Hair Restoration Blog

Q:

Dear doctor Parsa Mohebi

I have got some questions that I request you to answer them, so that I can have a better decision.

1- Is it possible to use the hair of other members of the family as donor?

2-May the transplanted hair at the fore part of the head recede again? If yes, how long does it take to begin?

3-If the hair recedes to the back of the head, the scar of the surgery appears and it is so ugly. What should we do in this case? And in the case of FIT after receding in the back, that area looks very sparse and with little hair? These make a bad appearance. What should we do in this case?

I appreciate you before and I wish more successes in life for you.

Truly yours
Patient name

A:

I will answer your questions in the order you asked them:

1- Is it possible to use the hair of other members of the family as donor?

No

2-May the transplanted hair at the fore part of the head recede again? If yes, how long does it take to begin?

No it will not. Transplanted hair is considered permanent and there is no chance that you lose it in regular male pattern baldness. However you may continue to lose your own hair if you have any left in and around your transplanted hair. Here at US Hair Restoration we recommend finasteride to most patients around the time of surgery to prevent shock loss that could be seen after surgery.

3-If the hair recedes to the back of the head, the scar of the surgery appears and it is so ugly. What should we do in this case? And in the case of FIT after receding in the back, that area looks very sparse and with little hair? These make a bad appearance. What should we do in this case?

Scar or the surgery should never be seen if placed properly. The only way you can see the scar is if you decide to shave your head. If you plan to shave your head for any reason scar of the strip technique hair restoration surgery will be seen and you may want to choose FUE (Follicular Unit Extraction) or as some people call it FIT (Follicular Isolation Technique). FUE transplant or FIT are the same and if done properly should remove hair follicular units evenly throughout your donor area and it should not look thinned out in any particular area. Of course the donor area will be thinner than before the hair transplant surgery, but density of the hair on the back of our head is not what makes you look bald. Not having a solid frame around your face is responsible to give you the appearance of baldness and can make you look older.

I have announced on some TV talk shows that I will be in Dubai this summer along with my all surgical staff to present our high quality hair restoration surgeries to people who prefer having their surgeries closer to their country of residence or have difficulty traveling to the United States. As I said before, I prefer to have a full photo consultation through email and then phone conversation and then book the patients who are interested to have hair transplant surgery with us in Dubai, United Arab Emirates.

We will be in Dubai from August 14, 2008 to August 21, 2008. We have already done some consultations with patients from Dubai, UAE, Iran and. If you are interested in having a hair transplant surgery with US Hair Restoration, please don’t purchase a ticket or arrange for your travel before completing your hair transplant consultation and booked your hair restoration surgery with us. We do not accept walk in patients while we are in Dubai.

The process of online consultation is very simple. You need to visit US hair Restoration online hair transplant consultation page in US Hair Restoration web site and fill the questionnaire. In the comment section, mention that you are interested in having your hair transplant surgery in Dubai, UAE. When we receive your email, we will send you another email asking some more questions and pictures that could be sent through email. At the end, we will have a phone conversation with you to answer all your questions and if you are a good candidate for hair transplantation book you for your hair restoration surgery in our Dubai office.

I hope this service can provide US Hair Restoration quality hair transplant surgery including follicular unit transplant (FUT) and follicular unit extraction (FUE) for people of Middle East, such as UAE, Qatar, Saudi Arabia, Iran, Iraq and Kuwait and other countries of the region. Our Dubai hair transplant clinic may also be easily accessible from India, Pakistan, and European countries. If you have more questions on your hair loss treatment with US Hair Restoration, please email us at info@ushairrestoration.com or call our Los Angeles Hair Transplant center at 1-818-788-8363.

Dr. Parsa Mohebi

Medical Director

US Hair Restoration

Los Angeles, California

Hair transplant cost is one of the questions that we have answered many times in this blog and we still receive it from our patients. The quality of hair transplant surgery have been improving within the last few decades with the use of stereotactic microscopes and advanced methods of handling and maintaining the hair grafts. However, not every hair transplant clinic could have kept up and adopted the new technology.

Cost of hair transplant surgery varies from clinic to clinic and from surgeon to surgeon. You may find a wide variety in hair transplant costs. Many clinics that offer cheap hair transplants are not committed to the quality of service. They hire inexperienced hair transplant staff. Some of the hair restoration surgery clinics do not use microscope and are not scientifically in line with the advanced techniques that are available today. Some clinics are run by technicians and doctor is only involved in a small portion of the procedure.

