Hair Restoration Blog

Q:

Dr. Mohebi, I have already made an appointment for hair transplant surgery on Wed April 20th per your recommendations and paid the deposit. If you don’t mind I have a quick question.

Do you think it’s realistic for me to see patients on Monday following my procedure? I have clinic that day and OR the next (will need to wear surgical cap), is this okay in the week following?

A:

Because we will be transplanting a large number of hairs in the frontal area of your scalp, we expect significant swelling until day 4-5 after surgery.  Occasionally patients may experience swelling until day 6-7, but your surgical cap use is okay and should easily cover it.

In addition, some patients occassionally get swelling and bruising around their eyes (which may be difficult to cover). Probability of bruising/swelling around the eyes is minimal but its possibility should still be notated.

Q:

I had a hair transplant back on October 31, 2009. I started getting red boils along my transplanted area (suspected to be folliculitis) in January and I have been taking Accutane for the last complete month.

My question to you is, why did it happen? Was it due to infected surgical equipment used in the surgery? I was advised to get such a heavy drug which has effected the overall tone of my face somewhat like getting severe dryness. Lastly, sir what do u think there are few patches in the infected area who are now like bald patches. Do you have any suggestions or medicine for the future?

A:

Pimple-like scalp lesions that develop after hair transplant surgery are typically folliculitis.

Folliculitis can typically be seen after hair transplant surgery in both the implanted and donor wound areas in the few weeks to month after hair transplant.

The development mechanism of folliculitis is similar to acnea.  It is usually due to blockage in the exit pores of the sebaceous gland (skin oil glands).  Following obstruction of those pores that can occur after hair transplant surgery, sebum (skin oil) cannot be emptied to the skin surface and instead begins accumulating underneath the skin surface.  The result is red or white head-like pimples.

Recovery is generally spontaneous. Although, if too many of these lesions develop, or if there was any sign of secondary infection (i.e.- redness or swelling around the area), the lesions may need to be drained by your physician and the patient may occasionally be recommended to use antibiotics.

Thanks to the generous vascular supply of scalp skin, the infection of scalp skin after hair transplant surgery is extremely rare.

The growth cycle of hair follicles differs between each individual.  For that reason, transplanted hair grafts also may not follow a universal pattern.  We generally schedule follow up visits for our hair transplant patients on the day 1, day 10, month 5 and month 10 following their hair transplant surgery.  Our five month follow up is to make sure patients are having a smooth early growth without any problems or complications.  In most cases, early growth is seen at five months post op.   In some people who started growing hair earlier we may even see something close to their final result.  However, we have had some cases that we did not see impressive results at month five and patients experienced delayed growth of their transplanted grafts following the procedure.

Delayed hair growth after After a hair transplant procedure - Class VI baldness - Before (left), five months (middle) and ten months (right) after hair transplant with US Hair Restoration

Most of these patients do not have anything wrong with their transplanted hair and will only have to be more patient with their hair growth.  We bring all hair transplant patients back in month 10 after their surgery and the results at that time are much better.  This group of patients may see their final result more than 10 months from the time of their hair transplant and it may take 12 to 18 months to see full result.  If the results are still poor at month 10, more diagnostic tests such as a scalp biopsy may be needed to rule out other causes of hair loss that might have been involved with the growth of their transplanted hair.

Using hair from other parts of the body for transplantation into scalp has been used for many years.  Unfortunately though, the change in the life cycle of body hair from different areas of the body has caused the body hair to stay as the last option for scalp hair restoration.  Body hair has long resting phase and short growth phase which means that most of the transplanted hair will stay in resting phase without having visible hair growth.

Comparison of scalp (left) vs. facial (right) hair: Note the difference in density of hair per surface area and the average number of hair in each follicular unit. Scalp hair is denser with more hair per grafts (over 2hair/graft) while beard hair is less dense with fewer hair per grafts (1-2 hair/graft)

Facial hair such as beard and mustache hair on the other hand has a longer growth phase and shorter resting phase.  That is why men can grow their facial hair to become really long.  Facial hair is also thicker than scalp hair in most people.  Thicker hair could be translated as more bulk of hair after hair transplantation.  Both longer growth phase and thicker hair shafts make beard hair a better option for scalp hair restoration in comparison to body hair transplant from other areas.

There are two problems with with beard hair restoration.  One is that they are very sparse and removing hair only needs to be done through a strip procedure.  The other problem with using facial hair for scalp transplant is that the facial follicular units are having fewer number of hair per unit that means less hair per grafts removed with FUE techniques.

