Hair Restoration Blog

This is another article from Dr. Mohebi that is recently published on the cover of the Hair Transplant Forum International: the journal of the International Society of Hair Restoration Surgery.

The laxometer was invented by Dr. Parsa Mohebi two years ago. Laxometer is a device that is used to measure the mobility of scalp skin, which is a crucial piece of information for hair transplant surgeons before hair restoration surgery with strip method.

Evaluation of scalp laxity prior to hair transplant procedures has been a clinical subjective evaluation that varies with each surgeon and each visit. Hair transplant surgeons have been traditionally assessing the laxity of the scalp with manual palpation of the donor area and by moving the scalp horizontally or vertically, estimating the scalp movement against the occipital bone.

Measurements have been recorded with subjective term such as very loose, moderately loose, average, moderately tight, and severely tight. With the use of the laxometer we are provided a more precise metric for use in hair transplant surgery.  You can read the full article “How to assess scalp laxity” on US Hair Restoration Website.

Los Angeles is known as the Mecca of cosmetic surgery.  Hair restoration is not an exception to this rule and the demand for high quality hair transplant surgeries attracted the best hair transplant surgeons to Los Angeles and Beverly Hills in particular.

We launched the first branch of the US Hair Restoration in Encino, Los Angeles, California. Its central location makes it accessible from many different areas including Beverly Hills, Santa Monica, downtown LA, Glendale, and all of San Fernando Valley. I did not believe that you should be in Beverly Hills to be able to provide high quality cosmetic surgeries and hair transplants until a few months after starting the first branch of US Hair Restoration. The volume of inquiries from Beverly Hills patients proved my theory wrong and we had to start our Hair Restoration Beverly Hills hair transplant office in the heart of Beverly Hills just a few months after establishing our Encino Hair restoration clinic in the San Fernando Valley.

Are all Beverly Hills hair transplant surgeons capable of providing high quality hair restoration procedures? I guess we all know the answer to this question. In fact, Beverly Hills, like any other high end cities, attracts a mixed crowd of both “good and bad” specialists. Truth is some mediocre hair transplant surgeons only established their hair restoration clinics in Beverly Hills for financial gain from the patients who don’t have time to do their homework before choosing their hair transplant surgeon.

Hair transplant is considered a permanent procedure and, good or bad, the results stay with you for the rest of your life. As much as a good hair transplant can remove years from your face and restore the beauty of it, a bad hair transplant looks unnatural and stands out as unreal. I do a few hair transplant repairs every month for hair transplants that are done with the old techniques that were once considered the standard of care. What’s more disappointing is some of those hair transplants are done only recently and by hair transplant surgeons that could not adapt to the new techniques of hair transplant surgery. I have seen micro-graft hair transplants done only one or two years ago which means there are some doctors out there that resist or are unable to learn the new techniques of hair restoration. Those procedures leave patients with unnatural looking hair and forces them to get another surgery to correct the pluggy appearance.

The good news is that having a bad hair transplant is not the end of the world and if your donor area was not violated badly, your transplanted hair can almost always be repaired with a follicular unit transplant that is artistically done by a good hair transplant surgeon whether in Beverly Hills or elsewhere.

This article was just published last month in Dermatologic Surgery Journal.  I thought the results should be interesting for the readers of this blog.  The article title is Survival of densely packed follicular unit hair grafts using the lateral slit technique.

The authors, Nakatsui, Wong and Groot, describe their experiment on densely packed follicular hair units and follow up on the rate of survival of the transplanted hair.  They use a density of 75 hairs per square centimeter which is even higher than the regular hair transplantation methods currently in use. The authors explain that the use of densely packed follicular unit grafts (>30 grafts/sq cm) is a highly debated issue with some claiming decreased survival rates.

Those who perform dense packing routinely do not believe they have seen any impaired survival. However, no prior study has rigorously analyzed densely packed areas to assess survival rates.

This is true and some hair transplant surgeons still advocate the use of lower densities which make the patient commit to multiple surgeries. These hair transplant surgeons convince their patients that dense packing can negatively affect the circulation of the skin and jeopardize the rate of growth for implanted hair follicles.

The study was only done on one patient and needs to be experimented on a larger number of patients but this at least clarifies the mechanism of hair restoration with new methods of highly dense packing. The authors concluded that 98.6% of transplanted hair follicles survived and were able to re-grow a normal hair.  Obviously, this is the first study that demonstrates high growth rates in densely packed follicular units using the lateral slit technique, even at densities of 72 grafts/sq cm.

We do perform densepacking hair transplant surgery at the US Hair Restoration clinics in Los Angeles, Beverly Hills and Orange County in California on a regular basis.

Q:

Thanks Dr Mohebi,

for your time and information, really appreciate it. I have seen a neurologist who gave steroid shots and a pain management Dr who gave an occipital nerve block, neither worked. Had Botox injection into the area also. EMG and neck MRI tests didn’t show anything. Is the donor incision sometimes deep enough to damage muscle such as the occipital muscle or trapezius? Deep enough to damage the fascia tissue?

thanks again,

A:

It seems like you have done the proper work up for evaluation of your donor scar complication. If a hair transplant is done by a skilled hair transplant surgeon it should not be that deep to injure the fascia. In most patients it is easy to find the subcutaneous fat, which is our safe zone. Even if the fascia is injured, it should not create such a problem. The area of the strip is generally much higher than the levels of the neck muscles. Injury to the muscle and fascia should not cause any such feeling without involvement of the nerves.

I cannot imagine anything except the nerve damage to be the cause of your current problem. I occasionally have seen patients with some unusual sensation after old surgeries that get better when they get a repeat hair transplant. The reason for the improvement is that the hair transplant surgeon removes the scar and by doing that can release the adhesion of scar of first hair transplant and underlying tissues including the nerves.

