Hair Restoration Blog

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.

I just gave a lecture on a new application for Laxometer in mega and giga session hair transplants in the annual ISHRS (International Society of Hair Restoration Surgery) meeting in Amsterdam, Netherlands.  As we presented the Laxometer in the prior hair restoration scientific meetings, Laxometer can make us capable of increasing the precision of strip removal method of follicular unit hair transplants while minimizing the risk of donor scar complications.

This year, I presented a new application for Laxometer for its use in patients who have limited laxity of the scalp due to prior hair restoration surgeries or for those who require a maximum number of grafts in one session (3000+, 4000+, 5000+ and so forth).  I performed a research in US Hair Restoration last year in which we removed the strip in sequences for hair transplant surgeries using Laxometer before and after removal of each section of the strip.  This method has increased the safety of the strip removal while decreasing the risk of donor wound complications.

The result that was presented in the ISHRS meeting indicated the effectiveness of Laxometer at increasing the number of grafts in a strip hair transplant while minimizing the donor complications of a hair restoration surgery.  Based on our findings, we now use Laxometer in our California hair transplant offices on a regular basis and obtain positive results consistently.

Yes, I am  back from Amsterdam.  I spent one week there and I was mostly involved with the meetings of the International Society of Hair Restoration Surgery.  The city of Amsterdam was beautiful and I still cannot believe in this day and age people still bike to work on a regular basis in a capital city in Europe.

As always of every year, we had a large number of hair transplant surgeons come from all over the world. My lecture this year was on a new application for the Laxometer and the title was Laxometer and Sequential Strip Removal for Increasing the Safety of Strip Removal in Mega-session Hair Transplants.  We will be placing a summary of the lecture in the hair loss library on our website US Hair Restoration soon.

The research results that was presented by the consultant of Intercytex for hair multiplication was disappointing and basically despite the fact that they announced they started Phase III of the study, this year they said they have not even finished the II yet.  They claimed financial problems to be the cause of that.  We will look closely as we were before to see what is going to be out in the horizon for hair multiplication or as it is often called “hair cloning”.

Several new automated techniques were also introduced for FUE harvesting but I was not impressed by any of those.  It seems like no one could come up with an ideal technique for the automated FUE that does not have significant problems.  We will continue with the manual methods for FUE hair transplant graft removal and placement at this time.

There were many nice discussions on new techniques in making sites, closing the donor wound and preparation of the hair transplant grafts.  The aesthetic aspects of hair restoration surgery was also discussed in many sessions and nice new concepts were introduced by several doctors.  Hairline design and temple points were again discussed and it seems that more doctors are realizing the importance of restoration on hair in the temple areas.  We at US Hair Restoration are very big in restoration of the temple points in the patients that need it and temple hairline is a necessary part of our hair restoration and hairline designs.

The comparison of the maintaining solutions is always part of the discussions.  This year there were a few nice comparative researches on densely packed hair and also the comparison of the grouping of the hair grafts in follicular unit form or isolate single hair groups.

Hair Restoration is one of the young fields of cosmetic surgery.  It has been revolutionized in the last 10 years with development of the idea of follicular unit transplantation and stereotactic microscopy that gave us the capability of producing such great results that are undetectable from the natural hair.  Presence of hair transplant doctors in scientific meetings of this kind help the hair transplant surgeon to be able to deliver the highest standard of hair transplant to his patient that can eventually guarantee both the doctor and the patient satisfaction.  I recommend the meeting of ISHRS to every doctor who performs hair transplant surgery as a big part of his practice.  In fact I do not understand how some doctors can afford not to be there while new findings are changing the face of hair restoration medicine on a regular basis.

Happy New Year! Last year was a year of great accomplishments for our group, and I have a lot to share with you in this blog. We are proud to be able to continue our research in hair loss and hair restoration and be active at the medical meetings at an international level.  I am also proud that our articles were published on Hair Transplant Forum, the most prestigious journal of hair restoration surgery.

Two of our articles, Psychology of Hair Transplants and How to assess scalp laxity, were published on this journal as their cover article within the last year.  I have to appreciate Dr. William Rassman, Medical Director of the New Hair Institute, who coauthored me on those articles and also Dr. Jae Pack who helped us with the technical aspect of our invention: Laxometer.

I presented a lecture on Psycho-social impacts of hair restoration surgery on men at an annual meeting of the International Society of Hair Restoration Surgery (ISHRS), which is the most important event in the hair restoration society.  One of the medical equipment companies is working on producing the Laxometer, which was invented a year ago and was perfected within the last year.  Laxometer is a device that can help hair transplant surgeons to increase their precision in harvesting hair and making hair transplant a safer procedure for patients.

Beside our achievements in hair restoration, we have expanded our Encino Medical Spa to be able to provide many more cosmetic needs of our patients under one roof.  Our hair restoration offices in Encino, Beverly Hills and Orange County facilitated the access of the patients to our services for residents or Southern California.  We also provided great travel packages for the patients who traveled from other states or other Countries to take advantage of our quality services.  I have to thank Niki and Rey and other medical assistants for coordinating this process and making our procedures as smooth and pleasant as possible.

