Hair Restoration Blog

DHT or dihydroxytestosterone is a byproduct of testosterone that causes hair loss in men who are prone to baldness. Another negative effect of DHT is increasing the incidence of prostate enlargement and prostate cancer. Other than above effects, no other major physiologic function is known for the hormone DHT in adult males.

During infancy and childhood, DHT accelerates the development of male genital organs. This effect of DHT stops when a male external genitalia matures completely.
By using 5 alpha reductase inhibitor medications such as finasteride in medical hair restoration, we can block the enzyme to slow down the process of baldness in men and prevent prostate enlargement in elder men.

There is a congenital disorder in which the enzyme 5 alpha reductase is lacking that leads to the lack of DHT production. Congenital 5 alpha-reductase deficiency is also known as familial incomplete male pseudohermaphroditism type 2, seudovaginal perineoscrotal hypospadias, 5-ARD, 5-alpha-reductase type 2 deficiency, ambiguous genitalia or male pseudohermaphroditism.

Deficiency of the type 2 isozyme 5-alpha-reductase, which transforms testosterone to DHT is the cause of this disorder. DHT major role is in development of male fetus external genital organs and without that effect male newborn can develop immature or ambiguous external genitalia.

Diagnosis of congenital 5 alpha-reductase deficiency is through testing the testosterone to Dihydrotestosterone level. Elevated ratio is an indication of 5 alpha-reductase deficiency. The Level of testosterone is also elevated. There is also alteration in HCG stimulation test. In congenital alpha reductase deficiency male fetus develops a female phenotype without presence of uterus.

Congenital 5-alpha reductase deficiency could be treated to some degrees and the symptoms could be controlled with high doses of testosterone to make the deficient enzyme make normal or close to amount of DHT in this patients.

I am in the Detroit airport on my way back to Los Angeles from the 16^th annual meeting of international society of hair restoration surgery (ISHRS) that was held in the beautiful city of Montreal in Canada last week. This five day meeting was filled with a variety of presentation on the clinical and basic science aspects of hair transplant surgery and medical hair restoration.

I gave a lecture on psycho-social impacts of hair restoration on men on the first day of the meeting. The lecture has been prepared based on my other article on Psychology of Hair Transplant that was previously presented and published on the Hair Transplant Forum International on April, 2008. In the current presentation on psycho social impacts of hair transplantation, I explored some other social and psychological aspect that hair transplant patients experience after their hair restoration procedures based on experience we had with our Los Angeles hair transplant patients and what we found in our research last year with New Hair Institute (NHI).

Several other interesting studies were presented on the aesthetic planning and designing of the hair line and frame of the face with hair transplantation. There were many articles on the hair transplant surgery techniques that could be used for optimization of the final appearance of a hair transplant.

Few articles were presented on hair stem cell research and hair multiplication. However based on the presented evidences, there were no signs of an upcoming solution for hair multiplication or hair cloning any time soon.

One article discussed an innovative method of hair graft harvesting that can produce more hair from an existing follicular unit. The result of this study, although interesting was very controversial among the experts and the author could not release the study details on the methodology to elucidate this matter.

I will publish the highlights of this meeting on the website of US Hair Restoration soon.

The article “Surgeon Restores Patients’ Hair, Self-Confidence” was recently published in the popular newspaper of “The Beverly Hills Courier” based on the interview with Dr. Parsa Mohebi, medical director of US Hair Restoration.

Here is a summary of the article, which mostly focuses on the psychological impacts of hair restoration on men. Dr. Mohebi also discussed some of the new methods of hair restoration that is offered by the Beverly Hills Office of US Hair Restoration. Here is how he goes:

Nothing looks better than a full head of hair, and one of the best people to provide it is Dr. Parsa Mohebi, medical director of US Hair Restoration.

