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Frequently Asked
Questions
In this FAQ, you
will find answers to
commonly asked
medical questions
about the surgery,
controversial
issues, and subjects
you might not have
even considered. If
you have a question
that still has not
been answered,
please
contact us
today to have your
specific questions
answered directly.
For your
convenience, FAQ
section is divided
into several parts.
1)Introduction,
2)Facts, 3)Safety,
4)Procedure,
5)Results,
6)Aftercare,
7)Cost,
8)Complications,
9)Ladies and Hair
Loss, 10)Medications
1) Introduction :
2) Facts :
3) Safety :
4) Procedure :
5) Results :
6) Aftercare :
7) Cost :
8) Complications :
9) Ladies and Hair
loss :
10) Medications :
1A) I want to learn
more about normal
hair growth.
A terminal scalp
hair will typically
grow 1 cm per month
for 2-6 years in the
“Anagen” phase then
over 2-4 weeks it
will go through a
transition phase,
called the “Catagen”
phase, at the end of
which begins a
resting phase,
called the “Telogen”
phase, which lasts
for 2–4 months. In
the Catagen Phase
the “root” or dermal
papilla shrinks and
migrates upward
toward the surface
of the skin. The
hair in the Telogen
Phase is club-shaped
and does not have
the full ball or
root that an Anagen
hair has.
The hairs you see
every day on your
brush or pillow, or
in your shower or
sink are those that
are shed in the
Telogen Phase. They
will be replaced by
new, growing Anagen
hairs. Research is
being done to
determine what
controls this growth
cycle but there is
still much to learn.
Most
people(including
many doctors)believe
that hair grows in
single strands very
closely together. It
doesn't !
A magnified look at
scalp hair that has
been trimmed to 1 –
2 mm long will show
you that, in fact,
hair grows in small
"bundles" of 1,2,3,
occasionally 4, and
rarely 5 hairs per
"bundle". These
hairs, along with
their accompanying
support system
(sebaceous glands,
erector pilae muscle
etc.) form what is
now known as the
"Follicular Unit".
These 1-5 hair
"bundles" usually
exit the scalp
through just a
single pore! When
examined under a
powerful microscope,
these "Follicular
Units" are clearly
distinct anatomical
entities,
“individually
wrapped” by a layer
of (connective)
tissue.
Follicular Unit
Transplantation
requires the precise
dissection of each
Follicular Unit,
keeping all of its
elements intact.
This ensures optimal
survival and growth
of the hair and
properly
transplanted
follicular units are
indistinguishable
from naturally
occurring follicular
units. Using
nature’s own
building blocks for
hair transplantation
with follicular unit
hair transplantation
provides reliably
good, natural
results.
up
1B) What is
considered Normal
Hair Loss?
Most hair loss is
normal and part of
each person's
individual genetic
makeup. We lose hair
everyday. Hair grows
for a period of
time, usually for 2
to 6 years, and then
the
follicles shed the
hair and go into a
resting stage for
approximately 3
months, then a new
hair growth cycle
begins. It is normal
to lose between 50
to 150 hairs per day
from normal hair
shedding.
up
1C) Speake a little
about gentic hair
loss in men?
Androgenetic
alopecia is the
scientific name for
the genetic
predisposition in
both men and women
for pattern
baldness. Pattern
hair loss in men is
often referred to as
male pattern
baldness(MPB).
Androgenetic
alopecia is the
cause of over 95% of
all pattern hair
loss, including
baldness in men and
thinning hair in
women. Pattern hair
loss occurs in
somewhat predictable
stages, and is
relentlessly
progressive. Usually
the earlier in life
pattern hair loss
begins the more
advanced the hair
loss pattern will
ultimately become.
Studies have shown
that pattern loss is
increasingly evident
and advanced as
people age.
In MPB the hairs on
the top of the scalp
have a genetic
sensitivity to the
male hormone
testosterone (DHT).
DHT is believed to
contribute to:
1)Shortening of the
growing phase of the
hairs,
2)Progressive
miniaturization of
hair follicles,and
3)A decrease in the
number of visible
hairs
The hairs on the
sides and back of
the scalp do not
possess this genetic
trait and therefore
are not affected.
For this reason
hairs removed from
the sides and the
back(donor hair)will
maintain their
genetic
predisposition when
transplanted and
continue to grow
when moved to the
top of the scalp
where hair loss has
occurred.
Another interesting
aspect of male hair
loss is the
inheritance of the
gene for baldness.
Note that many years
ago we were taught
that genetic hair
loss was sex-linked
and thereby
transmitted from
mother's side only.
We have since
learned that this
was only the tip of
the iceberg. Like a
political
investigation, as
the research goes
deeper, more and
more players(in our
case,
chromosomes)are
implicated. Although
male pattern
baldness is
definitely
transmitted on the X
chromosome(XY is a
male, XX is a
female), there are
numerous other
chromosomes(humans
have forty-six)that
help determine the
age of occurrence,
rate and degree of
hair loss. So just
because your
maternal grandfather
is bald doesn't mean
you will be also.
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1D) Does stress play
any role in Hair
Loss?
Stress can speed up
the rate of hair
loss. Although it
usually does not
cause permanent loss
in an area not meant
to bald, it can
considerably speed
up the time frame in
which genetically
doomed hair dies.
Stress such as the
loss of a loved one
can similarly speed
up hair loss.
Physical stress such
as heavy athletic
training as well as
even the simple
stress of moving to
a new country with a
new language can
push the fast
forward button on
male pattern hair
loss. It's important
to understand that
stress can help
cause hair loss
other than that
determined by
heredity. We see
this in alopecia
areata as well as
other more dramatic
forms of baldness,
such as that which
occurs during
chemotherapy. What
is important to
remember is that
with the exception
of hereditary and
exotic causes for
balding, hair will
generally grow back.
up
1E) Why start now?
If you have been
determined to be a
candidate for
restoration by a NHI
physician, and if
you are
uncomfortable with
your hair loss, why
not start now? With
your restoration
completed, you can
get on with life
without this
distraction.
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1F) Is it better to
begin early?
A hair transplant
should begun when
your degree of hair
loss is unacceptable
to you. Not when you
are only worried
about future loss or
"So no one will
notice." Starting
early will often
require multiple
small sessions, and
your expectations
may be unrealistic.
up
1G)How much
hair do I have?
The Norwood
classifications were
adapted from the
patterns described
by Dr. O'Tar
Norwood. There are
seven classes of
hair loss in the
main series and five
variations of these
classes called the
'A' series. If you
compare your hair
loss pattern with
these diagrams, you
can probably see the
pattern you are in
now. Discussion with
one of NHI's
knowledgeable
physicians can help
you determine how
extensive your hair
loss may become.
Please see
Assessing Your Hair
Loss
for more info.
up
1H) How much hair do
I need?
When you have your
consultation with a
NHI physician, he
will suggest how
many grafts may be
available for your
first procedure (and
subsequent
procedures if they
will be needed).
This number will be
based on your
present balding
pattern, what it may
become in the
future, and how much
donor hair is
available. When an
individual has high
donor density, the
follicular units
usually contain
multiple hairs, and
when an individual
has low donor
density the
follicular units
often contain only
one hair. If an
individual has a
very loose scalp, a
larger donor strip
can be removed,
while an individual
with a tight scalp
will have a smaller
donor strip. When an
individual has a
relatively small
amount of hair that
can be moved, our
physicians take
great pains to
distribute the
available hair in
ways that produce
the best coverage.
Please see
Assessing Your Hair
Loss
for more info.
up
1I) What is the
difference between
density and
fullness?
The word fullness
rather than density,
more accurately
describes the visual
phenomenon in what
we perceive as thick
hair vs. thin hair.
The concept of
fullness is broader
and more inclusive.
Density, the number
of hairs/cm2, is
only one of several
contributing factors
that are responsible
for the visual
impression of hair
that appears
"thick". Other
factors include hair
shaft diameter,
color, texture, and
curl, which may be
of equal of even
greater importance
than density, in
contributing to the
visual appearance of
a "full" head of
hair.
In the early stages
of balding the "thin
look" is caused by a
process called
"miniaturization"
where hair is
reduced in size, but
not actually lost.
Therefore, the
density (the counted
number of hairs/cm2)
remains the same,
although the persons
look of fullness can
be dramatically
reduced.
up
1J) What is a
typical hair
transplantation
surgery day like?
