Hair Restoration Blog

Q:

Dear Dr. Mohebi,

Hello, I am really interested in doing hair transplant by you, as my friends in California highly recommended you. I wonder if you can please help me with this questions:

1. Which method would you recommend, FUT or FIT?
2. I have had Alopecia areata in the past in back part of my head. It happened several times, last time 3 years ago. I wonder how it will affect my chance for doing hair transplant. I really appreciate if you can please answer me in details.

Thank you so much for your attention and time.

Sincerely,
S T

A:

Thanks for you interest in our hair restoration services.  I will answer your questions in the order they were received:

1. Follicular Unit Transplantation (FUT) is the gold standard method in doing hair restoration. FUT is done in two methods 1. strip technique and 2. Follicular unit extraction (FUE, also called FIT).  It has to do with your goals in hair restoration and you can read more about advantages and disadvantages of FUE in my hair restoration blog.  Planning on doing one vs. the other needs to be discussed with the patient during the initial consultation.
2. Alopecia areata (AA) is an autoimmune disorder and usually a reversible condition in which a patient loses hair in a patchy fashion.  It affects transplanted hair the same as normal hair.  I generally make sure that patients don’t have active AA before proceeding with hair transplant.  A physical examination is extremely important in differentiating between male patterned baldness and diffuse alopecia areata (a rare type of alopecia areata).  In undiagnosed cases of alopecia areata, if a patient gets a transplant in the balding area that hair is lost due to AA, there is a risk that patient will lose the transplanted hair with the same mechanism.

Looking at the trend of search on our website, I noticed hair transplant cost, hair transplant costs, cost of hair transplant are among the most popular phrases that are used by the visitors who are trying to educate themselves on hair restoration and what is involved including the cost of hair transplant or hair restoration cost or costs in a hair restoration procedure.  There are many people who try to get the best value their money can buy and some people are cheap shopping.  I don’t mind finding a chip product when I am shopping for the same brand that I usually buy at a discounted rate.  However, when it comes to the cost of hair restoration, I don’t recommend finding a hair transplant surgeon merely based on the price of hair restorations.

Affordable hair transplant surgeries or other promotional phrases such as discounted hair transplants, $1 per hair, low cost hair transplants could be found everywhere, however when it comes to hair transplant with its permanent effect on your face, it should be more of a value shopping rather than price shopping.  Remember that you are buying something that is going to stay with you for the rest of your life.

I perform quite a few hair transplant repair procedures every months.  Some of the patients who go through repaire surgery are the ones who had their hair transplantation years ago, before the era of follicular unit transplants, but unfortunately a large number of those patients had their hair restoration surgeries in the last few years.  They either never received the number of grafts that they were promised and end up with less than optimal coverage due to technical problems or got problem with the artistic design of the hairline or issues with distribution of the hair on the balding area.

Among hair transplant surgeons some charge more due the name, brand and the location.  You have probably seen the signs like: “Beverly Hills Hair Transplant Surgeon.  Some of the older hair transplant doctors have been unable to keep up with the new techniques of hair restoration, I don’t see then participating in hair restoration scientific meetings thus are simply are not aware of what is the gold standard in hair transplantation.  Having said that, I do now some of the the pioneers in hair restoration that are always ahead of their time and are involved in hair transplant research and development.  One good example is Dr. William Rassman whom I had privilege of working with closely in the past.  He is one of the few hair transplant surgeons capable of providing quality hair restorations utilizing the new techniques while using his years of experience in the field of hair restoration.

In conclusion, it all comes bacn to the patient who need to realize what he is getting is a procedure that produces permanent changes and they better off doing it right the first time and don’t risk getting a less than optimal hair restoration that might need a repair hair transplant in the future.  Whether you are in Los angeles or elsewhere, you need to do your homework to find a good hair transplant surgeon and even after that know what kind of questions to ask from your hair transplant doctor.

Hair transplant cost is important and is a determining factor for some people, but you should not make your decision solely based on the cost and affordability in your hair transplant surgeon search.  That is why I deliberately avoided explaining about hair transplant cost in Southern California hair transplant centers of US Hair Restoration in this article, which is titled “hair transplant cost in Los Angeles”.

Please call Los Angeles Offices of US Hair Restoraiton for our current rates and promotions on hair transplants:  Telephone: 888-302-8747
Or visit: Hair Transplant Cost

They have setup specific guidelines for identifying these physical traits as well as for performing hair transplantation and surgical excision in order to achieve optimal cosmetic outcomes and minimize postoperative complications.

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.

