Hair Restoration Blog

Q:

I have heard of FUE transplants with relatively high-quality hair coming from the neck area, and from the beard. It seems like this could dramatically increase the number of grafts available for patients, at least for the hairline and front.  Then, body-hair (chest, back…), which I think are lower quality (but very abundant on me!), could possibly be used for the crown area. I would like to take as few hair from the back of the head as possible, and as much as possible from other areas.
Doctor, what do you think of this plan? Would it be a good strategy to pull from other sources rather then the scalp for donor hairs? What would be the costs involved?

A:

Follicular Unit Extraction (FUE) can remove hair from anywhere in the body as long as you are tested positive for FOX for those areas.  Neck hair is not the best option for hair transplantation because those hairs may fall out at higher ages of some patients. We can use body hair for hairline, and front or even the crown, but you may need multiple surgeries to obtain adequate density from those areas with body hair.  As we discussed before, body hair has a long resting phase in relation to its growth phase.  So you will have more follicles in resting phase (telogen phase) that do not have any visible hair in comparison to the ones in growth phase (anagen phase) that provide you with actual hair and give you coverage. We do FUE transplants in our California hair transplant centers on a regular basis.  FUE procedures are more labor intense and more time consuming so the cost of them are almost double in comparison to regular strip hair transplant procedures.

Q:

We discussed the possibility to close the scar, which I think is a good idea, but again, I had already achieved camouflage with longer hair. While it may only be a 2-hour operation, I admit being very weary of such an operation because my skin is already so tight. I understand that the skin exercises you recommended should help a great deal, but for whatever reasons I am not comfortable with such an operation, especially considering that I would like to cover the whole head with some hair anyway. Perhaps you will convince me on the scar revision, or maybe you will advise me to pursue the FUE plan which would cover the rest of my head. Assuming I have an “average” density in the donor area, how many grafts do you think you could extract from it? How good or bad would be the mini-scars scattered all over the back of the head? I am assuming the surrounding hair will camouflage them?

A:

If you don’t want to pursue scar revision, the only option will be an FUE transplant into the scar from neighboring areas.  I recommend for you to wait until we see you in your follow up visit with a little longer hair before continuing. You also need to schedule for the FOX test to determine your eligibility for a Follicular Unit Extraction procedure.  The answer to your questions about how many grafts could be harvested in one session of your FUE procedure will be answered the day we do FOX test and confirm your eligibility.

You need to contact US Hair Restoration to schedule the FOX test as soon as you are able.  FOX test’s are done quite easily and assisted by numbing a very small area on the back of your scalp. The small scars of the FUE are going to be scattered throughout a larger area.  That can minimize the visibility of those pinpoint scars.  If you keep your hair not too short it is generally not possible to see them at all, but with a shaved head the tiny scars might be detectable from a close view.

In a standard hair transplant procedure (follicular unit transplant through strip technique), having adequate scalp laxity is crucial to avoid complications in the donor area. Doing so has required the individual judgment of an experienced hair transplant surgeon but still leaves room for human error. If the surgeon removes too wide of a strip, there may be issues with wound closure, a visible wide scar, telogen effluvium (hair loss around donor wound), and/or skin necrosis. Areas around the scalp most at risk are the mastoids or the area behind ears.

Laxometer has been designed to minimize hair transplant complications (in 15th annual meeting of International Society of Hair Restoration Surgery) by helping assess scalp laxity more accurately prior to a hair transplant procedure. After the first assessment, the patient then practices the scalp exercise to increase mobility and is then reassessed the day of surgery. The more laxity the patient has the higher the chances of increasing the number of grafts that can be transplanted in a single hair transplant.

We performed a study on 37 different patients to assess the success and functionality of laxometer. In all of these patients, half of the donor wound was closed during the procedure to evaluate the impact of donor excision on the laxity of the donor area. Three (3) locations of donor area were assessed before and after incisions were made:

I.    Right side
II.    Mid line
III.    Left Side

The laxity of the sides were measured approximately 10-15cm above the mastoid bone from the midline. The incision was made using a double bladed knife to insure uniformity.