A) The
patient signs a
consent form for
surgery.
B)
Antibiotics are
given to prepare for
surgery.
C) The area
for transplantation
is confirmed and the
new hairline design
is drawn onto the
scalp.
D) Photo
documentation.
E) The
patient enters the
operating room and
changes into surgery
clothes.
F) The
patient sits,
relaxes, and listens
to music while the
heart rate, blood
pressure and oxygen
saturation are
carefully monitored.
G) It will
take our surgical
team about four to 4
hours to perform a
1000-graft session,
5 hours for a 1500
graft session. Each
patient receives the
full attention of
our staff.
H) The
patient is given
local anesthesia
with or without a
mild sedative
intravenously.
I) Hair is
taped up in the back
to allow access to
the selected area of
hair-bearing donor
scalp. A thin strip
of the permanent
hair along the lower
back of the scalp is
used. Afterwards,
this thin scar will
be easy hidden
underneath the
surrounding
permanent hair.
J) Using a
very fine 30 gauge
needle, the scalp is
anesthetized. Once
the scalp is numbed,
the surgery is
virtually painless
as the nerves are
blocked.
K) After the
fine strips of hair
are removed from the
back of the scalp,
the technicians
divide them into the
predetermined sizes
of grafts using a
video visualizer or
a stereoscope.
L) The back
of the scalp is
sutured by the
surgeon. This scar
will be barely
detectable in a few
months and will be
completely hidden by
hair growth.
M) The grafts
are now ready to be
transplanted into
the "recipient"
area. Mini-slits are
made for the
modified follicular
grafts (2 to 4
hairs) while 19
gauge needle holes
are made for the
micro grafts (1 to 2
hairs.) We are able
to accomplish
several thousand
hair grafts in one
session. Two to four
surgical technicians
begin implanting the
grafts. This part of
the procedure can
last between 2 to 4
hours.
N) After all
grafts have been
completed and
checked, the donor
and recipient areas
are cleaned and the
donor area only is
bandaged. The
patient is given a
list of
post-operative
instructions and
medications. If I.V.
sedation is used,
the patient must not
drive home himself.
It will be necessary
to arrange for
transportation home
prior to arrival at
the clinic.
up
2A) What is realy a
Hair Transplantation
Surgery?
By age 50, about 50%
of men—and a
substantial number
of women—are
affected by hair
loss, much of which
is hereditary. Hair
transplantation
surgery is a
state-of-the-art
special procedure
for the correction
of male pattern
baldness, scarring
alopecia, and other
causes of permanent
alopecia. It
involves removing
some of the
hair-bearing scalp
from the back of the
head where
“permanent” hair
grows and planting
it in the bald area
in tiny seedlings or
“grafts.” The hair
continues to grow in
the bald region just
as it was doing in
the back(the
permanent hair from
the back of the head
normally grows for
life). The area from
which the hair is
removed at the back
of the head is
called the “donor
site.” It is closed
with stitches or
staples, heals
quickly, and the
scar is concealed
with the remaining
hair.
up
2B) Is there any
alternative to Hair
Transplantation
Surgery?
There are currently
no good alternatives
for hair and
in fact alternatives
to transplantation
aren't great.
Hairpieces are a
hassle. They're
expensive
(frequently more
than transplants
over the long term),
they often look
unnatural, and they
can come off or move
out of place
unexpectedly,
causing
embarrassment. And
some physicians
think that
hairpieces actually
kill more hair. One
alternative,
Rogaine,® is a
nonprescription hair
growth medicine
applied to the
scalp. It works for
only about 25 to 50
percent of users.
And, if you stop
using it, any new
hair will fall out.
Propecia® is another
medicine that comes
in pill form. It
works well if you
have some hair left,
but also must be
taken daily for an
indefinite length of
time. Although side
effects are usually
modest or none, your
doctor should
periodically monitor
your treatment. So
transplantation is
often the best
choice. Most “new
hair” seen on the
heads of American
men these days
involves the minor
surgery of hair
transplantation.
up
2C) When should I
consider Hair
Transplantation
Surgery?
Hair transplantation
can be done both on
patients with
advanced baldness
and earlier
thinning. In
general, hair
transplantation is
not considered for
patients younger
than their mid 20s
because of
difficulty in
predicting ultimate
extent of hair loss.
up
2D) What
qualification should
I expect from my
physician?
Hair surgery
requires both
medical and
technical expertise
as well as an
aesthetic
appreciation of
natural hair growth.
Here your transplant
will be performed by
a team led by Dr
Vafaei, a
Board-certified
specialist in
dermatology with
training and
experience in
dermatologic
surgery. He is a
dermatologic
surgeon, experienced
in hair
transplantation, as
well as other
cosmetic and
reconstructive skin
surgeries. He
received his
qualifications in
Dermatology in 1998.
He is trained in
hair transplantation
surgery.
up
2E) Is it true that
all Hair
Transplantation
Surgery`s Patients
are men?
No. Of course, most
hair transplant
patients are men
between the ages of
30 and 50, but you
may be surprised to
learn that women
also suffer from
hair loss and lots
of our clients are
ladies. Over 200,000
people had hair
transplants in 1994
(more than four
times the 1990
rate), and of those,
about 13,000 were
women.
Women with localized
thinning on the top
of their heads or
thinning around the
temples often make
good candidates for
hair
transplantation.
Prior to evaluation
for hair
transplantation, it
is important for
women to discuss
your thinning hair
with a dermatologist
and/or
endocrinologist to
make sure there is
no other treatable
reason for the hair
loss.
up
2F) What factors my
Doctor consider when
evaluate me for Hair
Transplantation
Surgery?
The list of these
factors is very long
but some of more
important of them
are:
Age, Sex, Past
medical history,
Current physical
condition, Current
medications, Degree
of hair loss, Rate
of hair loss, Past
hair restoration
treatments (medical
hair restoration
and/or surgical hair
restoration), Family
history, Your
thoughts and
expectations, and
many more.
up
2G) What makes the
Iran Hair Center
different from other
hair transplant
groups?
We believe in the
dignity and
intelligence of our
patients. We spend a
significant amount
of our energy to
publish information
that will be of
benefit to our
patients so that
patients can have
the best answers to
their questions.
Our aim is to
provide
straightforward,
understandable
information so
patients are
empowered to make
their own decisions
about hair
restoration. For
those who desire
surgery, we are
proud to offer
Follicular Unit
Transplantation
techniques at very
affordable rates.
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2H) How do I know if
I'm a good candidate
for hair
transplants?
Even in the most
extreme balding
patterns, a
permanent 'wreath'
of hair exists on
the sides and back
of the head. This
hair is unaffected
by the balding
process. In
Follicular Unit Hair
Transplantation, a
thin strip of skin
containing this
permanent hair is
removed from the
back of the head
(because the skin of
the scalp is
flexible, the scalp
can be sutured
together again after
the strip is removed
leaving little trace
that anything was
done). The hair
follicles are then
carefully removed
from that piece of
skin and placed in
very small surgical
sites made in the
thinning or balding
areas of the scalp.
Once transplanted,
this hair behaves as
it was programmed to
behave in the
original area it
came from and will
grow naturally for
the rest of your
life.
Most men in good
general health are
candidates for hair
transplantation. In
order to determine
your candidacy, you
should arrange to
have a free, private
consultation with a
NHI physician.
During your
consultation, the
physician will
measure your donor
density and scalp
laxity. He will also
determine your
balding pattern and
take your individual
hair characteristics
such as color and
wave into
consideration to
develop a plan for
your hair
restoration.
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2I) How long should
I wait between
hair-transplant
procedures?
We routinely
schedule a second
surgery 8-12 months
after the first for
the following
reasons:
-
At 8-12 months, hair
length is adequate
to see the effects
of styling. With
that in mind, the
patient can work
concomitantly with
the surgeon to make
many of the
decisions regarding
further distribution
of grafts, and the
process is
more'owned' by the
patient.
-
Occasionally, when
hair first begins to
grow, its texture
may be slightly
different from your
original hair. After
8-12 months this
generally returns to
normal making
decisions about the
grooming easier, and
grooming preferences
may affect the way
the next procedure
is planned.
-
Some patients have
cyclical growth,
which means that all
of the growth may
not be in and of
adequate length at 4
or 5 months. Waiting
the few extra months
gives the person
enough time to see
hair growing and
this can be a
psycholigical
advantage for the
patient.
