Hair Restoration Blog

Often times we at US Hair Restoration receive calls and emails from individuals who are ashamed that they need a hair restoration for their balding situation and want to hide the fact they contacted us for advice. Although we are very sensitive to the needs of each individual who seeks our help, we also want to speak encouragement over their situation as well as give them new hope, confidence, and a fresh perception of what they are getting themselves into.

Modern technology has allowed us capabilities we did not have 50 years ago. Just as with vision problems, many have the disadvantage of wearing glasses. Although there are contact lenses as well, there is still a dependence upon outside tools for sight, which can be inconvenient. After many years, LASIK was developed which has solved this stubborn problem of fading eyesight which many, to this day continue to suffer from.

If someone chooses to undergo a LASIK procedure, does it make them an insecure person? Not in the least! Rather, they are using their resources to look their best and be as functionally independent as possible.

We always use the latest technology in hair restoration at US Hair Restoration, which was not available as recent as 10 years ago. The question to ask is, why not use it? Thousands are doing it every year with excellent results, and nobody is concerned if their hair is native or transplanted.  Hair loss is a disease, yes a common one and like any other diseases there are treatments for it.  The proper conclusion is that these individuals are no longer bald and don’t have the competitive disadvantage like those who decided to do nothing for their baldness.

 In the end we all must be ourselves and do whatever makes us feel our best. No matter what we do with our lives, there will always be someone who will be critical of whatever we do.  Regardless of what others may say, do whatever makes you feel good about yourself.  There are options available to you today that was not available to your ancestors.

Often times we at US Hair Restoration receive questions about the difference between the FUT Strip Method and the FUE procedure. Some will make claims that one option is superior, while the other is inferior. Both hair transplant techniques are done in US Hair Restoration and have their own adavntages and disadvantages.  Here is a list of reasons supporting both the strengths and weaknesses of the FUT Strip Method and the FUE:

The FUT Strip Method

• Allows the hair transplant surgeon to transplant a larger number of grafts in one session. Most people who have never had a hair transplant surgery can have maximum results in only one procedure.

• Allows the surgeon(s) to process and harvest the grafts under a microscope minimizing the level of damaged hair follicles.

•  Can be achieved at a more rapid speed than the FUE.

• What can be achieved in one FUT strip procedure can take 2-3 FUE surgeries.

• The number of damaged grafts might be greater for certain patients which undergo the FUE procedure because of their unique hair characteristics. People with wavy or   curly hair may have a higher risk of transection than patients with straight hair. A FOX test may be performed on patients with curly hair or wavy hair to determine whether or not they make good candidates for an FUE procedure. A FOX test is a small FUE procedure which helps to determine the level of damage to follicular graft before proceeding with a complete FUE transplantation procedure.

• The FUE requires more tedious labor and the cost for performing an FUE is usually more than a strip hair transplant.

• FUE procedures require a highly skilled operator and create a technical challenge for less experienced technicians who don’t have good hand-eye coordination.

The majority of the patients which receive a hair transplant with the strip method are going to have a linear scar on their donor area.  This scar can be minimized with certain surgical techniques such as the trichophytic closure, but it can never completely be eliminated. FUE hair transplant procedures offer unique advantages for differing patient circumstances.

FUE Procedure

• The scar visibility is slightly noticeable to completely non-existent with the FUE.  It may leave some miniature spots because of a lack of hair in that particular area or de-pigmentation, like a small dot which is lighter when seen close up.

• Hair can be kept short after the Hair Transplant surgery in front and back.  Any types of spots or de-pigmentation are not easily detectable.

• There is minimal pain for most patients and they don’t need pain killers after their hair transplantation.

• The surgeon can get donor hair from different parts of the body which the strip method has limited areas to take from. Areas such as the temples, beard and other body hair is included in this.

• The surgeon can choose the specific type of grafts to harvest.  When a special type of follicular unit is needed, this option is very good because the surgeon can choose the exact number of specific grafts to transplant. This is great for touch up work on the frontal hairline which needs single hair grafts, or for filling an isolated crown balding spot that does not require any singles.

• The contrast between high hair density and bald areas can be decreased by the FUE. Restoring hair in a scar only needs hair added to the scar, and the FUE would help to minimize the contrast between the scar and the surrounding areas more easily.

Despite of all above advantages and disadvantages about the two methods discussing them with a good hair transplant surgeon is a good starting point to find out what it the best option for you.

