Parsa Mohebi, MD

Here are the post op 8 months pictures from a patient with Class VII results after one session with 2635 grafts with Dr. Parsa Mohebi at US Hair Restoration. Placement: Hair line: 300 single grafts Front: 1500 Top: 585 Crown: 250

Great points, We need to have more of these discussions on this forum where the hair transplant surgeons can share their experiences. I don't use custom blades in my practice. I either use 20 gauge needles for frontal hair line or 18 gauge needles for the grafts with more than one hair behind the hairline. I believe solid wire needles have the smallest risk for transecting existing hair, so I use them especially when I am transplanting in a previously transplanted area or when I have to go between remaining native hair.

Hair transplant repair procedure from Dr. Mohebi's Los Angeles hair transplant clinic (US Hair Restoration). Patient had a micro graft procedure in 2007 with another hair restoration center with following problems: 1. Pluggy hair on the hair line (2-3 hair grafts) 2. Less than optimal coverage on front area 3. Asymmetrical hair coverage on the front area

Hair transplant repair procedure from Dr. Mohebi's Los Angeles hair transplant clinic (US Hair Restoration). Patient had a micro graft procedure in 2007 with another hair restoration center with following problems: 1. Pluggy hair on the hair line (2-3 hair grafts) 2. Less than optimal coverage on front area 3. Asymmetrical hair coverage on the front area

Hi everyone, It was a pleasure for me and my staff to perform Bruce's surgery at our Los Angeles Hair Transplant Office. Bruce is one those patients that most surgeons love to have. He did his homework. He read about the procedure and its Pros and Cons. He visited online communities like Hair Transplant Network. He had consultations with some other Los Angeles hair transplant clinics and he eventually made an informed decision about his hair transplant surgery. Bruce also asked great questions before during and after his hair transplant surgery. I will answer to your questions and address your comments below. If you have more questions on our techniques I will be glad to answer them here. I am very much into patient education and generally spend plenty of time with my patients during the consultations and in follow up visits. Here are the answers: 1. Hair line: I design the shape of the hairline based on several factors including patient race and age, characteristics of the donor hair, and patient's hairline before balding (if we have pictures available). We draw hairline at the day of our initial consultation and make sure patient is completely happy with it. Bruce is one of those great patients who do their homework and come to you prepared. He has read a lot about hair transplant and consulted several other hair transplant clinics in Los Angeles before coming to us for his initial evaluation. He brought with him his pictures before he lost his hair. I always send a letter of consultation to the patients and include some of the pictures that show patient's picture so he can go over it and discuss it with friends or family if need be. 2. Pre-op medications: The injections are done in patient's deltoid muscle for its accessibility and safety. Patient usually receives two intramuscular injections: Midazolam, a short acting sedative, which induces sedation with minimal side effects for the first 30 to 60 minutes and Dexamethasone (steroid) that minimizes the swelling and redness after the surgery. I particularly use steroid for large procedures or for people who have history of severe bruising or redness after skin procedures if there is no contraindication for its use. 3. Donor closure: I always use two layer closures for reducing the tension of the skin edges that can lead to reduced size of the final scar. For deep layer I use absorbable suture. For superficial layer, we have the option of using staples or suture. Since staples might not be as comfortable as suture, patients with less pain tolerance may choose sutures. Also I use absorbable suture for patients who may not be able to come back to our office at day 10 after their surgery for staple removal. The cosmetic end results comparison of scalp sutures vs. staples is not researched and they could be used interchangeably. 4. Local anesthesia: I generally start with local infiltration of the combination of Lidocaine epinephrine and bicarbonate (for rapid onset anesthesia) and reinforce the initial anesthesia with the combination of Lidocaine 0.5% and Bupivacaine 0.25% for long lasting local anesthesia. I reinforce the local anesthesia about every 2 hours for complete pain relief during the whole procedure. 5. Covering large balding areas: Even with mega sessions that we are able to do today, it is hard to cover the whole head in high classes of baldness V-VII. In order to get the most out of the limited number of grafts, surgeon can focus on one area (usually front) and leave the other areas to be dome in the future surgeries. For Bruce, we transplanted the whole head, but we used different densities in different areas. We created a nice irregular hairline with single hair follicular unit graft. We dense packed the front. We used less density for top and even less for crown. For his crown we followed the natural orientation of hair on the swirl area. Since our single hairs were more to just be used for the hairline, we chose not to double up them on the crown so its thinning does not cause pluggy appearance in the area. I would like to have patients involved in planning and designing of their hair before their hair transplant surgery. I educate them on the methods that should be used for the best appearance of their hair, but also let them to actively get involved with their needs and concerns. I also consider patient's special conditions. A patient, who may be working with the computer most of the times, may be more concerned with the crown coverage than a tall person who does not have a sedentary job. Parsa Mohebi, M.D. Medical Director US Hair Restoration Los Angeles, California

Dear Pat, I enjoyed meeting you last week in our Los Angeles Hair Restoration clinic. I am glad to see you visit different hair transplant clinics and observe them closely and meticulously before recommending them on your website. I look forward to working with this network and to actively participating in this informative and educational network. Best, Dr. Mohebi

Hi Jason, Thanks for the comment. I do weigh hair on the side that patient part his hair to use the maximum effect of the transplanted hair and to create the maximum appearance of fullness for patient. However that was not the case for this patient and he wanted to just comb his hiar back. Here is a more focused picture that shows the even distribution of the hair in both sides of the frontal area. Best, Dr. Mohebi

Thank you Bill, Here are the details of the posted surgery; Number of grafts: 3560, that I used 400 singles for hairline, 1800 for front, 1000 for top and 400 on the crown area. Incision sizes: 20 Gauge for hair line (only single hair) and 18 gauge for other follicular unit grafts. I made 400 sites with 20 gauge needle for hair line, which is about average for patients who get their whole hairline restored. I am very much in to patient's education so I will be more active with more updates from my patients in this great informative online community. Best, Dr. Parsa Mohebi

Dr. Parsa Mohebi, Medical Director of US Hair Restoration offers mega sessions at his offices at Los Angeles.