-
Seeing the hair
allows the surgeon
to clearly see where
to place the new
grafts.
For those patients
with tighter scalps,
the skin has a
greater time to
restore some of its
previous laxity.
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2J)
How many sessions of
surgery will I need?
If you have a
completely bald
area, it may take
two to three
surgeries to cover.
If you have an area
partially covered
with hair, it may
take only one
surgery to fill in
the area. Our goal
is to restore about
twenty-five percent
to thirty-five
percent of the
donor's original
density in each
surgery. After two
surgeries, the
density is at about
fifty to sixty
percent which is
often adequate
coverage to satisfy
the patient. The
time between each
session is usually
four to six months
in order to see how
the hair is growing
out and to provide
more equal
distribution.
up
2K) Is the hair
restoration surgery
painful?
You may have heard
that the process is
very painful. But
with the proper
technique in the
application of
anesthesia, it does
not have to be a
painful process at
all. It all depends
on how the surgeon
applies the
anesthesia, and our
office uses the
least painful
process available
for the comfort of
our patients.
For a hair
transplantation
process, every
surgeon uses either
a nerve blocking
process or a local
anesthesia (general
anesthesia is never
used in this case).
Any pain at all
during our procedure
would be during the
initial needle
injection. Our
office uses a
special kind of
Anesthesia Method
to reduce even this
small pain. The
anesthetic is warmed
to reduce reaction
time, the skin is
pre-numbed before
each localized shot
and the finest gauge
needle (30 gauge) is
used to minimize
this pain.
Initially, the
patient is given a
sedative through an
IV medication. This
sedative puts the
patient into a
relaxed, "twilight
zone" state to
minimize any pain
there might be from
the subsequent
injections. The
tumescent technique
is used for
prolonging the
anesthesia time.
Most patients have
informed us that the
process was less
painful than a
routine trip to the
dentist. In
addition, the day
after the hair
transplant process,
50% of our patients
do not require any
pain relievers at
all, and the other
50% will take pain
reliever for only
one or two days
until the discomfort
is gone.
We feel that our
procedures are much
less painful in
comparison to many
other clinics. The
only disadvantage to
this "twilight zone"
anesthesia is that
the patient will not
be able to drive on
the day of the
surgery. However,
should the patient
forego the "twilight
zone" anesthesia and
opt instead for a
local anesthesia, he
will be able to
drive on that day.
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2L) Is there any
pre-operation
instructions?
Maintain an adequate
length of hair on
the back of your
head. Your donor
grafts will be
removed from here
and you should
expect coverage
following your
procedure.
A) Two weeks
before surgery: No
Aspirin
(acetylsalicylic
acid - A.S.A.) or
anti-inflammatory
medications that
contain Aspirin.
B) One week
before surgery: 1)
No Vitamin E. 2) No
Ginkgo Biloba,
Ginseng or other
herbal supplements.
C) One day
before surgery; 1)
No Alcohol. 2) Make
arrangements for
someone to take you
to and from the
clinic if you want
to have I.V.
sedation in addition
to local anesthesia.
3) Confirm your
appointment.
D) On surgery
day:
-
Wash your hair
in the morning
using your
regular shampoo.
-
Have a light
meal one hour
prior to your
procedure.
-
Wear a
button-down
shirt and
comfortable,
easily laundered
pants. You
should also
bring an
adjustable
baseball cap or
scarf along with
you.
-
No tight hats or
caps.
-
Do not wear
anything that
will have to be
pulled tightly
over your head.
-
Eat a light meal
just before
coming to the
clinic
up
3A) Has Hair
Transplantation
Surgery been
improved in recent
years?
In the last few
years doctors have
used smaller and
smaller graft sizes.
In the past, large
“plugs” — groups of
up to 25 hair roots
— were transplanted
together, but now
the tiny grafts
contain just one to
six hairs. We've
learned that fewer
hairs per graft
produce a more
natural result, and
the problem of
handling large
numbers of grafts
has also been
solved. The
techniques for
“harvesting” hair
from the back of the
head have improved
too. These new
techniques result in
less damage to the
hair, less healing
time, less
discomfort, and a
better look.
up
3B) Is Hair
Transplantation
Surgery as a whole
dangerous to me?
The methods for
doing hair
transplantation have
improved vastly in
recent years, with
much better results,
less patient
discomfort and less
recovery time. Our
patients are mostly
quite comfortable
during and after
their hair
transplantation.
Some medications for
pain relief are
prescribed for the
first week; however,
lots of patients say
that they do not
have to take any
medication beyond
the first day or two
after their
operation.
up
3C) Is it possible
for me to repeat
this procedure?
In many cases, a
patient may wish to
return for
additional
transplants several
months after the
first surgery. When
large quantities of
hair need to be
implanted, repeat
sessions can be
scheduled every 6-12
months. Some
patients who are
persistent with
their process
sometimes have as
many as ten
sessions, but this
is most often
unnecessary with the
large number of
grafts transplanted
using modern
methods. More
commonly, men are
very satisfied with
at most, 2,000 to
3,000 grafts for an
area of baldness
that extends over
much of the top of
the scalp. If you
have more hair to
begin with, you will
probably need fewer
grafts.
up
3D) Speake a little
about medications I
should receive for
Hair Transplantation
Surgery?
Use of prophylactic
antibiotic in hair
transplant surgery
is recommended
because it can
decrease the risk of
wound infection. The
most common kind of
antibiotic used is
Ciprofloxacine Cap.
500 mg. one every 12
hours from 3 days
befor surgery to 4
days after it. A
single dose of
intramuscular
corticosteroid (Dexamethasone)
to reduce
postoperative
swelling is also
used. Some patients
require oral
analgesic for the
first few days after
hair
transplantation.
Usually,
Acetaminophen
codeine is
sufficient to
alleviate most
postoperative
discomfort.
up
3E) I have heared
about `Shock fall
out`. Clarify this
matter to me?
The medical term for
the very onerous
sounding "shock fall
out" is "effluvium"
which literally
means shedding.
It is usually the
miniaturized hair
i.e. the hair that
is at the end of its
lifespan due to
genetic balding that
is most likely to be
shed. Less likely,
some healthy hair
will be shed, but
this should regrow.
Rarely, but
sometimes, we notice
some shedding of
hair from a prior
transplant when
transplants are
spaced less than one
year apart. However,
this hair grows back
completely.
For most patients,
effluvium is not a
major issue and
should not be a
cause for concern.
In the typical case,
a patient looks a
little thinner
during the several
month period
following the
transplant, when the
transplanted hair is
in its latent phase.
It ends when the
transplanted hair
begins to grow. The
thinning is often
more noticeable to
the patient himself,
than to others.
Shedding is
generally noted as a
thinning, rather
than of "masses of
hair falling out",
as the term "shock
fall out"
erroneously
suggests.
In general, the more
miniaturization one
has and the more
rapid the hair loss,
the more likely will
be shedding from
surgery. Young,
actively balding
patients would be at
the greatest risk.
Older patients with
stable hair loss
would have the least
risk.
up
3F) What can be done
to minimize the
effects of post-op
shedding?
The first is using
medication, the
second is timing the
transplant properly,
and the third is
performing a
procedure using a
sufficient number of
grafts. Finasteride
1mg reverses or
halts the
miniaturization
process in many
individuals and is
thus the logical way
to decrease the risk
of shedding
following a
transplant. Although
many physicians have
the clinical feeling
that that this
assumption is
correct, there has
been no controlled
studies to date that
prove this.
Timing and the size
of the transplant
are the most
important issues. It
is important to wait
until a patient is
ready to have a
transplant, and then
to perform one of
sufficient size so
that if there is
some shedding, the
procedure will more
than compensate for
it - and be
worthwhile. A
problem that
patients often run
into is that they
present to their
doctor with early
hair loss but with a
significant amount
of miniaturization.
The doctor performs
a small procedure
and it doesn't even
compensate either
for potential
shedding or for
progression of the
hair loss. The
result is that the
patient is thinner
(or more bald) than
he was before the
procedure. The
doctor rarely blames
the problem on the
fact that the
procedure was too
small or that there
the miniaturization
was not taken into
account, but only
that the patient
continued to bald.
The better solution
is to treat early
hair loss with
medication, but once
you make a decision
to begin surgery,
and then have a
procedure large
enough to make a
significant cosmetic
improvement.
