Dr Mohebi,

I hope you are well. As we get closer to my surgical date I have put together some questions for you.

I have been reading a lot on the hair restoration network and found this 1 individual called Megatron with a similar makeup to myself.

I have looked at his very detailed journal and find many similarities to myself. Because of this I have several concerns.

If you look through his journal you will notice that he has a similar hair type to myself. It appears he got acne throughout the donor and recipient area that looks horrible at about 2 months after hair transplant and continued for several months. I was very prone to acne as a child and as I mentioned in our consultation I have incredibly sensitive skin and very thin tissue. If I went to a spa and received a facial not only would my face become very red and inflamed but the benefit of the facial would not be realized for sometime due to the fact that I would most certainly get a breakout the following day. Seems like my skin does not like to be touched, squeezed etc. It also appears that he was treated for several infections around the 2 month mark as well which may have affected or increased his shock loss.

I am also concerned about the level of shock loss that he had. What are the common reasons for this and is there a way to minimize this other that the propecia you have already prescribed? It appears as if he lost a good portion of the density at about 2-3 months in the recipient area. I am not sure if I am ready to go through that even for the greater good. I understand that everyone is different and will react differently to the surgery. I have always been on the side of having the most and weirdest reactions to everything that messes with my bodies natural makeup!

When would you say that a return to normal sleeping patterns is likely?

I am not sure if this can be considered a random case of cold feet but I just wanted to get some additional reassurance from you prior to finalizing everything today

A:

It is great to hear from you. I will be answering your questions in the order you asked:

1.      What is generally seen a few months after a hair transplant procedure in some individuals is called folliculitis. This happens due to an accumulation of sebum, oily secretions, of the hair follicles.  They are not seen in every patient and do not generally have to do with having a history of acne in the past.

2.      Having sensitive skin may indicate more swelling and redness for the first few days after surgery, but this might be controllable with steroids that we already give to most patients.

3.      Shock loss is most often seen in the areas where you have significant miniaturization, which in your case we know exists based on our microscopic evaluation.  However, we recommend using finasteride after your hair transplant for a few months to minimize the shock loss.

4.      You may want to add minoxidil after hair transplant to the finasteride, to minimize the risk of shock loss even further.

5.      You can go back to your normal sleeping pattern after the 4th day after hair transplantation. Within the first four days you need to sleep in semi-sitting position, but there is no problem with putting pressure on the closed donor area.

In closing, be aware it is normal to have some level of anxiety before any type of procedure.  Please contact me if you have any other questions.

Hi Dr. Mohebi,
I saw on Channel 4 News a new type of hair restoration called the Fleming/Mayers flap method. What is your opinion on this procedure vs FUT?

A:

The Fleming/Mayer Flap method used to be one of the more solid options for treatment of frontal hair loss in patterned baldness, but with today’s more advanced methods of microscopic follicular unit transplantation, flap surgery does not have any place compared to hair restoration surgery. The result is unnatural, causing an awkward hair angle and unusually high density in the narrow strip at the front. There is an exposed linear scar on the front of your hairline.

There might be some occasions when the flap surgery might be beneficial, but for a routine patterned hair loss hair, restoration it is not recommended anymore. In fact, we do repair the scar of the patients who had a flap surgery in the past and create a transitional zone consisting of single and double hair grafts in front of the flap (this is only possible if the flap is placed high enough). Unfortunately in cases that the flap is not high enough we cannot do much to repair them and at times we have to remove some hair from the flap area to thin it out and make it look more normal.

Medical Director, Parsa Mohebi MD, is making the consultation process even easier by soon opening a Bakersfield Consultation office where patients in the Central California area, will receive an expert opinion with greater convenience and financial ease. This new office is scheduled to be opened in March 2012 and will utilize the newest technology in hair restoration communications.

We are excited to have the opportunity to join the Bakersfield family and more conveniently serve the residents of Bakersfield, Lancaster, Visalia, and Fresno.

