Hair Restoration Blog

Shock loss after a second hair transplant

Q:

I am considering a second procedure in a few months for additional coverage in my mid-to-crown area, will the frontal area (my first procedure) be affected with ’shock loss’ during the healing process of the second procedure?

Thanks again for your replies.

A:

Transplanted hair from a previous surgery won’t be affected as native hair to a second hair transplant procedure, however, the surgeon should be extremely careful with transplanting into the area that has already been transplanted. We at US Hair Restoration use special devices and needles to minimize the transaction rate of preexisting hair follicles.  Some loss of the transplanted hair may be seen when we transplant to thicken up the already transplanted area, but it will be reversible as opposed to the permanence of shock loss.

Q:

Hi doctor, I had synthetic hair transplantation last year. After a few months following the starting process, several complications started to appear such as, blistering, infection, folliculitis and a currently very red scalp. I finally had to yank out nearly all the transplanted artificial hairs, but there is still severe redness as well as a demarcated line on my scalp with some blistering and diffuse atrophy of my scalp skin. Where do I go from here? Do you have any recommendations from this point?

With thanks,

An unhappy synthetic hair recipient,

A:

Synthetic hair is known for its problems including infection, severe skin contact reaction and inflammation of scalp that may occur after their use.  We discussed artificial hair implantation in this blog before.  If you removed them, it is likely that the rest will fall off too.  Do not manipulate your scalp and your skin inflammation should improve with time.  The FDA has never approved artificial hair for their hair transplant use in the United States and hair transplantation through the use of a patients own hair is the gold standard for hair replacement surgery.  Below, you can see a summary of an article on artificial hair and its consequences from the Indian Journal of Dermatology.(1)

Implant or transplant

At the outset, it is important to distinguish between implants and transplants of hair.  In contrast to transplants that use patient’s own hairs, usually taken from the occipital area, implants indicate the implantation of prosthetic hair fibers just as artificial hair implantation does.

There are two types of prosthetic hair:

1. Synthetic fibers (such as monoacrylic, polyacrylic, and polyester)
2. Natural fibers (such as processed human hair).

They are implanted into the galea (which is the fibrotic layer underneath the skin and fat layer under that) by use of a knot through an implanter device. The advantages claimed with this technique are the relative ease of the procedure, which can be learned in a few days, relatively bloodless technique, and immediate cosmetic result. In contrast to transplants however, these fibers do not grow and hence cannot be cut or shaven. In this respect, they resemble a wig, which has been fixed permanently to the scalp.

Problems with synthetic hairs

These fibers have had a checkered history. First introduced in 1970s, they soon became the subject of much controversy because of their numerous complications including recurrent infections, rejection, periodic loss of fibers needing frequent replacement, frequent allergic reactions leading to severe contact dermatitis, irritant effects, fears about carcinogenicity, cicatricial alopecia, granulomatous hypersensitivity, and cyst formation.

In 1983, the US Federal Drug Administration banned the fibers for the following reasons:

1. The fibers presented risks of illness or injury owed to the non-biocompatibility of the fibers and non-medical performance of the implant.
2. The fibers presented fraud owing to the following:
   • Deceptive information on the efficacy.
   • Inadequate information on risks from implant.
   • They did not show any benefit for public health.

The ban on prosthetic hair fibers is established in Section 895.101 of Code 21 of Federal regulations of the FDA, title 21, vol. 8, revised as of April 1, 2004.

Reference:
1. Mysore V. Synthetic hairs: Should they be used?. Indian J Dermatol Venereol Leprol 2006;72:5-7

Q:

Hi Dr. Mohebi,

I am a male to female transgender patient of yours.  I was doing some research and I wondered if I should use Dutasteride in the form of Avodart instead of Finisteride in the form of Proscar. Here is the link I found: http://en.wikipedia.org/wiki/Dutasteride
This wikipedia artical inidicates that Dutasteride inhibits both isoforms of 5-alpha reductase, Type I and Type II, while finasteride only inhibits Type II.  Some early studies showed that Dutasteride is more effective.
I’m curious to know your opinion of taking this drug, and if it will have any effect of regenerating any of my lost hair?  While Finisteride seems to have mostly abated hair loss, I haven’t seen any kind of re-growth.

Thank you so much

A:

Dutasteride has been studied for its effect on hair loss prevention and prevention of miniaturization process.  The studies show that Dutasteride is more potent for hair loss treatment in comparison to finasteride.  Having said that, dutasteride (Avodart) has never been approved by FDA for hair loss treatment partially due to its side effects that are more commonly seen.

