Hair Restoration Blog

I am back from our summer vacation and we will be posting on the site regularly again. We have several visits to local California attractions and as always I took a whole lot of pictures.

This bald Lego-Man in LegoLand (San Diego, CA) looked very sad and reminded me of the article we published a few years ago on Hair Transplant Forum International “Psychology of Hair Transplant”.  In the article we discussed how hair transplant can affect changing people’s mood and energy level and make them feel happier.

I guess anything with hair loss is a subject for my photography and a topic for my blogs these days.

Q:

It seems to me that successful outcomes can, to a substantial degree, rely on the technicians handling the hair follicles. How do you measure your technicians skills?

A:

We have a great quality control system at US Hair Restoration in which every technician is monitored during cutting and placing.  We also have surveillance cameras in the OR to record the entire procedure for quality control.  We hire only highly qualified hair transplant technicians.  We still need to provide some special training to assure they can function according to US Hair Restoration standards.  We hold regular educational meeting for hair transplant techs to keep them all up to date on current procedures as well as US Hair Restoration quality expectations.

Check this post on my blog:  US Hair Restoration – Hiring Qualified Hair Transplant Technicians for more information on quality of hair transplant technicians.

Q:

What is the average hair loss after hair transplants? I.e. The number of grafts lost? I am sure that also relies heavily on techniques of hair transplantation.

A:

The survival of transplanted hair grafts should be over 95%.*

We do not expect to lose any grafts after hair restoration surgery.  There may be a 1-5% transection experienced with microscopic follicular unit transplants, but we have aimed to minimize this rate by enhancing the quality of our hair transplant techniques.

* According to some studies that were done on microscopic follicular unit transplant methods, 95-99% of newly transplanted grafts should take and hold.  We expect that the hairs should grow healthy hairs within a few months after hair transplant surgery.

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.

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).

Q:

Hi doc I have a question.  I really need to get an answer towards this.

I am a propecia (finasteride 1mg) user for hairloss.  I just read an article regarding how the FDA recently(yesturday) rejected finasteride for use as a prostae cancer prevention due to the fact that finasteride sometimes increases high grade prostate cancers in  individuals who take it.  I am a bit scared since I am a healthy 25 year old who has been taking finasteride 1mg for a while and plan to to take it for hairloss.  Is it possible that finasteride can cause prostate cancer for someone who takes propecia for long term?  please help.  the article really freaked me out. I will post the link to the article below.

http://www.nytimes.com/2010/12/02/health/policy/02drug.html

A:

Finasteride is a DHT Blocker that is used both for prevention of male patterned baldness as well as prevention of prostate cancer.  There are several studies that evaluated the rate of prostate cancer in patients who take Finasteride long term.

The reported data from a recent Food and Drug Administration advisory committee evaluates available data on DHT blockers and whether or not the labels should stat that they decrease the rate of prostate cancer.

They evaluated results from two large studies of the drugs. GlaxoSmithKline’s study involved 8,000 men at risk for prostate cancer because their PSA (prostate specific antigen) tests had found elevations of PSA. The men also had prostate biopsies, but at the start of the study none had received a diagnosis of prostate cancer.

The Finasteride study, sponsored by the National Cancer Institute, was done on 18,800 healthy men over age 55 who were randomly assigned to take either the drug or a placebo.

Both above studies indicated the drugs reduced the overall prostate cancer risk by about 25 percent which is a significant improvement.  However, both studies also found small increases in the incidence of higher-grade, riskier cancers, in men taking the drugs as compared with placebos.

There are two suggested reasons for the increase in these numbers.  One is that the drugs reduced the size of a man’s prostate, making it easier to find lethal cancers on biopsies.  Also, both medications reduce the levels of PSA in blood making early diagnosis of prostate cancer in those patients difficult.

In summary we know that DHT blockers such as Finasteride (Propecia or Proscar) reduce the rate of prostate cancer, there are some reports on some slight increase in the higher stages of prostate cancer in patients who were on those medications.  Finasteride (1miligram) is still recommended for prevention of male pattern baldness.

I generally ask the patients who are over 50 to be tested for PSA before they start taking Finasteride.  I also stress that their family doctor be aware of the medication they are using so any slight increases in PSA are able to be taken more seriously (as opposed to people who are not taking the Finasteride medication).

Q:

hi doc I have another question for you. I was wondering…when a person begins taking Finasteride, they go thru an accelerated shedding period that lasts roughly 3-6 months. After this initial period of shedding, just say that the Finasteride works and stabilizes the loss. Does the person end up growing back the hair that was lost during the accelerated shed? What if it doesn’t grow back? Is this the price that you must pay to halt or slow down loss with Finasteride? Do you have to take your amount of hair a step down in order maintain whatever’s left?

What if you fall into that 20-25% category of users who don’t respond to Finasteride in terms of hair stabilization? You could end up just accelerating your loss for those 6 months for no reason at all. Whether you stay on it or off, after this period, you will continue to lose. This is a big risk for people thinking about taking meds.

A:

Hair shedding is not equivalent to hair loss and shed hair will regrow as normal (especially in long and thick hair that is not miniaturized).

People who take Finasteride may have increased levels of hair shedding possibly due to increased hair cycling within the first few weeks or months of taking Finasteride, but the initial hair shedding should resolve within a month or two from the start date. Final effects of Finasteride should be assessed after at least 6 months from the time the medication was started, but can be seen as late as 12 months from when you start the medication.

For more information on this topic, please feel free to check out an earlier blog post below:

http://ushairrestoration.com/blog/2008/05/hair-shedding-after-starting-finasteride/

Q:

I recently had a hair transplant consultation with Dr. Mohebi but just had a few quick questions to clarify the information told to me in my consultation.

Dr. Mohebi recommended 3000++ grafts grafts to me. With an FUT hair transplant procedure involving 3000++ follicular unit grafts, what is the typical range of units that are actually harvested? And what proportion of the units harvested typically transplant successfully?

A:

With Dr. Mohebi’s recommendation of 3000++ grafts, he hopes to achieve somewhere between 3000-4000 successfully transplanted grafts.

While we cannot offer an exact number during your consultation, these are his recommendations based on your hair loss pattern, your personal expectations, density of hair on donor area and for strip surgery, scalp laxity.

If doctor Mohebi had recommended scalp exercises to you, that means you can help to improve the laxity of the scalp and increase the number of grafts that could be safely removed by performing the recommended exercises.  This helps the number of transplanted grafts to go more toward 4000, if you successfully perform scalp exercises.

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