Modern technology has allowed us capabilities we did not have 50 years ago. Just as with vision problems, many have the disadvantage of wearing glasses. Although there are contact lenses as well, there is still a dependence upon outside tools for sight, which can be inconvenient. After many years, LASIK was developed which has solved this stubborn problem of fading eyesight which many, to this day continue to suffer from.

If someone chooses to undergo a LASIK procedure, does it make them an insecure person? Not in the least! Rather, they are using their resources to look their best and be as functionally independent as possible.

We always use the latest technology in hair restoration at US Hair Restoration, which was not available as recent as 10 years ago. The question to ask is, why not use it? Thousands are doing it every year with excellent results, and nobody is concerned if their hair is native or transplanted.  Hair loss is a disease, yes a common one and like any other diseases there are treatments for it.  The proper conclusion is that these individuals are no longer bald and don’t have the competitive disadvantage like those who decided to do nothing for their baldness.

 In the end we all must be ourselves and do whatever makes us feel our best. No matter what we do with our lives, there will always be someone who will be critical of whatever we do.  Regardless of what others may say, do whatever makes you feel good about yourself.  There are options available to you today that was not available to your ancestors.

The FUT Strip Method

• Allows the hair transplant surgeon to transplant a larger number of grafts in one session. Most people who have never had a hair transplant surgery can have maximum results in only one procedure.

• Allows the surgeon(s) to process and harvest the grafts under a microscope minimizing the level of damaged hair follicles.

•  Can be achieved at a more rapid speed than the FUE.

• What can be achieved in one FUT strip procedure can take 2-3 FUE surgeries.

• The number of damaged grafts might be greater for certain patients which undergo the FUE procedure because of their unique hair characteristics. People with wavy or   curly hair may have a higher risk of transection than patients with straight hair. A FOX test may be performed on patients with curly hair or wavy hair to determine whether or not they make good candidates for an FUE procedure. A FOX test is a small FUE procedure which helps to determine the level of damage to follicular graft before proceeding with a complete FUE transplantation procedure.

• The FUE requires more tedious labor and the cost for performing an FUE is usually more than a strip hair transplant.

• FUE procedures require a highly skilled operator and create a technical challenge for less experienced technicians who don’t have good hand-eye coordination.

The majority of the patients which receive a hair transplant with the strip method are going to have a linear scar on their donor area.  This scar can be minimized with certain surgical techniques such as the trichophytic closure, but it can never completely be eliminated. FUE hair transplant procedures offer unique advantages for differing patient circumstances.

FUE Procedure

• The scar visibility is slightly noticeable to completely non-existent with the FUE.  It may leave some miniature spots because of a lack of hair in that particular area or de-pigmentation, like a small dot which is lighter when seen close up.

• Hair can be kept short after the Hair Transplant surgery in front and back.  Any types of spots or de-pigmentation are not easily detectable.

• There is minimal pain for most patients and they don’t need pain killers after their hair transplantation.

• The surgeon can get donor hair from different parts of the body which the strip method has limited areas to take from. Areas such as the temples, beard and other body hair is included in this.

• The surgeon can choose the specific type of grafts to harvest.  When a special type of follicular unit is needed, this option is very good because the surgeon can choose the exact number of specific grafts to transplant. This is great for touch up work on the frontal hairline which needs single hair grafts, or for filling an isolated crown balding spot that does not require any singles.

• The contrast between high hair density and bald areas can be decreased by the FUE. Restoring hair in a scar only needs hair added to the scar, and the FUE would help to minimize the contrast between the scar and the surrounding areas more easily.

Despite of all above advantages and disadvantages about the two methods discussing them with a good hair transplant surgeon is a good starting point to find out what it the best option for you.

US Hair Restoration sees hundreds of Hair loss patients each year. Many people find seeking treatments for hairloss to be embarrasing and prefer to keep them confidential. Every now and again there are individuals who are confident in overcoming any social taboo’s about hair replacement, and let others know about their new found joy and are excited to share how their lives changed because of new hair growth.

