Dr. Omer Ibrahim on Hair Loss: What Works, What Doesn’t, and Why It’s So Confusing

Omer Ibrahim, MD, FAAD (: 00:26

Thanks for having me.

Omer Ibrahim, MD, FAAD (: 00:45

You

Omer Ibrahim, MD, FAAD (: 00:54

Glad to be here.

Omer Ibrahim, MD, FAAD (: 01:27

So.

It's interesting because the treatment of hair, especially in the dermatological community among dermatologists, like as a dermatologist, you are an expert in skin, hair and nails, whether you like it or not. And there is a stigma even within the derm community of hair loss is aesthetic. Hair is, it's not life threatening. It's not skin cancer. It's not some autoimmune disease that's going to eat up your skin or your joints or anything like that.

And so treating hair can be very frustrating because one, we don't fully know exactly what is causing hair loss and hair thinning, especially postmenopause. And the treatments out there, a lot of them are outdated. Many of them work. Many of them don't. There's a lot of smoke and mirrors. The hair care and hair loss industry is a multi-billion dollar industry. And so it's really difficult to navigate. And when it comes to the providers,

and patient relationship when it comes to hair loss. There's a lot of counseling, a lot of hand holding, a lot of expectation setting. And so it tends to be, especially in this day and age when dermatologists and physicians in general are expected to do more with less time.

hair takes the backseat, unfortunately. So it's a lot of factors as to why the treatment of hair and hair thinning is not very robust within the derm community because it's a factor of time, it's a factor of money at the end of the day, it's a factor of the, you know, not many treatments work. There is a lot of smoke and mirrors. So there are lot of reasons why it's not practiced as widely because it definitely is taught.

Omer Ibrahim, MD, FAAD (: 03:17

It's just, is it taken seriously by the professional? Is it taken seriously by the person or not?

Omer Ibrahim, MD, FAAD (: 03:39

Exactly. so for myself, if when I see patients coming in, in general, when I see patients in clinic and they have a concern for hair loss or hair thinning, I always try to 99 % of the time, I try to make my hair loss visits their own separate visits because hair is complicated, as we mentioned, and it requires a lot of history, it requires a physical exam, sometimes it may require a biopsy, and to give it the

attention that it deserves and the attention that it needs, it does need the time. And so when someone comes in for a skin check, acne, this, X, Z, and also, by the way, I have hair loss, we call those doorknob questions. You're like, absolutely not, now's not the time. So it's dedicating the time to it that's necessary. That way the patient is well taken care of in terms of their hair concerns.

Omer Ibrahim, MD, FAAD (: 04:55

Absolutely, absolutely. So you have to be efficient, train your assistants, your medical assistants or your nurses to gather, you know, thorough but also concise and accurate history so you can make the efficient, the visit as efficient as productive as possible.

Omer Ibrahim, MD, FAAD (: 05:29

Yeah, so I did my residency at Cleveland Clinic. That's where I did my dermatology residency. And Cleveland Clinic was, and I'm pretty sure still is, considered one of the top hair loss centers in the country, thanks to the individuals under whom I trained. I trained under Dr. Wilma Bergfeld, who was the first female president of the AAD, the American Academy of Dermatology. She was one of the trailblazers in the field of dermatology,

specifically in hair and I trade under Dr. Angela Che, Dr. Melissa Piliang. So whether we liked it or not, hair loss was shoved down our throats. So we became, we, you either denied it, you either struggled or you just floated down the stream and embraced it. And I, and I remember in the middle of residency when I thought, you know what, I'm not going to resist this anymore. I actually physically thought that to myself.

I said, know what, embrace it. And I did. I took it and I started treating my hair loss patients in my own way. And so, and just seeing the impact that you can have on someone's self-esteem, someone's psyche, that's what kept me in treating hair.

Omer Ibrahim, MD, FAAD (: 07:21

Absolutely, absolutely. I think it just points to how little, at least from the hair loss standpoint, how little we truly understand about what is going on, what's the pathophysiology, is it, the answer is no, but is it as simple as just hormones and genetics? The hormones and genetics are probably just two of a hundred different factors that impact.

hair and hair thinning, especially once hormonal changes are coming in. And so that's why our medications can sometimes be a little rudimentary. They work, but you have to really, like you said, you really have to balance the risks and benefits before starting any of these treatments.

Omer Ibrahim, MD, FAAD (: 08:42

So postpartum hair loss, so when a patient or a person is pregnant.

