Q:

Dr. Mohebi,

We have a 6-year old patient with severe form of Alopecia Areata.  The patient has undergone all the standard forms of treatment including scalp injections of steroids.  The patient has lost about 70% of the scalp hair.  Now that there has been no respond to any of the other treatment options, the patient’s father is inquiring about Platelet Rich Plasma (PRP) for this patient.

My questions to your regarding PRP are:

• Is this a process you offer at US Hair Restoration?  You mention the process in your blog: http://www.ushairrestoration.com/blog/tag/platelet-rich-plasma/ but does not say if you offer this treatment.
• Is this something that an Alopecia Areata patient as young as 6-years old should take?Thank you for your help.

 A:

 This is a great question.

Base on the information in your query it appears that this child has Alopecia Areata (AA) or its more severe form “Alopecia Capitis”.  Alopecia Areata is an autoimmune disease that might progress to involve large areas of the scalp in some cases.  This disorder can improve spontaneously and without any treatment. When this does not occur a physician must monitor it and consider various approaches. There is no perfect treatment that can guarantee full recovery in resistant cases of AA.

PRP (Platelet Rich Plasma) has been in the news in recent years.  PRP has been suggested for treatment of several types of hair loss conditions. However at this time, there is not sufficient level of solid evidence to prove its effectiveness for hair loss conditions.

Since Alopecia Areata may resolve spontaneously with no treatment in most cases, The few reports of the recovery of alopecia areata after PRP treatment may simply  be reflecting the spontaneous regression of the disease. These isolated instances do not definitively prove the positive effect of PRP in the treatment of AA.  A double blind study of comparison of the patients who were treated with PRP vs. Placebue is necessary to prove this claim.

As a researcher and hair restoration surgeon, I believe a well designed study is necessary to substantiate this claim for PRP. We at US Hair Restoration do not recommend PRP for treatment of patterned hair loss, alopecia areata or any other types of hair loss disorders. Further consideration can be given if more solid evidence from scientific research is available to prove PRP’s effectiveness for hair loss treatment

I appreciate your contact and question and will submit it to our Hair Restoration Blog as it may be of benefit to other people too.

Thanks,

Parsa Mohebi MD

Today’s hair transplant surgeries differ greatly than the previous decades.  Patients no longer end up with results that appear as an artificial ‘doll like’ look as in the era micro-grafts and plugs thanks to the modern Follicular Unit Transplantation (FUT) methods.  In the Follicular Unit Transplant, hair grafts are harvested with different techniques; Strip and FUE. The difference in these procedures is the manner in which the donor hair is harvested from the donor area of scalp as described below:

1. Strip method in which a strip of scalp is removed from the back of the head and the surgical wound sutured or stapled. This strip then has the follicular grafts removed from it or “harvested” for donor hair to be transplanted. Strip method is the most often performed hair restoration procedure at this time.
2. FUE (Follicular Unit Extraction) method is the other type of hair transplant procedure. FUE hair transplant involves the removal of the individual follicular units from the permanent zone one at a time. FUE does not require removal of a strip and these grafts are selectively taken throughout the permanent zone.

Both FUE and strip methods have their own advantages and disadvantages.  If the patient selection is done right both procedures could be successful to achieve the patient’s goals. The chart below provides a comparison between FUE hair transplant surgery versus Strip hair transplant.

* FUE Research Committee of the International Society of Hair Restoration Surgery has been established in 2012 to perform several studies to find the answer for these and many other questions.  We will update this information when the results of those studies are available.

 ** Patients who are qualified for large number of grafts (gigasession) should have high density and good laxity of scalp.

Q:

Dr. Mohebi,

Reading thru a website about hair restoration and what is needed after a hair transplant. Resulted in a question; I wanted to see what you recommend here:

• Apply huge amounts of Aloe Vera gel to both donor and recipient area but not until five days after surgery (then twice a day minimum).

A:

You don’t need anything other than the shampoo that we gave you and proper techniques of washing that we instructed you for washing off the scabs.  If your scabs remain in place for more than one week after surgery, you can leave the shampoo on the scalp longer for over ten minutes to help remove all the scabs.  Aloe Vera Gel won’t hurt, but it does not replace proper washing.

Q:

Hi Dr. Mohebi,

Trust you are well. It was a pleasure meeting you in Los Angeles back in June. I had a few concerns about taking Finasteride and wanted to have your opinion before taking the medication.

