Hair Restoration Blog

People ask about hair multiplication, hair loss, stem cell hair regrowth, and hair cloning transplant all the time.  The last annual meeting of the International Society of Hair Restoration Surgery (ISHRS), where all authorities in medical hair restoration get together, did not have any good news for the people who are eagerly following the progress of hair multiplication research.  In fact, the newly disclosed information from Intercytex who is considered the leading group working on hair multiplication revealed that they never successfully finished phase II of their study on hair follicle multiplication.

This is contradicting with what they released previously regarding completion of phase II and the commencement of phase III.  This is considered a step back in the field of hair restoration and it means a longer waiting time for people who are impatiently waiting for hair multiplication to become a reality.

When any new treatment modality is being researched, scientists need to go through several phases to establish its effectiveness and safety.  Phase III of a study is when a few subjects (human) are being treated with the new modality on a longer period of time to assure the long term effect and safety of the new treatment.

The reason for the delay in completion of phase II of hair multiplication research was not fully disclosed.  However, knowing this fact leads us to believe that using multiplied hair won’t be possible at least in the next 8 years.  We at US Hair Restoration are collaborating with the academic center in some different stem cell hair research.  Our research is still in its early stages, but we will release our findings of this hair stem cell research as soon as they are available.

I just gave a lecture on a new application for Laxometer in mega and giga session hair transplants in the annual ISHRS (International Society of Hair Restoration Surgery) meeting in Amsterdam, Netherlands.  As we presented the Laxometer in the prior hair restoration scientific meetings, Laxometer can make us capable of increasing the precision of strip removal method of follicular unit hair transplants while minimizing the risk of donor scar complications.

This year, I presented a new application for Laxometer for its use in patients who have limited laxity of the scalp due to prior hair restoration surgeries or for those who require a maximum number of grafts in one session (3000+, 4000+, 5000+ and so forth).  I performed a research in US Hair Restoration last year in which we removed the strip in sequences for hair transplant surgeries using Laxometer before and after removal of each section of the strip.  This method has increased the safety of the strip removal while decreasing the risk of donor wound complications.

The result that was presented in the ISHRS meeting indicated the effectiveness of Laxometer at increasing the number of grafts in a strip hair transplant while minimizing the donor complications of a hair restoration surgery.  Based on our findings, we now use Laxometer in our California hair transplant offices on a regular basis and obtain positive results consistently.

Q:

I recently had a FUE hair transplant in the front and my temples (2500 grafts) and everything was ok until 5 months after the procedure. I had to be out in the sun for a little longer and the temprature that day recorded more than a 100 degrees. Once I got back home I looked at my scalp and the skin in grafted area had turned white. I guess I got a sun burn. I did not take it seriously and I continued to use the Minoxidil with Betaderm spray that my doctor prescribed.

Over the last 1 month the top layer of the grafted area dried up and pealed off (like scabs). I also saw a few strands of the new hair come off with the dried skin but not much. Now after 2 months after that incident my scalp is clear and there are a few rashes here and there. But mostly it is clean. I am concerned if I have sabotaged the grafts by exposing it to the sun. Obviously I got a sun burn at the sixth month but is it going to be bad for the grafts if not already? I read some articles about sun burn but I am confused if this sun burn will be bad only for the skin or the grafts itself? If it is only the skin and it darkens the pigments that is ok. I am worried if I had killed my grafts. Could you please help me understand?
Thanks in advance for your response.

Regards,

A:

Sun exposure can be harmful for the native and transplanted hair.  Especially when you do not have full coverage and sun rays can reach to the scalp skin and cause sun burn. I generally advise against exposure to sun for anything more than a few minutes.  Patients can use sun block or a hat for the first 6 months after hair transplant to avoid hair loss or irreversible damage to the hair follicles.

The patients who do not have good hair coverage on their scalp should protect their scalp religiously forever, until your hair density increases to the level that your scalp is covered completely by the hair and protected from the sun.

It is hard to say if you damaged your transplanted hair or not.  You only need to be more careful from now on and wait and see what is going to happen in the future.

Q:

Dear Dr. Mohebi,

It has been 17 days after my hair transplant at your Encino office.  If you recall, an FUT procedure with bi-lateral trichophytic closure was performed for about 650 grafts to reinforce the front hairline.  First of all, I’d like to thank you for taking the time to professionally and candidly answer all questions I had and ensuring the experience was comfortable and hospitable.  I must say it was a very inviting experience compared to my first session with a different doctor.

