Hair Restoration Blog

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.

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.

Q:

Hi,

How soon after a FUE procedure could I expect to see some growth?
Thanks

A:

The growth after a FUE transplant would be the same as that for a strip technique.  When the telogen (resting) phase of the hair follicles is finished and the anagen (growth) phase begins, you ought to be able to see some growth after two to three months. To start with, young hair shafts are fine; it takes a few months for the hair shafts to grow to their final thickness. To see optimal results, you may need to wait up to one year (from the time of your hair transplant surgery) as that is the amount of time it takes for transplanted hair to reach its final thickness and length.

Q:

My son and I discussed the procedure with his Mom.  We are thinking, even though the other “FUE ?” procedure is about twice the money, it would be worth going the alternative route in order to avoid the issue of his being left with a scar (e.g., if he ever decides to shave his head, or get a very close “buzz cut”).  What is the more expensive, alternative procedure called?  And, how does that change the logistics?  By that last question, I mean, for example, what you described yesterday was a one-day procedure if we went with the “scar” procedure.  Now, however, if you do not cut a “strip” and leave a scar, how many days is required?

A:

What we discussed was Follicular Unit Extraction (FUE) procedure.  That is another version of Follicular Unit Transplant (FUT) surgery in which instead of removing a strip, we remove follicular units or the natural bundles of hair one at a time.  Removing individual follicular units allows us to keep scars small and scattered.  This prevents a linear scar on the back and donor area.

FUE is ideal for people who have a limited need for hair follicles and try to keep the option of buzzing or shaving their head open after the hair transplant surgery.  It is not for people who are destined to have large areas of baldness, due to the number of sessions they may need and the fact that their eligibility for hair transplant surgery may change over time.  In other words, they might be FOX positive to start with but after the initial surgery their candidacy may change.  Not to mention the cost of hair transplant surgery that may play a major role down the road when you are looking into filling a large area of the scalp with transplanted hair.

Strip procedure is definitely more efficient both in terms of cost of the hair transplant and the number of grafts that one can get over a certain period of time.  The donor scar of a hair transplant surgery is also getting better with the new techniques of hair restoration surgery.  However, if you want to eliminate the linear scar of strip hair transplant on the back, FUE is the only way to go about it.

Donor Scar left behind from a previous Hair Transplant Procedure

Q:

Hi,

I had an FUT procedure done a little more than 5 months ago which left a scar in the donor area at the lower left-rear of my scalp.  The FUT was meant to bring out and define my front hairline.  Can your FUE procedure cover this up as I always prefer to wear my hair short (almost military fade short)?

Also, I was wondering if it\’s possible to increase the density of my new hairline with FUE as the hairs appear to be positioned farther away than my natural hair which makes it look as if I\’m thinning at the front.  I live in San Diego, CA and am interested in your Orange County facility.
Please help.

Thanks,

A:

FUE (follicular unit extraction) can easily be used to bring more hair into the donor scar area to improve the visibility of the donor area.  However, there are other techniques that could be used to help with this condition.  First, you need to be seen by a hair transplant surgeon and be examined for the donor scar type that you have and the quality of your hair in front. In addition, you hair characteristics need to be determined as well.

Many people who need more hair in larger areas can have another strip surgery to respond to that need while removing the old scar and closing it with either one or two sided trichophytic closure. This option can minimize the appearance of the hair transplant donor scar while giving you an adequate number of hair to cover the front or balding areas.  It is also more affordable.  I have seen wonders with this technique.

People who have a stretched scar from their previous hair restoration surgeries can benefit from Botox injection around the scar of surgery after their repeat surgery.  There are reports of improvement in the size of the scar with the Botox in some patients.

If your scar is still visible after doing all those techniques, you can use an FUE transplant to fill the scar in with follicular unit grafts and improve it even further.  You have to understand that none of these techniques eliminate the scar, but they can improve its appearance significantly.

Q:

I recently had a FUE hair transplant in the front and my temples (2500 grafts) and everything was ok until 5 months after the procedure. I had to be out in the sun for a little longer and the temprature that day recorded more than a 100 degrees. Once I got back home I looked at my scalp and the skin in grafted area had turned white. I guess I got a sun burn. I did not take it seriously and I continued to use the Minoxidil with Betaderm spray that my doctor prescribed.

Over the last 1 month the top layer of the grafted area dried up and pealed off (like scabs). I also saw a few strands of the new hair come off with the dried skin but not much. Now after 2 months after that incident my scalp is clear and there are a few rashes here and there. But mostly it is clean. I am concerned if I have sabotaged the grafts by exposing it to the sun. Obviously I got a sun burn at the sixth month but is it going to be bad for the grafts if not already? I read some articles about sun burn but I am confused if this sun burn will be bad only for the skin or the grafts itself? If it is only the skin and it darkens the pigments that is ok. I am worried if I had killed my grafts. Could you please help me understand?
Thanks in advance for your response.

Regards,

A:

Sun exposure can be harmful for the native and transplanted hair.  Especially when you do not have full coverage and sun rays can reach to the scalp skin and cause sun burn. I generally advise against exposure to sun for anything more than a few minutes.  Patients can use sun block or a hat for the first 6 months after hair transplant to avoid hair loss or irreversible damage to the hair follicles.

The patients who do not have good hair coverage on their scalp should protect their scalp religiously forever, until your hair density increases to the level that your scalp is covered completely by the hair and protected from the sun.