Recently, one such patient shared his new more youthful look with the world and was happy to let us know of his actions. We are pleased whenever we get to share our art and science of hair transplantation, but when an individual goes out of their way to do something we never asked or imagined, we take pride in knowing we changed someone’s life. We want to say “Thank You” to this individual for:

Allowing us the opportunity to make a difference in his life
AND
Letting others know there is a solution for balding!

 US Hair Restoration always appreciates when individuals spend time on their own to let others know about their satisfied results, and we are happy to share them with others. We encourage our patients not to feel ashamed about recieving a hair transplant, but rather accept the fact of baldness being a reality for many which today has natural, lifelong alternatives. People always feel better when having a solution to any common problem, and we are happy to be available as one of those solutions!

I went to a couple different hair transplant doctors for evaluations when I was 24/25 and was told I have a juvenile hairline and that i have a good donor area and scalp laxity. The doctors recommended around 2000 grafts to fill in the diffused area at the time.

One of the doctors I visited told me to give propecia another try which I did for an additional six more months, but stopped because it seemed to have no effect and from my understanding it doesn’t really help with hair in the frontal area which was my main problem. I also did not want to risk getting any more health side effects from taking propecia.

During this time I was also taking biotin supplements which I had read are good for hair but they didn’t have any noticeable effects. I decided against getting a hair transplant because of my age and I wanted to see if the hair might grow back naturally (some people who have lost hair from accutane reported regrowing their hair several years after taking the medication).

I have a history of MPB in my family but it seems to be hit or miss. My grandfathers both had full heads of hair, my dad and 1 of his brothers are completely bald but another brother has a full head of hair. My mom has 1 brother who is bald and another with very thick hair and a low hairline (which my hair most closely resembled before taking accutane). I also have a brother who is 21 and has extremely thick hair like I used to with no signs of hair loss whatsoever.

A:

Male patterned baldness (MPB) is a progressive condition and it generally won’t get better without treatment.  The medications that are being used for the treatment of hair loss are generally for maintaining your existing hair and have preventative effects rather than restoring your hair at its full thickness like what you had in previous years.

A good hair transplant surgeon can help you realize what the best options for hair restoration are; whether it is a surgery or medication.  Using Accutane could cause hair loss as one side effect, but that is reversible within a few months after stopping it.  That is the most common case for medication related hair losses.

It is important for you to develop a good relationship with a qualified hair transplant surgeon whom you can trust.  Then let him walk you through this process.  Using medications for a while is a good idea and some patients respond well to using them.  Unfortunately the results are not permanent and most hair loss sufferers continue losing hair, but at a slower rate.  

You can use medications such as Propecia or Rogaine to minimize the speed of hair loss. When it is the time for a hair transplant you can consider that as another option as well.

My doctor put me on propecia at 21 when I told him about the hair loss and I took it for about six months but it had no effect on my hair loss. I also started to use rogaine around age 23/24 for a couple of months but stopped because it made my hair loss worse (before rogaine the majority of my hair loss was in the front area of my head and after using rogaine I started to lose hair on my crown as well). My hair loss has been pretty stable over the past 2-3 years and I have continued to lose some hair but nowhere near the amount I lost initially.

I wash my hair every 2-3 days and only notice about 20-30 hairs lost compared to the hundreds I lost early on. My hairline has not really been effected at all and my hair loss doesn’t seem to match any on the norwood scale, it is just diffused loss throughout and matches the description of many accutane users who have lost hair. I have also been using the ProThik concealer spray for the past 3 years which works great because my hair loss is diffuse and makes it unnoticeable, but the process of applying it in and combing through it causes my hair to get tangled and pulled out so I think over time that has also contributed to my hair loss. I lose far more hair putting in the concealer than I do washing it and combing through it naturally.

For the first 2 years of using it I would wash my hair and re-apply it daily, although over the past 6-8 months I have gone 2-3 days between washing and reapplying it and only lose 10-20 hairs when I comb through it in the morning. I am not sure how much of my hair loss in recent years has been caused by this but I suspect that is has had some effect, especially during the time I was applying the concealer every day.