The there so let me take a step back. So the hair cycle or the hair follicle cycle is in like at least three different stages the antigen which is the growth phase the catagen resting and then telogen phase so there's there has to be I think it's like 20 % of the amount of your hairs that have to be in telogen phase the shedding phase is about 20 % you're supposed to lose about a hundred hundred fifty hairs a day normally when you're pregnant you kind of get spoiled because that telogen phase

stops or decreases. You're not shedding as much and that's why people say my hair is it's fuller, it's thicker. So postpartum hair loss is something natural and it's something that should occur. However, however, what I tell patients and the myth that was told to pretty much everybody was that, you just let it run its course, it will all grow back.

That's when we know it's not true. We know that there's a certain subset of patients that will grow back about 30, 40 % of what they lost. There's another subset that will grow about 60 to 80%. And then there's a subset that will grow everything back.

100 % and so I tell patients I'm not really concerned about the hair that's being lost. It was supposed to be lost anyway I'm more concerned about the regrowth about the bounce back. It's like an orthopedic surgeon trying to prevent you from you know Breaking your knee or something when you're a kid Really? It's the recovery. It's the healing process. So I come that's where I come in So I counsel and like this is normal too. I don't think it's wise to say okay

Omer Ibrahim, MD, FAAD (: 10:30

just let it run its course. think there are treatments and we can go into treatments later, but there are treatments, early interventions that are, you know, breastfeeding safe that you can implement early on to make sure that you curtail that process. You slow down that process quicker, that shedding process, but also get your bounce back at the hair back as healthily as we can. I never promised that we're going to get 100 % back if we do. Hallelujah. But I say let's try to get as close

Omer Ibrahim, MD, FAAD (: 11:16

I have because

The telogen phase, which is that shedding phase, it can really vary from two months to like six to seven months, depending on the individual. I, the most commonly, the most common sort of timeline for which the shed should occur is about three months. So I tell patients, give it about three months or so. If it's not improving, that's when I usually see them back. But that being said, I have patients that I see back within two to four weeks after delivery and they say, let's go, we need to start treatment.

it now which is totally fine but I say give it that three month mark

Omer Ibrahim, MD, FAAD (: 12:21

Absolutely. whether it's postpartum or not and someone comes in and says, you know, I am shedding, there are, and this is a condition that we call telogen effluvium, where your telogen hairs are, instead of going, instead of losing 100, 150 hairs, you're losing 200, 300, 400 hairs. That is when really, as you mentioned, the history and physical as well as some pointed laboratory tests are important because it could be stressor. So, it could be psychological.

stressors like new psychological stress of being a new mom. see in patients that have you know recently gotten married, recently getting a divorce, exam time, job changes, job loss, that's psychological stressors. Physical stressors like surgeries, c-section, even the anesthesia from surgeries can cause these accidents.

These are physical stressors on the body that shock the hair. And then once we get the history, if it's warranted, usually I would do a blood work panel. That's where we check for anemias. We check for a low blood count. We check for iron levels. We check certain hormone levels, thyroid, nutritional things like zinc and vitamin D. So patients commonly ask me, okay, so what's the cause?

Omer Ibrahim, MD, FAAD (: 14:09

That's exactly it. most of the time, and I practice in like downtown Chicago, the population tends to be a little younger. They're usually not on any other medications and it's usually stress or psychologically induced. For example, I had one patient who lost her fiance, unfortunately she was very young, lost her fiance, excruciating amount of hair loss. I mean, she lost about 80 % of her hair.

Just saying, okay, manage your stress, especially an individual like that is not a good enough answer. So I go right for, I go right towards, you know, treatments, whether it's oral or it's medical or it's topical or it's procedural. So some of the treatments that I do, one, if they are, and I'm seeing this a lot with this new GLP-1s, if it's weight loss induced, which is very, very common, I make sure that they are

supplementing with proper amount of iron, proper amount of vitamin D, make sure their protein intake is robust, at least on the lowest end, 60 grams a day, but 80 to 100 grams a day of protein, make sure their vitamin D, make sure their iron levels are, you know, in check. But also, I will reach out to treat, I will reach out to medications and ingredients such as minoxidil. Minoxidil is sort of like the golden child of treating hair

hair thinning and hair loss. In my practice, I use minoxidil orally. 99.9 % of my patients are on it orally. Why? Because some studies show that it is better than, depending on the dose, that minoxidil is superior to topical, or oral minoxidil is superior to topical minoxidil once a day, which is hard enough to get people to apply something to their scalp once a day. And compliance is much higher and patients are much happier. They're like, I'd rather take a small little half

a pill rather than apply something that's greasy topical on my scalp. find that minoxidil really really helps if we're talking just shedding. think minoxidil and proper supplementation of nutrients and vitamins and protein and like dietary supplementation in addition to minoxidil is usually enough in most of my patients.