Dutasteride is FDA approved for Benign Prostate Hypertrophy (BPH) treatment.  It might become approved for hair loss in the future, but until then I do not prescribe it for my patients on a regular basis.
Since you are a transsexual person and you are going through medical treatments and sex reassignment surgeries and until you have your testosterone, you can use dutasteride instead of finasteride for a more complete male hormone blockage as long as you understand that you may have a higher risk of experiencing the sexual side effects.

Every now and then I see patients in my office that have no sign of baldness whatsoever, yet they are extremely concerned about losing their hair.  Some of these patients have even previously received hair transplants from other clinics.  Body Dysmorphic Disorder (BDD) or body dysmorphia is a type of mental illness in which a patient is always preoccupied with his or her appearance and cannot stop thinking about one or several problems in their face or body.  This problem may be an exaggerated preexisting problem or it may be totally imaginary.

People with BDD often have significant anxiety and do not want to be seen by anyone if possible because they think their appearance seems too shameful.   BDD could be seen in both men and women and it is estimated that 1–2% of the world’s population meet all the diagnostic criteria for body dysmorphic disorder (Psychological Medicine, vol 36, p 877).

People with BDD are intensely obsessed over their appearance and their body image, often for many hours a day or even to the point that it affects their life or work. They may ask for several cosmetic procedures in an attempt to improve their perceived image, however they are never satisfied and their perceived image cannot ever be met. If the doctor seeing this patient cannot diagnose the problem and agree to pursue with a cosmetic procedure, he or she will also tend to be blamed for some (or at times all) of the problems that they imagine they have.

Diagnosis of BDD

1. Preoccupation with an imagined or slight defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)

In research carried out by Dr. Katharine Philips, involving over 500 patients with BDD, percentages of patients concerned with the most common problem locations of their bodies were recorded and hair problems were reported in as high as 56% of patients as the second most common problem (after skin) that these patients express having.

Treatment of BDD

Treatment of body dysmorphic syndrome involves cognitive-behavior therapy which includes education about BDD and its treatment, and specific treatments to deal with faulty thoughts.  In some patients, medications may be needed as well.

Q:

I am a man with male patterned hair loss and I have been using Propecia for 2 years now.  My wife and I are planning to have children.  What are the effects of Propecia on fertility?  Can it affect the unborn child?

Thanks,

A:

Propecia (finasteride) can reduce the volume of semen slightly in 1% of the patients, but it does not affect the sperm count or chances of fertility.  Nor does the use of finasteride in men decrease the chance of pregnancy in their partners.

Propecia can be secreted through all body fluids, including semen, but its amount in semen is very minimal.  The amount that is absorbed into the mother’s body is so minimal that its risk to the baby is considered negligible.  Thus, it is not recommended for men to discontinue Propecia when their wives are pregnant, or trying to get pregnant.

FUE Transplant Discount

Previously, we announced that US Hair Restoration, as a leader in hair restoration, is launching a new research to compare different methods of hair restoration with FUE method (between May and July of 2010).  The study is conducted on certain days by Dr. Mohebi and the volunteers who are qualified for participation in the research can receive a discount off the cost of their FUE transplant procedure.

Are You a Candidate?

This discounted rate of the FUE cost does not apply to any of our other hair transplant procedures.  Applicants can call  1 (800) 302-8747  to schedule a consultation with Dr. Mohebi in order to determine their eligibility for a FUE procedure.  If you are unsure whether or not FUE is the right procedure for you, then before your consultation, please read about FUE surgery in our website.  You can also read several posts on Follicular Unit Extraction (FUE) including FUE transplant vs. strip surgery in The Hair Restoration Blog.

Methods of FUE

In this study, all FUE procedures will be performed by Dr. Mohebi himself. All stages of FUE transplantation follow our standard procedures and the only difference is going to be the technique of harvesting hair follicular units.  We will use two main techniques for extracting the follicular unit grafts including manual and automated methods.  For the automated method, we will use either the NeoGraft machine or Harris’ Safe System.  The patient cannot choose the system that we will use. The volunteers will be randomly selected for one of the above FUE methods.