Beard transplants are gaining popularity recently with newer techniques for extraction of hair (FUE) and it can be a great alternative to scalp hair for transplanting to the balding area in people who do not have good quality scalp hair.

Hi everyone,

I had a somewhat funny call to me the other day from a past patient of mine and wanted to share his experience with this blog. Although we, at US Hair Restoration, are known worldwide for our quality results and affordable prices, there are some downsides to the remarkable effects that your hair restoration may bring you without prior notice.

One of our patients called over to our office the other day laughing and telling our front desk receptionist that his passport photo looks NOTHING like him. He was traveling out of the country the following day when he had glanced at his photo and realized that the previously taken photo in no way resembled his current image. He called to request that I write a general letter confirming his procedure in the event that there were any discrepancies in his change of appearance.

We would like to apologize in advance for any unexpected changes in your appearance that may make you look years younger or like a different person following your hair transplant procedure. We are 100% proud of our patient results and happy to hear that if nothing else, these are the only few negative aspects of a hair transplantation with US Hair Restoration. We thank our patient for the great laugh and hope that he made it through customs without a hitch!

Q:

Where can I see Dr. Mohebi’s before and after photos? Would Dr. Mohebi be doing the hair transplant surgery himself? How are the donor hairs relocated once broken down into follicular units? Do they just get shoved into place? Am I completely out during the procedure or awake? How long before I don’t look like I just dove into a pool full of needles? Can you send me a link to you’re site if you have one. Thanks so much!
A:

Here is the answer to your questions:
Before and after photos could be seen in our hair transplant photo gallery that we try to keep updated with the new pictures on a regular basis.

Would Dr. Mohebi be doing the hair transplant surgery himself?
Yes, at this point all surgeries will be performed by Dr. Mohebi himself.  A surgical team will assist the doctor during the dissection and implantation of hair follicular unit grafts.

How are the donor hairs relocated once broken down into follicular units?
We transplant the hair grafts or follicular units based on the need of a patient. The doctor will draw the hairline before surgery and discuss it in detail with the patient.  Hairline designing has to do with the degree of baldness in each area and patients preferences.

Do hair grafts just get shoved into place?
The follicular units need to be maintained in special solutions in sold temperature while they are out of the body.  When the sites are made, we insert the grafts gently into them one at a time.  This process is very meticulous and usually takes a few hours.

Am I completely out during the procedure or awake?
You will be sedated, but you will not be totally out.  You will become more alert during the surgery in which you are sitting in a surgical chair most of the time.  You can be watching a movie, listening to the music or reading a book during your hair transplant surgery.

How long before I don’t look like I just dove into a pool full of needles?
You will probably never look like that, but if you are concerned with redness and swelling after surgery they may last a few days.  Most patients recover from surgical swelling and redness after the first 4 or 5 days.

Q:

Hi Doctor,

I am a class VI hair loss patient and have had one hair transplant in the past to get some thin hair on the front and top.  I am keeping my hair very short on the back and my primary goal was to camouflage the scar in the back of my head from previous hair transplants. So far, I have achieved this simply with longer hair, and the rest of my scalp was covered with Toppik-like products.

Cosmetically, it was successful, but usage of this kind of product is a bit messy and cumbersome. Thus I have shaved my head completely to try a different route. With the help of tattooing, I was going to go for a shaved head. Of course, the scar is a show-stopper and I need to consider my options. What I would consider successful is this: short hair covering my head completely, even with relatively light density. Combined with tattooing and a self-tanner to reduce contrast, that would be a success to me. I am not “greedy” about the sides at the front, and will accept a 3 or 3A pattern.

Is it possible in my case?

A:

It is good that you are not after high density and that you are realistic about the final appearance of your hair.  Being a class VI with limited donor hair, it should be possible to create some light density in the large balding area, but obtaining more density would be impossible or difficult due to your insufficient donor.  You need to know what your priorities are and how many surgeries you are committed to have.

• If you only need to revise the scar and get trichophytic closure to minimize the visibility of the scar, one surgery is adequate.  Double edged trichophytic closure is a new technique that can improve the appearance of the scar tremendosly.
• If you are after achieving higher densities and scar revision, you may need several hair transplant procedures if you have enough donor for them.

Through a consultation with an experienced hair transplant doctor, your donor hair can be easily evaluated and that can give you a good idea about what could be expected (in your case).

