Hair Restoration Blog

Q:

Thanks Dr. Mohebi,

Your input is much appreciated.  The shock loss you had mentioned has been my concern, as a few of my frontal hair seem lighter than before.  You had mentioned that the shock loss might be visible for a few weeks to months – will it be the case that after that shock loss stage, the hair will likely return back to original form?

There’s a very important question that i would like to ask you, and was thinking the it would be great for the blog to have.  Basically, when you saw my before and after picture, i feel like i changed a bit.  The “after” picture seems like i have more redness, and i’m hoping it’s not the case where the hair transplant affects the circulation (e.g., tight donor area/scalp affecting the blood flow to my head).  My surgeon told me before the procedure that i will eventually be back to the way i was before (i.e., the “before” picture), but just have a new scar and more gafted hairs.  That’s the ultimate question: would you agree that a patient who does a hair transplant will relatively return to the condition that he was before the particular sugery (w/ of course, a new scar and more hair)?  This is what keeps me up at night, thinking perhaps my scalp has worsened, or i am now more prone to lose hair.  I hope that’s not the case, and every patient should be aware about before she or he gets a hair transplant done.

Thanks again for your help.  If I see you in person at your office, I might be interested in discussing about future scar work.

A:

What is hair transplant shock loss

Some of the hair shafts that fall off due to shock loss might come back. Especially if the shock loss happens in an area with permanent hair like back of the head. However, losing hair in the frontal area because of shock loss might not be completely reversible. But, you have to understand that falling hairs are the ones that were supposed to fall off anyway and a hair transplant just accelerates the loss.

How to prevent shock loss

Again, using finasteride can significantly reduce the extent of shock loss. After surgery, in the transplanted area, the tightness should not affect the circulation of the scalp. After a few days to weeks, on the donor area, the tightness goes back to normal.

Donor scar in strip hair transplant

And to answer to your last question, I do not agree you go back to the condition before surgery with only a new scar and some more hair. What I personally do in a repeat surgery is remove the old scar; the patient at the end has only one scar that at times may be even better than the initial scar.

How to improve the appearance of the scar

I perform trichophytic closure when I think it is the final surgery that the patient may need.  Trichophytic closure is when we close scalp skin on the back in a way that hair can grow through the scar.  Trichophytic closure reduces the contrast between donor scar and surrounding areas that eventually improve the appearance of the scar, so you are not more prone to hair loss because of your hair transplant.

In some cases and when we are looking for even less visible scar, the scar may get filled with FUE into the scar in a few months from the initial surgery.

Be patient and you should be able to see results in the coming months.

Q:

Dear Dr. Mohebi,

I had the hair transplant done about 5 weeks ago.  I’m very concern with the recent hair transplant.  First of all, I thought the look of my hair was fine already.  However, I did notice there are some thinning parts and it would be good to thicken the middle a bit.

I look like a mess!  My cousin saw me and she noticed that I looked different and was wondering if I had a hair transplant done.  Ahhh!  I didn’t want it to be noticeable.  If I look at myself now, I can’t help but notice the color of my scalp and how different it looks.  Pic 3 shows a clearer look on how the transplant was done.

Is there something you can do or recommend to make it look more normal to before (it kind of looks like I have thinner hair now too)?  Also, after reading your blogs, I hear that doing the procedure would cause stress to the scalp.  I’m very concern with this also b/c I’m 27 yrs old and this is actually my 2nd procedure.  I hope this does not make me more prone to losing my original hair.  I feel like it’s all my fault that I went to this particular procedure at this time and now I am completely anal about losing my hair.  Hopefully my hair loss pattern is still the same as I was before this recent procedure.

Your input would be much appreciated.

Thanks a lot,

-

A:

The hair shafts on transplanted grafts stay in place for a few weeks after the hair transplant and since they are shorter they may be detectable, but they usually fall out and you go back to where you were before. Then you have to be patient until the transplanted hair starts to grow. I usually recommend to people like you who have long hair on the back to comb their hair forward for the first few weeks after their hair transplant and also for the time that the transplanted hair might be visible because of the short hair there or the slight pinkish discoloration of the scalp.

