Hair Restoration Blog

Doctor Mohebi,

Q:

I wish to discontinue using both finasteride and minoxidil in the long run after minimizing the chance of shock loss following my hair transplant surgery.  Is this something we can achieve at my current stage or will I need allow further progression then have a second procedure?

A:

Stopping finasteride and minoxidil after the first six month following your hair transplantation will be alright.  However, you need to understand the risks involved, including continued loss on your existing hair.  Whether or not you need a second procedure is something that could be determined by a microscopic evaluation of scalp (miniaturization study).  If you have more than a certain number of miniaturized hair at any area, you will be running the risk of losing hair on those areas.

Stopping finasteride does not affect your transplanted hair, but you are going to run the risk of losing your existing native hair at any time you stop taking the  medications.

The use of growth factors to restore hair and to minimize hair loss, has been one of the latest techniques in hair restoration. Platelet Rich Plasma (PRP) which contains soluble proteins, including some growth factors, has been suggested as a treatment for hair loss, as well as many other medical conditions.  A new clinical study published in the Journal of Dermatologic Surgery, by Takikawa et al. from Japan, tries to shed some light on using PRP for the growth of hair in balding men.

What is PRP?

PRP or Platelet Rich Plasma, is the non-cellular component of blood that includes platelets and growth factors.  Plasma can be extracted from a patient’s blood in an outpatient setting. This portion of plasma which is extracted generally has a number of growth factors such as Platelet Derived Growth Factor (PDGF), Vascular Endothelial Growth Factor (VEGF) and many others. The growth factors are responsible for some stages of healing and remodeling after injuries or inflammatory conditions. This is why PRP injections have been claimed to be useful in helping many medical conditions with the healing of tissues and organs such as inflammation of soft tissues and injuries of tendons, fascias and muscles.

How is PRP prepared?

The process of harvesting PRP is rather simple, even from a non-medical point of view, which involves collecting the patient’s blood and separating plasma by spinning it in a centrifuge device. This process separates the cellular elements of blood such as RBCs (Red Blood Cells) and WBCs (White Blood Cells) from the liquid portion (plasma) that contains growth factors and platelets.

The study published by Japanese researcher featured 26 volunteers with balding and thinning scalp hair. 13 patients were treated with PRP-containing Dalteparin and protamine microparticles (D/P MPs) versus the other 13 that were treated with Platelet Rich Plasma (PRP) and saline.  The researchers tried to see the difference between the treatment of hair thinning with PRP, as well as the combination of PRP and D/P MPs. Dalteparin and protamine microparticles (D/P MPs) are carrying growth factors (GFs) in platelet-rich plasma (PRP).

Hair Quality

The quality of hair such as thickness and the number of follicles was evaluated at 2 to 3 week intervals and evaluated for a total of 12 weeks from the beginning to the end.  During this study a scalp with thinning hair was injected with PRP or saline in the frontal or sides of the scalp in volunteer individuals.

The final results were compared both macroscopically (from a big picture scale) and microscopically.  What resulted from the study indicated significant differences seen in hair cross-section, but not in hair numbers in PRP or the control group (D/P MPs). The report of this researchers indicated that addition of D/P MPs to PRP resulted in highly noticeable stimulation in hair cross-section. The Microscopic findings showed thickened epithelium (outermost layer of the skin), production of collagen fibers and fibroblasts, and increased vessels around hair follicles.
The researchers concluded that PRP&D/P MPs and PRP facilitated hair growth.

This study is a good start to focus more investigations on growth factor induced hair growth and should be completed in the future with more sophisticated research. A greater number of participants will be needed and a longer follow-up in order to reveal the long term effects of growth factors on hair restoration.

Future Studies

At Johns Hopkins Medical School, we did several studies using growth factors for wound healing.  The problem in most studies like this was that growth factors were usually very labile and were removed from the tissue very quickly.  In order to see the stimulating results on a cellular level, a continuous source of growth factors was needed.  We have attempted to overcome this problem by inducing the growth factors genes into skin cells using certain gene therapy techniques. I believe this might be a more promising path for using growth factors for hair growth or wound healing in the future.

Q:

Hi Dr. Mohebi,

I am not sure how rare hair growth after wound healing is in humans, but having done my Master’s in Tissue Engineering I was excited to find out that my condition might be of benefit to science.

I recently lacerated my shin mountain biking and after it healed I have fast growing dark hair around it.  I don’t have much hair on my legs so it was quite a shock.

Anyway, I just thought I would send you an email in case this was important.  Perhaps its more common than the literature states.

–
A:

Dr. Mohebi's research on wound healing and hair growth in animal model: Left: right after skin irritation, Right: 42 days after wound healing with longer than normal and de-pigmented hair

This is a great observation you’ve made.  The research team I was on had done some research on animal models a few years ago at Johns Hopkins that showed wound healing can enhance the growth of hair.  That was an incidental finding during some of our wound healing studies.  We noted some gene therapy techniques we used in the process of wound healing might have affected the hair in the animals we were studying.  In order to understand what this exact mechanism was, we did another study and only focused on hair growth.  It was during this particular study we noticed only the wounding of skin can cause hair to grow faster and thicker.

