Hair Restoration Blog

Q:

Hello,

Have been diagnosed with Alopecia Universalis, not a problem from a cosmetic point of view as I’m over 65, comfortable with myself as a person, and have a positive outlook on life and a strong faith.  The only thing that is bugging me is my finger and toenails.  The pitting and destruction of the nail bed is a problem.  Wondered what the best thing I can do at this point.  I have had the nails covered with an acrylic at a nail studio and for the most part, this seems to work until they get long and snap off.  Should I be taking a special vitamin such as Biotin or Zinc?
Thanks,

A:

This is a good question and I personally could not find your answer myself anywhere. I discussed it with some of my dermatologist colleagues (when it comes to nails, they are more involved with this condition and have probably seen or treated more similar cases of nail changes with Alopecia Areata or Alopecia Universalis.

Here are two of the answers I received from other doctors who see this condition more than me:

1.    Um…I see a fair number of patients with significant deformities of their nails including clubbing, rippled nails, flaking, dents in the names and the distal phalanges with granulation tissue and fullness all starting after they started getting those acrylic manicures. They are pretty rough and they often get damaged nail beds.

2.    Hey Parsa, Unfortunately there isn’t much you can do for the nail pitting that you see with Alopecia Areata or Alopecia Universalis. You can cover it with acrylics - that would be fine, but would damage the nail further over time. Nail polish and manicuring would be preferred treatments. Using Biotin would be fine to promote healthier nails but wouldn’t get rid of the underlying problem. You can also try potent topical steroids to see if that would make a difference.  Hope this helps.

Q:

I started the Propecia at the beginning of March (8 months ago), prior to the procedure last March. Should I still be on it?

A:

It is great to hear from you and I am glad you are happy with the result of your hair transplant. The final result of your hair may still get better up until one full year after your surgery if you allow your hair on the transplanted area to grow longer.

Finasteride was mostly prescribed for prevention of shock loss after hair transplant or losing native hair on the balding areas after a hair transplant. You have significant miniaturization on the front, top and crown area (90%-100%), which makes your preexisting hair on balding areas prone to further hair loss. Now that you had your transplanted hair grown, you can decide to stop Propecia. By doing that, you may risk losing your own hair on the balding area further (transplanted hair does not need Propecia for its growth) or you can continue taking the medication to increase the longevity of your preexisting hair on those areas.

Q:

Hi,

I’m a woman and I’m single. I feel like I need any edge I can get in the dating world, as I’m in my thirties and would like to begin dating for the possibility of marriage. I found Latisse on the Web but was wondering how I could buy it for myself.

A:

Hey there,

Latisse (bimatoprost 0.03%) is only available by prescription by a practicing doctor. Do not, I repeat, do not purchase Latisse at another place other than from a prescribing physician or your local pharmacy. There might be quack Latisse products on the market which may have severe side effects.

Latisse side effects include: eyelid skin darkening which may be reversible, and potential for increased brown iris pigmentation which is likely to be permanent.

Latisse does seem to enhance the appearance of eyes. A lot of people want big and beautiful eyes. Latisse can help make eyelashes look longer and thicker.  The effect is through increasing the period of time that hair follicles grow.

For those who want longer eyelashes and already have eyelashes that do not grow long and thick, Latisse is the right product. Another option you might want to consider is an eyelash hair transplant, if you qualify. People with scarring alopecia on the eyelash areas are good candidates for an eyelash transplant, and also people who don’t have very much eyelashes or none at all.

Q:

Hey there, doc,

It’s been about three weeks since my second hair transplant in Los Angeles. As of this moment, when I bend my neck, there’s a tightness and tension on the back of my head (donor area). Can you tell me if this tightness will ever go away and be back to the way it was before my operation? I really want to be back in the gym doing my jump ropes and abs.

A:

I’d say to give it about three weeks and begin more gentle activities such as jogging, brisk walking, bike riding, or push-ups. As long as you don’t stretch that donor area by looking down (this is important), you ought to be OK.

Activities to stay away from four to six weeks after a hair transplant: wrestling, flag football, basketball, boxing, abs exercises, and surfing or boogie boarding. Make sure there isn’t much strain on the donor area. It’s sensitive and requires protection and non-contact to heal.

