Hair Restoration Blog

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.

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:

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.

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.

Here is one interesting news from the AP: “A South Florida man says he was denied a hair transplant because he is HIV positive.”

Diego Del Rio said in a lawsuit that he was refused a transplant by Dr. X of the Age Defying Surgical Center.  The 28-year-old hair loss patient, Del Rio, said he told “them” he is HIV positive.  After a series of follow-up phone calls, a “staffing medical coordinator” told him the office would not treat him.

This is not the first time that a person with HIV is denied the right to have surgery like other patients.  (Attorney to the doctor), Gabriel Imperato, said Thursday he had not seen the lawsuit, and he and (the doctor) will “respond in court, not in the media.”
The Florida Health Department says denying someone treatment simply because they are HIV positive is against state law.  Del Rio is suing for $15,000 or more. The lawsuit was filed Tuesday in Broward Circuit Court.

US Hair Restoration in Beverly Hills and Los Angeles has been welcoming patients with different medical conditions including blood born diseases as long as the hair transplant procedures were safe to the patients.  The fear around HIV is more of the potential risk of contraction of the virus or other diseases. With universal precaution, however, the risk to the surgeon and surgical staff is very minimal.

I just read a nice article in Dermatologic Surgery Journal on naturally occurring female hairline based on a study on a large group of normal women.  The study was done in Miami, Florida by Dr. Nausbaum et al.  Although due to the higher numbers of men with hair loss who undergo hair restoration surgery, male hairline has been studied and published more comprehensively though female hairline design through hair transplant is also gaining popularity in the last few years.

The authors came up with a guideline that could be used for designing a female hairline.  The numbers were calculated based on the average of the recorded parameters in women with healthy non-balding female hairline.   Among the interesting parameters, you could see that the presence of the widow’s peak was recorded in 81% of all 360 women.

The authors report that lateral mounds were observed in 90% of the patients in the study.  They published the average measurement parameters on all the indexes in the article.  We at US Hair Restoration perform hair transplants for women with some types of female patterned hair loss and alterations in the pattern of their hairline, or the ones with a male patterned hairline.  We also perform transgender hair transplants for male to female transsexuals.  I believe that transgender hair transplants should be one of the first cosmetic surgeries that a transgender individual should have done to achieve a more feminine appearance.

Q:

Hello,

I did a search for hair re-growth, hair loss, etc. and I found your email address.  These internet searches are definitely far from perfect, in fact sometimes they are way off!  So if this is not the type of business or practice you’re in, I apologize and please disregard this email.

I’m a 43 year-old male.  I started losing my hair, very slightly, at age 27.  I really haven’t lost a whole lot since then, however, my hairline has receded a little and I have been using Rogaine pretty faithfully.
I’m trying to find the best way or multiple ways of re-growing my hair.  First, I am curious to know if it is okay to use Rogaine (5%) and take Propecia?  Do you know if Nioxin or any other shampoos or hair thickeners are helpful?  Would you recommend any?  Are there any other factors that make a difference in re-growing hair such as: vitamins, hormones, foods or physical exercise?

Do you think these types of remedies are all stop-gap solutions and I will need to look for something more permanent? Do you have any insight or additional thoughts or sell any products or services that I can purchase that will help?

Thank you,

A:

Thanks for your email.  You have asked many questions which most have been answered in our Hair Restoration Blog.  There are many hair loss products in the market, but most of them do not have any active ingredients that can help your hair loss condition.  There are only two FDA approved medications that have been approved and proven to be effective and safe for hair loss treatment and prevention.  Those two medications are Rogaine and Propecia.  If you are suffering from male pattern baldness, hair transplant surgery may be the only option that can improve or eliminate the appearance of baldness by bringing good quality hair from the permanent zone to the front and balding areas.