I’ve attached 5 snapshots of the graph’s current status at a little more than two weeks out.  I was able to remove all scabs on the grafts and donor site.  Now that I can see the grafts slightly growing although some may have fallen out, I have a couple questions.

• One of the photographs shows a red circle at the peak of the front hairline where the area appears bare and open.  Do you recall planting any grafts at this site?  I was hoping this particular area would be covered due to the apparent nature of the front tip.

• My donor site is still tender, numb, and feels dully painful.  Is this normal after 2 weeks?

• My donor site is very very tight which makes it difficult to look down without some major strain or pulling.  I don’t recall having this problem with my first procedure or at least lasting this long with the intensity of the tension.  Is this due to the bi-lateral trichophytic closure on a previous scarline?  Can you advise on how or when this tension will subside?

I appreciate for your time and effort in advance Dr. Mohebi and have an excellent day!

A:

It is good to hear from you.  I am glad you had a good experience from your hair transplant surgery with us.  You had a donor scar revision procedure to improve the appearance of your donor linear scar in the back of the head with two sided tricophytic closure to grow hair into the scar.  Here is the answers to your questions in the order you asked them.

• One of the photographs shows a red circle at the peak of the front hairline where the area appears bare and open.  Do you recall planting any grafts at this site?  I was hoping this particular area would be covered due to the apparent nature of the front tip. We purposefully make the frontal area irregular so it won’t look linear and unnatural.  You should have lost most if not all of the grafts at this point after your hair transplant so what you can see now is not representing what you will eventually get.  My recommendation is to try to ignore them for at least the next 6 to 8 months so that hairs should all be grown out.

• My donor site is still tender, numb, and feels dully painful.  Is this normal after 2 weeks? Mild inflammation due to the healing process could be present for a few weeks after strip method hair transplant surgery, however, if it doesn’t gradually subside or if it becomes worse we need to see you immediately.

• My donor site is very very tight which makes it difficult to look down without some major strain or pulling.  I don’t recall having this problem with my first procedure or at least lasting this long with the intensity of the tension.  Is this due to the bi-lateral trichophytic closure on a previous scarline?  Can you advise on how or when this tension will subside? More tension might be seen in repeat surgeries due to the prior scarring that was present from before in comparison to performing surgery on a virgin scalp.  You need to avoid bending your head with force for the next two months after surgery while there is a risk of stretching the donor scar.  At month two, if you still have tension you need to see us.  Meanwhile if you have any other concerns regarding your growth or any other issues you can make an appointment to be seen.

I look forward to seeing you in your follow up visits.

Q:

Dear Sir,

I’m 36 years old and having many close round patches about the size of coin (Doctors called it Alopecia Areata) in my head and full body since last 5 years which is increasing slowly. I’m getting medical treatment which is included MINOXIDIL GEL 2%.

One year ago, one doctor injected 1 KANACART OR CANAKART injection/month for 5 times but not any positive result.  Now since last 10 months, I’m using MINOXIDIL GEL 2%, still there is no result. I visited few clinics in UAE.
I’m seriously depress now a days.
Can you advise me!!! what I’ve to do!

Thanks & regards

A:

Although Alopecia Areata (AA) is generally a self limiting condition, in many patients hair loss patches may last for a long time and warrant some types of treatments.  There are several recommended methods for the treatment of alopecia areata such as minoxidil and steroid injections into the hair loss patches.  However, there is no single treatment that can improve the lesions on all patients.  It seems like you have been treated with a variety of medical options in the past without a good result.

The diagnosis of alopecia areata is clinical in most cases, however, in some instances that the lesions do not look typical for AA or the recovery is not complete in a reasonable period of time, the skin lesions or hair loss patches need to be biopsied to confirm the diagnosis of alopecia areata.  You need to be evaluated by a good dermatologist to rule out other conditions that might be presented in a similar fashion.

Q:

Dear Doctor,

I am a 26 year old woman with a hair loss problem. I was diagnosed with PCOS (Polycystic Ovary Syndrome) and thyroid malfunction 5 years ago. Prior to my diagnosis I suffered a mild case of hair loss mostly on the top around the hair line but after I received treatment my hair was better than it ever was long thick and strong.

when I stopped the thyroid and PCOS treatment and my hair started falling like never before. I started treatment again for PCOS a year ago but nothing happened. My hair is still falling particularly at the front and my scalp is showing. I’m middle eastern and my mom had a severe case of hair loss but she never had a problem such as PCOS! Now I’m taking Glucophage and oral contrasiptives to treat PCOS. Could it be my thyroid again? Does thyroid malfunction cause hair loss? Could it be the PCOS or could it be genetic? And how can I treat it?