Remember: Activities which increase tension between the edges of the healing wound in the donor area, such as lifting barbells or weights and other exercises involving intense bending of the neck are to be avoided. You should wait at least six months for this type of exercise in order to prevent reopening of the wound or stretching and widening of the donor scar.

Recently, the Senate proposed a health legislation which includes a 5% tax on cosmetic procedures. The cosmetic surgeries include hair restoration procedures and many other surgeries for men and women.

The potential 5% tax on cosmetic surgeries is a no-win situation for American citizens and potential hair transplant patients. By levying a tax on cosmetic procedures throughout the United States, it may further cripple our stumbling economy and reduce the much-needed funding states receive from cosmetic surgeons in order to build, for example, a high-speed train in California, create more innovative after-school programs for teenagers, poverty intervention programs for inner-city residents, more efficient forms of public transportation (e.g. metro rails).

But, at the heart of the issue, I believe, is the obstruction of an American citizen’s right to the pursuit of happiness. Through an orthodontist, people have the right to get their teeth straightened out; by undergoing a vasectomy, a married couple no longer has to deal with an unwanted pregnancy; through the purchase of an electric hybrid Honda Civic, a motorist can fight sky-rocketing gas prices.

The government doesn’t tax citizens for making these types of decisions. People do them because they believe these things will improve their lives. But why impose a tax only on cosmetic surgeries? Where do we draw the line? Who can be the judge of whether a hair transplant is a luxury for a 25-year-old man who started to lose hair and looked less attractive, which led him to struggle with social anxiety and feel depressed a lot of the time?

I believe this young person ought to be given the same opportunities as the other non-bald peers in his life, especially when we are talking about dating, relationships, and employment prospects in this increasingly-competitive time. Who knows, if this legislation passes, maybe in the near future, people who wear contacts will be taxed an additional 5%.

At US Hair Restoration, we perform hair transplants for lots of patients who travel from other countries, such as Canada, Europe, and the Middle East. Many of these patients visit the United States because they want, for their cosmetic surgeries, to be exposed to the most modern techniques; but many of them may consider the cost of cosmetic procedures, too. Increasing costs for these surgeries may deprive us from a potential source of income and deprive them of potential patients.

Currently, some states impose a tax on cosmetic procedures. According to doctors who work in these states, the results haven’t been pretty. The plan has fallen 59% short of its projected revenue; it’s proven to be an administrative pain-in-the-behind, and it was forcing many prospective clients to obtain cosmetic surgery services in surrounding states, resulting in reduced tax revenue collected from plastic surgeons from cosmetic-tax-imposing states.

For myself, as the medical director of US Hair Restoration, I’m against this legislation for the simple fact that people ought to have the freedom to do what they think will make them happy–without imposing additional costs on them. Our motto at US Hair Restoration has always been: “quality hair transplants for everyone.” Some of my patients have told me that they have lost a lot of life opportunities because of their baldness. Why not allow these wonderful people to get back what they deserve: their hair.

Let’s be fair to all people. After all, we live in the land of liberty.

-

Parsa Mohebi, MD
US Hair Restoration

In the study of hair growth and hair elongation, there’s a new kid on the block. He goes by “TRH” or, to be more specific, Thyrotropin-Releasing Hormone. TRH has the potential to play a major role in Hair Restoration and Hair Transplants.

This month, a new discovery in hair growth and the hair growth cycle was published in the Journal of the Federation of American Societies for Experimental Biology. The study was done in Germany by Dr. Gaspar at the University of Lübeck, Department of Dermatology and Department of Internal Medicine.

Thyrotropin-Releasing Hormone (TRH) has proven to be one of the factors involved in the hair follicle growth cycle. Thyrotropin-Releasing Hormone is in closest proximity to the hypothalamic-pituitary-thyroid axis, which regulates thyroid hormone synthesis.

Since transcripts for members of this axis were detected in normal cultured human skin cells, and because it’s been found that when human hair follicles (HFs) are stimulated with thyrotropin, they respond, researchers have decided to study whether human hair follicle functions are also modulated by thyrotropin-releasing hormone. They report that the epithelium of normal human scalp hair follicles expresses not only TRH receptors (TRH-R), but also TRH itself at the gene and protein level.

