Hair Restoration Blog

Hair Care Beverly Hills

Here is the content of the interview with US Hair Restoration’s Medical Director, Dr. Mohebi done by BuziMoms which is published in hair care Beverly Hills.  The interviewer asked several hair loss and hair restoration questions from Dr. Mohebi based on the requirements of the visitors and readers of the site.  Here are the questions and Dr. Mohebi’s answers:

An Interview With Dr. Prasa Mohebi, M.D. , A Qualified Hair Restoration Surgeon For Moms In Beverly Hills

BuzyMoms: If a hair loss patient has already had a transplant with another doctor and is disappointed with the results, can the procedure be redone or is repair possible?

Dr. Mohebi: Yes, hair restoration surgery repairs are a good portion of our operations performed in our Southern California offices (located in Beverly Hills, Encino and Orange County).  Many people may have unnatural results from previous hair transplants due to the older techniques, but some even have problems with recent hair restoration due to technical issues or lack of proper judgment on the part of the hair transplant surgeon. In most cases, the repair is easy and can be done in one or two sessions.

BuzyMoms: Is there a minimum age for hair loss surgery?

Dr. Mohebi: Hair transplant surgeons used to say that 24 was the minimum age to perform a hair restoration procedure.  However, nowadays microscopic techniques being used to evaluate the miniaturization of hair can assist surgeons in predicting the final pattern of hair loss. By being able to predict each patient’ s  final stages of hair loss, we are able to see where the pattern of baldness is heading and recommend hair transplant surgery at an earlier age.

BuzyMoms: Won’ t my bare scalp be showing in the back of my head once the donor hair is taken?

Dr. Mohebi: If you do not plan on shaving your hair, your donor wound will never be visible.  However, if you plan on shaving your head for any reason, you may need to have a FUE or Follicular Unit Extraction procedure done rather than the general FUT procedure.  This method eliminates the visibility of a linear scar on the back of your head and is the best option for patients who plan on shaving their head or keeping their hair very short in the future.

BuzyMoms: Do you provide free consultations?

Dr. Mohebi: Yes, the initial consultation with us is always free in any of our three hair transplant offices in Beverly Hills, Encino and Orange County.

BuzyMoms: What type of information should be brought to the consultation?

Dr. Mohebi: Anything related to your hair loss and hair restoration, including medical, surgical or even cosmetic changes that you like and may help you have a better result after a hair restoration procedure.

BuzyMoms: Are lab tests required prior to surgery?

Dr. Mohebi: We may need lab work for men or women who have hair loss without showing a typical pattern that we see in most male or female patterned hair loss or in people who have lost hair due to any other medical conditions such as thyroid problems, hormonal imbalances or lack of certain elements such as Iron.  We also need certain lab works from patients who have medical risk factors for surgery like diabetes to make sure those medical conditions are under control before we can pursue with the hair transplant surgery.

Dr. Mohebi,

You performed a hair transplant on me to make a female hair line as part of my male to female transgender process.  I recently decided to do a scalp surgery that may require a scalp advancing procedure.  My Dr. Will transplant hairs along the scar in hairline.  I am not convinced this will be enough, and we may need to do one final pass after all is done to be sure, possibly the middle of next year.  I’ll have to wait and see, money is also an issue.

A:

Good luck with your scalp advancement surgery. Please do your research and make sure your plastic surgeon does perform hair transplant on a regular basis before letting him place hair on your hairline.  It is especially important that he has experience with creating hairline for transgenders.

If he is not doing hair transplant on a regular basis as is the case for many cosmetic surgeons, it might still be OK to have him put the hair removed during the scalp advancement surgery on the top areas, where you still need more reinforcement.

Hairline is very meticulous specially for male to female trans gender patients.  We can easily repair the hairline in front of the scar of your scalp advancement surgery.  It will be more difficult if there is less than perfect transplanted hair on the hairline area.  that requires removing the hair grafts that are transplanted out of their normal locations and reuse them in the other areas.

Q:

Dear Dr. Mohebi,

Thank you for taking the time to see me on Saturday! Your correspondence providing a summary of our discussion was very comprehensive and is much appreciated!

Since our meeting on Saturday, I have done some research and would like to trouble you with a few more questions:

1) Is Alopecia the correct term to describe my hair loss pattern?

2) Would you consider cortizon shot treatment for me?

3) Would you consider laser therapy?

4) If I were to use monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

I wish to thank you again for all your time and patience!

Best regards,

A:

Hi,

Here are your answers in the order you asked:

1) Is Alopecia the correct term to describe my hair loss pattern?

Alopecia is a general term that means hair loss. We have many different patterns of hair loss or alopecia, like male pattern or female patterned alopecia or alopecia cicatricial. Your pattern is similar to a male pattern because you lost your hair on the frontal area while you kept your hair on the donor area intact, which is why you might be a good candidate for a hair transplant procedure considering that your medical evaluation is negative for any medically treatable cause of hair loss.

