Hair Restoration Blog

Q:

Are there any constraints on performing a further procedure if required in terms of the time interval and / or the number of grafts that can be harvested within a second procedure which is a) FUT, or b) FUE?

A:

If we need to add density to an already transplanted area we have to wait 6 months following the first hair transplant surgery.  By waiting this minimum of 6 months, we are able to see the complete growth of the recently transplanted hair  from the first hair transplant and thus, we can go in between these hairs to put the new hair.  The number of transplanted grafts in the second procedure is typically a bit less than the first surgery because we remove the scar of the first surgery for the second time.

Q:

Dr. Mohebi,

I would like to thank you for the time you spent with me during my consultation.

You were thorough, knowledgeable and willing to spend as much time with me as was necessary in order to answer all my numerous questions.

I would also like to thank your office staff for their friendly and courteous treatment.

I have a  question regarding the prescription for Finasteride.  Am I to begin this prescription regimen immediately, just prior to surgery, or after hair transplant surgery?

I am certain you directed me at the time, but with all the info I had to digest, I somehow forgot whatever it was you said regarding the prescription.

Thanks in advance for your time in addressing my question.

A:

I am glad you had a good experience with our office.  I always enjoy having patients who present educated questions.  Below are my responses to your recent questions:

We are prescribing finasteride to you in order to prevent shock loss in the areas at the edge of your balding area following hair transplantation.  I generally recommend starting this medication about a week before surgery so it is locked in your system and shock loss could be prevented.  You should then continue this mediation for the fist 8 months following surgery, which is the time that you are most at risk for losing hair due to shock loss.

It does not matter what time of day you use Finasteride, as long as you are sure to take it once every day.
We look forward to see you soon.

Have a great weekend

Q:

Quick question for you doc.

I was wondering, will I need to buzz off all my hair before a hair transplant surgery? It really doesn’t matter, but I just want to know what I’m getting into. I imagine that my remaining hair, while very thin, obscures the scalp too much for comfort.

A:

You do NOT need to buzz off your hair before a hair transplant.

While some patients with significant miniaturization of their existing hair may be asked to cut it short or clip it, we typically are able to do this in office before the procedure if they are OK with it. Clipping hair is not mandatory in any way. However, it may increase our precision in some patients and we do it for them only if they have no problem with having very short hair for a while after hair transplant.

Q:

Thank you for your reply to my previous e-mail Dr. Mohebi. I’m getting close to being ready for this, but I still have some concerns that I would like to address prior to booking.

I realize I won’t come out of this looking like Brad Pitt, but can I expect some decent density in the area you’re going to operate on? I’ve seen a lot of pictures of “great” results that were little more than thin whiffs of hair lying limp over shiny, conspicuous scalp. I’d like to be able to style it in the youthful way, showing off my hair line. I suppose that depends on the number of grafts?

A:

The number of transplanted grafts and extent of your balding area are two very important factors in the final thickness of your hair. However, because you have fine hair, even with using the maximum density, you may not achieve the original fullness that you once had. Some patients with the same circumstances as yourself may need more than one surgery to develop maximum density close to that of their original coverage prior to losing hair.

Q:

I feel the Propecia takes an unbearable toll on my health, so I’m planning to drop the dose about 25% following the surgery. Provided that I have diffuse thinning all throughout, do you find this irresponsible?

Before seeing these latest photos, I thought the middle and back would hold out for a couple years on less finasteride, but it looks thinner to me now. Please let me know your thoughts overall on this subject.

With utmost respect,

A:

Decreasing the dosage of your medication may be considered if you present real side effects from your use of finasteride. It is easy to attribute many different health conditions to whichever medication that you are taking on a regular basis, but the best way to determine your next steps and how to properly decrease your dosages is to have your side effects evaluated by a specialist.

By having your side effects properly evaluated, your physician can ensure that you have no other conditions or causes for your bothersome effects. If we find that the problems you are experiencing truly are the side effects of finasteride, we may consider changing the dose or frequency of the medication.

Trichotillomania is a type of patchy hair loss which results from the compulsive pulling out or scratching of hair shafts.   The cause of this compulsive behavior is not completely understood.  Trichotillomania is not an uncommon condition and it can be seen in both sexes as well as different ethnic backgrounds.  Its lifetime incidence is about 0.6% and may be as high as 1.5% in men or 3.4% in women.

People with trichotillomania may initially be seen by a dermatologists or hair transplant surgeons without its sufferer being aware of their pulling hair habits.  Trichotillomania generally shows its first signs before the age of seventeen.  Circular balding patches are the initial signs that are typically seen almost anywhere that hair grows.  The balding patches are uneven and incomplete, unlike other patchy baldness conditions such as Alopecia Areata in which hair loss is almost complete in the balding patch.

Trichotillomania: Microscopic evaluation of lesions. Left: Hair shafts in different length and growth phases. Right: Hair loss and scalp skin inflammation due to scratching the skin by patient. (Parsa Mohebi, MD)

Microscopic examination of the balding patchs show broken hair and fine hair in different stages of growth.  Balding patchs of trichotillomania can most-likely be found on the scalp, eyebrows and eyelashes, but almost any area of skin has the possiblity of being involved.

Denying hair pulling is very common and in most patients, the doctor or one of the family members notices their habits first. Other self injury behaviors may be accompanied in patients with trichotillomania. These self inflicting habits should be addressed by a psychiatrist for the best possible outcomes.

Diagnosis of trichotillomania is clinical and and more often than not, no labwork is required to confirm its diagnosis.  Occasionally a skin biopsy may be necessary to rule out other causes of patchy hair loss, such as alopecia areata, cicatricial alopecia or fungal infections.

Most patients suffering from trichotillomania need behavioral therapy, but some may require medications such as selective serotonin reuptake inhibitors (SSRIs) to assist in breaking the habit.  Medical or behavioral treatments for stress reduction is also recommended for many patients.  Hair transplants are not recommended for patients suffering from trichotillomania due to the high likelihood of its sufferes pulling out the newly transplanted hair just as they had initially with their natural hair.  In most patients, trichotillomania hair loss can be reversible as long as the compulsive disorder is sucessfully treated.  A hair transplant can be used to restore balding or thinning patches that never completely recovered, but a hair transplant for trichotillomania is only recommended after months or years following the complete resolution of its sufferer’s compulsive hair pulling episodes.