Hair Restoration Blog

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.

The 19th Annual ISHRS meeting for 2011 was held in Anchorage, Alaska. It was my first trip to Alaska and I was looking forward to seeing the beauties of the largest state in America.  Being very busy with many different activities, it made my time for sightseeing nearly impossible. I was required to be available one day prior to the opening day of the conference to get prepared for the many different events which were to come.

Hair Transplant Workshop

Dr. Mohebi and other faculties teach Hair Transplantation Techniques in ISHRS Meeting Anchorage, Alaska

I was one of the faculties for the surgical workshop. There were many new hair transplant surgeons who came from around the world to this annual scientific meeting to learn more about the art and science of hair restoration. The workshops included topics such as hair line design, cutting, placing, anesthesia, and donor harvesting and I was there to teach the latter course. There was great interaction between the faculties and students as they got the chance to learn the hands on techniques of surgical hair restoration.

Latest techniques of Hair Transplantation

The main thrust of the conference was the lecture series which gave a forum to many lecturers covering multiple topics regarding the many different areas of hair restoration. Since hair transplant surgery is still a relatively new field in the medical world, the greatest emphasis was on new technologies in hair transplantation, the latest techniques of hair transplant surgeries, devices, tools and methods of diagnosis and the treatment of hair loss.

ISHRS 19 Meeting: New Hair Transplant Surgical Instruments and Techniques Panel, Drs. Parsa Mohebi, Alan Bauman, Sara Wasserbauer and Kongkiat Laorwong

This year I was the moderator for the Giga-Session Hair Transplantation Panel. The panel included 2011 Golden Follicle Award winner Dr. Jerry Wong and Doctors Sharon Keene, Arthur Tykocinski, and Akaki Tsilosane. The discussions included properly choosing the best candidates for large number of grafts hair transplant surgeries (Giga Session Hair Transplants), planning for surgeries, as well as the full spectrum of Giga-Session Hair Restoration.

The Laxometer II was one of the newest innovative technology devices presented by me. The Laxometer was developed as a response to the need within the hair restoration industry for a measuring device for calculating the scalp laxity or skin mobility before hair transplantation surgeries. The Laxometer precisely measures the mobility of the scalp giving greater accuracy for larger surgeries or if a patient has a tight scalp. This device was introduced to the market for increasing the safety, precision, and efficiency of the hair transplantation.

Another device presented at the 19th Annual ISHRS Scientific Meeting was the upgraded Restoration Robotics, now called ARTAS System. This machine is now FDA approved for use in the United States and several lectures were presented about this new hair transplant technology. ARTAS was developed to help meet the need for increased precision and speed for scoring the follicular grafts in Follicular Unit Extraction (FUE) hair transplants. This is considered a very new technique in hair transplantation, but the robot currently only assists in one step of hair restoration. That is scoring the follicular grafts.  We still do not have a perfect automated system to extract and transplant the hair grafts. This device will need more time for testing and post-operation, long-term patient results.

Other New Technologies for Hair Restoration

In last few years, we have witnessed emergence of several new tools in hair transplantation that carried the claim to be the latest technologies and ground breaking tools for the field.  A lot of devices claimed they could change the way hair transplantation was done. However, many of those new tools did not deliver on their promise.  This has been a trend which has continued to be repeated for several years now. One of these devices was the NeoGraft that was sold to many non-hair transplant doctors with the promise of the simplicity of use and the minimal need for a surgeon’s involvement. The company has stated that the technicians can run the machine for the most part. One major issue the NeoGraft company forget to point out to these new costumers is the fact that hair transplant surgery requires experience and proper training in order to deliver great result. No machine, especially in the wrong hands, can substitute for lack of experience and expertise.

There were a number of lectures presented regarding the problems involved in hair multiplication, auto-cloning, hair stem cell research, and others important topics. Like years previous, there were several debates about Strip FUT vs. FUE,  manual FUE vs. automated FUE, also sharp vs. blunt punches for Follicular Unit Extractions.

Controversies in Hair Restoration

This year we had many controversial lectures such as lasers for hair restoration and growth factors, as well as mesotherapy and PRP (Platelet Rich Plasma).  The ISHRS allows for an open forum for hair transplant surgeons to share their innovative ideas, work, and theories that they can be giving constructive criticism and analysis by other experts in the field. This has been effective in keeping members of the society updated with new ideas and methods for hair restoration. It is unanimously agreed by members of ISHRS that hair restoration surgery is a progressing science and art which is rapidly growing into more advanced technologies and cellular level manipulations. It is well accepted that greater research is needed in order to thrust the industry forward in these new innovative areas for the art and science of hair restoration

Laxometer II

Often times we receive inquiries at US Hair Restoration about the latest hair transplant technology, and we feel obligated to spread the news about the latest hair transplant technology.  We are excited about the new generation of Laxometer, the newest hair transplant device invented by Dr. Parsa Mohebi. The Laxometer II is a handheld device which revolutionizes the art and science of hair restoration. Being in the growing sector of the cosmetic surgery arena, progressive updates on hair transplant new technology is critical.