It is hard to say if you damaged your transplanted hair or not.  You only need to be more careful from now on and wait and see what is going to happen in the future.

Hair follicles removed from neck to be used for mustache restoration

I have been looking into, the cost, scarring, technique, of the FUE method and am getting the impression that the method permanently removes the hair from the donor area.  If this is true, could the chin/sideburns be used as the donor area?   And instead of placing the hair follicle in my scalp, the extractions be disposed.
My sole objective is to permanently remove my facial hair.  And the FUE method seems to be the least invasive, least time consuming, and most effective (compared to laser and electrolysis).

Lasers works best on dark hair and fair skin, which I have not.  Electrolysis is more effective than Laser and is FDA approved to permanently remove hair. However, Electrolysis is very time consuming, I scar, and over time can be quite costly, as my hair growth is hormonal, where treatment could take years, and at 65.00 per week, get pretty expensive.

If possible I would like to have my hair follicles removed by way of FUE or any similar alternative.  Please let me know, if this is possible with this practice, or any information that would point me in the right direction.

Thank you,
A:

Hi there,

You are correct.  FUE is basically removing and replacing hair follicles permanently from one area to another.  FUE or Follicular Unit Extraction can move hair follicles or follicular units from pretty much everywhere and the extracted hair obviously could be transplanted into any part of body which is covered by skin.

Removing hair for the purpose of getting rid of hair permanently is doable, but you need to be evaluated through a FOX text first.  FOX test is a minor procedure that we perform in the offices of US Hair Restoration to determine the candidacy of the patients for FUE hair transplant procedure.  FOX is a small FUE procedure in which we attempt to remove hair under local anesthesia from the donor area (could be scalp or body).  The reason that we perform a FOX test is to make sure the the hair grafts can be removed from the patient with minimum transection.

If you want to remove body or facial hair through FUE technique instead of laser hair removal, you need to be FOX tested prior.  If we cannot remove hair follicles intact from your donor area, follicles or part of them remain in the skin and can grow into new hair.  Even if you do not want to use harvested hair for transplant purposes, you still need to have a FOX test to make sure that hair follicles can come out completely.

Q:
We have an additional question about the FUT-strip procedure.  My son has explained that he does NOT envision ever shaving his head completely bald.  Instead, what he envisions, someday, is to go with a classic crew (or, “buzz”) cut.

With the scar that is left in the donar area using the FUT-strip procedure, if he were to get such a crew-cut (”buzz cut”) using either a #1 comb clipper-attachment (1/8 inch length of remaining hair) or a # 2 comb clipper-attachment (1/4 inch length of remaining hair) or #3 comb clipper-attachment (3/8 inch length of remaining hair), would the scar show through and be apparent with that close of a cut?  Or, do you think that the hair would be long enough to sufficiently cover or mask the resulting scar?

Putting the question another way, how long do you think the hair would have to be after the crew-cut to cover (or mask) effectively the scar:  1/8 inch; 1/4 inch; 3/8 inch; or, even longer (a #4 comb clipper attachment leaves the hair at 1/2 inch length)?

Thank you again for your continued time and support.

A:

If you are looking for no linear scar the answer is only through FUE or Follicular Unit Extraction technique.  We try our best to minimize the scar of the donor area, but the size of the donor scar may vary in different patients.  In some patients it is very difficult to detect the scar while on the others scar may stretch and become more visible.  By performing tricophytic closure we can bring more hair to the scar which can help to minimize the detectability of the scar.  However, it may not completely eliminate the visibility of the scar especially if you want to shave your head or do 1/4 inch hair crew cut.

There are other methods to minimize the visibility of the scar even further, but it requires other procedures. Today I am repairing a linear scar of a previous strip hair transplant by transplanting hair into the donor scar on the back.  Implanting hair may completely eliminate the scar visibility in many patients and we have previously studied and published the effect of hair transplant on neurosurgical scars.

Q:

Dear Dr. Mohebi,

Hello, I am really interested in doing hair transplant by you, as my friends in California highly recommended you. I wonder if you can please help me with this questions:

1. Which method would you recommend, FUT or FIT?
2. I have had Alopecia areata in the past in back part of my head. It happened several times, last time 3 years ago. I wonder how it will affect my chance for doing hair transplant. I really appreciate if you can please answer me in details.

Thank you so much for your attention and time.

Sincerely,
S T

A:

Thanks for you interest in our hair restoration services.  I will answer your questions in the order they were received:

1. Follicular Unit Transplantation (FUT) is the gold standard method in doing hair restoration. FUT is done in two methods 1. strip technique and 2. Follicular unit extraction (FUE, also called FIT).  It has to do with your goals in hair restoration and you can read more about advantages and disadvantages of FUE in my hair restoration blog.  Planning on doing one vs. the other needs to be discussed with the patient during the initial consultation.
2. Alopecia areata (AA) is an autoimmune disorder and usually a reversible condition in which a patient loses hair in a patchy fashion.  It affects transplanted hair the same as normal hair.  I generally make sure that patients don’t have active AA before proceeding with hair transplant.  A physical examination is extremely important in differentiating between male patterned baldness and diffuse alopecia areata (a rare type of alopecia areata).  In undiagnosed cases of alopecia areata, if a patient gets a transplant in the balding area that hair is lost due to AA, there is a risk that patient will lose the transplanted hair with the same mechanism.

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.