Hair Restoration Blog

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.

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:

Hi, I have a few thousand grafts already and I am interested in getting more as well as trying to revise my scar. My donor area is still quite dense.

A:

Scar revision could be done through several different methods depends upon the location, size and orientation of the scalp scars. The scalp scars that are not aligned with the Resting Skin Tension Lines (RSTLs) generally do not respond well to the revision through simple excision of the scars. For these scars hair follicular unit transplantation is a better solution. Filling the scalp scar with follicular unit transplant can be a successful method for the scars that do not respond to the regular excision. We have treated the scars that have been previously operated with multiple simple excisions by other plastic surgeons with no significant improvement in the final size and appearance of the scar. For more on scalp scar management with hair transplantation, you can read on one of my presentations in the fifteenth annual meeting of the international society of hair restoration surgery (ISHRS) which was titled: Hair Transplant and Neurosurgical Scars. You can also check our website at www.ushairrestoration.com to get more information on the modern hair restoration procedures and possible options for repair of old surgeries or scar revision procedures. You can also browse the Hair Restoration blog at www.ushairrestoration.com/blog to familiarize yourself with the available hair transplantation methods and techniques for revision of the hair transplant scar.

I have performed a hair transplant surgery on this 42 year old man who had another hair transplant last year with micor- and minigraft with another office last year. I would like to assume that the era of mini and micro-grafts are over, but still every now and then I see patients who are recently operated with micrograft or minigraft techniques. This 42 year old patient had small number of grafts for a large area with less than adequate coverage.

The patient’s old hair line is lower than where it should be on the corners for his age and race. He had some pluggy hair growth on the corners and on his hairline. We restored his hairline with 400 single hair FUT grafts, removed some of the pluggy hairs on the hairline using a 1mm punch biopsy device. We increased the density of hair on the front are with total of 2293 follicular unit grafts.

The frontal area was densely packed and the some of the frontal grafts with pluggy appearance were removed. I expect great result in a few months for this patient at our 10 month follow up.

Patient immediately after hair transplant surgery with 2293 FUT grafts including 400 single hair grafts on hairline.

Q:

Dear doctor Parsa Mohebi

I have got some questions that I request you to answer them, so that I can have a better decision.

1- Is it possible to use the hair of other members of the family as donor?

2-May the transplanted hair at the fore part of the head recede again? If yes, how long does it take to begin?

3-If the hair recedes to the back of the head, the scar of the surgery appears and it is so ugly. What should we do in this case? And in the case of FIT after receding in the back, that area looks very sparse and with little hair? These make a bad appearance. What should we do in this case?

I appreciate you before and I wish more successes in life for you.

Truly yours
Patient name

A:

I will answer your questions in the order you asked them:

1- Is it possible to use the hair of other members of the family as donor?

No

2-May the transplanted hair at the fore part of the head recede again? If yes, how long does it take to begin?

No it will not. Transplanted hair is considered permanent and there is no chance that you lose it in regular male pattern baldness. However you may continue to lose your own hair if you have any left in and around your transplanted hair. Here at US Hair Restoration we recommend finasteride to most patients around the time of surgery to prevent shock loss that could be seen after surgery.

3-If the hair recedes to the back of the head, the scar of the surgery appears and it is so ugly. What should we do in this case? And in the case of FIT after receding in the back, that area looks very sparse and with little hair? These make a bad appearance. What should we do in this case?

Scar or the surgery should never be seen if placed properly. The only way you can see the scar is if you decide to shave your head. If you plan to shave your head for any reason scar of the strip technique hair restoration surgery will be seen and you may want to choose FUE (Follicular Unit Extraction) or as some people call it FIT (Follicular Isolation Technique). FUE transplant or FIT are the same and if done properly should remove hair follicular units evenly throughout your donor area and it should not look thinned out in any particular area. Of course the donor area will be thinner than before the hair transplant surgery, but density of the hair on the back of our head is not what makes you look bald. Not having a solid frame around your face is responsible to give you the appearance of baldness and can make you look older.

