Hair Restoration Blog

Central centrifugal cicatricial alopecia or CCCA is one of the less common causes of hair loss. This medical condition, which characterizes with circular balding, mainly on the top (vertex and crown) which can be expanding and only leave a rim or hair around the scalp with total baldness in the more central areas in extreme cases (see picture).

The causes of this type of balding are now quite known. This disease used to be called with different names such as hot comb alopecia, follicular degeneration syndrome, pseudopelade in African Americans and central elliptical pseudopelade in Caucasians. Microscopic evaluation of the hair loss areas shows evidences of inflammation in the area of disease activity, chronic and rapidly progressive skin changes with eventual complete baldness in some part of the scalp with its unique pattern.

This hair loss condition could be started with the evidences of skin inflammation (redness and itching), but this phase might be temporary and patient may not have any signs or symptoms other than hair loss with its specific pattern.

Treatment of this condition could be challenging. Treatment with medications is generally not successful in prevention of the hair loss and to reverse the process. Hair transplant could be an option, but it could not be done in the acute phase of the disease. Hair transplant for Central centrifugal cicatricial alopecia might be considered when the active phase is over and when the inflammation is completely subsided. I would like to do a small test hair transplant before committing to the actual hair transplant surgery to be assured of the survival of the hair grafts.

Q:

Hey doc!

How’s it going? I hope all is well. I have two things on my mind. One is a question: the Murad shampoo directs users to use the shampoo daily.. do you think i is okay to use that shampoo daily? The reason why I am asking is because of the chemical content in shampoo, it is usually recommended to shampoo every other day or so.

A:

I answered another question about Murad shampoo “Murad Shampoo for hair loss” before. I don’t believe that DHT blockers especially in the form of shampoo can be absorbed from the skin to affect the hair growth compared with systemic DHT blockers i.e. finasteride pill. I don’t think that daily use of the shampoo can hurt your hair either, unless it is specifically prohibited by the manufacturer.

Q:
Does your new Irvine facility sell toppik hair fibers? Is it safe to use daily or soon after a hair transplant until the hair grows?

Hope to hear from you soon.

Thank you.

A:
We don’t sell any products in any of the offices of US Hair Restoration, but you can easily buy Toppik online through several websites.

Toppik is made of several inert substances that none of them affect the progress of the hair loss or gain.

If you are planning to have a hair transplant surgery, you need to stop using Toppik for the first four days after your hair transplant when the process of healing of the transplanted grafts is not finished. You can start using it again as early as day 5 after your hair transplant surgery when the healing process of transplanted grafts is considered to be completed.

Have a great weekend.

Q:

I am a 30 year old white man. Today I noticed a balding spot on my neck where I used to have hair. I have had a few of them in the past in the size of a penny. They usually come and go in a few days maybe weeks. It does not bother me, but do I need to worry about it?

A:

Patchy areas of baldness at your neck in the area that you used to have hair could be a skin condition called alopecia areata (AA). Alopecia areata is an autoimmune disease that causes round patches of baldness and could happen to any part of the skin, including beard, scalp, eyebrow and even eyelashes. The outcome of alopecia areata is usually good and in most cases hair re-grows within several months. Occasionally the baldness could be permanent.

Alopecia areata usually recovers without any treatments. If the balding spots of alopecia (hair loss) don‚Äôt disappear in a few months the medical treatment might be necessary. See Dr. Mohebi’s article on treatment of alopecia areata.

Treatment of alopecia areata is different than medical treatment of patterned hair loss.  Local injection of steroids may help in some cases. Other medication are also recommended such as topical steroids in form of creams or lotions, but are not as effective as steroid injections. Local immuno-suppressive medications have also been tried with some success in more severe forms of alopecia areata. Minoxidil is proven to be effective in some cases and is the only over the counter medication for alopecia areata and could be sued in more extensive diseases. You need to see a doctor to confirm the diagnosis of alopecia areata (AA) and to get started on some sort of treatment if it is really bothering you.

Alopecia areata could be progressed and beyond its typical patchy characteristics. If hair loss involves whole scalp, it is called alopecia Capitis and if hair loss seen everywhere in the body; it is called alopecia universalis.

