Hair Restoration Blog

Q:

I had a burn on my upper lip with blistering 10 years ago. I lost half of my moustache that it never grows back. I want to grow moustache but it won’t be symmetrical. Is there a method that I can restore my mustache with hair transplant surgery. I don’t know anything about it so I’m unsure of where to go to for a mustache hair restoration.

Thanks,

A:

Hair transplant surgery can restore mustache hair and can be used for restoration of hair in scars such as scars of beard and mustache. You are right about mustache hair restoration that is not as popular as scalp hair transplant. We get to do mustache hair transplant every now and then. Here are the pictures of one of my patients who had a similar problem and lost his mustache hair on one side due to some skin condition.

We restored his mustache with about 200 follicular unit grafts. We generally use scalp hair for mustache and beard hair restoration, but this patient had a very fine scalp hair on the donor area that was not a perfect match with the size of his mustache so we had to harvest some hair follicles from his beard and transplant them on the upper areas of his upper lip so they could create a similar appearance and cover the other hairs while scalp hair gave the needed hair bulk below that level to his mustache.

mustache hair loss before hair transplant

Picture of mustache before hair transplant

Immediately after mustache hair transplant

Picture of mustache after hair transplant into the mustache

FUE hair follicle harvesting from beard for mustache hair transplant

FUE donor area from beard for mustache hair transplant

We used FUE or follicular unit extraction techniques for removing hair follicles from beard area from under the jaw area.

A Los Angeles Hair Restoration patient asked me today about Kevis products for medical hair loss treatment in men the other day. His father used to use those hair loss products when he was in Europe and He recommended that he can use them as well. I had to do some research on the website of the company to find out what are the ingredients of this presumed hair loss medication.

Kevis products are claimed to be natural and chemical drug-free. They work through the biological compound, hyaluronic acid, which is found in eyes and joints in its highest concentration.

Kevis uses a high-molecular-weight product called HUCP, to address hair loss and follicular mal-nutrition. HUCP is claimed that it directly impacts hair follicles, cuticles, and shafts in a positive way, bringing about stronger, thicker, and healthier hair. HUCP also hydrates and balances the moisture levels in hair and the skin of the scalp.

Kevis hair loss prevention and hair care products gently clean hair and selectively remove residue from the scalp, encouraging follicular health and greater natural hair production.

It is all nice to have a product to help cleaning the scalp and the root of our hair and also to keep the moisture to the hair shaft, but neither dryness nor dirtiness of hair is the cause of hair loss. I could not find a significant research on the effect of any of those ingredients on the health and growth of hair. We at our Los Angeles hair transplant clinics of US Hair Restoration recommend products with solid medical research showing their effectiveness and safety.

Q:

I take Errin Tablets for a few months as a contraceptive. I have also been experiencing hair loss recently. I wanted to know if there is a correlation between losing hair and this particular contraceptive. I had a baby 4 months ago. I see thinning everywhere but it is more obvious on the front and top as diffuse thinning.

A:

Your hair loss could be related to your pregnancy and delivery of your baby. Human hair grows in cycles and goes to resting phase (telogen) between the growth cycles. About 95% of your hair is in growth phase (anagen) at anytime and about 5% of them are in resting phase. You may not see any hair growing from the follicles during resting phase. That is the reason we normally lose scalp hair on a regular basis. In fact losing up to 200 hairs every day is normal and part of the cycling of our hair. Some stimulants can put a large number of our hairs into telogen phase. This condition is called Telogen effluvium. Telogen effluvium (TE) can be seen in women after delivery of a baby. Telogen effluvium is especially seen between months one to five following delivery of a baby, when the load of estrogen is removed. It is usually seen in 40 to 50% of women after pregnancy, and like most of the changes in pregnancy, it is temporary. Wait 4 to 6 months and you should grow your hair back. Meanwhile, make sure you are taking sufficient minerals and vitamins on a daily basis.

Any other cause of imbalance in estrogen level may increase hair loss. Scalp hair loss is reported in users of oral birth control pills containing norethindrone and ethinyl esteradiol, like Errin tablets or other brands: Brevicon, Norinyl, Norethindrone. However the association of those contraceptives and hair loss has not been completely confirmed through medical literature. I women think their hair loss may be linked to the use of birth control pills, they need to stop the pill and use another birth control method after discussing that with their doctor.

Many hair transplant patients are concerned with the scar of cosmetic surgeries including hair transplants. Several techniques have been suggested to minimize the scar such as corticosteroid injections, irradiation, ultrasound, silicone applications into and around the forming scar. However, the effects of most these methods were far from satisfactory. Botox is a new method that could be used to minimize the size of both facial and scalp scars. The use of Botox for reduction of facial scars from surgeries was first suggested by plastic surgeons who were trying to reduce postoperative effect of facial muscles on stretching and widening of scars.

