Hair Restoration Blog

Although the vast majority of men and women who undergo modern day surgical hair restoration are completely satisfied with the results, with the aesthetic and emotional benefits far exceeding their initial desires, it’s important to understand that there are limits to what hair transplantation can do. And for each patient, there are unique variables that play a major role in the outcome.

> Hair loss (androgenetic alopecia) is a progressive, ongoing genetic disorder that first manifests itself as thinning hair and ultimately results in hair loss, in those pre-determined hair follicles effected.

> You should never expect to retain the same hair density or the same hair line placement you had as a teenager, nor should you want to. Hairlines and overall hair density evolve as we age.

> You may have already lost up to 70% of your hair density before you’ve even realized your hair was thinning.

> Hair transplantation simply relocates natural hairs, it does not produce new hair.

> Hair transplantation does not stop affected native hair from thinning and future loss. The transplanted hairs are permanent, as they are genetically different from the thinning hairs, but hairs that are pre-disposed to thinning and loss will continue on that course.

> If warranted, in addition to hair transplant surgery to replace lost hairs, your physician may recommend finasteride or minoxidil in an effort to stabilize existing thinning hairs.

> Since beauty is in the eye of the beholder, and hair loss is progressive, somewhere down the road, you may elect a second hair transplant procedure to help you achieve your hair restoration goals.

Here are some factors that directly impact surgical results and should be considered when setting realistic expectations:

1) The ratio of supply (donor hair) and demand (area of hair thinning and loss). In essence, the more significant the hair loss and/or the larger area of scalp affected by hair loss, the more donor hair required. Hair density following one surgical procedure will be based on limits to donor hair extraction.

2) The caliber (diameter) of each hair shaft. Thicker hair will provide greater coverage and volume than fine hair.

3) The body of hair. Curly or wavy hair tends to create greater coverage than straight hair, resulting in greater hair density.

4) The contrast between the scalp and the hair. Hair density, or at least the perception of greater hair density, increases as the contrast (or visibility) of the scalp through the hair diminishes. For patients with dark hair and a light scalp, this contrast is greater, giving the appearance of thinner hair, or less hair density.

5) The density of the donor area. The donor area is the source of the hairs utilized in surgical hair transplantation. The greater the natural donor hair density (hairs per square millimeter), the more available donor hairs for possible future procedures.

6) Scalp elasticity. Mega-session and giga-session hair transplant procedures are becoming more common. For a surgeon to safely perform a procedure of this size (4,000 to 5,000 grafts or more), there has to be a need for it, the donor area has to have sufficient density, AND the scalp has to have enough elasticity to accommodate the donor removal, allowing the surgeon to close the area safely, leaving nothing more than an undetectable scar.

7) Future thinning and loss. Unless a patient is a Class 7, having lost most of the hairs in the affected area, it’s important to anticipate future, continued loss and recession. A secondary procedure and/or the use of finasteride or minoxidil may be recommended to achieve the hair restoration objective.

It’s important to review all available information, to make an informed decision. And when considering hair transplant surgery, or any surgery for that matter, it’s good to remember that the most critical decision is the surgeon himself… his training, his artistry, his skill, his compassion, his surgical techniques, his results.

If you are looking for answers to hair loss and are considering hair transplant surgery, we encourage you to visit a good hair transplant surgeon. In the right hands, you too can experience the life-changing benefit of hair transplantation, exceeding all of your expectations.

Q:

What is the average hair loss after hair transplants? I.e. The number of grafts lost? I am sure that also relies heavily on techniques of hair transplantation.

A:

The survival of transplanted hair grafts should be over 95%.*

We do not expect to lose any grafts after hair restoration surgery.  There may be a 1-5% transection experienced with microscopic follicular unit transplants, but we have aimed to minimize this rate by enhancing the quality of our hair transplant techniques.

* According to some studies that were done on microscopic follicular unit transplant methods, 95-99% of newly transplanted grafts should take and hold.  We expect that the hairs should grow healthy hairs within a few months after hair transplant surgery.

Q:

Dr. Mohebi, I have already made an appointment for hair transplant surgery on Wed April 20th per your recommendations and paid the deposit. If you don’t mind I have a quick question.

Do you think it’s realistic for me to see patients on Monday following my procedure? I have clinic that day and OR the next (will need to wear surgical cap), is this okay in the week following?

A:

Because we will be transplanting a large number of hairs in the frontal area of your scalp, we expect significant swelling until day 4-5 after surgery.  Occasionally patients may experience swelling until day 6-7, but your surgical cap use is okay and should easily cover it.

In addition, some patients occassionally get swelling and bruising around their eyes (which may be difficult to cover). Probability of bruising/swelling around the eyes is minimal but its possibility should still be notated.

Q:

I had a hair transplant back on October 31, 2009. I started getting red boils along my transplanted area (suspected to be folliculitis) in January and I have been taking Accutane for the last complete month.

My question to you is, why did it happen? Was it due to infected surgical equipment used in the surgery? I was advised to get such a heavy drug which has effected the overall tone of my face somewhat like getting severe dryness. Lastly, sir what do u think there are few patches in the infected area who are now like bald patches. Do you have any suggestions or medicine for the future?

A:

Pimple-like scalp lesions that develop after hair transplant surgery are typically folliculitis.

Folliculitis can typically be seen after hair transplant surgery in both the implanted and donor wound areas in the few weeks to month after hair transplant.

The development mechanism of folliculitis is similar to acnea.  It is usually due to blockage in the exit pores of the sebaceous gland (skin oil glands).  Following obstruction of those pores that can occur after hair transplant surgery, sebum (skin oil) cannot be emptied to the skin surface and instead begins accumulating underneath the skin surface.  The result is red or white head-like pimples.

