Hair Restoration Blog

The Value of Hair Transplant Medical Technicians  

Hair transplant technicians are an integral and important part of the operation in hair transplant surgeries.  Therefore properly trained hair technician plays an important role in hair restoration results.

At US Hair Restoration we utilize a well designed system in which we train our hair technicians.  Our hair technicians are selected by a discerning level of criteria:

*    A high level of personal ethics
*    Initially demonstrate a natural level of strong hand eye coordination
*    General training as medical or surgical assistant
*   Further training as hair transplant technician —  is provided in our office for more junior   technicians.

Hair Transplant Technician Selection

After a vigorous selection process our technicians must complete US Hair Restorations custom designed Hair Technicians Training Program. Our technicians complete intense period of training under the direct tutelage and supervision of medical director Dr. Parsa Mohebi. This training includes:

     *   lectures
     *   surgical observation
     *   demonstration high level of skills on synthetic hair and laboratory models
     *   compliance of surgical techniques and standards

At each level technicians must show proper improvement and competency prior to moving to the next level of training.  We do not allow technicians to work on actual patients before they demonstrate proper skills and above satisfactory completion of our training program.

US Hair Restoration Hair Technician Training Program

During this program each technician first learns how to cut and place grafts on synthetic hair and scalp at the next level the hair technician candidates’ advance to working and mastering their skills Bovine skin which is close enough to human hair orientation for laboratory purposes and skill development.

Laboratory conditions replicate the hours of actual surgery. During this time future hair technicians for US Hair Restoration spend hours cutting and implanting bovine hair grafts. This training improves their hand eye coordination until they reach a level of competency to assist in an actual hair transplant surgery.

 Advancement to Hair Transplant Surgical Procedures

Upon successful completion of all necessary lecture series and hands on training our hair technicians receive approval from the medical director to working in the operating room under supervision of a senior hair restoration technician.

When hair transplant technicians are properly trained they will demonstrate their abilities and skills by passing the written and oral examinations.  After demonstrating that they are capable of working to the high standards of US Hair Restoration, they graduate as hair transplant technicians.  Recently graduated hair transplant technicians continue to be supervised to improve their skills.  They also are required to participate in internal educational series, as well as, and external hair transplant seminars that are designed for hair technicians.

We are proud to announce that US Hair Restoration is ready to train technicians for other centers that need to have highly trained technicians for their hair restoration services.

Innovation in Chronic Wound Healing

A new study on hair transplant in chronic wound healing brings new hope for many patients who suffer from non-healing or delayed healing wounds.  The study was conducted by my friend Dr. Francisco Jiménez in Spain. In this research, Dr. Jiménez and his colleague evaluate the effect of hair transplant grafts on improved healing of chronic wounds.

Area reduction in experimental group (black line) that received hair transplant into their ulcers vs. the control group (red line)

The study is based on the fact that epidermal sheets from the hair follicle may help in re-epithelialization of the wound bed.  The investigators reported that healing of chronic wounds progresses faster in skin where healthy hair follicles exist.

This may be explained by the fact that hair follicles are full of progenitor cells (cells that can transform to other types).  In this study 10 patients with chronic wounds (ulcers) of about 36 cm².  Most wounds were present without complete healing for about 10 years. The researchers implanted 20 hair grafts in an area of 2×2 centimeter.  They also used a similar square of non grafted area as control.

After evaluation of the wound in those two areas it was readily apparent that the area receiving hair implants healed much faster at the 18-week end point.  In this particular case the transplanted area of wound (ulcer) healed significantly better than non transplanted area (27.1% vs. 6.5% ulcer area reduction).  The maximum healing has been noted to be 33.5% vs. 9.7% (transplanted vs. control group) reduction at week four.  In further microscopic evaluation, the investigators noted an increase in several wound healing elements such as epithelialization, neovascularization, and dermal reorganization.

This study demonstrates the amazing role of hair follicle grafting into wound that do not heal normally due to a variety of different causes.  The process of transplanting the wound with hair grafts can be done as an outpatient procedure. This new procedure could improve the life style of many people while reducing the financial burden of treating chronic wounds for the society.

