Hair Restoration Blog

Q:

What do you think about starting Minoxidil if you want to help speed up hair growth?

A:

There is no evidence that minoxidil (Rogaine) can improve the growth of transplanted hair after a hair restoration surgery.  However it could minimize the risk of shock loss which is losing hair when you are transplanting close to the areas that you are supposed to lose more hair in the future. Minoxidil should be started at day four after hair transplant surgery.  We most often prescribe finasteride for our patients to prevent shock loss;  adding minoxidil to finasteride may slightly add to the positive effect of finasteride.

Q:

What do you think about applying Emu oil or distilled witch hazel to the healing areas to help soothe and speed up healing process; (apply from seven/eight days post-op). Distilled witch hazel helps with redness?

A:

There is no evidence to show emu oil, witch hazel or other commercially available oils can help healing after hair transplantation.  Using the shampoo that we recommend and provide for use after hair transplant is the best thing you can do to minimize the scabs maintaining a proper environment for the hair grafts to grow.

Q:

Dr. Mohebi,

Reading thru a website about hair restoration and what is needed after a hair transplant. Resulted in a question; I wanted to see what you recommend here:

• Apply huge amounts of Aloe Vera gel to both donor and recipient area but not until five days after surgery (then twice a day minimum).

A:

You don’t need anything other than the shampoo that we gave you and proper techniques of washing that we instructed you for washing off the scabs.  If your scabs remain in place for more than one week after surgery, you can leave the shampoo on the scalp longer for over ten minutes to help remove all the scabs.  Aloe Vera Gel won’t hurt, but it does not replace proper washing.

Q:

Dr. Mohebi, I had a surgery in 1991. At the time it was better than being bald I thought. But the joke even in my house is “Doll Head.” Is there any help for guys like me; can you repair older plug-like transplants? I am anticipating your answer.

  A:

Absolutely, there is hope for you.  In fact, we perform a few repair hair transplant surgeries every month.  Mostly for people like you with plug hair transplants from the past; modern advancements and techniques have really increased your options.  Most people could use Follicular Unit Transplant (FUT) to restore the appearance of their hair significantly.  Here are some of the procedures that could help someone with an outdated plug surgery:

Creating a transitional zone consisting of refined follicular unit grafts in front of the plugs

1. Filling in between the plugs and even out the area so they won’t be as noticeable.
2. Thinning out the plugs by removing some of the hair units through follicular unit extraction techniques.

Unlike what some people think, plug transplant results from old hair transplant procedures are easy to repair in most cases. That means you and many people can enjoy a natural undetectable look after a hair transplant repair surgery no matter how un-natural their current hair may be.

Natural Hair Vitamins: Can they help transplanted hair grow?

Q.

Hi Dr. Mohebi

Hope you are doing well.  I am 3 weeks after my hair transplantation with you. I have two questions about two products after my hair transplantation.  The first is the Hair Essentials? Can I buy and use this product now?  Is it going to help my hair growth? Also, I will go to a party next week, I was wondering if I can use Toppik and use it for that night. I don’t know if it is going to be harmful on my hair?

Thanks

A.

I  am doing great, thanks for asking. It’s good to know you are doing well after your surgery and enjoying an active social life. Your questions are good ones and may help other readers. I will answer them in the order you asked.

Hair Essentials are vitamin and herbal supplements that declare it will assist with hair growth. There are no significant medical research studies verifying this vitamin formula as a sufficient hair growth simulator. As you know it is the effect of DHT on your hair follicles that attributed to your hair loss. It was not the lack of vitamins. Hair Essentials product has Saw Palmetto which is a DHT blocker and is used by some patients.  However, I believe the finasteride which I prescribed for you is approved by the FDA because it is a well researched and verified DHT blocker.

Toppik is a product that reduces the look of baldness by reducing the contrast between your scalp and hair color. Using it on this special occasion is a solution while you are waiting for your transplanted hairs to start to grow.  I hope this helps and I look forward to your follow up in the future.

Comment on Andrew Sullivan’s website:

… Another has a “warning to those men who are reading the posts exclaiming the positive impact of hair transplants”:

Like your reader who had a follicular transplant, one of my good friends also had this procedure when he was in his mid-20s; receiving rows and rows of transplanted hairs placed in neatly symmetrical patterns over the entire top of his head.  In the short run, this procedure, I’m sure, did much to help the self-esteem of a young man prematurely balding and panicked about his looks and the impact on his attractiveness to prospective mates.  The problem is that someone experiencing balding that severely in his early/mid-20s, is likely going to continue to bald.  Now, in his early 40s, my friend has the top of his obviously implanted head cut extremely short – making the unnatural pattern even more noticeable – because the balding has extended down creating a bare ring of head before the fringe of hair at his ear level.  The worst part of all of this: because of the horrible scarring created by the removal of the strip of hair from the back of his head to create the transplants, fully shaving  his head is no longer a reasonable option.  It’s an unfortunate example of having to live with a constant reminder of the vanity of youth.  He would have been better to just have left his hairline to nature.