As a final point, it
is a fallacy that
some doctor's
techniques are so
impeccable that they
can avoid effluvium
or those "small"
procedures will
avoid shedding. Of
course, bad
techniques and rough
handling will
maximize effluvium,
but effluvium is
what hair naturally
does when the scalp
is stressed and it
is stressed during a
transplant from the
anesthetic mixture
and the recipient
site creation. It
cannot be totally
prevented.
In sum, the best way
to deal with
effluvium is to
treat with
Finasteride when
hair loss is early,
perform a transplant
only when indicated
and finally, to
perform a procedure
of Follicular Unit
Transplantation with
skill and with a
sufficient number of
grafts.
up
3G) Explain things
that may increase my
risk for
complications after
surgical hair
restoration.
You may think of
surgical hair
restoration as minor
surgery compared to
major procedures
such a hip
replacement and
organ
transplantation.
While those and
other major surgical
procedures are long,
complex operations,
hair restoration
surgery is not major
surgery and has
proven to be very
safe. As with all
surgical procedures,
the more risk
factors a patient
has, the greater the
possibility for
postoperative
complications.
Risk factors are
factors that
increase a patient’s
risk for harm. Some
risk factors are
associated with the
surgical procedure.
Patient risk factors
are those associated
with the patient.
Patient risk factors
important in
surgical hair
restoration are
those that increase
risk for
postoperative
infection, excessive
bleeding, and
delayed healing.
The hair restoration
surgeon will
determine risk
factors based on the
information given by
the patient prior to
any surgical
procedure. Some
important patient
risk factors the
physician will want
to know about
include:
-
Tobacco use,
especially
long-term
cigarette
smoking
-
Alcohol abuse or
heavy drinking
-
Obesity
-
Malnutrition,
including
bulimia and
anorexia
-
Use of
immunosuppressive
drugs, including
corticosteroids
and chemotherapy
-
Use of herbal
supplements
-
Immunosuppressive
disease—e.g.,
HIV-AIDS
-
Diabetes or
other chronic
metabolic
disease
-
Chronic disease
of the heart,
liver, kidneys,
lungs or
gastrointestinal
system
-
Chronic or
recurrent skin
infections such
as boils
-
Chronic or
recurrent
bacterial or
viral infections
-
Medications that
decrease the
ability of the
blood to clot,
such as
anti-inflammatory
drugs
-
Conditions that
require
antibiotics
prohylaxis, such
as artificial
joints or valves
A prospective
candidate for
surgical hair
restoration should
answer questions
about risk factors
as fully as
possible. For the
patient’s own safety
it is essential for
the physician to
know in advance if
there are risk
factors that
increase the
possibility for
postoperative
complications—even
if risk factors such
as tobacco or
alcohol use are
somewhat
embarrassing for the
patient to discuss.
The presence of risk
factors will rarely
deny a hair
restoration
procedure to the
patient, but the
physician will be
aware of the
possibility of
complications
associated with the
risk factors.
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4A) What must I do
befor Hair
Transplantation
Surgery?
Since hair
transplantation is a
surgery, all
candidates have to
be in good health.
He or she should
perform some
laboratory tests
including: complete
blood count,
coagulation study,
HIV Antibody, HCV
Antibody and HBS
Antibody & Antigen.
You need to
discontinue
blood-thinning
agents before
surgery to normalize
bleeding time.
Patients must stop
taking aspirin,
aspirin-containing
products and
Nonsteroidal
anti-inflammatory
medications (eg,
Advil, Motrin,
Aleve) 5 days before
surgery. Alcoholic
beverages increase
bleeding tendency
and should be
stopped 7 days
before surgery.
Patients are advised
to discontinue
vitamin E
supplements a
minimum of 1 week
before surgery.
To lower the
possibility of
infection, patients
must shampoo their
hair the morning
before surgery and
abstain from using
hair products (eg,
gel, mousse, hair
spray).
up
4B) Explain a little
about the beginning
of the surgery?
The procedure can
take several hours.
At first, you'll
generally be given a
relaxation medicine,
and the process will
begin. Many of our
patients sleep for
20 to 40 minutes and
miss the start of
the procedure. They
don't feel a thing.
We have an extensive
video library, so
you can choose to
watch one or more
movies during the
course of the day.
If you would rather
listen to music, you
can bring your own
CDs and we will play
them for you. We
make every effort to
keep you
comfortable, amused
and happy.
The doctor will
closely examine the
back of the head, or
the donor area, and
may estimate hair
density, sometimes
with a magnifying
instrument. Based on
the number of the
grafts to be
planted, he will
decide how big an
area needs to be
removed. The donor
site is cleaned with
Betadine. The
patient is placed in
a prone position
when harvesting
donor strip. Hair at
the donor site most
often is trimmed
using shaver. Next,
the area is numbed,
and the donor hair
is removed. You may
feel a little
pressure during this
process, but little
or no pain. This
donor site heals
with a scar that is
usually only visible
to your hairdresser,
unless you razor cut
your hair extremely
short. Rarely,
patients may get
spread or thickened
scars in the back.
up
4C) What about pain
during operation?
Most patients watch
a movie or take a
nap while we work.
Afterwards, thanks
to modern anesthetic
agents they tell us
that during the
procedure they felt
no pain. Several
methods are used to
provide anesthesia
to the operation
sites. The best is
using 2% lidocaine
with 1:100,000
epinephrine to
infiltrate the donor
site. Other options
include a mixture of
lidocaine with
1:100,000
epinephrine and 0.5%
bupivacaine.
Any discomfort they
feel afterwards is
usually very
temporary and nearly
always minimal and
easily relieved with
simple pain tablets
taken for 1 - 2 days
after the procedure.
One third of our
patients do not take
any pain tablets.
up
4D) How do you remove
my hairs from back
of the head?
It is well known
that some hair
follicles (usually
found in the
inferoposterior
scalp and inferior
parietal scalp) are
not lost during
androgenic alopecia.
It is essential that
only these follicles
be transplanted to
ensure maximal
survivability.The
donor site is
excised as an long
strip of skin with
great care when
excising not to
damage hair
follicles. The
resultant defect is
closed using suture
or skin staples, and
the scar is minimal.
up
4E) What do you do
with the removed
strip?
Once the first part
of HTS is completed,
the patient sleeps
or watches
television. Then,
the technicians
divide donor tissue
carefully into tiny
segments, sometimes
as small as a
quarter of a grain
of rice by using a
special dissecting
microscope,
magnifying loupes
and other
devices.These are
the grafts, and they
will be prepared to
“plant” into tiny
openings on the
head. There are
usually from one to
four hairs in each
graft but the
smallest ones
contain only one
hair.
up
4F) What happens to
the grafts?
While the
technicians are
working, the doctor
numbs the scalp and
makes tiny openings
where the grafts are
to be inserted. The
openings are made at
the proper angle so
that the hair grows
correctly. In the
front of the head
the hair grows
forward and somewhat
to the sides, and in
the back of the head
it grows backward.
Sometimes the doctor
will even reproduce
the irregular
pattern or “whorl”
that occurs in the
crown.Sophisticated
techniques are used
for creating and
preparing recipient
sites (where grafts
are to be placed).
Using a very fine
scalpel multiple
minute slits are
made in the scalp in
which the grafts are
placed.
By
using jeweler's
forceps or similar
small nontoothed
forceps we gently
insert grafts. We
sometimes use a
needle to insert and
tease grafts gently
into place.
It's a lot like
transplanting
seedlings in a
garden. The grafts
fit snugly into the
openings, and the
skin simply seals
together. There is
usually no
significant
discomfort during
the procedure (the
local anesthetic is
in place). You can
be awake and
chatting with the
doctor and
technicians, or
possibly a little
sleepy from the
relaxation medicine.
up
4G) How long does a
normal session take
?
Hair transplantation
is an office
procedure that takes
approximately 4-6
hours depending on
the extent of the
planned procedure. A
proper modern hair
transplant is a
labor-intensive
process, and
implanting so many
tiny grafts into
over a thousand
points on the scalp
takes time.
up
4H) What is
Follicular Unit
Transplantation?
Follicular Unit
Transplantation is
the transplantation
of very small,
individual,
naturally occurring
groups of hair
called follicular
units. Follicular
units are comprised
of one, two, three
and sometimes four
hairs each. These
units are placed in
thinning/balding
areas following
carefully studied
natural hair growth
patterns. The
results are
incredibly natural
in appearance.
up
4I) What is
Follicular Unit
Extraction
Procedure?
