Hair Restoration Blog

Recipient sites are the very fine incisions made in the balding scalp to receive the follicular unit grafts extracted from the donor hair of the permanent zones of the scalp. Hair transplant surgeons utilize variation in technique when making of these sites during hair transplant surgery.

The use of ‘premade sites’ and the termed ‘stick and place’ have been used harmoniously in hair transplant surgeries for years.  In our practice at US Hair Restoration centers we primarily utilize pre-made sites rather than stick and place. This is because in our perform a substantial number of ‘Gigosession Hair Transplants’ and the use of stick and place would unnecessarily prolong the procedure; while also increasing the duration in which grafts are out of the body. Recently, we have started to making recipient sites even before removing the grafts in many of our hair transplants (strip and FUE). We do this for two important reasons:

1. Making the sites before hands minimizes the time that grafts have to stay out of body and technicians can start implanting grafts as soon as we are done with removing the grafts (in FUE cases or strip procedures).
2. There are some evidences that an incision (wound) that is made a few hours earlier contain more growth factors and would healing associated cells than a fresh wound.  So we can assume that the process of healing is already started by the time we are inserting the grafts. This can accelerate the healing of the transplanted grafts. (1)

It is important to recognize that the best hair transplant surgeons incorporate surgical techniques and procedures that are best suited to the success of a particular patients surgery.

1. View Reference Here

Does vitamin D deficiency cause hair loss?

There are several studies that show the effect of Vitamin D Receptors in hair follicle cycling.  Most of the studies show a relationship between vitamin D receptor (VDR) and hair follicle anagen (growth phase) initiation.  View research here.

Most studies on vitamin D receptor are done on animal models and we cannot completely explain the same condition in human hair follicle. The result of most research to date is a recommendation for future research studies to explore the role of vitamin D and its receptor in human hair cycling. A more extensive body of research on the levels of vitamin D in human body is needed.  The aim of these studies should be to determine  effect of vitamin D in human hair cycling and a comparison to the observed data from the mouse model.

The business of hair loss vitamins and supplements is a multi-billion dollar business. However,  in my years of study and medical practice have not read or found  a study that shows patterned hair loss in healthy men and women could be improved with any amount of vitamin therapy.   Despite The fact that  In my medical hair restoration practice in Los Angeles we see men and women in various stages of hair loss. We often request levels for essential elements such as Iron or specific hormonal levels. Conversely we rarely find a need to order lab work to check the vitamin levels. The reason for this is that vitamin deficiencies are very rare in America. If a patient had a  vitamin deficiency that had caused him/her hair loss; then he/she would have greater medical conditions and would unlikely be able to make it to our office. The level of vitamin deficiency to create a clinical level of hair loss would present many other systemic conditions  that would occur prior to presenting hair loss.

Discount for FUE Transplant – Limited Only for Study Participants

As a leader in hair restoration, US Hair Restoration is now conducting a study on different methods of FUE (Follicular Unit Extraction) hair transplantation in its Southern California offices.  Our main goal of this study is to compare the quality of grafts harvested by the most advanced hair restoration techniques.  Study patients will be entitled to a discount from our standard rates of FUE hair restoration. The study will be going on until the end of July 2010 and the results will be submitted for publication in world-wide medical journals.

Who is a good candidate?

Hair loss patients who does not want to have linear scar on the back of their head might consider this option most probable for their needs.  Also, any candidate should know that the number of grafts available to be harvested in one FUE session might be significantly less than what could be done through a traditional strip method.  Thus, in addition to those who want to avoid scarring, patients who does not need a large number of grafts for their hair restoration may also be relatively better candidates.  FUE could be used for treatment of male patterned hair loss with class III and IV, eyebrow hair transplants, or to restore the linear scar from a previous strip procedure. Applicants can call the US Hair Restoration office at 1 (800) 302-8747 to schedule a consultation with Dr. Mohebi.  If you are still unsure whether or not FUE is the right procedure for you, please read our website and in particular the page on Follicular Unit Extraction.

Hair Care Beverly Hills

Here is the content of the interview with US Hair Restoration’s Medical Director, Dr. Mohebi done by BuziMoms which is published in hair care Beverly Hills.  The interviewer asked several hair loss and hair restoration questions from Dr. Mohebi based on the requirements of the visitors and readers of the site.  Here are the questions and Dr. Mohebi’s answers:

An Interview With Dr. Prasa Mohebi, M.D. , A Qualified Hair Restoration Surgeon For Moms In Beverly Hills

BuzyMoms: If a hair loss patient has already had a transplant with another doctor and is disappointed with the results, can the procedure be redone or is repair possible?

