Hair Restoration Blog

Q:

I have had a hair transplant surgery of 1500 grafts 2 weeks ago. I have been told that scabs should be gone in 5 to 6 days, but I still have scabs. I am very careful with washing my hair once a day since the day of surgery. I don’t scrub my scalp. Yesterday I tried to be a bit more aggressive and I picked and pulled a scab and it came off with a hair. Did I lose a hair graft? When should one start scrubbing scalp and at what point can I go back to my regular washing and cleansing of my hair?

A:

Scabs are almost always seen after hair transplant surgeries. You may continue to see scabs for a variable amount of time. One of the common causes of losing a graft is pulling scabs during washing and combing hair within the first few days after hair transplant surgery. Fortunately, we have researched evidence that shows pulling scabs with hair can dislodge hair grafts if done in the first five days after hair transplantation.

At US Hair Restoration, we recommend washing transplanted areas twice a day to prevent formation of scabs within the first four days after hair transplant surgery. After day five patient can start his regular hair wash, but if scabs continue to be present at transplanted area, more frequent washing is recommended until the scabbing is all gone.

The good news is; if you lose hair after this day, active part of the hair follicle stays in skin and can generate a new hair. When fully healed, the follicle becomes part of the recipient skin and will keep its ability to generate new hair. At this time you are well beyond day five and it is unlikely that what you saw was a lost graft. My recommendation to patients is that they can start their normal hair wash and styling methods and use their usual shampoo or conditioner after first week. At this time you should be able to get back to your normal life and scrub and style your scalp as you wish.

Dr. Parsa Mohebi announced this week that US Hair Restoration will soon have a branch in Dubai, UAE (United Arab Emirates) in a TV talk show in Los Angeles. This hair transplant center is going to be the first branch of the US Hair Restoration in middle east that could be utilized by hair loss patients in United Arab Emirates, Saudi Arabia, Qatar, Kuwait, Iran, Pakistan, India (good news for Bollywood actors) and even Europe that may find having a Quality hair transplant surgery in the middle east more feasible than getting a hair transplant surgery in America.

Dr. Mohebi will be in Dubai for the first time with his whole surgical team for the summer of 2008 to offer the high standard follicular unit transplant surgery to the hair loss patients in Middle East and Asia. Dr. Mohebi will be performing hair transplant surgeries on patients who had already contacted US Hair Restoration and booked their surgery in advance. Eligibility of the patients would be determined through online, phone and photo consultation before the time of their hair transplant procedure.

Q:
Does your new Irvine facility sell toppik hair fibers? Is it safe to use daily or soon after a hair transplant until the hair grows?

Hope to hear from you soon.

Thank you.

A:
We don’t sell any products in any of the offices of US Hair Restoration, but you can easily buy Toppik online through several websites.

Toppik is made of several inert substances that none of them affect the progress of the hair loss or gain.

If you are planning to have a hair transplant surgery, you need to stop using Toppik for the first four days after your hair transplant when the process of healing of the transplanted grafts is not finished. You can start using it again as early as day 5 after your hair transplant surgery when the healing process of transplanted grafts is considered to be completed.

Have a great weekend.

Q:

I am a 30 year old white man. Today I noticed a balding spot on my neck where I used to have hair. I have had a few of them in the past in the size of a penny. They usually come and go in a few days maybe weeks. It does not bother me, but do I need to worry about it?

A:

Patchy areas of baldness at your neck in the area that you used to have hair could be a skin condition called alopecia areata (AA). Alopecia areata is an autoimmune disease that causes round patches of baldness and could happen to any part of the skin, including beard, scalp, eyebrow and even eyelashes. The outcome of alopecia areata is usually good and in most cases hair re-grows within several months. Occasionally the baldness could be permanent.

Alopecia areata usually recovers without any treatments. If the balding spots of alopecia (hair loss) don‚Äôt disappear in a few months the medical treatment might be necessary. See Dr. Mohebi’s article on treatment of alopecia areata.

