Hair Restoration Blog

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:

I had a hair transplant surgery a month ago.  As it turns out, I have a huge amount of shock loss right now.  As i’ve never taken propecia before, do you think it’s too late to combat this shock loss with propecia?  Any suggestions on how i could eliminate this shock loss from further damage?  I hope my hair will return.

A:

To prevent shock loss, it is never too late for Propecia (finasteride) if you really need it. You may not get the maximum benefit as if you started on the medications before your hair transplant, but your shock loss may not have been completed yet.

We generally start our patients on Propecia a few days prior to their hair transplant so the medication is in the system at its therapeutic level on the day of surgery.

Many people choose to continue the medication after hair restoration surgery and we encourage that. We continue the medication for 6 to 8 months after the hair transplant, depending on the degree of miniaturization for patients who do not want to be on finasteride for the rest of their lives or the ones who have minimal miniaturization. After the first few months, the chance of shock loss due to the hair restoration surgery is very minimal but it still may occur.

Q:

Thanks Dr. Mohebi,

Your input is much appreciated.  The shock loss you had mentioned has been my concern, as a few of my frontal hair seem lighter than before.  You had mentioned that the shock loss might be visible for a few weeks to months - will it be the case that after that shock loss stage, the hair will likely return back to original form?

There’s a very important question that i would like to ask you, and was thinking the it would be great for the blog to have.  Basically, when you saw my before and after picture, i feel like i changed a bit.  The “after” picture seems like i have more redness, and i’m hoping it’s not the case where the hair transplant affects the circulation (e.g., tight donor area/scalp affecting the blood flow to my head).  My surgeon told me before the procedure that i will eventually be back to the way i was before (i.e., the “before” picture), but just have a new scar and more gafted hairs.  That’s the ultimate question: would you agree that a patient who does a hair transplant will relatively return to the condition that he was before the particular sugery (w/ of course, a new scar and more hair)?  This is what keeps me up at night, thinking perhaps my scalp has worsened, or i am now more prone to lose hair.  I hope that’s not the case, and every patient should be aware about before she or he gets a hair transplant done.

Thanks again for your help.  If I see you in person at your office, I might be interested in discussing about future scar work.

A:

What is hair transplant shock loss

Some of the hair shafts that fall off due to shock loss might come back. Especially if the shock loss happens in an area with permanent hair like back of the head. However, losing hair in the frontal area because of shock loss might not be completely reversible. But, you have to understand that falling hairs are the ones that were supposed to fall off anyway and a hair transplant just accelerates the loss.

How to prevention shock loss

Again, using finasteride can significantly reduce the extent of shock loss. After surgery, in the transplanted area, the tightness should not affect the circulation of the scalp. After a few days to weeks, on the donor area, the tightness goes back to normal.

Donor scar in strip hair transplant

And to answer to your last question, I do not agree you go back to the condition before surgery with only a new scar and some more hair. What I personally do in a repeat surgery is remove the old scar; the patient at the end has only one scar that at times may be even better than the initial scar.

How to improve the appearance of the scar

I perform tricophytic closure when I think it is the final surgery that the patient may need.  Tricophytic closure is when we close scalp skin on the back in a way that hair can grow through the scar.  Tricophytic closure reduces the contrast between donor scar and surrounding areas that eventually improve the appearance of the scar, so you are not more prone to hair loss because of your hair transplant.

In some cases and when we are looking for even less visible scar, the scar may get filled with FUE into the scar in a few months from the initial surgery.

Be patient and you should be able to see results in the coming months.

Q:

I just had a few questions following the consultation,

As you said I have slightly more miniaturization in the crown than the donor area, but still in normal range, what would cause me to have more in one area than another other than MBP, is that normal for non MPB scalps?

• Could finasteride worsen the hairline due to the rise of testosterone, or is that irrelevant?
• Are there any safe and minor treatments to slow the progress of maturation or reverse it that you would recommend at this stage?

A:
I will be sending you a letter with all information that we discussed during our consultation at US Hair Restoration Beverly Hills Office.  You may have very initial signs of MPB, but the numbers for miniaturized hairs are not far from high normal.  Let us wait and see your progress before putting you on hair loss medication finasteride.  Early stages of male patterned hair loss may not always be obvious enough in our scalp microscopic evaluation to be differentiated from having upper normal levels of miniaturization.  Propecia (finasteride) is a great hair loss medication to prevent balding, but I know many people who went on it without the proper documentation of their miniaturization.  These hair loss patients may have to take it for the rest of their lives without knowing that they have really needed it to start with.