Q:

I went to a couple different hair transplant doctors for evaluations when I was 24/25 and was told I have a juvenile hairline and that i have a good donor area and scalp laxity. The doctors recommended around 2000 grafts to fill in the diffused area at the time.

One of the doctors I visited told me to give propecia another try which I did for an additional six more months, but stopped because it seemed to have no effect and from my understanding it doesn’t really help with hair in the frontal area which was my main problem. I also did not want to risk getting any more health side effects from taking propecia.

During this time I was also taking biotin supplements which I had read are good for hair but they didn’t have any noticeable effects. I decided against getting a hair transplant because of my age and I wanted to see if the hair might grow back naturally (some people who have lost hair from accutane reported regrowing their hair several years after taking the medication).

I have a history of MPB in my family but it seems to be hit or miss. My grandfathers both had full heads of hair, my dad and 1 of his brothers are completely bald but another brother has a full head of hair. My mom has 1 brother who is bald and another with very thick hair and a low hairline (which my hair most closely resembled before taking accutane). I also have a brother who is 21 and has extremely thick hair like I used to with no signs of hair loss whatsoever.

A:

Male patterned baldness (MPB) is a progressive condition and it generally won’t get better without treatment.  The medications that are being used for the treatment of hair loss are generally for maintaining your existing hair and have preventative effects rather than restoring your hair at its full thickness like what you had in previous years.

A good hair transplant surgeon can help you realize what the best options for hair restoration are; whether it is a surgery or medication.  Using Accutane could cause hair loss as one side effect, but that is reversible within a few months after stopping it.  That is the most common case for medication related hair losses.

It is important for you to develop a good relationship with a qualified hair transplant surgeon whom you can trust.  Then let him walk you through this process.  Using medications for a while is a good idea and some patients respond well to using them.  Unfortunately the results are not permanent and most hair loss sufferers continue losing hair, but at a slower rate.  

You can use medications such as Propecia or Rogaine to minimize the speed of hair loss. When it is the time for a hair transplant you can consider that as another option as well.

Q:

My doctor put me on propecia at 21 when I told him about the hair loss and I took it for about six months but it had no effect on my hair loss. I also started to use rogaine around age 23/24 for a couple of months but stopped because it made my hair loss worse (before rogaine the majority of my hair loss was in the front area of my head and after using rogaine I started to lose hair on my crown as well). My hair loss has been pretty stable over the past 2-3 years and I have continued to lose some hair but nowhere near the amount I lost initially.

I wash my hair every 2-3 days and only notice about 20-30 hairs lost compared to the hundreds I lost early on. My hairline has not really been effected at all and my hair loss doesn’t seem to match any on the norwood scale, it is just diffused loss throughout and matches the description of many accutane users who have lost hair. I have also been using the ProThik concealer spray for the past 3 years which works great because my hair loss is diffuse and makes it unnoticeable, but the process of applying it in and combing through it causes my hair to get tangled and pulled out so I think over time that has also contributed to my hair loss. I lose far more hair putting in the concealer than I do washing it and combing through it naturally.

For the first 2 years of using it I would wash my hair and re-apply it daily, although over the past 6-8 months I have gone 2-3 days between washing and reapplying it and only lose 10-20 hairs when I comb through it in the morning. I am not sure how much of my hair loss in recent years has been caused by this but I suspect that is has had some effect, especially during the time I was applying the concealer every day.

A:

Many young hair loss patients may start taking finasteride or minoxidil when they see the signs of active hair loss in their early 20s.  That is the time most people lose hair at its maximum speed.  Medications such as finasteride or minoxidil are only to prevent hair loss or even in some cases slow down the process.  They are not to bring your hair back to where it was before you started the process of hair loss.

I recommend you visit a hair specialist who can perform microscopic evaluation of your scalp (miniaturization study).  That can give you more information about the type of your hair loss and the treatment methods. Having regular follow up visit with your hair doctor helps you to know whether or not your hair loss medication works.  You may also need a hair transplant when the time come and the time and type of the restoration surgery could be discussed with your hair transplant surgeon.

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.

Q:

Hi Dr Mohebi,

Can you tell me your opinion on products like iGrow (low level laser therapy).

