Hair Restoration Blog

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.

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:

Q:

I was told that a spot has opened up for my hair transplant surgery. I told them to slot me in, but now that I’ve jumped into the deep end I’m a bit nervous. My nerves don’t have to do with what it will look like six months or a year from now, but for the weeks following the surgery.
I need to take the next day to really meditate on this. Although my hair loss does bother me, it’s not as if I’m noticeably bald. So I’m deciding if this is something that makes sense for me.

A:

It is completely normal to have a touch of nervousness prior to this elective surgery. Since it is an elective procedure, it is common to have questions and/or
reservations. We need to remember that it is simply hair and not some life threatening procedure! Many patients have this reluctance and there is never a clear or definitive answer aside from your intuitive feelings.

Your particular situation is for the enhancement and detailing in order to complement what you already currently have. Your hair loss is probably going to progress in the future but again, it depends on when you want to address the issue.

Having experienced seeing many other patients who had similar feelings before their hair restoration procedure, I think you will very happy you did it!! Either way, I support whatever decision you make. US Hair Restoration is always going to be a resource for you with whatever questions or concerns you have regarding hair loss and the treatment options available.

Meditate  on that assurance and clarity will present itself!

Q:

I am planning to have my hair transplantation with you soon and I have a few questions about the few days after hair transplantation.  I’ve been letting my hair grow so that I’ll be able to push it forward to cover the frontal work, but I’m concerned with how much swelling there might be, or if there’s a lot of shock loss, so that the hair I was going to use to conceal, fell out.
How many days is it again that the scabs usually persist? And how long would it be until I could get back into the gym or doing some other kind of exercise?

Also, I have been taking finasteride (1mg) and cutting the tablets into quarters. Is that correct? I haven’t kept up with the scalp massaging though. It was taking so long I was starting to wonder if was going to happen at all. But I could start doing that again now.

Thanks in advance, for your answers!

A:

These are great questions and I will be happy to answer them!

• Swelling
  Generally speaking, swelling after hair transplant surgery may occur 1-5 days following the procedure. It is usually moderate with certain exceptions which might be more noticeable and involve some area around the eyes as well. Not everyone experiences swelling, but I must always describe the worst case scenario: you may have an elevation (due to fluid) on your forehead which is alleviated by the medication we provide and elevating your head during the first few days after hair transplant.
• Bruising
  You may have some bruising or discoloration on the transplanted area, forehead, and occasionally around eyes which is even less likely, but necessary to mention. Wearing a baseball cap usually conceals your hair transplant for the following week. I’m sure your existing hair will do an adequate job as well (of course that is only for individuals who have some existing hair to cover the transplanted area).
• Shock loss
  The medication finasteride, or minoxidil in women, will help to lighten the shock loss (acceleration of the loss of native hair in balding area). Most of those shocked hairs usually go into a temporary resting phase and come back with your new transplanted hair.
• Scabbing
  The scabs are simply tiny crusts that dry up and flake off within a week.  They are hardly noticeable, and if you wear a cap no one can see anything.
• limitations in physical activities
  Exercise can be resumed two days following your surgery. Try to keep the blood pressure down (no squats, dead lifts, bent rows, etc) for the first four days after hair transplantation. If you can do some light machine work for a week, that would be best. Try to keep your head elevated/upright. You can do the treadmill or cycle, but just keep the intensity moderate. After 4 days post op, the grafts are pretty much locked in.

Rub your scalp before the hair transplantation. It helps! Your procedure size is rather small so scalp laxity will be a minor issue. However, do the scalp exercises! They are good for the delts also! And yes, you are correct in dividing the finasteride into 1/4′s!

Q:

I am on my day 4 after my hair transplant surgery. I’m a little concerned that I may have pulled out a few grafts accidentally. They sure look like grafts. But then, the hairs are all dry and brittle, with no moisture at the ends, and that gel-like substance is also dry. Could they have just broken off, or are these grafts that didn’t take?

Thanks again for all of your help and support. I really appreciate it.

Best wishes,

A:

That is an excellent picture! The most important question is whether you lost a graft or hair with scabbing after or before day 4 from your hair transplantation.  Looking closely at the photo you submitted shows that you may have lost the entire graft and it may have happened before then and you have found it now.

Remember that follicular units (a unit of one or a few hairs and their appendages) are very fragile in the first 4 days after hair transplantation.  If you accidentally scratched or rubbed the transplanted area during the first few days you may have dislodged the grafts and lost it completely.  However, any loss of hair after day 4 might be just a telogen (resting) hair with its attached scabbing and you still will grow normal hair from the remaining follicle.

Dihydrotestosterone (DHT) is a byproduct of the hormone testosterone, which is formed in different areas such as the prostate gland and hair follicles.  Hair follicles which are susceptible to genetic male patterned baldness contain DHT receptors.  Over time as males produce more and more DHT the molecules affect hair follicles and cause them to become decrease in size, and eventually fall out permanently.

DHT and having the gene of male pattern baldness are the primary contributing factors for male pattern baldness. Women with female-pattern baldness, unlike men with male-pattern baldness, are usually not characterized by increased production rates of DHT due to their low levels of testosterone.  However if for any reason a woman has increased testosterone, she may develop female patterned baldness just like a man does with the same mechanism.

Hair in the areas that are prone to male patterned baldness such as corners, top and crown areas are loaded with DHT receptors in men with Androgenetic Alopecia.  However, the hair on donor areas such as back and sides do not have as much DHT receptors.  This is why hair is more permanent on the sides and back as opposed to the top and front.

The distinction in hair quality on different areas (donor vs. recipient) allows a hair transplant surgeon to remove hair from one area and transplant it to the balding portions of the scalp.  These transplanted hairs are permanent and won’t be affected by circulating DHT. Finasteride (Propecia) is a drug that blocks the conversion of testosterone to DHT by blocking the enzyme alpha reductase.  DHT levels in hair loss patients decrease when they are on Propecia and this helps maintain healthy hair, and this helps some of the miniaturized hair become stronger.

We recommend medical treatment with DHT blockers in many of our patients who undergo a hair transplant procedure to help maintaining their own hair in addition to restoring the balding areas with hair restoration surgery.

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.

Avodart (dutasteride) and Propecia (finasteride) have recently been in the news for the report of some studies regarding their role in increased or decreased risk of prostate cancer.  Avodart and Propecia are both 5-alpha reductase inhibitors (5-ARI), which help prevent production of DHT (dihydrotestosterone).  This class of medications is indicated for the treatment of benign prostate (BPH) hypertrophy.  These DHT blockers also help with the prevention of male patterned hair loss and have been recommended and prescribed for hair loss treatment, for many years.

On one hand, several studies have indicated that DHT blockers could decrease the rate of prostate cancer.  On the other hand,  there are some studies that indicate they may increase the incidence of high-grade prostate cancers.  Those studies performed on both finasteride (7 years study) and dutasteride (4 years study).  It has been concluded that the patients who take DHT blockers should have prior knowledge of whether they have a lower risk of prostate cancer.  However, if the patient gets prostate cancer it might be in a category which is more advanced.

Doctors should be aware DHT blockers can decrease the levels of PSA artificially, so a small increase in PSA levels might reflect a higher activity of prostate tissue in comparison to patients who are not on DHT blockers. Overall, it is good practice to make sure all patients age 50 and older have a baseline PSA reading before they get started on finasteride.  This will determine their PSA levels before they begin taking medications, and the doctor will be able to monitor changes in PSA with greater precision.