Treatment of alopecia areata is different than medical treatment of patterned hair loss.  Local injection of steroids may help in some cases. Other medication are also recommended such as topical steroids in form of creams or lotions, but are not as effective as steroid injections. Local immuno-suppressive medications have also been tried with some success in more severe forms of alopecia areata. Minoxidil is proven to be effective in some cases and is the only over the counter medication for alopecia areata and could be sued in more extensive diseases. You need to see a doctor to confirm the diagnosis of alopecia areata (AA) and to get started on some sort of treatment if it is really bothering you.

Alopecia areata could be progressed and beyond its typical patchy characteristics. If hair loss involves whole scalp, it is called alopecia Capitis and if hair loss seen everywhere in the body; it is called alopecia universalis.

Q:

You have mentioned shock loss in some of your articles that may happen after hair transplant surgeries in young men. Does it happen to everyone and if happened, is it reversible.

A:

Shock loss used to be a big problem for many hair transplant patients. Shock loss generally happens in the first 1 to 3 months following the hair transplant procedure and can be reversible in some patients and to some degrees. Remember that shock loss happens mostly to the hair follicles that have some degree of miniaturization are already in the process of falling out and the stress of surgery just accelerates the rate of hair loss. Strong terminal hairs are usually resistant to the shock loss.

There are several ways to minimize shock loss after hair transplant surgeries. Topical medications like minoxidil could prevent shock loss to some degrees. Finasteride (Propecia) would perhaps be the most helpful medication for reducing the shock loss after hair restoration surgeries, if patient starts taking Propecia right before his hair transplant surgery.

My recommendation to most patients is to start finasteride even a few days before the surgery so it is locked in the system by the time of surgery and can protect hair from shock loss phenomenon. The rate of shock loss has significantly dropped in our hair transplant patients in the last few years, and it has to do with us strongly recommending finasteride use before hair transplant surgery to all our male patients.

Hello doctor Mohebi,

I’m currently not living in America. I’m researching to decide where in the world -country and clinic- is the best place to have this done. I wonder if you’d be so kind to clarify 3 questions that came after I read the links you sent me:

1) Does FUE leave or not scars? One doc it says it doesn’t -advantage for people who like to or may have to shave their heads. Another doc says it leaves small punctuate scars that “may make FUE hair transplant surgeries more difficult or impossible.”
2) I understand the less number of grafts you can get through FUE makes it likely that you have another surgery.
3) You mention body hair. Do you usually implant body hair on the head, or am I tripping? If so, how does the extraction process work? Scars left?
4) In bold figures or percentage, how much more expensive would FUE be than the strip removal method to achieve the exact same result?
5) I wonder how efficient FUE is in covering large areas, how many surgeries you’d have to have done to get the exact same result as the strip removal method.
Plus, I wonder if -besides the healing process- the hair growing time is shorter than the strip removed one.

Well, that for now.
Thanks a lot for your patience,
Patient’s name

A:

Thanks for your email. Here are the answer to your questions in the order you asked them:

1. Does FUE leave or not scars?A: Any skin incision leaves scar. The point is the scars of FUE (Follicular Unit Extraction) are so small and scattered in a large area that they are not distinguishable.

2. Related to the previous: I understand the less number of grafts you can get through FUE makes it likely that you have another surgery.A: That is true. However repeat FUE procedures might be even more difficult to extract grafts in consequent procedures, due to the presence of scars of the first surgery on the donor area. However you should not have any limitations doing regular strip technique if you have a FUE in the past.

3. You mention body hair. Do you usually implant body hair on the head, or am I tripping? If so, how does the extraction process work? Scars left?A: Body hair transplant to the scalp is not something that we do on a regular basis and in fact I only recommend body hair for people with extreme depletion of scalp donor hair. If eligible for body hair (you should have thick body hair and you also need to be tested positive with FOX test before FUE procedure) it is similar to scalp FUE with none or minimally visible, scattered scars.

