Hair Restoration Blog

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?

Mega session hair transplant surgery has been around for almost a decade since Dr. Rassman and others started doing bigger and bigger sessions. Before 1993 all could be done was less than 1000 and occasionally 1500 grafts per each session. Using newer techniques and larger team of experienced technicians, we at US Hair Restoration are currently performing large sessions on a regular basis.

Not all physician teams are equal. If a doctor routinely performs sessions in over 2500 graft size, then it would be safe to assume that this doctor has mastered the skills required for large session. Unfortunately, not all doctors have either the teams or the skills to accomplish the feat on a routine basis. Limiting the size of the session to under 2000 grafts, it may take more surgical sessions to accomplish the same goal as when twice the number is transplanted.

Many factors should come together for a megasession hair transplant surgery. First, the surgical team must be trained in doing large sessions with fast, efficient cutting and placing. The following points must be available for the surgery to be successful. The sessions should not take more than eight to ten hours, for more than that, the grafts that are out of the body awaiting placement produces reduced graft growth. Hair transplant surgeon should keep a larger team of technicians to help reducing the time of surgery.

The surgeon must know the nuances of prolonged anesthesia without increasing the risks to the patient. The patient’s scalp laxity must be very loose so that a wide strip can be taken safely (often these strips measure greater than 2cm in width and 22cm in length). The patient’s density must be high (50% higher than normal densities). Large sessions might carry increased risk of swelling and redness after surgery, but overall are not more risky than smaller sessions, but the above criteria must be bet or the yield would not be there. At US Hair Restoration, we offer megasessions to patients with extensive baldness with good donor quality with excellent results.

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.

Question:

Dear Dr. Mohebi,

Dr., I had a question: say I would use proscar now and took it for a while, after how long based on studies is it possible to see adverse side effects, if any? The reason why I ask is because when I went and read the messages on the forums, I saw positive and negative feedbacks. One person used proscar for 7 years and saw nothing but great results. I would like to give it a shot and see if I am lucky, hopefully. Thank you! Have a great weekend,

Answer:
The side effects of finasteride (Propecia/Proscar) could be seen anytime from right after starting it to months after starting finasteride. If you read the articles on adverse effects of finasteride you can clearly see that there is a small difference between the rates of side effects from the people who took placebos to the ones taking finasteride.

Let’s face it; you are prescribing a drug to a patient telling him that it works through altering your male hormones. What do you think the chances are that the patient will have problems with his sex drive?

The good news is that the side effects of finasteride are few and the most problematic one (decreased sex drive) is only seen in one out of a hundred patients. The other good news is that even if you are in that one percent category and you decide to continue using finasteride anyway, after one year of using finasteride the rate of side effects decreases to about the rate that was shown in people who only took a placebo.

I saw an 18 year old patient today who was worried about the recession of his hairline. We mapped his scalp hair to analyze the degree of miniaturization using a digital microscope. Here are pictures from the microscopic of his donor hair (left) vs. very frontal hairline (right).

Healthy donor hair (left) vs. significant miniaturization in hairline (right)

You can see significant miniaturization in the frontal area. When we examined a few centimeters behind his frontal hairline the miniaturization rate dropped sharply to less than 20% which was consistent throughout the top and crown area of the scalp. The patient’s father lost his hair at an early age. Patient started taking finasteride a month before his visit with us and topical Rogaine about a week before this visit.

What we observed was the maturation of his hair line, which occurs between the ages of 16-25 in most men. Hair line maturation is when the hair line migrates 1 to 2 cm higher than its normal position as when we are child (kiddy hairline). It is more significant in the corners but could be seen in the midline too. As Caucasian men go through the maturation process, the hairline rises, but many non-Caucasian men never experience hair line maturation and the hairline stays flat and low.

The best way to distinguish the maturation of the hairline from the early stages of baldness is by comparing miniaturization in different scalp areas. If you are experiencing early hair loss, your miniaturization could be seen behind the first centimeter of the frontal hairline, but if the rate of miniaturization drops sharply it could indicate that the hair line is going through maturation and the hair loss may stop shortly after maturation is complete.

We stopped all anti hair loss medications that the patient recently started, and we recommended another miniaturization study in 6 months to a year to follow his hair loss progression.

Dihydrotestosterone (DHT) is a byproduct of the hormone testosterone, formed primarily in the prostate gland and hair follicle cells. Hair follicles contain DHT receptors. Over time as males produce more and more DHT, the DHT molecules cause hair follicles to miniaturize and eventually fall out permanently in people who are genetically prone to baldness. In other words, some males have more hair follicles with these receptors than others.

DHT is the primary contributing factor in male pattern baldness. Unlike men with male-pattern baldness, women with female-pattern baldness are usually not characterized by increased production rates of DHT. Women with increased levels of DHT may develop certain male secondary sex characteristics, including a deepened voice and facial hair. Hair in the Crown and top of the head are usually loaded with these receptors in men with male pattern baldness. But the hair on the sides and the back, termed the permanent zone or donor area, are not affected by DHT. This allows us to transplant hair from the donor area into the frontal area without fear of it falling.

The transplanted hairs keep their resistance to DHT after hair transplant. Propecia is a drug that decrease the production of DHT by blocking the enzyme 5-alpha reductase that converts testosterone to DHT. This is how Propecia is effective in treating hair loss. Hair loss patients will decrease levels of DHT when they are on Propecia and this will help maintain and un-miniaturize hair follicles or even increase the size of hair shaft within the first year of using them.

Question:

Hi, My boyfriend here wants to know what he should do to prevent more hair loss. He has hair now but it’s receding a bit on his front at right and left sides.  He’d be most grateful for some advice. (Or I could just listen on Saturday!!)

Answer:

The Saturday radio show is going to be a 55 min program on hair loss with a focus on male pattern hair loss. I am sure you will find it useful. Also we have an online consultation page on our website that allows patients from all over the world to ask questions about the characteristics of their own hair and hair loss.

As a general rule, most young men can use Propecia (generic: finasteride 1mg/day), if they do not have any contraindication (allergic reaction or other negative side effects) for its use to prevent further hair loss or slow down the hair loss process. I generally do miniaturization studyies on all my patients to map out their hair loss pattern before starting them on Propecia or any other hair loss prevention medication. This way we can measure their response to the effect of treatment and optimize the medical or surgical treatment if needed.