I cannot predict what it may look like down the road, but I do not see anything unusual for this phase after a hair transplant procedure. Some thinning in your native hair for weeks to months after a hair transplant might be seen due to shock loss. I do recommend that you be on finasteride, which can prevent shock loss (losing hair due to the stress of surgery on vulnerable hair on scalp) to some degree. Try to camouflage your transplanted area and be patient for the next few months that the new hair grows and cover the balding areas.

Previously, we posted an article in our hair restoration blog: Tax on Cosmetic Procedures. For our readers, the good news  is that there were many people who supported us in our rally against the cosmetic tax proposal. Even more good news: the current cosmetic tax proposal has been dropped (hooray!). It was the same proposal that was part of the massive health care reform bill presently being considered on the Senate floor.

But let’s keep in mind that it is quite possible the “Bo-tax” could be tacked back on before the bill’s final passage.

I say the five percent tax is insane because a very similar type of cosmetic tax has been implemented in New Jersey, with disastrous results. Tax revenues from plastic surgeons and cosmetic doctors have dipped in that state, probably because potential patients are going to doctors in surrounding states for their cosmetic surgery needs, while not having to pay as much.

In this case, we may deter those people who visit the United States every year from coming to America in order to take advantage of our top-of-the-line cosmetic procedures.

The additional tax on cosmetic procedures has lowered business profits for doctors, thus limiting the amount of tax revenue the state of New Jersey receives to pour into public institutions and not-for-profit organizations. It seems to be a no-win situation for everyday citizens, doctors, and state assemblymen and politicians who are sincerely trying to do good service for the people of their district.

Another drawback: the tax may be applicable to a broad-range of procedures that improve a person’s self-image and self-confidence. These procedures may very well end up improving a person’s depression or social anxiety, as described in our article, Psychology of Hair Transplants.

Lastly, the cosmetic surgery levy unfairly discriminates against people with congenital defects, such as bald people who are looking for a hair transplant or women seeking to rid themselves of wrinkles by using Dysport or Radiesse.

Data sources show that about 90 percent of people who are considering cosmetic-type treatment are women (source: American Society of Plastic Surgeons). These women are seeking to enhance their self-perception and to feel more comfortable in social settings and also looking to gain an edge in the workforce (studies show chances are better for more “attractive” people to get hired, to receive promotions, or to receive a higher salary).

I would like to take this time to thank all physicians, patients, and politicians who supported the drop of this proposal from the health care reform bill.

Dear Dr. Mohebi,

First of all, thanks for this great blogging avenue.  I am very thankful that this website is around.

I’m a bit concern w/ my recent hair transplant.  i’m only 27 years old, and had decided to have a 2nd hair transplant done one month ago.   i was mainly just thinning in my front side, and was convinced by my hair surgeon that i should get a 2nd hair procedure done to add thickness in the thinning front side. Please note that the sides of my front have been pretty thick already, but i did have a few thinning gaps in the top center of my scalp.  Overall, i had a total of 1500 grafts transplanted on the front and a few on the center of my scalp (crown).

Immediately after the surgery, i felt remorseful.  i realized i should’ve done more research.  It just didn’t occur to me until the day after the surgery that this procedure might cause me to lose my native hair faster.  Right now, i notice a few shock loss on the frontal thinning hair.  I don’t think the center had much (if any) shock loss, as it had pretty thick native hair already.

I was wondering, would this shock loss accelerate the affected hair to retirement stage?  Lastly, overall, do you think this hair transplant will make my native hair to thin out faster had I not done the transplant?  I recall that my hair surgeon informed me that it shouldn’t be the case, and that any thinning results would be directly from my own thinning pattern.

Please support.  Thanks in advance.

A:

Many people who undergo a hair transplant have some degree of miniaturization (thinning hair shafts) on the balding area, which indicates there is active hair loss in those areas. Miniaturized hair is when your hair has already started the process of balding. Although the process of hair loss is usually very gradual and it may take years to complete, stressor (either physical or emotional) may accelerate the loss and facilitate the process of balding in prone hair (in thinning areas).

