Hair Restoration Blog

This type of “hair test” is done by a hair transplant surgeon or dermatologist to find out the rate of telogen hiar. It’s a simple procedure. The doctor pulls hair to find out the number of hair follicles in the resting phase. The way the test works is that the doctor grasps a couple of hair shafts between the pointing finger and thumb, then pulls them ever so softly. There are two classifications of hairs: Anagen, which are growing hairs that ought to remain in place; and telogen: hairs that should pull out rather easily.

By keeping track of the number of pulled hairs, a person can approximately calculate, in the telogen state, the hair follicle percentage. For example, if a person pulls on 10 hairs and then 2 come out, then the telogen hair follicles frequency is 20%.  If extracted hair follicles percentage is up to 25%, that is still considered OK, but if it’s over 35%, it is not normal and shows that there’s a disproportionate amount of hair in the resting phase.  This condition is often seen in Telogen Effluvium (TE).

Even though this hair-pulling test seems simple, a person may come to the wrong conclusions if they do not carry out the test properly and he or she does not have a full comprehension of the test’s limitations. The biggest concern is that the test results may be affected by what the patient did with her hair in the preceding hours. When the patient washes her hair, it will cause many of the telogen hairs to fall out.

There are several factors which can increase the accuracy of the hair pull test. The hair pull test can be ratcheted up to another level by conducting the “unit area trichogram”. This type of test requires that a couple hair follicle samples are grabbed from the scalp utilizing rubber-covered forceps; both telogen and anagen hairs are yanked. These hairs are to be placed on a glass slide and inspected using a microscope. After that, the dermatologist is to count up the telogen hairs and the anagen hairs as well.  The test can help the doctor in differentiating a variety of hair loss conditions.

Q:

Hi,

How soon after a FUE procedure could I expect to see some growth?
Thanks

A:

The growth after a FUE transplant would be the same as that for a strip technique.  When the telogen (resting) phase of the hair follicles is finished and the anagen (growth) phase begins, you ought to be able to see some growth after two to three months. To start with, young hair shafts are fine; it takes a few months for the hair shafts to grow to their final thickness. To see optimal results, you may need to wait up to one year (from the time of your hair transplant surgery) as that is the amount of time it takes for transplanted hair to reach its final thickness and length.

Where can we take hair for hair transplant other than the back and sides of the scalp?  This is a common question that I am asked on a regular basis.  The answer is “hair can be harvested from almost any part of scalp or body that grows hair and it can be transplanted to any part of the skin.  We have performed hair transplant from many different areas of the body on patients who do not have sufficient donor hair on their scalp for transplantation or in people who had old hair transplant procedures that violated the donor area with multiple punch biopsies and through scarring.

Pubic area is prepped before harvesting hair for hair transplantation into the balding spot of patient

It is important to understand that scalp donor hair is always the best option when it comes to hair quality for the best result in hair transplant surgery.  The scalp hair has a longer growth phase (anagen) that is about 1-6 years and a shorter resting phase (telogen) that lasts around 4-6 weeks.  This makes scalp hair a more economic choice for hair restoration surgery.  When using scalp hair for donor, almost every transplanted hair stays in growth its phase and only a small portion goes into the dormant phase in which hair falls and another hair grows in a few weeks.

Body hair, in general, has a shorter growth phase which could last only about a few months and a longer resting phase.  That is why body hair never grows more than a certain length.  There are some limited studies that show that transplanted body hair can change their innate characteristics and increase its growth phase when transplanted to the scalp, but we still need more research to provide information on the details of the process.

At US Hair Restoration, we have used pubic hair successfully in a patient with great demand due to his fine scalp hair and violated donor hair that could not provide sufficient hair for transplantation into the scalp.  The patient’s hairline has been restored using scalp hair from the occipital area (back) of the head and the balding spot on the crown was reinforced using pubic hair.

