss is losing miniaturized hair that you really cannot see. People who take finasteride may have increased levels of hair shedding due to the increased hair cycling within the first few weeks to months. The initial hair shedding should get resolved within a month or two from the time it starts. The final effect of finasteride should be assessed and judged at least after 6 months from the time you start the medication, but it may be also seen as late of 12 months from when you start the medication.

Remember that with Propecia, we are not only after re-growing hair and stopping or slowing down the process of baldness is the goal of treatment for most people.

I understand your points on the research done on Propecia (finasteride). Most Propecia studies are done on a large number of patients like many other double blinded prospective clinical trials; so the individual differences are diluted and negligible.