Hair Restoration Blog

Hair Care Beverly Hills

Here is the content of the interview with US Hair Restoration’s Medical Director, Dr. Mohebi done by BuziMoms which is published in hair care Beverly Hills.  The interviewer asked several hair loss and hair restoration questions from Dr. Mohebi based on the requirements of the visitors and readers of the site.  Here are the questions and Dr. Mohebi’s answers:

An Interview With Dr. Prasa Mohebi, M.D. , A Qualified Hair Restoration Surgeon For Moms In Beverly Hills

BuzyMoms: If a hair loss patient has already had a transplant with another doctor and is disappointed with the results, can the procedure be redone or is repair possible?

Dr. Mohebi: Yes, hair restoration surgery repairs are a good portion of our operations performed in our Southern California offices (located in Beverly Hills, Encino and Orange County).  Many people may have unnatural results from previous hair transplants due to the older techniques, but some even have problems with recent hair restoration due to technical issues or lack of proper judgment on the part of the hair transplant surgeon. In most cases, the repair is easy and can be done in one or two sessions.

BuzyMoms: Is there a minimum age for hair loss surgery?

Dr. Mohebi: Hair transplant surgeons used to say that 24 was the minimum age to perform a hair restoration procedure.  However, nowadays microscopic techniques being used to evaluate the miniaturization of hair can assist surgeons in predicting the final pattern of hair loss. By being able to predict each patient’ s  final stages of hair loss, we are able to see where the pattern of baldness is heading and recommend hair transplant surgery at an earlier age.

BuzyMoms: Won’ t my bare scalp be showing in the back of my head once the donor hair is taken?

Dr. Mohebi: If you do not plan on shaving your hair, your donor wound will never be visible.  However, if you plan on shaving your head for any reason, you may need to have a FUE or Follicular Unit Extraction procedure done rather than the general FUT procedure.  This method eliminates the visibility of a linear scar on the back of your head and is the best option for patients who plan on shaving their head or keeping their hair very short in the future.

BuzyMoms: Do you provide free consultations?

Dr. Mohebi: Yes, the initial consultation with us is always free in any of our three hair transplant offices in Beverly Hills, Encino and Orange County.

BuzyMoms: What type of information should be brought to the consultation?

Dr. Mohebi: Anything related to your hair loss and hair restoration, including medical, surgical or even cosmetic changes that you like and may help you have a better result after a hair restoration procedure.

BuzyMoms: Are lab tests required prior to surgery?

Dr. Mohebi: We may need lab work for men or women who have hair loss without showing a typical pattern that we see in most male or female patterned hair loss or in people who have lost hair due to any other medical conditions such as thyroid problems, hormonal imbalances or lack of certain elements such as Iron.  We also need certain lab works from patients who have medical risk factors for surgery like diabetes to make sure those medical conditions are under control before we can pursue with the hair transplant surgery.

It’s been almost 7 and 3/4’s of a month now since my hair transplant surgery with Dr. Mohebi at the Encino office.
It’s been pretty tense working on the computer for extended hours the last few months, so I wanted to get a full body massage to relax, specifically including the face and head.

Would getting a head massage risk loosening the implants?

I figured it might be good to help increase circulation.

Sincere thanks

A:

The new hair that could be seen after months 3 are considered permanent and they are completely part of your scalp.  Anything that may remove your own hair can affect transplanted hair too.  If you pull transplanted new hair, the hair shaft may come out but the active part of the follicle stays in and can generate another hair in a few weeks.

Increasing circulation of scalp during a scalp massage, however, is not proven to increase the quality and quantity of your native or transplanted hair.  Today in age, we know that people do not lose hair due to lack of blood circulation or oxygenation in scalp.

Enjoy your massage,

–
Best,

Parsa Mohebi, M.D.
US Hair Restoration
16661 Ventura Blvd.
Encino, CA 91436
Tel: 818-788-8363
www.ushairrestoration.com

Q:

Hello, I am having my third hair transplant in a few weeks by Dr. X in Las Vegas. My 2nd time I experienced a very wide scar. I researched about using Botox to lessen the width. My doctor and I ordered Botox but would like information regarding the area to which inject it. On the scar itself? Around it? How many cc’s? I would truly appreciate the info.

Thank you.