Stimulation of micro-dissected, organ-cultured hair growth with thyrotropin-releasing hormone promotes hair shaft elongation, prolongs the hair cycle growth phase (anagen), and antagonizes its termination by TGF-beta2. It also increases proliferation and inhibits the apoptosis of hair matrix keratinocytes. These Thyrotropin-Releasing Hormone effects may be mediated in part by reducing the ATM/ATR-dependent phosphorylation of P53. By microarray analysis, several differentiated up-or down-regulated TRH-target genes were detected (e.g., selected keratins).

Thus, human scalp follicles are both a source and a target of thyrotropin-releasing hormone, which operate as a potent hair-growth stimulator. Human hair follicles are an excellent discovery tool for identifying and dissecting non-classical functions of thyrotropin-releasing hormone and TRH-mediated signaling, which emerge as players in human epithelial biology.

Q:

Is it fine for me a get a hair cut this week.  It will not be a buzz cut and there should be a fingers width of hair in the back, at the very least.

A:

Haircut before hair transplant surgery is OK and you can pretty much do whatever you want with the hair on donor and recipient area.  However, I generally prefer to clip the hair in our office the day of surgery.  It is better to leave the hair on the back a little bit longer so the staple or suture line will be covered better.  You can leave the recipient area the way it is.  I sometimes prefer to have the hair short, almost buzz cut in the recipient area to visualize the recipient hair better.  However, cutting hair is usually not mandatory in most patients who undergo a hair transplant procedure in US Hair Restoration.

Q:

Hi Dr. Mohebi,

What do you think about this topical scar gel called Kelo-cote for my hair transplant donor scar?

A:
Kelo-cote® is one of the many topical products that is used along with other methods of wound closure or by itself to improve the alignment of the wound in the early stages of wound healing.  Advanced Bio-Technologies, Inc. has developed this wound product, which can maintain the benefits of silicone gel sheets while eliminating the limitations associated with their use.

Kelo-cote® is a topical silicone gel that is used for the management of scars and for the prevention of abnormal scars in the form of hypertrophic scars and keloids. Kelo-cote® is claimed to be beneficial for a variety of scars resulting from trauma, surgery and burns.

Kelo-cote® gel dries to a waterproof sheet that is gas permeable and acts like an extra layer of skin. This wound care product can help to soften and flatten the scar of skin wounds.  Although Kelo-cote has been anecdotally reported to be useful for the donor scar from hair transplant surgery, there is little significant data to prove that claim.  I personally believe that the maturation and stretching of the scalp wound takes a long time after wound closure and post operative care using this type of wound products may not significantly impact the final appearance of the donor scar.

Hello everyone,

I will be in Amsterdam to attend the annual meeting of International Society of Hair Restoration Surgery.

I will be lecturing on a new application of Laxometer too.  I will keep the blog updated with the news in hair restoration world when I am back next week.

Best,

Parsa Mohebi, MD

Here is one interesting news from the AP: “A South Florida man says he was denied a hair transplant because he is HIV positive.”

Diego Del Rio said in a lawsuit that he was refused a transplant by Dr. X of the Age Defying Surgical Center.  The 28-year-old hair loss patient, Del Rio, said he told “them” he is HIV positive.  After a series of follow-up phone calls, a “staffing medical coordinator” told him the office would not treat him.

This is not the first time that a person with HIV is denied the right to have surgery like other patients.  (Attorney to the doctor), Gabriel Imperato, said Thursday he had not seen the lawsuit, and he and (the doctor) will “respond in court, not in the media.”
The Florida Health Department says denying someone treatment simply because they are HIV positive is against state law.  Del Rio is suing for $15,000 or more. The lawsuit was filed Tuesday in Broward Circuit Court.

US Hair Restoration in Beverly Hills and Los Angeles has been welcoming patients with different medical conditions including blood born diseases as long as the hair transplant procedures were safe to the patients.  The fear around HIV is more of the potential risk of contraction of the virus or other diseases. With universal precaution, however, the risk to the surgeon and surgical staff is very minimal.