Hair Restoration Blog

Q:

I have diabetes. Can I have a hair transplant procedure?

A:

Patients with diabetes can successfully have a hair transplant surgery if diabetes is under good control. Diabetes used to be a life limiting disorder and diabetic patients could not have many elective surgical procedures due to their increased risk of wound complications and infection. With the new medications and methods for controlling diabetes, patients with diabetes can safely have hair transplant surgery or any other elective procedures without significant increased risk of infection or complications with their healing phase. Here at US Hair Restoration, we need to have a clearance from the doctor who follows patient for his/her diabetes to make sure patient’s blood sugar is in normal range and diabetes is effectively controlled.

Q:

Is Hair cloning or multiplication being done anywhere yet?

A:

Hair cloning or multiplication has been in the news in the last few years. I prefer to use the term hair multiplication, rather than cloning because cloning refers to production of genetically identical organisms. Dolly the most celebrated sheep was the product of first cloning. When it comes to hair, we do not really clone the cells, but we culture them and try to get a whole organism from cultured cells. Unfortunately the process of culturing hair follicle cells has not been as simple as some other tissues in human body. The complexity of hair physiology is due to participation of many different stem cells in development of each hair follicle. In this process, we do not multiply genetic material or DNA of cells.

Hair cloning news

Hair multiplication if become a reality could bring about a great opportunity for bald people with violated donor scalp who cannot be good candidates for hair transplantation with current techniques. Despite our enthusiasm about hair multiplication, hair cloning news in last few years has not been filled with many success stories.

Hair cloning 2007

Year 2006 intercytex company announced that they are going to start phase 3 of hair multiplication study soon. Hair cloning has been in the news and many people are eagerly following that news to see when and how they can get a full head of hair using hair cloning techniques. Unfortunately, cloning hair has not been going that well and in last few years we only had limited research results on hair multiplication in animal models and in human. Here is the question that people usually ask me: Is hair cloning being done anywhere yet? And my answer usually is: Not except on experimental levels. Several investigations are in process on hair multiplication field and hair stem cell research.

Hair cloning 2008

Hair multiplication or as people call it hair cloning is a method that allows us to culture hair follicles and multiply it so we can increase the final number of hairs. So far, we know that it is doable on animals, and there are some reports of its feasibility on human volunteers. Safety has been one of the biggest questions on any research involved with stem cells. Stimulating growth of stem cells has always raised the flag for possible tumor formation. In year 2008, we should witness some results of the phase 3 studies on the procedure. During this year or in next few years, we should have a better understanding of the effectiveness and safety of hair multiplication. I know many of my patients are following hair cloning news carefully. Unfortunately, hair multiplication news has not been very fruitful in last year, but the process is complex and one way or another it will become clear in next few years that we can or cannot use hair multiplication methods in hair restoration surgeries.

Q:

How are you doing? All I have to say is TGIF.

I was doing a little bit research on hair loss, and I stumbled over retinoic acid. I read about it and have a basic understanding. Have you heard any claims that it could possible revive hair loss?

Have a great weekend!

A:

This is a good question. There are several claims on therapeutic effect of all-trans-retinoic acid (tretinoin) alone and in combination with 0.5% minoxidil for hair loss based on limited studies.

In one study the combination of tretinoin and minoxidil was used for 56 patients who had androgenic alopecia (male pattern baldness) and hair growth was followed. The growth of terminal hair was studied after one year of treating balding scalp with combination of topical tretinoin with 0.5% minoxidil. Increase in hair growth was reported in 58% of the patients who could complete the study.

Although tretinoin has been stated as a promoter of cell proliferation and vascular creation, which are both important in hair growth, there is still not enough scientific evidence from large studies to prove these effects. Also double blind studies on the efficiency and adverse effects of the product is lacking.

Alopecia areata

Alopecia areata is an autoimmune condition and causes patchy hair loss in any area in body. The bald areas of the skin usually look normal with no gross evidence of irritation or inflammation. A genetic association could be found in some cases and it could also be linked to other autoimmune disorders. Alopecia areata is usually a self limiting disease, but could be treated by a dermatologist with injection of steroid or with topical medications if necessary. See my article on alopecia areata “Treatment of Alopecia Areata РTreat or Not Treat”

Traction alopecia

Traction alopecia is very common cause of hair loss in children. This condition that is particularly seen among girls happens mostly due to the fragility and weakness of hair follicle in children. Tight ponytail is the common cause of traction alopecia that can cause hair loss at sides and frontline in most cases. Traction alopecia could present with elevation of hair line as an initial sign. Treatment of traction alopecia of children is by cutting hair short and by eliminating the physical assault. Recovery is generally spontaneous, and may take a few months. In some cases of prolonged traction alopecia, damage to the hair follicles could be permanent and hair transplant might be necessary.