A:
It seems like you have significant family history for female patterned hair loss.  Obviously, you need to be under care of a good endocrinologist due to the extent of your hormonal imbalances.  Polycystic ovary disease can often alter your sex hormone levels.  You need to make sure your sex hormones are not out of range.  You also need to have your thyroid hormone levels checked on a regular basis and treat any abnormality accordingly.

Having said that, your condition might be only an exaggeration of a typical female patterned baldness secondary to your other medical conditions.  This is not a typical condition and we see it in our offices on a regular bases.  Hair loss could be seen in association with many other medical conditions in men and women including the two conditions that you experienced.

In normal individuals who are not prone to hair loss, the condition is generally reversible only after correction of medical disorders.  However, patients who are genetically susceptible to patterned baldness may never gain their lost hair back even after complete treatment of the underlying medical condition.

Q:

Scar of face lift surgery

I believe I am a casualty of a brow lift gone wrong.  Three and half years after my brow lift surgery, I am seeing extreme hair loss on the top of my head, with itching burning and a crawling sensation at the affected area.

If this conclusion is correct will any treatment stop the hair loss? Will hair transplantation work?
Thank you

A:

Recession of hairline in a male patterned after a face lift surgery

The condition you are describing may be the beginning of cicatricial alopecia or hair loss secondary to a face or brow lift surgery.  You need to be seen by a good hair restoration surgeon or dermatologist for a close evaluation.  Brow Lift or face lift surgeries require incisions in the scalp that result in scarring and hair loss at the point of incision and around it on the temporal or frontal areas.  This hair loss condition could be seen as a complication of the face lift procedure with unknown mechanism.

Although a rare side effect of the face lift surgery, as a hair transplant surgeon with particular experience and interest in scalp scar revisions, I see many patients with hair loss after face lift procedures in our California hair transplant offices.  Your condition has two components; 1. the scar of incision in the hairy part of scalp; 2. the loss of hair on the temples and frontal areas.   Both these problems can be easily treated with transplanting hair into the scar and on the hair loss areas of the scalp.  If the procedure is done through follicular unit transplantation the result should be quite natural.

I have recently seen a familial case of hair loss that was caused by exposure to fungus toxin.  Three members of a family were referred to me by their doctor for hair loss problems secondary to the diagnosed chronic mold exposure.  The family used to live in a house with a sewage problem causing some molding in the old walls approximately three years ago.  The walls with mold were painted over but never changed.  The family members presented a variety of symptoms such as nausea, sleep disorder, and speech problems.  The female member showed some cognitive disorders with episodes of sever confusion and was initially diagnosed with premature Alzheimer’s disease at the age of 53.  A 34 year old male member of the family had seizure attacks and episodes of nose bleeding.  What was reported by all these patients was hair loss.

The female member of the family had diffuse loss of hair as universal thinning and loss of hair volume.  During the examination, hair thinning was obvious on a large area of the scalp.  Microscopic examination did not show significant miniaturization, however, hair density was significantly lower than density of a normal Caucasian woman with no hair loss.  We scheduled her for a follow up visit in 6 months.

A 34 year old male member of the family showed evidence of typical male patterned hair loss that was not evident in the pictures from 3 years ago (before the mold exposure).  The miniaturization study was similar to atypical male patterned hair loss with preserved hair on the donor area with minimum miniaturization despite having significant miniaturization on a large area at front, top and crown areas.  I prescribed finasteride and scheduled him for a follow up visit in 6 months.  We will address the need for a hair transplant at that point.

A 40 year old male member of the family showed diffuse miniaturization throughout scalp.  The patient did not have any hair loss problem before the exposure to the toxin.  This patient has also been started on finasteride with a follow up visit in six months.

Below we describe two known fungal toxins that may cause hair loss in addition to other symptoms.

Stachybotrys

Some strains of this fungus (S. atra, S. chartarum and S. alternans are synonymous) may produce a toxin, which is poisonous by inhalation. The toxins are present on the fungal spores. This is a slow growing fungus. The dark colored fungi grow on building material with high cellulose content (wooden material). Areas with relative high humidity that are subject to temperature fluctuations are ideal for toxin production.