Hi there, If you are feeling depressed by your hair loss, you are not alone. There are several researches on psychology of hair loss showing association of hair loss and depression and anxiety. Last year Dr. Rassman and I did a research on psychology of hair transplant. We asked 200 people who had their first hair transplant surgery over a year ago eight questions on the changes they felt after complete result of their hair transplant surgery. The good news is you can reverse your depression with hair restoration and with available technology it is easily available. I presented the result on the last annual meeting of international society of hair restoration surgery in Vegas. I also submitted an article to the journal of the society that was recently published as cover article. Here is the abstract of the article that I put in my hair transplant weblog: ?« US Hair Restoration Video ClipPsychology of Hair Transplant I just received the last issue of the Hair Transplant Forum International, the Journal of International Society of Hair Restoration Surgery (ISHRS). Our article "Psychology of Hair Transplant" is published as the cover article on this issue of the journal. Here is an abstract: -------------- Psychology of Hair Transplant Parsa Mohebi, M.D., William Rassman, M.D. Balding and its psychological impacts has been the subject of many studies in the past. The relationship between hair loss and stress is clear to all clinicians who practice in this field. Negative psychosocial impacts of hair loss in male patterned baldness and in women with generalized thinning have also been seen. Many of us (hair transplant surgeons) have seen the negative effects of hair loss on self esteem and self-image. We know that hair loss impacts some men's sex life and their stability with regard to career choices in men of different ages. Despite the solid evidences and published literature on psychological impact of hair loss, the corrective effect of medical and surgical hair restoration has never been studied. After observing the drastic changes in patient behavior and the high level of patient satisfaction in those who had hair transplant procedure, we were motivated to look into the psychological impact of hair restoration on different aspects of a patient's life. We came up with a series of criteria that could have been modified by having a hair restoration procedure; we used some indexes that were previously studied comparing bald and non bald men on different psychological variables. We initially performed a pilot study and asked patients about different aspects of their lives during their post op visits. We gave our patients open ended questionnaires and probed their psychological state after their hair restoration procedure was complete. Eventually we focused in on eight major criteria that have been reported and documented as variables associated with hair loss in the literature. We collected a subset of them in our pilot study. Included were questions on the general level of happiness, energy level, feeling of youthfulness, anxiety levels, self confidence, outlook on their future and impact on their sex life. We have chosen the patients who had their first hair transplant surgery between one to three years from the time of our study, so they had seen the final result of their hair restoration procedure. We limited the study to male patients with male pattern baldness and the ones who had surgeries less than three years ago so they still had a fresh memory of the changes they experienced. Each patient had exclusively follicular unit transplants that reflected our standard of care for that period. We sent a questionnaire with a brief description on the nature of this scientific study. We did not collect any patient identifiers and the response was totally voluntary. We sent the two hundred questionnaires with stamped return envelope. The response rate to our questionnaire was 37 (18%). Each patient was used as his own control since we asked about the changes that they experienced after surgery in comparison to those variables before the surgery. We used T-test to compare patient's responses. Table 1 shows the mean and standard error in eight different criteria that were asked. Patients had significant improvements in all eight criteria regardless of their stage of baldness and their ages. In another attempt to compare psychological changes that patients experienced in different stages of baldness, we divided patients into two groups: (1) those who had Norwood IV patterns or less and (2) the ones with Norwood V patterns and above. We observed the most significant difference in two categories, (a) sex life and (b) career experience. Patients with less balding had a greater impact on their sex life and career when compared to patients who had more advanced stages of hair loss. These changes were not age related. Hair restoration surgery can affect many aspects of a patient's life. Hair transplant can potentially reverse psycho-social problems associated with hair loss. The positive impact of hair restoration surgery is more visible among patients who suffer from those undesirable effects the most. In early stages of hair loss, patients may have more awareness of their condition and they might be more affected than men in the later stages of hair loss. Patients who experienced hair loss at an early age while involved in an active social life were more prone to the negative side effects of balding. That could explain why younger people with hair loss appeared more benefited by hair restoration procedures. Also it could be assumed that hair loss can have a negative impact on a patient's outlook which seems to reverse after receiving a hair restoration procedure which improved their outlook. Low response rate from a blind mailing has always been a drawback in questionnaire studies. We received 37 out of 200 of the questionnaires that we sent out (response rate was 18.5%). Giving incentives to responders may be a good way of increasing the participation rate of any questionnaire studies. We presented the result of this study at the annual scientific meeting of ISHRS and have been contacted by many of our colleagues who expressed interest in collaborating in a larger scale study. We are currently trying to rise funding for repeating this study to optimize our response rate and the statistical value of the study. ----- This attached graph can say more than anything on the changes that you can experience after hair transplant surgery. Good luck. Best, Dr. Parsa Mohebi