Dr. Mohebi: Yes, hair restoration surgery repairs are a good portion of our operations performed in our Southern California offices (located in Beverly Hills, Encino and Orange County).  Many people may have unnatural results from previous hair transplants due to the older techniques, but some even have problems with recent hair restoration due to technical issues or lack of proper judgment on the part of the hair transplant surgeon. In most cases, the repair is easy and can be done in one or two sessions.

BuzyMoms: Is there a minimum age for hair loss surgery?

Dr. Mohebi: Hair transplant surgeons used to say that 24 was the minimum age to perform a hair restoration procedure.  However, nowadays microscopic techniques being used to evaluate the miniaturization of hair can assist surgeons in predicting the final pattern of hair loss. By being able to predict each patient’ s  final stages of hair loss, we are able to see where the pattern of baldness is heading and recommend hair transplant surgery at an earlier age.

BuzyMoms: Won’ t my bare scalp be showing in the back of my head once the donor hair is taken?

Dr. Mohebi: If you do not plan on shaving your hair, your donor wound will never be visible.  However, if you plan on shaving your head for any reason, you may need to have a FUE or Follicular Unit Extraction procedure done rather than the general FUT procedure.  This method eliminates the visibility of a linear scar on the back of your head and is the best option for patients who plan on shaving their head or keeping their hair very short in the future.

BuzyMoms: Do you provide free consultations?

Dr. Mohebi: Yes, the initial consultation with us is always free in any of our three hair transplant offices in Beverly Hills, Encino and Orange County.

BuzyMoms: What type of information should be brought to the consultation?

Dr. Mohebi: Anything related to your hair loss and hair restoration, including medical, surgical or even cosmetic changes that you like and may help you have a better result after a hair restoration procedure.

BuzyMoms: Are lab tests required prior to surgery?

Dr. Mohebi: We may need lab work for men or women who have hair loss without showing a typical pattern that we see in most male or female patterned hair loss or in people who have lost hair due to any other medical conditions such as thyroid problems, hormonal imbalances or lack of certain elements such as Iron.  We also need certain lab works from patients who have medical risk factors for surgery like diabetes to make sure those medical conditions are under control before we can pursue with the hair transplant surgery.

Hi Doctor,

My son has had a hair transplant years ago with old techniques and he has bad hair transplant scar now. He now wants to shave his head, but the scar of hair transplant on the back of his head may become exposed. Do you perform hair transplant scar repair or do you recommend any procedure that can help with hair transplant donor scar coverage?

Answer:

Hair transplant with strip technique can cause a linear scar that could be visible on the back of head if the patient wants to shave his/her head. A hair transplant scar is not limited to a bad hair transplant technique and it might have to do with one’s personal healing process too (some people are generally better healers compared to the others).

The good news is that we have methods to minimize the size of the scars nowadays and if you have bad hair transplant scars from bad transplants in the past, there are several new methods that can help improving the appearance of the donor scar. A hair transplant scar could be improved by repair of linear widened scars with different methods that we perform at our Los Angeles office of US Hair Restoration. Dr. Mohebi is the inventor of the axometer, a device that measure the laxity of the scalp precisely before hair transplant surgeries. Good measurement of the scalp laxity is one of the best ways to minimize development of donor wound complications and widening of donor scar and the Laxometer is the device to do these measurements.

One method is through simply excising the scar. Excision of the donor scar may be helpful for some donor scars. After removing the scar, hair transplant surgeon can close the skin with the trichophytic closure method in which a small wedge on one or both sides of the skin edge is removed and the skin is closed primarily. Trichophytic closure allows some hair follicles to grow new hair into the final scar. Presence of hair helps making the hair transplant scar become invisible.

Hair transplant donor scar coverage could also be performed by transplanting hair into the scar. Hair could be harvested from other areas using FUE or mini-strip techniques. Again, presence of the hair inside scarred area could trick the discriminating eye and the scar would become less detectable. Patients may need more than one hair transplant procedure into the donor scar for minimizing the difference between the densities of hair in scar and surrounding areas.

