Follicular Unit Extraction and Scalp Micropigmentation

 Most men will suffer hair loss to some degree in their life. This is because of DHT a male hormone that negatively affects the hair follicles of the scalp; most aggressively at the temples, crown and top of the head. So men bear this change or maturation of male pattern baldness (MPB) well; but many experience the well documented ‘psychological effects’ which culminate in low self image, esteem and confidence.

It is no wonder that hair restoration through hair transplant surgery is  one of the leading medical cosmetic concerns among men.  Today’s follicular unit transplant (FUT) surgery is providing the undetectable and natural solution that patients’ seek.

Nevertheless, some people with advanced hair loss and limited donor hair for the surgery have fewer choices. Follicular Unit Extraction (FUE) surgery combined with scalp micropigmentation (SMP) offers and innovative approach for men with advanced male pattern baldness (MPB).

A combination of these less invasive procedures can provide excellent results under the skills of today’s leading hair transplant surgeons.  A combined FUE and SMP procedure means:

• Individual follicular units (FUs) will be transplanted for balanced and even coverage
• Individual FUs will be transplanted to created an attractive age appropriate hairline

• will include selection of dermal pigment to match your hair color
• micro injections of dermal pigment to simulate ‘stubble hair’

• to support the development of transplanted hair a short term prescription of Propecia may be prescribed

 These two advanced hair restoration procedures can provide a patient with the option of having a shaved or ‘military type hair style that is attractive and a safe medical solution to their hair loss. s 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.

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). Los Angeles hair transplant centers are innovative leaders in hair restoration procedures.

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.

 The Cause and Problem of  Hair Loss

Dihydrotestosterone (5α-Dihydrotestosterone), [DHT] is a male sex hormone, an androgen. Male and female adults can lose hair as a consequence of changes in the metabolism of androgen in the body – men far more commonly than women. Most men experience hair loss from the effects throughout their life. The incidence increase with age; however, some men can experience it even in their adolescent years.

Male pattern baldness, [MBP] is also known as androgenic alopecia or androgenetic alopecia, is caused by the hair follicle’s sensitivity to DHT. The follicles miniaturize [shrink], reducing the lifespan of the follicle resulting in abnormal production of hair. Hair loss is considered to be a legitimate medical problem that in some individuals leads to serious depression.  DHT plays a major role in hair loss.

Female Pattern Baldness, [FPB] also has an androgenic component but can also have some other contributing factors.  The best hair restoration surgeons will order additional tests to isolate that the cause is androgenic. In patients where this is accurate than hair transplant is a natural, proven and permanent solution.

Hair Transplant Surgery is a Great Solution (watch video)

Medical Treatment for Increase Hair Loss from Androgenic Alopecia

Online sources assert that topical Spironolactone (Aldactone) can be used to reduce hair loss; as well as, Nizoral shampoo. There is not strong medical evidence supporting Spironolactone effect on reducing hair loss.  Orignally developed for hypertension some level of anti-androgenic effects have been noted. Systematic use has shown effective in female hair loss depending on the type. Use in men manifested side effects of sexual dysfunction and is not recommended for treatment of androgenic alopecia in men.

Nizoral (ketoconazole 5%) is an anti dandruff medication with antifungal properties. There are some indicators that it can affect hair loss in male patterned baldness. Presently it does not have FDA approval nor does Sprionolactone.

The only FDA approved medications for hair loss treatment are Minoxidil and finasteride. Nizoral is not one of the FDA approved medications for hair loss treatment. A daily regimen of finasteride with Minoxidil is effective for many men. Minoxidil is recommended to be used twice a day, some find positive results with just a once a day application. Minoxidil does not double up the effect of finasteride but can add to it as an adjunct treatment.

Not too long ago, consumer columnist David Lazarus, in a Los Angeles Times story, mentioned he had visited an open house at a hair transplant office and, to his surprise, saw that there were a lot of men who showed up. For him, it was unexpected. Lazarus said he had a conversation with the owner of the hair transplant center and learned that, in this fragile economy, a lot of men who are shopping for a hair transplant are thinking that it will better their job opportunities by having a full head of hair.

According to a CNN report, findings have shown that people who are better looking, or are slim (vs. fat), or who are of a younger age tend to have better success in the nation’s economy. These “lookers” bring in more money, have a better chance of moving up in the company, and tend to be treated more graciously. Albeit the results of this study may be a bit disturbing, it may be a somewhat accurate reflection of our society.

When we take into account these conclusions, it ought to come as no surprise that there are balding men in America who really hold fast to the idea that they can boost their chances of landing a job by sporting a full head of hair. It might just end up being a mental edge, or a self-esteem enhancer, for these adult males to give a good impression during their interviews.

All things considered, in my humble view, the crucial aspect of a job interview is a how a potential employee presents himself to his interviewer. The responses she gives, her demeanor, attitude about previous employers, and overall impression.

But, these days, some men believe it wouldn’t decrease their chances to have a full head of hair. In addition, due to the slumping economy, a hair transplant cost is at an all-time low for high-quality hair restorations. If there ever was a time to get a hair transplant for those who, under different circumstances wouldn’t get one, now is the time.

Recently, Dr. Parsa Mohebi, Medical Director of US Hair Restoration Los Angeles, gave a lecture on a new way to use the Laxometer during mega and giga-session hair transplants at the annual ISHRS (International Society of Hair Restoration Surgery) gathering in Amsterdam, Netherlands. As mentioned in other hair transplant industry gatherings, the Laxometer has the ability to make more accurate the strip removal method during a follicular unit hair transplant and, at the same time, minimizing the risk of donor scar complications.

At the 2009 ISHRS Meeting, Dr. Mohebi discussed a new manner in which to utilize the Laxometer for patients who have limited laxity of the scalp because of previous hair transplant surgeries or for people needing a max number of grafts in one session (3000+, 4000+, 5000+, etc.). In 2008, Dr. Mohebi  tried a different method by which he removed the strip in sequences for hair restoration procedures using the Laxometer before and after removal of every part of the strip. This particular way of using the Laxometer has resulted in a safer strip removal and, at the same time, has lessened the risk of donor wound complications.

The findings revealed at the ISHRS meeting proved that the Laxometer is the ideal surgical tool for increasing the number of hair grafts during a strip hair transplant while minimizing donor wound complications of a hair transplant surgery. Because of the results Dr. Mohebi found, he has been using the Laxometer at his California hair transplant offices quite often and it has resulted in a lot of satisfied patients.

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.

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.