Hair Restoration Blog

Q:

Hiya Doc,

I’ve read in a book on hair loss that mentioned, in certain circumstances, hair loss can be caused by emotional or mental stress. I’ve started to lose a bit of hair, but I’m really hoping it’s only temporary, as I don’t think I have genetic hair loss because my two older brothers seem to be doing OK.

How common is it for hair loss to be caused by emotional distress?

Thanks,

A:

Many hair loss patients who come to me for their initial hair loss evaluation associate the beginning of their hair loss to some stressful event in their lives. Many say they notice hair loss when they moved to another city or different country, got divorced or had significant problems at work or in their personal lives. Usually, they are right as these types of evens can accelerate hair loss.

However, hair loss would not happen to these same people if they were not genetically predisposed to balding. In other words, at age 30 and after, we may have the hair loss gene which is supposed to cause balding. At age 30 or after, if we are involved in a stressful situation, an emotional traumatic event, or major surgical procedure, it can accelerate the hair loss process. So the loss expected to be seen in 10 years could come around sooner.

Stress, trauma, or major surgeries may cause hair loss in people who are not supposed to lose hair, but the condition is temporary and the lost hair will grow back after the passing of the stressful condition, or treatment of the medical condition.

In these cases, patients have a condition called telogen effluvium in which, due to stress, a significant number of hair follicles go to sleep. Remember: patients do not lose those follicles permanently and the follicles can produce new hairs in just a few weeks.

My recommendation for you is to see a hair specialist and get your hair miniaturization mapped by microscope; this way the doctor can tell you whether or not you are experiencing an early stage of patterned baldness or that you have lost your hair due to stress.

If your baldness has just begun, medication may help you. If you are experiencing telogen effluvium without being predisposed to pattern baldness, you only need to wait and your hair will grow back in a couple of weeks.

Dear Dr. Mohebi,

First of all, thanks for this great blogging avenue.  I am very thankful that this website is around.

I’m a bit concern w/ my recent hair transplant.  i’m only 27 years old, and had decided to have a 2nd hair transplant done one month ago.   i was mainly just thinning in my front side, and was convinced by my hair surgeon that i should get a 2nd hair procedure done to add thickness in the thinning front side. Please note that the sides of my front have been pretty thick already, but i did have a few thinning gaps in the top center of my scalp.  Overall, i had a total of 1500 grafts transplanted on the front and a few on the center of my scalp (crown).

Immediately after the surgery, i felt remorseful.  i realized i should’ve done more research.  It just didn’t occur to me until the day after the surgery that this procedure might cause me to lose my native hair faster.  Right now, i notice a few shock loss on the frontal thinning hair.  I don’t think the center had much (if any) shock loss, as it had pretty thick native hair already.

I was wondering, would this shock loss accelerate the affected hair to retirement stage?  Lastly, overall, do you think this hair transplant will make my native hair to thin out faster had I not done the transplant?  I recall that my hair surgeon informed me that it shouldn’t be the case, and that any thinning results would be directly from my own thinning pattern.

Please support.  Thanks in advance.

A:

Many people who undergo a hair transplant have some degree of miniaturization (thinning hair shafts) on the balding area, which indicates there is active hair loss in those areas. Miniaturized hair is when your hair has already started the process of balding. Although the process of hair loss is usually very gradual and it may take years to complete, stressor (either physical or emotional) may accelerate the loss and facilitate the process of balding in prone hair (in thinning areas).

Shock loss is losing hair in an area with significant miniaturization due to a stressor. Shock loss after hair transplants used to be common in the past. However, using finasteride (Propecia) is proven to prevent this type of hair loss after hair transplant or significantly minimize it. I usually start all my patients on finasteride a few days before their hair transplant and continue it for at least six to eight months if they do not want or cannot continue it for the rest of their lives.

In regards to whether or not this hair transplant can affect the thickness of your native hair, I cannot say without performing a miniaturization study (examining hair with a microscope to determine the rate of miniaturized hair). If you had a large number of miniaturized hair to start with, you would be running a higher chance of shock loss. The chance of shock loss is usually higher for the first hair transplant. It seems like if you were to have a lot of vulnerable hair, you would have lost them mostly at your first hair transplant surgery. I recommend that you go on finasteride as soon as possible to protect your native hair if you are not already on it.  That is all you can do at this point.

What is Saw Palmetto?

Saw Palmetto is an extract of the fruit of Serenoa Repens. It is rich in fatty acids and phytosterols. It has been used in alternative medicine for a variety of indications, most notably benign prostatic hyperplasia (BPH).

Indications:

Prostate treatment

Saw Palmetto has also been used in treatment of benign prostatic hyperplasia (BPH), a condition known by enlarged prostate size to the degree that it makes urinating difficult.

Hair loss prevention

The role of Saw Palmetto in hair loss prevention has also been documented. Saw Palmetto is one of the few effective herbal treatments that can reverse hair loss process in some people to some degree and slow down the process of  balding in men. Saw Palmetto bio active ingredients prevent conversion of testosterone into dihydrotestosterone (DHT).

That is how Saw Palmetto helps to stop the process of balding on the hair follicle level. It can help increase the thickness of miniaturized hair and make them grow longer. The Saw Palmetto effect is comparable to finasteride or other DHT blockers by mechanism. Saw Palmetto is available in oil extract for topical use on scalp or as pills used for prostate enlargement treatment.