I do not have any particular hair loss product nor recommend many different lotions and potions that are out there in the market for hair loss.  You can find other valuable information on our postings in our blog and can answer your questions on:

• Nioxin - hair loss product
• other shampoos for hair loss
• vitamins for hair loss
• balding and hormones
• foods for hair restoration
• physical exercise and hair loss

I recommend that you find a good hair restoration doctor who can evaluate you and come up with a master plan for your condition.  This may include medications, surgery or even cosmetic changes that you need to bring your hair and beauty back to your life.  We do offer an online consultation for hair restoration through pictures and if decided that you are a candidate and you choose to have a hair transplant with us, it could be easily done.  Our California offices of hair restoration can arrange your trip to our Los Angeles office for your hair restoration surgery.

You can contact our office at 888-302-8747.

Good luck,
Parsa Mohebi, MD

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.

How to choose a hair restoration surgeon has been addressed in our hair restoration blog before.  However we still get a number of questions on a regular basis from other parts of the world from hair loss patients who are shopping around for a hair restoration procedure.  For most of those patients, the quality of a hair transplant clinic is the best factor to decide which hair transplant clinic to choose.

Being in Southern California, I see hair transplantation results from other hair transplant doctors and I might be able to say who can be in a list of best hair transplant doctors in Los Angeles.  It would be hard for me to really say who is the best hair transplant doctor in America, let alone other countries that I have limited exposure to and have not had a chance to see their best hair transplantation results.

As we said before, searching for a good hair transplant doctor can be a difficult job. In large metropolitan areas such as Los Angeles and Orange County, referrals for cosmetic and hair transplant surgeons come far and wide. Compared to other cosmetic surgical procedures, hair transplant surgery and in particular follicular unit transplantation is one of the newer fields. You can find a variety of hair transplant surgeons with different levels of experience in your country. Overall, hair restoration and other cosmetic procedures should not be taken lightly. Just because you see a billboard stating “the most experienced Hair Transplant surgeon in …” does not make it a true statement.

Most hair transplant surgeons now in days offer a free hair transplant consultation. You should know that the end result of hair transplant surgery is permanent and it should be to your liking. Take advantage of the situation and shop around. It isn’t enough to just visit several hair transplant doctors.  You also need to educate yourself on the hair transplant process, the surgical techniques and the hair transplant surgeon’s background before visiting the doctor.

By doing so, you can appreciate a good technique and a knowledgeable doctor when you see one.  US Hair Restoration offers a free physician consultation for everyone and we specialize in state-of-the-art exclusive follicular unit transplants (FUT), mega sessions for people with extensive hair loss and follicular unit extraction (FUE), or minimally invasive hair transplant that does not leave a scar in the donor area.

In today’s world it is getting easier to look your best. Modern hair transplant surgeries with undetectable results have become a demanding field in many large metropolitan areas.  This is my one single advice on how to find the best hair transplant or the best hair transplant doctor: do as much research as you can and then meet your hair transplant doctor prepared with good questions and see if he is someone you can really trust.

Parsa Mohebi, MD
Hair Transplant Surgeon

Picture taken During a Hair Transplant -- when transplantation of single hair grafts for hairline are almost completed

Hello Doctor how are you?

Thanks for giving me my pics.  I cant wait to start my blog. I attached some post op pics. Dr.Mohebi just a quick question, what is that white stuff during my post op?just curious since my brother brought it up when i showed him the pics.i was looking around the net to see other post op pictures,i wanted to find out what it was,but i didnt seem to see it on other patients.

thanks Dr.Mohebi.

A:

Hi there,

The white part of the grafts that you can see is the top part of the graft that is above the skin level.  As you know, a hair transplant does not implant hair but an entire organ.  This includes the collagen band around a follicular unit, microscopic muscle, small supporting vessels and a small portion of epithelium (superficial layer of skin) within each graft.  The white portion on the picture is the skin part or epithelium.  During hair transplant surgery, the goal is NOT to bury the grafts.  Buried grafts may folliculitis, sebaceous cysts and/or dimpling of the skin.  Here at US Hair Restoration, in order to prevent those complications, we make sure to keep the grafts slightly elevated from the skin surface.  Obviously the white part that you can see will dry up and fall off after a few days after a hair transplant surgery but this little mechanism alone can certainly prevent many problems that are seen by buried grafts.

Have a great weekend,

Best,
Parsa Mohebi, MD