Monthly Archives: May 2013

FUE Hair Transplantation-Challenges for surgeons


Derm SurgRecent Publication on FUE Hair Surgery-Dermatologic Surgery

Hair surgery techniques to redistribute hair to areas of alopecia include scalp reduction surgery; scalp and rotation flaps, advancement flaps, and free flaps; FUT by strip harvesting; and FUT by the follicular unit extraction (FUE) technique. The more aggressive hair surgical techniques such as flaps and scalp reduction are largely abandoned for cosmetic cases, but are used primarily in reconstructive surgerical cases from trauma and infection. The most common surgical method for hair transplantation is FUT either by the Strip technqiue or by FUE.

With the recent worldwide  interest of hair transplantation using FUE, many hair surgeons, plastic surgeons, dermatologists, and medical spa physicians are jumping on board. The introduction of this surgical technique into cosmetic practices is accelerated by certain FUE device manufacturers promoting a “turnkey” model for increasing the surgeons income.

But with the recent increase in physician training in FUE,  and an increase in consumer interest, new and different  challenges in the hair restoration field have emerged. The primary controversy is physicians with no formal training with this newer hair transplantation technique, and even worse physicians without any training or experience in hair transplantation; are contracting with non-physicians or hair technicians to perform the entire FUE surgical hair transplantation.

Dr.-Mohebi-Teaching-to-new-hair-transplant-surgeons

Irvine based hair transplant surgeon, Dr. Ken Williams, recently published in Dermatologic Surgery an article on this subject is entitiled: Current  Practices and Controversies in Cosmetic Hair Restoration.

In his paper, Williams “raises concern for the future viability, practice, and art of hair restoration surgery. The concept of physicians with outdated, minimal, or even no knowledge of hair restoration to allow nonphysicians (hair technicians) to perform hair surgery from start to finish is unethical and potentially criminal. In the view of many surgeons in the hair restoration specialty,it is inappropriate to advocate these “new” hair technician responsibilities.”

Even the worldwide medical society of hair surgeons, the International Society of Hair Restoration Surgery , has decided to establish best practices and standards by stating donor harvesting and expanding the duties of hair technicians is a “serious disservice to the patient.”

Todays medical literature reveals ample science-based evidence of the efficacy and reliable clinical outcomes of hair restoration surgery through the last few decades with Strip and FUE surgical techniques. Modern day hair transplantation began in the fifties using a now outdated technique where a 4mm circular manual punch removed  large pieces of scalp tissue containing numerous hair follicles causing an unnatural look. Today,  individual follicular units are removed and transplanted with motorized or robotic devices with a punch the size of the tip of a pen-1mm, and all patients can enjoy restoration of their hairlines with their own natural hairline.

Before Hair Surgery-Norwood 5-6

Before Hair Surgery-Norwood 5-6

After FUE Surgery

After FUE Surgery

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Testosterone Replacement Therapy Linked to Hair Loss


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A recent study released in the May issue of The Journal of Sexual Medicine revealed the compliance rate for taking Testosterone Replacement therapy (TRT) is low in hypogonadal males. The study showed that by six (6) months of therapy only 35 % of male patients had continued on their medication. At twelve (12) months, the adherence rate had dropped to 15.4%. So what did we learn from this study ? Men are bad when it comes to taking medication.

Those numbers don’t surprise physicians who engage in hair loss and hair restoration procedures and treatments. Patients who fail to take physician prescribed medications, such as DHT blockers and TRT is a common problem.  Patients that have purchased and used illegal anabolic substances from nutrition sports stores are even more difficult to treat.  These patients often times present, unknowingly, with clinical findings of Anabolic Steroid abuse. Hair loss patients using anabolic steroids can also present with side effects including fatigued, erectile dysfunction,  poor libido, and low sex drive.

For the average medical doctor, the suspicion of underlying illegal anabolic steroid (AS) use as a cause for the patient’s subjective complaints often goes undetected. In patients who are no longer cycling on AS,  the development of  Anabolic Steroid Induced Hypogonadism (ASIH) is common unless the patient goes on another cycle of AS.

bald bb6Doctors often miss the correct diagnosis because they fail to ask the right questions, or patients are too embarrassed to offer this medical information during their office visit. The situation is only made worse because of inadequate training and knowledge of physicians in treating patients with ASIH from anabolic steroid use.

Most practicing physicians don’t understand  anabolic steroid use or the use of testosterone because physicians are taught early in medical school and residency to avoid these trouble causing and drug abusing patients. It is critical that patients be given direct instructions by healthcare providers about the serious side effects of steroid use.

Only a handful of physicians are engaged in evaluating the endocrine functions of their patients, and an even lesser amount of physicians have any idea of the side effects associated with steroid or non-physician prescribed testosterone. These side effects include hair loss, testicular atrophy, gynecomastia, lipid and liver abnormalities, and an increase in red blood cells called polycythemia.

