Hair Restoration Blog

Q:

It’s been just over 4 weeks since I had my hair transplantation. I still have a few scabs. It just happened that while shampooing my hair, I ended up accidentally removing a scab and the area underneath the scab appeared red. The area that has gone red, I could not say for sure if there was any bleeding as I would have been washing it at the time with shampoo. Did I lose any graft? Its 4 weeks post op and I am not sure when I can get to my normal hair wash and I really don’t want to compromise with the results.

A:

Transplanted hair is vulnerable in the first 4 days. The most important day is the first day after surgery in which I would like to bring patients back to wash their hair professionally. You can read more on Dos and Don’ts after hair transplant in our web blog. Washing after hair transplant surgery is very meticulous, but after day 4 following a hair restoration surgery, transplanted hair follicles become part of your skin and you cannot dislodge them even if you remove hair. I usually recommend that my patients follow our washing and after hair transplant care directions on the first four days to minimize scabbing after hair transplant surgery and don’t use any other products.

In your case at 4 weeks after hair transplant, you should have been able to wash your hair in your routine long ago. At this time, you can use your regular shampoo and conditioner without being worried about losing your precious implanted hair grafts.

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.

Intercytex has recently released some information on its hair multiplication experiments in a new article in the Journal of experimental dermatology. The title is “A graft model for hair development” and the article discusses what is done so far for hair multiplication experimentally. Intercytex has been involved with hair stem cell, hair culturing and hair multiplication, which is also known as hair cloning.

In this article follicular cell implantation (FCI) is discussed as an experimental cell therapy for the treatment of hair loss that uses cultured hair follicle cells to induce new hair formation. The process of culturing hair cells is based on the demonstration that adult dermal papilla cells (DPC) retain the hair inductive potential that they acquired during hair morphogenesis before birth. To obtain FCI, the investigators isolated hair inductive cells from scalp biopsies and then propagated them in culture media in order to provide adequate cells to generate several new follicles from a few hair follicles.

Following expansion of cells in culture, they implanted those cells into the scalp where they induce the formation of new follicles below the level of skin. They describe a consistent, reliable method in which they can test hair induction. Since the process relies on the ability to retain the potential for hair induction during the expansion of DPC in culture.

They go over a simple graft model that supports hair morphogenesis. In this experiment, they combine dermal cells with embryonic mouse epidermis that provides the keratinocyte (one of the skin cells) component of induced follicles. The grafts are placed under a protective skin flap in the host athymic mouse (a special mouse without capability to reject the transplanted grafts from human) where the cells will form a skin graft with hair if the dermal cells are hair inductive DPC.

Using the assay freshly isolated and cultured mouse embryo dermal cells as well as cultured dermal papilla cells from other species all induced hair formation. They also showed that induced hairs were aesthetically indistinguishable from those of the epidermal donor in length, thickness, and pigmentation. The investigators stated that the newly formed hairs were histologically normal and could resemble a complete natural hair.

We at Los Angeles hair transplant surgery centers of US Hair Restoration will closely follow up with the progress of hair multiplication and cloning techniques. Although the result of the cultured hair on animals has been released before, the current released article is interesting and elucidates more on the characteristics of cultured hair during the process of hair multiplication so called hair cloning. It seems like we still have a long way to go till we can practically use hair multiplication techniques in restoring human hair.

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.

Mega session hair transplant surgery has been around for almost a decade since Dr. Rassman and others started doing bigger and bigger sessions. Before 1993 all could be done was less than 1000 and occasionally 1500 grafts per each session. Using newer techniques and larger team of experienced technicians, we at US Hair Restoration are currently performing large sessions on a regular basis.

Not all physician teams are equal. If a doctor routinely performs sessions in over 2500 graft size, then it would be safe to assume that this doctor has mastered the skills required for large session. Unfortunately, not all doctors have either the teams or the skills to accomplish the feat on a routine basis. Limiting the size of the session to under 2000 grafts, it may take more surgical sessions to accomplish the same goal as when twice the number is transplanted.

Many factors should come together for a megasession hair transplant surgery. First, the surgical team must be trained in doing large sessions with fast, efficient cutting and placing. The following points must be available for the surgery to be successful. The sessions should not take more than eight to ten hours, for more than that, the grafts that are out of the body awaiting placement produces reduced graft growth. Hair transplant surgeon should keep a larger team of technicians to help reducing the time of surgery.

The surgeon must know the nuances of prolonged anesthesia without increasing the risks to the patient. The patient’s scalp laxity must be very loose so that a wide strip can be taken safely (often these strips measure greater than 2cm in width and 22cm in length). The patient’s density must be high (50% higher than normal densities). Large sessions might carry increased risk of swelling and redness after surgery, but overall are not more risky than smaller sessions, but the above criteria must be bet or the yield would not be there. At US Hair Restoration, we offer megasessions to patients with extensive baldness with good donor quality with excellent results.

