Hair Restoration Blog

Diffuse Unpatterned Alopecia (DUPA) is a hair loss condition in which hair thinning is seen diffusely throughout the scalp.  In DUPA, there is no a reserved area with good quality hair even on the areas of the back and side which are typically designated as the donor area in hair transplant patients.

A microscopic evaluation of the scalp generally shows significant miniaturization (fineness) of scalp hair diffusely.  DUPA can be seen in both men and women but its female type may at times be mistaken with typical female patterned baldness due to its close similarities.

A thorough medical evaluation with supporting lab work to rule out other causes of diffuse hair loss is always warranted before determining eligibility for a hair restoration procedure.  Hair transplantation is generally not a good option for people who have DUPA due to instability of the scalp hair on the back and side areas of the scalp.  Many people who have DUPA may suffer from other medical conditions that cause hair loss such as Iron Deficiency, thyroid or other hormonal imbalances or autoimmune disorders.  Medical treatment such as minoxidil in women and finasteride in men could be helpful in treatment of this condition.

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.

Every now and then I see patients in my office that have no sign of baldness whatsoever, yet they are extremely concerned about losing their hair.  Some of these patients have even previously received hair transplants from other clinics.  Body Dysmorphic Disorder (BDD) or body dysmorphia is a type of mental illness in which a patient is always preoccupied with his or her appearance and cannot stop thinking about one or several problems in their face or body.  This problem may be an exaggerated preexisting problem or it may be totally imaginary.

People with BDD often have significant anxiety and do not want to be seen by anyone if possible because they think their appearance seems too shameful.   BDD could be seen in both men and women and it is estimated that 1–2% of the world’s population meet all the diagnostic criteria for body dysmorphic disorder (Psychological Medicine, vol 36, p 877).

People with BDD are intensely obsessed over their appearance and their body image, often for many hours a day or even to the point that it affects their life or work. They may ask for several cosmetic procedures in an attempt to improve their perceived image, however they are never satisfied and their perceived image cannot ever be met. If the doctor seeing this patient cannot diagnose the problem and agree to pursue with a cosmetic procedure, he or she will also tend to be blamed for some (or at times all) of the problems that they imagine they have.

Diagnosis of BDD

1. Preoccupation with an imagined or slight defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)

In research carried out by Dr. Katharine Philips, involving over 500 patients with BDD, percentages of patients concerned with the most common problem locations of their bodies were recorded and hair problems were reported in as high as 56% of patients as the second most common problem (after skin) that these patients express having.

Treatment of BDD

Treatment of body dysmorphic syndrome involves cognitive-behavior therapy which includes education about BDD and its treatment, and specific treatments to deal with faulty thoughts.  In some patients, medications may be needed as well.

International Society of Hair Restoration Surgery (ISHRS) has done a nice work on its website.  The organization that is the most prestigious organization for hair restoration surgery has challenges people for the differentiating a transplanted hair to a natural head of hair without any hair restoration surgery done.

The site requires you to take a survey to see if you can detect which of the people in the photos in the site have had a hair transplant and to determine how important hair is to you. The survey will only take about 5 minutes to complete. Here is the questionnaire.  By responding to the hair transplant challenge survey you can help to add to the knowledge about hair loss and hair restoration surgery.

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Q:

Hi Doc! How are you?

I have question regarding my hair loss problem. I’ve noticed it just 3 weeks back. As I’ve been reading your infomercial regarding the causes of hair loss. I think I am categorizing my problem to Alopecia Areata where I have one circled affected areas on the right of my front hairline & 2 at the right side at the back of my head. Before that it was small and now it is becoming bigger day by day.

Hope you could help me to find a solution of my problem. Thanks a lot! Hope to hear from you soon!!!
More power!!!

A:

Alopecia areata (AA) in its typical form is easily distinguished from typical patterned male and female hair loss.  Obviously, you need to be examined by a hair specialist or a dermatologist to confirm the diagnosis.  Alopecia areata generally present itself with a patchy or circular (coin shaped) balding spot and could be seen in almost anywhere in the skin.  The lesions are confined to their primary spots with no sign of hair loss in neighboring areas.  Some authorities have recommended steroid injections to facilitate the improvement of the lesions.  However, spontaneous recovery is seen in most patients with no interventions.

In contrast, hair loss pattern in male or female patterned hair loss is more widespread with the hair miniaturization (thinning) advancing to the neighboring areas.  Hair transplantation is not indicated in alopecia areata while it could be the only permanent solution in most cases of patterned baldness.

Dr. Mohebi,

You performed a hair transplant on me to make a female hair line as part of my male to female transgender process.  I recently decided to do a scalp surgery that may require a scalp advancing procedure.  My Dr. Will transplant hairs along the scar in hairline.  I am not convinced this will be enough, and we may need to do one final pass after all is done to be sure, possibly the middle of next year.  I’ll have to wait and see, money is also an issue.

A:

Good luck with your scalp advancement surgery. Please do your research and make sure your plastic surgeon does perform hair transplant on a regular basis before letting him place hair on your hairline.  It is especially important that he has experience with creating hairline for transgenders.

If he is not doing hair transplant on a regular basis as is the case for many cosmetic surgeons, it might still be OK to have him put the hair removed during the scalp advancement surgery on the top areas, where you still need more reinforcement.

Hairline is very meticulous specially for male to female trans gender patients.  We can easily repair the hairline in front of the scar of your scalp advancement surgery.  It will be more difficult if there is less than perfect transplanted hair on the hairline area.  that requires removing the hair grafts that are transplanted out of their normal locations and reuse them in the other areas.