Follicular Unit
Extraction involves
the removal of
individual
follicular units
from the donor area,
one by one, without
a standard surgical
incision. The FOX
test is performed to
determine which
patients are good
candidates for this
procedure.
up
5A) Will I get to see
an actual person who
has had the work
done?
You will see photos
of our previous
patients and may
meet with one of
them who have had
hair restoration
performed by Dr.
Vafaei. If so,
You'll be able to
look through his or
her hair closely to
inspect Dr. Vafaei's
hairline recreation.
up
5B) How long will it
take to recover?
Hair Restoration
Surgery is always
performed on an
outpatient basis.
Most patients return
to thier normal
acyivities after 2
days.This time is
clearly depending
upon the patient's
occupation and
activity level.
up
5C) Are Dr. Vafaei's
results really too
much better than
other doctors?
Each physician has
his or her own
methodology and
artistic skills but
attention to the
smallest details and
experiences lead to
excellent results.
Every operation is
designed to produce
very natural looking
results both now and
in the future, which
often are
undetectable to the
lay person and are
difficult to
distinguish from
those created by the
Nature.
up
5D) Will I be
satisfied with the
results?
Yes. In the hands of
well-trained and
experienced
physicians, and
using newer
techniques with
smaller grafts, the
hair grows in the
proper direction
with a feathered
hairline, and a
highly aesthetic
result. The hair is
your own, and just
like all of your
hair it grows, can
be washed, curled,
cleaned, permed and
styled as desired.
Once the transplants
are completed, no
special maintenance
is required.
up
5E) Will I get a full
head of hair?
No. Remember, the
technique
redistributes
existing, healthy
hair. It does not
create any new hair.
So, it is not
possible to provide
a “full” head of
hair. However, a
comparatively small
amount of hair
transplanted
expertly can produce
the illusion of
substantially more
hair than there
actually is. It is
amazing how often
the end result looks
as if it really is a
“full” head of hair.
The results will
improve how you look
to others and to
yourself.
It's important that
you do not expect
your hair to return
to 100 percent of
its original glory.
But the improvements
after a hair
transplant can be
very impressive, and
it almost always
grows. Realistic
expectations are
vital to your
satisfaction. As
with any cosmetic
surgery, you must
have realistic
expectations .Yes,
we do replace
thousands of hairs,
and you will have
real, natural hair
growing in an area
that may once have
had little or none.
But keep in mind
that hair
transplantation is
also somewhat of a
visual trick,
designed to look
like you have more
hair than you really
do. Don't expect the
same density that
you have in the back
of your head. During
initial visit, your
Doctor examine the
patient, recognize
the underlying cause
of your hair loss,
and evaluate your
goals. You are
provided with enough
time to ask
necessary questions
and have a full
understanding of the
procedure, expected
results, and the
changes that can be
expected over time
(eg, how results
will change with
future hair loss).
up
5F) I want to learn
more about my
hairline creature?
We will mark the
outline of your new
hairline at the
beginning of the
surgery and you
should agree with
it. Remember that
with time you will
get older, but your
new hairline is
fixed, so it is a
must that the new
one be appropriate
for the rest of your
life. If it's placed
too low, similar to
where it was when
you were 20 years
old, it will look
strange and quite
inappropriate when
you are over 50.
up
5G) When does the
hair grow?
In most cases, after
the hair transplant
the hairs grows for
about 3-4 weeks and
then, fall out of
the grafts, and do
not regrow for 1-3
months. After this
they begin to grow
as normal hair. With
each session there
is more hair, and
the resulting
appearance is
thicker hair.
up
5H) Can you give me
an idea about the
number of grafts
being implanted in
one
session?
A typical modern
hair transplant
session involves 750
to 1,500 grafts, and
sometimes more. It's
a long, slow
process, inserting
the grafts one at a
time with small
forceps. One
thousand is a good
number for both our
technicians and
patients — no one
gets too tired, and
patients are usually
impressed with the
quantity of hair
they ultimately get.
Some doctors do more
grafts per session,
but there is
controversy about
graft survival with
the higher numbers.
up
5I)
How
long does it take
the transplanted
hair to grow out
long enough to fill
in the balding area?
Usually it takes
three to six months
for the hair to grow
out, and after that
it will grow about
half and inch per
month which is the
same rate as the
donor hair. Initial
hair quality is
usually very thin,
softer in texture
like baby hair and
then it becomes
coarser over time.
Sometimes the
initial hair is
curlier, then
straightens in about
one year. The color
of the initial hair
may also be darker.
It may be lightened
by the sun later.
up
5J)
How
long will the
transplanted hair
continue to grow?
Typically male
pattern baldness
affects the frontal
or vertex area of
the scalp, while not
affecting the sides
and the back of the
scalp. The hairs on
the back of the head
are genetically
programmed to be
life permanent. The
transplanted hair
comes from the hair
on the back of the
head, and will
retain all of the
characteristics as
those hairs,
including being
practically life
long lasting.
Therefore, it is
reasonably safe to
say that the results
of hair
transplantation will
continue to grow for
the rest of your
life.
up
5K) Do large grafts
produce a better,
denser result than
smaller grafts?
Can a portrait
painter create a
better portrait with
a house painter's
equipment i.e. by
using a roller
rather than a brush?
The use of an
artist's brush is
analogous to the use
of very small
grafts. High-quality
hair transplants
require fine
instruments and
delicate, small
grafts. These grafts
must be distributed
in a way that
balances the facial
features, hair
characteristics, and
goals of the
individual patient.
Large grafts simply
can't offer
sufficient
flexibility to allow
this "customizing"
and their
unnaturally high
density doesn't take
into account the
progressive nature
of hair loss,
placing the patient
at great risk of
having an unnatural
appearance in the
future.
up
5L) Is removing large
amounts of donor
hair unsafe?
This is a statement
commonly made by
doctors who lack
sufficient
experience, or
technique, in
performing large
sessions. The amount
of hair needed for
the average large
session is well
within the safe
limits of what can
be moved, provided
that the procedure
is done properly. It
is the experience
and judgment of the
surgeon that will
insure that the
amount of hair that
is harvested from
the donor area is
safe and
appropriate.
up
5M) Is it true that
the blood supply of
the scalp cannot
support a large
session?
No. People who make
such comments don't
understand the
oxygenation process
in the transplanted
grafts or the
anatomy of the
scalp's circulatory
system. The issue is
one of oxygenation,
not blood supply. By
their very size,
large grafts over 2
mm, will result in
oxygen deprivation
to the hair located
in their center.
This has been proven
over and over again
by observing the
phenomenon called
donuting (the loss
of hair follicles in
the center of larger
grafts).
In contrast, oxygen
diffuses easily into
grafts 1 mm or less
in size. The blood
supply of the scalp
is among the richest
in the entire body,
enabling it to
support the growth
of large numbers of
grafts, provided
that they are kept
very small. The
Follicular
Transplantation
procedure performed
at the Iran Hair
Center insures that
these implants are
kept to their
optimum size.
up
5N) Do scalp
reductions save hair
for future loss?
No! Hair is a
limited resource. It
is used up
regardless of how it
is moved and scalp
reductions are just
another method of
moving hair around.
Scalp reductions
move hair to the
crown at the expense
of the front of the
scalp, the
cosmetically more
important area. As a
result of the
reduction, the hair
in the sides and
back of the scalp is
reduced in both
density and
looseness (This is
why the procedure is
appropriately called
a "reduction"). The
hair on the sides
and back of the head
thins considerably
through the process
and this, together
with the tighter
scalp, makes it more
difficult to move
the hair to the
cosmetically
important areas such
as the frontal
hairline and front
part of the scalp.
After a scalp
reduction, the
surgeon may never be
able to harvest
enough hair to
complete the
transplant. In
addition, the scalp
reduction can cause
problems such a
scarring, a thin
scalp, altered hair
direction, and a
host of other
unwanted effects. No
wonder that the use
of this procedure
has dropped so
dramatically in
recent years!
up
5P) Are Lasers useful
in Hair
Transplantation
Surgery?
No! Lasers are used
by some hair
transplant doctors
to make the
recipient sites. The
laser works by using
a beam of very high
energy to burn a
hole in the skin.