Hello doctor Mohebi,

I’m currently not living in America. I’m researching to decide where in the world -country and clinic- is the best place to have this done. I wonder if you’d be so kind to clarify 3 questions that came after I read the links you sent me:

1) Does FUE leave or not scars? One doc it says it doesn’t -advantage for people who like to or may have to shave their heads. Another doc says it leaves small punctuate scars that “may make FUE hair transplant surgeries more difficult or impossible.”
2) I understand the less number of grafts you can get through FUE makes it likely that you have another surgery.
3) You mention body hair. Do you usually implant body hair on the head, or am I tripping? If so, how does the extraction process work? Scars left?
4) In bold figures or percentage, how much more expensive would FUE be than the strip removal method to achieve the exact same result?
5) I wonder how efficient FUE is in covering large areas, how many surgeries you’d have to have done to get the exact same result as the strip removal method.
Plus, I wonder if -besides the healing process- the hair growing time is shorter than the strip removed one.

Well, that for now.
Thanks a lot for your patience,
Patient’s name

A:

Thanks for your email. Here are the answer to your questions in the order you asked them:

1. Does FUE leave or not scars?A: Any skin incision leaves scar. The point is the scars of FUE (Follicular Unit Extraction) are so small and scattered in a large area that they are not distinguishable.

2. Related to the previous: I understand the less number of grafts you can get through FUE makes it likely that you have another surgery.A: That is true. However repeat FUE procedures might be even more difficult to extract grafts in consequent procedures, due to the presence of scars of the first surgery on the donor area. However you should not have any limitations doing regular strip technique if you have a FUE in the past.

3. You mention body hair. Do you usually implant body hair on the head, or am I tripping? If so, how does the extraction process work? Scars left?A: Body hair transplant to the scalp is not something that we do on a regular basis and in fact I only recommend body hair for people with extreme depletion of scalp donor hair. If eligible for body hair (you should have thick body hair and you also need to be tested positive with FOX test before FUE procedure) it is similar to scalp FUE with none or minimally visible, scattered scars.

4. In bold figures or percentage, how much more expensive would FUE be than the strip removal method to achieve the exact same result?A: At US Hair Restoration, the cost of FUE procedure is twice as a strip hair transplant procedure of the same size.

5. I wonder how efficient FUE is in covering large areas, how many surgeries you’d have to have done to get the exact same result as the stip removal method. Plus, I wonder if -besides the healing process- the hair growing time is shorter than the strip removed one.A: FUE is an efficient method of hair transplant, but probably not as efficient as follicular unit transplantation with strip technique. For large cases I prefer FUT that we almost have no limitation on the number of grafts. FUE is for people who prefer to have no visible scars on the donor area, but less number of hairs is acceptable to them. FUE can work beautifully for people with low degrees of hair loss. You have to realize which is more important to you: “No donor scar” or “A fuller head of hair” if you have extensive balding. Healing process in donor area is much shorter than the strip technique and donor area is back to normal in abut 4-6 days as opposed to in the strip method that the donor wound healing may takes up to 2 weeks. Healing on recipient area is the same in FUE and strip surgery.

Best,
Dr. Mohebi

Q:

Great blog Dr. Mohebi, Thanks,

I have had a hair transplant 5 days ago. I have been washing my hair in last 5 days with my regular shampoo. I don’t rub the transplanted area, except for some dabbing with shampoo for about 4 to 5 minutes every day. Can you please explain how I should wash at this point and how long I need to continue with any special care after hair transplant surgery? Do you recommend any after hair transplant care product or shampoo?

Thank you for your time.

A:

There is not a certain standard in washing hair after hair transplant surgery. I previously posted an article on the blog “After hair transplant Care” and explained the care that is needed after a hair transplant surgery. We fine-tuned our after hair transplant care procedures to minimize the risk of hair graft dislodging, which is a threat in the first few days after hair transplant surgery. A study showed that there is a decreasing risk of dislocation of grafts within the first few days after hair transplant surgery “Graft anchoring in hair transplantation Drs. Bernstein and Rassman”.

