Hair Restoration Blog

I visited a 30 year old patiet for a hair loss consultation a while back who believed he lost his hair due to having too much sex.  The fact is that most patients attempt to find a reason for rapid loss of hair in the early stages.  Thas is often the same age that they are most active sexualy.  The combination of the two may convince them that they may have lost their hair due to having too much sex in those years.

These people are not the only balding peole who try to find an environmental situation and blame it for their genetic balding problem.  Many people blame their partner, bad relations, stressful situations and other significant events in their lives for their hair loss.  The reality is that gene, sex and time are the only major contributors to male or female patterned hair loss and environmental factors only may accelerate the presentation of the hair loss.  Normal people without balding gene may lose hair for different reason, namely stressful conditions, but the hair always grow back when stressor is gone.   This is not the case for people who have the gene of hair loss that may never grow their back what they lost after losing it due to stressors.

Dr. Mohebi,

You performed a hair transplant on me to make a female hair line as part of my male to female transgender process.  I recently decided to do a scalp surgery that may require a scalp advancing procedure.  My Dr. Will transplant hairs along the scar in hairline.  I am not convinced this will be enough, and we may need to do one final pass after all is done to be sure, possibly the middle of next year.  I’ll have to wait and see, money is also an issue.

A:

Good luck with your scalp advancement surgery. Please do your research and make sure your plastic surgeon does perform hair transplant on a regular basis before letting him place hair on your hairline.  It is especially important that he has experience with creating hairline for transgenders.

If he is not doing hair transplant on a regular basis as is the case for many cosmetic surgeons, it might still be OK to have him put the hair removed during the scalp advancement surgery on the top areas, where you still need more reinforcement.

Hairline is very meticulous specially for male to female trans gender patients.  We can easily repair the hairline in front of the scar of your scalp advancement surgery.  It will be more difficult if there is less than perfect transplanted hair on the hairline area.  that requires removing the hair grafts that are transplanted out of their normal locations and reuse them in the other areas.

Q:

Hiya Doc,

I’ve read in a book on hair loss that mentioned, in certain circumstances, hair loss can be caused by emotional or mental stress. I’ve started to lose a bit of hair, but I’m really hoping it’s only temporary, as I don’t think I have genetic hair loss because my two older brothers seem to be doing OK.

How common is it for hair loss to be caused by emotional distress?

Thanks,

A:

Many hair loss patients who come to me for their initial hair loss evaluation associate the beginning of their hair loss to some stressful event in their lives. Many say they notice hair loss when they moved to another city or different country, got divorced or had significant problems at work or in their personal lives. Usually, they are right as these types of evens can accelerate hair loss.

However, hair loss would not happen to these same people if they were not genetically predisposed to balding. In other words, at age 30 and after, we may have the hair loss gene which is supposed to cause balding. At age 30 or after, if we are involved in a stressful situation, an emotional traumatic event, or major surgical procedure, it can accelerate the hair loss process. So the loss expected to be seen in 10 years could come around sooner.

Stress, trauma, or major surgeries may cause hair loss in people who are not supposed to lose hair, but the condition is temporary and the lost hair will grow back after the passing of the stressful condition, or treatment of the medical condition.

In these cases, patients have a condition called telogen effluvium in which, due to stress, a significant number of hair follicles go to sleep. Remember: patients do not lose those follicles permanently and the follicles can produce new hairs in just a few weeks.

My recommendation for you is to see a hair specialist and get your hair miniaturization mapped by microscope; this way the doctor can tell you whether or not you are experiencing an early stage of patterned baldness or that you have lost your hair due to stress.

If your baldness has just begun, medication may help you. If you are experiencing telogen effluvium without being predisposed to pattern baldness, you only need to wait and your hair will grow back in a couple of weeks.

Dear Dr. Mohebi,

First of all, thanks for this great blogging avenue.  I am very thankful that this website is around.

I’m a bit concern w/ my recent hair transplant.  i’m only 27 years old, and had decided to have a 2nd hair transplant done one month ago.   i was mainly just thinning in my front side, and was convinced by my hair surgeon that i should get a 2nd hair procedure done to add thickness in the thinning front side. Please note that the sides of my front have been pretty thick already, but i did have a few thinning gaps in the top center of my scalp.  Overall, i had a total of 1500 grafts transplanted on the front and a few on the center of my scalp (crown).

