Hair Restoration Blog

Q:

I had gastric bypass about 10 years ago. Not only have I lost a lot of my hair but i have never regained it. Especially after taking a shower i notice that i loose a lot more hair then i should. I have brought this concern up with my doctor but all he tells me is to increase my vitamin intake. I have also been taking Biotin for about three months and vitamin B12 along with a multi-vitamin but have not seen a difference. In addition my eyelashes are thinner and I have lost the thickness of them. I am thinking about rogain for women but if you can please give me any advice I would really appreciate it I am only 38 and fear i will be bald byt the time i turn 40.
Thank You,

A:

As we discussed in the article “Gastric Bypass Surgery and Hair Loss”, it is common to see hair loss or changes in the quality and color of hair after a gastric bypass surgery. The changes are generally seen in the first few months after the gastric bypass surgery. Similar hair loss conditions could also be seen in a variety of other medical conditions, major surgeries or trauma.

The immediate few months following a gastric bypass surgery mimics sever starvation conditions in which body may have difficulty obtaining many essential elements or nutrients through regular diet and supplement of nutrients and vitamins may become necessary.

Hair loss after a gastric bypass may be seen in the patients who don’t have any obvious vitamin or mineral deficiency. Patients need to be evaluated on a regular basis by their surgeon and with regular lab tests. The initial hair loss should return to normal if there is no other underlying condition exists.

In case patient has any other medical condition that can accelerate hair loss or in the case of genetic male patterned or female patterned baldness, patient may never gain their hair back. In those conditions the stress of the surgery acts as a stimulator forcing patient scalp hair to fall on a faster than normal pace.

My recommendation is to see a good hair transplant surgeon and undergo a miniaturization study to rule out any other treatable causes of hair loss.

Q:

I am 27 and have a very high laying hairline.  My hair line is the same as my mother and aunts.   High hair line resembles a male hair line with mild recession on the corners.  I know I am not balding because a few other female members of the family have an exact similar hairline patter.  Can you help me with a hair transplant procedure?

A:

There are several methods to lower a hairline both in men and women.  Hair line can be lowered by hairline lowering hairline surgery, in which a strip of skin is removed from just below the frontal hairline to bring the hairline lower.  In this method a trichophytic incision can help to blend frontal hair into the forming scar.  The result of lowering hairline surgery is instant and the surgery is less time and labor consuming in comparison with a hair transplant procedure. 

At US Hair Restoration, we recommend hair transplant using follicular unit transplant methods for lowering hairlime in men and women for the best cosmetic results.  Hair transplant cannot make such a drastic change in such a short time, but the result is completely normal with no visible scar on the frontal area.  The presence of linear scar at frontline is a major disadvantage of hairline lowering procedure.  The scar of hairline lowering surgery could be camouflaged with a hair transplant surgery with placement of minimal number of grafts on the frontal area and in front of the hairline scar.

Q:

I have heard that one of the side effects of finasteride could be breast enlargement. Is it possible to develop more breast tissue because of blocking effect of finasteride on testosterone?

A:

One of the released researches from finasteride clinical studies indicates that breast enlargement (gynecomastia) rate was not higher in patients who took Propecia (finasteride) in comparison to the ones who were on placebo. One out of every 100 patients may experience breast tenderness and some degrees of enlargement, which is about the same in placebo and medication group. The similar rate of breast complications indicates that this side effect may be simply a placebo effect. Think about it, you are giving a medication to male patients, which they know has to do with their testosterone or testosterone related factors. What do you expect?

Q:

I take Errin Tablets for a few months as a contraceptive. I have also been experiencing hair loss recently. I wanted to know if there is a correlation between losing hair and this particular contraceptive. I had a baby 4 months ago. I see thinning everywhere but it is more obvious on the front and top as diffuse thinning.

A:

Your hair loss could be related to your pregnancy and delivery of your baby. Human hair grows in cycles and goes to resting phase (telogen) between the growth cycles. About 95% of your hair is in growth phase (anagen) at anytime and about 5% of them are in resting phase. You may not see any hair growing from the follicles during resting phase. That is the reason we normally lose scalp hair on a regular basis. In fact losing up to 200 hairs every day is normal and part of the cycling of our hair. Some stimulants can put a large number of our hairs into telogen phase. This condition is called Telogen effluvium. Telogen effluvium (TE) can be seen in women after delivery of a baby. Telogen effluvium is especially seen between months one to five following delivery of a baby, when the load of estrogen is removed. It is usually seen in 40 to 50% of women after pregnancy, and like most of the changes in pregnancy, it is temporary. Wait 4 to 6 months and you should grow your hair back. Meanwhile, make sure you are taking sufficient minerals and vitamins on a daily basis.