I read few articles that side effects of finasteride include impotence, abnormal ejaculation, decreased ejaculatory volume, abnormal sexual function, gynecomastia, erectile dysfunction, ejaculation disorder and testicular pain of which I experienced some of them when using the medication back in 2010. It was also stated that patients have reported persisting erectile dysfunction despite discontinuing the drug. I do feel this is also the case for me at times. Do I need to consult with a Urologists?  Would taking 1/4 of the pill every other day have any impact on slowing down/ prevent the hair loss and at the same time not damage sperm quality?

I am still looking at a few dates to come back and get my hair transplant as I don’t want to depend on medications for long. I am aiming for either this Nov. or April at the latest.

 Regards,

A:

The initial double blind study of Propecia (finasteride) did not reveal any evidence of permanent side effects from it.  This research was done on over 1000 patients and around the same number of people who were enrolled in placebo arm of the study. In fact it showed that the adverse effects of Propecia in people who initially experienced sexual side effects and decided to continue the medication improved over one year from the time they started experiencing the side effects. Recent reports from smaller studies that focus on possible long term or permanent side effects of Propecia, listed side effects including erectile dysfunction, lack of sex drive or even mood changes.  After reviewing the cited articles and their methodology, I was not convinced that the data was collected and documented properly.  The International Society of Hair Restoration Surgery (ISHRS) also assembled a group of hair restoration doctors to evaluate the validity of some of these reports regarding the side effects of Propecia.  The group’s evaluation did not support the claims of the new reports on irreversible side effects of Propecia.

It should be noted that, Merk & Co. Inc, pharmaceuticals now include an insert in Propecia packaging. This insert discusses the possibility of long term side effects. We also review this with our patients.   My thought is that a more significant study on a large group of people who took finasteride for a long period of time is needed to confirm the new claims.

If you have any sexual side effects such as changes in sex desire, erection or sperm count, you need to be evaluated by your primary doctor or a urologist instead of assuming that it is only a side effect of finasteride.

All the Best,

Dr. Parsa Mohebi

US Hair Restoration Centers welcomes people who have considered hair restoration for years to make this step in 2013. The science of medical hair restoration is now a natural, proven and permanent method to improve your self image. Led by renown Los Angeles and Beverly Hills Surgeon, Parsa Mohebi, MD we continue our commitment to be leaders in the field. Learn More >>>

We wish all our patients and everyone a promising and successful new year!

Some hair loss is correlated to stress. This type of hair loss is generally reversible and does not require medical treatment or hair transplant. Hair loss induced by stress usually occurs after severe stress, such as surgery, starvation, emotional stressful situation or illness. Stress and hair loss don’t have to be permanent. Getting your emotional stress under control or alleviating a physical stressor usually results in your hair growing back.

How Stress Causes Hair Loss

Extreme stress can interrupt the normal hair growth cycle. Your body may want to spend its vital resources on more essential organs such as heard and brain so the luxury hair could be cut off its supply. As much as seventy percent of your hair can prematurely and nearly simultaneously enter the resting phase (telogen.) The hair that entered telogen phase will start to fall in a few days to weeks following the stressful condition.  This process can cause noticeable hair loss which is usually known as telogen effluvium.

The person will not become completely bald but the thinning is readily apparent in most cases. The delay from the trigger stressor seems causes confusion on the part of the patient concerned about hair loss. In most instances hair will begin to grow back within three to six months.  In a minute percentage of people, telogen effluvium may be only the trigger for longer term hair loss.  Those are generally people who are prone to patterned hair loss and stressor can accelerate the inevitable loss of hair that was destined to occur anyway.

One of the most common medical problems is hair loss. and it will affect most men at some point in their life. Hair loss is more than cosmetic it detrimentally effects the self esteem of many men an women.

It is a complex hereditary condition androgenic alopecia – baldness can begin for some even in puberty. Women can also suffer from androgenic alopecia.

Recent medical advancements have brought two FDA medical solutions that can positively affect hair loss; finasteride (Propecia) and Minoxidil. However, hair transplants are the most natural, proven and permanent solution for baldness. The FDA medications have proven to be a good adjunct treatment; but hair transplants are the most successful permanent solution for hair loss. Learn More>>>

Modern hair transplantation is a natural, proven and permanent solution to hair loss. Follicular Unit Transplants (FUT) is the state of science and art in today’s hair restoration.

