Hair Restoration Blog

Q:

Dear Dr. Mohebi,

I had the hair transplant done about 5 weeks ago.  I’m very concern with the recent hair transplant.  First of all, I thought the look of my hair was fine already.  However, I did notice there are some thinning parts and it would be good to thicken the middle a bit.

I look like a mess!  My cousin saw me and she noticed that I looked different and was wondering if I had a hair transplant done.  Ahhh!  I didn’t want it to be noticeable.  If I look at myself now, I can’t help but notice the color of my scalp and how different it looks.  Pic 3 shows a clearer look on how the transplant was done.

Is there something you can do or recommend to make it look more normal to before (it kind of looks like I have thinner hair now too)?  Also, after reading your blogs, I hear that doing the procedure would cause stress to the scalp.  I’m very concern with this also b/c I’m 27 yrs old and this is actually my 2nd procedure.  I hope this does not make me more prone to losing my original hair.  I feel like it’s all my fault that I went to this particular procedure at this time and now I am completely anal about losing my hair.  Hopefully my hair loss pattern is still the same as I was before this recent procedure.

Your input would be much appreciated.

Thanks a lot,

-

A:

The hair shafts on transplanted grafts stay in place for a few weeks after the hair transplant and since they are shorter they may be detectable, but they usually fall out and you go back to where you were before. Then you have to be patient until the transplanted hair starts to grow. I usually recommend to people like you who have long hair on the back to comb their hair forward for the first few weeks after their hair transplant and also for the time that the transplanted hair might be visible because of the short hair there or the slight pinkish discoloration of the scalp.

I cannot predict what it may look like down the road, but I do not see anything unusual for this phase after a hair transplant procedure. Some thinning in your native hair for weeks to months after a hair transplant might be seen due to shock loss. I do recommend that you be on finasteride, which can prevent shock loss (losing hair due to the stress of surgery on vulnerable hair on scalp) to some degree. Try to camouflage your transplanted area and be patient for the next few months that the new hair grows and cover the balding areas.

Previously, we posted an article in our hair restoration blog: Tax on Cosmetic Procedures. For our readers, the good news  is that there were many people who supported us in our rally against the cosmetic tax proposal. Even more good news: the current cosmetic tax proposal has been dropped (hooray!). It was the same proposal that was part of the massive health care reform bill presently being considered on the Senate floor.

But let’s keep in mind that it is quite possible the “Bo-tax” could be tacked back on before the bill’s final passage.

I say the five percent tax is insane because a very similar type of cosmetic tax has been implemented in New Jersey, with disastrous results. Tax revenues from plastic surgeons and cosmetic doctors have dipped in that state, probably because potential patients are going to doctors in surrounding states for their cosmetic surgery needs, while not having to pay as much.

In this case, we may deter those people who visit the United States every year from coming to America in order to take advantage of our top-of-the-line cosmetic procedures.

The additional tax on cosmetic procedures has lowered business profits for doctors, thus limiting the amount of tax revenue the state of New Jersey receives to pour into public institutions and not-for-profit organizations. It seems to be a no-win situation for everyday citizens, doctors, and state assemblymen and politicians who are sincerely trying to do good service for the people of their district.

Another drawback: the tax may be applicable to a broad-range of procedures that improve a person’s self-image and self-confidence. These procedures may very well end up improving a person’s depression or social anxiety, as described in our article, Psychology of Hair Transplants.

Lastly, the cosmetic surgery levy unfairly discriminates against people with congenital defects, such as bald people who are looking for a hair transplant or women seeking to rid themselves of wrinkles by using Dysport or Radiesse.

Data sources show that about 90 percent of people who are considering cosmetic-type treatment are women (source: American Society of Plastic Surgeons). These women are seeking to enhance their self-perception and to feel more comfortable in social settings and also looking to gain an edge in the workforce (studies show chances are better for more “attractive” people to get hired, to receive promotions, or to receive a higher salary).

I would like to take this time to thank all physicians, patients, and politicians who supported the drop of this proposal from the health care reform bill.

Dear Dr. Mohebi,

First of all, thanks for this great blogging avenue.  I am very thankful that this website is around.