The above described techniques are among the well-known effective methods of performing FUE transplant surgeries.  We hope that by performing this study, we will be able to elucidate the pros and cons of each currently used method and be able to introduce a preferred method of Follicular Unit Extraction to the field of surgical hair restoration today.  The results of this study will be released on our website and in future medical literature.

Not long ago, I was invited to attend the Orlando Hair Transplant Workshop as a faculty member.  This workshop is sponsored by the International Society of Hair Restoration, held once a year, and is geared toward not only bringing together many prominent hair transplant doctors from all over the world, but also to teach the new techniques of hair restoration surgery to the new comers in the field.  My lecture and workshop sessions were focused on Donor closure techniques.

FUE procedure comparison

Among the different panels, one of the better lecures was on Follicular Unit Extraction (FUE) in which different techniques of FUE transplants where compared to eachother. In the last few years, we have had more advanced automated devices for performing FUE procedures surface, causing the cost of FUE procedures to decline as the new methods are exposed. Because the advance of devices used to perform the procedures has allowed FUE procedures to become more efficient, physicians are thus now able to lower the FUE pricing to patients, making it a win-win situation for patients and doctors alike.

In one panel, the comparison of different FUE procedures including manual FUE transplant and automated FUE procedure with at least two different devices was explained.  Both Dr. Harris and Dr. Bauman have done FUE procedures in live surgery workshops with automated Follicular Unit Extraction methods (Safe system vs. NeoGraft) .  It is interesting and riviting to see that any new small invention in the field of hair transplantation can improve an entire aspect of the procedure.  The most eagerly asked or wondered about question though, is which invention will become the perfect solution for hair loss patients who search the world for a better solution.

US Hair Restoration FUE Procedures

US Hair Restoration is known for offering quality FUE transplants in its Los Angeles and Beverly Hills hair transplant offices along with its other offices in Southern California.  These FUE procedures are being offered to patients for treatment of different patterned baldness or FUE scar repair procedures. The hope is that the use of new Follicular Unit Extraction methods could help to improve overall FUE results.  By the same token, and to even further optimize the FUE methods, we have designed a study to compare the best FUE procedures done by prominent FUE doctors throughout the world.  We will be comparing the best FUE methods in a clinical setting side by side (All procedures performed by Dr. Mohebi himself) to minimize the selection bias.  The results will be presented in scientific meetings, published in medical journals and will also be posted in our website to review.

FUE Transplant Research

In order to proceed with this study, US Hair Restoration is offering a few exclusive spots with significant discounts. This discount will only be available to the participants of the study, who may have one or a variety of FUE techniques used for the purpose of the research.  This FUE study will not affect any of the stages of FUE surgery. The only variable that will be affected by the use of different FUE techniques is the method of extraction of the follicular units, all techniques of which are known as superior in the hair transplantation field.

FUE discount

So, by participating in this study, patients who are qualified for a FUE procedure can receive their procedure at an extremely discounted cost.  The FUE transplant study will only be going on from May until July of 2010. Volunteers for this study can call (888) 302-8747 to schedule their complimentary consultation with Dr. Parsa Mohebi. We strive to improve the quality of hair restoration surgeries with every passing day.

Q:

Hi Dr. Mohebi,
I was at your hair restoration clinic a few months ago asking about hair loss. I was curious, have you heard of anything regarding Avodart (Dutasteride) causing significant thinning just in the front of the hairline? I got on it a month ago and I’m shedding a whole hell of a lot. Any idea how long the sheds last? I heard that the hair from the hairline actually does not grow back. Have you heard anything about that?

A:

Dutasteride (Avodart) although not FDA approved for hair loss treatment is prescribed by some physicians for treatment of male patterned baldness.  The effect of Dutasteride on slowing down the process of hair loss is documented through several studies.  Dutasteride blocks both isoenzymes (Type I and II) of 5 alpha reductase inhibitor and for that reason can help hair loss even more effectively than finasteride (Propecia).

Hair loss patients who start taking any dihydrotestosterone blockers may initially experience more hair shedding that is assumed to have to do with an increase in the turn over of miniaturized hair follicles.  The shedding and hair loss is usually temporary and new and stronger hair shafts will grow from the same follicles in a few months after the initial shedding.

Q:

Hello Doctor Mohebi,

I hope all is well and that Orlando was a success.

I am now creeping on 3 weeks post operation and just as you expected the en masse shedding commenced at right around the 2 week mark.  The good news is that I still have a sizable number left, which goes to show a large number of grafts are the way to go, but I did have a couple of more questions I thought were valuable and perhaps worthy of your blog.