But, regardless of
how precise the
laser, it still
works by destroying
tissue i.e. by
making a hole. The
beauty of Follicular
Unit Transplantation
is that the tiny
follicular unit
grafts can fit into
very small sites
that are made with a
needle poke rather
than by an
instrument that
removes healthy
tissue. In
Follicular Unit
Transplantation, the
blood vessel rich
tissue that it is to
receive the grafts
does not need to be
destroyed, so the
growth is maximized.
up
5Q) With new surgical
techniques, is it
possible to restore
a full head of hair?
No! All hair
transplantation
procedures move hair
around to make you
look better, but
none create more
hair. However, if
performed properly
and on the right
person, it can make
an incredible
improvement in your
appearance.
up
6A) Is dressing
mandatory after the
surgery?
Most surgeons
advocate use of
surgical dressings
to minimize risk of
graft loss. Most
often, this dressing
is removed after 24
hours; no dressing
is required
thereafter.
up
6B) Is it necessary
to have a companion
guy after HTS?
It isn`t absolutely
mandatory but
because you take
some medications
durins surgery some
of them induce
drowsiness, You`d
better have a friend
after finishing of
the surgery. it is
also necessary to
have anyone else
drive you home after
the procedure.
up
6C) Speake a little
about the first
night after surgery?
When you leave the
office, you usually
have a headband and
bandages around your
head to protect the
donor site. The
majority of patients
have little trouble
sleeping the first
night, and any
discomfort can be
relieved with
medications.
Patients having
second and third
procedures sometimes
have a little more
postoperative
discomfort.
up
6D) Tell me about the
first days after
surgery?
For the first 24
hours, there will be
a strip of bandage
around the head.
After that, you will
be able to remove
the bandage and
shampoo your hair.
If you have the
surgery done on the
hairline, the small
scabs will remain
for seven to ten
days. Some patients
may want to cover
the area with a cap
or even a hairpiece
at work if they
desire. If you have
partial hair, it is
much easier to cover
up the area, or you
can use a camouflage
product.
When the small scabs
fall off after seven
to ten days, the
freshly implanted
grafts will be pink,
slightly shiny skin
which is usually a
similar color to the
surrounding normal
skin and is
minimally obvious at
first. After
approximately six
weeks, the areas
where the grafts
were transplanted
are barely visible.
Pre-existing hair
around or adjacent
to the transplanted
grafts may shed,
giving a thinner
look, but will begin
to grow back within
a few months. This
temporary thinning
of pre-existing hair
is called Telogen
Effluvium.
Unfortunately there
is a time lag
between this
increased thinning
of pre-existing hair
and re-growth of
transplanted hair,
so do not be alarmed
if this happens.
up
6E) Is it needed for
me to take off from
my daily activities
after Hair
Transplantation
Surgery?
With the new-style
tiny grafts, little
or no time off from
work is required
and you can resume
relatively normal
activities the next
day with few
problems but if you
are sensitive about
how you will look
during the days
immediately
following, you can
wear a hat, or, if
that's not possible
in your work
environment, Dr.
Vafaei recommends
beginning the
process just before
your holidays. It is
best to avoid heavy
exercise for several
days. You might not
need to take much
time off from work
or from your routine
social activities.
With the older style
hair plugs, you had
to be careful to
avoid any activity
for fear of losing
the grafts, which
were four
millimeters (about
one fifth of an
inch) in diameter.
Now, you'll just
have some redness of
your scalp, and
usually some
scabbing, which will
last for 10 days or
so.
up
6F) Explain about
Aftercare of Hair
Transplantation
Surgery?
You`d better return
to the office the
next day to have
their dressings
removed and their
hair washed. You
won't need bandage
after that, and the
grafts won't usually
be very obvious,
other than some
redness and/or
crusting. Any
shampooing you do
should be done with
mild massage very
gently. Scratching
of the transplanted
area is strictly
firbidden. Scabbing
can last roughly 5
days. You should
avoid the sun, and
if you live or work
in an environment
that's dusty or
dirty, you should
wear a cap. we will
recheck you in about
14 days to remove
stitches from the
donor area. After
the first month you
may see about a half
Cm. of hair growth,
but after that the
hair will go into a
resting period for
about 2-3 months,
and then start
growing again. This
is normal, and
doesn't mean that
the transplant
didn't “take.” It’s
hard to kill those
hair transplants;
they are tough. At
about 4 months, you
will often see one
Cm. of hair. The
hair will gradually
thicken and
strengthen over a
period of about 12
months.
up
7A) How much does it
cost?
This is a very
difficult question
to answer until you
are totally
evaluated and we
know how much
coverage you need.
Hair transplantation
is a
cost-competitive
solution for hair
loss. Other hair
replacement
alternatives require
additional
maintenance over the
years. In general,
the cost of the
surgery is anywhere
from US$ 1,700 to
US$ 2,500 per
procedure, depending
upon many factors
eg. your current
degree of hairloss,
your goals and
expectations.
up
7B) Isn`t Hair
Transplantation
Surgery too much
expensive?
Comparatively, no.
While there are
costs involved, the
benefits of growing
your own hair make
hair transplantation
much more
cost-effective than
other methods,
because afterwards
no further expense
is incurred. There
are no expensive
chemicals to be
bought or used
continually. There
are no expensive
hair pieces to be
maintained,
repaired, tinted,
conditioned and
replaced regularly
every 18 months in
order to look
natural. So, weighed
in the light of all
possible
alternatives, the
hair transplant
solution is not only
the best, but is
also the most
economical overall.
up
8A) Will I scar after
surgery?
The site from where
the hair is taken is
usually a fine scar
line which is hidden
by the permanent
hair in that area.
After the procedure
there are tiny marks
where the grafts
have been placed.
Initially there is
some crusting over
these areas (5-14
days) but after
this, these areas
are usually not
detectable.
up
8B) What about
possible
Complications?
Many people may
assume hair
transplantation is
an easy procedure
with little or no
risk. However, as
with any surgical
procedure, a risk
exists of the
following
infrequent, minor
and
temporarycomplications:
A)
Temporary Thinning
of Pre-Existing
Hair: After the
surgery, it is
normal for some
pre-existing hair to
thin. The
pre-existing hair
will return to
normal in full
condition within a
few months after the
surgery.
B)
Bleeding: Some
bleeding is normal
and will stop with
simple pressure.
Persistent bleeding
occurs in about one
in a few hundred
cases. Additional
stitching is rarely
required.
C)
Pain: Pain is
usually fairly
minimal and lasts
only a few days. 50%
of our patients do
not require any pain
relievers, and the
others take Tylenol
for a few days.
D)
Numbness: Some
transient numbness
is inevitable, and
usually lasts from
three to eighteen
weeks. It is rarely
bothersome or
long-lasting.
E)
Hiccups: Hiccups
may occur after
surgery. The cause
is not well known,
but hiccups seem to
occur more
frequently after
hair transplantation
than scalp
reduction. The
incidence of this
complication is
about 5%. It usually
lasts several hours
to several days. If
left untreated, the
hiccups may
interfere when you
eat and sleep, but
there is a
medication that the
doctor can prescribe
to ease the hiccups.
F)
Itching : Some
itching commonly
occurs but is rarely
troublesome and
lasts only a few
days. Shampooing the
hair daily will help
the discomfort.
G)
Swelling: There is
some swelling in
nearly all cases. It
affects the forehead
and the area around
the eyes and lasts
two to five days,
being maximal on the
fourth day. In about
one in fifty cases,
a "black eye"
develops. With
particular patients,
swelling can be
considerable and
temporarily
disfiguring,
especially after the
first session.
However, it does
little harm and
lasts no more than a
week. We can
prescribe you some
medication to reduce
the swelling.
H) Infection: This
happens in one in
several thousand
cases and is easily
cured with
antibiotics. We will
provide you
antibiotics prior
and after the
procedure to prevent
it from happening.
I)
Scarring: Keloid
scarring occurs only
in pre-disposed
individuals, and
even more rarely
(1/1000 cases) has
this keloid scarring
been hypertrophy to
the point of
"ridging."
J)
Cysts: One or more
cysts may occur in
the recipient area
when many
mini-grafts have
been inserted. They
usually disappear by
themselves after a
few weeks or
immediately with
various simple
treatments. They are
not usually more
than 2 or 3 mm in
diameter, i.e., the
size of small
pimples.