Shock loss is losing hair in an area with significant miniaturization due to a stressor. Shock loss after hair transplants used to be common in the past. However, using finasteride (Propecia) is proven to prevent this type of hair loss after hair transplant or significantly minimize it. I usually start all my patients on finasteride a few days before their hair transplant and continue it for at least six to eight months if they do not want or cannot continue it for the rest of their lives.

In regards to whether or not this hair transplant can affect the thickness of your native hair, I cannot say without performing a miniaturization study (examining hair with a microscope to determine the rate of miniaturized hair). If you had a large number of miniaturized hair to start with, you would be running a higher chance of shock loss. The chance of shock loss is usually higher for the first hair transplant. It seems like if you were to have a lot of vulnerable hair, you would have lost them mostly at your first hair transplant surgery. I recommend that you go on finasteride as soon as possible to protect your native hair if you are not already on it.  That is all you can do at this point.

Q:

It’s a little over 3 weeks after my hair transplant now and I’ve noticed there’s a 1inch in diameter bald spot roughly two inches to the left of my right ear (when viewed from the right side).  Though I had been keeping that area clean as instructed for the last 3 weeks, it hasn’t filled in, just appears to be the same size.  I’m pretty sure it’s not getting bigger.  It’s sensitive to temperature, too, like skin on the inside of the wrist. The last scab fell off today while washing, but it was nearly as big as the spot, .3cm x .75cm big right at the center of the spot.

There’s also numbness still concentrated right around the bald spot.  This is the first time I’ve ever seen a circular bald spot on the donor area, so it’s scary. Is there something I should do? Does trauma cause fallout even in donor areas?  I’ve been taking 1.25mg finasteride daily, prior to, during and after surgery. In retrospect, except for a few erratic glucose levels (low and high) I actually think I’ve taken better care of my head this time than the 3 previous surgeries, so I’m worried.

What’s the likelihood of it growing back granted the area isn’t scarred over? A quarter-sized bald spot doesn’t make sense to me because that makes it seem like the wound healed while gaping open. That area was sensitive this whole time, but I never noticed any infection or excess oozing after the first few days, so it seems only possible that the hair around a fixed point on the wound got shocked and fell out.

Please advise,

A:

Thanks for the email.

You are right and the hairless spot is probably due to shock loss around the donor wound area. You have had a tight closure at the donor wound. I guess the tight closure has caused some shock loss and the areas on both sides of the scalp are very typical for shock loss.

When it happens, it is usually seen on both sides. The shock loss around the donor wound is almost always reversible and hair will usually come back. Re-growth of hair that is fallen due to the shock loss may take up to 6 months and recovery may be gradual.

There is not much that could be done at this point. However, you need to be seen and examined to confirm the diagnosis. The numbness around the donor area, if it occurs, may last for weeks to months and has to do with the inflammation of the healing area that may affect the fine nerves on the area. It generally gets better on its own.

Q:

When I do look down placing more tension or pull on the tight donor area, I noticed it is also pulling my neck muscles and there is no laxity at all (compared to the right).  There is no up or down movement possible of any subcutaneous tissue or the galea at the donor site. Is this normal? If the tightness does not subside, what solution options are there?

I also understand there are recommended scalp exercises before and after HT surgeries?

Regards,

A:

It is normal to feel tension on the side that we removed the strip.  Skin needs a few weeks to get relaxed and stretches to compensate for the removed area.  Although we generally recommend scalp exercise before hair restoration surgeries with strip technique, you should avoid scalp exercise after hair transplant for the first 3 or 4 months.

I recommend that you avoid all movements that increase the tension in the area until you feel that the tension on the skin is gone.  If you put too much stretch on the back of your head in the first few months after hair transplant, you running the risk of stretching the donor scar.

Have a good weekend.