Hair transplant costs are generally calculated as per hair graft basis. Hair transplantation with exclusive follicular unit transplant could cost $3 to $10 per each graft (average for exclusive follicular unit transplantation). That is the cost of hair transplants with strip techniques of FUT or follicular unit transplant and the price of the FUE (follicular unit extraction) hair transplant is higher. Affordable hair transplant could be found in high-quality hair restoration clinics too. They may not be able to lower the cost of surgeries to $2 per graft (as you may see in some hair transplant offices) because of the fact that having an experienced surgical team and skillful surgeon cost more than that.

As I said, you can find low cost hair transplant centers that still offer quality hair restoration surgeries. Some of them are very skillful and offer individual services unlike the big chain hair transplant centers. The big chain hair transplant centers have a variation in their services due to different surgeons and staff. I have seen a diversity of results from some of those clinics. The variation is generally seen due to difficulty keeping the same standard in different offices. Most patients with a previous surgery in the chain clinics who have a repeat surgery at Los Angeles Hair Transplant center of US Hair Restoration are critical of the lack of personal attention and individual care in those clinics.

In conclusion, although the cost of hair transplant surgery is an important factor, it should not be the sole factor in choosing a hair transplant clinic. I always encourage my patients to educate themselves on the most advanced techniques of hair restoration surgery. Internet is a great source of information. We have a useful collection of hair loss and hair restoration articles in our web site. I also answer the patient’s hair restoration questions in hair restoration blog on a daily basis.

My recommendation is to shop around for the best value hair restoration surgery and not for the cheapest one. Think about it as a lifetime investment. Good or bad you will see your hair every day for the rest of your life.

Autologous Hair Regeneration - ICX-TRC (Intercytex)

ICX-TRC is an autologous hair regeneration system. ICX-TRC project is an ongoing research program that uses a suspension of human dermal papilla cells (one of the stem cells of the hair follicle which is involved in the growth and cycling of hair follicles. The system is claimed to be used for the treatment of male and female patterned baldness. The intention of ICX-TRC is to provide a technique to restore hair in patients who do not have adequate supply of donor hair on scalp for the hair transplant process and maybe for everyone with baldness.

Both types of patterned hair loss have significant genetic influence. It was claimed that with the ICX-TRC procedure, the process of hair restoration would be less problematic than conventional hair transplants. The proposed idea is to remove a few normal hair follicles from the donor area and harvest their active cells called dermal papilla (DP). These active cells are cultured and multiplied by different techniques and eventually the multiplied cells from this culturing process could be used to produce multiple hair follicles. The goal is to grow the hair follicles that are produced with this method while keeping the original characteristics of donor hair.

The cultured cells are supposed to be injected to the bald areas of skin. Interaction between the DP cells and normal epithelial cells in the skin can potentially generate new hair follicles under a certain circumstances. The process of culturing the DP cells and getting the new cells may last around three weeks.

Intra-dermal injections of new DP cells in the scalp could be done under local anesthesia with the current techniques of hair transplantation. It is claimed that some sort of hair growth could be seen after 3 months. However the condition and characteristics of the new hairs have not completely elucidated.

ICX-TRC clinical trial

Every new medication or medical technique needs to be examined closely through a systematic process for evaluating its effectiveness and safety. Intercytex has announced that they have finished their phase I (for safety and tolerability of the system) on volunteer patients and it has been successful. It means that the procedures did not have a serious or lethal side effects, at least in short term.

They also announced that they started phase II in Manchester to optimize the delivery of the DP cells and to refine their techniques, which is completed as well. They have obtained hair and measured the growth by shaving and taking photos of the transplanted area with cultured DP cells. On the phase II of the study they used 19 volunteer. They describe few different techniques that were used including pre-stimulation of the skin before injection of the cultured cells. Unfortunately, there is not much information available on the technique and methodology of the studies.

Here is what is stated in Intercytex web site for the result of the phase 2 of this experiment:

• Eleven subjects have now passed the 24-week time point since treatment and specialized image analysis at this time point showed
• Of the group of six patients without stimulation of the scalp, three had an increased hair count and two had a reduced hair count; one has been lost to follow-up
• Of the five subjects with pre-treatment scalp stimulation, all had increased hair count at 12 weeks and the three who were evaluable at 24 weeks all had an increased hair count at that time point

They are still looking for the 24 week data on all subjects in September 2008. At that time if it is all promising we should expect to see the phase III started on a larger group of patients who try this treatment for a longer period of time (years) to rule out any long term complications.

Intercytex is also claimed that they are working on an automated device that can facilitate the injections of cultured grafts, which could be used for the transplantation of cultured hair cells.

Conclusions:

1. The progress of Intercytex research and the released results are not quite clear yet
2. The safety of this system has not yet evaluated for long term potential side effects of cultured human cells such as increased risk of cancer or other dermatologic or systemic abnormalities
3. If proven safe and effective after completion of the phase III, we should have an estimate of the cost for this procedure. It is unclear whether or not this is going to be affordable and something that could be used for everyone or it should be reserved for patients with special needs.

