Hair Restoration Blog

Q.

Hi Dr. Just got back from my vacation in XX, had a good and relaxing time. While I was gone for 2 weeks all the scabbing from my hair transplantation is pretty much gone in the donor scar and the implanted areas. Also I noticed that I did lose hairs as you mentioned would most likely happen. the hairs that fell that looked like the grafts were just the hair shaft that I saw fall. I did not see skin attached to the end of the hair shaft so I assume the follicle survived in the skin where it was implanted. not all have fallen but I did notice a good amount. I also notice small dark hairs sprouting in the implanted area. I assume these are coming from where the originial grafts shed?
 
Its almost a month post op and I feel no pain and have all feeling back on my scalp. I pretty much wash and style my hair as usual.
 
Is all this normal progress after the surgery?
Thanks.A.

It is good that you had a nice vacation! 
 
One month after hair transplant surgery is the general time which you should have lost most of your transplanted hair shafts.  The follicles are now part of your scalp and will be growing new hair in 2-3 months.  Your inflammation should be subsided on both the transplanted and donor areas.  Minor itching might be noticed at this time which is a good sign of the scalp wound healing.  You may have lost or will soon lose some of the bulk of your existing hair due to the shock loss.  Using finasteride can significantly minimize it.  You will be noticing new hair growing in 2-3 months from now and the hair shafts will continue getting longer and thicker till about one year from the time of your hair transplant.

Here is our recent instructional Scalp Exercise Video which is to be done at home prior to a Hair Restoration

It is very important to do these scalp exercises prior to a hair restoration procedure as it increases the laxity needed for the Follicular Unit Transplant (FUT) strip method. When the skin laxity on the back of the head is increased, the size of the donor strip is also increased and more hair grafts can be transplanted in one surgery as well as receive minimal scar results. This pre-operational exercise has helped to move the hair restoration industry forward into having larger one-time procedures which has helped to save time and money for both the patients and physicians. Taking the necessary time to properly do these will help to bring about the best possible results.

Q:

Is my donor area thick enough and did I have any signs of miniaturization there? Most men I have seen that are bald on top have a much thicker back area of their hair that is not affected by mpb than I do. From your experience and knowledge is it good enough not only to be used as a donor now, but also in the future if I need to cover crown or do any other procedure. It seems to me that my hair is too thin in the back to conceal a scar and that it might possibly thin out a lot when im older. But I’m not a professional so please give me your opinion and insight. The scars all look thin enough for contentment but its when you dont have hair growing around it making it look like someone scrapped a bald line in the back of your head with a hair cutting tool.

A:

When I reviewed your microscopic exam I found it to shows you have only 10% miniaturization in that particular area.  Less than 20% hair miniaturization measurement is within normal range for someone with male pattern baldness (MPB). As we discussed before, if you keep your hair the same length as during your consultation, you should not be able to see the scar. We perform double edged trichophytic closure for most patients which minimizes the visibility of a scar even when you decide to keep your hair very short.

The 19th Annual ISHRS meeting for 2011 was held in Anchorage, Alaska. It was my first trip to Alaska and I was looking forward to seeing the beauties of the largest state in America.  Being very busy with many different activities, it made my time for sightseeing nearly impossible. I was required to be available one day prior to the opening day of the conference to get prepared for the many different events which were to come.

Hair Transplant Workshop

Dr. Mohebi and other faculties teach Hair Transplantation Techniques in ISHRS Meeting Anchorage, Alaska

I was one of the faculties for the surgical workshop. There were many new hair transplant surgeons who came from around the world to this annual scientific meeting to learn more about the art and science of hair restoration. The workshops included topics such as hair line design, cutting, placing, anesthesia, and donor harvesting and I was there to teach the latter course. There was great interaction between the faculties and students as they got the chance to learn the hands on techniques of surgical hair restoration.

Latest techniques of Hair Transplantation

The main thrust of the conference was the lecture series which gave a forum to many lecturers covering multiple topics regarding the many different areas of hair restoration. Since hair transplant surgery is still a relatively new field in the medical world, the greatest emphasis was on new technologies in hair transplantation, the latest techniques of hair transplant surgeries, devices, tools and methods of diagnosis and the treatment of hair loss.

