Hair Restoration Blog

Hello, Dr. Mohebi.

I used the Propecia prescription you gave me.  It cost me over 80$ to get 30 1mg pills, since it’s not covered under my insurance.  I looked online to see if I could find it cheaper and found a number of sites selling it for much less.

Do you think it’s not a good idea to buy Propecia online?  The site I found doesn’t require a prescription or anything and I can actually get 270 pills for almost the same price I just got the 30 pill refill for at the pharmacy.

Could you check out this link out and tell me if it’s not a good idea to buy it? It seems to me that the pharmacies can charge whatever they want for it, but 80 dollars for 30 pills just seems outrageous to me…  I wonder if $90 for 270 1mg pills is for generic finasteride, and not actual propecia.

I just want to know what your opinion on buying propecia online is.  Sincere thanks.
See you soon.

A:
I have heard bizarre stories about online medications that are sold to patients. There are many stories about affordable hair loss treatments as there are for affordable hair transplants.  I generally don’t approve buying Propecia or any other medications online.

Think about it, the current medical system closely supervises all stages of production, distribution and sales of the medications. Everything is highly regulated and controlled to minimize the chance of mistakes.

Online medications for hair loss or any other conditions, do not have this regulations and if something goes wrong or you get a product that does not contain the medication at all, you have no control on it and no one will be responsive. The fact that prescription medication is sold online without the doctor’s script is risky too.
You can shop around to find the best price for Propecia or finasteride, but I cannot support online shopping for medication from non-supervised resources.

Q:
I am 24 with a strong family history of hair loss in the male members at and around early 20s. Recently, I started seeing hair in my sink and on the bed that is much lighter my regular hair. Is it normal? Am I balding and can I use a hair transplant to prevent further hair loss.
A:
Male patterned hair loss is characterized with miniaturization of hair shafts before complete losing them. In genetically prone men to male pattern baldness, hairs of an affected area gradually become thinner and thinner, before they ultimately become nonexistent.

Miniaturization hair shafts make them look thinner, because of the smaller size and then the smaller amount of darker pigments that could be seen.

It seems that you started with hair loss phenomenon and you only need to get it diagnosed by a good hair specialist who can also get you started on medication treatment if need be. A miniaturization study can give you some ideas of where you are heading before starting with the medications.

Q:
I am 30 year old man with male pattern baldness. I have been on Propecia for two years. I have been feeling hot flashes in the last month to the point that I cannot tolerate them at night. My doctor thinks that I have to stop Propecia, but I am hesitant to do so because I have seen good results from Propecia in last 2 years. What do you think I should do?

A:
Hot flashes are seen in some hormonal imbalances. More commonly it is seen in pre menopausal women and in men following castration or using anti-androgen medications. Hormones such as FSH, LH and lactogene are responsible for hot flashes. None of the Propecia studies did prove association between those hormonal levels and Propecia use.

Since you have been on Propecia for about 2 years, but only experiences hot flashes in the last month it may not be related to Propeica. There are many other medical problems that can produce hot flashes such as other hormonal disorder like thyroid diseases.

You need to be seen by an endocrinologist and be evaluated for other medication problems, which can mimic hot flashes. Many of those conditions could be easily diagnosed by a simple lab work. Some medications can also be responsible for hot flashes and need to be considered.

One simple solution is to stop taking Propecia for a short period of time and see if your hot flashes get better. If that is the case then you have the option of switching to other medications that can help your hair loss but don’t give you hot flashes.

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.

Q:

I had gastric bypass about 10 years ago. Not only have I lost a lot of my hair but i have never regained it. Especially after taking a shower i notice that i loose a lot more hair then i should. I have brought this concern up with my doctor but all he tells me is to increase my vitamin intake. I have also been taking Biotin for about three months and vitamin B12 along with a multi-vitamin but have not seen a difference. In addition my eyelashes are thinner and I have lost the thickness of them. I am thinking about rogain for women but if you can please give me any advice I would really appreciate it I am only 38 and fear i will be bald byt the time i turn 40.
Thank You,

A:

As we discussed in the article “Gastric Bypass Surgery and Hair Loss”, it is common to see hair loss or changes in the quality and color of hair after a gastric bypass surgery. The changes are generally seen in the first few months after the gastric bypass surgery. Similar hair loss conditions could also be seen in a variety of other medical conditions, major surgeries or trauma.

The immediate few months following a gastric bypass surgery mimics sever starvation conditions in which body may have difficulty obtaining many essential elements or nutrients through regular diet and supplement of nutrients and vitamins may become necessary.

Hair loss after a gastric bypass may be seen in the patients who don’t have any obvious vitamin or mineral deficiency. Patients need to be evaluated on a regular basis by their surgeon and with regular lab tests. The initial hair loss should return to normal if there is no other underlying condition exists.

In case patient has any other medical condition that can accelerate hair loss or in the case of genetic male patterned or female patterned baldness, patient may never gain their hair back. In those conditions the stress of the surgery acts as a stimulator forcing patient scalp hair to fall on a faster than normal pace.

My recommendation is to see a good hair transplant surgeon and undergo a miniaturization study to rule out any other treatable causes of hair loss.

Q:

I am 27 and have a very high laying hairline.  My hair line is the same as my mother and aunts.   High hair line resembles a male hair line with mild recession on the corners.  I know I am not balding because a few other female members of the family have an exact similar hairline patter.  Can you help me with a hair transplant procedure?

A:

There are several methods to lower a hairline both in men and women.  Hair line can be lowered by hairline lowering hairline surgery, in which a strip of skin is removed from just below the frontal hairline to bring the hairline lower.  In this method a trichophytic incision can help to blend frontal hair into the forming scar.  The result of lowering hairline surgery is instant and the surgery is less time and labor consuming in comparison with a hair transplant procedure. 

At US Hair Restoration, we recommend hair transplant using follicular unit transplant methods for lowering hairlime in men and women for the best cosmetic results.  Hair transplant cannot make such a drastic change in such a short time, but the result is completely normal with no visible scar on the frontal area.  The presence of linear scar at frontline is a major disadvantage of hairline lowering procedure.  The scar of hairline lowering surgery could be camouflaged with a hair transplant surgery with placement of minimal number of grafts on the frontal area and in front of the hairline scar.

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.

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.