Q:

I have been diagnosed with a thyroid problem called Hashimoto’s Disease.  I am 23 and I am losing hair on head, and also developing some bald spots on my beard area on the neck and scalp too.  My eyebrow hair is also falling out on the sides.  Doctors said that I have low function of thyroid and put me on thyroid pills.  Now that my thyroid is under control, I would like to know whether or not that my hair ever grows back.

A:

Hypothyroidism or low functioning thyroid can cause scalp and eyebrow hair loss.  However the balding spots that you are experiencing are not typical for hypothyroidism.  The patchy hair loss spots are usually due to a disorder called alopecia areata.  Alopecia areata (AA) is an autoimmune disease that could be seen in association with other autoimmune disorders like Grave’s disease or Hashimoto’s disease.  Thyroid disease is reported in almost 10% of the patients who have alopecia areata.

To confirm the diagnosis and start with a treatment plan, you need to see a dermatologist.  If the diagnosis of alopecia areata is confirmed then you can choose to wait for spontaneous recovery as it is in most of cases of alopecia areata or seek treatment methods that can facilitate the recovery and re-growth your hair.

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.

We have discussed different methods to repair hair transplant donor scar in the past. There was an interesting article in Dermatologic Surgery Magazine last months on repairing the wide donor scar using body hair by Dr. Robert Jones from Oakville, Ontario, Canada.

Dr. Jones has reports revising a wide donor scar after previous hair transplant surgery by body hair transplant. He uses chest hair removed by follicular unit extraction method using a 1mm punch device. He has transplanted the grafts directly into the scar area so follicular unit grafts did not have to wait more than a few seconds.

Three months post-op follow up pictures were shown with some hair growth on transplanted donor scar with some reasonable coverage. The growth of the transplanted hair is not completed before 6-8 months after hair transplant and it is expected to see better coverage by the end of that period.

I have had a presentation on revising neurosurgical scars using hair transplant with follicular unit transplantation in the annual meeting of International Society of Hair Restoration Surgery in 2007. In that meeting, I presented four patients who underwent hair transplant surgeries to revise the widened scar of their neurosurgical scars. The results of the hair transplant on those patients were great and the appearances of the scars were completely vanished in all four of them.

Again the current article by Dr. Jones proves that hair restoration could be used effectively for improving the appearance of scalp scars. My personal preference and the method that I use in our Los Angeles hair transplant clinics is to use scalp scar rather than body hair unless patient’s donor area is completely depleted and there is not enough harvestable hair on the donor area. In those cases body hair transplant could be an alternative if patient have good quality body hair for a body hair transplant through FUE (Follicular Unit Extraction).

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:

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.

Hi Dr. Mohebi,

A couple of questions for you and the blog perhaps.

Just wondering - I’ve noted that one LA area hair transplant doctor has used Vaseline on patient’s heads after surgery to prevent graft scabbing - what’s your opinion on this?

By the way I’m mentioning this as I feel I may have a greater tendency to scab as despite the twice daily washings my three grafts that you so kindly placed scabbed up and still are scabbed on this 6th day out, Sunday, but seeming to loosen up a bit now (patient had a FOX test with us to check his candidacy for FUE procedure and we implanted the three intact grafts that we biopsied to his crown). I’ve had prolonged scabbing before despite the washings and frequent wetting that I was advised with prior procedures. Also, I don’t necessarily mind the scabs other than I’d prefer not to have to return to work with them if they could be minimized with the Vaseline possibly or something similar.

Otherwise I’m wondering if Neutragena shampoo is okay post op vs. baby shampoo? Here’s a Neutragena link for reference.

http://www.drugstore.com/qxp14485_333181_sespider/
neutrogena_shampoo/shampoo_anti_residue_formula.htm

Thanks much,

Patient’s name

A:

Scabbing after hair transplant is very important and if not treated properly may affect the growth of the transplanted hair grafts. We are very meticulous on the care after hair transplant especially hair wash after hair transplant.

Many shampoo s are recommended and used by different hair transplant doctors, but we really don’t have a strong researched based proof for many of those. The only thing that I can tell you is to increase the number of washing in every day to minimize the chance of scabbing. In terms of using shampoos, I prefer using baby shampoo for the first 4 days that skin incisions area still healing, but after that you can use whatever you were using before. We know that there are some solutions and shampoos that can minimize the scabbing and crusting that is seen in the process of wound healing, but since we don’t know how they affect the growth of transplanted grafts we really cannot recommend them in our Los Angeles hair transplant centers. Not until we can have the evidence of their safety on the grafts from a medical study.

Using Vaseline falls in the same category. I prefer not using it in the first two days when the tiny incisions on the recipient area might not be quite sealed.