Hair Restoration Blog

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,

How soon after a FUE procedure could I expect to see some growth?
Thanks

A:

The growth after a FUE transplant would be the same as that for a strip technique.  When the telogen (resting) phase of the hair follicles is finished and the anagen (growth) phase begins, you ought to be able to see some growth after two to three months. To start with, young hair shafts are fine; it takes a few months for the hair shafts to grow to their final thickness. To see optimal results, you may need to wait up to one year (from the time of your hair transplant surgery) as that is the amount of time it takes for transplanted hair to reach its final thickness and length.

Q:

I had a hair transplant (FUE) over 2300 grafts 6 weeks ago all in my front and hairline and I still have over 90% of all my transplanted hair and was also wondering if this is normal since everywhere I read that all transplanted hair will completely fall out between 1 to 2 months. I hope that I am part of that 10% you spoke of in this blog.

A:

Yes, you might be.  Every now and then we have seen patients who do not follow the regular pattern of hair loss and hair growth after hair transplant.  As we mentioned before, most patients lose all transplanted hair in 2-3 weeks after their hair transplant.  This is because the change in the physiologic environment of the hair forces the hair follicles into the telogen phase.  Patients generally do not have any hair on the transplanted area from 3 to 6 weeks after surgery.  When new hairs start to sprout, they become long and thick in the next few months after that.

There is some exceptions and every now and then we see patients who not only do not lose their transplanted hair, but their transplanted hair keeps growing from day one after hair restoration surgery.  You might be one of those exceptions.

There are also reports on some patients who have delayed growth on their hair growth and they do not see any growth in the first 6, 8 or even 12 months.  We do not know what is causing that but it has been anecdotally reported.  Close supervision of the patient and serial follow ups is needed to reassure the patient that he or she does not have any serious problem and the transplanted hairs are not wasted.

We know that direct sunlight and ultraviolet radiation can affect the growth of hair follicles negatively. There is new research resulting on profiling the response of human hair follicles to ultraviolet radiation that was published in the Journal of Investigative Dermatology this month (January 2009). The joint effort work Department of Dermatology at the University of Lübeck in Lübeck, Germany and Zhejiang University in Hangzhou, China showed that excessive UVR ranks among the most harmful environmental influences on human skin.

The research was mainly done on organ-cultured human anagen hair follicles in vitro were irradiated with UVB (one of the two main types of Ultra Violet light), and reduction of hair shaft elongation, premature catagen entry, and reduced hair matrix keratinocyte proliferation were observed.

Upon irradiation with UVB at lower powers apoptotic cell death prevailed, whereas at higher power, necrotic cell death was predominant. These investigators concluded that UVR differentially modifies hair growth and cycle, promotes cell death, and induces complex regulatory events in human hair follicles in vitro. The leads from this human organ model, which is a living and human tissue interaction system under physiologically relevant in situ conditions, may encourage its use for general investigation of UV-induced effects as well as for testing possible agents for their UV-protective agents.

We can see that some patients who are exposed to sunlight for extended periods of time experience hair loss on unprotected parts of their scalp skin. I personally have a no sun exposure policy for 6 months after hair transplantation for all my patients at our Los Angeles hair transplant clinics.  Now it is becoming even clearer that both native hair and transplanted hair could get hurt by being exposed to direct sunlight.

I just read another article that may bring more hope for the people with hair loss.  Kang et al has been working with a plant native to Jeju Island in South Korea by the name of Schisandra Nigra.  They studied the effect of the extract of this plant on hair growth.  The article which is published in the European Journal of Dermatology is the result of a study on application of this product on rat hair with some promise. This study was conducted to evaluate the effect of Schisandra Nigra on the promotion of hair growth.

When rat vibrissa follicles were treated with 85% ethanol extract of S. Nigra, the hair-fiber lengths of the vibrissa follicles increased significantly. In addition, after topical application of the EtOH extract of S. nigra onto the back of C57BL/6 mice every other day, anagen (growth phase) progression of the hair shaft was induced. Moreover, the extract increased both the expression of proliferating cell nuclear antigen in the bulb matrix region and the proliferation of immortalized vibrissa dermal papilla cells.  Both of those showing more activity on hair follicle cells.

In order to determine the mechanism by which the plant S. nigra promotes hair growth, the researchers examined its relationship with the TGF-beta2, which is a signal pathway, known to be a regulator of catagen induction (the phase that come after growth phase in hair cycle).

When the vibrissa follicles in the anagen phase were treated with S. Nigra extract for 7 days, the expression of TGF-beta2 in the bulb matrix region was found to be lower than that of the control follicles that were expected to be in the anagen-catagen transition phase.  These results suggest that S. Nigra extract has the potential to promote hair growth via down regulation of TGF-beta2 and the proliferation of dermal papilla.

In less scientific words, the plant has been able to stop hair follicles from going into their resting phase from their growth phase and thus increasing the number of growing hair follicles.  Could this hair loss product be used as a valid option for treatment of baldness in humans?  We can not be sure yet.  More studies are needed to prove the therapeutic effects of this product on human hair growth.

We do not recommend any herbal hair loss products at this point for treatment of male or female patterned hair loss due to the lack of adequate evidence based on documents that support that in humans.  However, we follow the findings of the new research through the world and keep our readers posted if one becomes available.

There is just another study on a potential new medication that could be used for treatment of hair loss. Currently, there are only two FDA approved medications for male patterned baldness or typical men hair loss in United States. The two medications that we have extensively discussed on this web site are finasteride (Propecia) and minoxidil (Rogaine).