-

Dr. Mohebi’s Response:

I read the negative comment about hair transplants of one of the readers of Andrew Sullivan’s “THE DISH” blog.  As medical director of US Hair Restoration I could not stay silent because of the erroneous information disclosed in this reader’s response on your site.

The comparison of follicular unit transplantation which is the current gold standard of hair restoration surgery with old techniques that involved transplanting plugs of hair in rows is inaccurate.  Hair transplant surgery has come a long way in only the last 20 years, from plug surgery and mini-micro grafting to natural looking hair transplant surgery through follicular unit transplants. Modern hair transplant surgical procedures are technology advanced; a skilled surgeons procedure results are natural.  Most hair stylist cannot detect that their client has had a hair transplant. This has been proven true and our practice and colleagues.

In today’s Follicular Unit Transplantation, hair follicles are divided into the natural groupings harvested from the patient’s donor area of scalp.  These grafts are transplanted in natural direction and distribution in the balding areas of the scalp.

Undergoing hair transplant at an early age as cited by your reader is no longer a problem.  Microscopic diagnostic methods assist a hair transplant surgeon in predicting the pattern of future hair loss in a young man.  Current state of the art diagnostic technique allows the surgeon to be able to design placement of hair grafts in a way that it looks normal at any age.  For example when I design someone’s hair line I pay less attention to where it was before and more to where it is going to be as a mature hairline in the future.  The result of a hair transplant that is done correctly should look good now and it should look good twenty years from now.

The newest methods of donor wound closure resolves the issues concerning scarring at the back of head.  One such method trichophytic closure allows hair to grow inside the scar and makes the hair transplant scar less visible.  Today, we also perform Follicular Unit Extraction (FUE) for the ones who cannot have any linear scar on the back of their head.  The FUE method is more labor intense and time consuming but it allows surgeon to remove follicular unit grafts one at a time.  After a FUE transplant the patient can keep his hair very short without being concerned about the visibility of scar of the donor area.

Finally I would like to clarify that with the knowledge we have today about balding and its adverse effects on men’s psycho-social lives, I don’t call hair transplant a vanity but a requisite that is available to us to make our lives better, just like many other advancements that are available to us in today’s world.

Parsa Mohebi, MD

Medical Director
Mohebi Medical and US Hair Restoration.com
Los Angeles, California

Q:

Permanent shock loss- in the front center mostly and also areas in the temples. Is it likely from your experience that hair like mine will survive?

A:

Although could be seen in some patients for the first few months after surgery, taking finasteride will minimize or, in most cases, eliminate that risk in the majority of patients.  However, if you do experience shock loss, it won’t be for more than 2-3 months and after that time, your transplanted hair will begin to re-grow. It is by then that your hair should look much better than it did before.

Q:

I’m a 26 year old man and I am not completely bald yet.  Would doing the procedure right now add extra difficulties with the existing balding hairs or transplanted hair?  In other words, when my existing hair eventually fall out, would my hair look like they are thinning again?

A:

Transplanted hair is considered permanent and you won’t lose it.  However, you may need a touch up hair transplantation if you lose your existing hair in balding areas to maintain the maximum density for your hair line and other areas.

Q:

Hello I do mix martial arts and would like to know, how long will i be out from MMA (wrestling, jujitsu, muay thai, etc…) after strip surgery? also when can I return to regular cardio (running, rowing, sprinting,etc..) and weight lifting?  thank you. I have contacted other doctors too, but they all tell me different answers. the internet says to stay away from MMA at least for 3 months? some doctors tell me I can return to MMA after one month but in wrestling and jujitsu they are always grabbing and pulling down the back of the head in a very fast and hard manner.

A:

It has to do with the technique of hair transplantation.  If you are considering the conventional hair transplant surgery with a strip method, you should not perform any aggressive contact sports for the first month. After that first month, you can resume most of your activities, but you really need to be careful for the first 3 months and avoid some moves such as bending your head forcefully until your donor scar is fully healed, which is 3 months after  your hair transplant.

FUE (Follicular Unit Extraction) has different timelines after hair transplantation.  If receiving a FUE transplant you should be able to resume activities much quicker  because there is not a linear scar on the back of your head and you do not have to avoid bending your head for 3 months after hair transplant.  For more information, you can also read this other blog post in which I have answered another similar question from one of my patients (Physical Activity Limitations After Hair Transplant).

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!