Hair Restoration Blog

Q:

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.

Alopecia areata (AA) is a type of local hair loss due to autoimmune reaction of the patient’s body against hair follicles.  Alopecia Areata generally presents as circular coin shape hair loss lesions, but it can progress to involve larger areas of the scalp (Alopecia Capitis) or even the entire body (Alopecia Universalis).

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.

At the 2011 International Society of Hair Restoration Surgery (ISHRS) Scientific Meeting, the updated statistics for the Hair Restoration industry were released. Hair Restoration continues to be a growing branch in the cosmetic surgery field for decades now.  The new data shows that it continues to be emerging exponentially and in 2010 there was an estimated 279,381 surgical hair restoration procedures, an 11% increase over the 2008 census. The United States alone reported 101,252 surgical procedures in 2010 as well.

The ratio between male to female hair transplantation patients in 2010 was 85.9% to 14.1%.  Since 2004, the number of female hair restoration patients has increased 24% which might be due to the better techniques of evaluation of female hair loss and better methods of determining the eligibility of the women with hair loss for hair transplantation.  Since 2008, eyelash, eyebrow, and face hair restorations procedures increased 14.2%. In the US alone, mustache and beard procedures nearly doubled (1,369 to 2,382).

For more information, check out the ISHRS Practice Census located at: www.ishrs.org/mediacenter/media-statistics.htm

Q:

Permanent shock loss- in the front center mostly and also areas in the temples. Is it likely from your experience that hair like mine will survive?

A:

Although  could be seen in some patients for the first few months after surgery, taking finasteride will minimize or, in most cases, eliminate that risk in the majority of patients.  However, if you do experience shock loss, it won’t be for more than 2-3 months and after that time, your transplanted hair will begin to re-grow. It is by then that your hair should look much better than it did before.

Q:

Hello Dr. Mohebi,I had a hair transplant consultation with you about a week ago regarding my hair loss type and the best method that suits my need. I am still doing some more reading and researching and I came across to the Bio-Matrix Strand by Strand (non-surgical) process.  I really would like to get your input on this particular process and if this is something that you recommend for someone like me who has lost almost 90% of his hair and might not get even 80% of it if I go through the surgical process…

I would really appreciate it if you can also advise whether you perform this method or not and if so how much it will cost approximately if I decide to do the non-surgical….

Thank you so much in advance and looking forward to hear from you…

Close up image of a Biomatrix - The mesh that keeps hair attached to the scalp. Click to see enlarged picture.

A:

Q:

Dear Dr. Mohebi,

I have recently learned that Finasteride injected into scalp and or taken orally not only stops hair loss but makes hair growth as well.  What is your opinion on the use of this  medication for female with hereditary pattern hair loss?  Is it safe, is it effective, do you use this method of treatment in your office?

 Thx.

A:

Finasteride injection is not approved nor recommended for male or female patterned hair loss and we do not recommend it.  Finasteride is prescribed for male patterned baldness in men and also it could be beneficial for women with hair loss secondary to hyperandrogenism (increased levels of male hormones) in women* to prevent or minimize the process of hair loss.  Finasteride (Propecia) is prescribed for typical forms of female patterned baldness without elevation of testosterone levels by some doctors.  However, there is no evidence to support its effectiveness on women with hair loss without elevated testosterone.

* The use of finasteride for women should be under a physician supervision and it is contraindicated in pregnant women.

Q:

Dear Dr. Mohebi,

I’m in my sixties and  consulted with you a year ago at your clinic, and had tests done, all normal.   I have had hair loss ever since I was nineteen years old.  The onset  was when I traveled to Europe, and it never stopped until in two cases:

1. With each pregnancy my hair loss almost completely stopped and gained a lot of hair back, but fell out after a few months during the period I was nursing my babies.

2.  About twenty years ago, I saw Dr. XX XX in Beverly Hills who prescribed Rogaine a solution that at the time wasn’t available over the counter.  After six weeks of application, I saw results, and after about four months I gained abundance of hair back, but started itching of scalps, and discontinued it.  When after being out of town for a while, I started seeking help, he had moved away, and couldn’t find that doctor.

For the past ten years or so that Rogaine has been readily available, I attempted using it even at the strength of male 5%, but have had no results.

Hair loss has been in my family, from my grandfather, on mother’s side, to my mother, and to me and now to my children.

My main questions are:

1. What was in the initial solution of Rogan that worked, and then over the counter ones didn’t work?
2. What is the latest preventive measures/solutions/hopes for this type of hair loss at least for my children’s generation?