Patients always ask whether or not they can skip washing the first few days when there is risk of dislodging for the newly transplanted grafts. The truth is, hair washing reduces the chance of scab formation and extensive scabbing after hair transplant increases the risk of graft dislodging. The above mentioned study shows that the scabbing after hair transplant extends the interval that grafts are at risk of being dislodged.

We at US Hair Restoration recommend frequent but gentle hair wash in the first few days post-operation with only dabbing and without rubbing in the recipient area. We recommend professional hair wash for the first day to all our patients and during that time teach patients how to wash their hair at home for the next few days. There are some products that are claimed to reduce the scabbing and infection rate after hair transplant with no documented evidence to support them.

I generally use and recommend baby shampoo for hair wash for the first few days after hair transplant surgery. I don’t recommend using any other commercially available products for hair wash after hair restoration surgery.

Best,

Dr. Parsa Mohebi

Q:

I am 34, male with recession of hairline slightly. There are many bald men in both side of my family. I have been trying Rogaine for about 10 years until I thought it is not working anymore and my hair loss strated to speed up. I recently started taking Propecia. I am originally Mexican. Is Propecia as effective for Mexican as white Caucasians?

Thank you

A:

Propecia (finasteride) has been studied extensively within the last few decades in terms of its effectiveness on different age groups, balding classes and even ethnic groups. Below you can see that the effectiveness of Propecia in comparison with the Placebo on the vertex baldness has been compared in different ethnic groups:

Combined analysis of the two studies on vertex baldness, mean hair count changes from baseline among Caucasians, Blacks, Asians, Hispanics and other ethnic groups. Patient self-assessment showed improvement across racial groups with PROPECIA treatment, except for satisfaction of the frontal hairline and vertex in Black men, who were satisfied overall.

Q:

Hope you had a great weekend, Just a quick question.

After how long usually I would see the result of those pills (finasteride)? Will it grow like baby thin hair and it thickens over time or should I like shave my head to help it? J just wonderin‚
Regards,

A:

Be patient,

It is unlikely that you grow new hair from the areas that you lost hair follicles. The medication finasteride can help increase the thickness of your miniaturized hairs that normally do not give you any significant cosmetic effects. You should not see the effect of medication before 3-6 months from the time you started it.

Remember, the purpose of medical treatment is not to grow your hair back as it was when you were 17. The goal of medical hair restoration treatment with either minoxidil or finasteride would be to stop or at minimum slow down the progression of hair loss. Shaving your head should not change the progress of hair loss or gain either. When you manipulate your hair whatever you do, you are dealing with external part of the hair, which is not alive. The follicle does not sense what is going on outside at hair shaft level. To restore it more permanently in front and top of your scalp, you would need a hair transplant.

Best,
Dr. Mohebi

Q:

I have diabetes. Can I have a hair transplant procedure?

A:

Patients with diabetes can successfully have a hair transplant surgery if diabetes is under good control. Diabetes used to be a life limiting disorder and diabetic patients could not have many elective surgical procedures due to their increased risk of wound complications and infection. With the new medications and methods for controlling diabetes, patients with diabetes can safely have hair transplant surgery or any other elective procedures without significant increased risk of infection or complications with their healing phase. Here at US Hair Restoration, we need to have a clearance from the doctor who follows patient for his/her diabetes to make sure patient’s blood sugar is in normal range and diabetes is effectively controlled.

Question:

Hello,

I’m very interested in learning about the future methods and advancements in the science of hair restoration as you may have guessed. Is there an “on line” information source you could direct me to, in order to keep of with the current work on stem cell progression, and the like? I have ushairrestoration.com site, of course, because it’s on your card. But am at a lose as how to get more information. Is there a site that publishes research papers and cases studies of new developments?

Answer:

I am not aware of any site that is dedicated to the advancements on stem cell research, but there are some sites that you can get good information on hair restoration and possibly get yourself familiarized with the new surgical and medical methods to restore hair. One that I recommend is the website of the International society of hair restoration surgery. It may not be updated very often, but is being fed through many different sources and could be a good source of information for someone like you to get some general information. Of course if you are interested in more scientific articles, you can use the National Center for Biotechnology Information, which gives you the most recent publication in most medical journals. This site is searchable for different criteria so you can put your keywords in and see what new information is out there.