Applications

The revolutionary Laxometer II increases the number of hair grafts which can safely and precisely be transplanted in one surgery. A hair transplant of more than 3500 hair grafts once upon a time took two or more surgeries to complete, but with this latest technology in hair transplantation, it can be done in only one procedure.

The Laxometer II, the new technology in the hair transplant industry, is basically a measuring device which is used to calculate the laxity of one’s scalp. An accurate measurement of scalp laxity is critical when determining how large the donor strip can be. This latest breakthrough hair transplant technology gives a precise measurement which can be increased as a result of patients actively doing daily scalp exercises. The larger the available strip, the more grafts can be made available for transplantation.

At the International Society of Hair Restoration Surgery’s 19th Annual Scientific meeting in Alaska in September 2011, Dr. Mohebi unveiled his new invention for purchase to all hair transplant surgeons. This latest technology in hair transplant surgery was welcomed with anticipation and applause as it will help to continue the industry progressing forward.

Here is a video demostration of the Laxometer work: Laxometer Instructional Video

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.

DHT and Hair Growth Inhibition in Mice

There is new research about hair growth and the effect of DHT which indicates more details of DHT (Dihydrotestosterone) mechanism on hair growth in mice through inhibition of insulin-like growth factor-1 in dermal papillae cells of hair.  The study results are published by Growth Hormone Research Society (Zhao et al.).
The researchers showed IGF-I [Insulin-like growth factor-I (IGF-I)] present in some hair follicle stem cells (dermal papillae) was increased following the stimulation of their sensory nerves in mice.

We know DHT inhibits hair growth by negatively modulating growth regulations.  The researchers found DHT blocks the release of calcitonin gene-related peptide (CGRP).  They noticed an increase in the IGF-I and proteins which are being made from that effect.  They demonstrated the administration of DHT for three weeks lowers the levels of CGRP, IGF-I AND IGF-I mRNA in the skin of mice. The number of growing hairs was decreased and the re-growth of hair follicles was blocked after the administration of DHT to those mice. Observations of this sort makes clear DHT causes its anti-growth effects on hair through decreasing IGF-I in dermal papillae hair cells.

These new research reports on hair, growth factors, and hair stem cells will lead us in the direction of finding more efficient ways for treating human hair loss in the future.

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:

Minoxidil (Rogaine) is one of the two proven treatments for hair loss along with hair transplant. Although minoxidil mechanism of action for hair growth is not fully understood, there have been several suggested mechanisms such as:

• Nitric oxide chemical agonist effect impactig scalp blood vessels
• Potassium channel opener causing hyperpolarization of follicles cell membrane
• Vasodilation possibly due to its nitric oxide effect

This new study is done in Department of Immunology of Kyungpook National University in Korea. The result of the study was published in The Journal of Dermatological Science shows a new mechanism for minoxidil as activator of β-catenin pathway in human dermal papilla cells, one of the two stem cells involved in development and growth of hair. The investigators announced that this mechanism could be an explanation for anagen prolongation effect of minoxidil.

The length of the actively growing hair in anagen phase (growth phase) is responsible for hair length. The investigators indicated that maintenance of β-catenin activity in the dermal papilla cells (DPCs) enables hair follicles to keep growing actively. Minoxidil or Rogain promotes hair growth in male patterned baldness suggesting that minoxidil can prolong the growth phase in hair life cycle.

The study is done in mouse model with application of 3% minoxidil for ten days. DPCs were transfected with β-catenin responsive TCF reporter plasmid. They showed that extension of anagen phase was significantly promoted after minoxidil application. The researchers concluded that minoxidil extends the anagen phase by activating β-catenin activity in the DPCs and that can be one of the main pathways in its hair growth or hair loss prevention mechanism.

Studies like this increase our understanding of hair loss and hair growth and over time can help hair restoration field to have more options to fight hair loss in a more efficient way.

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.

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.

Discount for FUE Transplant – Limited Only for Study Participants

As a leader in hair restoration, US Hair Restoration is now conducting a study on different methods of FUE (Follicular Unit Extraction) hair transplantation in its Southern California offices.  Our main goal of this study is to compare the quality of grafts harvested by the most advanced hair restoration techniques.  Study patients will be entitled to a discount from our standard rates of FUE hair restoration. The study will be going on until the end of July 2010 and the results will be submitted for publication in world-wide medical journals.

Who is a good candidate?

Hair loss patients who does not want to have linear scar on the back of their head might consider this option most probable for their needs.  Also, any candidate should know that the number of grafts available to be harvested in one FUE session might be significantly less than what could be done through a traditional strip method.  Thus, in addition to those who want to avoid scarring, patients who does not need a large number of grafts for their hair restoration may also be relatively better candidates.  FUE could be used for treatment of male patterned hair loss with class III and IV, eyebrow hair transplants, or to restore the linear scar from a previous strip procedure. Applicants can call the US Hair Restoration office at 1 (800) 302-8747 to schedule a consultation with Dr. Mohebi.  If you are still unsure whether or not FUE is the right procedure for you, please read our website and in particular the page on Follicular Unit Extraction.