Reference:

Jiménez F et al. A pilot clinical study of hair grafting in chronic leg ulcers, Wound Repair Regen. 2012 Nov-Dec;20(6):806-14

Q:

Hello Dr Mohebi,

I recently read an article on the web that you commented on Harvard research for hair cloning.  I am in my early 40′s, fairly broke, and eagerly awaiting the day that hair cloning is successful and available to the market.  For the past decade, I keep hearing the same promises that it will arrive in 5 years, but still no luck.  Can you comment on why it is not here yet, and perhaps when we will see it.  Thanks in advance.

A:

Hair multiplication also referred to as “Hair Cloning” is a hot topic in hair restoration over the last few years it is garnering more and more attention.  The research for multiplying hair (hair cloning) has been going on for years now in several centers around the world over the past few years.  The study that we performed with collaboration with some scientists in Cedar Sinai is only one of the many steps that need  be taken to successfully multiply hair.

Hair multiplication would offer superior benefits to patients and represent a significant advance for medical science and hair restoration. Still the march towards this being a medical reality moves slowly for a several different reasons:

1.  Although hair loss has detrimental effects on patients’ lives, is yet to be recognized as a burning issue in medical field to warrant more funding for hair loss research.
2.  Hair multiplication studies are usually done in private setting without the support of larger institutions such as universities and NIH (National Institute of Health).
3. The growth rates of the hair stem cells are extremely slow in cell cultures.  That makes the overall period of hair multiplication timelier and adds exponentially to the cost of these studies.

The combination of above three factors and other obstacles in this process has made progress of hair multiplication very slow.  My best estimation of current research is that hair multiplication is probably at least 8 years away from practical medical application.  The reason for this is that any new medical treatment or device needs to go through different phases to obtain FDA approval for its use in the U.S.

The last phase necessary in development of a new treatment is ‘clinical trials’. The phase three is done on volunteer patients to find out more about long term complications that might be associated with the treatment. At this time no study has reached the clinical trials stage this makes it unlikely that we can have hair cloning available to public within the next eight years.

Q:

I have read online that Propecia can cause depression as a side effect. Some articles I read say it is a very rare side effect and others say it can occur in 75-80% of the time. Which is correct?  Thanks.

A:

The primary clinical trials on finasteride (Propecia) were conducted with a large number of patients over a period of 5 years. These initial trials did not reveal any evidence of depression in the participants. However, subsequently a few more recent reports indicate the possibility of depression occurring after taking finasteride.

A prospective study on 174 young men in 2004 suggested a higher chance of depression in men who used finasteride. The authors of the study concluded that finasteride might induce depressive symptoms. The recommendation from this study was that finasteride should be prescribed cautiously in patients who have higher risk of depression. This could be further underscored by the studies on psychology of hair loss and hair transplant in patients which notes alteration in self image and esteem and possibility of improvement of depression. The 2004 study emphasized that further clinical research is necessary to evaluate the behavioral effects of finasteride in higher doses in patients who are more susceptible to depression.

Based on the results of this study, we cannot suggest a percentage for depression in patients taking finasteride. Obviously, if you are experiencing mood disorders or any other symptoms while taking finasteride, you need to discuss it with your doctor for further diagnosis and treatment.

Q:

Dear Dr. Parsa Mohebi,

Exactly 2 years ago (2011), I was diagnosed with Oral Candidiasis (Candida Albicans, Yeast, Thrush. Till presently, I still suffer from Oral Candidiasis and oral hair growth. My gums get itchy to the point of comparison to poison ivy, & hairs which feel like multiple splinters in my gums.

In the beginning, my gums were so soft that they were literally piecing off. In the back of my left, last tooth it was so unbearably itchy and the skin became multiple white balls coming off the gum. It was biopsied for cancer, although I had expected that the results would have rather been that of a diagnosis.