After excising the first half of the strip, laxity was measured on the secondary section prior to full incision and excision. If laxity has been compromised due to the first excision and closure, then the second incision will be smaller. Out of the 37 patients that underwent follicular unit transplantation through strip technique, only six (6) patients required a smaller incision due to a lesser laxometer reading caused by reduction of laxity. Our study shows that wound tension:

I.    May increase on the secondary side in some patients (~16% chance)
II.    May not be an issue in most patients (~84% chance)

Laxometer helps determine scalp laxity before, during, and after a hair transplant procedure for optimal excision and closure. It helps determine the maximum amount of tissue that can be excised safely helping increase the chance of more grafts that can used a single session. This practice is best applied on patients undergoing a mega-session hair restoration in which over 2500 grafts are being transplanted in one hair transplant session.

Hair Care Beverly Hills

Here is the content of the interview with US Hair Restoration’s Medical Director, Dr. Mohebi done by BuziMoms which is published in hair care Beverly Hills.  The interviewer asked several hair loss and hair restoration questions from Dr. Mohebi based on the requirements of the visitors and readers of the site.  Here are the questions and Dr. Mohebi’s answers:

An Interview With Dr. Prasa Mohebi, M.D. , A Qualified Hair Restoration Surgeon For Moms In Beverly Hills

BuzyMoms: If a hair loss patient has already had a transplant with another doctor and is disappointed with the results, can the procedure be redone or is repair possible?

Dr. Mohebi: Yes, hair restoration surgery repairs are a good portion of our operations performed in our Southern California offices (located in Beverly Hills, Encino and Orange County).  Many people may have unnatural results from previous hair transplants due to the older techniques, but some even have problems with recent hair restoration due to technical issues or lack of proper judgment on the part of the hair transplant surgeon. In most cases, the repair is easy and can be done in one or two sessions.

BuzyMoms: Is there a minimum age for hair loss surgery?

Dr. Mohebi: Hair transplant surgeons used to say that 24 was the minimum age to perform a hair restoration procedure.  However, nowadays microscopic techniques being used to evaluate the miniaturization of hair can assist surgeons in predicting the final pattern of hair loss. By being able to predict each patient’ s  final stages of hair loss, we are able to see where the pattern of baldness is heading and recommend hair transplant surgery at an earlier age.

BuzyMoms: Won’ t my bare scalp be showing in the back of my head once the donor hair is taken?

Dr. Mohebi: If you do not plan on shaving your hair, your donor wound will never be visible.  However, if you plan on shaving your head for any reason, you may need to have a FUE or Follicular Unit Extraction procedure done rather than the general FUT procedure.  This method eliminates the visibility of a linear scar on the back of your head and is the best option for patients who plan on shaving their head or keeping their hair very short in the future.

BuzyMoms: Do you provide free consultations?

Dr. Mohebi: Yes, the initial consultation with us is always free in any of our three hair transplant offices in Beverly Hills, Encino and Orange County.

BuzyMoms: What type of information should be brought to the consultation?

Dr. Mohebi: Anything related to your hair loss and hair restoration, including medical, surgical or even cosmetic changes that you like and may help you have a better result after a hair restoration procedure.

BuzyMoms: Are lab tests required prior to surgery?

Dr. Mohebi: We may need lab work for men or women who have hair loss without showing a typical pattern that we see in most male or female patterned hair loss or in people who have lost hair due to any other medical conditions such as thyroid problems, hormonal imbalances or lack of certain elements such as Iron.  We also need certain lab works from patients who have medical risk factors for surgery like diabetes to make sure those medical conditions are under control before we can pursue with the hair transplant surgery.

Q:

Dear Doctor,

I am 14 years old and I have hair loss in form of CTTA and my parents agreed to let me get the hair transplant, but will it actually take months for my hair to grow and I need to know how much it cost for the operation please.

