Hair Restoration Blog

Q:

I have been diagnosed with a thyroid problem called Hashimoto’s Disease.  I am 23 and I am losing hair on head, and also developing some bald spots on my beard area on the neck and scalp too.  My eyebrow hair is also falling out on the sides.  Doctors said that I have low function of thyroid and put me on thyroid pills.  Now that my thyroid is under control, I would like to know whether or not that my hair ever grows back.

A:

Hypothyroidism or low functioning thyroid can cause scalp and eyebrow hair loss.  However the balding spots that you are experiencing are not typical for hypothyroidism.  The patchy hair loss spots are usually due to a disorder called alopecia areata.  Alopecia areata (AA) is an autoimmune disease that could be seen in association with other autoimmune disorders like Grave’s disease or Hashimoto’s disease.  Thyroid disease is reported in almost 10% of the patients who have alopecia areata.

To confirm the diagnosis and start with a treatment plan, you need to see a dermatologist.  If the diagnosis of alopecia areata is confirmed then you can choose to wait for spontaneous recovery as it is in most of cases of alopecia areata or seek treatment methods that can facilitate the recovery and re-growth your hair.

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.

Q:

It’s been just over 4 weeks since I had my hair transplantation. I still have a few scabs. It just happened that while shampooing my hair, I ended up accidentally removing a scab and the area underneath the scab appeared red. The area that has gone red, I could not say for sure if there was any bleeding as I would have been washing it at the time with shampoo. Did I lose any graft? Its 4 weeks post op and I am not sure when I can get to my normal hair wash and I really don’t want to compromise with the results.

A:

Transplanted hair is vulnerable in the first 4 days. The most important day is the first day after surgery in which I would like to bring patients back to wash their hair professionally. You can read more on Dos and Don’ts after hair transplant in our web blog. Washing after hair transplant surgery is very meticulous, but after day 4 following a hair restoration surgery, transplanted hair follicles become part of your skin and you cannot dislodge them even if you remove hair. I usually recommend that my patients follow our washing and after hair transplant care directions on the first four days to minimize scabbing after hair transplant surgery and don’t use any other products.

In your case at 4 weeks after hair transplant, you should have been able to wash your hair in your routine long ago. At this time, you can use your regular shampoo and conditioner without being worried about losing your precious implanted hair grafts.

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 have read an article on the active half life of finasteride, which is a few hours, but you mentioned in one of the posts that its side effects may last up to 5 days after discountinuing the drug. How do you explain that?

A:

Finasteride (Propecia) functions through blocking the enzyme, 5 alpha reductase. The enzyme five-alpha reductase is responsible for conversion of the male hormone, testosterone to dihydroxytestosterone (DHT), which is the form of the hormone affecting hair follicles and causing hair loss. That is true that finasteride gets eliminated from our body in a few hours, but its blocking effects on the enzyme 5 alpha reductase continues for a long time. If you ever experience side effects of finasteride, you can stop the medication and its effect will be gone in 5 to 6 days.

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.

A Los Angeles Hair Restoration patient asked me today about Kevis products for medical hair loss treatment in men the other day. His father used to use those hair loss products when he was in Europe and He recommended that he can use them as well. I had to do some research on the website of the company to find out what are the ingredients of this presumed hair loss medication.

Kevis products are claimed to be natural and chemical drug-free. They work through the biological compound, hyaluronic acid, which is found in eyes and joints in its highest concentration.

Kevis uses a high-molecular-weight product called HUCP, to address hair loss and follicular mal-nutrition. HUCP is claimed that it directly impacts hair follicles, cuticles, and shafts in a positive way, bringing about stronger, thicker, and healthier hair. HUCP also hydrates and balances the moisture levels in hair and the skin of the scalp.

Kevis hair loss prevention and hair care products gently clean hair and selectively remove residue from the scalp, encouraging follicular health and greater natural hair production.

It is all nice to have a product to help cleaning the scalp and the root of our hair and also to keep the moisture to the hair shaft, but neither dryness nor dirtiness of hair is the cause of hair loss. I could not find a significant research on the effect of any of those ingredients on the health and growth of hair. We at our Los Angeles hair transplant clinics of US Hair Restoration recommend products with solid medical research showing their effectiveness and safety.

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.