Before we publish our finding in our animal model of wound healing/ hair growth study, Dr. Cotsarelis and his team from the University of Pennsylvania published a very nice article in Nature in 2007: “Wnt-dependent de novo hair follicle regeneration in adult mouse skin after wounding”

This study has never been duplicated in humans, but it is a subject that definitely requires more investigation.  It is possible that with the same mechanism, the wound healing process in humans can affect hair growth.  We do know this won’t happen every time we have an injury in our body.  However, I am interested to know what other elements were happening in your case. Whether you had any medical condition, used medications during the time of injury or after, and how your wound was treated?  I also would like to see some pictures of the area with growing hair!

The 19th Annual ISHRS meeting for 2011 was held in Anchorage, Alaska. It was my first trip to Alaska and I was looking forward to seeing the beauties of the largest state in America.  Being very busy with many different activities, it made my time for sightseeing nearly impossible. I was required to be available one day prior to the opening day of the conference to get prepared for the many different events which were to come.

Hair Transplant Workshop

Dr. Mohebi and other faculties teach Hair Transplantation Techniques in ISHRS Meeting Anchorage, Alaska

I was one of the faculties for the surgical workshop. There were many new hair transplant surgeons who came from around the world to this annual scientific meeting to learn more about the art and science of hair restoration. The workshops included topics such as hair line design, cutting, placing, anesthesia, and donor harvesting and I was there to teach the latter course. There was great interaction between the faculties and students as they got the chance to learn the hands on techniques of surgical hair restoration.

Latest techniques of Hair Transplantation

The main thrust of the conference was the lecture series which gave a forum to many lecturers covering multiple topics regarding the many different areas of hair restoration. Since hair transplant surgery is still a relatively new field in the medical world, the greatest emphasis was on new technologies in hair transplantation, the latest techniques of hair transplant surgeries, devices, tools and methods of diagnosis and the treatment of hair loss.

ISHRS 19 Meeting: New Hair Transplant Surgical Instruments and Techniques Panel, Drs. Parsa Mohebi, Alan Bauman, Sara Wasserbauer and Kongkiat Laorwong

This year I was the moderator for the Giga-Session Hair Transplantation Panel. The panel included 2011 Golden Follicle Award winner Dr. Jerry Wong and Doctors Sharon Keene, Arthur Tykocinski, and Akaki Tsilosane. The discussions included properly choosing the best candidates for large number of grafts hair transplant surgeries (Giga Session Hair Transplants), planning for surgeries, as well as the full spectrum of Giga-Session Hair Restoration.

The Laxometer II was one of the newest innovative technology devices presented by me. The Laxometer was developed as a response to the need within the hair restoration industry for a measuring device for calculating the scalp laxity or skin mobility before hair transplantation surgeries. The Laxometer precisely measures the mobility of the scalp giving greater accuracy for larger surgeries or if a patient has a tight scalp. This device was introduced to the market for increasing the safety, precision, and efficiency of the hair transplantation.

Another device presented at the 19th Annual ISHRS Scientific Meeting was the upgraded Restoration Robotics, now called ARTAS System. This machine is now FDA approved for use in the United States and several lectures were presented about this new hair transplant technology. ARTAS was developed to help meet the need for increased precision and speed for scoring the follicular grafts in Follicular Unit Extraction (FUE) hair transplants. This is considered a very new technique in hair transplantation, but the robot currently only assists in one step of hair restoration. That is scoring the follicular grafts.  We still do not have a perfect automated system to extract and transplant the hair grafts. This device will need more time for testing and post-operation, long-term patient results.

Other New Technologies for Hair Restoration

In last few years, we have witnessed emergence of several new tools in hair transplantation that carried the claim to be the latest technologies and ground breaking tools for the field.  A lot of devices claimed they could change the way hair transplantation was done. However, many of those new tools did not deliver on their promise.  This has been a trend which has continued to be repeated for several years now. One of these devices was the NeoGraft that was sold to many non-hair transplant doctors with the promise of the simplicity of use and the minimal need for a surgeon’s involvement. The company has stated that the technicians can run the machine for the most part. One major issue the NeoGraft company forget to point out to these new costumers is the fact that hair transplant surgery requires experience and proper training in order to deliver great result. No machine, especially in the wrong hands, can substitute for lack of experience and expertise.

There were a number of lectures presented regarding the problems involved in hair multiplication, auto-cloning, hair stem cell research, and others important topics. Like years previous, there were several debates about Strip FUT vs. FUE,  manual FUE vs. automated FUE, also sharp vs. blunt punches for Follicular Unit Extractions.