The main cause of hair loss is DHT (Dihydrotestosterone) and not testosterone, so finasteride can not deteriorate your hair loss or hairline maturation changes. Maturation of hairline is a natural phenomenon and should not be mistaken with balding.  We do not want to stop it.  I do not recommend any medications to stop the maturation of hairline either.

Q:

Hello,

Do you map hair for miniaturization, and are you able to tell which, if any, hairs are currently being attacked by dht, testosterone, or something else entirely such as a disease? Or should I be looking into a dermatologist?

Thinking about getting on Propecia, but I am not sure if my receding hairline is caused by dht (androgenic alopecia), or just naturally receding from testosterone. If it’s the latter then Propecia might affect my hairline negatively due to an increase in testosterone. Or perhaps something else entirely, deficiancy, or disease. Just a bit precautious and want to stay ahead of whatever is causing it.

Please advise,
thanks!

A:

Yes, as part of our hair loss evaluation, we do perform a miniaturization study on all of our hair loss patients before planning any medical or surgical hair restoration.  This helps to determine the candidacy of each individual before starting them on medical treatment.  A miniaturization study needs to be done before starting hair loss medical treatment so you have the mapping of the scalp before the treatment that could be used in the future to assess the effectiveness of the medication.  Miniaturization study also can predict your destination when hair loss is concerned.

You can call our main office at 1 (888) 302-8747 and arrange a hair restoration consultation at one of the California offices of US Hair Restoration - Beverly Hills, Encino or Orange County.  We look forward to assist you to come up with a master plan for the prevention or treatment of your hair loss condition.

Q:

My hair is very thin and I want to strengthen it. There are two products I tried before, one suggested by my hairdresser called “Chronostin” and the other one prescribed by my skin doctor, called Minoxidil, Estradiol Vateral, Esopropyl Acohol, if I read it correctly.

I would highly appreciate your advice,
Best regards,

A:

It was good that you saw a dermatologist.  I am sure you have been examined by your doctor for miniaturization of the hair as part of his diagnostic for male patterned hair loss.  Combining minoxidil with other hormonal medications is not proven to add any value to its effect for the treatment of hair loss.  The doctor who put you on minoxidil probably diagnosed male pattern baldness.   If that is the case you can benefit from using finasteride as well which is a medication with more potency in comparison to minoxidil based on several studies.

I have not heard of Chronostim which was recommended to you by your hairdresser.  However, I did some research on it. Chronostin is claimed to be a solution that allows it to act on the group of factors which play a part in the loss of hair. It has both morning and evening solutions where the day one serum contains sabal enriched in lauric acid (seborrhea regulating ), tocopherol Nicotinate (microcirculation stimulating, oxygenating bulbar), glycyrrhetinic Acide béta (reinforces the activity of 5-alpha réductase), Excipient alcohol-silicone, and Perfume- hypoallergenic.

Chronostim ” NIGHT” has extract of Ruscus enriched in Neoruscine (stimulating of the VEGF), Diguanosine tétraphosphate (GP4G) (cellular stimulant), Piroctonolamine (cleansing, anti-irritant). Excipient hydro-alcoholic, Perfume- hypoallergenic.

Sounds confusing, Right?  These components have not been studied through medical research as to have any effect on male hair loss in this combination.

I would stick with finasteride (Propecia) if it is OK with your dermatologist.  Obviously, if you continue to have hair loss or currently have a balding area, hair transplant surgery is probably the answer to restore the balding area.

–
Best,

Parsa Mohebi, M.D.
Medical Director
US Hair Restoration

Q:

Dear Mr. Mohebi,

I would like to ask you a question concerning possible side effects that finasteride (Propecia) may cause. I read on the manufacturers instructions that broken tablets must not be handled by women who are or may become pregnant. Can finasteride cause damage to pregnant women health or to the health of the developing fetus? Here I’d like to know also if finasteride can be found in body liquids such as men’s saliva, sweat or sperm? In such case is there any risk that a pregnant woman is exposed to finasteride? Are there any recommendations concerning taking or not propecia before planned or during wife’s pregnancy?