Thanks so much,

A:

Hello,

Unfortunately, there has been very little research done on different types of laser treatments for hair restoration and most studies are done in small numbers, lacking significant results.  As you already know there are a variety of devices such as laser combs, hoods, or brushes, yet most of these do not show significant improvement like I continue hearing from my patients who used them before. In spite of all this, I have heard a growing number of hair specialists talk about how they are seeing good results from the Laser Cap.

It seems like the best candidates are people with generalized hair thinning, as in typical female patterned hair loss.  Laser cap treats entire scalp with 224 individual red 5mw – 650 laser diodes.  This is much more coverage than the comb or other hand held laser devices offers.

I reviewed your file and based on your microscopic evaluation from 3 years ago you might be a good candidate.  However, I would like to evaluate your current condition with another microscopic evaluation.

A person’s self-esteem and self-image is greatly affected by the amount of hair they have on their head. When a disease or trauma brings about hair loss, those results can have be weighty on the individuals they affect. Finding solutions to these situations isn’t always easy, but there is an opportunity available to help these individuals get through these physical and emotional recoveries.

We are pleased to announce that Dr. Parsa Mohebi is one of the active members of Operation Restore.  Operation Restore is a Pro Bono Foundation established by the International Society Of Hair Restoration Science (ISHRS) which connects prospective patients suffering from hair loss due to an accident with volunteer physicians to help restore the physical appearance and emotional wellbeing. This program specializes in giving a new opportunity and fresh start to those who cannot afford hair restoration, but are in great need of a hair transplantation.

Over the years multiple patients have been helped through this honorable charity and Dr. Parsa Mohebi is proud to be a part of it. He, along with many others, continues to donate thousands of man hours each year to see those who are victim to disfiguring accidents, receive a new start.  US Hair Restoration is proud to give back to this cause and see many receive a new beginning.

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.

Prostaglandins have been traditionally used for the treatment of both open-angle glaucoma and ocular hypertension. The funny thing is doctors accidentally found out the prolonged use in these eye drops surprisingly increased the density and pigmentations of eyelashes. This epiphany is what brought up the idea for why they later used and marketed these drops for cosmetic purposes to elongate the eyelashes in the form of Latisse.

The active ingredient of Latisse, bimatoprost, is present in Allergan’s product.  The drug company Pfizer sells a similar product called Xalatan.  Xalantan (latanoprost) behaves similar to prostaglandin PGF2α and for the same reason can increase the growth of eyelashes.

As mentioned, the effect of Xalantan on length and pigmentation of eyelashes was proven several years ago. There are several positive studies which indicate the effects of Xalantan on hair in the other parts of the body such as eyebrows or scalp hair. However Xalantan is still not approved, nor currently recommended for scalp hair restoration. More research is needed to address its efficacy for hair loss prevention in its pattern form.

There is a recently published study in the Journal of American Academy of Dermatology called “Assessing the Efficacy of Topical Treatment by Latanoprost on Hair Growth and Pigmentation in Androgenetic Alopecia.”

This study was writen by Blume -Peytavi et al. in the Department of Dermatology of Charite-Universitatsmedizin in Berlin. In this study the researchers evaluated the number of hairs, their thicknesses, and pigmentations in a 24 week period while patients used the medication topically on their scalp. They concluded that Latanoprost significantly increases hair density in the form of terminal (thick, mature hair) and vellus hair (peach fuzz). It is recommended that this product could be used as a hair loss medication in the future, but more research is needed to assess its long term effects before we can truly consider latanoprost as a hair loss medication.

Dr. Mohebi,

You classified my hair loss as class III.  I agree with the evaluation but given my family background I will be approaching more towards class V or VI.  My miniaturization % is 30 in both Top and Crown areas which means there is a sign of active hair loss.  Do you think we can arrange something to cover up those two areas as well?  Or, is my miniaturization level too low to have any type of procedure in those areas?

A:

You are class III of hair loss and as you said, you might be going toward class V or VI.  However, prescribed finasteride  you might change what is considered your genetic pattern by taking it.  I don’t recommend that we transplant hair in certain areas just in case you get lucky with the hair loss medications, you may never lose that existing hair.  If you progress to lose more hair, you can always have another hair transplant surgery in the future for those existing areas.  Even if you don’t continue hair loss medications, it is hard to predict if you will totally lose hair on the top and crown areas.  Your particular numbers for miniaturization is slightly more than normal.  A good decision today is a good decision tomorrow.