Here is a question from a previous patient of US Hair Restoration:

I was wondering if there is any limitations on performing a second hair transplant surgery for me who have one surgery with you before.  I am experiencing more hair loss on the top and I also want to make it even denser in the front. I need to know when is the best time of doing a second procedure and what will be the cost of hair transplant for my second procedure.

A:

The best time for your second hair transplant is around six months from the first hair transpalant is you want to add density to an already transplanted area.  If the transplantation is to be done on any other areas it could be done as early as 2 months as long as the donor is healed properly adn allows a second round of removal of strip.  In FUE cases anytime after the first 2 weeks when the inflammation is over the second procedure could be done.  We have done 2 FUE procedures as back to back but occasionally in some patients the swelling of tissue minimize our success in the first few days after surgery.

The cost of a second procedure in US Hair Restoration is based on the number of grafts and the current cost of hair transplant.  However, we have 10% discount on our rates for our previous patients so your future hair transplant procedure will always be discounted with USHR.

Here are a few frequently asked questions we have for your general inquiry:

How do you relocate hair grafts once broken down into follicular units?

The hair grafts (or follicular units) are transplanted based on the individual needs of the patient. The doctor will draw the hairline at your initial consult and right before the procedure and discuss it in detail with the patient. Designing the hairline has to do with the degree of baldness in each area of the scalp and the patients’ preference.

How are the hair grafts placed?

The follicular units must be immersed in a special solution in cold temperature once they are taken from body. When the sites are completed by the surgeon, the hair technician will gently insert the grafts one at a time. This is a very meticulous process and typically takes a few hours.

Does Dr. Mohebi perform the hair transplant surgery himself?

All surgeries are performed by Dr. Mohebi. He will get assistance from a surgical team of hair technicians during dissection and implantation of the follicular unit grafts.

Am I put under sedation while I get the procedure?

You will be put under sedation during the procedure but you will still be conscious. You will become more alert and aware as the surgery goes on, in which you will be sitting in an upright position in a surgical chair most of the time. You can watch a movie, read a book, listen to music or you can sleep (if you choose to) during your hair transplant surgery.

How long before the transplanted area doesn’t look like a procedure has been done?

Redness and swelling after hair restoration surgery is not uncommon and may last a few days following the procedure. Most patients generally recover from surgical swelling and redness after day 4 or 5. A loose fitting hat can be worn to prevent direct sunlight, which will protect the grafts and also keep your swelling or redness from being seen by others, if that is your concern.

Where can I find before and after photos of Dr. Mohebis’ work?

Before and after photos as well as video testimonials of previous hair transplant patients can be found at our facebook page: http://www.facebook.com/home.php#!/pages/US-Hair-Restoration/148987321796051, which we will keep updated as much as possible on a regular basis.

Q:

About 18 years ago, I underwent a hair restoration procedure with primitive technology. Nowadays, I’m very reluctant to ever do such a thing again. Since I had the transplant, I’ve been wearing a hair piece, which I don’t really like to do. I wonder: is it possible for my hair to ever look the way it did in my twenties? And, also, what if I don’t have enough donor hair, can I still get a hair transplant? If I don’t have enough donor hair, body hair is possible, right?

Also, I’m an algebra teacher, anyway this can be afforded on a salary like mine?

Sincerely,

-

A:

I appreciated the email.  Here are my answers to your questions, in chronological order.

1. Most of the time, it can be corrected. A lot of our patients actually have needed repair hair transplants. Their situation was very similar to yours in that they had plugs or micro-graft surgeries.

2. Whether your donor hair is sufficient, I don’t know. I have to examine you for that. A good majority of people have enough hair to cover up a hair plug procedure. Some men have so much donor hair that they can even cover up other areas of hair loss.

3. It is plausible to use body hair, but it is much better to use head hair. If you’re in a situation in which you have virtually no scalp hair, and also high-quality body hair, you could be a good candidate for a body hair to head procedure.

4. I can’t tell you if your hair transplant surgery will be affordable right now. Only after I evaluate you. It’ll all be based on the number of grafts that you require. We offer discounted rates to qualified candidates on our standby program.

5. Make sure to attach photos of yourself and email them to me. The photos we need of your head are from the front, left and right sides, top and back. Make sure to also include a picture of the hair plugged areas of your head so I can take a better look at it.

After taking a look at your head shots, I’ll have a phone consultation with you and talk about the options that are open to you. It’s also a time where I can reply to all your questions.

Q:

Not too long ago, I had a hair transplant (using FUE). Things were OK until several months after the transplant. I spent some time having fun in the sun, and it was maybe close to triple digit degrees outdoors. As soon as I got back to my house, I noticed my scalp in the transplanted area had turned white. It looked like the skin on my head had been scorched. But I didn’t think it was a big deal and I kept on using the Minoxidil with Betaderm spray, which my doctor highly recommended.

