Hair Restoration Blog

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.

Q:

Hello Doctor Mohebi,

I hope all is well and that Orlando was a success.

I am now creeping on 3 weeks post operation and just as you expected the en masse shedding commenced at right around the 2 week mark.  The good news is that I still have a sizable number left, which goes to show a large number of grafts are the way to go, but I did have a couple of more questions I thought were valuable and perhaps worthy of your blog.

1)  Even though I am at my 3rd week post op and many hairs have already been shed, many more seem to be sticking around — at least for now.  I am wondering if there’s any kind of benchmark to assess when I can expect the shedding to stop.  I would like to be able to clip all of my hair short so as to not have to keep “covering up” with hats and the alike, but I am not sure how much more shedding will take place.  Should I just wait til new hairs start to grow (1-3 months post operation, as I’ve been told) or is it relatively safe to assume that most of the hair which has not been shed after approximately a month will stick around (hang in there)?

2) For a more long-term question, what happens to the new transplants that have fallen out?  Given that telogen effluvium has taken place, I am assuming that the new hair will sprout once anagen takes place.  But here’s the dilemma:  If the front of my head contains transplants that ALL FALL OUT (for the sake of the argument, as you have stated that 90% or so of patients experience this) then that would suggest that all of this hair would be hitting CTR+ALT+DEL (or restart!) at about the same time.  If that is true, then all this hair should be hitting catagen and then telogen again at relatively about the same time, say between 2-3 years for most people.  Am I then to assume that my forehead will become synchronously thin at about 3 years only to become very full again a few months later????

Thanks Doctor.

Anonymously Yours,

A:

These are very clever questions and I will happily post them on our Hair Restoration Blog for others to see.  I will try to answer your questions in the order you asked them.

Hair Shedding After Hair Transplant

Losing hair shafts of newly transplanted hair generally occurs in most transplant cases and only a small percentage of them will continue growing the transplanted hair from the day of surgery.  Even if you are one of those lucky people who never loses their hair after surgery, you still may lose a significant number of hair shafts and only some of them will continue growing without going through shock loss.  It is not always easy to predict the timing of hair shedding in transplanted grafts, but if you have kept them for the first month after hair restoration surgery, it is likely that they will not shed.

As far as clipping your hair, you could have done it at any time after the first week following your hair transplantation.  Just be careful about the length of hair on the donor area.  You don’t want to expose your wound on the back and clipping your hair short tends to do this.  The transplanted hairs are part of your scalp at this stage and you cannot dislodge them even if you try.

Are all transplanted hairs entering the resting phase at the same time?

When hair shafts fall out due to telogen, the follicles enter their resting (or telogen) phase.  In this phase the grafts lose their shafts, the follicles shrink and become dormant for a short period of time (usually 4-6 weeks).  Following telogen comes another anagen phase in which new hairs sprout from the same transplanted hair follicles.  The initial hair grown is short and fine almost similar to vellus hair, but unlike vellus hair, it becomes longer and thicker over time.

For some reason, the biologic timer of your hair follicles are not quite synchronized.  The shedding of the transplanted hair won’t happen at the same time and therefore you won’t have to experience baldness again in the transplanted area a few years from now.  You should have some of your hair growing while a small portion of them remain in resting phase the whole time.

Q:

Hey Doctor Mohebi,

I was wondering, I’m thinking about getting a hair transplant, but I’m afraid of telling my future wife and female friends that I’ve had a hair restoration. I know men may not care that much, but if I’m dating someone and eventually I tell them I’ve gotten a hair transplant, I fear that they may get turned off.

I kind of look at it like plastic surgery. I know when I meet women who has undergone a nose job, I kind of feel strange about it and think maybe that person was not happy with their looks.
To be honest, it  turns me off.

So, my question is: from your experience with patients, do they keep it a secret from others or do they not mind telling people?