So if you are lacking adequate hair on your donor area of the scalp or need a large number of grafts, you may be able to consider other options including pubic hair transplant.  Obviously, the donor quality should be evaluated closely by a good hair transplant doctor to determine the candidacy of the patient for body hair transplant to scalp.  The details and methodology of this process is being published in medical journals.

I just read another article that may bring more hope for the people with hair loss.  Kang et al has been working with a plant native to Jeju Island in South Korea by the name of Schisandra Nigra.  They studied the effect of the extract of this plant on hair growth.  The article which is published in the European Journal of Dermatology is the result of a study on application of this product on rat hair with some promise. This study was conducted to evaluate the effect of Schisandra Nigra on the promotion of hair growth.

When rat vibrissa follicles were treated with 85% ethanol extract of S. Nigra, the hair-fiber lengths of the vibrissa follicles increased significantly. In addition, after topical application of the EtOH extract of S. nigra onto the back of C57BL/6 mice every other day, anagen (growth phase) progression of the hair shaft was induced. Moreover, the extract increased both the expression of proliferating cell nuclear antigen in the bulb matrix region and the proliferation of immortalized vibrissa dermal papilla cells.  Both of those showing more activity on hair follicle cells.

In order to determine the mechanism by which the plant S. nigra promotes hair growth, the researchers examined its relationship with the TGF-beta2, which is a signal pathway, known to be a regulator of catagen induction (the phase that come after growth phase in hair cycle).

When the vibrissa follicles in the anagen phase were treated with S. Nigra extract for 7 days, the expression of TGF-beta2 in the bulb matrix region was found to be lower than that of the control follicles that were expected to be in the anagen-catagen transition phase.  These results suggest that S. Nigra extract has the potential to promote hair growth via down regulation of TGF-beta2 and the proliferation of dermal papilla.

In less scientific words, the plant has been able to stop hair follicles from going into their resting phase from their growth phase and thus increasing the number of growing hair follicles.  Could this hair loss product be used as a valid option for treatment of baldness in humans?  We can not be sure yet.  More studies are needed to prove the therapeutic effects of this product on human hair growth.

We do not recommend any herbal hair loss products at this point for treatment of male or female patterned hair loss due to the lack of adequate evidence based on documents that support that in humans.  However, we follow the findings of the new research through the world and keep our readers posted if one becomes available.

Good morning, Dr. Mohebi.  I wanted to update you on my doctor’s visit.  All lab results, including the ones you suggested, are normal.  I have noticed a decrease in hair loss over the past few days, but it is still occurring.  Is there a possibility that stress would cause hair loss for 2.5 months?  I was wondering what my next step should be.  Is there other medicinal treatments besides Rogaine?  Also, I read that pregnant women should not use Rogaine.  Is this true?  I was planning to have a child within the next couple of years.  Your expertise is greatly appreciated.

Thank you
A:

Thanks for the update,

Stress can definitely increase the speed of hair loss. In women who are not genetically prone to balding, stress can only force hair follicles to enter the resting phase (telogen). In this case, the hair follicle is in its resting phase, but is capable of growing another hair in a few weeks. However if you are prone to typical women hair loss or female patterned alopecia the loss of hair due to stress can be irreversible.

At this time there is no other FDA approved medication that can be used for treatment of female hair loss and, unfortunately, pregnant women cannot take Rogaine because of its effects on the fetus. On a more positive note, there are some hormonal changes during pregnancy that can potentially protect vulnerable hair and might be able to compensate for Rogaine withdrawal to some degrees in women who stop using Rogaine during pregnancy as well.

There is just another study on a potential new medication that could be used for treatment of hair loss. Currently, there are only two FDA approved medications for male patterned baldness or typical men hair loss in United States. The two medications that we have extensively discussed on this web site are finasteride (Propecia) and minoxidil (Rogaine).

The article “Effect of Cuscuta reflexa Roxb on androgen-induced alopecia” was published in the Journal of cosmetic dermatology September 2008. The research is done in India and the authors discuss the significance of hair loss in men and the effect of androgenetic alopecia on millions of men and women. They classify typical men hair loss as androgen-driven disorder. They used Cuscuta feflexa Roxb for hair growth activity in androgen-induced alopecia.