A:

Congenital Temporal Triangular Alopecia (CTTA) is a congenital condition that is noted by parents at birth or soon after that.  CTTA could easily be treated with hair transplantation at any age. We at US Hair Restoration charge patients with the number of grafts and since patients only need a small number of grafts, the cost falls into our minimum charge category. Having said that you need to have a consultation with me so we can confirm the diagnosis and make sure you are a good candidate for a hair transplant surgery. 

Transplanted hair will grow in 2 to 3 months after hair restoration surgery and will become even better than that for the following months after that.  Since the location of the transplanted hair is only in the temple areas, it may not show as much since most people can easily comb their hair to cover the hair loss area.

Please feel free to call our office at 1 (888) 302-8747 and schedule your complementary consultation at one of our Southern California offices. If you are contacting from other states, you can send us an inquiry through our website and we contact you to complete your online consultation.
We look forward to seeing you soon.

Dr. Parsa Mohebi

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.

According to a recent L.A. Times article, people in our current economy are scaling back on elective cosmetic treatments, and finding ways to negotiate costs and figuring out what’s really necessary (e.g. Botox) and what’s not (e.g. massages and body scrubs).  We have posted on Recession and hair transplant cost before.

US Hair Restoration understands that people have found themselves in challenging economic circumstances. Our goal has always been, “offering quality hair transplant for everyone”. We want to relieve the pressure on people by responding to patients’ needs for more affordable hair transplant prices.

Every year, we have a summer hair transplant special, but this year, we’re going to offer it several months in advance as part of an unprecedented and huge hair transplant cost reduction. And we promise it will be the lowest price ever for our hair transplants using our standby program.

For those who are seriously considering getting a hair restoration procedure, the best time to get one is when we have this reduced-price offer. This is a limited offer and the price might not ever be this low. Now is the time to take advantage of it.

Offering hair transplant cost discounts in our standby program helps us to fill all openings in our operating room schedules. On the other hand, for those people who can be a bit more flexible with the timing of the surgery, it helps them get a US Hair Restoration-quality hair transplant done at historically low rates, at one of our Southern California offices: Beverly Hills, Encino, and Orange County.

The bright side to the recession is that retailers and companies are offering lower-than-usual prices for their products, knowing consumers have become increasingly tight-fisted about their cash. Our earlier-than-usual summer special is our way of saying we are sensitive to our patients’ financial circumstances.

Check US Hair Restoration for more info on our hair transplant promotions.

This type of “hair test” is done by a hair transplant surgeon or dermatologist to find out the rate of telogen hiar. It’s a simple procedure. The doctor pulls hair to find out the number of hair follicles in the resting phase. The way the test works is that the doctor grasps a couple of hair shafts between the pointing finger and thumb, then pulls them ever so softly. There are two classifications of hairs: Anagen, which are growing hairs that ought to remain in place; and telogen: hairs that should pull out rather easily.

By keeping track of the number of pulled hairs, a person can approximately calculate, in the telogen state, the hair follicle percentage. For example, if a person pulls on 10 hairs and then 2 come out, then the telogen hair follicles frequency is 20%.  If extracted hair follicles percentage is up to 25%, that is still considered OK, but if it’s over 35%, it is not normal and shows that there’s a disproportionate amount of hair in the resting phase.  This condition is often seen in Telogen Effluvium (TE).

Even though this hair-pulling test seems simple, a person may come to the wrong conclusions if they do not carry out the test properly and he or she does not have a full comprehension of the test’s limitations. The biggest concern is that the test results may be affected by what the patient did with her hair in the preceding hours. When the patient washes her hair, it will cause many of the telogen hairs to fall out.

There are several factors which can increase the accuracy of the hair pull test. The hair pull test can be ratcheted up to another level by conducting the “unit area trichogram”. This type of test requires that a couple hair follicle samples are grabbed from the scalp utilizing rubber-covered forceps; both telogen and anagen hairs are yanked. These hairs are to be placed on a glass slide and inspected using a microscope. After that, the dermatologist is to count up the telogen hairs and the anagen hairs as well.  The test can help the doctor in differentiating a variety of hair loss conditions.