Could you please comment on this?
Thanks in advance.

Best regards,

A:

This is a common question that many of my young patients ask me.  Finasteride (Propecia) blocks the conversion of testosterone to dihydroxytestostrone (DHT).  DHT does not have any known role in adult men development, but it is crucial in development of a male fetus and child external genitalia (their penis).  We at our Los Angeles, California hair transplant clinics don’t recommend taking finasteride for hair loss prevention and treatment before adulthood while maturation of external genitalia is not completed.  Pregnant women should not take finasteride because of its effect on the external genitalia of their male unborn baby.

The pharmaceutical company (Merck) recommends that pregnant women or any women who might have a chance of being pregnant should not be exposed to finasteride.  They should not even be cutting pills that might increase the chance of inhaling small particles of finasteride.  You are right about finasteride being present in body secretion such as semen and saliva.  However, the amount of the medication is so small that it is considered negligible or safe for pregnant women.  So the research shows that it is safe for pregnant women to be exposed to the secretions of a man whom takes finasteride.  That is why we do not recommend men to stop taking finasteride if their wife becomes pregnant.  There has been no evidence of any risk to a male baby from secretion of finasteride through the father’s saliva, sweat or sperm.

Trichotillomania (TTM) [Greek: tricho (hair), till (to pull), and mania], also called trich, is hair loss due to an impulse control disorder distinguished by the repeated urge to pull out hair of scalp, body, eyelashes, eyebrows, facial hair, nose hair or pubic hair.  Trichotillomania may result in noticeable bald spots or hairless patches.

Trichotillomania is more common during the first two decades of life with female predominance; however it could be seen in both sexes and all ages. Trichotillomania may resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual’s teenage years, but may happen at any age. Depression or stress can trigger the trich. Due to social implications, the disorder is often unreported and it is difficult to predict accurately prevalence of Trichotillomania.  It is stated that 2.5 million people in the U.S. may have TTM, with a 1% prevalence rate.

Patients with trichotillomania may live relatively normal lives.  TTM may not be known by the patients and in fact most patients deny any manipulation of the hair.  An additional psychological effect can be low self-esteem, often associated with being rejected by peers and the fear of socializing due to appearance and negative attention they may receive.  Trichotillomania can be effectively treated by habit reversal training along with a variety of psychiatric medications based on the underlying disorder.

I have recently seen a male patient with male patterned baldness in our Los Angeles hair transplant clinic who has previously undergone a hair transplant surgery in another hair transplant clinic about a year before with over 500 grafts on his crown area.  The result of the surgery that should have been completed at the time of our consult was very disappointing both to the patient and to us.  I performed a microscopic evaluation of the scalp in both the frontal and crown area.  I noticed broken hair at both frontal native hair area and crown area, which was evidence of manipulation of the hair.

Patient denied any hair pulling, but had disclosed having experienced a nervous breakdown recently.  However, he did not deny that he had been too conscious about newly implanted hair follicles after his hair transplant that might have forced him pulling most of his transplanted hair grafts.

I recommended a psychological evaluation and treatment of any underlying disorder and we decided to re-evaluate him in a few months after his psychological treatment.  I won’t recommend a hair transplant until he shows no evidence of trichotillomania for a considerable period of time.  I have previously treated a patient who has had hair loss due to trichotillomania at childhood with hair transplant, but was treated completely with no evidence of pulling hair for a long period of time.

Q:
Dear sir,

I am 43 year old and I have lost my hair in top portion of my head. so I want to get advice from you that which one will be suitable for me either plantation or restoration

A:

I’m guessing you are asking about Medical Hair Restoration vs. Hair Transplant in your condition. If so, it needs to be evaluated by a hair transplant surgeon through a microscopic miniaturization study. If your hair loss is limited to your crown area and you have significant miniaturization in that area, then you might be a good candidate for medical treatment with finasteride or minoxidil. You may be able to see drastic changes within a year. However, if your hair loss evaluation is completed and you don’t have much miniaturized hair on the crown area, medical treatment of hair loss is not going to help you much and I recommend hair transplantation assuming that you have healthy donor hair.