Q:

Dear Doctor,

I had a hair transplant at another clinic, X Medical, 8 yrs ago. The donor area was 1 strip 1 inch wide, 4 inch length, going diagonally from the occipital protuberance bone towards the right ear.

When I woke up the day after the procedure, I could tell something was really wrong. The whole back and right side of my head was really tight. It felt like the scalp was being pulled backwards, mostly on the right side. It hasn’t changed to this day and its constant. It’s a crippling feeling and I’ve been having problem with it since then. I understand there could be some tightness from removing the donor area. But this is something different than just tightness or scalp stretching; it’s a whole other type of problem in the tissue under the scalp surface. The clinic said the tightness should go away after awhile but hasn’t given me any possible solutions or possibilities.

I thought I might get some answers by contacting other hair transplant doctors who do these procedures frequently and who know the anatomy of the head. It would be so helpful if you could try to give me an idea of what could have happened or went wrong.

Thank you for your time,

A:

Hi,

This is an unusual condition that I have not seen or heard. The donor skin tightness usually improves in two to three weeks following a hair restoration surgery with strip technique. However the numbness and tingling around the donor incision may continue for a few months due to violation of the very small superficial branches of nerves of the donor area.

Although removing the donor strip may look simple, it should be done meticulously. The best method of removing the strip is to trace the skin on the back superficially while having a good control on the depth of the incision and then remove the right thickness of the scalp skin. We follow this procedure religiously at the Los Angeles hair transplant offices of US Hair Restoration. The incisions should be done within the subcutaneous fat layer, which is the safe zone with minimal chance of injuring the main sensory nerves of that area.

Since you have an unusual sensation on the back of head, you need to be evaluated by a physician for confirming your diagnosis. I have not examined you, but one of your sensory nerves might have been injured during the strip removal. Mild nerve injuries recover within a few months with complete return of the sensation. More serious injuries may leave patient with a numb area or a sense of tingling or tightness for a longer time or permanently. This complication is generally rare, but may be seen in any skin procedure that involves making incisions around the sensory nerves. If this is the right diagnosis and you are experiencing a phantom pain or sensation due to injury of a nerve, a pain specialist might be able to help you with the injections of some medications into the local nerve to block the irritated nerve.

US Hair Restoration is proud to announce the opening of its new Beverly Hills hair transplant center. We have posted another title in this blog titled “Beverly Hills Hair Transplant” before and mentioned that our patients constantly ask us why we are not present in Beverly Hills cosmetic surgery world. I think continuation of the same trend of demand from the patients asking for a Beverly Hills hair transplant surgeon was the reason behind considering the option of having a hair transplant clinic in Beverly Hills. In our Beverly Hills Hair Restoration center, we perform free hair loss consultation for men and women. We offer a comprehensive hair loss evaluation including the microscopic evaluation of the scalp and hair.

Beverly Hills hair transplant office of the US Hair Restoration collaborates with a team of cosmetic doctors including a cosmetic dermatologist, a plastic surgeon and a facial cosmetic surgeon. Dr. Parsa Mohebi personally evaluates patients for hair transplant in the Beverly Hills office.  We hope that Beverly Hills office of US Hair Restoration can increase our accessibility for the patients in Beverly Hills, Century City, Holly Wood, downtown LA, Santa Monica, Pasadena, Pacific Palisade and many other locations in Southern California who would need quality hair loss treatments from a good hair transplant surgeon.

US Hair Restoration offers the most recent techniques of hair restoration including Follicular Unit Extraction (FUE), Body hair transplant and Mega Session Hair Transplant Surgery.

Hi Doctor,

My son has had a hair transplant years ago with old techniques and he has bad hair transplant scar now. He now wants to shave his head, but the scar of hair transplant on the back of his head may become exposed. Do you perform hair transplant scar repair or do you recommend any procedure that can help with hair transplant donor scar coverage?

Answer:

Hair transplant with strip technique can cause a linear scar that could be visible on the back of head if the patient wants to shave his/her head. A hair transplant scar is not limited to a bad hair transplant technique and it might have to do with one’s personal healing process too (some people are generally better healers compared to the others).

The good news is that we have methods to minimize the size of the scars nowadays and if you have bad hair transplant scars from bad transplants in the past, there are several new methods that can help improving the appearance of the donor scar. A hair transplant scar could be improved by repair of linear widened scars with different methods that we perform at our Los Angeles office of US Hair Restoration. Dr. Mohebi is the inventor of the axometer, a device that measure the laxity of the scalp precisely before hair transplant surgeries. Good measurement of the scalp laxity is one of the best ways to minimize development of donor wound complications and widening of donor scar and the Laxometer is the device to do these measurements.

One method is through simply excising the scar. Excision of the donor scar may be helpful for some donor scars. After removing the scar, hair transplant surgeon can close the skin with the trichophytic closure method in which a small wedge on one or both sides of the skin edge is removed and the skin is closed primarily. Trichophytic closure allows some hair follicles to grow new hair into the final scar. Presence of hair helps making the hair transplant scar become invisible.

Hair transplant donor scar coverage could also be performed by transplanting hair into the scar. Hair could be harvested from other areas using FUE or mini-strip techniques. Again, presence of the hair inside scarred area could trick the discriminating eye and the scar would become less detectable. Patients may need more than one hair transplant procedure into the donor scar for minimizing the difference between the densities of hair in scar and surrounding areas.

The last method that could be used to camouflage the linear scar is by tattooing the scar. People who plan to keep the hair very short can easily tattoo the scar with the figures of short hairs so it seems that there are some hairs present in the scar area, which can help minimizing the visibility of the scar.

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 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.