Any other cause of imbalance in estrogen level may increase hair loss. Scalp hair loss is reported in users of oral birth control pills containing norethindrone and ethinyl esteradiol, like Errin tablets or other brands: Brevicon, Norinyl, Norethindrone. However the association of those contraceptives and hair loss has not been completely confirmed through medical literature. I women think their hair loss may be linked to the use of birth control pills, they need to stop the pill and use another birth control method after discussing that with their doctor.

Many hair transplant patients are concerned with the scar of cosmetic surgeries including hair transplants. Several techniques have been suggested to minimize the scar such as corticosteroid injections, irradiation, ultrasound, silicone applications into and around the forming scar. However, the effects of most these methods were far from satisfactory. Botox is a new method that could be used to minimize the size of both facial and scalp scars. The use of Botox for reduction of facial scars from surgeries was first suggested by plastic surgeons who were trying to reduce postoperative effect of facial muscles on stretching and widening of scars.

In many patients with ugly scars of the face, botulinum toxin (Botox) was used successfully to induce temporary paralysis of the muscles during revision surgery. Botox with the same mechanism can help minimizing tension on the healing wound edges until collagen could mature and scar if completely adnd firmly formed.

The use of Botox has been suggested for the treatment of stretched scars on the face by many plastic surgeons now. Hair transplant surgeons also use Botox for treatment of the hair transplant widened scars of the donor area that do not show improvement with a simple scar revision procedure. There are reports of successful decrease in the final size of the scars with injection of Botox into the muscles surrounding the maturing scar. We at the Los Angeles hair transplant offices of US Hair Restoration don’t offer Botox to every patient who is having a hair transplant surgery through strip technique, but it certainly could be used for the patients who suffered from widened scars of prior surgeries and did not respond to the other methods of scar revision.

Q:

Thanks Dr Mohebi,

for your time and information, really appreciate it. I have seen a neurologist who gave steroid shots and a pain management Dr who gave an occipital nerve block, neither worked. Had Botox injection into the area also. EMG and neck MRI tests didn’t show anything. Is the donor incision sometimes deep enough to damage muscle such as the occipital muscle or trapezius? Deep enough to damage the fascia tissue?

thanks again,

A:

It seems like you have done the proper work up for evaluation of your donor scar complication. If a hair transplant is done by a skilled hair transplant surgeon it should not be that deep to injure the fascia. In most patients it is easy to find the subcutaneous fat, which is our safe zone. Even if the fascia is injured, it should not create such a problem. The area of the strip is generally much higher than the levels of the neck muscles. Injury to the muscle and fascia should not cause any such feeling without involvement of the nerves.

I cannot imagine anything except the nerve damage to be the cause of your current problem. I occasionally have seen patients with some unusual sensation after old surgeries that get better when they get a repeat hair transplant. The reason for the improvement is that the hair transplant surgeon removes the scar and by doing that can release the adhesion of scar of first hair transplant and underlying tissues including the nerves.

Q:

Dear Doctor,

I had a hair transplant at another clinic, X Medical, 8 yrs ago. The donor area was 1 strip 1 inch wide, 4 inch length, going diagonally from the occipital protuberance bone towards the right ear.

When I woke up the day after the procedure, I could tell something was really wrong. The whole back and right side of my head was really tight. It felt like the scalp was being pulled backwards, mostly on the right side. It hasn’t changed to this day and its constant. It’s a crippling feeling and I’ve been having problem with it since then. I understand there could be some tightness from removing the donor area. But this is something different than just tightness or scalp stretching; it’s a whole other type of problem in the tissue under the scalp surface. The clinic said the tightness should go away after awhile but hasn’t given me any possible solutions or possibilities.

I thought I might get some answers by contacting other hair transplant doctors who do these procedures frequently and who know the anatomy of the head. It would be so helpful if you could try to give me an idea of what could have happened or went wrong.