Other complications
not listed here may
also occur. You
should ask your
doctor for more
information on these
risks and consider
them carefully when
making your decision
regarding hair
transplantation.
up
8C) If I am unhappy
with a transplant
performed by another
doctor, can I have
repair work done at
Iran Hair Center?
Of course, it is
always better to do
things right the
first time.
Unfortunately, many
individuals have had
hair restorations
with less than
satisfactory
results. NHI has
been able to develop
strategies that can
effectively
camouflage many of
the mistakes caused
by less
sophisticated
procedures.
Individuals have
come to NHI from all
parts of the world
for repairs. To
determine if you are
a candidate for
repairs, you should
arrange a free,
private consultation
with a NHI
physician.
up
8D) Will smoking
affect my hair
transplant
procedure?
Smoking causes
constriction of
blood vessels and
decreased blood flow
to the scalp,
predominantly due to
its nicotine
content. The carbon
monoxide in smoke
decreases the oxygen
carrying capacity of
the blood. These
factors may
contribute to poor
wound healing after
a hair transplant
and can increase the
chance of a wound
infection and
scarring. Smoking
may also contribute
to poor hair growth.
The deleterious
effects of smoking
wear off slowly when
one abstains,
particularly in
chronic smokers, so
that smoking puts
one at risk to poor
healing even after
smoking is stopped
for weeks or even
months. Although it
is not known exactly
how long one should
avoid smoking before
and after a hair
transplant a common
recommendation is to
abstain from 1 week
prior to surgery to
2 weeks after the
procedure.
up
8E) Will Senile
Alopecia affect my
hair transplant
procedure?
Diffuse un-patterned
and patterned
alopecia is
uncommon. The
medical descriptive
term 'senile'
appears in
literature;
unfortunately, the
word implies that it
impacts only the old
and senile, which is
not the case. It has
appeared in almost
every age group
somewhat equally,
but as each carries
the malady
throughout its life,
the frequency
increases as the
population ages.
However, Senile
Alopecia is a more
commonly accepted
diagnosis for the
younger population,
potentially skewing
population data. As
a guess, its
incidence amongst
men is 1%.
Prior to the advent
of Propecia,
recognizing the
malady did nothing
more than eliminate
surgical candidacy.
Now with Propecia,
effective treatment
is available for
some. Approximately
50% of affected
individuals that saw
doctors at NHI have
realized benefits
from the drug. Most
saw reduced
miniaturization and
a subjective
appearance of
additional fullness.
Despite these
desirable drug
benefits, impacted
alopecia patients
seem to finish with
less than desirable
surgical results.
up
9A) Do women have
problems with
balding?
Women experience
hair loss, too, and
it is quite common,
although not as
common as in men.
up
9B) How can I find
out about female
hair loss?
Some women have
genetically
determined hair
loss, while others
may experience hair
loss from surgery or
injury. Depending on
their type of hair
loss, women may or
may not make
excellent candidates
for surgery. For
more information on
candidacy you should
consult a NHI
physician.
up
9C) What causes hair
loss in women?
Some women have
genetically
determined hair loss
or hair loss from a
series of medical
conditions or
genetic inheritance.
Others may
experience hair loss
from surgery, or
injury. Still others
experience hair loss
from wearing very
tight hairstyles
that exert constant
pull on the hair.
Because some hair
loss in women can be
caused by underlying
medical conditions,
it is important that
women with
undiagnosed hair
loss be evaluated by
their own
physicians. If
clinically
appropriate, the
following disease
processes should be
considered: anemia,
thyroid disease,
connective tissue
disease,
gynecological
conditions and
emotional stress. It
is also important to
review the use of
medications that can
cause hair loss,
such as oral
contraceptives,
beta-blockers,
Vitamin A, thyroid
drugs, coumadin and
prednisone. The
following laboratory
tests are often
useful if underlying
problems are
suspected: CBC, Chem
Screen, ANA, T4,
TSH, STS,
Androstenedione,
DHEA-Sulfate, Total
and Free
Testosterone.
up
9D) Why are some
women not candidates
for hair restoration
surgery?
Hair transplantation
involves the
movement of hair
from an area of
greater density and
fullness in the back
of your scalp to an
area of hair loss in
the front, top or
crown. Women who
have generalized
thinning (Diffuse
Unpatterned
Alopecia) have hair
that is thin all
over the head, and
it may not be
beneficial to
transplant hair that
has been weakened by
the balding process.
When hair is
transplanted into a
part of the scalp
that is thin, but
not completely bald,
there is a risk that
some of the hair
that is weak will
not regrow in its
new location. There
is also the
possibility that the
hair in the
recipient area is
more fragile and
some or all of the
original hair in
this area may be
lost. This process
is called "telogen
effluvium" and when
it occurs, it is
usually reversible
in a 3-6 month time
frame when the hair
that has been lost
has been weakened by
balding. Also, when
the donor area
continues to thin,
then the
transplanted hair
will also thin over
time, since it came
from the same area.
In hair
transplantation, as
in all surgical
procedures, it is
important to balance
the potential gain
against the possible
risks when making a
decision to go
forward with the
treatment.
up
10A) Will new
medications make
surgical hair
restoration
obsolete?
No! New medications
work best by
retarding or
preventing future
hair loss. There are
no known medications
that can
significantly regrow
hair once it has
been lost.
up
10B) On what parts of
the scalp do Propecia and Rogaine
actually work?
Although their
mechanisms of action
are different and
although Propecia
(finasteride) is far
more effective than
Rogaine (minoxidil)
they both work on
similar "targets."
Both drugs work ONLY
on miniaturized hair
by increasing their
diameter. Neither
medication will work
on areas that are
totally bald i.e.
that have no hair.
Both work in any
areas on the scalp
that are subject to
androgenetic changes
i.e. the front top
and crown. The
medications work
best in the crown
where the
miniaturization
period is more
prolonged. However,
if there is
miniaturization in
the front of the
scalp (this is
particularly seen in
younger persons with
early hair loss) the
medications can
regrow hair in this
part of the scalp as
well. As far as
preventing hair
loss, they work in
all parts of the
scalp subject to
androgenetic
changes. Both
medications are far
more effective in
preventing hair loss
rather than
"regrowing hair"
(i.e. thickening
hair once it is
extensively
miniaturized).
Remember that
finasteride is far
more effective than
minoxidil for both
regrowing hair (i.e.
thickening
miniaturized hair)
and preventing hair
loss. Their actions
do appear to be
synergistic and
their use together
may be advantageous,
particularly in
young people,
although on the
long-term it is
probably too much of
a nuisance to use
both. I generally
just recommend
finasteride for
older people or for
those considering
hair restoration
surgery.
Much of the
confusion stems from
the FDA requirement
that claims of
pharmaceutical
companies regarding
their products must
be limited to things
that were actually
tested clinically.
Both Upjohn
(Rogaine) and Merck
(Propecia) did the
testing in the crown
since this is
generally the area
of greatest
miniaturization and
the area most likely
to show the most
dramatic response. I
think that in trying
to show
effectiveness (a
requirement for FDA
approval) the drug
companies overlooked
the importance of
frontal hair to a
person's appearance.
In retrospect, they
probably should have
done studies both in
the front of the
scalp and in the
crown, even if
though the response
of the frontal scalp
would be less
pronounced.
up
10C)Propecia
(Finasteride) :
I heard that
Propecia works only
in the back of the
head?
No. It can work all
over, as long as the
balding is not
complete. It has the
potential to work
wherever there are
miniaturized (fine)
hairs. It is just
that the crown has a
longer phase where
the hairs are in
their transitional
state. That is why
it is important to
treat the front
early on.
I heard that
Propecia doesn't
work in older
people, so why
should I bother?
It is true that it
is less effective in
growing hair in
older individuals,
but a main benefit
of Propecia, that of
prevention of
further loss is just
as important.
Once I start
Propecia won't I
have to use it for
life?
Not necessarily. You
use it only as long
as you want it to
work to hold onto
your hair. And there
will even be better
treatments in the
future. However,
regardless of future
medical advances, it
will always be much
easier to hold onto
your hair than to
grow it back.
Patients ask to
prescribe Proscar.
Should I do this?