Omer Ibrahim, MD, FAAD (: 16:37

Yeah. Yeah. So I'm sure and the marketing is great there. And I mean, the supplements, they're all somewhat different. But when it comes to specific ingredients, I think, I do think that there is some utility in the supplements that have some collagen and some have some.

They're usually marine based collagen that actually does help with hair. And I've seen the studies. Yes, it can help with hair regrowth. Biotin does nothing for hair on its own, especially, especially high dose biotin has been shown. I mean, biotin deficiency in the U.S. is impossible. It's just physically impossible. Biotin deficiency causing hair loss. You see it in developing countries or countries that really nutrition is a severe issue.

on its own, especially in the US, really doesn't do much for hair. All it does is really mess with your blood work. It can mess with your thyroid numbers. It can mess with certain heart markers. And so I try to steer patients off of those. Hair loss supplements on their own.

don't really do much either. I think they have some utility in combination with tried and true treatments like minoxidil, like spironolactone, like finasteride, like dutasteride, all of these things that have been tried and true.

Omer Ibrahim, MD, FAAD (: 18:20

Yeah. No, I'm Egyptian. Middle Eastern. Yeah.

Omer Ibrahim, MD, FAAD (: 18:41

Yeah. Yeah.

Omer Ibrahim, MD, FAAD (: 19:03

Yeah, so I didn't realize it was one in four. I mean that number, that's shocking to me, but also I mean I see just looking back at like my last eight years in practice in Chicago. Can you hear me?

Omer Ibrahim, MD, FAAD (: 19:27

Can you hear me?

Okay, so I mean, that kind of tracks with what I see in my own clinic, because I do tend to see more, I tend to see a lot of what we call female pattern hair loss or formerly androgenetic alopecia in especially younger South Asian women. And it tends to be a lot more stubborn to treat. You can still get results, but I've noticed that, and that sort of tracks with the one in four statistic.

is make sure that they are of course following up with their endocrinologist, gynecologist, whoever is managing their PCOS primarily, but the treatment for hair thinning induced from or in the setting of PCOS is a little bit different. I know metformin and things are used on the other side, but really doesn't have much utility for hair. Number one, minoxidil for sure. Number two, I really do think there is utility in some of these anti-androgenetic medications.

So spironolactone, which is a medication that was originally developed as a, you know, a heart failure, blood pressure medication has a lot of utility in the treatment of hair and skin in the setting of PCOS. Because when we see patients with PCOS, the three main things that we see are hair thinning, hair growth in the lower face, usually in the beard area and acne and excess oil production. And spironolactone really does help with all of those. So almost all

the PCOS patients need to be on a combination, I call them Batman and Robin, of minoxidil spironolactone, and then depending on the severity and depending on their habits and their reproductive age and things like that, plus or minus finasteride or dutasteride. So I have some patients with severe, especially the younger patients with severe PCOS that are in their 20s,

Omer Ibrahim, MD, FAAD (: 21:28

and then they have the scalp of a 60 or 70 year old, that's when you get aggressive. And some of them I have on three medications, they're doing well, they are under my care, under my supervision of course, and we're always monitoring for side effects, but some of them need it until we can figure out more hair directed treatments, which we are slowly getting closer to.

These are the medications that we have and thankfully they work and are relatively low risk.

Omer Ibrahim, MD, FAAD (: 22:29

Absolutely and then they have that weight loss induced and I think I read something recently that I don't know it definitely needs more study.

they're thinking that maybe the GLP ones themselves are causing hair thinning and hair loss and hair shedding. So it might not be just the fact that you're losing weight and losing a lot of weight very quickly is causing the hair loss. The GLP ones themselves to differing degrees might actually be inducing some hair shedding and hair loss. So TBD still more needs to be studied with that. But yeah, it starts to add to the problem. can accumulate the amount of hair loss.

Omer Ibrahim, MD, FAAD (: 23:26

Yes, yes 50 % and higher. So it can go to 50, 60 % of perimenopausal onwards of women will experience hair thinning at some point. So that's one and two. Yeah.

Omer Ibrahim, MD, FAAD (: 24:00

Exactly.

Omer Ibrahim, MD, FAAD (: 24:28

Yeah. Yeah.