2) Would you consider cortizon shot treatment for me?

No, steroid shots are sometimes used for Alopecia Areata (AA), which is an autoimmune disorder. Alopeica Areata is a hair loss condition with patchy hair loss spots. Your condition does not seem to be Alopecia Areata.

3) Would you consider laser therapy?

I do not recommend laser therapy for hair loss in the form of laser comb or laser machines because of the lack of solid medical evidence that support their effectiveness at this time.

4) If I were to use Monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

You can start with 2% and then you need to be re-evaluated in six to 12 months and a treatment plan might need to be adjusted at that time.

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

Any good internist or endocrinologist could follow through with the lab works that you need.  Our letter includes the list of medical conditions that should be considered and lab works to rule out those women like you who have hair loss. You can share my letter with any good internist or endocrinologist and he or she should be able to follow through with your lab result and treat any treatable conditions that could possibly be found.

Have a great day,

Q:

I am a 26 year old female and felt like the world was mine, and then this happened and now I would rather hide, so I understand about feeling like a freak. But I think we all have to remember that we have nothing to be ashamed of This disease is more widespread than we think and people are more understanding than we give them credit for. We can all still live long and happy, if a little self consciously. Since getting AU, I have heard of so many people who have friends or family with this disease - there are a lot of us, and we are still lovable, attractive, successful and admired. We may look different but if we can overcome the self-imposed stigma of it, I think it will just serve to make us stronger.

Speaking as a woman, let’s give our daughters, sisters and mothers a good example for self-respect, and show them how to be fearless, how to overcome obstacles and show them that women are more than long shiny hair and a media approved image.

I know I am young and have not yet suffered with this disease as long as any of you, so it is likely easier for me to say these things. I just hope to remain this optimistic and not let it get the better of me. We are all more than our hair. And if being bald and shapely or hairy and fat is the choice, I choose to keep my body healthy on the inside instead of just looking it on the outside.

Thanks to all of you, I wish you all the best and just remember, you are more than your hair and do not accept feeling like a freak! Remember the people that love you when you are at home and hairless for all to see, what they see in you is what you truly are, not the you that has to wear a wig so people don’t stare or the one who has come to hate the wind.

A:

I like your attitude.  Treatment of Alopecia Universalis (AU) could be difficult or impossible in some cases.  You have to come to my office and talk to some of my patients who think the world has come to an end because they are losing their hair.

This is what I always say to my patients: It is important to try to look your best. If you have the option to change your appearance for the better, do it as much as possible, but for the part that you cannot change, accept it.  Learn to use it to your advantage and learn to love it.

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

Q:

I had a hair transplant (FUE) over 2300 grafts 6 weeks ago all in my front and hairline and I still have over 90% of all my transplanted hair and was also wondering if this is normal since everywhere I read that all transplanted hair will completely fall out between 1 to 2 months. I hope that I am part of that 10% you spoke of in this blog.

A:

Yes, you might be.  Every now and then we have seen patients who do not follow the regular pattern of hair loss and hair growth after hair transplant.  As we mentioned before, most patients lose all transplanted hair in 2-3 weeks after their hair transplant.  This is because the change in the physiologic environment of the hair forces the hair follicles into the telogen phase.  Patients generally do not have any hair on the transplanted area from 3 to 6 weeks after surgery.  When new hairs start to sprout, they become long and thick in the next few months after that.

There is some exceptions and every now and then we see patients who not only do not lose their transplanted hair, but their transplanted hair keeps growing from day one after hair restoration surgery.  You might be one of those exceptions.

There are also reports on some patients who have delayed growth on their hair growth and they do not see any growth in the first 6, 8 or even 12 months.  We do not know what is causing that but it has been anecdotally reported.  Close supervision of the patient and serial follow ups is needed to reassure the patient that he or she does not have any serious problem and the transplanted hairs are not wasted.

I just read a nice article in Dermatologic Surgery Journal on naturally occurring female hairline based on a study on a large group of normal women.  The study was done in Miami, Florida by Dr. Nausbaum et al.  Although due to the higher numbers of men with hair loss who undergo hair restoration surgery, male hairline has been studied and published more comprehensively though female hairline design through hair transplant is also gaining popularity in the last few years.

The authors came up with a guideline that could be used for designing a female hairline.  The numbers were calculated based on the average of the recorded parameters in women with healthy non-balding female hairline.   Among the interesting parameters, you could see that the presence of the widow’s peak was recorded in 81% of all 360 women.

The authors report that lateral mounds were observed in 90% of the patients in the study.  They published the average measurement parameters on all the indexes in the article.  We at US Hair Restoration perform hair transplants for women with some types of female patterned hair loss and alterations in the pattern of their hairline, or the ones with a male patterned hairline.  We also perform transgender hair transplants for male to female transsexuals.  I believe that transgender hair transplants should be one of the first cosmetic surgeries that a transgender individual should have done to achieve a more feminine appearance.