A:

Today, we have capabilities we did not have 50 years ago. As a young soccer lover, I used to have the disadvantage of wearing glasses.  It was very difficult for me to stay competitive in succer team without wearing my glasses.  Every now and then, I use contact lenses to be able to put aside my glasses. I am planning to get a LASIK procedure for that as well.

If I undergo a LASIK procedure, does it make me an insecure person. Not at all. I call it using all your resources to look your best.

We do have technology that we did not have 10 years ago. I say: why not use it? A lot of people are doing it, and nobody cares if these peoples’ hair is native hair or transplanted. The point: they are not bald any more and they can be as competitive as their non bald rivals in life.

One time, I met a very beautiful woman at a party and I ended up having a conversation with her.  When I told her I do hair transplants, she told me a story about someone who proposed to her and she rejected him. She said the man was bald. But I’m not saying because he was bald that he got rejected, but because he did not do anything about it. I know the argument can be made that what the woman did is sad and superficial but, hey, looks do play a part in initial courtship, whether we would like to admit it or not. And it was her prerogative to make that decision.

My point is: Be yourself and do whatever makes your heart happy. No matter what you do with your life, there are going to be people who may not like it. It should not influence your decisions.

Q:

When I do look down placing more tension or pull on the tight donor area, I noticed it is also pulling my neck muscles and there is no laxity at all (compared to the right).  There is no up or down movement possible of any subcutaneous tissue or the galea at the donor site. Is this normal? If the tightness does not subside, what solution options are there?

I also understand there are recommended scalp exercises before and after HT surgeries?

Regards,

A:

It is normal to feel tension on the side that we removed the strip.  Skin needs a few weeks to get relaxed and stretches to compensate for the removed area.  Although we generally recommend scalp exercise before hair restoration surgeries with strip technique, you should avoid scalp exercise after hair transplant for the first 3 or 4 months.

I recommend that you avoid all movements that increase the tension in the area until you feel that the tension on the skin is gone.  If you put too much stretch on the back of your head in the first few months after hair transplant, you running the risk of stretching the donor scar.

Have a good weekend.

Q:

Dr. Mohebi, my next follow up appointment with you for 10 months follow up is scheduled in early January. I am very pleased with the results of my hair transplant, at the front, but, as we had thought, we may need to do some more at the back. When is a good time to do a repeat hair restoration surgery after the first one?

With all best wishes,

A:

If you need more density on the crown, you can consider another hair transplant surgery for that area anytime after 6 months from your first hair transplant. The reason you have to wait for 6 months is because at that point you should be evaluated for the growth of the grafts from your prior hair restoration surgery and donor area. All grafts should be grown at month six after your other hair transplant. So we should be able see which areas need to be covered further. Performing another hair transplant surgery may risk putting a new graft on top of an area that is supposed to grow new hair, but the hair is not visible yet.

One time, a friend told me he was at a diversity conference and there was a man who came up to the podium to speak. He asked the audience, “what is the first thing you notice about me?” Someone yelled out, “BALDIE!” And subsequent laughter ensued (being an African American, it turned out he was hoping someone would say, “you’re black”).

Although the remark was taken as a joke, it’s unfortunate many people in our society notice physical appearances before anything else. There’s no shame whatsoever in losing one’s hair. The reality is that it’s not that person’s fault. It’s their genetic coding.

For those losing hair, there’s a socially acceptable solution: A hair transplant. Hair transplants have done wonders for all types of people, from big-name actors to prominent television sports anchors. It boosts self-confidence, makes a person feel less conspicuous in social settings, and may even increase the chance of a person landing a first date or better someone’s job prospects.

Hair transplants at US Hair Restoration are all-natural. Take a look at our hair transplant before and after photo gallery.  In a way, a hair restoration can restore your youth and help you feel at ease around people you’re meeting for the first time, making the experience of life better and more rewarding.

Much like narrowing a gap between teeth by getting braces, or correcting one’s near-sightedness by lasik eye surgery, a hair restoration can be a wonderful option for those who believe they may benefit from it.