Within the past 2 years, my gums and teeth have been suffering from this phenomenon. Within the past year and a half, I had a tooth extracted, which immediately after the anesthesia had worn off, began feeling like something sharp was inside the gum. The dentist would not fully examine it, and before I realized the extent of it, hair (some resembling nasal hair and stubble) was growing in, and coming out of my gums; increasing in numbers, forms and areas as time has passed.

Having gone to over twenty-five doctors/specialists, not one is knowledgeable, nor believes that anyone can have hair growing in the oral cavity.

Despite indeed this is a rare case, after reading your blog, articles, and speaking with you, I have the utmost confidence with your knowledge and expertise, that you will be of great help in solving this dreadful, debilitating health issue.

Thank you ever so much!

A:

Hi,

Growing hair inside mouth is an extremely rare condition but it was reported in medical literature in past as “oral hirsutism”. I have written a post on that in our blog in November of 2009 as Hair Growth in Woman’s Mouth. The diagnosis on that particular case was hyper-androgenism. Hyper androgenism is due to excess secretion of the male hormone (testosterone). Elevated testosterone could be present in some conditions like polycystic ovary disease or other endocrinology disorders.

In your case, you need a lab work to check your hormonal levels. Most importantly, the levels of testosterone and DHEA should be measured. If any of those hormones are elevated, further investigation is warranted to find out the reason for the excess hormones. Then your oral doctor should find the exact location that grows hair and try to remove the hair follicles.

There should not be any further growth of hair, if the elevated hormone is treated and after the hair follicles are removed. Thank you for sharing with us your condition. I hope this condition gets treated completely soon.

Q: Hello Dr. Mohebi, I had a strip procedure a month back for 1500 FUs on the front/middle section of head. While I wait for this results, I was thinking if I can have a FUE procedure for crown and hairline enhancement, so that my recovery will be well utilized. I may be wrong. Could you provide your recommendation/suggestion? Thanks. A: In short the answer to your question is yes.  However, there are some qualifying factors and conditions for this consideration. When performing a ‘Strip Method’ FUT surgery it is possible to also perform and ‘FUE’ follicular unit transplant immediately following the first surgery. Actually the two types of procedures can be performed in the same session; as long as the FUE grafts are being placed in different recipient areas.. If you need to restore hair in the same recipient area as a previous hair transplants procedure, then I recommend a minimum wait of 5-6 month from the first hair transplant procedure. The reason for this is that we need to see outgrowth of hair from the first procedure. The visibility of the new hairs allows us to be able to place new hair in between them and to avoid placing a new hair graft on top of the old ones.

Innovation in Hair Loss

Hair loss continues to be one of the leading medical cosmetic concerns among men and to a lesser degree for women. Modern hair transplant is a proven natural solution and continues to benefit many people. Follicular Unit Extraction (FUE) is growing in popularity and can offer a unique solution to some individuals with limited donor hair.

Many men today are opting for shaved or ‘military type hair styles where the entire scalp and hairline frames the face with closely cropped ‘stubble’ hair. A person with limited donor hair can be a prime candidate for this safe and less invasive hair transplant procedure.

Hair Transplant Surgeon Can Combine both Techniques

Skilled hair restoration surgeons can take individual follicular units (FUs) and create the maximum balanced coverage over the scalp. They can then create further ‘look of density’ by simulating hair stubble with scalp micro-pigmentation (SMP).

SMP is a procedure where special surgical needles are used to inject dermal pigments into the scalp or other areas such as eyebrows into the skin. The color of pigment selected is close to that of the patient’s hair resulting in a cosmetic hair shadow. SMP is a safe and very non invasive procedure.

Combining FUE and SMP to resolve the challenge of hair loss for people with little alternatives and represents an advancement in modern hair restoration. This solution is not for everyone but is a welcome choice for some people who previously had limited alternatives to resolve their hair loss problem.

Follicular Unit Extraction (FUE) and Slap Micro Pigmentation (SMP) could be both used to minimize the visibility of the scalp scars after a strip hair transplant procedure.  At US Hair Restoration, we offer both these techniques.  However, there are pros and cons to each that the patients need to know before proceeding with the procedure.