I’m a bit concern w/ my recent hair transplant.  i’m only 27 years old, and had decided to have a 2nd hair transplant done one month ago.   i was mainly just thinning in my front side, and was convinced by my hair surgeon that i should get a 2nd hair procedure done to add thickness in the thinning front side. Please note that the sides of my front have been pretty thick already, but i did have a few thinning gaps in the top center of my scalp.  Overall, i had a total of 1500 grafts transplanted on the front and a few on the center of my scalp (crown).

Immediately after the surgery, i felt remorseful.  i realized i should’ve done more research.  It just didn’t occur to me until the day after the surgery that this procedure might cause me to lose my native hair faster.  Right now, i notice a few shock loss on the frontal thinning hair.  I don’t think the center had much (if any) shock loss, as it had pretty thick native hair already.

I was wondering, would this shock loss accelerate the affected hair to retirement stage?  Lastly, overall, do you think this hair transplant will make my native hair to thin out faster had I not done the transplant?  I recall that my hair surgeon informed me that it shouldn’t be the case, and that any thinning results would be directly from my own thinning pattern.

Please support.  Thanks in advance.

A:

Many people who undergo a hair transplant have some degree of miniaturization (thinning hair shafts) on the balding area, which indicates there is active hair loss in those areas. Miniaturized hair is when your hair has already started the process of balding. Although the process of hair loss is usually very gradual and it may take years to complete, stressor (either physical or emotional) may accelerate the loss and facilitate the process of balding in prone hair (in thinning areas).

Shock loss is losing hair in an area with significant miniaturization due to a stressor. Shock loss after hair transplants used to be common in the past. However, using finasteride (Propecia) is proven to prevent this type of hair loss after hair transplant or significantly minimize it. I usually start all my patients on finasteride a few days before their hair transplant and continue it for at least six to eight months if they do not want or cannot continue it for the rest of their lives.

In regards to whether or not this hair transplant can affect the thickness of your native hair, I cannot say without performing a miniaturization study (examining hair with a microscope to determine the rate of miniaturized hair). If you had a large number of miniaturized hair to start with, you would be running a higher chance of shock loss. The chance of shock loss is usually higher for the first hair transplant. It seems like if you were to have a lot of vulnerable hair, you would have lost them mostly at your first hair transplant surgery. I recommend that you go on finasteride as soon as possible to protect your native hair if you are not already on it.  That is all you can do at this point.

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.

Q:

Hey there, doc,

It’s been about three weeks since my second hair transplant in Los Angeles. As of this moment, when I bend my neck, there’s a tightness and tension on the back of my head (donor area). Can you tell me if this tightness will ever go away and be back to the way it was before my operation? I really want to be back in the gym doing my jump ropes and abs.

A:

I’d say to give it about three weeks and begin more gentle activities such as jogging, brisk walking, bike riding, or push-ups. As long as you don’t stretch that donor area by looking down (this is important), you ought to be OK.

Activities to stay away from four to six weeks after a hair transplant: wrestling, flag football, basketball, boxing, abs exercises, and surfing or boogie boarding. Make sure there isn’t much strain on the donor area. It’s sensitive and requires protection and non-contact to heal.

Remember: Activities which increase tension between the edges of the healing wound in the donor area, such as lifting barbells or weights and other exercises involving intense bending of the neck are to be avoided. You should wait at least six months for this type of exercise in order to prevent reopening of the wound or stretching and widening of the donor scar.

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.

Recently, the Senate proposed a health legislation which includes a 5% tax on cosmetic procedures. The cosmetic surgeries include hair restoration procedures and many other surgeries for men and women.

The potential 5% tax on cosmetic surgeries is a no-win situation for American citizens and potential hair transplant patients. By levying a tax on cosmetic procedures throughout the United States, it may further cripple our stumbling economy and reduce the much-needed funding states receive from cosmetic surgeons in order to build, for example, a high-speed train in California, create more innovative after-school programs for teenagers, poverty intervention programs for inner-city residents, more efficient forms of public transportation (e.g. metro rails).

But, at the heart of the issue, I believe, is the obstruction of an American citizen’s right to the pursuit of happiness. Through an orthodontist, people have the right to get their teeth straightened out; by undergoing a vasectomy, a married couple no longer has to deal with an unwanted pregnancy; through the purchase of an electric hybrid Honda Civic, a motorist can fight sky-rocketing gas prices.