A:

The use of BOTOX injection into the donor area to prevent stretching of the scar is a relatively new concept that has been recently introduced to hair transplant surgery.  The research has not been done on a large number of patients yet.  It mainly compared the effect of injection of BOTOX on the width of the donor scar on one side to the other side in post hair transplant surgery follow up visits.  Because of the shortage of the number of experimented cases it is hard to conclude what is the best dose for BOTOX injection in and around the donor wound.

As we previously mentioned in this blog, Botox Can Reduce Widening of Hair Transplant Scars by reducing the pulling effect of the muscles on the edges of the healing wound.   Botox helps minimize tension on the edges of the healing wound until collagen matures and the scar forms completely.

The same goes for the timing and more studies need to be done to compare the optimum required units of BOTOX needed to provide the best result.  The BOTOX dose stays within the scope of practice of the individual surgeon and may change based on the length and size of the hair transplant donor scar.  The time for injection should not be within the first week when there is acute inflammatory reaction from the surgery and it should also be repeated in 4 months when the muscles tend to gain their strength back.

Q:

I am a male to female transgender.  I have some hair thinning on top with receded corners as a male hairline.  I am already taking Propecia and Spironolactone to block my testosterone effect. I would like to change my hairline from a male hairline with corner recessions to a female one. I have some thinning on the top too.  I have fine and curly hair to start with.  How can a male hairline be converted to a female pattern?  Do you recommend hair transplant for transsexuals or is there any other options to restore receded corners to a perfect feminine hair line?  I’m interested to know my options and what you recommend.

A:

Male to female transgender patients may experience two personal problems.  The first is having receded frontal corners in mature male patterned hairline which is what makes the frame of the face “masculine”. Receded corners can be easily restored with hair restoration through follicular unit transplantation.  The second issue is when there is also miniaturization or balding of the rest of their hair in a male patterned baldness that may require further hair restoration.  Taking anti-testosterone medications can help to slow down your hair loss, but it does not stop the balding process completely.  Removing the testicles surgically as part of a transgender procedure can eliminate testosterone and, in turn, stop the process of male pattern hair loss in people who are genetically susceptible to it.
If you are only changing your male mature hairline to a feminine one or if you have male patterned balding, a hair transplant can help you.  Obviously, you need to continue with your anti-testosterone medications and get a hair transplant to reshape the frame of your face.  You may need more than one hair transplant procedure for maximum fullness of the hairline in a perfect female pattern.

Transsexual hair transplantation is a meticulous procedure and the hair transplant surgeon needs to understand your facial proportions.  Your Hair transplant doctor needs to be experienced with shaping the hairline in women.  Women hairline is different from male in many aspects such as: the location of the hairline from eyebrow level at mid frontal and laterals; temples need to be restored in a complete female shape; direction and orientation of hair shafts are also different between men and women.  All these features and details need to be dealt with meticulously.  We at US Hair Restoraiton offer quality hiar restoration to change a male to female hairline for transgenders.

Q:
Well I am only 18 yrs old from India and I have got a hair problem. usually when I was young I didn’t care much about my hair, but now I have  found that I have  lost my hair and they r falling very rapidly.

Well my diet is also not too good as I am very lean…..now I am getting very worried about my .They have not completely gone…. but volume or (say) quantity of hair has reduced very much from all over the head and the effect can be seen more on the crown area I don’t use much shampoo and usually I didn’t use to use oil but have started now.

My father is too bald so please help me that what should I do …so that I can restore my hair back……

A:
Your hair loss is most likely genetic and you might be experiencing the early stages of male pattern baldness.  Although malnutrition may cause some types of hair loss, it won’t happen until your are severely deficient of some particular elements.

Having said that, it is a good idea to see your doctor to confirm the diagnosis of the hair loss, especially if your hair loss does not follow a typical male pattern like what you can probably see in other male members of your family.  Men hair loss in its male pattern type is seen in men between their early 20s and will deteriorate for many years.  There are many hair loss products out in the market, but none of those are really proven to work except a few medications that are FDA approved such as minoxidil and finasteride.

My recommendation is not to start using hair loss medications before your diagnosis of male patterned baldness is confirmed by a doctor.  Hair transplant might be an option for you in the future so it is good to start your relationship with a hair transplant surgeon now.

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.