Hair Restoration Blog

Q:

My son and I discussed the procedure with his Mom.  We are thinking, even though the other “FUE ?” procedure is about twice the money, it would be worth going the alternative route in order to avoid the issue of his being left with a scar (e.g., if he ever decides to shave his head, or get a very close “buzz cut”).  What is the more expensive, alternative procedure called?  And, how does that change the logistics?  By that last question, I mean, for example, what you described yesterday was a one-day procedure if we went with the “scar” procedure.  Now, however, if you do not cut a “strip” and leave a scar, how many days is required?

A:

What we discussed was Follicular Unit Extraction (FUE) procedure.  That is another version of Follicular Unit Transplant (FUT) surgery in which instead of removing a strip, we remove follicular units or the natural bundles of hair one at a time.  Removing individual follicular units allows us to keep scars small and scattered.  This prevents a linear scar on the back and donor area.

FUE is ideal for people who have a limited need for hair follicles and try to keep the option of buzzing or shaving their head open after the hair transplant surgery.  It is not for people who are destined to have large areas of baldness, due to the number of sessions they may need and the fact that their eligibility for hair transplant surgery may change over time.  In other words, they might be FOX positive to start with but after the initial surgery their candidacy may change.  Not to mention the cost of hair transplant surgery that may play a major role down the road when you are looking into filling a large area of the scalp with transplanted hair.

Strip procedure is definitely more efficient both in terms of cost of the hair transplant and the number of grafts that one can get over a certain period of time.  The donor scar of a hair transplant surgery is also getting better with the new techniques of hair restoration surgery.  However, if you want to eliminate the linear scar of strip hair transplant on the back, FUE is the only way to go about it.

I just gave a lecture on a new application for Laxometer in mega and giga session hair transplants in the annual ISHRS (International Society of Hair Restoration Surgery) meeting in Amsterdam, Netherlands.  As we presented the Laxometer in the prior hair restoration scientific meetings, Laxometer can make us capable of increasing the precision of strip removal method of follicular unit hair transplants while minimizing the risk of donor scar complications.

This year, I presented a new application for Laxometer for its use in patients who have limited laxity of the scalp due to prior hair restoration surgeries or for those who require a maximum number of grafts in one session (3000+, 4000+, 5000+ and so forth).  I performed a research in US Hair Restoration last year in which we removed the strip in sequences for hair transplant surgeries using Laxometer before and after removal of each section of the strip.  This method has increased the safety of the strip removal while decreasing the risk of donor wound complications.

The result that was presented in the ISHRS meeting indicated the effectiveness of Laxometer at increasing the number of grafts in a strip hair transplant while minimizing the donor complications of a hair restoration surgery.  Based on our findings, we now use Laxometer in our California hair transplant offices on a regular basis and obtain positive results consistently.

Q:

I would like to ask Dr. Mohebi about hair stem cell research. If you can explain what it is, how long has it been in research, and in what phase it is at this moment? I’m 31and notice that I had AU, around the age of 29-30. At the time I was going through a lot of stress that made me feel like I’ve brought this on myself. I was taking treatment injections for my eyebrows to see if I can at least save my eye brows. Well, I got tired of the injections, and just left it in the hands of the Creator. Are there eyebrow and eyelash replacement that can be obtain and if so where? I just had a little girl and I really want to take some decent pictures with her and it bothers me at times that I can’t even do that, so I can relate to all who are going through the up’s an down’s and the fight within and without to BEAT-AU, and others. I guess only time will tell.

A:

Hair stem cell research is becoming very promising for treatment of many types of hair loss. Phase 3 of the study on hair multiplication was started about 3 years ago and it is still ongoing. The purpose of phase three study of any new treatment modality is to prove that there are no long term side effects on the volunteer patients who undergo any new treatment. Hair stem cell technology seems to be a real therapeutic option for many types of hair loss conditions for the next 5 to 10 years.

Having said that, some details about the process of hair multiplication is not quite clear yet. There is not much information released on the quality of multiplied hair and we are not quite aware about the final cost of the procedure. When it comes to AU (Alopecia Universalis) we cannot know for a fact that hair multiplication is the answer to this condition considering the mechanism of AU and the fact that the patient’s own immune system tends to destroy hair follicles.

It is likely that multiplied hair follicles have the same antigenic properties so they could be recognized by the immune system and destroyed the same way that the native hair was initially. A combination of some sort of anti-immune treatment and transplanting multiplied hair might be the answer, but we cannot know for sure before they are investigated thoroughly in the future.

Q:

When can I go back to work after my hair transplant surgery?

A:

This is one of the first questions that come to mind when people are preparing themselves for a hair transplant surgery.  The down time after a hair transplant has a lot to do with the type of work that you do, whether or not you can use a hat, how sensitive the issue of your hair transplant is and whether or not you want to keep it a secret.

