Hair Restoration Blog

Q:

It seems to me that successful outcomes can, to a substantial degree, rely on the technicians handling the hair follicles. How do you measure your technicians skills?

A:

We have a great quality control system at US Hair Restoration in which every technician is monitored during cutting and placing.  We also have surveillance cameras in the OR to record the entire procedure for quality control.  We hire only highly qualified hair transplant technicians.  We still need to provide some special training to assure they can function according to US Hair Restoration standards.  We hold regular educational meeting for hair transplant techs to keep them all up to date on current procedures as well as US Hair Restoration quality expectations.

Check this post on my blog:  US Hair Restoration – Hiring Qualified Hair Transplant Technicians for more information on quality of hair transplant technicians.

Below are some responses to a few basic questions we received from a patient online:

How many grafts/hairs would I require for a good restoration? Could you please point to some examples.

Although for most cases with only frontal hair loss we recommend 1500-2000 grafts on average, your personal recommendation can be above or below that number depending on your eligibility, extent of balding area, history, donor density and scalp laxity.

An example of a female who received 1609 grafts with us can be seen here: http://www.ushairrestoration.com/hairrestorationbeforeaftergallery-view.php?album=93

What is the cost for hair transplants (including everything – procedural cost, fees, everything)? I understand you will not be in a position to get me the exact figures without a personal meeting but I need to have some rough idea to estimate my costs.

A hair transplant procedure performed at US Hair Restoration is calculated based on the number of grafts recommended to you. To determine what is recommended for your specific case, we recommend attending a free consultation with Dr. Parsa Mohebi at your earliest convenience. To view additional information on our general hair transplant costs please visit our hair transplant cost page.

There are times that US Hair Restoration offers Standby Rate discounts available to those with flexible schedules for booking the procedure.  Our stand-by option can offer you an additional discount (for discount rates and availability of this option please call 1-888-302-8747). You can also use our financing option in addition to that for your hair restoration.

Can the whole procedure be done in one sitting?

Yes. Overall, most hair restoration procedures performed by at US Hair Restoration will be completed in one day.  Occasionally patients may need more density that is not possible to create in one session or they have extensive hair loss that requires more than one hair transplant session.

Does FUE still have shock loss risks?
Yes, regardless of the technique of harvesting hair we recommend some sort of medication to prevent shock loss after hair transplant surgery.

In regards to your in-depth questions on exact number of grafts, donor hair growth, care after hair transplant, etc:
I recommend calling to schedule a free 30-60 minute consultation in which we can explain more detailed information to you personally and recommend an accurate number of grafts for your specific case.

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!

Diffuse Unpatterned Alopecia (DUPA) is a hair loss condition in which hair thinning is seen diffusely throughout the scalp.  In DUPA, there is no a reserved area with good quality hair even on the areas of the back and side which are typically designated as the donor area in hair transplant patients.

A microscopic evaluation of the scalp generally shows significant miniaturization (fineness) of scalp hair diffusely.  DUPA can be seen in both men and women but its female type may at times be mistaken with typical female patterned baldness due to its close similarities.

A thorough medical evaluation with supporting lab work to rule out other causes of diffuse hair loss is always warranted before determining eligibility for a hair restoration procedure.  Hair transplantation is generally not a good option for people who have DUPA due to instability of the scalp hair on the back and side areas of the scalp.  Many people who have DUPA may suffer from other medical conditions that cause hair loss such as Iron Deficiency, thyroid or other hormonal imbalances or autoimmune disorders.  Medical treatment such as minoxidil in women and finasteride in men could be helpful in treatment of this condition.

Double edged trichophytic closure is a new approach to donor wound closure.  Double edged or two sided trichotomy can help to minimize the complications of trichophytic closure based on the width of epithelium that is being removed and inability of some the hair follicles or oil glands to find their way out to the skin surface.

Hair Restoration Surgery is evolving rapidly and we are consistantly refining our approach on a regular basis to improve the quality of transplanted hair while at the same time minimize the possibility complications.

Double edged trichophytic closure helps us to minimize the width of the top skin layer (epithelium) that is being removed from each edge of the donor wound.  This approach allows hair to grow into the wound from both edges and thus minimize the contrast between scar (with no hair) and surrounding scalp (with 100% hair density).

By employing double edged trichophytic closure we constantly have results of less detectable donor scars and are able to minimize the risk of folliculitis or ingrown hairs in the donor area, which are the two common complications of trichotomy with the traditional methods.

This type of “hair test” is done by a hair transplant surgeon or dermatologist to find out the rate of telogen hiar. It’s a simple procedure. The doctor pulls hair to find out the number of hair follicles in the resting phase. The way the test works is that the doctor grasps a couple of hair shafts between the pointing finger and thumb, then pulls them ever so softly. There are two classifications of hairs: Anagen, which are growing hairs that ought to remain in place; and telogen: hairs that should pull out rather easily.

