Female Hair Transplant?
Q:
Thanks.
Cutting Hair Before Hair Transplant
Q:
Quick question for you doc.
I was wondering, will I need to buzz off all my hair before a hair transplant surgery? It really doesn’t matter, but I just want to know what I’m getting into. I imagine that my remaining hair, while very thin, obscures the scalp too much for comfort.
A:
You do NOT need to buzz off your hair before a hair transplant.
While some patients with significant miniaturization of their existing hair may be asked to cut it short or clip it, we typically are able to do this in office before the procedure if they are OK with it. Clipping hair is not mandatory in any way. However, it may increase our precision in some patients and we do it for them only if they have no problem with having very short hair for a while after hair transplant.
Facial to Scalp Hair Transplant
Using hair from other parts of the body for transplantation into scalp has been used for many years. Unfortunately though, the change in the life cycle of body hair from different areas of the body has caused the body hair to stay as the last option for scalp hair restoration. Body hair has long resting phase and short growth phase which means that most of the transplanted hair will stay in resting phase without having visible hair growth.

Facial hair such as beard and mustache hair on the other hand has a longer growth phase and shorter resting phase. That is why men can grow their facial hair to become really long. Facial hair is also thicker than scalp hair in most people. Thicker hair could be translated as more bulk of hair after hair transplantation. Both longer growth phase and thicker hair shafts make beard hair a better option for scalp hair restoration in comparison to body hair transplant from other areas.
There are two problems with with beard hair restoration. One is that they are very sparse and removing hair only needs to be done through a strip procedure. The other problem with using facial hair for scalp transplant is that the facial follicular units are having fewer number of hair per unit that means less hair per grafts removed with FUE techniques.
Beard transplants are gaining popularity recently with newer techniques for extraction of hair (FUE) and it can be a great alternative to scalp hair for transplanting to the balding area in people who do not have good quality scalp hair.
Rogaine After Hair Transplant
Q:
Hi doc? could Rogaine foam have adverse effect on hair transplant result? some say it helps for hair growth, some say it does not add to hair growth, but have you seen any where saying it might prevent hair growth on men with hair transplant? thanks.
A:
Rogaine (minoxidil) can be used after hair transplantation (only on the newly transplanted area) to protect the native hair and not to promote the growth of transplanted hair. Transplanted hair does not need any medication to promote permanence or grow and if chosen correctly it is considered to be a permanent hair loss solution. I personally recommend Propecia to protect patient’s existing hair against shock loss (losing native hair) after hair transplant on men. It is proven that this medication works better than Rogaine for shock loss prevention and has had remarkable results in those patients who have used it as directed. Women cannot use Propecia and I tend to offer them Rogaine as an alternative for the few months following their hair restoration.
Complications After Hair Transplant
Q:
Thanks Dr. Mohebi,
Your input is much appreciated. The shock loss you had mentioned has been my concern, as a few of my frontal hair seem lighter than before. You had mentioned that the shock loss might be visible for a few weeks to months – will it be the case that after that shock loss stage, the hair will likely return back to original form?
There’s a very important question that i would like to ask you, and was thinking the it would be great for the blog to have. Basically, when you saw my before and after picture, i feel like i changed a bit. The “after” picture seems like i have more redness, and i’m hoping it’s not the case where the hair transplant affects the circulation (e.g., tight donor area/scalp affecting the blood flow to my head). My surgeon told me before the procedure that i will eventually be back to the way i was before (i.e., the “before” picture), but just have a new scar and more gafted hairs. That’s the ultimate question: would you agree that a patient who does a hair transplant will relatively return to the condition that he was before the particular surgery (w/ of course, a new scar and more hair)? This is what keeps me up at night, thinking perhaps my scalp has worsened, or i am now more prone to lose hair. I hope that’s not the case, and every patient should be aware about before she or he gets a hair transplant done.
Thanks again for your help. If I see you in person at your office, I might be interested in discussing about future scar work.
A:
What is hair transplant shock loss
Some of the hair shafts that fall off due to shock loss might come back. Especially if the shock loss happens in an area with permanent hair like back of the head. However, losing hair in the frontal area because of shock loss might not be completely reversible. But, you have to understand that falling hairs are the ones that were supposed to fall off anyway and a hair transplant just accelerates the loss.
How to prevent shock loss
Again, using prescription medicine for hair loss can significantly reduce the extent of shock loss. After surgery, in the transplanted area, the tightness should not affect the circulation of the scalp. After a few days to weeks, on the donor area, the tightness goes back to normal.
Donor scar in strip hair transplant
And to answer to your last question, I do not agree you go back to the condition before surgery with only a new scar and some more hair. What I personally do in a repeat surgery is remove the old scar; the patient at the end has only one scar that at times may be even better than the initial scar.
How to improve the appearance of the scar
I perform trichophytic closure when I think it is the final surgery that the patient may need. Trichophytic closure is when we close scalp skin on the back in a way that hair can grow through the scar. Trichophytic closure reduces the contrast between donor scar and surrounding areas that eventually improve the appearance of the scar, so you are not more prone to hair loss because of your hair transplant.
In some cases and when we are looking for even less visible scar, the scar may get filled with FUE into the scar in a few months from the initial surgery.
Be patient and you should be able to see results in the coming months.
Vitamins and Hair Loss
Q:
Hi Doctor,
My mother is obsessed with my hair loss and gives me a whole bunch of vitamins and mineral tablets everyday to help regrow my hair.
Do you think they work? Or should I stop them.