Dear Dr Parsa Mohebi,

I have been experiencing male pattern baldness for some years now. Initially used Rogaine, it worked at first but now no longer respond to it. Next used Propecia, but had to stop due to side effects. Lasercomb failed too. I am currently saving up and considering getting a hair transplant maybe in 4 years time. I’ll have enough money by then.

There’s one thing I’m really curious about. Would you happen to know anything about Revivogen from www.revivogen.com. It’s a topical lotion combined with shampoo/conditioner that was invented by Doctor Alex Khadavi, MD, a US Board-certified dermatologist. I have a question below which I hope you can answer and shed light on.

All I just want to know before trying the product and applying the lotion to my scalp is for my “safety” concerns. If this product was developed by a dermatologist is it okay to allow myself to test it out even if it may not grow/and or stop hair loss but at least I can be rest assured it won’t cause allergic reactions on the localized surface of my scalp. Although I don’t have sensitive scalp skin, some of the things I’m scared of are like more hair loss(worse than pre-treatment) or cause unknown severe harm like scalp dermatitis/acne/burn/swolleness, stain my scalp permanently orange etc.(I’ve probably just exaggerated every side effect.May or may not true!). This is what I mean by safety. What’s the worse a topical solution like Revivogen could do to my scalp anyway? Any potential risks? Are the ingredients mentioned on the website even safe on humans?
Finally, do you believe it is safe enough and whether its worth a try for me to test out what appears to be a very safe and sound consumer product and hopefully not a scam? There’s nothing else on the market and I’m really desperate too to give it a go.

Please do feel free to take your time and answer me whenever you can. Your comments and recommendations would be very appreciated. Thanks.

Kind regards,
-

A:

It seems like you tried everything for your hair loss, but stopped them all due to either side effects or inefficiency. You are now exploring other options before you can get a hair transplant surgery. You are not alone and there are many other young men who are going through the same path.

First of all, I really like to know what kinds of side effects you experienced with finasteride (Propecia), because finasteride is an effective hair loss medication, although it has been blamed unfairly for many side effects. I put most my patients at our Los Angeles and Orange County Hair Restoration Clinics who have significant miniaturization on finasteride. Finasteride can help prevent further hair loss. Some of your hair loss might be irreversible by medication and you may need hair restoration surgery, but at least you can stop further hair loss by the time that you can restore your hair surgically. Revivogen® is a hair loss product with some natural compounds that mainly inhibit 5-Alpha-Reductase. 5-Alpha-Reductase is the enzyme that converts testosterone to dihydroxytestostrone (DHT). Prevention of DHT production can slow down hair loss in male pattern baldness.

One of the components of Revivogen is Saw Palmetto Extract, which is a DHT blocker and is used systemically for prevention of both hair loss and prostate enlargement. The efficacy of its topical product is not studied as extensively in large human experiments. Other components include a variety of fatty acids like: Gamma Linolenic acid (GLA), Alpha Linolenic acid (ALA), Linoleic Acid and Oleic Acid without strong human research on their absorption from skin level as well as their efficacy on human hair growth. Other components such as Azaleic acid, Vitamin B, Zinc, Beta-Sitosterol and Procyanidin Oligomers have shown some effects on the DHT production in labs, but the extensive studies to compare their effect with more researched medical treatments for hair loss is lacking.

The absorption level of the ingredients of Revivogen® from human scalp skin is not studied as extensively as well. I personally have not heard anything about any serious side effects of Revivogen, but I would rather have more information about long term studies, which are published in peer reviewed medical journals, before I can recommend the product to my patients. There are many hair loss products out there, which are safe, but you do not have a life time to go around and try them all to find out whether they have any effect on your hair or not.

You need to establish a good relationship with a good hair specialist that you can trust. He or she should be able to document the level of your current hair loss and miniaturization of hair and can come up with a master plan, which includes medication treatment, surgery and even cosmetic alterations that can make your hair look better. Side effects of the medications that you tried before need to be re-evaluated closely by your doctor.

You don’t want to deprive yourself from effective, FDA approved hair loss medications that their safety and efficacy are confirmed in scientific studies and instead start looking around to see what else is in the market. If you have no alternatives, your doctor may have some suggestions for your individual condition to preserve whatever hair you have with a product with minimal side effects.