Generally, we at our Los Angeles center of US Hair Restoration would like to bring patients back for a hair wash after the first day of their hair transplantation.  I like to make sure that they are given a professional hair wash with our special technique and teach the patient how to wash his or her hair for the first few days after hair transplantation.

Patients may have some swelling and redness on the transplanted and forehead area for a few days after their hair transplant surgery and the swelling after hair transplant may last up to 4 to 5 days.  Patients can use a hat for the first few days to cover the red and swollen area on forehead.

The redness and swelling may spread down to the level of the eyebrows or even eyelids in more extensive hair transplantations.  The swelling is generally completely gone by day 5 or 6 after hair restoration surgery.  The degree of swelling has to do with the size of the hair transplant surgery and the number of grafts.  Larger surgeries (over 2500 grafts) generally create more swelling, but small surgeries may not have any detectable swelling.

The other issue is the presence of hair after hair transplant.  Patients will have short hair (0.5 to 2cm) on transplanted areas for two to three weeks after their hair transplant.  They fall out in about 90% of the patients after their hair transplantation within 3 weeks after hair implantation.  Patients should be back to where they were before their hair transplant in about 3 to 4 weeks.  At that point, there should not be any swelling or redness, staples or sutures must be removed and the transplanted hair follicles will have gone into their resting phase.

Where can we take hair for hair transplant other than the back and sides of the scalp?  This is a common question that I am asked on a regular basis.  The answer is “hair can be harvested from almost any part of scalp or body that grows hair and it can be transplanted to any part of the skin.  We have performed hair transplant from many different areas of the body on patients who do not have sufficient donor hair on their scalp for transplantation or in people who had old hair transplant procedures that violated the donor area with multiple punch biopsies and through scarring.

Pubic area is prepped before harvesting hair for hair transplantation into the balding spot of patient

It is important to understand that scalp donor hair is always the best option when it comes to hair quality for the best result in hair transplant surgery.  The scalp hair has a longer growth phase (anagen) that is about 1-6 years and a shorter resting phase (telogen) that lasts around 4-6 weeks.  This makes scalp hair a more economic choice for hair restoration surgery.  When using scalp hair for donor, almost every transplanted hair stays in growth its phase and only a small portion goes into the dormant phase in which hair falls and another hair grows in a few weeks.

Body hair, in general, has a shorter growth phase which could last only about a few months and a longer resting phase.  That is why body hair never grows more than a certain length.  There are some limited studies that show that transplanted body hair can change their innate characteristics and increase its growth phase when transplanted to the scalp, but we still need more research to provide information on the details of the process.

At US Hair Restoration, we have used pubic hair successfully in a patient with great demand due to his fine scalp hair and violated donor hair that could not provide sufficient hair for transplantation into the scalp.  The patient’s hairline has been restored using scalp hair from the occipital area (back) of the head and the balding spot on the crown was reinforced using pubic hair.

So if you are lacking adequate hair on your donor area of the scalp or need a large number of grafts, you may be able to consider other options including pubic hair transplant.  Obviously, the donor quality should be evaluated closely by a good hair transplant doctor to determine the candidacy of the patient for body hair transplant to scalp.  The details and methodology of this process is being published in medical journals.

I just found this article on transplantation of artificial hair.  Artificial or synthetic hair for the treatment of male pattern baldness or androgenetic alopecia has been tried in many countries, but has been unsuccessful at getting FDA approval in America for a variety of problems that it had.  The result of the study published in Journal of Cosmetic Dermatology is very limited in terms of the number of participants and transplanted hair but it is worthy of mentioning in our hair restoration blog.

The article discusses the problems of the artificial hair implantation such as poor quality fiber, untrained operators, and inadequate techniques.  However, the paper aims to establish safety and efficacy of a new artificial copolyamide fiber implantation in male patterned baldness or androgenetic alopecia.

In the study, ten healthy adults with androgenetic alopecia who had failed prior conventional therapies such as medical or surgical hair restoration were implanted with copolyamide fiber and were followed for a minimum of 3 years. Implantation consisted of 100 test fibers followed by subsequent sessions of up to 500 fibers every 4-6 weeks to achieve a density of 20-40 fibers per cm(2).

The techniques of implantation and follow-ups maintained a strict adherence to schedule.  In this study 10,000 fibers were implanted with a mean of 1000 fibers per patient. With the exception of one patient, implantation was found to be safe, aesthetically pleasing, and psychologically rewarding to its recipients. Sebum deposition and temporary pitting at entry point of most fibers were universal. Recurrent mild folliculitis occurred in 30% of patients.

The other complications such as facial swelling, cellulitis, and severe scarring were not seen in this study. Between 15-20% of all transplanted fibers fell every year and maintenance of the procedure was shown to be necessary.  In conclusion, the choice of fiber implantation technique and mandatory follow-up were deemed to be some of the important contributory factors towards positive results.  Hair restoration with artificial hair might become more popular in the future for patients who lack good quality donor hair with extensive baldness.  However, other studies on a larger number of patients need to be done before it can really prove to be safe for practical use.