The authors of the article used petroleum ether extract of C. reflexa for its hair growth-promoting activity on albino mice. They induced male patterned alopecia in mice by testosterone administration for 20 days. The inhibition of baldness by simultaneous administration of the extract was evaluated using follicular density, anagen/telogen ratio, and microscopic observation of skin sections. To investigate the mechanism of observed activity, in vitro experiments were performed to study the effect of extract and its major component on activity of 5alpha-reductase enzyme.

The researchers announced that petroleum ether extract of C. reflexa exhibited promising hair growth-promoting activity as reflected from follicular density, anagen-telogen ratio, and skin sections. Inhibition of 5alpha-reductase activity by extract and isolate suggest that the extract reversed androgen-induced alopecia by inhibiting conversion of testosterone to dihydrotestosterone. They concluded that the petroleum ether extract of C. reflexa and its isolate is useful in treatment of androgen-induced alopecia by inhibiting the enzyme 5alpha-reductase.

This hair loss research needs more research on human volunteers on a long period of time before it can be considered as a balding treatment. There must also be more research done on the application of the product on human in terms of medication side effects and its comparison with currently available medications for treatment of hair loss.

We at US Hair Restoration continue to follow on the most advanced investigations and researches on hair loss treatment. We keep our patients and the readers of hair restoration blog updated with the new information and medical technology to improve the quality of our hair restoration treatments at our Los Angeles hair restoration clinics.

Continue from the question “FUE - Body Hair Transplant“

Question 4: What is your view on “out of body” time for grafts?

Answer: There are articles on out if body time for grafts, what we do is to keep grafts in chilled physiologic solution (0-4 C). If grafts are kept in this condition the survival rate is over 90% in up to 12 hours. That number starts to drop gradually after 12 hours.

Question 5: Do your charges apply for every graft extracted, even if transected, or only charge for each intact graft?

Answer: Only the grafts that are intact and transplanted are counted.

Question 6: How much of the work do you do and how much of the work do your Assistants do? What specific tasks are allocated to Assistants and what do you undertake? To what degree are you present in the room where surgery is being carried out? Do you use needle or blade to make incisions?

Answer: In FUE procedures either body hair transplant, or scalp transplant I am present in the OR the whole time because the majority of the work is done by me. I score the grafts and remove them. Techs generally help me in retracting the grafts from scalp. Trimming under microscope is done by technicians. I constantly observe them for the quality and integrity of the grafts. Every now and then, we may have to change our methods for removing FUE grafts in different areas so the surgical team should be constantly communicating with me in the OR. For incisions I usually use solid core needles to minimize the trauma to tissue and preexisting hair.

Here are a series of very good questions on hair transplant with FUE (follicular unit extraction) and body hair transplant from a patient who did his homework and educated himself on his upcoming surgery.

Question 1: Do you have a pre op protocol for chest to scalp?

Answer: For FUE from chest I want to have a clean wet shave from the whole chest one week before the surgery day so in a week when we do harvest the grafts we only remove growing hairs (the ones that are in anagen phase). Scalp hair on the other hand, I don’t want it shaved at all and I will do my own clipping right before the procedure. We do FOX test for all new patients to determine their candidacy for FUE with a small number FUE harvesting under local anesthesia.

Question 2: How many grafts can you transplant per day and how many hours is a typical working day?

Answer: Just for you to get the idea of how long does a FUE hair transplant may take, the last two FUE that we did in US hair restoration office were 1500 grafts per day each. One of them took 9 and the other one 11 hours. In both surgeries we used scalp hair only.

Question 3: Are grafts that are extracted placed straight into the recipient incisions or are they checked under the microscope first?

Answer: All grafts need to be visualized under microscope to make sure they are intact (not transected). Most of them need to be trimmed too. We usually have to remove some of the upper layers of skin and a little of extra fat around the grafts for them to be in the ideal size for transplant.

I will post the rest of this Q and A series in next few days.