Immediately after the surgery, i felt remorseful.  i realized i should’ve done more research.  It just didn’t occur to me until the day after the surgery that this procedure might cause me to lose my native hair faster.  Right now, i notice a few shock loss on the frontal thinning hair.  I don’t think the center had much (if any) shock loss, as it had pretty thick native hair already.

I was wondering, would this shock loss accelerate the affected hair to retirement stage?  Lastly, overall, do you think this hair transplant will make my native hair to thin out faster had I not done the transplant?  I recall that my hair surgeon informed me that it shouldn’t be the case, and that any thinning results would be directly from my own thinning pattern.

Please support.  Thanks in advance.

A:

Many people who undergo a hair transplant have some degree of miniaturization (thinning hair shafts) on the balding area, which indicates there is active hair loss in those areas. Miniaturized hair is when your hair has already started the process of balding. Although the process of hair loss is usually very gradual and it may take years to complete, stressor (either physical or emotional) may accelerate the loss and facilitate the process of balding in prone hair (in thinning areas).

Shock loss is losing hair in an area with significant miniaturization due to a stressor. Shock loss after hair transplants used to be common in the past. However, using finasteride (Propecia) is proven to prevent this type of hair loss after hair transplant or significantly minimize it. I usually start all my patients on finasteride a few days before their hair transplant and continue it for at least six to eight months if they do not want or cannot continue it for the rest of their lives.

In regards to whether or not this hair transplant can affect the thickness of your native hair, I cannot say without performing a miniaturization study (examining hair with a microscope to determine the rate of miniaturized hair). If you had a large number of miniaturized hair to start with, you would be running a higher chance of shock loss. The chance of shock loss is usually higher for the first hair transplant. It seems like if you were to have a lot of vulnerable hair, you would have lost them mostly at your first hair transplant surgery. I recommend that you go on finasteride as soon as possible to protect your native hair if you are not already on it.  That is all you can do at this point.

What is Saw Palmetto?

Saw Palmetto is an extract of the fruit of Serenoa Repens. It is rich in fatty acids and phytosterols. It has been used in alternative medicine for a variety of indications, most notably benign prostatic hyperplasia (BPH).

Indications:

Prostate treatment

Saw Palmetto has also been used in treatment of benign prostatic hyperplasia (BPH), a condition known by enlarged prostate size to the degree that it makes urinating difficult.

Hair loss prevention

The role of Saw Palmetto in hair loss prevention has also been documented. Saw Palmetto is one of the few effective herbal treatments that can reverse hair loss process in some people to some degree and slow down the process of  balding in men. Saw Palmetto bio active ingredients prevent conversion of testosterone into dihydrotestosterone (DHT).

That is how Saw Palmetto helps to stop the process of balding on the hair follicle level. It can help increase the thickness of miniaturized hair and make them grow longer. The Saw Palmetto effect is comparable to finasteride or other DHT blockers by mechanism. Saw Palmetto is available in oil extract for topical use on scalp or as pills used for prostate enlargement treatment.

Q:

How many days will I have a ‘bleeding’ scalp after the procedure?

A:

You should not have any bleeding after your hair transplant surgery.  Some Oozing might be present for the first night after hair restoration from the donor area and that should be all.  We usually put a bandage around the head to support the closed donor wound on the back in a strip procedure for only one night.  The bandage will be removed the day after surgery when the patient comes back to get their day one hair wash after hair transplant.  You won’t be needing the dressing on the donor area anymore after the hair wash.

Q:

I had a hair transplant (FUE) over 2300 grafts 6 weeks ago all in my front and hairline and I still have over 90% of all my transplanted hair and was also wondering if this is normal since everywhere I read that all transplanted hair will completely fall out between 1 to 2 months. I hope that I am part of that 10% you spoke of in this blog.

A:

Yes, you might be.  Every now and then we have seen patients who do not follow the regular pattern of hair loss and hair growth after hair transplant.  As we mentioned before, most patients lose all transplanted hair in 2-3 weeks after their hair transplant.  This is because the change in the physiologic environment of the hair forces the hair follicles into the telogen phase.  Patients generally do not have any hair on the transplanted area from 3 to 6 weeks after surgery.  When new hairs start to sprout, they become long and thick in the next few months after that.