We will follow the progress of ICX-TRC project along with other similar projects on hair stem cell and hair multiplication studies and keep our readers posted.

Follicular Unit Extraction (FUE) - Advantages or disadvantages

My patients always ask about advantages and disadvantages of Follicular Unit Extraction so I thought this topic makes a good post for the blog. Before going over these points I have to say, although we at US Hair Restoration offer the most advanced techniques of FUE nationwide, most of our patients are still being transplanted by strip technique and I don’t recommend FUE to everyone and select my FUE patients very meticulously. Here are the main reasons why we do recommend FUE to some people and not to everyone.

Advantages

• FUE does not leave a linear scar, which is great for those who want to wear their hair very short on the back or the ones who may need to shave their head in the future (like actors).
• FUE has a more comfortable healing process with decreased healing time.
• No restrictions in physical activities for those who want to do strenuous exercise right after FUE procedure.
• FUE is a viable alternative for those who have tight scalp that makes strip surgery risky or impossible.
• Follicular unit extraction makes it possible to harvest hair from body, beard or almost everywhere else.
• FUE is very useful when we need limited number of grafts like for restoration of eyebrow hair.

Disadvantages

• The biggest disadvantage of follicular unit extraction is that the maximum follicular unit graft yield is lower than when it is done with strip technique due to higher rate of follicular transection compared to the strip technique.
• Although linear scar is not present after FUE, small punctuate scars will be there that may make future FUE hair transplant surgeries more difficult or impossible.
• Not everyone is a candidate for FUE and patients need to be tested with FOX before proceeding with the surgery.
• FUE procedure takes much longer to perform compared with strip FUT procedure.
• FUE is more laborious thus it cost more compared with strip technique hair transplants.
• In FUE, we have more chance of burying grafts that increases the risk of having folliculitis (tiny inflamed cysts under the skin) on the donor area.

Q:

I underwent a gastric bypass surgery about 2.5 years ago and since a few months after surgery my hair has been thinning. What do I need to do to prevent further loss?

A:

Losing hair or changing the quality and color of hair after gastric bypass surgery is commonly seen within the first few months after the gastric bypass surgery. This condition can mimic shock loss that could be seen after hair restoration surgery. Right after the gastric bypass surgery your body goes through a period of severe starvation and tries to divert nutrients toward more vital organs instead of skin and hair. Although carbohydrates, proteins, minerals and vitamins especially the family of vitamin B has been blamed for the hair loss in patients who had gastric bypass, it can happen while all of those elements are within normal range and the exact mechanism of hair loss after gastric bypass surgery is not completely known.

The great news is that the hair loss after a gastric bypass surgery is always temporary. Your hair condition should return to normal within a few months of hair loss occurrence. Patients who had gastric bypass should have serial examinations within the first few months of their gastric bypass. Your surgeon should check many elements because gastric bypass surgery could increase the incidence of iron, folic acid, vitamin B12, calcium, and vitamin D deficiency. Most people need to stay on supplementation of these minerals and vitamins. Close monitoring with regular laboratory tests for these deficiencies should be done by your surgeon or primary care physician.

Q:

Hi Doctor,

Some doctors prescribe Dutasteride (Avodart) for hair loss prevention. I know you don’t recommend Dutasteride for hair loss for obvious reasons, but based on available research findings on this medication, what do you think are the most likely possible side effects from using Dutasteride if worse come to worse. Would it be like multitude of finasteride side effects? Again, I know your view of non-FDA approved drugs.

A:

Dutasteride (Avodart) is one of the selective inhibitors of the type I and II of the enzyme 5-alpha-reductase, the enzyme that converts the male hormone testosterone to 5-alpha-dihydroxytestosterone (DHT). In comparison with dutasteride, finasteride (Propecia) acts as an inhibitor of just type II of the enzyme 5-alpha-reductase, which is more specific. Studies around dutasteride mechanism of action shows that, blocking both type I and type II enzyme can be more potent that only one in reducing the levels of DHT in the body.

If you are taking dutasteride for other indications, you may get some hair growth as a good side effect. As you guessed I cannot recommend dutasteride solely for prevention of hair loss not until it is approved for hair loss treatment by FDA. Other than not being FDA approved my other reasons are:

1. The optimum dose of dutasteride for hair loss prevention is not determined.
2. The side effects of dutasteride are much more prominent comparing to finasteride.
3. If you are considering the cost effectiveness of dutasteride, with new price reduction of finasteride that should not be in the picture any more.

Q:

I have diabetes. Can I have a hair transplant procedure?