You should not use
and/or break up the
5-mg pills because:
-
Risk insurance
fraud if submitted
as medically
necessary
-
Uneven
distribution of
active ingredient
-
Uncertain
stability if broken
up and mixed in a
drink
-
No safety profile
if patient takes
more
-
Risk of pregnant
woman taking pill
-
Merck bore the
cost of R&D so it is
only fair to be able
to sell 1mg pill
If a pregnant woman
can't even handle
the pill how can
Propecia possibly be
safe?
Since the absorption
through the
fingertips can't be
measured, the FDA
considers it all to
be absorbed,
regardless of how
infinitesimal the
absorption actually
is. If there were
really a concern the
FDA would require
men, taking Propecia
to wear condoms when
their wife is
pregnant, but they
do not even
recommend this.
I was told to use an
herbal 5-alpha
reductase inhibitor
since it is safer.
Is that true?
Unlike food that is
best taken as a
"natural" substance,
medications are
taken for a specific
problem. Therefore,
one should take a
form that is pure,
where the exact dose
is known, where
controlled
scientific studies
have been performed
and published in
reputable medical
journals to show its
efficacy and safety,
and where other
ingredients of
unknown safety are
not included. It is
generally not
understood by the
lay public that if a
herbal form of a
medication is taken
at a dose that is as
effective a
medication then the
same side effects
have the potential
to occur.
There are so many
non-prescription
hair loss products
on the market. The
ads sound so
promising, surely
some must work?
Remember, a
prescribing
physician "usually"
has no financial
interest in the drug
he prescribes. He
receives office
visit fees from the
consult or from
performing a
surgical procedure.
When non-physicians
sell products for
hair loss they
always have a
financial interest.
There is no other
reason for them to
manufacture, market
and sell their
product. More
importantly, claims
of effectiveness of
non-prescription
medications are not
as strictly
regulated by the
FDA.
Why can't Propecia
be used in
post-menopausal
women?
The studies using
finasteride 1-mg
have shown that it
is not effective. It
may be useful at
higher doses, but
good studies showing
its efficacy and
safety still need to
be done.
I've heard about all
the side effects!
What good is having
hair if I can't...
The occurrence of
sexual dysfunction
is only about 1% and
it always goes away
when you stop the
medication. Over
half the time it
goes away even if
you continue using
Propecia.
But I don't want to
use the medication
for a year and then
have to stop and
have all my hair
fall out.
In the occasional
case where there are
side effects, they
seem to mostly
appear in the first
month or two, long
before the effects
on the hair begin,
so it is easy to
stop it without a
problem.
What about the new
Glaxo medication,
Dutasteride?
Combined blockers
knock out over 90%
of circulating DHT
and may have
increased side
effects as a result.
It is not being
approved for hair
loss. Once it is FDA
approved and used
for BPH (benign
prostatic
hypertrophy) we will
look at the
risk/benefits of
this medication
closely.
up
10D)Rogaine
(Minoxidil)
My doctor gave me a
combination of
Minoxidil and
Retin-A in a single
solution. Should I
use it?
We are generally
against the
physician-based
practice of
combining Retin-A
with minoxidil. The
reason some doctors
do this is to get
around the law that
prevents a doctor,
who sells medication
in his office, from
marking up the price
of an individual
medication more than
10%. The doctor,
however, has the
ability to charge
anything that he/she
wants if he makes
his own formulation.
If the formulation
benefits the patient
that is OK, the
price might be
justified, but in
the case of
Retin-A/Minoxidil,
it is often a scam
that actually harms
patients.
Here is why: Retin-A
only needs to be
applied once a day
to exert its effects
on the skin. That is
why Retin-A is
prescribed only once
a day for acne,
where all the other
acne medications
i.e. topical
antibiotics and
benzyl peroxide must
be used multiple
times. Retin-A works
by altering the
follicular
epithelium (the
outer layer of skin)
so that it doesn't
keratinize (form a
hard compact layer).
This is helpful in
acne because it
keeps the opening of
the follicles from
clogging. By
preventing
keratinization,
Retin-A also
decreases the
protective barrier
of the skin and
makes it more able
to absorb
medications (like
minoxidil) and more
sensitive to
chemicals (like the
propylene glycol and
alcohol base of
Rogaine).
Since Retin-A binds
well to the skin and
exerts it influence
over 24 hours, it
only needs to be
applied once a day.
Using it more than
once a day causes
unnecessary
irritation, without
increasing its
effectiveness.
Minoxidil, on the
other hand, needs to
be used twice a day
to be effective.
Since the base of
minoxidil (the
propylene glycol and
alcohol) is
irritating,
minoxidil should not
be used more than
twice a day.
We are not overly
enthusiastic about
minoxidil because we
do not think that it
works well over the
long-term and think
that it is too
fussy. We find that
finasteride is far
more effective both
on the short and
long-term. We will
occasionally
prescribe both to
patient with early
hair loss that are
not yet candidates
for a transplant,
but for the most
part, we use
Propecia alone as
our mainstay of
medical treatment.
That said, if
patients are set on
using minoxidil and
want to increase its
effectiveness, we
suggest that they
apply it to damp
scalp as soon as
they get out of the
shower. Applying
medication to
hydrated (damp) skin
can increase the
absorption up to
5-fold, without
introducing another
medication and
without causing
excessive
irritation. It also
makes the hair more
groomable.
For patients who
insist on using
Retin-A and
minoxidil, we would
use them separately
and stop the Retin-A
as soon as there was
any sign off
irritation.
Remember, irritated
skin has very little
barrier to
absorption, so when
you apply medication
to irritated skin
you are essentially
dumping it directly
into the blood
stream. We know that
oral minoxidil is a
very potent blood
pressure medication
that can have very
significant adverse
side effects of the
cardio-vascular
system. That is why
it is not used
either as a first
line, or even second
line blood pressure
medication, but only
as a medication for
patients with severe
hypertension that
don't respond to
other medications.
If a person were not
getting irritation,
the only local
damage would be that
the Retin-A would
make one more
sensitive to the sun
(and cause increased
facial hair in
women). The possible
long-term systemic
consequences,
although probably
remote, are unknown.
Cardiac enlargement
from minoxidil had
been reported in a
single animal study
a number of years
ago in England, but
did not get much
press here. To our
knowledge, it has
not been duplicated
in humans. However,
we are always
concerned when
minoxidil is used
with medications
that increase its
systemic absorb ion
such as Retin-A,
since we know that
minoxidil orally is
a very potent and
potentially
dangerous
medication.
The main problem
with the combination
is that when
patients begin to
get irritation, they
are afraid to stop
using the minoxidil
for fear of loosing
their hair. Since
the Retin-A and
minoxidil are mixed,
they are forced to
continue both, i.e.
they are in a
Catch-22. When they
call the prescribing
doctor, they are
often advised to do
things to decrease
the irritation, even
sometimes to use
steroids…but not
stop the medication.
The doctor doesn't
generally give the
proper advice and
say to simply use
over-the-counter
minoxidil alone
until the irritation
subsides and then
gradually
re-introduce Retin-A
as a separate
medication a little
at a time, since
this would uncover
the doctor's scam.
Therefore, the
doctor sticks to his
speech about the
importance of the
combined mixture and
the patient is
sometimes left with
scarring (if the
inflammation is not
treated properly)
and always left with
a jacked up bill. (Minoxidil
is over-the-counter
and very inexpensive
and Retin-A just
needs to be used
very sparingly, no
more than once a
day. So the cost is
very modest.)
We have seen
patients that have
been given a
doctor's mixture of
an expensive, in
house combination of
Retin-A solution
(which is very
potent) mixed with
minoxidil 4%, and
told that they must
use the combination
four times a day.
When they got
irritation, they
were not advised to
stop the medication.
They continued using
this potent
medication on an
irritated scalp,
with the risk of
both local scarring
(which some actually
got) and the risk of
systemic toxicity
from the increased
absorption into the
bloodstream.
In sum, the reason
we do not like the
combination is that
it has some
potential risk, it
increases the
irritancy and
fussiness of a
medication that we
do not think is that
effective to begin
with, and most
importantly, it is
often abused.
The above
information is an
educational help
only. It is not
intended as medical
advice for
individual
conditions or
treatments. Talk to
Dr. Vafaei before
following any
medical regimen to
see if it is safe
and effective for
you. This health
encyclopedia is made
by the Dr. Ali
Vafaei . If you
want, you can fill
the following form
and send it to us.Dr.
Vafaei will answer
your questions
regarding Hair Loss
and Natural Hair
Transplantation
soon.
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