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.

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:

Dr. Mohebi,

What do you think about Nioxin for hair loss treatment? Do you offer it in your Los Angeles hair restoration offices?

A:

We currently do not sell any products in our Los Angeles hair restoration offices. Nioxin makes different products such as cleansers (shampoos), conditioners, reconstructors, and other products for hair and scalp. They are in the market and could be purchased from beauty salon. Nioxin shampoos are popular, but there appears to be nothing in them that will cure hair loss. I have had many patients who used them in the past for a while and they gave me a mixed report. If they are affordable and you are happy using them as cleansers or conditioners I have no problem with that. However, by looking at what is out there on the ingredients on Nioxin products and the reports from my patients, I cannot recommend them as a treatment for hair loss.

Many people ask me on the use of hair products such as shampoos or conditioner after a hair transplant procedure in our Los Angeles hair transplant clinic. My answer as you probably have seen in this blog is that you can go back to your routine hair wash and maintenance after the first five day after your hair transplant surgery. They practically cannot damage the transplanted hair at that time by washing or shampooing it.

Q:

I am a 40 year old man with class IV hair loss. I started taking Propecia recently with great result on the crown area only after a few months. However, it seems like I need more time to get an erection. The other problem is that I cannot maintain an erection as before. I know there is a lot of psychogenic side effect associated with this drug so I am not sure I am really experiencing a side effect or it is just in my head?

Thank you,

A:

You have been taking Propecia (finasteride) recently and have had great result from it, but you are recently experiencing erectile dysfunction. Erectile dysfunction has been reported in men who used Propecia. The comparison of its occurrence between the Propecia and placebo group showed a slight difference (1.3% in Propecia group vs. 0.7% in placebo group).

You can stop Propecia for 2 weeks to test it. If you don’t feel any improvements in 2 weeks, Propecia cannot be the cause of your problem. If your erectile dysfunction improves by stopping Propecia, then you can reduce the dose of Propecia to half and you may not experience the problem with the new dose. This method is effective in most patients who experience erectile dysfunction with Propecia.

You have to understand that erectile dysfunction may be the sign of some other medical problems and you need to discuss it with your primary physician to rule out more serious causes.

Q:

Do you recommend Finepecia for treatment of hair loss?

A:

Finepecia is another name for finasteride or Proscar. Finepecia, Propecia or finasteride is a medication that blocks the production of Dihydroxytestosterone (DHT) and can stop or slow down the process of baldness. The medication is also prescribed for treatment of enlargement of prostate by physicians. You need to be evaluated by your hair doctor preferably with a miniaturization study before starting on Finepecia. For more on Finepecia or generally medical treatment of hair loss you can visit the website of US Hair Restoration.

Can shampooing affect our hair loss? Can I hurt my hair by doing too much washing and shampooing? Is there a shampoo that can help the growth of my hair? These are some questions that patients ask me in my office on a daily basis.

The answer is simple. The external factor such as shampoos and conditioners cannot really affect the growth or fall of your hair much. You can wash your hair on a regular basis with shampoos if you have oily scalp and greasy hair. You can choose special shampoos for that matter as well; shampoos that have a stronger cleansing effect for oily scalps. You cannot possibly hurt your hair by washing your hair if you are not having obsessive compulsive disorder. Not washing hair may cause you to lose your partners or friends, but it does not affect your hair strength much.

You can find many different shampoos in the market with the claim of helping your hair growth and preventing further hair loss. Unfortunately most those statements are not quite accurate. Even using the shampoos with some effective ingredients such as minoxidil or DHT blockers chemicals cannot be that effective on preventing your hair loss. The active ingredients of the shampoos cannot freely enter the skin and even if they can be absorbed to some degrees, they cannot reach the generative layers of the skin. The contact time of the shampoo and conditioner with the skin is also limited that does not allow for the ingredients to penetrate the skin.

My suggestion to those patients is to stick with whatever shampoo that they are comfortable with and not to change the shampoo because of the miracle shampoo advertisement they saw on the news paper.

