Hair Restoration Blog

Q:

I was told that a spot has opened up for my hair transplant surgery. I told them to slot me in, but now that I’ve jumped into the deep end I’m a bit nervous. My nerves don’t have to do with what it will look like six months or a year from now, but for the weeks following the surgery.
I need to take the next day to really meditate on this. Although my hair loss does bother me, it’s not as if I’m noticeably bald. So I’m deciding if this is something that makes sense for me.

A:

It is completely normal to have a touch of nervousness prior to this elective surgery. Since it is an elective procedure, it is common to have questions and/or
reservations. We need to remember that it is simply hair and not some life threatening procedure! Many patients have this reluctance and there is never a clear or definitive answer aside from your intuitive feelings.

Your particular situation is for the enhancement and detailing in order to complement what you already currently have. Your hair loss is probably going to progress in the future but again, it depends on when you want to address the issue.

Having experienced seeing many other patients who had similar feelings before their hair restoration procedure, I think you will very happy you did it!! Either way, I support whatever decision you make. US Hair Restoration is always going to be a resource for you with whatever questions or concerns you have regarding hair loss and the treatment options available.

Meditate  on that assurance and clarity will present itself!

Turban Alopeica due to chronic use of turban and knotting hiar - Bottom: hair line design before hair transplant surgery

Turban Alopecia is a type of traction alopecia that is seen in people who wear tight turbans, such as Sikhs.  Turban Alopecia can also occur as a result of knotting and braiding long hair which results in hair being pulled continuously for long periods of time.  This can cause hair loss with the same mechanism as many other types of traction alopecia – chronic pull on hair follicles can destroy them permanently.

Prognosis of Turban Alopecia is similar to other types of traction alopecia.  It might be reversible to some degree only in some patients.  However, if re-growth is not seen after a year of stopping the use of the turban and tight hair braiding, it is unlikely that new growth will occur at all, leaving the affected areas of the scalp with permanent hair loss.

Turban Alopecia is generally seen in the frontal area of the scalp and in some cases in temple areas.  Those are the areas that are directly affected by the traction effect of the turban and hair braiding.  (This could be seen in most members of a Sikh family.)  Unlike the more common androgentic alopecia, which is a genetic predisposition to hair loss, Turban Alopecia is not genetic, but being predisposed to familial male patterned baldness is an accelerator factor and can cause occurrence of male patterned hair loss prematurely.

The risk of traction alopecia in Turban Alopecia type could be reduced by not knotting or braiding the hair and by wearing turbans more loosely. But for those who have experienced permanent hair loss due to Turban Alopecia, there is a natural and proven treatment option available through surgical hair transplantation. (It will be important to control hair braiding and tight turbans following hair transplantation to insure continued hair growth in these areas.)

Also see: Hair loss for cap

Q:

Hi Parsa,

Thanks for meeting with me last Sat for consultation regarding hair transplantation. I very much liked your “bedside manner”! And your explanation of the procedure, etc. As I mentioned to you my brother is also very interested and would like more information. He lives in another state but would be willing to travel for a procedure – you mentioned an internet consult?

Best,

A:

I enjoyed meeting you too.

As previously discussed, internet consultations are available to your brother and other clientele of his circumstance. To proceed with scheduling an internet consultation for hair loss, you can forward your brother the following link and request that he personally fill and forward the information to us at his convenience. The form is on our Online Hair Restoration Consultation Page.

I will be attending a medical meeting in Orlando, FL this week, but my staff will set up a phone consultation for him as soon as they receive his information.

Have a great day and do not hesitate to contact me if you have any other questions. I look forward to seeing you for your hair transplant procedure soon and thank you for your inquiries.

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.

Q:

Hi Dr.,  I saw your TV show, and would like to ask you if it is ok for me to buy minoxidil and dissolve it in the shampoo?
Also there are products that says gradually will change the color of my hair to natural color, are they safe to use? wouldn’t they interfere with my scalp respiration?

Thanks a lot

A:

Minoxidil mixed with shampoo

Minoxidil is one of the FDA approved medications for balding prevention and hair loss treatment.  The recommended dose and method for its use is applying it topically on balding area twice a day and leaving the product without washing it off.
Although combination of minoxidil with shampoos are available commercially, I don’t believe you can get a complete result by using them because:
1.    Minoxidil would be diluted with shampoo and water and that will reduce its strength.
2.    The active ingredient (minoxidil) would be rinsed and it would not get enough time to have contact with the scalp skin.
3.    It would be less likely that it is used twice a day, which is the recommended method for its maximum result.

Hair product for white hair

To answer your second question, there are many products that are claimed to change the color of white and de-pigmented hair to a normal one.  Most of them are herbal extracts and there is just not enough long term studies that prove their safety that I am aware of.

Q:

It’s a little over 3 weeks after my hair transplant now and I’ve noticed there’s a 1inch in diameter bald spot roughly two inches to the left of my right ear (when viewed from the right side).  Though I had been keeping that area clean as instructed for the last 3 weeks, it hasn’t filled in, just appears to be the same size.  I’m pretty sure it’s not getting bigger.  It’s sensitive to temperature, too, like skin on the inside of the wrist. The last scab fell off today while washing, but it was nearly as big as the spot, .3cm x .75cm big right at the center of the spot.

There’s also numbness still concentrated right around the bald spot.  This is the first time I’ve ever seen a circular bald spot on the donor area, so it’s scary. Is there something I should do? Does trauma cause fallout even in donor areas?  I’ve been taking 1.25mg finasteride daily, prior to, during and after surgery. In retrospect, except for a few erratic glucose levels (low and high) I actually think I’ve taken better care of my head this time than the 3 previous surgeries, so I’m worried.