4. In bold figures or percentage, how much more expensive would FUE be than the strip removal method to achieve the exact same result?A: At US Hair Restoration, the cost of FUE procedure is twice as a strip hair transplant procedure of the same size.

5. I wonder how efficient FUE is in covering large areas, how many surgeries you’d have to have done to get the exact same result as the stip removal method. Plus, I wonder if -besides the healing process- the hair growing time is shorter than the strip removed one.A: FUE is an efficient method of hair transplant, but probably not as efficient as follicular unit transplantation with strip technique. For large cases I prefer FUT that we almost have no limitation on the number of grafts. FUE is for people who prefer to have no visible scars on the donor area, but less number of hairs is acceptable to them. FUE can work beautifully for people with low degrees of hair loss. You have to realize which is more important to you: “No donor scar” or “A fuller head of hair” if you have extensive balding. Healing process in donor area is much shorter than the strip technique and donor area is back to normal in abut 4-6 days as opposed to in the strip method that the donor wound healing may takes up to 2 weeks. Healing on recipient area is the same in FUE and strip surgery.

Best,
Dr. Mohebi

Q:

Great blog Dr. Mohebi, Thanks,

I have had a hair transplant 5 days ago. I have been washing my hair in last 5 days with my regular shampoo. I don’t rub the transplanted area, except for some dabbing with shampoo for about 4 to 5 minutes every day. Can you please explain how I should wash at this point and how long I need to continue with any special care after hair transplant surgery? Do you recommend any after hair transplant care product or shampoo?

Thank you for your time.

A:

There is not a certain standard in washing hair after hair transplant surgery. I previously posted an article on the blog “After hair transplant Care” and explained the care that is needed after a hair transplant surgery. We fine-tuned our after hair transplant care procedures to minimize the risk of hair graft dislodging, which is a threat in the first few days after hair transplant surgery. A study showed that there is a decreasing risk of dislocation of grafts within the first few days after hair transplant surgery “Graft anchoring in hair transplantation Drs. Bernstein and Rassman”.

Patients always ask whether or not they can skip washing the first few days when there is risk of dislodging for the newly transplanted grafts. The truth is, hair washing reduces the chance of scab formation and extensive scabbing after hair transplant increases the risk of graft dislodging. The above mentioned study shows that the scabbing after hair transplant extends the interval that grafts are at risk of being dislodged.

We at US Hair Restoration recommend frequent but gentle hair wash in the first few days post-operation with only dabbing and without rubbing in the recipient area. We recommend professional hair wash for the first day to all our patients and during that time teach patients how to wash their hair at home for the next few days. There are some products that are claimed to reduce the scabbing and infection rate after hair transplant with no documented evidence to support them.

I generally use and recommend baby shampoo for hair wash for the first few days after hair transplant surgery. I don’t recommend using any other commercially available products for hair wash after hair restoration surgery.

Best,

Dr. Parsa Mohebi

Q:

I am 34, male with recession of hairline slightly. There are many bald men in both side of my family. I have been trying Rogaine for about 10 years until I thought it is not working anymore and my hair loss strated to speed up. I recently started taking Propecia. I am originally Mexican. Is Propecia as effective for Mexican as white Caucasians?

Thank you

A:

Propecia (finasteride) has been studied extensively within the last few decades in terms of its effectiveness on different age groups, balding classes and even ethnic groups. Below you can see that the effectiveness of Propecia in comparison with the Placebo on the vertex baldness has been compared in different ethnic groups:

Combined analysis of the two studies on vertex baldness, mean hair count changes from baseline among Caucasians, Blacks, Asians, Hispanics and other ethnic groups. Patient self-assessment showed improvement across racial groups with PROPECIA treatment, except for satisfaction of the frontal hairline and vertex in Black men, who were satisfied overall.

Q:

Dr,

I am a 40 year old man with male pattern baldness. I have heard vitamin A could cause hair loss if used more than needed. I take several supplements that some have large amount of vitamin A 5000 unit each. One said that it is for hair regrowth. I want to make sure I am not hurting my hair by doing that.