In many patients with ugly scars of the face, botulinum toxin (Botox) was used successfully to induce temporary paralysis of the muscles during revision surgery. Botox with the same mechanism can help minimizing tension on the healing wound edges until collagen could mature and scar if completely adnd firmly formed.

The use of Botox has been suggested for the treatment of stretched scars on the face by many plastic surgeons now. Hair transplant surgeons also use Botox for treatment of the hair transplant widened scars of the donor area that do not show improvement with a simple scar revision procedure. There are reports of successful decrease in the final size of the scars with injection of Botox into the muscles surrounding the maturing scar. We at the Los Angeles hair transplant offices of US Hair Restoration don’t offer Botox to every patient who is having a hair transplant surgery through strip technique, but it certainly could be used for the patients who suffered from widened scars of prior surgeries and did not respond to the other methods of scar revision.

Q:

Thanks Dr Mohebi,

for your time and information, really appreciate it. I have seen a neurologist who gave steroid shots and a pain management Dr who gave an occipital nerve block, neither worked. Had Botox injection into the area also. EMG and neck MRI tests didn’t show anything. Is the donor incision sometimes deep enough to damage muscle such as the occipital muscle or trapezius? Deep enough to damage the fascia tissue?

thanks again,

A:

It seems like you have done the proper work up for evaluation of your donor scar complication. If a hair transplant is done by a skilled hair transplant surgeon it should not be that deep to injure the fascia. In most patients it is easy to find the subcutaneous fat, which is our safe zone. Even if the fascia is injured, it should not create such a problem. The area of the strip is generally much higher than the levels of the neck muscles. Injury to the muscle and fascia should not cause any such feeling without involvement of the nerves.

I cannot imagine anything except the nerve damage to be the cause of your current problem. I occasionally have seen patients with some unusual sensation after old surgeries that get better when they get a repeat hair transplant. The reason for the improvement is that the hair transplant surgeon removes the scar and by doing that can release the adhesion of scar of first hair transplant and underlying tissues including the nerves.

Q:

Dear Doctor,

I had a hair transplant at another clinic, X Medical, 8 yrs ago. The donor area was 1 strip 1 inch wide, 4 inch length, going diagonally from the occipital protuberance bone towards the right ear.

When I woke up the day after the procedure, I could tell something was really wrong. The whole back and right side of my head was really tight. It felt like the scalp was being pulled backwards, mostly on the right side. It hasn’t changed to this day and its constant. It’s a crippling feeling and I’ve been having problem with it since then. I understand there could be some tightness from removing the donor area. But this is something different than just tightness or scalp stretching; it’s a whole other type of problem in the tissue under the scalp surface. The clinic said the tightness should go away after awhile but hasn’t given me any possible solutions or possibilities.

I thought I might get some answers by contacting other hair transplant doctors who do these procedures frequently and who know the anatomy of the head. It would be so helpful if you could try to give me an idea of what could have happened or went wrong.

Thank you for your time,

A:

Hi,

This is an unusual condition that I have not seen or heard. The donor skin tightness usually improves in two to three weeks following a hair restoration surgery with strip technique. However the numbness and tingling around the donor incision may continue for a few months due to violation of the very small superficial branches of nerves of the donor area.

Although removing the donor strip may look simple, it should be done meticulously. The best method of removing the strip is to trace the skin on the back superficially while having a good control on the depth of the incision and then remove the right thickness of the scalp skin. We follow this procedure religiously at the Los Angeles hair transplant offices of US Hair Restoration. The incisions should be done within the subcutaneous fat layer, which is the safe zone with minimal chance of injuring the main sensory nerves of that area.

Since you have an unusual sensation on the back of head, you need to be evaluated by a physician for confirming your diagnosis. I have not examined you, but one of your sensory nerves might have been injured during the strip removal. Mild nerve injuries recover within a few months with complete return of the sensation. More serious injuries may leave patient with a numb area or a sense of tingling or tightness for a longer time or permanently. This complication is generally rare, but may be seen in any skin procedure that involves making incisions around the sensory nerves. If this is the right diagnosis and you are experiencing a phantom pain or sensation due to injury of a nerve, a pain specialist might be able to help you with the injections of some medications into the local nerve to block the irritated nerve.

Q:

Dr. Mohebi,

What do you think about Nioxin for hair loss treatment? Do you offer it in your Los Angeles hair restoration offices?