The government doesn’t tax citizens for making these types of decisions. People do them because they believe these things will improve their lives. But why impose a tax only on cosmetic surgeries? Where do we draw the line? Who can be the judge of whether a hair transplant is a luxury for a 25-year-old man who started to lose hair and looked less attractive, which led him to struggle with social anxiety and feel depressed a lot of the time?

I believe this young person ought to be given the same opportunities as the other non-bald peers in his life, especially when we are talking about dating, relationships, and employment prospects in this increasingly-competitive time. Who knows, if this legislation passes, maybe in the near future, people who wear contacts will be taxed an additional 5%.

At US Hair Restoration, we perform hair transplants for lots of patients who travel from other countries, such as Canada, Europe, and the Middle East. Many of these patients visit the United States because they want, for their cosmetic surgeries, to be exposed to the most modern techniques; but many of them may consider the cost of cosmetic procedures, too. Increasing costs for these surgeries may deprive us from a potential source of income and deprive them of potential patients.

Currently, some states impose a tax on cosmetic procedures. According to doctors who work in these states, the results haven’t been pretty. The plan has fallen 59% short of its projected revenue; it’s proven to be an administrative pain-in-the-behind, and it was forcing many prospective clients to obtain cosmetic surgery services in surrounding states, resulting in reduced tax revenue collected from plastic surgeons from cosmetic-tax-imposing states.

For myself, as the medical director of US Hair Restoration, I’m against this legislation for the simple fact that people ought to have the freedom to do what they think will make them happy–without imposing additional costs on them. Our motto at US Hair Restoration has always been: “quality hair transplants for everyone.” Some of my patients have told me that they have lost a lot of life opportunities because of their baldness. Why not allow these wonderful people to get back what they deserve: their hair.

Let’s be fair to all people. After all, we live in the land of liberty.

-

Parsa Mohebi, MD
US Hair Restoration

Earlier this year, in an L.A. Times story, business columnist David Lazarus said he had visited a hair transplant center’s open house and noticed a lot of men in attendance. A lot more than he expected. He spoke to the director of the business and found out that, these days, a lot of the men looking for hair transplants are hoping to increase their job prospects by having a full head of hair.

Some studies have shown that people who are more attractive, or are not overweight, or are younger, tend to have an edge on the job market. They get paid more, are more likely to get promoted, and are likely to be treated better. Although this finding may be saddening, it unfortunately may be somewhat of a reality.

Considering this finding, there are balding men in our society who believe they can increase their job prospects by having a full head of hair. It may simply turn out to be a psychological edge, or a self-image booster, for these men to perform well during their interviews.

Nevertheless, what seems more important is the manner in which a job seeker presents himself to his prospective employer. The answers he gives, his attitude, eye contact, and overall vibe. But, it seems, to some people, it wouldn’t hurt to have a full head of hair.  Plus, due to the current state of the economy, hair transplant costs are at an all-time low for high-quality hair restorations.

Over the last few decades, different therapies which effect wound repair have been proposed. The connection between wound healing and hair growth was already proposed by Dr. Catsarelis at the University of Pennsylvania through the WNT pathway (some molecular process that controls would healing and hair growth). Now, we review the emerging fields of gene and stem cell therapy in hair restoration and wound healing.

Gene therapy, initially developed for treatment of congenital defects, is a new option for enhancing wound repair. In order to accelerate wound closure, genes encoded for growth factors or cytokines showed the greatest potential.

The majority of gene delivery systems are based on viral transfection (intentionally contaminating the host cells with a particular virus that insert the desired gene to the target cells), naked DNA application, high pressure injection, or liposomal vectors, etc. Embryonic and adult stem cells have a prolonged self-renewal capacity with the ability to differentiate into various tissue types. A variety of sources, such as bone marrow, peripheral blood, umbilical cord blood, adipose tissue, skin and hair follicles, have been utilized to isolate stem cells to accelerate the healing response of acute and chronic wounds.

Recently, the combination of gene and stem cell therapy has emerged as a promising approach for treatment of chronic and acute wounds. This is good news for prospective hair loss patients: the idea that similar gene therapy techniques can be used to affect the baldness gene by switching the hair loss gene off and on.

This new study was done by Branski et al. at the Department of Surgery, The University of Texas Medical Branch and Shriners Hospitals for Children.