Hair Restoration Blog

Q:

My son and I discussed the procedure with his Mom.  We are thinking, even though the other “FUE ?” procedure is about twice the money, it would be worth going the alternative route in order to avoid the issue of his being left with a scar (e.g., if he ever decides to shave his head, or get a very close “buzz cut”).  What is the more expensive, alternative procedure called?  And, how does that change the logistics?  By that last question, I mean, for example, what you described yesterday was a one-day procedure if we went with the “scar” procedure.  Now, however, if you do not cut a “strip” and leave a scar, how many days is required?

A:

What we discussed was Follicular Unit Extraction (FUE) procedure.  That is another version of Follicular Unit Transplant (FUT) surgery in which instead of removing a strip, we remove follicular units or the natural bundles of hair one at a time.  Removing individual follicular units allows us to keep scars small and scattered.  This prevents a linear scar on the back and donor area.

FUE is ideal for people who have a limited need for hair follicles and try to keep the option of buzzing or shaving their head open after the hair transplant surgery.  It is not for people who are destined to have large areas of baldness, due to the number of sessions they may need and the fact that their eligibility for hair transplant surgery may change over time.  In other words, they might be FOX positive to start with but after the initial surgery their candidacy may change.  Not to mention the cost of hair transplant surgery that may play a major role down the road when you are looking into filling a large area of the scalp with transplanted hair.

Strip procedure is definitely more efficient both in terms of cost of the hair transplant and the number of grafts that one can get over a certain period of time.  The donor scar of a hair transplant surgery is also getting better with the new techniques of hair restoration surgery.  However, if you want to eliminate the linear scar of strip hair transplant on the back, FUE is the only way to go about it.

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.

Hair follicles removed from neck to be used for mustache restoration

I have been looking into, the cost, scarring, technique, of the FUE method and am getting the impression that the method permanently removes the hair from the donor area.  If this is true, could the chin/sideburns be used as the donor area?   And instead of placing the hair follicle in my scalp, the extractions be disposed.
My sole objective is to permanently remove my facial hair.  And the FUE method seems to be the least invasive, least time consuming, and most effective (compared to laser and electrolysis).

Lasers works best on dark hair and fair skin, which I have not.  Electrolysis is more effective than Laser and is FDA approved to permanently remove hair. However, Electrolysis is very time consuming, I scar, and over time can be quite costly, as my hair growth is hormonal, where treatment could take years, and at 65.00 per week, get pretty expensive.

If possible I would like to have my hair follicles removed by way of FUE or any similar alternative.  Please let me know, if this is possible with this practice, or any information that would point me in the right direction.

Thank you,
A:

Hi there,

You are correct.  FUE is basically removing and replacing hair follicles permanently from one area to another.  FUE or Follicular Unit Extraction can move hair follicles or follicular units from pretty much everywhere and the extracted hair obviously could be transplanted into any part of body which is covered by skin.

Removing hair for the purpose of getting rid of hair permanently is doable, but you need to be evaluated through a FOX text first.  FOX test is a minor procedure that we perform in the offices of US Hair Restoration to determine the candidacy of the patients for FUE hair transplant procedure.  FOX is a small FUE procedure in which we attempt to remove hair under local anesthesia from the donor area (could be scalp or body).  The reason that we perform a FOX test is to make sure the the hair grafts can be removed from the patient with minimum transection.

If you want to remove body or facial hair through FUE technique instead of laser hair removal, you need to be FOX tested prior.  If we cannot remove hair follicles intact from your donor area, follicles or part of them remain in the skin and can grow into new hair.  Even if you do not want to use harvested hair for transplant purposes, you still need to have a FOX test to make sure that hair follicles can come out completely.

Q:

I read on the website that scar revisions are case by case in terms of pricing. On an average how much do you charge? I had a hair transplant done in Newport Beach a couple of years ago, and I’d like to revise the scar to a hopefully smaller one. One side is fairly good, about 2-3 mm, the other side is more like 6mm. Is it better to do only half and not touch the good side so to speak? How long would the wait before such a procedure. I’m looking into doing it in May.
Please get back to me,
I’d appreciate it.
Thank you,

A:

Hair transplant scar revision could be done in part or the entire scar and it might require many different techniques:

1.    Simple excision and closure of the scar may reduce scar width.

2.    People who tend to stretch their scars can be treated by injection of BOTOX around the scar after wound closure to prevent future stretching.  Some people require tricophytic closure which allows hair to grow into the scar.
3.    Ultimate elimination of the scar visibility may require an FUE (Follicular Unit Extraction) to fill the scar of a strip hair transplant with hair.

Wound healing and scar maturation is a timely phenomenon.  Most scars continue to evolve for six months from the time of wound closure.  The process of scar maturation may even continue after that but it will be at a much slower pace.  In most cases I generally don’t want to touch scars before 6 months in our California office of US Hair Restoration.

The article “Surgeon Restores Patients’ Hair, Self-Confidence” was recently published in the popular newspaper of “The Beverly Hills Courier” based on the interview with Dr. Parsa Mohebi, medical director of US Hair Restoration.

Here is a summary of the article, which mostly focuses on the psychological impacts of hair restoration on men. Dr. Mohebi also discussed some of the new methods of hair restoration that is offered by the Beverly Hills Office of US Hair Restoration. Here is how he goes:

Nothing looks better than a full head of hair, and one of the best people to provide it is Dr. Parsa Mohebi, medical director of US Hair Restoration.