It is about 8:00 Pm and we just finished performing a big FUE procedure and I thought I write this post on “who is a candidate for FUE procedure” before going home.

Recipient and donor area right after a FUE (Follicular Unit Extraction) procedure.

Follicular Unit Extraction or FUE hair transplants is one of the methods of hair transplantation with Follicular Unit Transplant (FUT) technique. The biggest advantage of FUE is that, the linear scar in the donor area on the back is eliminated.

FUE has been around for a few years now. Many people ask about the advantages and disadvantages of FUE when they are considering doing a hair transplant surgery. People always ask; whether or not FUE hair transplant is the right procedure for them. There are many articles on hair transplant techniques including FUE and its different methods that compared FUE with regular techniques of strip hair transplant. Hair transplant surgeon has to consider patient‚Äôs needs when planning for a hair restoration procedure. Many surgeons don‚Äôt do FUE on a regular basis. This needs to be explained to the patient. Unfortunately some doctors talk patients out of this procedure simply due to their inability to perform one. That is the same for mega session surgeries that many people are told that grafts won’t survive if place too densely only because they can not perform one. This might be due to not having enough skilled personnel or any other limitations.

Donor area with small wounds of FUE punches right after FUE procedure

The most important factor that people consider when they consider doing a FUE is elimination of linear scar on the back with FUE hair transplant surgery. It might be because they want to wear their hair short on the back or shave it at some point. FUE by far is the only method that can completely eliminate the linear scar on the donor area. Have more comfortable post-op period is the other reason for choosing FUE.

All patients need to be tested before performing an FUE procedure for their candidacy. At the Los Angeles office of US Hair Restoration, Dr. Mohebi tests all patients who are considering this method for their hair restoration. FUE test (FOX) is easily done in the office with to extra charge to the patients. We perform a mini FUE procedure under local ansthesia to test feasibility of removing intact follicular unit grafts with different FUE technique and see which method is the right one for each patient. If patients are FOX negative then other options should be discussed with them. Even if patient’s are FOX positive, they have to understand that they may have a much better yield and superior final outcome with regular strip technique. For some patients, not having scar on the donor area is more important than having higher density in recipient area and they can live with thinner hair in the recipient area, but they don’t want any line of scar at all. These patients are the best candidates for FUE if they are tested positive for that.

Q:

hi, why do men with thinning hair seem to have a reddish color to their scalp and men with thick a thick head of hair seem to have a whiteish color to their scalps……i find it a condition that exists in alot of cases several of the men i observed wear caps when they are outside so i’m quite sure the sun had nothing to do with it. one of my sons has a very thick head of hair……..”whiteish” scalp..my other son has thin hair and a reddish skin colored scalp.

again thanks for your help

A:

Thin (Miniaturized) hair is generally seen lighter and in people with dark but thinning hair, hair could be seen as light brown or reddish color, not because it has less concentration of the pigment (melanin), but due to its smaller size and less number of pigments overall. One of the first signs of hair loss could be lightening hair color in the thinning areas. Scalp tone is also a reflection of hair color especially in people with fair skin that you can see through the skin and hair shaft may alter skin tone.

Q:

Hope you had a great weekend, Just a quick question.

After how long usually I would see the result of those pills (finasteride)? Will it grow like baby thin hair and it thickens over time or should I like shave my head to help it? J just wonderin‚
Regards,

A:

Be patient,

It is unlikely that you grow new hair from the areas that you lost hair follicles. The medication finasteride can help increase the thickness of your miniaturized hairs that normally do not give you any significant cosmetic effects. You should not see the effect of medication before 3-6 months from the time you started it.

Remember, the purpose of medical treatment is not to grow your hair back as it was when you were 17. The goal of medical hair restoration treatment with either minoxidil or finasteride would be to stop or at minimum slow down the progression of hair loss. Shaving your head should not change the progress of hair loss or gain either. When you manipulate your hair whatever you do, you are dealing with external part of the hair, which is not alive. The follicle does not sense what is going on outside at hair shaft level. To restore it more permanently in front and top of your scalp, you would need a hair transplant.

Best,
Dr. Mohebi

Q:

Hi Doctor,

My mother is obsessed with my hair loss and gives me a whole bunch of vitamins and mineral tablets everyday to help regrow my hair.
Do you think they work? Or should I stop them.

A:

Although lack of certain vitamins and minerals could cause hair loss in their sever form, living in north America and having a normal and balanced diet; it is unlikely that you are suffering from vitamin or mineral deficiency. On the contrary, if you look at your family pattern of hair loss, you probably can find other male members of the family who has similar male pattern hair loss. As I always say, you need to have the triangle of baldness, which is “Gene, Male gender, and time” to become bald. Vitamins deficiency is not to blame as part of triangle of male patterned hair loss. You can continue taking vitamins to please your mom, but don’t overdo it since vitamins are not going to bring your hair back. Instead you need to see a good hair specialist or dermatologist and undergo a good hair loss evaluation with miniaturization study and start taking one of the effective medications to prevent further hair loss or to use hair transplant to restore your lost hair.

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.