Question:
Hi Dr.Mohebi,

I am wondering if the chest hair be transfer to the head?

Yours,

Name

Answer:
Good question and the answer is yes. Some people with limited scalp hair can be good candidates for body hair transplants. This is how it works:

Body hair can be harvested and used for hair transplants in people who have both good course body hair and are severely depleted of scalp donor hair (hair on the sides and back of the head). Body hair should not regularly be used as an alternative to scalp hair for hair transplants. This is because body hair has a short growth cycle in comparison to scalp hair, which makes body hair less desirable than scalp hair for a hair transplant.

Each scalp hair grows between 1 to 6 years and then goes to its resting phase for 4 to 6 weeks in which the hair follicle falls out before the start of another growth cycle. Body hair on the other hand has a different growth cycle, which consists of much shorter growth phase and a longer resting phase. In other words, many body hair follicles that you transplant stay in resting phase most of their lives and only a fraction of them grow and are visible at any given period of time. So you are transplanting hair follicles knowing that not many of them could be seen at any given period of time.

Having said that body hair transplants are OK for people who have no alternative ie. bad donor hair density or quality.

I visited a woman today who was suffering from female patterned baldness. She said she heard about the great work we do and she was interested in having a hair transplant procedure done at US Hair Restoration. Since her hair thinning pattern was typical of hair loss in women with female patterned baldness (also called female patterned alopecia) I decided to post this article on women’s hair loss and hair transplant to answer some of the questions many women have pertaining to female hair loss.Our hair loss patient was around 50 years old with a history of hair loss for over 6 years with more accelerated hair loss in the last 2 years. This woman has dark hair and white skin. As you can see in the picture, the thinning in the front and top was giving her the appearance of balding in front that she could not hide this with regular styling techniques.

Patients with female pattern baldness usually have significant miniaturization of hair follicles and significant widening of the spacing between hair shafts. Miniaturization occurs when hair follicles start to get smaller and smaller and they look like baby hairs that do not grow past a certain length. This miniaturization and space widening occurs in a large area of skin including their donor area. The donor area is the hair on the sides and back of the head, which remains intact in men with male patterned baldness due to male genetics.

.

We discussed different medical problems that could cause hair loss in women and the importance of discussing those with her family doctor, internist or endocrinologist. The most common causes of accelerating genetic hair loss in women are:

• Iron deficiency

• Thyroid disorders
• Female hormonal imbalance or the use of OCP ‚Äúthe contraceptive pill‚Äù
• Excess levels of male hormones
• Auto-immune disorder
• Some medications

My recommendations to this patient and other patients with this similar condition are:

1. No hair transplant as of yet
2. Visit her family doctor with our letter in hand to look for any treatable causes of hair loss
3. Rogaine 2% lotion, twice a day
4. Visit us in a year to be evaluated with another miniaturization study for the progress of her hair loss or gain
5. Coloring hair lighter to decrease the sharp contrast between hair color and skin tone to create the appearance of fullness
6. Toppik, which is a topical hair product that can give more body to hair shafts

For more information on women’s hair loss you can also visit US Hair Restoration.

Question:

I am a 40 year old man. I had a hair transplant 15 days ago and have my sutured removed 5 days ago. I am generally very active, but my doctor said that I can not exercise intensively for first 3 months after surgery. When do you usually say is safe to resume heavy exercise.

Thanks A lot!!

Answer:

Dealing with daily activity and sports after hair transplant surgery is a concern for many patients who are physically active and want to get back to their normal routine as soon as possible. There are two areas of concern after a hair transplant surgery. First, you may lose newly implanted grafts when doing contact exercise like wrestling. This can only be problematic within the first 4 days after surgery. Research has shown that after this period the hair graft is completely healed and infused in surrounding skin. Usually evenpulling the hair after this period of time doesn’t have an adverse effect. The follicle stays in place and is capable of making a new mature hair.

The second concern is with the donor area, which is primarily closed by sutures or staples. Using Laxometer can help up to close donor wound with not much tension on the wound edges. The healing of the donor incision follows the general wound healing rules. The process of healing starts from the moment the wound is closed. The wound heals primarily within a few days from the time of hair transplant and any vigorous activity should be avoided within the first two weeks. After two weeks, the wound is practically healed, but the strength of this newly healed wound is nowhere close to normal skin. The wound needs a few months to get back to its final strength. However, regular aerobic exercise is not contraindicated even the day after surgery.The activities that you should be avoiding are: Anything that increases the tension between the edges of the healingwound in the donor area, such as weight lifting and other exercises which involve intense bending of the neck. You should wait at least 6 months for this type of exercise in order to prevent opening of the wound or widening of the final scar.