Tinea Capitis

Tinea Capitis is a fungal infection of scalp that affects head and neck hair. Approximately 3 to 8 percent of American children are affected. Many of these children are never diagnosed. Tinea Capitis is more common in children between 2 to 8 years of age and like other fungal diseases can be transferred through direct contact or contaminated comb, brush, towel and cloth. Fungus attacks hair shaft and decrease its integrity and makes it fragile. Again a good dermatologist should be involved for treatment of this condition, which may need systemic antifungal medications.

Trichotillomania

Trichotyllomania is one of the other common causes of hair loss in children. It is a compulsive disorder that the patient has a constant urge to pull his or her hair. It is not limited to scalp hair and could be seen in any hair bearing area. Parents are not aware of this condition in many cases and treatment is through psychotherapy and behavioral therapy. Most cases resolve completely after treatment of the compulsive disorder.

Telogen Effluvium

Telogen Effluvium could be seen in adults and children. Many factors like sever infection, big surgery, trauma, fever, and emotional distress will cause this condition through converting the growth phase of hair follicle into resting phase. The hair in resting phase starts to shed. This hair loss is typically self limiting and recovers spontaneously without treatment especially in children. Diagnosis of this condition is often through excluding other causes of hair loss. Complete recovery is expected within 4 to 6 months.

Q:
Our 2 year old son has very fine hair and his hair growth has been very limited around his scalp. Is he going to lose his hair or you think his hair may grow as he gets older? Is there anything we can do that his hair gets better.

A:
Hair loss in children is generally not associated with their pattern when they become adults. In fact, most hair loss cases or limited growth patterns during the first two years is hereditary and if you search child’s family hair growth pattern, you should be able to find similar pattern in other family members when they were that age.

Children’s hair loss usually resolves spontaneously in vast majority of children. Other than congenital hair loss of children, they may lose hair due to a variety of other causes including: Alopecia Areata, Traction alopecia, Tinea Capitis, Trichotillomania, or Telogen Effluvium due to different disorders. Although most types of hair loss is self limited and resolves without treatment, any child with a hair loss should be evaluated by a dermatologist to rule out treatable causes of hair loss.

Searching for the best Los Angeles hair transplant surgeon may not be an easy task, but Los Angeles has always been a referral center for most cosmetic surgeries, even though hair transplant surgery is one of the newer branches of cosmetic surgery. You can find a wide variety in style and levels of Los Angeles and Beverly Hills hair transplant surgeons. Some of the most updated hair transplant surgeons practice in Los Angeles and San Diego, California, but you can also see lousy surgeries done by some hair transplant surgeons. Overall, hair restoration surgery like any other cosmetic surgery is a buyer‚Äôs beware market, and one must be careful not to fall into the trap of signs such as “Number one Beverly Hills hair transplant surgeon” or “the most experienced Los Angeles hair transplant surgeon”. You can see similar advertisements and a lot more like Extreme make over hair transplant surgeon or doctor 90210.

The good news is that today, most hair transplant surgeons offer free initial consultation. It is importantto take advantage of this situation and shop around. It is your look and your desire to live with it for the rest of your life after all. It is not enough to visit several hair transplant doctors; you also need to educate yourself on hair transplantation process, surgical techniques and hair transplant surgeon’s background before visiting the doctor. This way, you can appreciate a good technique and knowledgeable doctor when you see one while you can find the most affordable hair transplant. US Hair Restoration – a Los Angeles hair transplant surgery center offers free physician consultation for everyone. We offer state-of-the-art hair transplant surgery with exclusive follicular unit transplants (FUT), mega sessions for people with extensive hair loss and follicular unit extractions (FUE) or noninvasive hair transplants that does not leave an scar in the donor area.