A few weeks later, the top of my head (which had been grafted) began to peel and the skin fell off (like a sun burn). And there were a few transplanted hairs which fell off as well, with the skin. This really alarmed me. After about eight weeks, the scalp seems to have healed, although there is some redness in places; but, overall, it seems to be OK. But, I’m a bit worried about the condition of my after-playing-in-the-sun scalp. I know it was probably a sun burn, but I just hope my grafts weren’t damaged beyond repair. I’ve done some research on skin consequences of sun burn, but I wonder if the grafts can ever fully recover from the exposure to the ultra-violet rays. I know if my skin becomes more tan, it’s OK. But about my grafts, I’m really concerned about them.

I need answers, doc.

Yours truly,

A beach bum with a hair transplant

A:

Hey beach bum,

Skin and scalp which has been exposed to the sun’s rays for long periods of time damage both native hairs and transplanted hair. The consequences can be especially harmful if a person who has had a hair transplanted is not under an umbrella or is not wearing a hat of some sort. The scalp skin could be damaged that way. It is best to stay out of the sun after a few minutes, at most. For the first six months, hair transplant patients may want to use sunscreen or wear a hat to prevent hair loss and to guard against permanent damage to hair follicles.

For those who don’t like to wear hats or other types of protective head wear ought to guard their hair as if their financial stability depended on it. Make sure your hair density increases to the point in which your hair follicles cover your entire scalp and so the scalp skin is not exposed to the sun’s scorching rays (especially during summer).

I can’t give you a verdict on whether your newly transplanted hair is permanently damaged. I’m sure I don’t have to tell you this, but I’ll say it anyway in case there are people reading this blog who are in a similar situation: from now on, be very careful about your scalp’s sun exposure. And just kick-back and wait a while to see if the damaged hair grows back.

Remember, after hair transplant care is very important, if not crucial to the longevity of your hair restoration results.

Temporal triangular alopecia also known as TTA is a congenital hair loss condition in which the patient had a limited balding area on his temples. The condition is assumed to be congenital and is generally obvious since birth. The balding spot may contain normal numbers of hairs, but they are all vellus and generally not visible.

Congenital temporal triangular alopecia is considered a nonscarring alopecia and if biopsied should not be mistaken for Cicatricial alopecia. TTA respond well to hair transplantation and there are some studies that patient were treated with hair transplant surgery successfully with adequate coverage.

The condition could be treated by a hair restoration surgery at any age. We at the California offices of US Hair Restoration offer treatments for congenital temporal trangular alopecia.

In a recent email sent to our office from a recent patient, he writes in regards to his scalp evaluation and regarding Propecia (Finasteride). He asks, “Could finasteride worsen the hairline due to the rise of testosterone?” and, “if there’s any safe and minor treatments to slow the progress of maturation or reverse it that you would recommend at this stage?”

Early stages of male patterned hair loss may not always be obvious enough to be differentiated from normal levels of miniaturized hair during scalp microscopic evaluation. Propecia (finasteride) is still the most recommended hair loss medication to prevent additional balding. Some patients have even been prescribed Propecia without proper diagnosis or documentation of their hair loss condition making it difficult to tell if they have gotten better since they started or worsened.

Propecia (finasteride) is designed to block DHT (Dihydrotestosterone) which is the main cause of male patterned hair loss. With this in mind, finasteride cannot deteriorate your hair loss or cause changes in the hairline. Maturation of the hairline is normal in all men and should not be confused with balding. We also do not have any further recommendation on medications that can stop the maturation of the hairline.

In a recent article published in Dermatologic Surgery Journal, Dr. Nausbaum et Al discusses naturally occurring female hairlines. His study was based on a large panel of normal women for the purpose of comparing and contrasting hairline variables to attain the perfect female hairline. Given that male hair restoration has almost always been the focus of hair restoration this new information can help benefit women who are candidates for hair transplant surgery.

The author came up with a guide or type of blueprint to help determine the best hairline for a woman. This guide was based on the average recorded parameters in women with healthy, non-balding hair. Among a panel of 360 women, the most dominant feature found in 81% of the women was in fact the presence of the widow’s peak. In addition, around 90% of these women also showed lateral mounds.

It’s great to know that there is now a bigger emphasis in hair restoration for women with more viable information and techniques to help solve their hair loss. Our hair transplant surgical offices already specialize in female hairline reconstruction in women suffering from female patterned hair loss or male patterned hair loss. This technique has also been applied on transgender (male to female) patients to help soften and alter their masculine features.

We at our California offices of US Hair Restoration perform transgender hair transplants regularly and I personally believe that hair restoration is one of the most key procedures in sex reassignments process for transsexuals.

