Hair Restoration Blog

Previously I published an article on the Hair Transplant Forum International titled Psychology of Hair Transplant. Our study evaluated the significance of hair loss on men’s psychology. We also discussed the improvements that men experienced after hair restoration surgery.

I just read another article that was just published on the International journal of clinical and experimental hypnosis titled: Hypnotic approaches for alopecia areata. I initially thought they have been able to treat Alopecia Areata (AA) with hypnosis. What they studied though was managing the psychological effects of alopecia areata with hypnotherapy.

Patients with alopecia areata like androgenic alopecia experience increased levels of anxiety and have higher rates of depression. Here are the synapses of what was researched by Willemsen and Vanderlinden from Department of Dermatology of Academic Hospital in Brussel, Belgium and put together as an interesting article:

AA or Alopecia areata is an autoimmune disease leading to loss of scalp hairs. The disease is generally triggered by stress. Data on the possibility of using hypnotherapy in the treatment of AA are very limited. In this study, twenty-eight patients with extensive AA, all refractory to previous conventional treatment, were treated with hypnosis at the Academic Hospital UZ Brussel, Brussels, Belgium.

The authors‚Äô hypnotherapeutic approach combining symptom-oriented suggestions was discussed in the article they also came up with suggestions to improve self-esteem. They are suggesting that twelve out of 21 patients, including 4 with total loss of scalp hair, presented a significant hair growth. All patients presented a significant decrease in scores for anxiety and depression. Although the exact mechanism of hypnotic interventions has not been elucidated, the authors’ results demonstrate that hypnotic interventions may ameliorate the clinical outcome of patients with AA and may improve their psychological well-being.

This article again is focusing on the significance of hair loss and hair loss treatment on patients psychology as we discussed before in our article titled: psychology of hair transplant that could be found on the website of US Hair Restoration, the Los Angeles hair transplant center.

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:

I am a 45 year old woman. My dermatologist told me that I have male patterned baldness. I am also diagnosed with Iron deficiency anemia. Can Iron deficiency in women cause hair loss in male patterned baldness and if so, can treatment of iron deficiency help reversing balding process?

A:

Iron deficiency with or without overt anemia can intensify the rate of hair loss in women with either male or female patterned hair loss. If Iron deficiency is the only cause of your hair loss and you are not genetically prone to anemia, hair loss can be reversible. However in many situations, patients are genetically predisposed to patterned hair loss and Iron deficiency has only accelerated the hair loss process. Accelerated hair loss in women who are genetically predisposed to patterned hair loss may not be reversible by just correcting the Iron deficiency. You need to see a good hair specialist to confirm the type of your hair loss and plan the proper treatment method including hair transplant surgery.

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:

You have mentioned shock loss in some of your articles that may happen after hair transplant surgeries in young men. Does it happen to everyone and if happened, is it reversible.

A:

Shock loss used to be a big problem for many hair transplant patients. Shock loss generally happens in the first 1 to 3 months following the hair transplant procedure and can be reversible in some patients and to some degrees. Remember that shock loss happens mostly to the hair follicles that have some degree of miniaturization are already in the process of falling out and the stress of surgery just accelerates the rate of hair loss. Strong terminal hairs are usually resistant to the shock loss.

There are several ways to minimize shock loss after hair transplant surgeries. Topical medications like minoxidil could prevent shock loss to some degrees. Finasteride (Propecia) would perhaps be the most helpful medication for reducing the shock loss after hair restoration surgeries, if patient starts taking Propecia right before his hair transplant surgery.

My recommendation to most patients is to start finasteride even a few days before the surgery so it is locked in the system by the time of surgery and can protect hair from shock loss phenomenon. The rate of shock loss has significantly dropped in our hair transplant patients in the last few years, and it has to do with us strongly recommending finasteride use before hair transplant surgery to all our male patients.

Q:

Hi Doctor,

My mother is obsessed with my hair loss and gives me a whole bunch of vitamins and mineral tablets everyday to help regrow my hair.
Do you think they work? Or should I stop them.