By keeping track of the number of pulled hairs, a person can approximately calculate, in the telogen state, the hair follicle percentage. For example, if a person pulls on 10 hairs and then 2 come out, then the telogen hair follicles frequency is 20%.  If extracted hair follicles percentage is up to 25%, that is still considered OK, but if it’s over 35%, it is not normal and shows that there’s a disproportionate amount of hair in the resting phase.  This condition is often seen in Telogen Effluvium (TE).

Even though this hair-pulling test seems simple, a person may come to the wrong conclusions if they do not carry out the test properly and he or she does not have a full comprehension of the test’s limitations. The biggest concern is that the test results may be affected by what the patient did with her hair in the preceding hours. When the patient washes her hair, it will cause many of the telogen hairs to fall out.

There are several factors which can increase the accuracy of the hair pull test. The hair pull test can be ratcheted up to another level by conducting the “unit area trichogram”. This type of test requires that a couple hair follicle samples are grabbed from the scalp utilizing rubber-covered forceps; both telogen and anagen hairs are yanked. These hairs are to be placed on a glass slide and inspected using a microscope. After that, the dermatologist is to count up the telogen hairs and the anagen hairs as well.  The test can help the doctor in differentiating a variety of hair loss conditions.

Q:

hi

I come from china ，I would like to consult your organization a few questions:

In your experience,usually Asians（chinese people) the normal growth of the number of roots Per cm² of hair? Head at the top and post-occipital whether there are different?
using FUE technology，on one operation ，After the occipital Site  get the maxinum number of FU (Asians including 2-3 days operation) at present,how much FU can be planted per square centimeter on Planting area? Between the scope of? and the percentage with normal?

Looking forward to your reply Details!

Thanks for your questions.

A:

Here are the answers in the order they were received:

The number of hair follicles

The number of hair follicles in non-balding areas of scalp like occipital areas have been studied.  A range of 80 – 120 follicular units (FUs) per centimeter were reported. The density of follicular units vary in different locations of the scalp. Also, the number of hairs per follicular unit vary in different areas and with different races. For example, Asians usually have less number of hair follicles per cm², so even with similar number of FUs per cm², the density of their donor area is still less than Caucasians. To calculate the number of hair per cm², you have to average the number of hairs per FU and multiply it by the number of FUs per cm².

Difference of hair on top and back

The shaft of hair may or may not be different in different areas of the scalp. Obviously, if you are balding, you see more miniaturization and less terminal hair, which makes the appearance of the hair less dense on the area. However, without baldness, hair quality would be the same in back and top of the head.

FUE and number of grafts

FUE (Follicular Unit Extraction) is more labor intense and requires more time for harvesting the grafts. For that reason, FUE procedures are generally smaller in terms of the number of grafts per session. What we do at US Hair Restoration is up to 1,500 grafts per day on average, for 8 to 10 hours work in a FUE procedure. The number may occasionally go up to 2,000 grafts, too, but not everyone can expect to get that number with FUE.

Density of transplanted hair

There are many research projects on this topic. The number can be as high as normal density in some circumstances. However, practically we can make up to 35%-40% of the normal density in one session. This is a good number if you consider that the density of hair on frontal areas could be about half of the hair on the donor area in some patients, so 35%-40% is not that far from the normal density in those patients.

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.

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:

Hi Doctor,

Some doctors prescribe Dutasteride (Avodart) for hair loss prevention. I know you do not recommend Dutasteride for hair loss for obvious reasons, but based on available research findings on this medication, what do you think are the most likely possible side effects from using Dutasteride if worse come to worse. Would it be like multitude of finasteride side effects? Again, I know your view of non-FDA approved drugs.

A:

Dutasteride (Avodart) is one of the selective inhibitors of the type I and II of the enzyme 5-alpha-reductase, the enzyme that converts the male hormone testosterone to 5-alpha-dihydroxytestosterone (DHT). In comparison with dutasteride, finasteride (Propecia) acts as an inhibitor of just type II of the enzyme 5-alpha-reductase, which is more specific. Studies around dutasteride mechanism of action shows that, blocking both type I and type II enzyme can be more potent that only one in reducing the levels of DHT in the body.

If you are taking dutasteride for other indications, you may get some hair growth as a good side effect. As you may guess cannot recommend dutasteride solely for prevention of male patterned hair loss; not until it is approved for hair loss treatment by FDA. Other than not being FDA approved my other reasons are:

1. The optimum dose of dutasteride for hair loss prevention is not determined.
2. The side effects of dutasteride are much more prominent comparing to finasteride.  That include the negative effect of the medication on sex drive in men.
3. If you are considering the cost effectiveness of dutasteride, with new price reduction of finasteride that should not be in the picture any more.