A:

We discussed vitamins and hair loss in several posts before. The question is why you take vitamin A. As I mentioned before, vitamins usually cause hair loss in their extreme deficiencies. A vitamin for hair loss such as “B12 hair loss vitamin” could be found in many products. There are many other hair loss vitamin products that are advertised and sold for treatment or prevention of hair loss, but most of hair loss vitamin products don’t do any good to your hair loss condition. The fact is that if you don’t have vitamin deficiency, you lose hair due to genetic and hormonal causes and vitamin supplements cannot grow your hair back.

Vitamin A is blamed for hair loss in high doses. The dose of daily vitamin A should be between 3000 to 9000 units for normal adults. The dose of vitamin A should be adjusted for pregnant women and children and patients doctor should be involved in all dose adjustments. If vitamin A is used for vitamin A deficiency disorders, higher doses might be required that should be prescribed and closely monitored by your doctor.

After hair transplant care: This is something that I have to go over for my patients who undergo a hair transplant procedure almost every day. So let’s go over it once and for all.

Here, I will go over the post-op instruction of our patients at US Hair Restoration. Different hair restoration clinics may have different post-op care and instructions because of their different surgical methods.

Our patients who have a hair transplant surgery using a strip technique usually leave our hair transplant center with a bandage around their head. The bandage is used only to support the newly closed donor wound on the back of scalp. Patients are given prescription for pain and anti-inflammatory medications for first few days after surgery. The first night after hair transplant surgery, patient needs to be cautious not to rub or scratch the transplanted area. We recommend that all patients take it easy for the first days and avoid heavy physical exercises.

We would like to bring all patients back for physician evaluation and hair wash the day after surgery. During this first visit, we remove the bandage and assess the transplanted follicular unit grafts and the donor wound. We wash the donor and recipient areas with our meticulous methods while teaching the patient how to wash it at home during day two to four after hair transplantation. Hair wash after hair transplant surgery needs to be performed twice a day with a special method to minimize the probability of dislodging the grafts. Patients ask if they can skip washing hair within the first few days to avoid damaging the grafts. The answer is “No”. Hair wash is a key step in hair transplant care that guaranties the normal growth of the transplanted hair follicular grafts.

I don’t believe in strict limitations in patient’s physical activities after hair transplants as I hear is recommended by some hair transplant clinics. I generally prefer that patient keeps his normal daily activities with some minor limitations. I discourage any activities that may add to the tension of the wound edges at donor area for the first four weeks after surgery. Those activities are: extreme bending of neck and heavy weight lifting. I also ask patients to avoid immersing their head into water and avoid any exercises that cause excessive sweating for the first four days as part of their after hair transplant care.

We would like to bring patients back at day ten after hair transplant surgery to remove the staples (for patients who had strip surgery and donor is closed with metal staples) and to reevaluate the donor and recipient area. For the patients who have their donor closed with absorbable sutures, we would still like to see then in ten days to assess the healthiness of recipient and donor area, which includes patient’s who had FUE (follicular unit extraction) surgery.

Patients need to avoid direct sun exposure to the recipient area for about six months after hair transplant surgery. Direct sun exposure may harm the growing grafts. Sun exposure can also cause skin hyper- or hypo-pigmentation (changing the skin color).

The last follow up appointment for their after hair transplant care is between months nine to twelve after their hair transplant surgery, when transplanted hair grows to its final thickness and length. At this session we can evaluate the transplanted hair grafts and assess the finial size and condition of donor scar. This visit is a good time for patients who want to consider a repeat surgery to increase the density of hair or cover the areas that has not been completely covered with first hair transplant surgery due to the limited scalp laxity or extended balding area. Having said that, patients who are planning for a repeat surgery do not have to wait that long and a repeat surgery could be done any time after month 5 after the initial hair transplant procedure.

What I explained above what a general rule for the follow up visits and after hair transplant care in most hair transplant surgeries. We may add or remove some instructions for some patients who have complex procedures or special conditions.