Omer Ibrahim, MD, FAAD (: 24:41

Yeah. So the first thing I tell my patients is the earlier treatment, the better. And it doesn't mean that we have to throw everything, including the kitchen sink at it from day one. First, the first thing I counsel is one, the earlier treatment, the better. So if you can get on top of treatment, at least add one thing to your regimen that can help that you're doing yourself a huge favor.

as opposed to waiting another five, 10 years. Number two, I always counsel that, am I gonna promise that I'm gonna get your hair back from when you were 10, 15, 20 years ago? Absolutely not. I wish I could. I would be a multi-billionaire, but I cannot.

And so I say that, you know what, we're gonna monitor and we're gonna see how things go. And then number three, it takes time. You're not gonna see results in two months, you're not gonna see results in three months, maybe four months. So I tell patients, if you're gonna embark on any sort of treatment for your hair thinning, we take photography in the beginning, baseline, always it's mandatory.

And then we follow up with follow up photography at six months. Some people do four months, but I think six months is probably that golden time. It's the, that's my primary endpoint is that six months. And if we see that things are better, great. Do we need to tweak anything? Are things the same? Are they stabilized or are they worse? And then we, and then we add medications depending on the patient's comfort level, their comorbidities.

side effect and they're willing and they're at the end of the day, their willingness to undergo treatment. I have some patients that, you know, they say, I'm done, I'm tired, I don't want to do anything about my hair, I'm going to, you know, look into hair prosthetics. That's still a treatment for hair thinning and hair loss. It's not giving up. It's still a treatment. And so, yeah, it's slow and steady, start early.

Omer Ibrahim, MD, FAAD (: 26:46

go very carefully, add medications gradually. There are things that we can try that are more on the quote unquote natural route. These are newer, more experimental treatments, not experimental, these are newer treatments, some are experimental, but we're talking things like red light therapy, low level laser therapy, PRP. Yeah.

So some of these newer procedures, so we can start with those laser caps or those red light caps. The studies actually show that they work. But however, you really do have to use these laser caps exactly as they're intended to be used and you need to use them very religiously and very strictly.

For some of them, for most of them actually, to see the full benefit, you need to use them consistently for at least a year, sometimes for even up to two years. But I say it takes a year's worth of use, but the studies have shown that there are lots of studies that show that they are useful. I use them as an adjunct. I use them as sort of a complimentary treatment. Most my patients are...

very much more motivated. They're very motivated. They want to do as much as they can. So it's usually a good complementary treatment. The newer sort of in office treatments are these injectable treatments, the platelet rich plasma injections, which accord it, which they're not FDA approved for injection. They're FDA approved for topical use. And you cannot say that, it treats hair thinning and hair loss. I don't want the FDA to go down on any of us.

But that being said, they are being microneedled and injected into the scalp to assess if it can increase the appearance or improve the appearance of thinning hair. PRP or platelet-rich plasma is still being used, but the studies are still a little bit out there. There are lots of studies that show they help. Some studies show that it doesn't do much, and I think that's because PRP really depends on how healthy your own platelets are.

Omer Ibrahim, MD, FAAD (: 29:04

really depends on the system that's being used, who's injecting it, what additives are being put in there. And then PRP, I like to call this PRP 2.0, are exosomes. Exosomes are what people are using right now. There are right now, exactly. Exosomes are what PRP was seven, eight years ago. So exosomes.

Again, not FDA approved for to treat any disease or anything like that and definitely not FDA approved to be injected. However, there are folks out there that with proper counseling, they are using them, microneedling them and injecting them into the scalp. I think exosomes are exciting because it's PRP that's in a bottle. It's concentrated. I think for wound healing, anti-aging, as well as hair thinning, I think they're showing a lot of promise. I'm very excited about exosomes.

Omer Ibrahim, MD, FAAD (: 30:11

Yeah, so I don't get a lot of female patients getting hair transplants just mainly because maybe it's my own patient population, maybe it's because I'm so aggressive with treating hair thinning and hair loss. Both my male and female patients, I say if we're gonna start the medical treatment, give me at least a year to reach a new baseline, at least a year to reach a new baseline.

then we can reassess and then I can refer you out for a hair transplant. I see women, some women get hair, not as much as men, but I, the old dogma was, you either do all these medications or you get a hair transplant. Like we were talking about earlier offline, they're intertwined. They are part of a spectrum. I think if you're gonna get a hair transplant,

your investments and get on some sort of at-home treatment. It's like going to the gym trying to get muscular trying to get lean but coming home and just eating pizza all day. You really have at-home treatment is just as important as in office.