Los Angeles is Hollywood and in Hollywood “appearance” is everything. Modern hair transplant surgery with undetectable results has become a demanding field in Southern California in last few years both because of the number of people looking for hair restoration surgery and the ones looking for the best hair transplant surgeon in Los Angeles, Beverly Hills and Southern California over all. Many people travel the world to get their hair transplant surgery done in Los Angeles or Beverly Hills. Los Angeles is and will probably always be the Mecca of hair transplant surgery for people who cannot accept anything but the best.

Q:

Dear Dr. Mohebi,

I hope all is well with you and the family. I wanted to see your opinion about something. Along with proscar, I use Murad shampoo (i dont know if you have heard of it) but it supposedly strengthens your hair and brings nourishment to the hair, therefore promoting hair regrowth. Remember how short my hair was when we first met, well now its relatively longer. Do you think i should keep it short for several reasons: easier to clean my scalp, exposure to vitamin d (sunlight). When my hair is long, I can see it shed, but when its really short it doesn’t seem that way. However, the downside to cutting my hair that short is that it will become pretty apparent that im experiencing hair loss. Thanks doc! take care!

A:

I hope you are doing well. Last time we met, we decided that you wait on doing a hair transplant procedure until your pattern of hair loss becomes more obvious. Here are the answer to your questions in the order you asked them:

• Murad shampoo has following active ingredients: Pomegranate extract, artemia extract, alpha hydroxy acids, phytantriol and Saw Palmetto. From all these only the last one or Saw Palmetto is proven for its anti hair loss properties through blocking DHT. However, the rate of penetration of this ingredient on deeper layers of skin where follicles reside is not completely clear. I don‚Äôt think it hurts to use it in general, but for someone like you who takes systemic form of DHT blockers (finasteride), I am not sure it can add anything in slowing your hair loss process.
• On whether or not keeping your hair short, it is up to you, you have to try them both and decide, long hair should not create any problem with cleaning hair. Do whatever you are more comfortable with. Neither of the two can affect the speed of your hair loss. If I wanted to choose, I would kept my hair long so layering can help covering the thin areas.
• Vitamin D could be absorbed from everywhere, especially in the sunny State of California.

Again, thanks for good questions,

Good Luck and have a great weekend
Dr. Mohebi

Toppik hair loss scam, does it really work? The fibers used by Toppik are made of the same material that hair shafts are made of and that is Keratin. The fibers of Toppik bond with hair and it’s nearly impossible with the naked eye to see that there is anything on your hair. It gives the appearance of fullness that you have a natural, thick looking head of hair. This is temporary because it does not grow hair but conceals it in the short term for a special meeting, date or party. Toppik is natural and safe and can eliminate the appearance of balding or thinning in only a certain group of patients.

The people who can get the most of Toppik are the ones who have hair with some degrees of miniaturization or thinning. If the hair is totally gone like in higher classes of baldness, Toppik does not help. Toppik needs some hair to be bond with to create the appearance of fullness.

Toppik - Scalp microscopic view

A scam is only realistic if you want to believe in it. We all know that hair loss is a bitter truth that affects many men. Men do anything to improve their appearance and hid their baldness. There are many methods that can help someone with hair loss to improve the appearance of his hair including hair transplant surgery and medical treatment for hair loss. Cosmetics like Toppik offer another way to deal with the hair loss problem.

Toppik for hair loss is a scam or not, does not really matter. The fact is that you should do whatever makes you feel better about yourself. Hair restoration is a proven treatment for psycho-social adverse effects of baldness. If you can use any other method such as Toppik to look better and feel better, why not trying it?

hey doctor!

As I read through forums and articles, people mention that propecia works better in conjunction with something else, such as rogaine for exmaple. At the moment, the vertex area of my scalp seems emptier than than the crown and minoxidil works well with the vertex. Do you recommend me go back on minoxidil for the vertex, or should I just focus on propecia?

Answer:
I generally prescribe finasteride to most of my patients who have significant miniaturization whether they are getting hair transplants or not. There are several studies on using Rogaine (minoxidil) and Propecia (finasteride) as single therapy and in combination with each other or with other medications.

Comparing minoxidil and finasteride for treatment of male pattern baldness clearly shows that treatment with only finasteride is more effective than treatment with only minoxidil. Combination of finasteride with minoxidil and with some other medications shows improved outcome, but the rate of improvement is not significant enough that I can convince myself to prescribe combination therapy to all my patients for the rest of their lives, considering difficulty of using topical minoxidil (topical spreading of medication twice a day on the balding area of scalp).