Last year has been a financially challenging year for America and many other countries.  We at US Hair Restoration succeeded at reducing rates of our procedures while maintaining our high standards.  We also offered a variety of low rates and 0% interest financing for hair transplants for qualified patients to make our hair transplant procedures more affordable.

I am glad that I found many new friends last year, people who I personally admire for their willingness to become a better person inside and out.  I appreciate my colleagues for referring their patients and friends to us and our previous patients who could not stop bragging about their new look after the procedures that they had with us.

Have a great Holiday,
Parsa Mohebi, MD
Medical Director
US Hair Restoration and USHR Medical Spa

This is another article from Dr. Mohebi that is recently published on the cover of the Hair Transplant Forum International: the journal of the International Society of Hair Restoration Surgery.

The laxometer was invented by Dr. Parsa Mohebi two years ago. Laxometer is a device that is used to measure the mobility of scalp skin, which is a crucial piece of information for hair transplant surgeons before hair restoration surgery with strip method.

Evaluation of scalp laxity prior to hair transplant procedures has been a clinical subjective evaluation that varies with each surgeon and each visit. Hair transplant surgeons have been traditionally assessing the laxity of the scalp with manual palpation of the donor area and by moving the scalp horizontally or vertically, estimating the scalp movement against the occipital bone.

Measurements have been recorded with subjective term such as very loose, moderately loose, average, moderately tight, and severely tight. With the use of the laxometer we are provided a more precise metric for use in hair transplant surgery.  You can read the full article “How to assess scalp laxity” on US Hair Restoration Website.

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.

Hi Doctor,

My son has had a hair transplant years ago with old techniques and he has bad hair transplant scar now. He now wants to shave his head, but the scar of hair transplant on the back of his head may become exposed. Do you perform hair transplant scar repair or do you recommend any procedure that can help with hair transplant donor scar coverage?

Answer:

Hair transplant with strip technique can cause a linear scar that could be visible on the back of head if the patient wants to shave his/her head. A hair transplant scar is not limited to a bad hair transplant technique and it might have to do with one’s personal healing process too (some people are generally better healers compared to the others).

The good news is that we have methods to minimize the size of the scars nowadays and if you have bad hair transplant scars from bad transplants in the past, there are several new methods that can help improving the appearance of the donor scar. A hair transplant scar could be improved by repair of linear widened scars with different methods that we perform at our Los Angeles office of US Hair Restoration. Dr. Mohebi is the inventor of the axometer, a device that measure the laxity of the scalp precisely before hair transplant surgeries. Good measurement of the scalp laxity is one of the best ways to minimize development of donor wound complications and widening of donor scar and the Laxometer is the device to do these measurements.

One method is through simply excising the scar. Excision of the donor scar may be helpful for some donor scars. After removing the scar, hair transplant surgeon can close the skin with the trichophytic closure method in which a small wedge on one or both sides of the skin edge is removed and the skin is closed primarily. Trichophytic closure allows some hair follicles to grow new hair into the final scar. Presence of hair helps making the hair transplant scar become invisible.

Hair transplant donor scar coverage could also be performed by transplanting hair into the scar. Hair could be harvested from other areas using FUE or mini-strip techniques. Again, presence of the hair inside scarred area could trick the discriminating eye and the scar would become less detectable. Patients may need more than one hair transplant procedure into the donor scar for minimizing the difference between the densities of hair in scar and surrounding areas.

The last method that could be used to camouflage the linear scar is by tattooing the scar. People who plan to keep the hair very short can easily tattoo the scar with the figures of short hairs so it seems that there are some hairs present in the scar area, which can help minimizing the visibility of the scar.

Question:

I am a 40 year old man. I had a hair transplant 15 days ago and have my sutured removed 5 days ago. I am generally very active, but my doctor said that I can not exercise intensively for first 3 months after surgery. When do you usually say is safe to resume heavy exercise.

Thanks A lot!!

Answer:

Dealing with daily activity and sports after hair transplant surgery is a concern for many patients who are physically active and want to get back to their normal routine as soon as possible. There are two areas of concern after a hair transplant surgery. First, you may lose newly implanted grafts when doing contact exercise like wrestling. This can only be problematic within the first 4 days after surgery. Research has shown that after this period the hair graft is completely healed and infused in surrounding skin. Usually even pulling the hair after this period of time doesn’t have an adverse effect. The follicle stays in place and is capable of making a new mature hair.

The second concern is with the donor area, which is primarily closed by sutures or staples. Using Laxometer can help up to close donor wound with not much tension on the wound edges. The healing of the donor incision follows the general wound healing rules. The process of healing starts from the moment the wound is closed. The wound heals primarily within a few days from the time of hair transplant and any vigorous activity should be avoided within the first two weeks. After two weeks, the wound is practically healed, but the strength of this newly healed wound is nowhere close to normal skin. The wound needs a few months to get back to its final strength. However, regular aerobic exercise is not contraindicated even the day after surgery.The activities that you should be avoiding are: Anything that increases the tension between the edges of the healingwound in the donor area, such as weight lifting and other exercises which involve intense bending of the neck. You should wait at least 6 months for this type of exercise in order to prevent opening of the wound or widening of the final scar.