Q:

Hey Doctor Mohebi,

I was wondering, I’m thinking about getting a hair transplant, but I’m afraid of telling my future wife and female friends that I’ve had a hair restoration. I know men may not care that much, but if I’m dating someone and eventually I tell them I’ve gotten a hair transplant, I fear that they may get turned off.

I kind of look at it like plastic surgery. I know when I meet women who has undergone a nose job, I kind of feel strange about it and think maybe that person was not happy with their looks.
To be honest, it  turns me off.

So, my question is: from your experience with patients, do they keep it a secret from others or do they not mind telling people?

A:

Today, we have capabilities we did not have 50 years ago. As a young soccer lover, I used to have the disadvantage of wearing glasses.  It was very difficult for me to stay competitive in succer team without wearing my glasses.  Every now and then, I use contact lenses to be able to put aside my glasses. I am planning to get a LASIK procedure for that as well.

If I undergo a LASIK procedure, does it make me an insecure person. Not at all. I call it using all your resources to look your best.

We do have technology that we did not have 10 years ago. I say: why not use it? A lot of people are doing it, and nobody cares if these peoples’ hair is native hair or transplanted. The point: they are not bald any more and they can be as competitive as their non bald rivals in life.

One time, I met a very beautiful woman at a party and I ended up having a conversation with her.  When I told her I do hair transplants, she told me a story about someone who proposed to her and she rejected him. She said the man was bald. But I’m not saying because he was bald that he got rejected, but because he did not do anything about it. I know the argument can be made that what the woman did is sad and superficial but, hey, looks do play a part in initial courtship, whether we would like to admit it or not. And it was her prerogative to make that decision.

My point is: Be yourself and do whatever makes your heart happy. No matter what you do with your life, there are going to be people who may not like it. It should not influence your decisions.

Q:

hi

I come from china ，I would like to consult your organization a few questions:

In your experience,usually Asians（chinese people) the normal growth of the number of roots Per cm² of hair? Head at the top and post-occipital whether there are different?
using FUE technology，on one operation ，After the occipital Site  get the maxinum number of FU (Asians including 2-3 days operation) at present,how much FU can be planted per square centimeter on Planting area? Between the scope of? and the percentage with normal?

Looking forward to your reply Details!

Thanks for your questions.

A:

Here are the answers in the order they were received:

The number of hair follicles

The number of hair follicles in non-balding areas of scalp like occipital areas have been studied.  A range of 80 - 120 follicular units (FUs) per centimeter were reported. The density of follicular units vary in different locations of the scalp. Also, the number of hairs per follicular unit vary in different areas and with different races. For example, Asians usually have less number of hair follicles per cm², so even with similar number of FUs per cm², the density of their donor area is still less than Caucasians. To calculate the number of hair per cm², you have to average the number of hairs per FU and multiply it by the number of FUs per cm².

Difference of hair on top and back

The shaft of hair may or may not be different in different areas of the scalp. Obviously, if you are balding, you see more miniaturization and less terminal hair, which makes the appearance of the hair less dense on the area. However, without baldness, hair quality would be the same in back and top of the head.

FUE and number of grafts

FUE (Follicular Unit Extraction) is more labor intense and requires more time for harvesting the grafts. For that reason, FUE procedures are generally smaller in terms of the number of grafts per session. What we do at US Hair Restoration is up to 1,500 grafts per day on average, for 8 to 10 hours work in a FUE procedure. The number may occasionally go up to 2,000 grafts, too, but not everyone can expect to get that number with FUE.

Density of transplanted hair

There are many research projects on this topic. The number can be as high as normal density in some circumstances. However, practically we can make up to 35%-40% of the normal density in one session. This is a good number if you consider that the density of hair on frontal areas could be about half of the hair on the donor area in some patients, so 35%-40% is not that far from the normal density in those patients.