Hair loss occurs for men and women who use testosterone or anabolic steroids because of the increase chemical conversion in the body of Testosterone to another hormone called, Dihydrotestosterone (DHT). During the metabolism or breakdown of  Testosterone, a equivalent increase in conversion to DHT occurs. This hormone has been known for over three(3) to four (4) decades to cause hair loss.

So what should a hair loss patient do when they have taken non-physician prescribed steroids?  Hair Restoration surgeon, Dr. Ken Williams of the Irvine Institute of Medicine and Cosmetic Surgery, states, “ Being honest with your doctor and obtaining medical care by a physician who is familiar with treating hair loss patients with hypogonadal symptoms is paramount.”

Williams adds,  “It is vital to have a comprehensive physical and endocrine evaluation. Baseline blood tests such as a PSA, Testosterone, CBC, and DHT are critical.  Routine office visits in time will eventually reestablish normal hormone levels, libido, and stabilize hair loss.

Patients with a history of steroid use and who suffer from hair loss can call Dr. Williams at his office at 949-333-2999 for a medical consultation and evaluation.

Using Fat Cells to Cure Hair Loss


Yale researchers have discovered the source of signals that trigger hair growth, an insight that may lead to new treatments for baldness. Researchers have identified stem cells within the skin’s fatty layer and showen that molecular signals from these cells were necessary to spur hair growth in mice, according to the data published in the Sept. 2 issue of the medical journal Cell.

“If we can get these fat cells in the skin to talk to the dormant stem cells at the base of hair follicles, we might be able to get hair to grow again,” said Valerie Horsley, assistant professor of molecular, cellular, and developmental biology and senior author of the paper.

Men with male pattern baldness still have stem cells in follicle roots but these stem cells have lost the ability to jump-start hair regeneration. Scientists have known that these follicle stem cells need signals from within the skin to grow hair, but the source of those signals has been unclear.

Horsley’s team observed that when hair dies, the layer of fat in the scalp which comprises most of the skin’s thickness shrinks. When hair growth begins, the fat layer expands in a process called adipogenesis. Researchers found that a type of stem cell involved in the creation of new fat cells, adipose precursor cells, was required for hair regeneration in mice. They also found these cells produce molecules called PDGF (platelet derived growth factors), which are necessary to produce hair growth.

Horsley’s lab is trying to find other signals produced by adipose precursor stem cells that may play a role in regulating hair growth. She also wants to know whether these same signals are required for human hair growth. Other authors from Yale are lead author Eric Festa, Jackie Fretz, Ryan Berry, Barbara Schmidt, Matthew Rodeheffer and Mark Horowitz.

The work was funded by the National Institutes of Health and the Connecticut Stem Cell Research Program.

New Finasteride and Dutasteride Medical Study


coverNewly released study on effects of DHT blockers

For over three decades, hair restoration surgeons have known that the Dihydortestosterone (DHT) molecule  has caused miniaturization of the hair follicle in both men and women. For over two decades we have known about specific blockers of these hormones, but only recently has the medical community come to understand the potential side effects of these powerful blockers.

A recent study  from Mayo Clinic and Tulane University School of Medicine physicians, was just released in the June 2013 issue of  Sexual Medicine Reviews. The article’s intended to review and summarize findings from all published medical and scientific literature detailing adverse events associated with Dihydrotestosterone blockers.

The results of the study validated current knowledge that DHT blockers are associated with a slightly increased rate of decreased libido, erectile dysfunction, ejaculatory dysfunction, gynecomastia, depression, and/or anxiety. This manuscript confirms previously known information and its findings do not change existing scientific and medical knowledge.

imagesThe controversy of DHT blocker use causing chronic sexual dysfunction began in 2012.  It was medical researcher, Dr. Michael S. Irwig, from George Washington University, who published a paper in the esteemed medical research periodical, Journal of Sexual Medicine, announcing certain chronic and long-term adverse sexual symptoms from DHT blockers.

The controversy surfaced because the study was not designed as a double blinded and traditional objective scientific study. Irwig’s study introduced researcher bias by recruiting patients from an internet forum site and a previous study he performed on the same subject material. Many medical doctors denounced this study citing inaccurate results because it could not be used to draw definite conclusions, and it lacked the high standards traditionally established in scientific publications.

Although, the majority of Irwig’s patients met the definition of sexual dysfunction by the Arizona Sexual Experience Scale, Irwig’s methodology in establishing a cause for his subjects sexual dysfunction has been scrutinized for simple issues such as a lack of baseline serum hormone levels of testosterone and DHT.

Irwig’s study today remains one of the very few studies defining possible long-term effects from DHT blockers. Dr. Ken Williams, an Irvine, California  hair restoration surgeon concludes, “This most newest research study reflects the need for ongoing and  further research, specifically aimed at finding prevalence rates and persistence of sexual side effects to establish a cause and effect relationships from DHT inhibitors.”