Parsa Mohebi, MD
Elite Coalition Physician
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Everything posted by Parsa Mohebi, MD
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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From the album: 2995 Total Grafts - Dr. Mohebi FUT Hair Transplant
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Thanks for the comment, -
On 09/23/2009, we performed a FUT Hair Restoration procedure on a 56 year old male with: • Hair loss pattern -- Class VI • Hair color -- Salt and Pepper • Hair character -- Straight • Hair thickness – Fine Treatment Plan as of 07/27/2009 (date of consultation): • Begin using Finesteride medication to control future hair loss • Begin scalp exercises to increase scalp laxity before procedure and increase number of possible grafts • FUT Hair Transplant procedure -- 3000+ grafts recommended (2000 + for the front/hairline and 1000 for crown area) FUT PROCEDURE PERFORMED: 1) FUT procedure performed on 09/23/2009 A Follicular Unit Strip Transplantation with 3471 total FU: • 364 – single hair FUT • 1445 – double hair FUT • 1662 – triple hair FUT • 0 – quadruple hair FUT Size of Donor Strip Cut: • 30 x 1.8 cm
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Thanks Robin for posting those photos and the video. I love seeing patients' improvement and their long term satisfaction is what makes my days. Mike, I hope see you next week in Boston. I am presenting a video-lecture in HD-Video presentation section on sequential strip removal techniques. I am sure Farjo's group is also coming with tons of new information as always. Looking forward to seeing you all. Best, Parsa Mohebi
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Hi there online inquirer, My assessment is that both doctors may have been right based on their own manual examination scale used. Scalp exercises have had a large matter of controversy surrounding them for years amongst hair transplant surgeons and thus have resulted in many different opinions on the matter. To answer to the qeustion that whether or not scalp exercise is really work, Dr. Rassman and I published the first metric system to accurately measure the laxity of a person's scalp without the need to guess or rely on physician's personal experience and method of measuring to do so and that was through the Laxometer. I had invented the Laxometer about 3 years ago and following its recognition we conducted a first time study to determine whether or not measuring scalp laxity really works and could have true value before hair transplantation. The resutl of this study was later published as a cover article in the "Hair Transplant Forum International" about 2 years ago. Here is a link to the article: http://ushairrestoration.com/mohebi-laxometer-scalp-laxity-article.pdf I urge you to read this article and see exactly how scalp exercise have been proven to help with the laxity of scalps before hair transplants. We do recommend scalp exercises in our practice to the majority of people who need a hair transplantation through strip method. Those who are recommended to do so are not only the ones that have tight scalp, but also those who have average or even loose scalps but need a large number of grafts to acheive their desired results.
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Thanks, Looking forward to your great questions.
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Thanks everyone, We look forward to participating even more in the growth of this fine community.
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You brought up important points. When scheduling a patient for hair transplant, it is not just enough to know the current pattern and other factors should be considered such as: Miniaturization study that has been a great help predicting where they are heading. Family pattern of baldness, it is also important to know whether or not the other member of family had similar pattern at their age and what has been the final pattern of the others. Compliance with the medical treatment. Although miniaturization study is very helpful to determine where a patient is heading, we do not ignore other items when finalizing our surgical plan. The patient that we have presented here has minimal miniaturization except for the front and corner areas, he did not have a significant family history and has been on finasteride even before seeing us and he was willing to continue the medication. We don't expect this patient to progress toward class VI or VII thus we can be more liberal with his hairline design.
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TC17, Good question. We do perform microscopic examination on all our patients to check the level of miniaturization of the hair on different areas of the scalp. This test helps us predict where the patient is heading in terms of future hair loss pattern. This patient has 100 percent miniaturizaiton on the front and corners but not any evidence of significant miniaturization in the other areas (0 to 20%), which is within normal range, so we know he will never be going to the advanced stages of hair loss and can safely restore his hair line. Thanks, miniaturization study.bmp
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Thanks Taking-The-Plunge for your comment and recognition, Hair Restoration Surgery is still young and we keep coming up with new methods and are able to refine our old ones. Since two years ago when Path visited our Los Angeles Hair Restoration Office we have made a few fine tuning in some of our procedures. We used to do one sided trichophytic closure in the past. Today, we do two sided trichophytic closure in most patients. By doing two sided trichophytic closure we minimize the width of skin top layer (epithelium) that is removed on each side and instead remove narrower epithelium from two edges of the wound. This approach allows us to get better results while it minimize the risk of folliculitis or ingrown hair which are the two complications of tricotomy (due to the width of epithelium that is being removed and inability of some the hair follicles or oil glands to find their way out). I will post some examples of the double edged trichophytic closure soon.