A:

Although lack of certain vitamins and minerals could cause hair loss in their sever form, living in north America and having a normal and balanced diet; it is unlikely that you are suffering from vitamin or mineral deficiency. On the contrary, if you look at your family pattern of hair loss, you probably can find other male members of the family who has similar male pattern hair loss. As I always say, you need to have the triangle of baldness, which is “Gene, Male gender, and time” to become bald. Vitamins deficiency is not to blame as part of triangle of male patterned hair loss. You can continue taking vitamins to please your mom, but don’t overdo it since vitamins are not going to bring your hair back. Instead you need to see a good hair specialist or dermatologist and undergo a good hair loss evaluation with miniaturization study and start taking one of the effective medications to prevent further hair loss or to use hair transplant to restore your lost hair.

Q:

I have heard high estrogen in males can contribute to hair loss. Is that true? I am a 40 year old man with low sex drive and female patterned hair loss.

A:

High levels of estrogen in men could be seen in many other conditions such as estrogen-producing tumors, congenital adrenal hyperplasia, chronic alcoholism and advanced liver disorders. Elevation of estrogen in men can cause sexual dysfunction, change in body fat distribution in a female pattern and breast enlargement and secretion.

Balding is not a typical sign of excess estrogen. In fact one of the signs of estrogen deficiency could be hair loss in female patients. A common type of this kind of hair loss is seen in telogen effluvium that women lose hair due to sudden drop of estrogen and progesterone levels. Although excess estrogen is generally not the trigger for hair loss, it can affect the balance of other hormones and indirectly cause hair loss. The latter is not a common cause of hair loss in men or women though.

Q:

How are you doing? All I have to say is TGIF.

I was doing a little bit research on hair loss, and I stumbled over retinoic acid. I read about it and have a basic understanding. Have you heard any claims that it could possible revive hair loss?

Have a great weekend!

A:

This is a good question. There are several claims on therapeutic effect of all-trans-retinoic acid (tretinoin) alone and in combination with 0.5% minoxidil for hair loss based on limited studies.

In one study the combination of tretinoin and minoxidil was used for 56 patients who had androgenic alopecia (male pattern baldness) and hair growth was followed. The growth of terminal hair was studied after one year of treating balding scalp with combination of topical tretinoin with 0.5% minoxidil. Increase in hair growth was reported in 58% of the patients who could complete the study.

Although tretinoin has been stated as a promoter of cell proliferation and vascular creation, which are both important in hair growth, there is still not enough scientific evidence from large studies to prove these effects. Also double blind studies on the efficiency and adverse effects of the product is lacking.

Cicatricial alopecia refers to a group of rare skin diseases in which hair follicle get destroyed and replaced by scar tissue. It is one of the rare causes of hair loss. Hair loss could be gradual or sudden. Hair loss could be without any symptoms or it could present with sever itching, burning and pain. There is usually no visible scar, because the inflammation is below the level of skin. Cicatricial alopecia could occur in otherwise healthy men and women of all ages.

Cicatricial alopecias could be primary or secondary. This discussion is confined to the primary cicatricial alopecias in which the hair follicle is the target of the destructive inflammatory process. In secondary cicatricial alopecias, a non-follicle-directed process or external injury, such as severe infections, burns, radiation, or tumors could cause destruction of the hair follicle.

The causes of the cicatricial alopecias are not completely known. However, all cicatricial alopecias involve inflammation directed at the hair follicle, the upper part of the follicle where the stem cells and sebaceous gland are located are generally involved. Permanent hair loss occurs when the stem cells and the sebaceous glands are destroyed. This type of hair loss is usually irreversible.

Cicatricial alopecias can affect both men and women. The majority of patients with cicatricial alopecia have no family history of a similar condition. Central centrifugal cicatricial alopecia is a type of cicatricial alopecia that is more prevalent among black woman. Frontal fibrosing alopecia on the other hand is seen most commonly in post-menopausal women.

could be seen in association with chronic skin conditions such as lupus erythematosus and in people with personal or family history of autoimmune disorder. A scalp biopsy is necessary for diagnosis of cicatricial alopecia. Presence of inflammatory cells and scarring could be diagnostic and essential for determining the type of treatment.

Treatment of the lymphocytic group of cicatricial alopecias involves use of anti-inflammatory medications such as steroids, cyclosporine, hydroxychloroquine. When hair follicle destroyed, hair will not grow back. However in some cases using minoxidil solution can help to stimulate growth of some of the remaining hair. Hair transplant could only be used in the patients who have normal healthy hair in donor area. If hair multiplication becomes a reality in the future that might potentially be an option for patients who lost their scalp hair extensively as result of this condition.