Double edged trichophytic closure is a new approach to donor wound closure.  Double edged or two sided trichotomy can help to minimize the complications of trichophytic closure based on the width of epithelium that is being removed and inability of some the hair follicles or oil glands to find their way out to the skin surface.

Hair Restoration Surgery is evolving rapidly and we are consistantly refining our approach on a regular basis to improve the quality of transplanted hair while at the same time minimize the possibility complications.

Double edged trichophytic closure helps us to minimize the width of the top skin layer (epithelium) that is being removed from each edge of the donor wound.  This approach allows hair to grow into the wound from both edges and thus minimize the contrast between scar (with no hair) and surrounding scalp (with 100% hair density).

By employing double edged trichophytic closure we constantly have results of less detectable donor scars and are able to minimize the risk of folliculitis or ingrown hairs in the donor area, which are the two common complications of trichotomy with the traditional methods.

Q:

Good Afternoon Dr. Mohebi,

My body trainer recently recommended that I go on a medication for body building purposes.  The medication that I am planning on taking is ANAVAR (an anabolic steroid), so I just wanted run it by you to make sure it would be OK to take it along with the Propecia I am currently taking.

I appreciate all you help, Thanks!

A:

Anavar (oxandrolone) is a weak androgen and is considered an anabolic steroid.  It is indicated as adjunctive therapy to enhance weight gain after weight loss due to an extensive surgery, infectious disease, trauma and so on.  Anavar has also been prescribed to some patients who for no reason fail to gain weight despite of proper nutrition and work out schedules.   It may also be used to maintain normal weight or to prevent the catabolism due to prolonged administration of corticosteroids.

There have been some online reports of hair loss with Anavar’s use and some exagerated hair loss reports in patients who take both Propecia (finasteride) and Anavar (oxandrolone) in conjunction. Although my personal searches in medical publications have never revealed any studies supporting this information, reports can be found online by its claimed users.

My general recommendation is, unless there is a strong medical indication for its use, those people with any evidence of male patterned baldness should stay away from anabolic steroids.  Although you may find some anabolic steroids over the counter, your family doctor should always be involved and aware of any anabolic steroids that you take as part of your body enhancing plan.

Hair Care Beverly Hills interview with Dr. Parsa Mohebi

Below is the second interview of Hair Care Beverly Hills with Dr. Parsa Mohebi.  Dr. Mohebi is the medical director of US Hair Restoration hair transplant centers in Southern California with offices in Encino, Beverly Hills, Orange County and San Diego.  Dr. Mohebi is the author of Hair Restoration Blog.  He also responds to the questions of many other resources of hair loss and hair restoration.  Her is his recent interview of him by Hair Care Beverly Hills for BuzyMoms.com.

• If a client has already had a transplant with another hair transplant doctor and is disappointed with the hair restoration results, can the procedure be redone?

Yes, hair transplant repairs are a good portion of our hair transplant surgeries performed in our Southern California offices (located in Beverly Hills, Encino and Orange County). Many people may have unnatural results from previous hair transplants due to the older techniques such as plug surgery, but some may even have problems with recent hair restoration procedures due to technical issues or lack of proper judgment on the part of the hair transplant surgeon. In most situations, the repair is easy and can be done in one or two sessions.

• Is there a minimum age for hair transplant surgery?

It was not unusual that a Hair transplant surgeon discourage a person younger than 24 for a hair restoration surgery.  However, nowadays microscopic techniques being used to evaluate the miniaturization of susceptible hair can assist surgeons in predicting the final pattern of hair loss. By being able to predict each patient’ s final balding stages, we are able to see where the pattern of baldness is heading and based on that recommend hair transplant surgery at an earlier age.

• Won’ t my bare scalp be showing in the back of my head once the donor hair is taken?

If you do not plan on shaving your hair after your hair transplant surgery, your donor wound will never be visible. However, if you plan on shaving your head for any reason, you may choose to have a FUE or Follicular Unit Extraction procedure done rather than the general FUT procedure through removing a strip from the donor area. FUE transplant eliminates the visibility of a linear scar on the back of your head and is the best option for patients who plan on shaving their head or keeping their hair very short in the future.

• Do you provide free consultations?

Yes, the initial consultation with me (Dr. Parsa Mohebi) is always free in any of our Southern California hair transplant offices in Beverly Hills, Encino and Orange County and San Diego.

• What type of information should be brought to the consultation?

Anything related to your hair loss and hair restoration, including family history of hair loss, other medical conditions that may have been attributed to ones hair loss, medical, surgical or even cosmetic changes that you like and may help you have a better result after a hair restoration procedure.