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Thanks Mike for your recommendation and recognition. I look forward to seeing you in the next annual meeting of ISHRS in Boston and to working along reputable practices like yours here in this society to educate patients in their hair restoration process. Best, Parsa Mohebi, MD
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Thanks every one for your warm comments and good questions. Future HT Doc, I use sagittal incision on the very front of my hairlines only to make the hairline (that will be receiving single hair follicular units). Sagittal incisions are used to minimize the level of injury to the small dermal blood vessels that travel from front to top. The reason we do not use sagittal incisions on the more posterior areas and behind the hairline is to increase the appearance of fullness in those areas (as Bill mentioned too). Thanks,
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Thanks Robin, Nicely presented. I believe presentations like this with complete details including consultation day information and surgical and medical plan helps people feel more comfortable to make an informed decision for their hair restoration process. They have the pictures and information from before hair transplant, recommendations and final plan including the number of surgeries and grafts transplanted and eventually the final pictures.
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Thanks Robin for posting this photos. To answer to Mike's question. Most younger patients with class VI of baldness would eventually need a second procedure. That would not only gives more coverage to the areas that were not heavily transplanted, but it can reinforce the hairline and increase the density of hair in the frontal and corner areas. That would be particularly important for a patient like this who chose to comb his hair backward so layering can help crown areas to look better with minimum number of grafts.
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Whether using deep layer or not has been a matter of controversy. We had a nice panel discussion in the last annual meeting on one layer vs. two layer closure. Many hair transplant surgeons are using only one layer closure because there have been no evidence that closing the donor wound with two layer necessarily gives a better result. I personally used to close all donor wound in two layer. Now and in the last year I have been getting more selective when it comes to wound closure. Many patients may not need to have two layer closure because of their loose scalp and the fact the proper approximation of skin edges with minimum tension is doable with only one layer. In addition to that using Laxometer allows us to measure the laxity of the scalp and be able to determine the widest safe size for the strip. In this patient we had very reasonable closure tension and we closed in one layer. Spacing between the staples or sutures also is something that you should evaluate during surgery and as you put the staples in. There should not be a set number for that and it may change from patient to patient. We do not have to put too many staples if perfect alignment of the skin edges are possible with less.
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Good observation and great question Future HT Doc. We use a special tool called Laxometer in our operating room right before our strip hair transplant surgeries to increase the preciseness of hair transplant procedures. The tool allows us to measure the laxity of the scalp and determine the widest safe size for the strip to be removed. In the last annual meeting of International Society of Hair Restoration Surgery (ISHRS) in Amsterdam Holland, I presented a new method of strip removal for mega and giga session hair restorations as "Sequential Strip Removal in Strip Hair Transplant Surgeries". We know that removing wide strip in some patients may increase the closure tension on both sides of the donor wound. That may lead to telogen effluvium or necrosis of those areas. I introduced sequential removal of strip to avoid this type of side effects. In this method I measure the laxity of the scalp using Laxometer before strip removal in three areas on right, middle and left. Then we remove the widest safe size strip from the left side and close the wound. We then measure the laxity of the intact side of scalp on the right side. If we see reduction in laxity or mobility of scalp on the second portion, we adjust the size of strip on that portion accordingly. If there is no change in the laxity of the second portion, it indicates that we can safely remove the strip with the same width from the second portion too. I have not seen any severe donor complications since I started using this method. I will put the abstract of this that presentation in our web site soon. Thanks again for good observation and the great question.