If you want to do everything possible to prevent or slow down further hair loss and maybe grow some, you can consider combination therapy, but remember when you start minoxidil you are committed to continue it for the rest of your life or until there are better alternatives.

I just received the last issue of the Hair Transplant Forum International, the Journal of International Society of Hair Restoration Surgery (ISHRS). Our article, Psychology of Hair Transplant‚ is published as the cover article on this issue of the journal. I also have a copy of the article in our hair loss library in our website. Here is the abstract:

Psychology of Hair Transplant

Parsa Mohebi, M.D., William Rassman, M.D.

Balding and its psychological impacts has been the subject of many studies in the past. The relationship between hair loss and stress is clear to all clinicians who practice in this field. Negative psychosocial impacts of hair loss in male patterned baldness and in women with generalized thinning have also been seen. Many of us (hair transplant surgeons) have seen the negative effects of hair loss on self esteem and self-image.

We know that hair loss impacts some men sex life and their stability with regard to career choices in men of different ages. Despite the solid evidences and published literature on psychological impact of hair loss, the corrective effect of medical and surgical hair restoration has never been studied. After observing the drastic changes in patient behavior and the high level of patient satisfaction in those who had hair transplant procedure, we were motivated to look into the psychological impact of hair restoration on different aspects of a patient’s life.

We came up with a series of criteria that could have been modified by having a hair restoration procedure; we used some indexes that were previously studied comparing bald and non bald men on different psychological variables. We initially performed a pilot study and asked patients about different aspects of their lives during their post op visits. We gave our patients open ended questionnaires and probed their psychological state after their hair restoration procedure was complete. Eventually we focused in on eight major criteria that have been reported and documented as variables associated with hair loss in the literature. We collected a subset of them in our pilot study. Included were questions on the general level of happiness, energy level, feeling of youthfulness, anxiety levels, self confidence, outlook on their future and impact on their sex life.

We have chosen the patients who had their first hair transplant surgery between one to three years from the time of our study, so they had seen the final result of their hair restoration procedure. We limited the study to male patients with male pattern baldness and the ones who had surgeries less than three years ago so they still had a fresh memory of the changes they experienced. Each patient had exclusively follicular unit transplants that reflected our standard of care for that period. We sent a questionnaire with a brief description on the nature of this scientific study. We did not collect any patient identifiers and the response was totally voluntary. We sent the two hundred questionnaires with stamped return envelope.

The response rate to our questionnaire was 37 (18%). Each patient was used as his own control since we asked about the changes that they experienced after surgery in comparison to those variables before the surgery. We used T-test to compare patient’s responses. Table 1 shows the mean and standard error in eight different criteria that were asked. Patients had significant improvements in all eight criteria regardless of their stage of baldness and their ages.

In another attempt to compare psychological changes that patients experienced in different stages of baldness, we divided patients into two groups: (1) those who had Norwood IV patterns or less and (2) the ones with Norwood V patterns and above. We observed the most significant difference in two categories, (a) sex life and (b) career experience. Patients with less balding had a greater impact on their sex life and career when compared to patients who had more advanced stages of hair loss. These changes were not age related.

Hair restoration surgery can affect many aspects of a patient’s life. Hair transplant can potentially reverse psycho-social problems associated with hair loss. The positive impact of hair restoration surgery is more visible among patients who suffer from those undesirable effects the most. In early stages of hair loss, patients may have more awareness of their condition and they might be more affected than men in the later stages of hair loss.

Patients who experienced hair loss at an early age while involved in an active social life were more prone to the negative side effects of balding. That could explain why younger people with hair loss appeared more benefited by hair restoration procedures. Also it could be assumed that hair loss can have a negative impact on a patient’s outlook which seems to reverse after receiving a hair restoration procedure which improved their outlook.

Low response rate from a blind mailing has always been a drawback in questionnaire studies. We received 37 out of 200 of the questionnaires that we sent out (response rate was 18.5%). Giving incentives to responders may be a good way of increasing the participation rate of any questionnaire studies. We presented the result of this study at the annual scientific meeting of ISHRS and have been contacted by many of our colleagues who expressed interest in collaborating in a larger scale study. We are currently trying to rise funding for repeating this study to optimize our response rate and the statistical value of the study.

If you have any questions on the content of this article you can contact US Hair Restoration office at Los Angeles through email at info@ushairrestoration or phone.