Mohebi specializes in several hair-transplant procedures:

• Follicular Unit Transplant (FUT) is the gold standard of hair-transplant surgery, Mohebi said, giving very natural results. A strip of donor scalp is removed and the follicles are prepared under microscopes and distributed in the bald area in the natural direction and orientation.
• Follicular Unit Extraction (FUE), also called non-invasive hair-restoration surgery, uses special biopsy devices to extract individual follicular units without having to remove a strip of skin; so there is no linear scar.

“Not everyone needs non-invasive surgery,” Mohebi says. “But people who want to shave their head in the future for any reason may consider FUE because there is no visible evidence of surgery on the back of their head. There’s nothing to suture, and the small dot wounds are not detectable a few days after surgery”.

• Mohebi also specializes in eyebrow transplants for both men and women.
• As testament to his skills, he also repairs bad or “pluggy” transplants, performed by other doctors. “We do several repair hair transplant surgeries a month,” he says.

Mohebi spends an hour with each new patient and does a microscopic evaluation of the scalp and a miniaturization study of the hair to predict future hair loss. “That way we’re not limited to the obviously bald areas, but we can transplant hair to where the patient may lose hair in the future. With the technology we have now, there’s no reason for anyone to experience hair loss.”

As a fellowship-trained hair-transplant surgeon, Dr. Mohebi continues research the latest high-transplant techniques and his writings have been presented and published in both national and international medical-society publications.

The article continues with discussing the published research on the psychology of hair transplant in men, which was finished last year: Dr. Mohebi’s latest article was the cover story for Hair Transplant Forum International, considered the most important journal in the field of hair restoration, on The Psychology of Hair Transplants. From research in Europe, we know that people with hair loss are prone to anxiety, depression and other psychological problems; we tried to see if we can reverse that with hair restoration surgery.

He evaluated 200 patients after surgery in eight criteria, and saw improvements with FUT in terms of happiness, youthfulness, energy levels, self-esteem and self confidence, future outlook and impact on their career and sex life. The results were amazing and improvements in all eight criteria were statistically significant. The authors, Dr. Mohebi and Dr. Rassman concluded that using the new techniques of hair restoration patient can drastically improve all of the psycho-social impacts of hair loss.

The reporter then set aside US Hair restoration from many other hair transplant clinics by several factors by referring to Dr. Mohebi’s comments on following the latest standards of hair restoration surgery and the fact that things have changed significantly recently in the field of hair restoration. What was done five years ago is not acceptable today. We have the most experienced technicians; and everything is done under a microscope to get the highest yield of hair.

Then there’s the customer service. “The day of the hair transplant procedure is a big day for patients,” Mohebi said, “often six to eight hours. Patients are usually amazed at how smooth and pleasant the day is.

Patients are given mild to moderate sedation and numbing medication for the donor and recipient area. Once the scalp is numb the strip of skin is removed and the wound is closed. The next step is to prepare hair grafts under microscope. While grafts are being made by experienced technicians of US Hair Restoration, Dr. Mohebi is designing the hair line and makes the sites according to the natural direction and distribution of hairs.

Since the newly placed follicles are so fragile, patients return the next day to get their hair washed professionally, given special shampoo and taught how to take care of their hair at home. “After five days, no special care is needed,” Mohebi said.

Ten days after the surgery, patients return to have the donor site checked and staples removed for those who had them. Hair starts growing after three months, and is long enough to style and comb after ten to twelve months. The third follow up is at 10 months after the procedure.

Severe baldness may require more than one surgery, usually spaced at least six months apart. “With megasession hair transplants we can do 4,000 grafts in one day. That significant number is a help to patients with a high class of baldness. We can get a higher stage of restoration with fewer sessions of transplants.”

Continuing to pioneer in the field, Dr. Mohebi is the inventor of the Laxometer, a device to measure the laxity or mobility of the scalp. Laxity of the scalp is key in determining the size of the donor strip so that enough can be removed for bigger cases, and the wound can be closed without too much tension and the scaring will be minimal.