I just received the last issue of the Hair Transplant Forum International, the Journal of International Society of Hair Restoration Surgery (ISHRS). Our article “Psychology of Hair Transplant” is published as the cover article on this issue of the journal. I also have a copy of the article in our hair loss library in our website. Here is the abstract:

Psychology of Hair Transplant

Parsa Mohebi, M.D., William Rassman, M.D.

Balding and its psychological impacts has been the subject of many studies in the past. The relationship between hair loss and stress is clear to all clinicians who practice in this field. Negative psychosocial impacts of hair loss in male patterned baldness and in women with generalized thinning have also been seen. Many of us (hair transplant surgeons) have seen the negative effects of hair loss on self esteem and self-image.

We know that hair loss impacts some men’s sex life and their stability with regard to career choices in men of different ages. Despite the solid evidences and published literature on psychological impact of hair loss, the corrective effect of medical and surgical hair restoration has never been studied. After observing the drastic changes in patient behavior and the high level of patient satisfaction in those who had hair transplant procedure, we were motivated to look into the psychological impact of hair restoration on different aspects of a patient’s life.

 

We came up with a series of criteria that could have been modified by having a hair restoration procedure; we used some indexes that were previously studied comparing bald and non bald men on different psychological variables. We initially performed a pilot study and asked patients about different aspects of their lives during their post op visits. We gave our patients open ended questionnaires and probed their psychological state after their hair restoration procedure was complete. Eventually we focused in on eight major criteria that have been reported and documented as variables associated with hair loss in the literature. We collected a subset of them in our pilot study. Included were questions on the general level of happiness, energy level, feeling of youthfulness, anxiety levels, self confidence, outlook on their future and impact on their sex life.

 

We have chosen the patients who had their first hair transplant surgery between one to three years from the time of our study, so they had seen the final result of their hair restoration procedure. We limited the study to male patients with male pattern baldness and the ones who had surgeries less than three years ago so they still had a fresh memory of the changes they experienced. Each patient had exclusively follicular unit transplants that reflected our standard of care for that period. We sent a questionnaire with a brief description on the nature of this scientific study. We did not collect any patient identifiers and the response was totally voluntary. We sent the two hundred questionnaires with stamped return envelope.

The response rate to our questionnaire was 37 (18%). Each patient was used as his own control since we asked about the changes that they experienced after surgery in comparison to those variables before the surgery. We used T-test to compare patient’s responses. Table 1 shows the mean and standard error in eight different criteria that were asked. Patients had significant improvements in all eight criteria regardless of their stage of baldness and their ages.

In another attempt to compare psychological changes that patients experienced in different stages of baldness, we divided patients into two groups: (1) those who had Norwood IV patterns or less and (2) the ones with Norwood V patterns and above. We observed the most significant difference in two categories, (a) sex life and (b) career experience. Patients with less balding had a greater impact on their sex life and career when compared to patients who had more advanced stages of hair loss. These changes were not age related.

Hair restoration surgery can affect many aspects of a patient’s life. Hair transplant can potentially reverse psycho-social problems associated with hair loss. The positive impact of hair restoration surgery is more visible among patients who suffer from those undesirable effects the most. In early stages of hair loss, patients may have more awareness of their condition and they might be more affected than men in the later stages of hair loss.

Patients who experienced hair loss at an early age while involved in an active social life were more prone to the negative side effects of balding. That could explain why younger people with hair loss appeared more benefited by hair restoration procedures. Also it could be assumed that hair loss can have a negative impact on a patient’s outlook which seems to reverse after receiving a hair restoration procedure which improved their outlook.

Low response rate from a blind mailing has always been a drawback in questionnaire studies. We received 37 out of 200 of the questionnaires that we sent out (response rate was 18.5%). Giving incentives to responders may be a good way of increasing the participation rate of any questionnaire studies. We presented the result of this study at the annual scientific meeting of ISHRS and have been contacted by many of our colleagues who expressed interest in collaborating in a larger scale study. We are currently trying to rise funding for repeating this study to optimize our response rate and the statistical value of the study.

If you have any questions on the content of this article you can contact US Hair Restoration office at Los Angeles through email at info@ushairrestoration or phone.