The article “Effect of Cuscuta reflexa Roxb on androgen-induced alopecia” was published in the Journal of cosmetic dermatology September 2008. The research is done in India and the authors discuss the significance of hair loss in men and the effect of androgenetic alopecia on millions of men and women. They classify typical men hair loss as androgen-driven disorder. They used Cuscuta feflexa Roxb for hair growth activity in androgen-induced alopecia.

The authors of the article used petroleum ether extract of C. reflexa for its hair growth-promoting activity on albino mice. They induced male patterned alopecia in mice by testosterone administration for 20 days. The inhibition of baldness by simultaneous administration of the extract was evaluated using follicular density, anagen/telogen ratio, and microscopic observation of skin sections. To investigate the mechanism of observed activity, in vitro experiments were performed to study the effect of extract and its major component on activity of 5alpha-reductase enzyme.

The researchers announced that petroleum ether extract of C. reflexa exhibited promising hair growth-promoting activity as reflected from follicular density, anagen-telogen ratio, and skin sections. Inhibition of 5alpha-reductase activity by extract and isolate suggest that the extract reversed androgen-induced alopecia by inhibiting conversion of testosterone to dihydrotestosterone. They concluded that the petroleum ether extract of C. reflexa and its isolate is useful in treatment of androgen-induced alopecia by inhibiting the enzyme 5alpha-reductase.

This hair loss research needs more research on human volunteers on a long period of time before it can be considered as a balding treatment. There must also be more research done on the application of the product on human in terms of medication side effects and its comparison with currently available medications for treatment of hair loss.

We at US Hair Restoration continue to follow on the most advanced investigations and researches on hair loss treatment. We keep our patients and the readers of hair restoration blog updated with the new information and medical technology to improve the quality of our hair restoration treatments at our Los Angeles hair restoration clinics.

Different types of body hair and the indication for the procedure is a question that I have been asked many times in last week. So that is why I thought I should write a post to answer it for everyone. Body hair transplant has been discussed in Hair Restoration Blog in the past in several posts. Patients ask which one is a better source for body hair transplant to the scalp: chest hair, abdominal hair, pubic hair or armpit hair.

Hairs of the body have different characteristics, than hair from the scalp Pubic hair is generally thicker and curlier than other areas of the body. Chest hair may be thick in some patients, but may be finer than scalp hair. Armpit (Axillary) hair is also generally curlier than scalp hair, but may not be as thick as the other types of body hair.

Before deciding to use body hair, a hair transplant surgeon has to examine the scalp donor hair carefully and then only consider body hair if the scalp hair is severely depleted. Depending on the area that you want to use body hair, you may choose different types of body hair. If you want to choose body hair only to fill in the crown area in patients who already have good coverage on top and front, pubic hair could be a good option.

Research has shown that body hair characteristics may change and become longer when transplanted to the scalp. It also shows the anagen phase of body hair may become longer after transplanting it to the scalp. Which is why this is one more advantage for body hair transplant, but still body hair transplantation needs to be done selectively.

Continue from the question “FUE - Body Hair Transplant“

Question 4: What is your view on “out of body” time for grafts?

Answer: There are articles on out if body time for grafts, what we do is to keep grafts in chilled physiologic solution (0-4 C). If grafts are kept in this condition the survival rate is over 90% in up to 12 hours. That number starts to drop gradually after 12 hours.

Question 5: Do your charges apply for every graft extracted, even if transected, or only charge for each intact graft?

Answer: Only the grafts that are intact and transplanted are counted.

Question 6: How much of the work do you do and how much of the work do your Assistants do? What specific tasks are allocated to Assistants and what do you undertake? To what degree are you present in the room where surgery is being carried out? Do you use needle or blade to make incisions?

Answer: In FUE procedures either body hair transplant, or scalp transplant I am present in the OR the whole time because the majority of the work is done by me. I score the grafts and remove them. Techs generally help me in retracting the grafts from scalp. Trimming under microscope is done by technicians. I constantly observe them for the quality and integrity of the grafts. Every now and then, we may have to change our methods for removing FUE grafts in different areas so the surgical team should be constantly communicating with me in the OR. For incisions I usually use solid core needles to minimize the trauma to tissue and preexisting hair.

Here are a series of very good questions on hair transplant with FUE (follicular unit extraction) and body hair transplant from a patient who did his homework and educated himself on his upcoming surgery.

Question 1: Do you have a pre op protocol for chest to scalp?

Answer: For FUE from chest I want to have a clean wet shave from the whole chest one week before the surgery day so in a week when we do harvest the grafts we only remove growing hairs (the ones that are in anagen phase). Scalp hair on the other hand, I don’t want it shaved at all and I will do my own clipping right before the procedure. We do FOX test for all new patients to determine their candidacy for FUE with a small number FUE harvesting under local anesthesia.

Question 2: How many grafts can you transplant per day and how many hours is a typical working day?

Answer: Just for you to get the idea of how long does a FUE hair transplant may take, the last two FUE that we did in US hair restoration office were 1500 grafts per day each. One of them took 9 and the other one 11 hours. In both surgeries we used scalp hair only.

Question 3: Are grafts that are extracted placed straight into the recipient incisions or are they checked under the microscope first?

Answer: All grafts need to be visualized under microscope to make sure they are intact (not transected). Most of them need to be trimmed too. We usually have to remove some of the upper layers of skin and a little of extra fat around the grafts for them to be in the ideal size for transplant.

I will post the rest of this Q and A series in next few days.