A:

Many young hair loss patients may start taking finasteride or minoxidil when they see the signs of active hair loss in their early 20s.  That is the time most people lose hair at its maximum speed.  Medications such as finasteride or minoxidil are only to prevent hair loss or even in some cases slow down the process.  They are not to bring your hair back to where it was before you started the process of hair loss.

I recommend you visit a hair specialist who can perform microscopic evaluation of your scalp (miniaturization study).  That can give you more information about the type of your hair loss and the treatment methods. Having regular follow up visit with your hair doctor helps you to know whether or not your hair loss medication works.  You may also need a hair transplant when the time come and the time and type of the restoration surgery could be discussed with your hair transplant surgeon.

Hello. I am considering getting a hair transplant and had some questions for you. I am 27 years old and began losing hair around age 21 immediately after using the drug accutane. I was on a very high dose and took more than the recommended amount during those couple weeks because I thought I would get better results. Within 3-4 weeks of starting the medication I lost an incredible amount hair. After losing the hair I read online that hair loss is a possible side effect of accutane and stopped taking it immediately . My hair went from being as thick as possible (my barber would using special thinning scissors because it was so thick) to being able to see my scalp within a month. The hair loss started in a diffuse pattern about 1-2 inches above my hairline and initially the affected area was about the size of my hand. Over the next 6-12 months I lost a ton of hair and was probably shedding a couple hundred hairs a day. I also had a burning sensation on my head for several weeks after I stopped using the medication. The shedding gradually slowed down over time but the hair I lost did not regrow.

A:

Many medications like Accutane may have hair loss as one of their side effects.  If your hair loss was only because of the use of this medication, it should have been improved after stopping it.  You  started losing your hair at the time that most people show early signs of Male Patterned Baldness (MPB).  Being on Accutane may have accelerated the pattern that you were supposed to develop, but probably was not the only reason for your hair loss.

Several treatment options are recommended for inducing hair growth for treatment of alopecia areata. Some patients may recover spontaneously over a period of time; because of this patients should be evaluated and selected carefully.  It is important that the options to forgo treatment are reviewed with the patients, as well as discussing the high failure rate of all the various options available.

Most people who have hair loss on the hair line prefer to treat this condition more aggressively with a variety of medications.  The chance of spontaneous recovery appears to be more in patients who have smaller and fewer hair loss paths.

• Topical Steroids

Topical steroids for treatment of AA has been widely used with little evidence of success.  They are easy to use and more affordable to many patients. However, the current lack of evidentiary success does not make this a valuable recommendation for patients.

• Local Injection of Steroids

Infiltration of long acting corticosteroids into the AA lesions has been studied with some degree of success.  Patients with smaller lesions of alopecia areata may respond better to local steroid injections.

This type of local injections of steroids is most desirable for limited lesions of cosmetically sensitive areas like hair lines and eyebrows.  The most common used medication is Triamcinolone acetonide (5-10 mg/mL).

• Systemic Steroids

Systemic treatment with steroids may stimulate hair regrowth in a limited number of patients.   Continued use of steroids is generally needed in most of these patients to maintain the level of hair growth.  Pros and cons of long term use of steroids should be discussed with these patients before initiating systemic steroid therapy.

• Topical immunotherapy

Topical immunotherapy utilizing allergens has been studied and proven to have some success in patients. The protocol for contact immunotherapy using DPCP has been recommended. Continued use of DPCP is needed to keep the skin irritated for a long time.  The inflammation seems to be able to change the progress of immune reaction that causes hair loss in alopecia areata.

Treatment should be discontinued only after full regrowth is apparent.  This can take an indeterminate length of time, and during this period patients may have to tolerate inflammation of the skin.  A high rate of relapse after discontinuation of treatment makes this option less desirable for most hair specialists.

• Other treatments of alopecia areata

Other medical treatments such as phototherapy, photochemotherapy, minoxidil and dithranol  have shown limited improvements.  Finally patients with extensive stages of hair loss with no response to treatment options may use wigs or hair systems.  That is more desirable for many women with extensive hair loss due to alopecia areata that are having zero to minimal response from any other treatments.