Thank you for your time,

A:

Hi,

This is an unusual condition that I have not seen or heard. The donor skin tightness usually improves in two to three weeks following a hair restoration surgery with strip technique. However the numbness and tingling around the donor incision may continue for a few months due to violation of the very small superficial branches of nerves of the donor area.

Although removing the donor strip may look simple, it should be done meticulously. The best method of removing the strip is to trace the skin on the back superficially while having a good control on the depth of the incision and then remove the right thickness of the scalp skin. We follow this procedure religiously at the Los Angeles hair transplant offices of US Hair Restoration. The incisions should be done within the subcutaneous fat layer, which is the safe zone with minimal chance of injuring the main sensory nerves of that area.

Since you have an unusual sensation on the back of head, you need to be evaluated by a physician for confirming your diagnosis. I have not examined you, but one of your sensory nerves might have been injured during the strip removal. Mild nerve injuries recover within a few months with complete return of the sensation. More serious injuries may leave patient with a numb area or a sense of tingling or tightness for a longer time or permanently. This complication is generally rare, but may be seen in any skin procedure that involves making incisions around the sensory nerves. If this is the right diagnosis and you are experiencing a phantom pain or sensation due to injury of a nerve, a pain specialist might be able to help you with the injections of some medications into the local nerve to block the irritated nerve.

Q:

I was recently diagnosed with hypothyroidism. I have been sensing some changes in my hair including; color and texture changes and some scalp hair thinning overall. Can all these changes be due to my hypothyroidism or should I look for any other causes?

A:

When you have hypothyroidism or low thyroid function, your hair tends to get more coarse and sparse. Changes in waviness of hair are not unusual either. Some degrees of hair color changes could also be seen.

You definitely need to be regularly seen and evaluated by your endocrinologist. In some medical syndromes patients may suffer from several different hormonal imbalances that may contribute to the changes in their hair color or characteristics.

We have discussed different methods to repair hair transplant donor scar in the past. There was an interesting article in Dermatologic Surgery Magazine last months on repairing the wide donor scar using body hair by Dr. Robert Jones from Oakville, Ontario, Canada.

Dr. Jones has reports revising a wide donor scar after previous hair transplant surgery by body hair transplant. He uses chest hair removed by follicular unit extraction method using a 1mm punch device. He has transplanted the grafts directly into the scar area so follicular unit grafts did not have to wait more than a few seconds.

Three months post-op follow up pictures were shown with some hair growth on transplanted donor scar with some reasonable coverage. The growth of the transplanted hair is not completed before 6-8 months after hair transplant and it is expected to see better coverage by the end of that period.

I have had a presentation on revising neurosurgical scars using hair transplant with follicular unit transplantation in the annual meeting of International Society of Hair Restoration Surgery in 2007. In that meeting, I presented four patients who underwent hair transplant surgeries to revise the widened scar of their neurosurgical scars. The results of the hair transplant on those patients were great and the appearances of the scars were completely vanished in all four of them.

Again the current article by Dr. Jones proves that hair restoration could be used effectively for improving the appearance of scalp scars. My personal preference and the method that I use in our Los Angeles hair transplant clinics is to use scalp scar rather than body hair unless patient’s donor area is completely depleted and there is not enough harvestable hair on the donor area. In those cases body hair transplant could be an alternative if patient have good quality body hair for a body hair transplant through FUE (Follicular Unit Extraction).

Q:

I am a 41 year old woman and have been suffering from hair loss for over 10 years. I have had some type of scalp dermatitis for a long time that has been treated with topical steroids over the last 20 years. Could dermatitis be the cause of my hair loss? Or could I have lost my hair due to the steroid solution that I used on my scalp?

A:

Topical steroids are not generally causing hair loss. Dermatitis on the other hand, can increase the rate of hair loss in people who are prone to patterned baldness. Sever scalp skin inflammation can also cause severe hair loss in some patients. Dermatitis has several types. Dermatitis can also be seen as part of other skin diseases that may cause hair loss. You need to see a good dermatologist or a hair specialist and get your hair mapped for miniaturization. Your hair loss type and whether it is simple female patterned or is associated to other medical problems could be determined after direct examination of your hair and evaluation of its miniaturization status.