Individuals with chronic exposure to the toxin produced by this fungus reported cold and flu symptoms, sore throats, diarrhea, headaches, fatigue, dermatitis, intermittent local loss of hair and balding and generalized malaise. Animals injected with the toxin from this fungus exhibited the following symptoms, necrosis and hemorrhage within the brain, thymus, spleen, intestine, lung, heart, lymph node, liver, and kidney.

This organism is rarely found in outdoor samples.  Appropriate media for the growth of this organism will have high cellulose content and low nitrogen content. The spores will die rapidly after release. The dead spores are still allergenic and toxigenic.  Percutaneous absorption has caused mild symptoms.

Aspergillus

Aspergillus is the most common genus of fungi in our environment with more than 160 different species of mold. Sixteen of these species have been documented as causing human disease. Aspergillosis is now the 2nd most common fungal infection requiring hospitalization in the United States. Exposure to aspergillus can often cause skin rashes and hair loss.
Symptoms of Fungal Exposure (Mycotoxicosis)
Mold toxicity is often the end result with constant exposure to mold of a toxic substance. A common misconception among allergists who are untrained in this type of toxicity levels in humans, which is technically not their area of expertise unless they have trained specifically in environmental medicine with their background in immunology, is to do general allergen testing. Most tests usually result in an unequivocal result, a 2+ or less.

This induces some physicians to order allergy shots, regardless. These shots are absolutely worthless (and could possibly be harmful) to a person who has been heavily exposed to these mycotoxins as they are already in a state of toxicity. If anything, this could exacerbate the problem. Because many doctors are not trained in this field, they may try to “guess” at a diagnosis.

In laymen’s terms, molds produce mycotoxins. These substances, although unseen by the naked eye, are ingested and then enter the body through the skin, mucous and airways. Once ingested, mold has the requirements to colonize and spread. In doing this, it can compromise the immune system and damage the everyday processes of the body. Mold and yeast are interchangeable only in their dimorphic state, which is often a big misconception, although both are fungi. There has been a theory of a connection between Autism Spectrum Disorder onset and Candida Albicans in the body.  Studies have started since the first quarter of 2006.

Fungi, which include yeasts, moulds, smuts and mushrooms, are responsible for causing four types of mycotic (fungal) disease:

• Hypersensitivity - an allergic reaction to moulds and spores
• Mycotoxicosis - poisoning by food products contaminated by fungi
• Mycetismus - the ingestion of preformed toxin (toadstool poisoning)
• Infection (systemic) - (Mycotoxicosis; the subject below)

The following are a list of the most common symptoms of fungal exposure. Most people with some forms of Mycotoxicosis meet at least 8 symptoms of the following criteria:

1. Fibromyalgia/mps (and several correlated symptoms)
2. Respiratory distress, coughing, sneezing, sinusitis
3. Difficulty swallowing, choking, spitting up (vomiting) mucous
4. Hypersensitivity pneumonitis
5. Burning in the throat and lungs (similar to acid reflux and often misdiagnosed as such)
6. Asthmatic signs; wheezing, shortness in breath, coughing, burning in lungs, etc.
7. Irritable bowel syndrome, nausea, diarrhea, sharp abdominal pains, stomach lesions
8. Bladder, liver,. spleen, or kidney pain
9. Dark or painful urine
10. Dirt-like taste in mouth, coated tongue
11. Food allergies/leaky gut syndrome/altered immunity
12. Memory loss; brain fog, slurred speech, occasionally leading to dementia
13. Vision problems
14. Swollen lymph nodes
15. Large boils on neck (often a sign of anaphylaxis)
16. Yellowing of nails, ridges, or white marks under nail
17. Thyroid irregularities, sometimes leading to complete dysfunction; adrenal problems
18. Headaches
19. Anxiety/depression, heart palpitations - confusion, PTSD
20. Extreme blood pressure, cholesterol, or triglycerides irregularities
21. Ringing in ears, balance problems (very common), dizziness, loss of hearing (aspergillus niger)
22. Chronic fatigue (also included under this classification directional confusion)
23. Intermittent face flushing; almost always systemic, Called the Mylar Flush (neurological»
24. Night head sweats, and drooling while sleeping, profuse sweating
25. Multiple chemical sensitivity; only upon exposure to Stachybotrys and Chaetomium
26. Nose bleeds (stachybotrys)
27. Bruising/scarring easily; rash or hives, bloody lesions all over the skin (Often systemic)
28. Reproductive system complications; infertility, changes in menstrual cycles, miscarriage
29. Sudden weight changes (Detoxifier genotypes tend to gain weight, non detoxifier genotypes tend to lose weight)
30. Cancer
31. Hair loss, very brittle nails, temporary loss of fingerprints (in rare cases)
32. Joint/muscle stiffness and pain
33. Irregular heart beat/heart attack
34. Seizures, inadvertent body jerking, twitching, inadvertent facial movements or numbness in face
35. Hypersensitivity when re-exposed to molds, which can lead to anaphylaxis
36. Anaphylaxis upon re-exposure to mycotoxin producing molds
37. Death, in extreme cases