Q:

Dear Dr. Mohebi,

Thank you for taking the time to see me on Saturday! Your correspondence providing a summary of our discussion was very comprehensive and is much appreciated!

Since our meeting on Saturday, I have done some research and would like to trouble you with a few more questions:

1) Is Alopecia the correct term to describe my hair loss pattern?

2) Would you consider cortizon shot treatment for me?

3) Would you consider laser therapy?

4) If I were to use monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

I wish to thank you again for all your time and patience!

Best regards,

A:

Hi,

Here are your answers in the order you asked:

1) Is Alopecia the correct term to describe my hair loss pattern?

Alopecia is a general term that means hair loss. We have many different patterns of hair loss or alopecia, like male pattern or female patterned alopecia or alopecia cicatricial. Your pattern is similar to a male pattern because you lost your hair on the frontal area while you kept your hair on the donor area intact, which is why you might be a good candidate for a hair transplant procedure considering that your medical evaluation is negative for any medically treatable cause of hair loss.

2) Would you consider cortizon shot treatment for me?

No, steroid shots are sometimes used for Alopecia Areata (AA), which is an autoimmune disorder. Alopeica Areata is a hair loss condition with patchy hair loss spots. Your condition does not seem to be Alopecia Areata.

3) Would you consider laser therapy?

I do not recommend laser therapy for hair loss in the form of laser comb or laser machines because of the lack of solid medical evidence that support their effectiveness at this time.

4) If I were to use Monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

You can start with 2% and then you need to be re-evaluated in six to 12 months and a treatment plan might need to be adjusted at that time.

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

Any good internist or endocrinologist could follow through with the lab works that you need.  Our letter includes the list of medical conditions that should be considered and lab works to rule out those women like you who have hair loss. You can share my letter with any good internist or endocrinologist and he or she should be able to follow through with your lab result and treat any treatable conditions that could possibly be found.

Have a great day,

Follicular Unit Extraction (FUE) – Advantages or disadvantages

My patients always ask about advantages and disadvantages of Follicular Unit Extraction so I thought this topic makes a good post for the blog. Before going over these points I have to say, although we at US Hair Restoration offer the most advanced techniques of FUE nationwide, most of our patients are still being transplanted by strip technique and I don’t recommend FUE to everyone and select my FUE patients very meticulously. Here are the main reasons why we do recommend FUE to some people and not to everyone.

Advantages

• FUE does not leave a linear scar, which is great for those who want to wear their hair very short on the back or the ones who may need to shave their head in the future (like actors).
• FUE has a more comfortable healing process with decreased healing time.
• No restrictions in physical activities for those who want to do strenuous exercise right after FUE procedure.
• FUE is a viable alternative for those who have tight scalp that makes strip surgery risky or impossible.
• Follicular unit extraction makes it possible to harvest hair from body, beard or almost everywhere else.
• FUE is very useful when we need limited number of grafts like for restoration of eyebrow hair.

Disadvantages

• The biggest disadvantage of follicular unit extraction is that the maximum follicular unit graft yield is lower than when it is done with strip technique due to higher rate of follicular transection compared to the strip technique.
• Although linear scar is not present after FUE, small punctuate scars will be there that may make future FUE hair transplant surgeries more difficult or impossible.
• Not everyone is a candidate for FUE and patients need to be tested with FOX before proceeding with the surgery.
• FUE procedure takes much longer to perform compared with strip FUT procedure.
• FUE is more laborious thus it cost more compared with strip technique hair transplants.
• In FUE, we have more chance of burying grafts that increases the risk of having folliculitis (tiny inflamed cysts under the skin) on the donor area.

Q:

I underwent a gastric bypass surgery about 2.5 years ago and since a few months after surgery my hair has been thinning. What do I need to do to prevent further loss?

A:

Losing hair or changing the quality and color of hair after gastric bypass surgery is commonly seen within the first few months after the gastric bypass surgery. This condition can mimic shock loss that could be seen after hair restoration surgery. Right after the gastric bypass surgery your body goes through a period of severe starvation and tries to divert nutrients toward more vital organs instead of skin and hair. Although carbohydrates, proteins, minerals and vitamins especially the family of vitamin B has been blamed for the hair loss in patients who had gastric bypass, it can happen while all of those elements are within normal range and the exact mechanism of hair loss after gastric bypass surgery is not completely known.

The great news is that the hair loss after a gastric bypass surgery is always temporary. Your hair condition should return to normal within a few months of hair loss occurrence. Patients who had gastric bypass should have serial examinations within the first few months of their gastric bypass. Your surgeon should check many elements because gastric bypass surgery could increase the incidence of iron, folic acid, vitamin B12, calcium, and vitamin D deficiency. Most people need to stay on supplementation of these minerals and vitamins. Close monitoring with regular laboratory tests for these deficiencies should be done by your surgeon or primary care physician.

Q:

I have heard high estrogen in males can contribute to hair loss. Is that true? I am a 40 year old man with low sex drive and female patterned hair loss.

A:

High levels of estrogen in men could be seen in many other conditions such as estrogen-producing tumors, congenital adrenal hyperplasia, chronic alcoholism and advanced liver disorders. Elevation of estrogen in men can cause sexual dysfunction, change in body fat distribution in a female pattern and breast enlargement and secretion.

Balding is not a typical sign of excess estrogen. In fact one of the signs of estrogen deficiency could be hair loss in female patients. A common type of this kind of hair loss is seen in telogen effluvium that women lose hair due to sudden drop of estrogen and progesterone levels. Although excess estrogen is generally not the trigger for hair loss, it can affect the balance of other hormones and indirectly cause hair loss. The latter is not a common cause of hair loss in men or women though.