A:
Although lack of certain vitamins and minerals could cause hair loss in their sever form, living in north America and having a normal and balanced diet; it is unlikely that you are suffering from vitamin or mineral deficiency. On the contrary, if you look at your family pattern of hair loss, you probably can find other male members of the family who has similar male pattern hair loss. As I always say, you need to have the triangle of baldness, which is “Gene, Male gender, and time” to become bald. Vitamins deficiency is not to blame as part of triangle of male patterned hair loss. You can continue taking vitamins to please your mom, but don’t overdo it since vitamins are not going to bring your hair back. Instead you need to see a good hair specialist or dermatologist and undergo a good hair loss evaluation with miniaturization study and start taking one of the effective medications to prevent further hair loss or to use hair transplant to restore your lost hair.
Tretinoin and Minoxidil Combination for Treatment of Hair Loss
Q:
How are you doing? All I have to say is TGIF.
I was doing a little bit research on hair loss, and I stumbled over retinoic acid. I read about it and have a basic understanding. Have you heard any claims that it could possible revive hair loss?
Have a great weekend!
A:
This is a good question. There are several claims on therapeutic effect of all-trans-retinoic acid (tretinoin) alone and in combination with 0.5% minoxidil for hair loss based on limited studies.
In one study the combination of tretinoin and minoxidil was used for 56 patients who had androgenic alopecia (male pattern baldness) and hair growth was followed. The growth of terminal hair was studied after one year of treating balding scalp with combination of topical tretinoin with 0.5% minoxidil. Increase in hair growth was reported in 58% of the patients who could complete the study.
Although tretinoin has been stated as a promoter of cell proliferation and vascular creation, which are both important in hair growth, there is still not enough scientific evidence from large studies to prove these effects. Also double blind studies on the efficiency and adverse effects of the product is lacking.
Psychology of Hair Transplant
I just received the last issue of the Hair Transplant Forum International, the Journal of International Society of Hair Restoration Surgery (ISHRS). Our article, Psychology of Hair Transplant‚ is published as the cover article on this issue of the journal. I also have a copy of the article in our hair loss library in our website. Here is the abstract:
Psychology of Hair Transplant
Parsa Mohebi, M.D., William Rassman, M.D.
Balding and its psychological impacts has been the subject of many studies in the past. The relationship between hair loss and stress is clear to all clinicians who practice in this field. Negative psychosocial impacts of hair loss in male patterned baldness and in women with generalized thinning have also been seen. Many of us (hair transplant surgeons) have seen the negative effects of hair loss on self esteem and self-image.
We know that hair loss impacts some men sex life and their stability with regard to career choices in men of different ages. Despite the solid evidences and published literature on psychological impact of hair loss, the corrective effect of medical and surgical hair restoration has never been studied. After observing the drastic changes in patient behavior and the high level of patient satisfaction in those who had hair transplant procedure, we were motivated to look into the psychological impact of hair restoration on different aspects of a patient’s life.
We came up with a series of criteria that could have been modified by having a hair restoration procedure; we used some indexes that were previously studied comparing bald and non bald men on different psychological variables. We initially performed a pilot study and asked patients about different aspects of their lives during their post op visits. We gave our patients open ended questionnaires and probed their psychological state after their hair restoration procedure was complete. Eventually we focused in on eight major criteria that have been reported and documented as variables associated with hair loss in the literature. We collected a subset of them in our pilot study. Included were questions on the general level of happiness, energy level, feeling of youthfulness, anxiety levels, self confidence, outlook on their future and impact on their sex life.
We have chosen the patients who had their first hair transplant surgery between one to three years from the time of our study, so they had seen the final result of their hair restoration procedure. We limited the study to male patients with male pattern baldness and the ones who had surgeries less than three years ago so they still had a fresh memory of the changes they experienced. Each patient had exclusively follicular unit transplants that reflected our standard of care for that period. We sent a questionnaire with a brief description on the nature of this scientific study. We did not collect any patient identifiers and the response was totally voluntary. We sent the two hundred questionnaires with stamped return envelope.
The response rate to our questionnaire was 37 (18%). Each patient was used as his own control since we asked about the changes that they experienced after surgery in comparison to those variables before the surgery. We used T-test to compare patient’s responses. Table 1 shows the mean and standard error in eight different criteria that were asked. Patients had significant improvements in all eight criteria regardless of their stage of baldness and their ages.
In another attempt to compare psychological changes that patients experienced in different stages of baldness, we divided patients into two groups: (1) those who had Norwood IV patterns or less and (2) the ones with Norwood V patterns and above. We observed the most significant difference in two categories, (a) sex life and (b) career experience. Patients with less balding had a greater impact on their sex life and career when compared to patients who had more advanced stages of hair loss. These changes were not age related.
Hair restoration surgery can affect many aspects of a patient’s life. Hair transplant can potentially reverse psycho-social problems associated with hair loss. The positive impact of hair restoration surgery is more visible among patients who suffer from those undesirable effects the most. In early stages of hair loss, patients may have more awareness of their condition and they might be more affected than men in the later stages of hair loss.
Patients who experienced hair loss at an early age while involved in an active social life were more prone to the negative side effects of balding. That could explain why younger people with hair loss appeared more benefited by hair restoration procedures. Also it could be assumed that hair loss can have a negative impact on a patient’s outlook which seems to reverse after receiving a hair restoration procedure which improved their outlook.
Low response rate from a blind mailing has always been a drawback in questionnaire studies. We received 37 out of 200 of the questionnaires that we sent out (response rate was 18.5%). Giving incentives to responders may be a good way of increasing the participation rate of any questionnaire studies. We presented the result of this study at the annual scientific meeting of ISHRS and have been contacted by many of our colleagues who expressed interest in collaborating in a larger scale study. We are currently trying to rise funding for repeating this study to optimize our response rate and the statistical value of the study.
If you have any questions on the content of this article you can contact Parsa Mohebi Hair Restoration office at Los Angeles through email at info@parsamohebi.com or phone.