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.

Q:

I am a male to female transgender.  I have some hair thinning on top with receded corners as a male hairline.  I am already taking Propecia and Spironolactone to block my testosterone effect. I would like to change my hairline from a male hairline with corner recessions to a female one. I have some thinning on the top too.  I have fine and curly hair to start with.  How can a male hairline be converted to a female pattern?  Do you recommend hair transplant for transsexuals or is there any other options to restore receded corners to a perfect feminine hair line?  I’m interested to know my options and what you recommend.

A:

Male to female transgender patients may experience two personal problems.  The first is having receded frontal corners in mature male patterned hairline which is what makes the frame of the face “masculine”. Receded corners can be easily restored with hair restoration through follicular unit transplantation.  The second issue is when there is also miniaturization or balding of the rest of their hair in a male patterned baldness that may require further hair restoration.  Taking anti-testosterone medications can help to slow down your hair loss, but it does not stop the balding process completely.  Removing the testicles surgically as part of a transgender procedure can eliminate testosterone and, in turn, stop the process of male pattern hair loss in people who are genetically susceptible to it.
If you are only changing your male mature hairline to a feminine one or if you have male patterned balding, a hair transplant can help you.  Obviously, you need to continue with your anti-testosterone medications and get a hair transplant to reshape the frame of your face.  You may need more than one hair transplant procedure for maximum fullness of the hairline in a perfect female pattern.

Transsexual hair transplantation is a meticulous procedure and the hair transplant surgeon needs to understand your facial proportions.  Your Hair transplant doctor needs to be experienced with shaping the hairline in women.  Women hairline is different from male in many aspects such as: the location of the hairline from eyebrow level at mid frontal and laterals; temples need to be restored in a complete female shape; direction and orientation of hair shafts are also different between men and women.  All these features and details need to be dealt with meticulously.  We at US Hair Restoraiton offer quality hiar restoration to change a male to female hairline for transgenders.

I just read another article that may bring more hope for the people with hair loss.  Kang et al has been working with a plant native to Jeju Island in South Korea by the name of Schisandra Nigra.  They studied the effect of the extract of this plant on hair growth.  The article which is published in the European Journal of Dermatology is the result of a study on application of this product on rat hair with some promise. This study was conducted to evaluate the effect of Schisandra Nigra on the promotion of hair growth.

When rat vibrissa follicles were treated with 85% ethanol extract of S. Nigra, the hair-fiber lengths of the vibrissa follicles increased significantly. In addition, after topical application of the EtOH extract of S. nigra onto the back of C57BL/6 mice every other day, anagen (growth phase) progression of the hair shaft was induced. Moreover, the extract increased both the expression of proliferating cell nuclear antigen in the bulb matrix region and the proliferation of immortalized vibrissa dermal papilla cells.  Both of those showing more activity on hair follicle cells.

In order to determine the mechanism by which the plant S. nigra promotes hair growth, the researchers examined its relationship with the TGF-beta2, which is a signal pathway, known to be a regulator of catagen induction (the phase that come after growth phase in hair cycle).

When the vibrissa follicles in the anagen phase were treated with S. Nigra extract for 7 days, the expression of TGF-beta2 in the bulb matrix region was found to be lower than that of the control follicles that were expected to be in the anagen-catagen transition phase.  These results suggest that S. Nigra extract has the potential to promote hair growth via down regulation of TGF-beta2 and the proliferation of dermal papilla.

In less scientific words, the plant has been able to stop hair follicles from going into their resting phase from their growth phase and thus increasing the number of growing hair follicles.  Could this hair loss product be used as a valid option for treatment of baldness in humans?  We can not be sure yet.  More studies are needed to prove the therapeutic effects of this product on human hair growth.

We do not recommend any herbal hair loss products at this point for treatment of male or female patterned hair loss due to the lack of adequate evidence based on documents that support that in humans.  However, we follow the findings of the new research through the world and keep our readers posted if one becomes available.

Q:
Dear sir,

I am 43 year old and I have lost my hair in top portion of my head. so I want to get advice from you that which one will be suitable for me either plantation or restoration

A:

I’m guessing you are asking about Medical Hair Restoration vs. Hair Transplant in your condition. If so, it needs to be evaluated by a hair transplant surgeon through a microscopic miniaturization study. If your hair loss is limited to your crown area and you have significant miniaturization in that area, then you might be a good candidate for medical treatment with finasteride or minoxidil. You may be able to see drastic changes within a year. However, if your hair loss evaluation is completed and you don’t have much miniaturized hair on the crown area, medical treatment of hair loss is not going to help you much and I recommend hair transplantation assuming that you have healthy donor hair.