As with any surgical procedure, you would have to worry about certain side effects or tedious maintenance. We are asked by every potential surgical patient, “When can I go back to work after my hair transplant surgery?”

Downtime doesn’t only apply to the amount of time you would spend away from your office or how soon you can return. This all depends on the type of work that you do, whether or not you can use a hat, how sensitive the issue of your hair transplant is and whether or not you want to keep it a secret.

We have a few follow up dates after the hair transplant surgery in our California Hair Transplant Offices and each must be completed. On the day after surgery, all patients must have a hair wash done in office to best instruct the patient. We make sure to clean the patient as thoroughly as possible without damaging the hair grafts in a professional and comfortable manner. We make sure the patient understands that scabbing and redness must be dealt with as soon as possible.

Patients are most concerned about how they will look the first few days. Redness and swelling are the most common side effect of the surgery and can last 4-5 days after the surgery. Patients can choose to wear a hat to cover the transplanted area from plain site.

On larger hair transplant cases, the swelling may actually progress to the eyebrow area or even the eyelids and under eyes. 5 to 6 days is all it should take for this kind of swelling to go down, generally. The swelling is most always triggered by large (2500 graft surgery) or mega-session (3000+ graft surgery) procedures but is almost undetectable on smaller cases.

The final concern or issue after hair transplant surgery is the visual aspect of the existing hair. Most cases, we trim the hair in both the recipient and donor area (0.5 to 2cm) and it will stay at about that length for 2 to 3 weeks. In about 90% of patients that undergo surgery, the transplant hair will fall out within the first 3 weeks. This means will look like they did before hair transplant surgery. By this point, there should not be any swelling or redness. Staples and/ or sutures are removed in less than 2 weeks after surgery and the transplanted hair follicles will then go into their resting phase until they are ready to grow again.

We understand people like to pamper themselves. A patient of ours wrote to us regarding a scalp and body massage. He had his hair transplant surgery in our Encino Surgical Office almost 8 months ago and asked, “Would get a head massage risk loosening the implants?” He also wanted to know if that would help increase circulation to the grafts and improve growth.

Hair that has been transplanted over 3 months ago and is growing normally is considered permanent and cannot be dislodged from your scalp. The main concern is in the first weeks of a hair transplant surgery when the hair is still settling in. Even so, some cases where the hair is removed the active part of the follicle may still remain and a new follicle will grow shortly after. At this point, hair cannot be harmed.

However, there is no proof that a scalp massage to increase scalp circulation is proven to increase the quality of existing or newly transplanted hair. More so, it has also not been proven that lack of blood circulation or oxygenation in scalp will cause hair loss.

Alopecia Areata (AA) is an autoimmune hair loss condition. It presents itself in the form of patchy hair loss on the scalp or other areas where hair exists. Some have questioned if AA can also be triggered by emotional stress. It has been discussed in some medical journals but the exact mechanism has never been explored. There has been a study conducted and published on the relationship between stress and the pathogenesis of alopecia areata. This was done by subjecting AA-affected and normal lab mice to ether anesthesia (stress) through restraining the animal.

The mice with alopecia areata had a marked increase in hypothalamic-pituitary-adrenal tone and activity centrally and peripherally in the skin and lymph nodes. Plasma corticosterone, adrenocorticotropic hormone, and estradiol levels were determined in this study as indicator or stress level, whereas gene expression in brains, lymphoid organs, and skin was measured by quantitative RT-PCR for corticotropin-releasing hormone, arginine vasopressin, proopiomelanocortin, glucocorticoid receptor, mineralocorticoid receptor, corticotropin-releasing hormone receptor types 1 and 2, interleukin-12, tumor necrosis factor-alpha, and estrogen receptors type-1 and type-2.

Compared to normal mice, there was an altered interaction seen between the adrenal and gonadal axis proving that the stress level in those animals was in fact higher. Stress also caused changes in the activity of the hypothalamus pituitary axis in the mice with AA.

In addition, animals with AA had significantly blunted corticosteroid and ACTH responses to acute ether stress (physiological stressor) and a deficit in habituation to repeated restraint stress (psychological stressor). These findings further suggest that altered brain responses caused by stress may be associated with the occurrence of alopecia areata, proving the hypothesis that stress plays an important factor.
Treatment of AA is done through observation of the patient and, in some cases, steroid injections can also prove useful. These treatment options have shown some improvement in those who have extensive types of AA like Alopecia Totalis. We do not recommend any patient to get hair transplant surgery if they have active AA since the chance of losing the newly transplant hair is very likely.

Although AA is not genreally treated with hair restoration, we at our offices of US Hair Restoration in LA, BH and Orange County visit and treat patients of AA in a regular basis.