Q:

Hello,

Have been diagnosed with Alopecia Universalis, not a problem from a cosmetic point of view as I’m over 65, comfortable with myself as a person, and have a positive outlook on life and a strong faith.  The only thing that is bugging me is my finger and toenails.  The pitting and destruction of the nail bed is a problem.  Wondered what the best thing I can do at this point.  I have had the nails covered with an acrylic at a nail studio and for the most part, this seems to work until they get long and snap off.  Should I be taking a special vitamin such as Biotin or Zinc?
Thanks,

A:

This is a good question and I personally could not find your answer myself anywhere. I discussed it with some of my dermatologist colleagues (when it comes to nails, they are more involved with this condition and have probably seen or treated more similar cases of nail changes with Alopecia Areata or Alopecia Universalis.

Here are two of the answers I received from other doctors who see this condition more than me:

1.    Um…I see a fair number of patients with significant deformities of their nails including clubbing, rippled nails, flaking, dents in the names and the distal phalanges with granulation tissue and fullness all starting after they started getting those acrylic manicures. They are pretty rough and they often get damaged nail beds.

2.    Hey Parsa, Unfortunately there isn’t much you can do for the nail pitting that you see with Alopecia Areata or Alopecia Universalis. You can cover it with acrylics – that would be fine, but would damage the nail further over time. Nail polish and manicuring would be preferred treatments. Using Biotin would be fine to promote healthier nails but wouldn’t get rid of the underlying problem. You can also try potent topical steroids to see if that would make a difference.  Hope this helps.

Q:

I started the Propecia at the beginning of March (8 months ago), prior to the procedure last March. Should I still be on it?

A:

It is great to hear from you and I am glad you are happy with the result of your hair transplant. The final result of your hair may still get better up until one full year after your surgery if you allow your hair on the transplanted area to grow longer.

Finasteride was mostly prescribed for prevention of shock loss after hair transplant or losing native hair on the balding areas after a hair transplant. You have significant miniaturization on the front, top and crown area (90%-100%), which makes your preexisting hair on balding areas prone to further hair loss. Now that you had your transplanted hair grown, you can decide to stop Propecia. By doing that, you may risk losing your own hair on the balding area further (transplanted hair does not need Propecia for its growth) or you can continue taking the medication to increase the longevity of your preexisting hair on those areas.

Q:

Dr. Mohebi, my next follow up appointment with you for 10 months follow up is scheduled in early January. I am very pleased with the results of my hair transplant, at the front, but, as we had thought, we may need to do some more at the back. When is a good time to do a repeat hair restoration surgery after the first one?

With all best wishes,

A:

If you need more density on the crown, you can consider another hair transplant surgery for that area anytime after 6 months from your first hair transplant. The reason you have to wait for 6 months is because at that point you should be evaluated for the growth of the grafts from your prior hair restoration surgery and donor area. All grafts should be grown at month six after your other hair transplant. So we should be able see which areas need to be covered further. Performing another hair transplant surgery may risk putting a new graft on top of an area that is supposed to grow new hair, but the hair is not visible yet.

Q:

Hi,

I’m a woman and I’m single. I feel like I need any edge I can get in the dating world, as I’m in my thirties and would like to begin dating for the possibility of marriage. I found Latisse on the Web but was wondering how I could buy it for myself.

A:

Hey there,

Latisse (bimatoprost 0.03%) is only available by prescription by a practicing doctor. Do not, I repeat, do not purchase Latisse at another place other than from a prescribing physician or your local pharmacy. There might be quack Latisse products on the market which may have severe side effects.

Latisse side effects include: eyelid skin darkening which may be reversible, and potential for increased brown iris pigmentation which is likely to be permanent.

Latisse does seem to enhance the appearance of eyes. A lot of people want big and beautiful eyes. Latisse can help make eyelashes look longer and thicker.  The effect is through increasing the period of time that hair follicles grow.

For those who want longer eyelashes and already have eyelashes that do not grow long and thick, Latisse is the right product. Another option you might want to consider is an eyelash hair transplant, if you qualify. People with scarring alopecia on the eyelash areas are good candidates for an eyelash transplant, and also people who don’t have very much eyelashes or none at all.