To help people stay abreast of all that’s happening the field of hair restoration, and to answer questions (he’s heard from Europe and China) Dr. Mohebi maintains a hair restoration blog, ushairrestoration.com/blog.

Intercytex has recently released some information on its hair multiplication experiments in a new article in the Journal of experimental dermatology. The title is “A graft model for hair development” and the article discusses what is done so far for hair multiplication experimentally. Intercytex has been involved with hair stem cell, hair culturing and hair multiplication, which is also known as hair cloning.

In this article follicular cell implantation (FCI) is discussed as an experimental cell therapy for the treatment of hair loss that uses cultured hair follicle cells to induce new hair formation. The process of culturing hair cells is based on the demonstration that adult dermal papilla cells (DPC) retain the hair inductive potential that they acquired during hair morphogenesis before birth. To obtain FCI, the investigators isolated hair inductive cells from scalp biopsies and then propagated them in culture media in order to provide adequate cells to generate several new follicles from a few hair follicles.

Following expansion of cells in culture, they implanted those cells into the scalp where they induce the formation of new follicles below the level of skin. They describe a consistent, reliable method in which they can test hair induction. Since the process relies on the ability to retain the potential for hair induction during the expansion of DPC in culture.

They go over a simple graft model that supports hair morphogenesis. In this experiment, they combine dermal cells with embryonic mouse epidermis that provides the keratinocyte (one of the skin cells) component of induced follicles. The grafts are placed under a protective skin flap in the host athymic mouse (a special mouse without capability to reject the transplanted grafts from human) where the cells will form a skin graft with hair if the dermal cells are hair inductive DPC.

Using the assay freshly isolated and cultured mouse embryo dermal cells as well as cultured dermal papilla cells from other species all induced hair formation. They also showed that induced hairs were aesthetically indistinguishable from those of the epidermal donor in length, thickness, and pigmentation. The investigators stated that the newly formed hairs were histologically normal and could resemble a complete natural hair.

We at Los Angeles hair transplant surgery centers of US Hair Restoration will closely follow up with the progress of hair multiplication and cloning techniques. Although the result of the cultured hair on animals has been released before, the current released article is interesting and elucidates more on the characteristics of cultured hair during the process of hair multiplication so called hair cloning. It seems like we still have a long way to go till we can practically use hair multiplication techniques in restoring human hair.

A Los Angeles Hair Restoration patient asked me today about Kevis products for medical hair loss treatment in men the other day. His father used to use those hair loss products when he was in Europe and He recommended that he can use them as well. I had to do some research on the website of the company to find out what are the ingredients of this presumed hair loss medication.

Kevis products are claimed to be natural and chemical drug-free. They work through the biological compound, hyaluronic acid, which is found in eyes and joints in its highest concentration.

Kevis uses a high-molecular-weight product called HUCP, to address hair loss and follicular mal-nutrition. HUCP is claimed that it directly impacts hair follicles, cuticles, and shafts in a positive way, bringing about stronger, thicker, and healthier hair. HUCP also hydrates and balances the moisture levels in hair and the skin of the scalp.

Kevis hair loss prevention and hair care products gently clean hair and selectively remove residue from the scalp, encouraging follicular health and greater natural hair production.

It is all nice to have a product to help cleaning the scalp and the root of our hair and also to keep the moisture to the hair shaft, but neither dryness nor dirtiness of hair is the cause of hair loss. I could not find a significant research on the effect of any of those ingredients on the health and growth of hair. We at our Los Angeles hair transplant clinics of US Hair Restoration recommend products with solid medical research showing their effectiveness and safety.

Q:

I am a 35 year old woman with history of scalp dermatitis. My doctor gave me steroid solutions for my dermatitis that helped the condition, but I have been suffering from hair loss now. Could steroid solution be the cause of my hair loss or could the scalp dermatitis be the cause of my hair loss?