Recovery is generally spontaneous. Although, if too many of these lesions develop, or if there was any sign of secondary infection (i.e.- redness or swelling around the area), the lesions may need to be drained by your physician and the patient may occasionally be recommended to use antibiotics.

Thanks to the generous vascular supply of scalp skin, the infection of scalp skin after hair transplant surgery is extremely rare.

Q:

Are there any constraints on performing a further procedure if required in terms of the time interval and / or the number of grafts that can be harvested within a second procedure which is a) FUT, or b) FUE?

A:

If we need to add density to an already transplanted area we have to wait 6 months following the first hair transplant surgery.  By waiting this minimum of 6 months, we are able to see the complete growth of the recently transplanted hair  from the first hair transplant and thus, we can go in between these hairs to put the new hair.  The number of transplanted grafts in the second procedure is typically a bit less than the first surgery because we remove the scar of the first surgery for the second time.

Q:

Dr. Mohebi,

I would like to thank you for the time you spent with me during my consultation.

You were thorough, knowledgeable and willing to spend as much time with me as was necessary in order to answer all my numerous questions.

I would also like to thank your office staff for their friendly and courteous treatment.

I have a  question regarding the prescription for Finasteride.  Am I to begin this prescription regimen immediately, just prior to surgery, or after hair transplant surgery?

I am certain you directed me at the time, but with all the info I had to digest, I somehow forgot whatever it was you said regarding the prescription.

Thanks in advance for your time in addressing my question.

A:

I am glad you had a good experience with our office.  I always enjoy having patients who present educated questions.  Below are my responses to your recent questions:

We are prescribing finasteride to you in order to prevent shock loss in the areas at the edge of your balding area following hair transplantation.  I generally recommend starting this medication about a week before surgery so it is locked in your system and shock loss could be prevented.  You should then continue this mediation for the fist 8 months following surgery, which is the time that you are most at risk for losing hair due to shock loss.

It does not matter what time of day you use Finasteride, as long as you are sure to take it once every day.
We look forward to see you soon.

Have a great weekend

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.

Q:

Hi doc?  could Rogaine foam have adverse effect on hair transplant result? some say it helps for hair growth, some say it does not add to hair growth, but have you seen any where saying it might prevent hair growth on men with hair transplant? thanks.

A:

Rogaine (minoxidil) can be used after hair transplantation (only on the newly transplanted area) to protect the native hair and not to promote the growth of transplanted hair. Transplanted hair does not need any medication to promote permanence or grow and if chosen correctly it is considered to be a permanent hair loss solution. I personally recommend Propecia to protect patient’s existing hair against shock loss (losing native hair) after hair transplant on men. It is proven that this medication works better than Rogaine for shock loss prevention and has had remarkable results in those patients who have used it as directed. Women cannot use Propecia and I tend to offer them Rogaine as an alternative for the few months following their hair restoration.

Hi everyone,

I had a somewhat funny call to me the other day from a past patient of mine and wanted to share his experience with this blog. Although we, at US Hair Restoration, are known worldwide for our quality results and affordable prices, there are some downsides to the remarkable effects that your hair restoration may bring you without prior notice.

One of our patients called over to our office the other day laughing and telling our front desk receptionist that his passport photo looks NOTHING like him. He was traveling out of the country the following day when he had glanced at his photo and realized that the previously taken photo in no way resembled his current image. He called to request that I write a general letter confirming his procedure in the event that there were any discrepancies in his change of appearance.

We would like to apologize in advance for any unexpected changes in your appearance that may make you look years younger or like a different person following your hair transplant procedure. We are 100% proud of our patient results and happy to hear that if nothing else, these are the only few negative aspects of a hair transplantation with US Hair Restoration. We thank our patient for the great laugh and hope that he made it through customs without a hitch!

Q:

Where can I see Dr. Mohebi’s before and after photos? Would Dr. Mohebi be doing the hair transplant surgery himself? How are the donor hairs relocated once broken down into follicular units? Do they just get shoved into place? Am I completely out during the procedure or awake? How long before I don’t look like I just dove into a pool full of needles? Can you send me a link to you’re site if you have one. Thanks so much!
A:

Here is the answer to your questions:
Before and after photos could be seen in our hair transplant photo gallery that we try to keep updated with the new pictures on a regular basis.

Would Dr. Mohebi be doing the hair transplant surgery himself?
Yes, at this point all surgeries will be performed by Dr. Mohebi himself.  A surgical team will assist the doctor during the dissection and implantation of hair follicular unit grafts.

How are the donor hairs relocated once broken down into follicular units?
We transplant the hair grafts or follicular units based on the need of a patient. The doctor will draw the hairline before surgery and discuss it in detail with the patient.  Hairline designing has to do with the degree of baldness in each area and patients preferences.

Do hair grafts just get shoved into place?
The follicular units need to be maintained in special solutions in sold temperature while they are out of the body.  When the sites are made, we insert the grafts gently into them one at a time.  This process is very meticulous and usually takes a few hours.

Am I completely out during the procedure or awake?
You will be sedated, but you will not be totally out.  You will become more alert during the surgery in which you are sitting in a surgical chair most of the time.  You can be watching a movie, listening to the music or reading a book during your hair transplant surgery.

How long before I don’t look like I just dove into a pool full of needles?
You will probably never look like that, but if you are concerned with redness and swelling after surgery they may last a few days.  Most patients recover from surgical swelling and redness after the first 4 or 5 days.