ISHRS 19 Meeting: New Hair Transplant Surgical Instruments and Techniques Panel, Drs. Parsa Mohebi, Alan Bauman, Sara Wasserbauer and Kongkiat Laorwong

This year I was the moderator for the Giga-Session Hair Transplantation Panel. The panel included 2011 Golden Follicle Award winner Dr. Jerry Wong and Doctors Sharon Keene, Arthur Tykocinski, and Akaki Tsilosane. The discussions included properly choosing the best candidates for large number of grafts hair transplant surgeries (Giga Session Hair Transplants), planning for surgeries, as well as the full spectrum of Giga-Session Hair Restoration.

The Laxometer II was one of the newest innovative technology devices presented by me. The Laxometer was developed as a response to the need within the hair restoration industry for a measuring device for calculating the scalp laxity or skin mobility before hair transplantation surgeries. The Laxometer precisely measures the mobility of the scalp giving greater accuracy for larger surgeries or if a patient has a tight scalp. This device was introduced to the market for increasing the safety, precision, and efficiency of the hair transplantation.

Another device presented at the 19th Annual ISHRS Scientific Meeting was the upgraded Restoration Robotics, now called ARTAS System. This machine is now FDA approved for use in the United States and several lectures were presented about this new hair transplant technology. ARTAS was developed to help meet the need for increased precision and speed for scoring the follicular grafts in Follicular Unit Extraction (FUE) hair transplants. This is considered a very new technique in hair transplantation, but the robot currently only assists in one step of hair restoration. That is scoring the follicular grafts.  We still do not have a perfect automated system to extract and transplant the hair grafts. This device will need more time for testing and post-operation, long-term patient results.

Other New Technologies for Hair Restoration

In last few years, we have witnessed emergence of several new tools in hair transplantation that carried the claim to be the latest technologies and ground breaking tools for the field.  A lot of devices claimed they could change the way hair transplantation was done. However, many of those new tools did not deliver on their promise.  This has been a trend which has continued to be repeated for several years now. One of these devices was the NeoGraft that was sold to many non-hair transplant doctors with the promise of the simplicity of use and the minimal need for a surgeon’s involvement. The company has stated that the technicians can run the machine for the most part. One major issue the NeoGraft company forget to point out to these new costumers is the fact that hair transplant surgery requires experience and proper training in order to deliver great result. No machine, especially in the wrong hands, can substitute for lack of experience and expertise.

There were a number of lectures presented regarding the problems involved in hair multiplication, auto-cloning, hair stem cell research, and others important topics. Like years previous, there were several debates about Strip FUT vs. FUE,  manual FUE vs. automated FUE, also sharp vs. blunt punches for Follicular Unit Extractions.

Controversies in Hair Restoration

This year we had many controversial lectures such as lasers for hair restoration and growth factors, as well as mesotherapy and PRP (Platelet Rich Plasma).  The ISHRS allows for an open forum for hair transplant surgeons to share their innovative ideas, work, and theories that they can be giving constructive criticism and analysis by other experts in the field. This has been effective in keeping members of the society updated with new ideas and methods for hair restoration. It is unanimously agreed by members of ISHRS that hair restoration surgery is a progressing science and art which is rapidly growing into more advanced technologies and cellular level manipulations. It is well accepted that greater research is needed in order to thrust the industry forward in these new innovative areas for the art and science of hair restoration

Laxometer II

Often times we receive inquiries at US Hair Restoration about the latest hair transplant technology, and we feel obligated to spread the news about the latest hair transplant technology.  We are excited about the new generation of Laxometer, the newest hair transplant device invented by Dr. Parsa Mohebi. The Laxometer II is a handheld device which revolutionizes the art and science of hair restoration. Being in the growing sector of the cosmetic surgery arena, progressive updates on hair transplant new technology is critical.

Applications

The revolutionary Laxometer II increases the number of hair grafts which can safely and precisely be transplanted in one surgery. A hair transplant of more than 3500 hair grafts once upon a time took two or more surgeries to complete, but with this latest technology in hair transplantation, it can be done in only one procedure.

The Laxometer II, the new technology in the hair transplant industry, is basically a measuring device which is used to calculate the laxity of one’s scalp. An accurate measurement of scalp laxity is critical when determining how large the donor strip can be. This latest breakthrough hair transplant technology gives a precise measurement which can be increased as a result of patients actively doing daily scalp exercises. The larger the available strip, the more grafts can be made available for transplantation.