Although hair loss is reported as a rate side effect of many medications, losing hair is not a common condition that could be seen after topical steroid use. Dermatitis or inflammation of skin could be seen as part of many other skin conditions. I think you have to see a good dermatologist and get an accurate diagnosis for your hair loss condition. Microscopic evaluation of the scalp or miniaturization study is a great tool to diagnose the condition of your hair loss and to see whether your hair loss is still active or not. I perform a miniaturization study on almost all my patients to determine the activity of their hair loss condition and also to predict their future hair loss. The type of your hair loss and its association with other medical conditions could be assessed by a hair specialist after taking a history and examination of your hair and scalp including performing a miniaturization study. We do perform

miniaturization study on all patients while evaluating them for hair transplant. If you are diagnosed with a treatable condition that has caused or accelerated your hair loss, proper treatment may cure your balding and give you your full head of hair back.

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.

Recently published in the Journal of Medical Hypotheses was an interesting article on the treatment of alopecia by transplantation of hair follicle stem cells and dermal papilla cells (the cells of the bottom of hair follicles) in alginate gels (media used for cell transplantation).

A group of scientists at regeneration lab of tissue engineering, Department of Bioscience of life science in Northwest University of China authored this article. They proposed a system to use the two important hair stem cells to form mature hair in people with hair loss. They explain that the discovery of hair follicle stem cells (FSC) brings gospel to the affected individual of hair loss because of its capacity of generating new hair when they interact with mesenchymal dermal papilla cells (DPC).

The above two cells are known as the necessary cells for formation of new hair. Since both FSC and DPC have strong proliferative capacity and the patient’s own cells could be expanded considerably in vitro, they hypothesize that the microencapsulation of the two kinds of cells in alginate gels could be implanted into the bald scalp of the patient since alginate gels is effective in cell transplantation. They concluded that the strategy may provide a more convenient and valid alternative to hair loss if the hypothesis proved to be practical.

Here at Los Angeles hair transplant office of US Hair Restoration, we follow the most recent findings on the field hair hair stem cell research or hair multiplication also known as hair cloning. The above theory sounds logical and seems to be simple. However, until it is experimented in the lab and then on life creatures we cannot know how practical it may be. It seems like the race to use hair stem cell for the treatment of men hair loss is started.

Q:

Hey there!

How’s everything? I had a quick question.  What do you think about nanogen hair?  From the fibres to shampoo?

Thanks!

A:

Nanogen manufactures a group of products for hair loss treatment and balding camouflage. You can read more on their products on their website at http://www.nanogen.co.uk.  I will go over the two products that you asked in your question, Nanofiber or as they called it “Precision Cut Microfiber Camouflage System” and Nanogen hair loss shampoo.

Nanogen Microfiber is made from keratin that is also the substance that hair is make from. The fibers bind to the existing hair electrostatically adding volume to your hair shafts. Nanofibr is similar to the hair product, Toppik that has been around for a while in the United States and works through attaching to the hair shafts and increasing the volume of each hair.

Nanogen Shampoo is claimed to work through different mechanisms:

1. Inhibiting sebum output in the scalp that has been stated that can control the waxy build up and associated problems. We know sebum production does not have anything to do with male patterned baldness.
2. Reducing dandruff and associated flaky skin by treating the causes of dandruff. Dandruff is not necessarily the cause of hair loss of any kind.
3. Containing anti-fungal properties that can control the fungal outbreak in the scalp. Some fungal diseases of the skin used to be causing infectious balding in past that are not seen as often now with the increased levels of public health. Typical men hair loss definitely doses not have to do with fungal diseases.
4. Reducing irritation and inflammation in the scalp that has been claims that can restore the barrier function of the skin. Again I have to question the role of this mechanism on restoration of hair in men with men hair loss.

In the other parts of the site of Nanogen, the causes of having unhealthy scalp is states as a combination of sebum, fungus like malassezia furfur, dandruff, scalp irritation and problems with inhibiting the barrier function of the skin. As we mentioned before, none of the above is the real cause of typical baldness in men hair loss or male patterned alopecia.

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.