Q:

I had a hair transplant surgery over two months ago.  Is it normal that I did not shed the transplanted hair (feels like beard stubs) but got thinning around the area. I saw on Rogaine insert that the use of Rogaine causes the miniaturized hair to fall off a month after use.
Thanks

A:

It might be normal not to lose all or some of the transplanted hair shafts after hair transplant.  In fact, this condition could be seen in 10% of the patients after hair restoration surgery.  If you have not lost the implanted hairs after a month from your hair transplantation, it is likely that you can keep them and they will continue to grow.

Rogaine may cause some hair shedding when people start to use it for the first time.  The hair shedding is mostly due to the increase of the hair follicle turn over.  If you only experience the loss of miniaturized hairs (fine hairs), you might also be experiencing “shock loss”.  Shock loss is a phenomenon in which the patient experiences an acceleration in shedding of miniaturized hair after any stressor such as stress of hair transplant surgery.

Dear Parsa Mohebi,

I hope you’re doing great. I hope you also remember me - it’s ….. - I visited your office in January in Mission Viejo, California. I am currently in Dubai! Thank you for the letter which you sent me regarding the tests I should take. I appreciate the time you took out for me. I have taken the tests and wait for the results.

I wanted to ask you a question regarding the hair growth. Recently I was going through some websites and landed on a product called ScalpMed.  I was quite alarmed at how this product worked (as it says it does). I am aware that there are numerous type of products available in the market but for some reason this really got me interested. Can you please have a look at it and advice me whether or not to take it seriously?

I appreciate for your time. Looking forward to hear from you!

A:

As my patients ask, I often answer questions on hair loss products on this blog.  Scalp Med makes a series of products for hair loss and hair thickening.  They are put together as different kits such as a Detoxifying Cleanser Kit, Scalp Med For Women and Mega-Multi Vitamins.  Scalp Med ads, like many hair loss products, claim that they are FDA approved hair loss products. You can find many pictures, testimonies and so on from balding patients who try to promote the product.  Here are the ingredients of Scalp Med:

Scalp Med has different products including topical Vitadil-5A for men, Vitadil-2A for women, topical NutriSol-RM, and Cortex Enlarger hair thickening spray.  The firs two Vitadils are topical solutions that contain minoxidil, which is also the key component of Rogaine.  They claim that they have a unique delivery agent formulated to increase the absorption of minoxidil in men and women.

When it comes to NutriSol-RM and Cortex Enlarger thickening spray, Scalp Med is a bit more vague as to its ingredients. Basically, other than the active ingredient minoxidil, the other ingredients do not seem to be scientifically proven to help the growth and health of hair. The cleansers that are put into many hair loss products should not do anything with the growth of your hair and advertising on the effect of better cleanser for hair growth is more like a myth.

My recommendation to you is to complete your medical evaluation to make sure you are not losing your hair due to a treatable cause.  If you are diagnosed to have a typical female patterned hair baldness, then you can use Rogaine.

I am a 26 year old female and felt like the world was mine, and then this happened and now I would rather hide, so I understand about feeling like a freak. But I think we all have to remember that we have nothing to be ashamed of This disease is more widespread than we think and people are more understanding than we give them credit for. We can all still live long and happy, if a little self consciously. Since getting AU, I have heard of so many people who have friends or family with this disease - there are a lot of us, and we are still lovable, attractive, successful and admired. We may look different but if we can overcome the self-imposed stigma of it, I think it will just serve to make us stronger.

Speaking as a woman, let’s give our daughters, sisters and mothers a good example for self-respect, and show them how to be fearless, how to overcome obstacles and show them that women are more than long shiny hair and a media approved image.

I know I am young and have not yet suffered with this disease as long as any of you, so it is likely easier for me to say these things. I just hope to remain this optimistic and not let it get the better of me. We are all more than our hair. And if being bald and shapely or hairy and fat is the choice, I choose to keep my body healthy on the inside instead of just looking it on the outside.

Thanks to all of you, I wish you all the best and just remember, you are more than your hair and do not accept feeling like a freak! Remember the people that love you when you are at home and hairless for all to see, what they see in you is what you truly are, not the you that has to wear a wig so people don’t stare or the one who has come to hate the wind.

A:

I like your attitude.  Treatment of Alopecia Universalis (AU) could be difficult or impossible in some cases.  You have to come to my office and talk to some of my patients who think the world has come to an end because they are losing their hair.

This is what I always say to my patients: It is important to try to look your best.  If you have the option to change your appearance for the better, do it as much as possible, but for the part that you cannot change, accept it.  Learn to use it to your advantage and learn to love it.