FUE for Scar Revision

FUE transplantation into the donor scar: Left side - Intact scar, Right side - FUE grafts transplanted into the scalp scar

Since the extraction of individual follicular units (FUs) is done individually it is perfect for the small procedure of revisioning a hair transplant scar from a previous hair transplant. The surgeon can extract a small number of grafts from the permanent zone and artistically and strategically place them in the scar. This process of using FUE uses hair to obscure and blend the margins of the scar to the surrounding scalp.

SMP for Scar Revision

SMP to minimize donor scar visibility after hair transplantation - Picture is taken immediately after the SMP procedure

Scalp Micro-Pigmentation is the process of using special pigments and fine needles to create the shade of stubble or shaved hairs on the scalp. SMP utilizes dermal pigments that match the patient’s hair color. Used in scars like FUE it can artistically applied revises the margins of the scars. This revision results in the obscuring or blending of the scars margins to the surrounding scalp.

SMP vs. FUE for Scalp Scar Revision

choosing FUE rather SMP for revising the scalp scar has to do with the type, location and size of the scar.  It also has to do with the patient preferences.  If patients are willing to keep it very short or they want to completely shave it.  It is good for the patients to educate themselves with pros and cons of each technique in order to make a more informed decision.

FUE and SMP

FUE and SMP are two methods that can also be used in conjunction with one another to revise a hair transplant scar. Recommendations and the preference of the surgeon most often provide the best results. These modern advances in scalp scar revision are performed in Los Angeles leading hair transplant centers like US Hair Restoration.

Q:

Dr. Mohebi

There seems to be a lot of talk on the internet about FUE and ARTAS procedures. Can you explain to me what the pros and cons are of these types of procedure vs the strip technique?

A:

We perform both ‘Strip Method’ and FUE transplants in our practice. Both of these procedures are the most modern forms of Follicular Unit Transplantation (FUT) for hair restoration. FUE procedure could be done through different techniques such as manual and automated.

ARTAS is a FUE machine that harvests Follicular units by a robotic arm. Since the robot removes the hair grafts, the procedure is easier on the surgeon, but it is not flexible as of using different punches that might be necessary in different individual. Besides the harvesting the rest of the procedures are the same in two techniques of Strip FUT and FUE.

Strip gives us better quality grafts and preserve your donor hair better. It is also more affordable. This is especially important for someone like you with possibility of further hair loss in the future (based on your microscopic evaluation). Strip hair transplant leaves a linear scar on the back that might be visible if you shave your head in the future or keep it very short. I think the main question is whether you need to keep the option to shave your head in the future or not. Here is more on the differences of FUE and strip hair transplants in our blog.

New Research in Study of Shock Loss

A new study from the Department of Dermatology at Johns Hopkins School of Medicine demonstrates that one of the inflammatory pathways present in the healing process could be responsible for what we know as shock loss after hair transplantation. Shock loss is when a patient experiences hair loss after a hair transplant procedure in recipient area.  This hair loss can be seen in just a few weeks up to several months after a hair transplant. 

The new study by Nelson et. al. shows that prostaglandin D2 (one of the factors that is seen in healing wounds inhibits Wound-Induced Hair Follicle Neogenesis through a Receptor called Gpr44.

The researchers explain that prostaglandins are key inflammatory mediators involved in wound healing process, as well as, regulating hair growth.  They considered the wound-induced hair follicle Neogenesis (WIHN) as a significant marker for skin regeneration.  This study was done in a simulated wound healing condition.  The researchers administered prostaglandin D2 to the skin and evaluated the WIHN condition.  They concluded that PGD2 inhibits hair follicle regeneration. 

New Possibilities in Hair Loss Treatment

The importance of this study is in the possibilities that it may lead researchers to the ways shock loss can be minimized after hair transplant surgeries. Another interesting possibility is that these studies may also illustrate a pathway that leads to continued hair growth through activation of prostaglandin receptors.  This pathway might be the key to a breakthrough method of hair restoration in the future.