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.

 

Dandruff is a scalp skin flaking condition due to the extreme shedding of dead skin cells. It is quite normal for skin cells to die and flake off, but the usual amount of flaking should not be grossly noticeable. If you experience an unusually large amount of dandruff or flaking, which can also be accompanied by redness and skin irritation you may be suffering from scalp skin inflammation due to several dermatologic conditions. One common disorder that can lead to excess dandruff is seborrhoeic dermatitis. Seborrhoeic dermatitis needs to be diagnosed by a dermatologist and treated properly. Seborrhoeic dermatitis may also accelerate the process of male pattern baldness or female pattern baldness if patient has its gene. I have seen many patients who came to me with an exacerbated androgenic alopecia due to activation of their seborrhoeic dermatitis. Other causes of Dandruff are:

• Psoriasis
• Infestation with head lice
• Fungal infection of scalp

In all above caused of excess dandruff, you need to be seen by a dermatologist. For milder forms of exacerbated dandruff there are many shampoos that some could be even purchased without a prescription.

There are several shampoos for treatment of dandruff such as:

• Head & Shoulder (include zinc pyrithione)
• Fungoral or Nizoral (Ketocoazole)
• Selsun Blue (Selenium sulfide)

Q:

Hi Dr. Mohebi,

I had asked you some question about Finasteride 1 mg. I am still hesitating to re-take it. I came across a product named Procerin. Do you suggest it? Does it work in a different way compared to Finasteride 1 mg. What are the side effects and efficiency with respect to Finasteride?

Regards,
Patient’s name

A:

Procerin is a mix of several elements such as some herbal, vitamin and minerals. To be more precise the ingredient formula of Procerin tablets includes:

• Saw Palmetto Berries (which is an herbal DHT blocker)
• Gotu Kola
• Nettles
• Magnesium
• Zinc Sulfate
• Eleuthero Root
• Vitamin B-6
• Pumpkin Seed Meal
• Muira Puma Root

Procerin XT Topical Serum ingredients include:

• Gamma Linolenic Acid
• Grape Seed Extract
• Azelaic Acid
• Saw Palmetto Extract
• Avocado Oil
• Nettle Extract

We know that pattern hair loss is not due to lack of vitamins or minerals so you really should not take those components on a regular basis. Out of the herbal components of Procerin the only ingredient that is known to help the stop hair loss is the Saw Palmetto extract that has DHT blocking activities. The effect of Saw Palmetto (topical or systemic) in comparison with finasteride is not studied extensively. I should say the same thing about its side effects that are not evaluated as in depth as finasteride so I do not recommend it regularly for my patients. However if you cannot take finasteride for any reason Saw Palmetto might be an alternative.

Different types of body hair and the indication for the procedure is a question that I have been asked many times in last week. So that is why I thought I should write a post to answer it for everyone. Body hair transplant has been discussed in Hair Restoration Blog in the past in several posts. Patients ask which one is a better source for body hair transplant to the scalp: chest hair, abdominal hair, pubic hair or armpit hair.

Hairs of the body have different characteristics, than hair from the scalp Pubic hair is generally thicker and curlier than other areas of the body. Chest hair may be thick in some patients, but may be finer than scalp hair. Armpit (Axillary) hair is also generally curlier than scalp hair, but may not be as thick as the other types of body hair.

Before deciding to use body hair, a hair transplant surgeon has to examine the scalp donor hair carefully and then only consider body hair if the scalp hair is severely depleted. Depending on the area that you want to use body hair, you may choose different types of body hair. If you want to choose body hair only to fill in the crown area in patients who already have good coverage on top and front, pubic hair could be a good option.

Research has shown that body hair characteristics may change and become longer when transplanted to the scalp. It also shows the anagen phase of body hair may become longer after transplanting it to the scalp. Which is why this is one more advantage for body hair transplant, but still body hair transplantation needs to be done selectively.