A:

We currently do not sell any products in our Los Angeles hair restoration offices. Nioxin makes different products such as cleansers (shampoos), conditioners, reconstructors, and other products for hair and scalp. They are in the market and could be purchased from beauty salon. Nioxin shampoos are popular, but there appears to be nothing in them that will cure hair loss. I have had many patients who used them in the past for a while and they gave me a mixed report. If they are affordable and you are happy using them as cleansers or conditioners I have no problem with that. However, by looking at what is out there on the ingredients on Nioxin products and the reports from my patients, I cannot recommend them as a treatment for hair loss.

Many people ask me on the use of hair products such as shampoos or conditioner after a hair transplant procedure in our Los Angeles hair transplant clinic. My answer as you probably have seen in this blog is that you can go back to your routine hair wash and maintenance after the first five day after your hair transplant surgery. They practically cannot damage the transplanted hair at that time by washing or shampooing it.

Q:

Hi, I have a few thousand grafts already and I am interested in getting more as well as trying to revise my scar. My donor area is still quite dense.

A:

Scar revision could be done through several different methods depends upon the location, size and orientation of the scalp scars. The scalp scars that are not aligned with the Resting Skin Tension Lines (RSTLs) generally do not respond well to the revision through simple excision of the scars. For these scars hair follicular unit transplantation is a better solution. Filling the scalp scar with follicular unit transplant can be a successful method for the scars that do not respond to the regular excision. We have treated the scars that have been previously operated with multiple simple excisions by other plastic surgeons with no significant improvement in the final size and appearance of the scar. For more on scalp scar management with hair transplantation, you can read on one of my presentations in the fifteenth annual meeting of the international society of hair restoration surgery (ISHRS) which was titled: Hair Transplant and Neurosurgical Scars. You can also check our website at www.ushairrestoration.com to get more information on the modern hair restoration procedures and possible options for repair of old surgeries or scar revision procedures. You can also browse the Hair Restoration blog at www.ushairrestoration.com/blog to familiarize yourself with the available hair transplantation methods and techniques for revision of the hair transplant scar.

I have performed a hair transplant surgery on this 42 year old man who had another hair transplant last year with micor- and minigraft with another office last year. I would like to assume that the era of mini and micro-grafts are over, but still every now and then I see patients who are recently operated with micrograft or minigraft techniques. This 42 year old patient had small number of grafts for a large area with less than adequate coverage.

The patient’s old hair line is lower than where it should be on the corners for his age and race. He had some pluggy hair growth on the corners and on his hairline. We restored his hairline with 400 single hair FUT grafts, removed some of the pluggy hairs on the hairline using a 1mm punch biopsy device. We increased the density of hair on the front are with total of 2293 follicular unit grafts.

The frontal area was densely packed and the some of the frontal grafts with pluggy appearance were removed. I expect great result in a few months for this patient at our 10 month follow up.

Patient immediately after hair transplant surgery with 2293 FUT grafts including 400 single hair grafts on hairline.

Q:

Dear doctor Parsa Mohebi

I have got some questions that I request you to answer them, so that I can have a better decision.

1- Is it possible to use the hair of other members of the family as donor?

2-May the transplanted hair at the fore part of the head recede again? If yes, how long does it take to begin?

3-If the hair recedes to the back of the head, the scar of the surgery appears and it is so ugly. What should we do in this case? And in the case of FIT after receding in the back, that area looks very sparse and with little hair? These make a bad appearance. What should we do in this case?

I appreciate you before and I wish more successes in life for you.

Truly yours
Patient name

A:

I will answer your questions in the order you asked them:

1- Is it possible to use the hair of other members of the family as donor?

No

2-May the transplanted hair at the fore part of the head recede again? If yes, how long does it take to begin?

No it will not. Transplanted hair is considered permanent and there is no chance that you lose it in regular male pattern baldness. However you may continue to lose your own hair if you have any left in and around your transplanted hair. Here at US Hair Restoration we recommend finasteride to most patients around the time of surgery to prevent shock loss that could be seen after surgery.

3-If the hair recedes to the back of the head, the scar of the surgery appears and it is so ugly. What should we do in this case? And in the case of FIT after receding in the back, that area looks very sparse and with little hair? These make a bad appearance. What should we do in this case?

Scar or the surgery should never be seen if placed properly. The only way you can see the scar is if you decide to shave your head. If you plan to shave your head for any reason scar of the strip technique hair restoration surgery will be seen and you may want to choose FUE (Follicular Unit Extraction) or as some people call it FIT (Follicular Isolation Technique). FUE transplant or FIT are the same and if done properly should remove hair follicular units evenly throughout your donor area and it should not look thinned out in any particular area. Of course the donor area will be thinner than before the hair transplant surgery, but density of the hair on the back of our head is not what makes you look bald. Not having a solid frame around your face is responsible to give you the appearance of baldness and can make you look older.