Thank you kindly for your response,

A:

Hair loss medications such as Rogaine work only if you have active hair loss.  The effect is mostly preventative, but since it may make some of the miniaturized hair (finer hair that is in process of balding) thicker, patients may experience some enhancement in their hair bulk only for the first year of its use.

Some women with genetic female patterned hair loss may be good candidates for hair transplant surgery as long as they have protected (Permanent) hair on their donor area on the back and sides of the scalp.  Hair transplant in this group of patients should be done only if they are trying to reinforce a limited area of scalp.  However, a hair transplant is not a good idea if their goal is to increase hair density throughout a large area or entire scalp.

To be able to say what options are out there for your children, they need to be individually evaluated by a good dermatologist or a hair transplant surgeon and treatment options should be tailored to their individual needs.

Hair loss is a common side effect with some types of chemotherapy and can be experienced by both men and women.  Chemotherapy medications attach rapidly to proliferating cells and hair follicles are some of those cells responsible for the continuous growth of the hair.

What do you need know about hair loss after chemotherapy?

Hair loss can typically be seen in the first few weeks after the start of chemotherapy and usually becomes worse with time.  It may be several months after the end of chemotherapy treatments before you notice that your hair growth is getting better.  The new hair may have a different color or texture than you are used to, but it will gain its normal characteristics back over time. 

Unfortunately, there is no known medication to completely prevent hair loss after chemotherapy.  It may take months for the hair to get back to normal following the end of chemotherapy treatments. While many patients will experience stabilization or regrowth of hair after completion of chemotherapy, some patients will experience accelerated hair loss that they were to have regardless.

If your hair growth is not back to normal after 2 years from completion of your chemotherapy, you are recommended to be evaluated by a dermatologist or hair specialist for hair loss medical treatments (hair transplantation is possible and eligibility should be determined for you by a quality hair transplant surgeon).

There are several studies that suggest ketoconazole (Nizoral Shampoo) to be beneficial for men with male patterned baldness.  Ketoconazole has been compared with minoxidil in a research in 1998 that (ketoconazole 2% vs.  minoxidil 2%  in men with typical male patterned alopecia.  The study indicated improvement of hair density and growing hair with both medications.  Both 1% and 2% solutions and shampoos reported to benefit patients with male patterned hair loss.  The shampoo however needs to stay on scalp for at least 3 to 5 minutes before it is rinsed, which is not always easy in our today’s life.  Ketoconazole shampoo is used for treatment of seborrheic dermatitis or hair dandruff.

At this time, Nizoral Shampoo is not FDA approved for the treatment of hair loss and thus is not endorsed for this purpose for public.  We recommend finasteride for most men with active male patterned hair loss which has higher potency for correcting male patterned balding in comparison to minoxidil.  For more information on this topic, please visit our page discussing minoxidil vs. finasteride for hair loss.

Below are some responses to a few basic questions we received from a patient online:

How many grafts/hairs would I require for a good restoration? Could you please point to some examples.

Although for most cases with only frontal hair loss we recommend 1500-2000 grafts on average, your personal recommendation can be above or below that number depending on your eligibility, extent of balding area, history, donor density and scalp laxity.

An example of a female who received 1609 grafts with us can be seen here: http://www.ushairrestoration.com/hairrestorationbeforeaftergallery-view.php?album=93

What is the cost for hair transplants (including everything – procedural cost, fees, everything)? I understand you will not be in a position to get me the exact figures without a personal meeting but I need to have some rough idea to estimate my costs.

A hair transplant procedure performed at US Hair Restoration is calculated based on the number of grafts recommended to you. To determine what is recommended for your specific case, we recommend attending a free consultation with Dr. Parsa Mohebi at your earliest convenience. To view additional information on our general hair transplant costs please visit our hair transplant cost page.

There are times that US Hair Restoration offers Standby Rate discounts available to those with flexible schedules for booking the procedure.  Our stand-by option can offer you an additional discount (for discount rates and availability of this option please call 1-888-302-8747). You can also use our financing option in addition to that for your hair restoration.

Can the whole procedure be done in one sitting?

Yes. Overall, most hair restoration procedures performed by at US Hair Restoration will be completed in one day.  Occasionally patients may need more density that is not possible to create in one session or they have extensive hair loss that requires more than one hair transplant session.

Does FUE still have shock loss risks?
Yes, regardless of the technique of harvesting hair we recommend some sort of medication to prevent shock loss after hair transplant surgery.

In regards to your in-depth questions on exact number of grafts, donor hair growth, care after hair transplant, etc:
I recommend calling to schedule a free 30-60 minute consultation in which we can explain more detailed information to you personally and recommend an accurate number of grafts for your specific case.