There is some exceptions and every now and then we see patients who not only do not lose their transplanted hair, but their transplanted hair keeps growing from day one after hair restoration surgery.  You might be one of those exceptions.

There are also reports on some patients who have delayed growth on their hair growth and they do not see any growth in the first 6, 8 or even 12 months.  We do not know what is causing that but it has been anecdotally reported.  Close supervision of the patient and serial follow ups is needed to reassure the patient that he or she does not have any serious problem and the transplanted hairs are not wasted.

Here is one interesting news from the AP: “A South Florida man says he was denied a hair transplant because he is HIV positive.”

Diego Del Rio said in a lawsuit that he was refused a transplant by Dr. X of the Age Defying Surgical Center.  The 28-year-old hair loss patient, Del Rio, said he told “them” he is HIV positive.  After a series of follow-up phone calls, a “staffing medical coordinator” told him the office would not treat him.

This is not the first time that a person with HIV is denied the right to have surgery like other patients.  (Attorney to the doctor), Gabriel Imperato, said Thursday he had not seen the lawsuit, and he and (the doctor) will “respond in court, not in the media.”
The Florida Health Department says denying someone treatment simply because they are HIV positive is against state law.  Del Rio is suing for $15,000 or more. The lawsuit was filed Tuesday in Broward Circuit Court.

US Hair Restoration in Beverly Hills and Los Angeles has been welcoming patients with different medical conditions including blood born diseases as long as the hair transplant procedures were safe to the patients.  The fear around HIV is more of the potential risk of contraction of the virus or other diseases. With universal precaution, however, the risk to the surgeon and surgical staff is very minimal.

Q:

Hi Doctor how are you?

I have been working out and i wanna take some diet pill to help my body loose fat. Is it ok to mix with Proscar? Aalso ive been putting rogaine on the recepient area to speed up the growth. As you can see i have 75% growth i think? In 3 months. It seems like the right side is growing faster and the left side worries me.see alot of fine hair coming out left side though. Dont know if its from proscar and roggaine effect or transplant hair.

Well see in the months to come. Just wanna leave an update doctor.

Thanks and have a good weekend

A:

Here is your answer for your questions in the order you asked them:

1. We do not have any documented evidence on using specific diet pills and/or its preventative effects on the growth of transplanted hair grafts.
2. I do not believe that Rogaine can accelerate the rate of your hair growth on the transplanted area.  They will, however, grow to become similar to what they were in their native location with or without Rogaine.
3. The growth of transplanted hair is not often even.  My recommendation is not to worry about it at this time and give them at least 4 more months until you see the final growth rate.  If you did not have hair in a particular area, medications such as finasteride or minoxidil cannot grow any hair back there.  You may notice improvements in the areas where you experienced significant miniaturization (thinning of hair shafts) with use of these medications.  In those areas, you may see some increase in the bulk of hair over a period of 6 - 8 months.

My recommendation is to continue to be patient and in a few months you may surprise yourself with the density and quality of the transplanted hair.

Have a nice day,

Q:

I just had a few questions following the consultation,

As you said I have slightly more miniaturization in the crown than the donor area, but still in normal range, what would cause me to have more in one area than another other than MBP, is that normal for non MPB scalps?

• Could finasteride worsen the hairline due to the rise of testosterone, or is that irrelevant?
• Are there any safe and minor treatments to slow the progress of maturation or reverse it that you would recommend at this stage?

A:
I will be sending you a letter with all information that we discussed during our consultation at US Hair Restoration Beverly Hills Office.  You may have very initial signs of MPB, but the numbers for miniaturized hairs are not far from high normal.  Let us wait and see your progress before putting you on hair loss medication finasteride.  Early stages of male patterned hair loss may not always be obvious enough in our scalp microscopic evaluation to be differentiated from having upper normal levels of miniaturization.  Propecia (finasteride) is a great hair loss medication to prevent balding, but I know many people who went on it without the proper documentation of their miniaturization.  These hair loss patients may have to take it for the rest of their lives without knowing that they have really needed it to start with.

The main cause of hair loss is DHT (Dihydrotestosterone) and not testosterone, so finasteride can not deteriorate your hair loss or hairline maturation changes. Maturation of hairline is a natural phenomenon and should not be mistaken with balding.  We do not want to stop it.  I do not recommend any medications to stop the maturation of hairline either.