Controversies in Hair Restoration

This year we had many controversial lectures such as lasers for hair restoration and growth factors, as well as mesotherapy and PRP (Platelet Rich Plasma).  The ISHRS allows for an open forum for hair transplant surgeons to share their innovative ideas, work, and theories that they can be giving constructive criticism and analysis by other experts in the field. This has been effective in keeping members of the society updated with new ideas and methods for hair restoration. It is unanimously agreed by members of ISHRS that hair restoration surgery is a progressing science and art which is rapidly growing into more advanced technologies and cellular level manipulations. It is well accepted that greater research is needed in order to thrust the industry forward in these new innovative areas for the art and science of hair restoration

The modern hair restoration surgery is still a fairly novel procedure in the world of cosmetic surgery even though it helps to retain a youthful appearance. Among the few known hair transplant practices around, there is great competition to appeal to the many patients who come each year to seek advice for their hair thinning and balding. The question in the back of many minds is “who is the best hair transplant company?” Or “how one should find the best hair transplant company?”

Although we at US Hair Restoration take pride in meeting the needs of all our patients, it’s our aspiration to provide the best hair transplant in Los Angeles, as well as to be one of the first choices for hair transplantation in the USA. Yet we want all who inquire about hair restoration to make an informed decision and be satisfied, even if they choose to see a different surgeon.

Reviewing all available information about a Hair Restoration practice is very important in order to make a fully informed decision. The questions to ask oneself should be, what are the doctor’s surgical technique expertise, experience, training, compassion, and results? Do these results show true value for the cost of a hair transplant? Do they place a high standard on honesty and integrity? These are all questions which will help navigate through the different options available to make a satisfied group of patients throughout the process of their hair transplantation.

Giving the fact that hair transplant has been rapidly growing in last few years, it is good to know whether or not the hair transplant surgeon you chose is involved in any studies, innovations and improvement of the field of hair restoration.  Being on the cutting edge of the industry is critical in an evolving scientific field which sets its aim of constantly improving in quality.

Finally you need to meet your doctor and interact with him or her.  Hair transplantation is a long process and it is important that you feel comfortable with the doctor before you proceed.  Make sure you have the proper questions during your consultation and that you don’t leave the doctor’s office before all the questions are answered.  At the end of the day you need to understand the results of a hair transplantation stay with you for the rest of your life. Take your time and find the best hair transplant surgeon for you.

We all agree it is a rough time for most people with the current economic state we are living in. At US Hair Restoration we hear many stories of individuals who greatly need to get a Hair Restoration surgery and want to do it with us, but are worried about Hair Transplant surgery costs. It is funny to tell you I have heard questions like “Doc, what is the hair transplant cheapest scenario?” from some of my young patients who know they need something done but are not sure if it would be affordable for them.  Every practice will have its own individual hair transplant price range, and here we want to emphasize the importance of not trading quality simply to appease the desire to find a cheap hair transplant.

What is the cost of my hair transplant:

Men and women hair transplant costs are the same and determined by the technique used to harvest grafts (FUE vs. Strip FUT) and how many grafts need to be transplanted. This is different for every patient. To give a precise estimation for the patient’s hair transplant costs, it requires a consultation by a hair transplant surgeon.

Quality vs. Affordability?

We believe in quality and patient satisfaction first and cannot provide one of those elements without the other. Even with all the competition in America and elsewhere, finding the most value for hair transplant cost in the USA is critical. We have plans which are catered toward meeting this need by giving an opportunity for financing a hair transplant.

Financing, Discounts, Other affordable rates for hair transplants!

Hair transplant financing is an opportunity we provide to all eligible patients. A patient who qualifies for hair transplant financing can receive a two year, 0% APR deal which makes paying their hair loss transplant cost an available option. Many have, and continue to take advantage of this affordable option for their hair restoration surgery.

Lastly, in our goal to provide an affordable cost of a hair transplant in the USA during this time of economic struggle, we have our stand-by program. We are excited to announce that if a patient is put on the stand-by list, they will get significant discount on total surgery costs.  We might also have special rates for students and group discounts if two or more member of a family or friends want to do their surgery within a month.  These additional offers have been a bridge to many who desire the procedure, in a time when money has been scarce.

We always knew that graying hair is thicker and may even grow slightly better than pigmented, or dark, hair. There was a recent article featured in the British Journal of Dermatology, which spoke of a study which aims to discover the correlation between why hair grey’s through evaluating the proteins or genes, which are related to hair growth in black and white hairs.

This was done by observing the morph patterns in scalp hair and eyebrows in humans. Also, using a microarray analysis, the white and black hairs were analyzed by looking at the differential expression of their genes.

These scientists showed that keratin and keratin-associated protein genes in gray hair were up-regulated at least 2-fold in comparison with black or pigmented hair in their analysis.  They concluded the expression of genes or proteins associated with active hair growth is up-regulated in white or non-pigmented hair compared with black or pigmented hair. These results suggest that hair graying is associated with active hair growth.

For more information on the published article, go to: http://www.ncbi.nlm.nih.gov/pubmed/21916889