Demodex folliculorum is a widespread skin parasite.  Demodex folliculorum is a microscopic creature in the form of an elongated and jointed worm.  Demodex folliculorum could be found on the skin surface, particularly on those parts of the skin with large sebaceous glands and on individuals affected with acne or seborrhea oleosa.

Demodex feeds on the oil and skin sebum so the more sebum the greater the number of Demodex folliculorum. While it is sometimes found on the surface of the skin, it is more commonly encountered in the substance of hair follicle comedo plugs, where five to twenty worms may be discovered in a single follicle. A similar species which is considered to be a variety of that discovered upon the skin of man infests dogs, mice and other mammals. However, none of these related demodex species are known to be transmissible to humans.

Demodex folliculorum infection is very common and around 80% of the adult population, both men and women, have a Demodex folliculorum infection. It is believed that the frequency of Demodex folliculorum is less in children.

There have been sporadic claims made about Demodex folliculorum and hair loss for over many years. Quite recently a theory has been put forward that patterned baldness could be associated with infection of hair follicles by the Demodex folliculorum parasite. By infiltrating the sebaceous gland of hair follicles the parasite causes an immune response and inflammation of surrounding tissue - so it is claimed. Through long term invasion, the parasite “exhausts” the hair bulb and shifts the hair cycle from anagen to telogen so more hair follicles stay in resting phase rather than growth phase.  That means less hair is seen on the scalp at any given time.  This theory is promoted by certain companies that just happen to have a range of products that destroy Demodex folliculorum. At least one of the companies has conducted research that allegedly showed 88% of 240 men (more than its rate in normal population) with male patterned baldness had Demodex folliculorum infection in their hair follicles. However, there are several problems with this theory:

1. Eighty percent of the normal population has Demodex folliculorum whether they have hair loss or not. The company conducting the research conveniently forgot to study normal haired people to find the frequency of Demodex folliculorum in people with a full head of hair.
2. Research has shown that there are frequently excessive numbers of the Demodex folliculorum parasite in eyelash follicles. However, people with pattern baldness do not lose their eyelash hairs.
3. There is a clear bias towards men having pattern baldness hair loss even though women are equally susceptible to Demodex folliculorum infection and at least some children are also infected. If Demodex folliculorum infection was causing inflammation that pushed hair follicles into telogen then one would expect to see some children with pattern baldness and women would be equally affected with hair loss. Indeed, women have a stronger immune system and so one might expect more women than men to have pattern baldness, but this is not the case.
4. If Demodex folliculorum was a key cause of pattern baldness it would be impossible for hair follicle transplants to work. Given thousands of transplant procedures are done every year and 80% of men have Demodex folliculorum infection, then most of the men with hair transplants must also have a Demodex folliculorum infection. In a hair transplant, follicles are moved from the back of the head to the top of the same individual. If the individual is infected with Demodex folliculorum one would expect that the transplanted follicles would either already be infected, or become infected in their new location. However, transplanted follicles grow in every individual who has had the procedure done and pattern baldness does not redevelop.
5. there is a widely available treatment to Demodex folliculorum infection called pilocarpine gel. However, using this gel on the skin does not promote any hair growth.

A theory for Demodex folliculorum infection in people with pattern baldness is that the sebaceous glands of alopecia affected hair follicles become larger and more active, producing oils at a faster rate, under the influence of dihydrotestosterone (DHT). The oils combine with dead cells from the hair follicle to make sebum. The sebum is a rich source of nutrients and this is the food that Demodex folliculorum eats. The oily food supply increases in most hair follicles affected by pattern baldness so these hair follicles can accommodate a greater number of Demodex folliculorum parasites. Rather than the parasites causing pattern alopecia. The parasite infection could be simply a consequence of pattern baldness rather than a cause of the hair loss.