A:

Patients with diabetes can successfully have a hair transplant surgery if diabetes is under good control. Diabetes used to be a life limiting disorder and diabetic patients could not have many elective surgical procedures due to their increased risk of wound complications and infection. With the new medications and methods for controlling diabetes, patients with diabetes can safely have hair transplant surgery or any other elective procedures without significant increased risk of infection or complications with their healing phase. Here at US Hair Restoration, we need to have a clearance from the doctor who follows patient for his/her diabetes to make sure patient’s blood sugar is in normal range and diabetes is effectively controlled.

Q:

Is Hair cloning or multiplication being done anywhere yet?

A:

Hair cloning or multiplication has been in the news in the last few years. I prefer to use tem “hair multiplication” rather than cloning because cloning refers to production of genetically identical organisms. Dolly the most celebrated sheep was the product of first cloning. When it comes to hair, we do not really clone the cells, but we culture them and try to get a whole organism from cultured cells. Unfortunately the process of culturing hair follicle cells has not been as simple as some other tissues in human body. The complexity of hair physiology is due to participation of many different stem cells in development of each hair follicle. In this process, we do not multiply genetic material or DNA of cells.

Hair cloning news

Hair multiplication if become a reality could bring about a great opportunity for bald people with violated donor scalp who cannot be good candidates for hair transplantation with current techniques. Despite our enthusiasm about hair multiplication, hair cloning news in last few years has not been filled with many success stories.

Hair cloning 2007

Year 2006 intercytex company announced that they are going to start phase 3 of hair multiplication study soon. Hair cloning has been in the news and many people are eagerly following that news to see when and how they can get a full head of hair using hair cloning techniques. Unfortunately, cloning hair has not been going that well and in last few years we only had limited research results on hair multiplication in animal models and in human. Here is the question that people usually ask me:” Is hair cloning being done anywhere yet?” My answer is: Not except on experimental levels. Several investigations are in process on hair multiplication field and hair stem cell research.

Hair cloning 2008

Hair multiplication or as people call it hair cloning is a method that allows us to culture hair follicles and multiply it so we can increase the final number of hairs. So far, we know that it is doable on animals, and there are some reports of its feasibility on human volunteers. Safety has been one of the biggest questions on any research involved with stem cells. Stimulating growth of stem cells has always raised the flag for possible tumor formation. In year 2008, we should witness some results of the phase 3 studies on the procedure. During this year or in next few years, we should have a better understanding of the effectiveness and safety of hair multiplication. I know many of my patients are following hair cloning news carefully. Unfortunately, hair multiplication news has not been very fruitful in last year, but the process is complex and one way or another it will become clear in next few years that we can or cannot use hair multiplication methods in hair restoration surgeries.

Searching for the best Los Angeles hair transplant surgeon may not be an easy task, but Los Angeles has always been a referral center for most cosmetic surgeries, even though hair transplant surgery is one of the newer branches of cosmetic surgery. You can find a wide variety in style and levels of Los Angeles and Beverly Hills hair transplant surgeons. Some of the most updated hair transplant surgeons practice in Los Angeles and San Diego, California, but you can also see lousy surgeries done by some hair transplant surgeons. Overall, hair restoration surgery like any other cosmetic surgery is a buyer‚Äôs beware market, and one must be careful not to fall into the trap of signs such as “Number one Beverly Hills hair transplant surgeon” or “the most experienced Los Angeles hair transplant surgeon”. You can see similar advertisements and a lot more like Extreme make over hair transplant surgeon or doctor 90210.

The good news is that today, most hair transplant surgeons offer free initial consultation. It is importantto take advantage of this situation and shop around. It is your look and your desire to live with it for the rest of your life after all. It is not enough to visit several hair transplant doctors; you also need to educate yourself on hair transplantation process, surgical techniques and hair transplant surgeon’s background before visiting the doctor. This way, you can appreciate a good technique and knowledgeable doctor when you see one while you can find the most affordable hair transplant. US Hair Restoration – a Los Angeles hair transplant surgery center offers free physician consultation for everyone. We offer state-of-the-art hair transplant surgery with exclusive follicular unit transplants (FUT), mega sessions for people with extensive hair loss and follicular unit extractions (FUE) or noninvasive hair transplants that does not leave an scar in the donor area.

Los Angeles is Hollywood and in Hollywood “appearance” is everything. Modern hair transplant surgery with undetectable results has become a demanding field in Southern California in last few years both because of the number of people looking for hair restoration surgery and the ones looking for the best hair transplant surgeon in Los Angeles, Beverly Hills and Southern California over all. Many people travel the world to get their hair transplant surgery done in Los Angeles or Beverly Hills. Los Angeles is and will probably always be the Mecca of hair transplant surgery for people who cannot accept anything but the best.