What’s the likelihood of it growing back granted the area isn’t scarred over? A quarter-sized bald spot doesn’t make sense to me because that makes it seem like the wound healed while gaping open. That area was sensitive this whole time, but I never noticed any infection or excess oozing after the first few days, so it seems only possible that the hair around a fixed point on the wound got shocked and fell out.

Please advise,

A:

Thanks for the email.

You are right and the hairless spot is probably due to shock loss around the donor wound area. You have had a tight closure at the donor wound. I guess the tight closure has caused some shock loss and the areas on both sides of the scalp are very typical for shock loss.

When it happens, it is usually seen on both sides. The shock loss around the donor wound is almost always reversible and hair will usually come back. Re-growth of hair that is fallen due to the shock loss may take up to 6 months and recovery may be gradual.

There is not much that could be done at this point. However, you need to be seen and examined to confirm the diagnosis. The numbness around the donor area, if it occurs, may last for weeks to months and has to do with the inflammation of the healing area that may affect the fine nerves on the area. It generally gets better on its own.

I found another interesting case report on a very unusual location for hair growth recently published in the Journal of Oral Surgery and Oral Medicine the other week.  The case study was reported by Femiano et al. at the Second University of Naples, in Naples, Italy.

He reported a woman who was found to have hair growing inside her mouth due to a medical condition.  Nasal-like hair.  Scientists said it had to do with the the high level of testosterone in her system. They called it “oral hirsutism”, which I guess should be considered a new term in medical terminology.

Numerous conditions and serious diseases can result in high levels of circulating testosterone, although the most common cause of hirsutism is polycystic ovary syndrome (PCOS).  In the future, maybe someday scientists specializing in hair follicle growth may utilize hormonal manipulations to grow hair on the scalps of men and women who qualify for  hair loss treatment.

Q:

Dear Dr. Mohebi,

Thank you for taking the time to see me on Saturday! Your correspondence providing a summary of our discussion was very comprehensive and is much appreciated!

Since our meeting on Saturday, I have done some research and would like to trouble you with a few more questions:

1) Is Alopecia the correct term to describe my hair loss pattern?

2) Would you consider cortizon shot treatment for me?

3) Would you consider laser therapy?

4) If I were to use monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

I wish to thank you again for all your time and patience!

Best regards,

A:

Hi,

Here are your answers in the order you asked:

1) Is Alopecia the correct term to describe my hair loss pattern?

Alopecia is a general term that means hair loss. We have many different patterns of hair loss or alopecia, like male pattern or female patterned alopecia or alopecia cicatricial. Your pattern is similar to a male pattern because you lost your hair on the frontal area while you kept your hair on the donor area intact, which is why you might be a good candidate for a hair transplant procedure considering that your medical evaluation is negative for any medically treatable cause of hair loss.

2) Would you consider cortizon shot treatment for me?

No, steroid shots are sometimes used for Alopecia Areata (AA), which is an autoimmune disorder. Alopeica Areata is a hair loss condition with patchy hair loss spots. Your condition does not seem to be Alopecia Areata.

3) Would you consider laser therapy?

I do not recommend laser therapy for hair loss in the form of laser comb or laser machines because of the lack of solid medical evidence that support their effectiveness at this time.

4) If I were to use Monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

You can start with 2% and then you need to be re-evaluated in six to 12 months and a treatment plan might need to be adjusted at that time.

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

Any good internist or endocrinologist could follow through with the lab works that you need.  Our letter includes the list of medical conditions that should be considered and lab works to rule out those women like you who have hair loss. You can share my letter with any good internist or endocrinologist and he or she should be able to follow through with your lab result and treat any treatable conditions that could possibly be found.

Have a great day,

The effectiveness of medical hair restoration alone with hair restoration medical options that are currently available such as finasteride or Rogaine has always been questioned.  Medical hair restoration without the surgical option (hair transplant), might work for some people, but should not be recommended to all as a cure-all solution, as you may find in some advertisements.

The available FDA-approved medications for hair loss prevention are finasteride and minoxidil.  Although both are effective, they may have different indications for male and female patterned baldness. They might not be considered a complete treatment for male patterned baldness, as pharmaceuticals may try to show.

Medical hair restoration should be seen as a preventative measure which should be considered, along with the surgical options, as part of a master plan. Most people are prone to shock loss that may happen after a hair transplant surgery and they need to be on preventative measures such as finasteride at least a few months around the time of surgery. Shock loss after a hair transplant used to be one of the biggest problems that hair transplant patients had up until the last few years. Now, most hair transplant patients go on finasteride after a hair transplant surgery.

What is Saw Palmetto?

Saw Palmetto is an extract of the fruit of Serenoa Repens. It is rich in fatty acids and phytosterols. It has been used in alternative medicine for a variety of indications, most notably benign prostatic hyperplasia (BPH).

Indications:

Prostate treatment

Saw Palmetto has also been used in treatment of benign prostatic hyperplasia (BPH), a condition known by enlarged prostate size to the degree that it makes urinating difficult.

Hair loss prevention

The role of Saw Palmetto in hair loss prevention has also been documented. Saw Palmetto is one of the few effective herbal treatments that can reverse hair loss process in some people to some degree and slow down the process of  balding in men. Saw Palmetto bio active ingredients prevent conversion of testosterone into dihydrotestosterone (DHT).

That is how Saw Palmetto helps to stop the process of balding on the hair follicle level. It can help increase the thickness of miniaturized hair and make them grow longer. The Saw Palmetto effect is comparable to finasteride or other DHT blockers by mechanism. Saw Palmetto is available in oil extract for topical use on scalp or as pills used for prostate enlargement treatment.