1)  Even though I am at my 3rd week post op and many hairs have already been shed, many more seem to be sticking around — at least for now.  I am wondering if there’s any kind of benchmark to assess when I can expect the shedding to stop.  I would like to be able to clip all of my hair short so as to not have to keep “covering up” with hats and the alike, but I am not sure how much more shedding will take place.  Should I just wait til new hairs start to grow (1-3 months post operation, as I’ve been told) or is it relatively safe to assume that most of the hair which has not been shed after approximately a month will stick around (hang in there)?

2) For a more long-term question, what happens to the new transplants that have fallen out?  Given that telogen effluvium has taken place, I am assuming that the new hair will sprout once anagen takes place.  But here’s the dilemma:  If the front of my head contains transplants that ALL FALL OUT (for the sake of the argument, as you have stated that 90% or so of patients experience this) then that would suggest that all of this hair would be hitting CTR+ALT+DEL (or restart!) at about the same time.  If that is true, then all this hair should be hitting catagen and then telogen again at relatively about the same time, say between 2-3 years for most people.  Am I then to assume that my forehead will become synchronously thin at about 3 years only to become very full again a few months later????

Thanks Doctor.

Anonymously Yours,

A:

These are very clever questions and I will happily post them on our Hair Restoration Blog for others to see.  I will try to answer your questions in the order you asked them.

Hair Shedding After Hair Transplant

Losing hair shafts of newly transplanted hair generally occurs in most transplant cases and only a small percentage of them will continue growing the transplanted hair from the day of surgery.  Even if you are one of those lucky people who never loses their hair after surgery, you still may lose a significant number of hair shafts and only some of them will continue growing without going through shock loss.  It is not always easy to predict the timing of hair shedding in transplanted grafts, but if you have kept them for the first month after hair restoration surgery, it is likely that they will not shed.

As far as clipping your hair, you could have done it at any time after the first week following your hair transplantation.  Just be careful about the length of hair on the donor area.  You don’t want to expose your wound on the back and clipping your hair short tends to do this.  The transplanted hairs are part of your scalp at this stage and you cannot dislodge them even if you try.

Are all transplanted hairs entering the resting phase at the same time?

When hair shafts fall out due to telogen, the follicles enter their resting (or telogen) phase.  In this phase the grafts lose their shafts, the follicles shrink and become dormant for a short period of time (usually 4-6 weeks).  Following telogen comes another anagen phase in which new hairs sprout from the same transplanted hair follicles.  The initial hair grown is short and fine almost similar to vellus hair, but unlike vellus hair, it becomes longer and thicker over time.

For some reason, the biologic timer of your hair follicles are not quite synchronized.  The shedding of the transplanted hair won’t happen at the same time and therefore you won’t have to experience baldness again in the transplanted area a few years from now.  You should have some of your hair growing while a small portion of them remain in resting phase the whole time.

I have not been answering any questions in our hair restoration blog for a few days because I am in Florida as one of the invited faculties members in the hair restoration surgery workshop of International Society of Hair Restoration Surgery (ISHRS).  The meeting is held annually each year in the beautiful city of Orlando and prominent hair transplant surgeons from all over the world get together to share ideas and teach the future generation of hair transplant surgeons the science and art of hair transplantation.

I had one lecture yesterday on my invention of the Laxometer and the method in which we measure the laxity of donor area in large hair transplant surgeries.  We also discussed our new method of sequential strip removal that guarantees removal of the maximum number of grafts while still assuring the safety and quality of the hair transplant.  As a hair transplant surgeon that performs a majority of hair transplant procedures with large number of grafts, we have developed this method geared for hair loss patients with advanced classes of baldness.

Workshop Faculties: Dr. Parsa Mohebi, Dr. David Perez and Dr. Mark Mckenzie

These verbal lectures are usually followed by surgical workshops in the afternoon.  I will be demonstrating use of the Laxometer in the surgical workshop again tomorrow.  Dr. Mark Leavit and Dr. David Perez, the main organizers of the hair transplant workshop, did a great job arranging the event which is a big step forward in education of hair transplant surgeons.

I will be back in Los Angeles next week and will continue answering your hair loss/hair transplant questions in the hair restoration blog upon my return.  I will also make sure to put a note on what was new in our Orlando Hair Transplant Work Shop this year. Be sure to stay tuned to the blog for this and all future updates.