I have announced on some TV talk shows that I will be in Dubai this summer along with my all surgical staff to present our high quality hair restoration surgeries to people who prefer having their surgeries closer to their country of residence or have difficulty traveling to the United States. As I said before, I prefer to have a full photo consultation through email and then phone conversation and then book the patients who are interested to have hair transplant surgery with us in Dubai, United Arab Emirates.

We will be in Dubai from August 14, 2008 to August 21, 2008. We have already done some consultations with patients from Dubai, UAE, Iran and. If you are interested in having a hair transplant surgery with US Hair Restoration, please don’t purchase a ticket or arrange for your travel before completing your hair transplant consultation and booked your hair restoration surgery with us. We do not accept walk in patients while we are in Dubai.

The process of online consultation is very simple. You need to visit US hair Restoration online hair transplant consultation page in US Hair Restoration web site and fill the questionnaire. In the comment section, mention that you are interested in having your hair transplant surgery in Dubai, UAE. When we receive your email, we will send you another email asking some more questions and pictures that could be sent through email. At the end, we will have a phone conversation with you to answer all your questions and if you are a good candidate for hair transplantation book you for your hair restoration surgery in our Dubai office.

I hope this service can provide US Hair Restoration quality hair transplant surgery including follicular unit transplant (FUT) and follicular unit extraction (FUE) for people of Middle East, such as UAE, Qatar, Saudi Arabia, Iran, Iraq and Kuwait and other countries of the region. Our Dubai hair transplant clinic may also be easily accessible from India, Pakistan, and European countries. If you have more questions on your hair loss treatment with US Hair Restoration, please email us at info@ushairrestoration.com or call our Los Angeles Hair Transplant center at 1-818-788-8363.

Dr. Parsa Mohebi

Medical Director

US Hair Restoration

Los Angeles, California

Hi Dr. Mohebi,

A couple of questions for you and the blog perhaps.

Just wondering - I’ve noted that one LA area hair transplant doctor has used Vaseline on patient’s heads after surgery to prevent graft scabbing - what’s your opinion on this?

By the way I’m mentioning this as I feel I may have a greater tendency to scab as despite the twice daily washings my three grafts that you so kindly placed scabbed up and still are scabbed on this 6th day out, Sunday, but seeming to loosen up a bit now (patient had a FOX test with us to check his candidacy for FUE procedure and we implanted the three intact grafts that we biopsied to his crown). I’ve had prolonged scabbing before despite the washings and frequent wetting that I was advised with prior procedures. Also, I don’t necessarily mind the scabs other than I’d prefer not to have to return to work with them if they could be minimized with the Vaseline possibly or something similar.

Otherwise I’m wondering if Neutragena shampoo is okay post op vs. baby shampoo? Here’s a Neutragena link for reference.

http://www.drugstore.com/qxp14485_333181_sespider/
neutrogena_shampoo/shampoo_anti_residue_formula.htm

Thanks much,

Patient’s name

A:

Scabbing after hair transplant is very important and if not treated properly may affect the growth of the transplanted hair grafts. We are very meticulous on the care after hair transplant especially hair wash after hair transplant.

Many shampoo s are recommended and used by different hair transplant doctors, but we really don’t have a strong researched based proof for many of those. The only thing that I can tell you is to increase the number of washing in every day to minimize the chance of scabbing. In terms of using shampoos, I prefer using baby shampoo for the first 4 days that skin incisions area still healing, but after that you can use whatever you were using before. We know that there are some solutions and shampoos that can minimize the scabbing and crusting that is seen in the process of wound healing, but since we don’t know how they affect the growth of transplanted grafts we really cannot recommend them in our Los Angeles hair transplant centers. Not until we can have the evidence of their safety on the grafts from a medical study.

Using Vaseline falls in the same category. I prefer not using it in the first two days when the tiny incisions on the recipient area might not be quite sealed.