At the International Society of Hair Restoration Surgery’s 19th Annual Scientific meeting in Alaska in September 2011, Dr. Mohebi unveiled his new invention for purchase to all hair transplant surgeons. This latest technology in hair transplant surgery was welcomed with anticipation and applause as it will help to continue the industry progressing forward.

Here is a video demostration of the Laxometer work: Laxometer Instructional Video

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.

Faculties: Drs. Suddleson, Mohebi and Perez in OLSW-17

Orlando Live Surgical Workshop (OLSW 17) of International society of hair restoration surgery (ISHRS) was held one more time in beautiful city of Orlando last month.  Hair transplant surgeons participated from different parts of the world.  We had many great lectures from the leaders of hair restoration surgery to cover basic information about hair restoration methods for new hair transplant surgeons and to refresh and update the more experienced ones.

We had lectures every morning and in the afternoon went to surgery center for hands on procedures to teach the techniques of hair transplant surgery.  I have to congratulate the the whole staff involved with this workshop for the great work they have done this year, coordinating a large group of doctors from all over the world and putting together a great set of lectures to cover a wide variety of subjects about modern hair restoration procedures and medical treatments.

Dr. Mohebi and Dr. Leavitt in OLSW-17

We had lectures about new methods of hair restoration surgery such as robotic hair transplant surgery.   The most updates on robotic surgery was shown to the audience.  There is a hope that the practical model of robotic hair restoration be available within a few months.

There is a woman behind every successful EVENT - Dr. Mohebi and Valarie Montalbano

I had two lectures that were both emphasizing on the techniques of removal of follicular units in hair transplants with large number of grafts using Laxometer.  I also demonstrated the applications of Laxometer in sequential strip removal techniques in live surgical workshop.

Technician training: Patrick Tafoya teaching hair transplant technicians

My second lecture was on Scalp Scars and the methods to revise them.  The lecture was focused on making surgeons more familiar with the proper techniques of scar revision and indications of each particular technique.

I went over trichophytic closure methods for a variety of different scars.  I discussed the implications of Follicular Unit Extraction (FUE) to revise scalp scars.  I presented a variety of several scalp scars treated with FUE methods.  I went over the pros and cons of FUE to revise scalp scar and provided a guideline that hair transplant surgeons can decide what method should be used for each type of scar.

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:

hi doc I have another question for you. I was wondering…when a person begins taking Finasteride, they go thru an accelerated shedding period that lasts roughly 3-6 months. After this initial period of shedding, just say that the Finasteride works and stabilizes the loss. Does the person end up growing back the hair that was lost during the accelerated shed? What if it doesn’t grow back? Is this the price that you must pay to halt or slow down loss with Finasteride? Do you have to take your amount of hair a step down in order maintain whatever’s left?

What if you fall into that 20-25% category of users who don’t respond to Finasteride in terms of hair stabilization? You could end up just accelerating your loss for those 6 months for no reason at all. Whether you stay on it or off, after this period, you will continue to lose. This is a big risk for people thinking about taking meds.

A:

Hair shedding is not equivalent to hair loss and shed hair will regrow as normal (especially in long and thick hair that is not miniaturized).

People who take Finasteride may have increased levels of hair shedding possibly due to increased hair cycling within the first few weeks or months of taking Finasteride, but the initial hair shedding should resolve within a month or two from the start date. Final effects of Finasteride should be assessed after at least 6 months from the time the medication was started, but can be seen as late as 12 months from when you start the medication.

For more information on this topic, please feel free to check out an earlier blog post below:

http://ushairrestoration.com/blog/2008/05/hair-shedding-after-starting-finasteride/

Q:

Quick question for you doc.

I was wondering, will I need to buzz off all my hair before a hair transplant surgery? It really doesn’t matter, but I just want to know what I’m getting into. I imagine that my remaining hair, while very thin, obscures the scalp too much for comfort.

A:

You do NOT need to buzz off your hair before a hair transplant.

While some patients with significant miniaturization of their existing hair may be asked to cut it short or clip it, we typically are able to do this in office before the procedure if they are OK with it. Clipping hair is not mandatory in any way. However, it may increase our precision in some patients and we do it for them only if they have no problem with having very short hair for a while after hair transplant.