Mohebi specializes in several hair-transplant procedures:

• Follicular Unit Transplant (FUT) is the gold standard of hair-transplant surgery, Mohebi said, giving very natural results. A strip of donor scalp is removed and the follicles are prepared under microscopes and distributed in the bald area in the natural direction and orientation.
• Follicular Unit Extraction (FUE), also called non-invasive hair-restoration surgery, uses special biopsy devices to extract individual follicular units without having to remove a strip of skin; so there is no linear scar.

“Not everyone needs non-invasive surgery,” Mohebi says. “But people who want to shave their head in the future for any reason may consider FUE because there is no visible evidence of surgery on the back of their head. There’s nothing to suture, and the small dot wounds are not detectable a few days after surgery”.

• Mohebi also specializes in eyebrow transplants for both men and women.
• As testament to his skills, he also repairs bad or “pluggy” transplants, performed by other doctors. “We do several repair hair transplant surgeries a month,” he says.

Mohebi spends an hour with each new patient and does a microscopic evaluation of the scalp and a miniaturization study of the hair to predict future hair loss. “That way we’re not limited to the obviously bald areas, but we can transplant hair to where the patient may lose hair in the future. With the technology we have now, there’s no reason for anyone to experience hair loss.”

As a fellowship-trained hair-transplant surgeon, Dr. Mohebi continues research the latest high-transplant techniques and his writings have been presented and published in both national and international medical-society publications.

The article continues with discussing the published research on the psychology of hair transplant in men, which was finished last year: Dr. Mohebi’s latest article was the cover story for Hair Transplant Forum International, considered the most important journal in the field of hair restoration, on The Psychology of Hair Transplants. From research in Europe, we know that people with hair loss are prone to anxiety, depression and other psychological problems; we tried to see if we can reverse that with hair restoration surgery.

He evaluated 200 patients after surgery in eight criteria, and saw improvements with FUT in terms of happiness, youthfulness, energy levels, self-esteem and self confidence, future outlook and impact on their career and sex life. The results were amazing and improvements in all eight criteria were statistically significant. The authors, Dr. Mohebi and Dr. Rassman concluded that using the new techniques of hair restoration patient can drastically improve all of the psycho-social impacts of hair loss.

The reporter then set aside US Hair restoration from many other hair transplant clinics by several factors by referring to Dr. Mohebi’s comments on following the latest standards of hair restoration surgery and the fact that things have changed significantly recently in the field of hair restoration. What was done five years ago is not acceptable today. We have the most experienced technicians; and everything is done under a microscope to get the highest yield of hair.

Then there’s the customer service. “The day of the hair transplant procedure is a big day for patients,” Mohebi said, “often six to eight hours. Patients are usually amazed at how smooth and pleasant the day is.

Patients are given mild to moderate sedation and numbing medication for the donor and recipient area. Once the scalp is numb the strip of skin is removed and the wound is closed. The next step is to prepare hair grafts under microscope. While grafts are being made by experienced technicians of US Hair Restoration, Dr. Mohebi is designing the hair line and makes the sites according to the natural direction and distribution of hairs.

Since the newly placed follicles are so fragile, patients return the next day to get their hair washed professionally, given special shampoo and taught how to take care of their hair at home. “After five days, no special care is needed,” Mohebi said.

Ten days after the surgery, patients return to have the donor site checked and staples removed for those who had them. Hair starts growing after three months, and is long enough to style and comb after ten to twelve months. The third follow up is at 10 months after the procedure.

Severe baldness may require more than one surgery, usually spaced at least six months apart. “With megasession hair transplants we can do 4,000 grafts in one day. That significant number is a help to patients with a high class of baldness. We can get a higher stage of restoration with fewer sessions of transplants.”

Continuing to pioneer in the field, Dr. Mohebi is the inventor of the Laxometer, a device to measure the laxity or mobility of the scalp. Laxity of the scalp is key in determining the size of the donor strip so that enough can be removed for bigger cases, and the wound can be closed without too much tension and the scaring will be minimal.

To help people stay abreast of all that’s happening the field of hair restoration, and to answer questions (he’s heard from Europe and China) Dr. Mohebi maintains a hair restoration blog, ushairrestoration.com/blog.

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.

Q:

I understand your FUE transplant cost is $8 per fue graft, with 30% discount for a short time. Are these for surgeries carried out in May/June or does this rate apply for any surgeries booked in those months but can be carried out in say July or August?

A:

Discounted rates on the cost of hair transplant is only valid for the patients who have their surgeries done by the end of stated dates. The only exception is for patients who are ready to do their surgery and we have to postpone their hair transplant for any reason (medical clearance needed or the ones that we recommend a few weeks of scalp exercise for strip technique patients who want to get a mega sessions (2500 to 5000 grafts per session).

For more on hair transplant costs you can visit the website of US Hair Restoration.

Continue from the question “FUE - Body Hair Transplant“

Question 7: What size punch do you use to extract grafts for FUE (follicular unit extraction)?

Answer: 0.8 to 1 mm.

Question 8: How many Assistants make up the team that works on a client?

Answer: That depends on the number of grafts and the method, but it is usually between 2 to 5.

Question 9: Do you use any special equipment to enhance your vision during the procedure?

Answer: Everything is being done with magnifying loops when we remove grafts and when we insert them into recipient incisions.  For more information on hair transplant techniques, you can visit US Hair Restoration web site.

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.