Hogan Shy, MD (retired)

Dear 22, 

You are very young for a hair transplant. It is very unfortunate that you already have hair loss at age 22. An important part of hair transplantation is planning for the future. If you use 2000-4000 hairs to strengthen your current hair line, you may have further loss and insufficient donor hair in the future. Also, if you reinforce a younger hair line, this will look unnatural when you are 40 or 50. 

At this time, I would recommend consulting with your physician and consider starting propecia. This would prevent further loss predominantly around the crown. You can consider viviscal or nutrafol as vitamins. PRP injections can also help support thinning hair. With propecia, you may have some gain and slowing of your hair loss.  I would save the hair resources when your hair loss is more stable, and consider a transplant at that time in the future. 

Hi, CoolSculpting is usually a safe procedure, however there is a concern about increased risk of complications in patients with autoimmune diseases, more specific cold agglutinins. The cold treatment from cool sculpting may correlate to a high risk of hyperplasia or even necrosis. I would not recommend taking the risk is you have an autoimmune disorder - as Sjogrens can be associated with a small increased presence of cold agglutinins.

If the laser treatment was done properly, the visible follicles that were treated would be destroyed by the laser. These hair would likely not recover. However often we do have hairs in typically in a dormant stage which are not visible and therefore not susceptible to the laser.  This is why, for hair removal we recommend repeat treatment in about 6 weeks. 

So in a few weeks, you may get some regrowth of the hair that was in a different cycle at the time of the laser treatment. PRP injection - is an option to stimulate and strengthen the hairs in the telogen phase (rest phase) to progress to the anagen phase (growth phase) of the hair cycle. This can mitigate the loss from the laser treatment. 

What type of anesthesia was used? For our hair transplants for FUE, we use mainly lidocaine and marcaine as a local anesthesic. There is a possibility of lidocaine toxicity with excess dosage - often over 300 mg (or 500 mg when mixed with epi.) Symptoms of lidocaine toxicity include perioral numbness, facial tingling, restlessness, vertigo, tinnitus, slurred speech, and in severe cases seizure. You can also get ECG changes at high doses.  I would discuss further anesthetics options with your surgeon, or trying again with minimal lidocaine use. 

If there is a hair underneath, these are hair follicles. In this case, laser hair removal treatment would address this issue. The dark spots will absorb the light from the laser, with goof results. At times 2-6 treatments may be necessary to remove all the underlying follicles. 

Shaving and exfoliating can cause more irritation to the area. I would recommend laser hair treatment.