Many people do not understand that FUT hair restoration is available in two distinct forms of hair transplant surgeries. They are one the ‘Strip Method’ and two ‘Follicular Unit Extraction (FUE) method.’ Both these procedures consist of transplanting hair from the permanent zone (areas of the scalp where hair loss does not occur.) The harvesting method in each procedure is different. This blog is particularly devoted to better understanding the ‘Strip Method.”

Strip Method Hair Transplants

In this form of FUT hair restoration surgery a donor strip is taken from the back of the patients scalp. The size of the donor strip is determined in the patient’s pre-op consult and microscopic evaluation.  The donor strip is removed by your hair transplant surgeon and separated into naturally occurring follicular grafts of 1, 2, 3 and 4 hairs. These grafts are meticulously and artistically placed in recipient incisions made by your doctor in the balding areas.  Below are some of the advantages that patients who elect the FUT strip method enjoy.

Advantages of FUT Strip Hair Transplant

1.  Maximization of the number of grafts that can be harvested in a single hair transplant session.   This advance technique allows for the transplanting of over 3500 grafts. Many patients who have never had a hair transplant can complete their hair restoration in a single surgery.
2. Damaged to hair grafts is minimized. The strip procedure allows the surgical team to harvest and process the grafts under microscope effectively reducing transection (damaging hair follicles).
3. The surgery is less labor intensive then its FUE counterpart and can be elected at a more affordable cost.

Q:

Hi Dr Mohebi,

Thank you for your detailed report on my hair loss. I have a few questions and comments that I forgot to ask at the time of my visit.  According to your report, I have 20% miniaturization almost all over my scalp so does this mean, I will completely lose all the hair on my scalp? I would like to get some hair extensions to give more density to my hair, is this a good idea? The hair extensions will not be with glue or any chemical it will be non-damaging to the existing hair (have an appointment for next week.)  Finally, am I possibly a candidate for hair transplant considering my diffused hair loss? I would appreciate your views and comments.

A:

Many women with early stages of hair loss may note some thinning of scalp hair diffusely.  Interpreting a microscopic hair evaluation, up to 20% hair miniaturization could be normal or borderline and more than that might be considered a sign of active hair loss.  In your case, you might be experiencing early signs of mild female patterned hair loss.  That does not necessarily mean that you will go bald on the top completely and more follow up studies are necessary to predict your future hair loss or gain. The key is to monitor any progression closely.

We also ordered some lab works for you that are important in women with early hair loss.  We are trying to rule out other medical causes of hair loss.  If we find a positive finding in your lab works, it could be treated and with it your hair loss might be cured.  You can get a hair extension as long as it does not put too much strain on you existing hair in the form of constant pull.

I did not recommend a hair transplant for you at this time.  However, we will address this option in your follow up visits, based on your progress of hair loss and other evaluations. I have developed a 5 Step Protocol for Women’s Hair Loss, to help educate them and the hair restoration professionals.

Have a really great day,

Often times we at US Hair Restoration receive calls and emails from individuals who are ashamed that they need a hair restoration for their balding situation and want to hide the fact they contacted us for advice. Although we are very sensitive to the needs of each individual who seeks our help, we also want to speak encouragement over their situation as well as give them new hope, confidence, and a fresh perception of what they are getting themselves into.

Modern technology has allowed us capabilities we did not have 50 years ago. Just as with vision problems, many have the disadvantage of wearing glasses. Although there are contact lenses as well, there is still a dependence upon outside tools for sight, which can be inconvenient. After many years, LASIK was developed which has solved this stubborn problem of fading eyesight which many, to this day continue to suffer from.

If someone chooses to undergo a LASIK procedure, does it make them an insecure person? Not in the least! Rather, they are using their resources to look their best and be as functionally independent as possible.

We always use the latest technology in hair restoration at US Hair Restoration, which was not available as recent as 10 years ago. The question to ask is, why not use it? Thousands are doing it every year with excellent results, and nobody is concerned if their hair is native or transplanted.  Hair loss is a disease, yes a common one and like any other diseases there are treatments for it.  The proper conclusion is that these individuals are no longer bald and don’t have the competitive disadvantage like those who decided to do nothing for their baldness.

 In the end we all must be ourselves and do whatever makes us feel our best. No matter what we do with our lives, there will always be someone who will be critical of whatever we do.  Regardless of what others may say, do whatever makes you feel good about yourself.  There are options available to you today that was not available to your ancestors.