The last method that could be used to camouflage the linear scar is by tattooing the scar. People who plan to keep the hair very short can easily tattoo the scar with the figures of short hairs so it seems that there are some hairs present in the scar area, which can help minimizing the visibility of the scar.

I just received the last issue of the Hair Transplant Forum International, the Journal of International Society of Hair Restoration Surgery (ISHRS). Our article, Psychology of Hair Transplant‚ is published as the cover article on this issue of the journal. I also have a copy of the article in our hair loss library in our website. Here is the abstract:

Psychology of Hair Transplant

Parsa Mohebi, M.D., William Rassman, M.D.

Balding and its psychological impacts has been the subject of many studies in the past. The relationship between hair loss and stress is clear to all clinicians who practice in this field. Negative psychosocial impacts of hair loss in male patterned baldness and in women with generalized thinning have also been seen. Many of us (hair transplant surgeons) have seen the negative effects of hair loss on self esteem and self-image.

We know that hair loss impacts some men sex life and their stability with regard to career choices in men of different ages. Despite the solid evidences and published literature on psychological impact of hair loss, the corrective effect of medical and surgical hair restoration has never been studied. After observing the drastic changes in patient behavior and the high level of patient satisfaction in those who had hair transplant procedure, we were motivated to look into the psychological impact of hair restoration on different aspects of a patient’s life.

We came up with a series of criteria that could have been modified by having a hair restoration procedure; we used some indexes that were previously studied comparing bald and non bald men on different psychological variables. We initially performed a pilot study and asked patients about different aspects of their lives during their post op visits. We gave our patients open ended questionnaires and probed their psychological state after their hair restoration procedure was complete. Eventually we focused in on eight major criteria that have been reported and documented as variables associated with hair loss in the literature. We collected a subset of them in our pilot study. Included were questions on the general level of happiness, energy level, feeling of youthfulness, anxiety levels, self confidence, outlook on their future and impact on their sex life.

We have chosen the patients who had their first hair transplant surgery between one to three years from the time of our study, so they had seen the final result of their hair restoration procedure. We limited the study to male patients with male pattern baldness and the ones who had surgeries less than three years ago so they still had a fresh memory of the changes they experienced. Each patient had exclusively follicular unit transplants that reflected our standard of care for that period. We sent a questionnaire with a brief description on the nature of this scientific study. We did not collect any patient identifiers and the response was totally voluntary. We sent the two hundred questionnaires with stamped return envelope.

The response rate to our questionnaire was 37 (18%). Each patient was used as his own control since we asked about the changes that they experienced after surgery in comparison to those variables before the surgery. We used T-test to compare patient’s responses. Table 1 shows the mean and standard error in eight different criteria that were asked. Patients had significant improvements in all eight criteria regardless of their stage of baldness and their ages.

In another attempt to compare psychological changes that patients experienced in different stages of baldness, we divided patients into two groups: (1) those who had Norwood IV patterns or less and (2) the ones with Norwood V patterns and above. We observed the most significant difference in two categories, (a) sex life and (b) career experience. Patients with less balding had a greater impact on their sex life and career when compared to patients who had more advanced stages of hair loss. These changes were not age related.

Hair restoration surgery can affect many aspects of a patient’s life. Hair transplant can potentially reverse psycho-social problems associated with hair loss. The positive impact of hair restoration surgery is more visible among patients who suffer from those undesirable effects the most. In early stages of hair loss, patients may have more awareness of their condition and they might be more affected than men in the later stages of hair loss.

Patients who experienced hair loss at an early age while involved in an active social life were more prone to the negative side effects of balding. That could explain why younger people with hair loss appeared more benefited by hair restoration procedures. Also it could be assumed that hair loss can have a negative impact on a patient’s outlook which seems to reverse after receiving a hair restoration procedure which improved their outlook.

Low response rate from a blind mailing has always been a drawback in questionnaire studies. We received 37 out of 200 of the questionnaires that we sent out (response rate was 18.5%). Giving incentives to responders may be a good way of increasing the participation rate of any questionnaire studies. We presented the result of this study at the annual scientific meeting of ISHRS and have been contacted by many of our colleagues who expressed interest in collaborating in a larger scale study. We are currently trying to rise funding for repeating this study to optimize our response rate and the statistical value of the study.

If you have any questions on the content of this article you can contact US Hair Restoration office at Los Angeles through email at info@ushairrestoration or phone.