Omer Ibrahim, MD, FAAD (: 31:28

Yeah, yeah. Yeah, exactly. Which is, it's shocking to me because a hair transplant is not a cure. It's, some people sell it as a cure, but it's not a cure.

Omer Ibrahim, MD, FAAD (: 31:47

Exactly and this is why we've sort of shifted now we call it laser hair reduction because you will need to touch it up every few years and it is what it is.

Omer Ibrahim, MD, FAAD (: 32:14

for hair thinning. Yes.

So, yeah, thank you for bringing that up. So there are a couple of devices. Was it radio frequency or ultrasound? Yeah, yes. So there are a couple of different devices that use either heat or like laser energy or even ultrasound to try, because normally your skin is like this. It tries to open up the pores and then they apply some growth factors. Yep, exactly. And so again, these are still newer. They're still

some of them are still very much experimental. For the most part, they're pretty safe. However, they are promising, but again, do they replace minoxidil or are they better than minoxidil? We need much larger studies to actually compare head to head to see if the, they cost money at the end of the day, these treatments can cost up to $1,000 per treatment and you usually need three of those and then you need two a year to maintain them.

the cost can rack up.

Omer Ibrahim, MD, FAAD (: 33:36

you

beauty trends we're seeing in: 2025

to sort of genetic and hormonal thinning. And they're actually sending out to labs and creating serums out of your own stem cells. I think that's gonna be the new frontier is using your own, whether it's bone marrow, using your own skin cells, using your own hair follicles, sending them out, purifying them and actually storing them. So they are like multiplying these stem cells and storing them in a fridge in some lab.

out somewhere and they're saving them for you for years to come to use whether either on your skin, on your scalp, and then going forward, I think fast forward 10 years, they're going to be used to regenerate your own neurons, your own to help with, to hopefully potentially treat things that we don't really know how to treat like Alzheimer's and dementia and things like that and your degenerative joint disease. So that's the news, using your own

Fortifying it, storing it, and saving it for later. I think that's the direction we're going.

Omer Ibrahim, MD, FAAD (: 35:19

Yeah. And a lot of the, so we do offer exosomes in our office and we use them, you know, after laser, we can use them for hair, microneedle them. Again, not saying they do anything or treat anything, but we have them. But they are sourced from cord blood. They are sourced from umbilical cords. Yeah.

Omer Ibrahim, MD, FAAD (: 36:02

Yeah.

Omer Ibrahim, MD, FAAD (: 36:13

No, I've had because I've gotten so crazy busy. I've had to really focus on aesthetics and hair. Yeah, so I'm niche like aesthetics and hair. That's pretty much what I do. Yeah.

Dr Sameena Rahman (: 36:28

Hey y'all, it's me, Dr. Smita Rahman, Gyno Girl. I'm excited for another episode of Gyno Girl Presents, Sex, Drugs, and Hormones. I'm Dr. Smita Rahman. I'm here with a very special guest today. You guys heard on the intro, we're gonna learn all about hair, which is such a concern for so many women, and men actually. So I'll do my Oprah introduction. It's Dr. Omar Ibrahim. Woo! All right.

Omer Ibrahim, MD, FAAD (: 36:31

Yeah, absolutely. mean, I have.

Unfortunately, or fortunately, I don't know what it is. People are getting younger and younger, but actually we're seeing a shift in the, to Instagram and TikTok, people are really pulling back on injecting stuff in their faces and Botox and fillers, and people are going more towards laser and light therapy and skincare, which I think is a very, it's refreshing. We're moving away from the overfilled lips and everything.

Dr Sameena Rahman (: 36:57

I'm so excited. met, well, we actually didn't formally meet, but I was introduced to you at the Metapod Society Conference. And so it was in Chicago this year. And so you had so many good things to say with all of us were like, we got to get Dr. Ibrinium on our podcast. So I'm excited that you're here and more excited that you live so close. So I'm going to maybe even come see you one day. Well,

Omer Ibrahim, MD, FAAD (: 37:08

Yeah, yeah. It's a lot of hysteria that I have to sort of like put out in the office in the clinic from day to day, but I think it's a breath of fresh air. think society has gone a little too far down the road.

Omer Ibrahim, MD, FAAD (: 37:25

Yep, yep, I do lasers, Botox filler, pretty much everything.

Dr Sameena Rahman (: 37:25

Omar, why don't you tell us a little bit about, because I always say I work in sex and nobody teaches people how to evaluate for sex, sexual dysfunction, or even menopause stuff. But I think it's the same, and I'm a gynecologist, so I see a lot of people for hair complaints, either in postpartum, postmenopause, irregular stressors in their lives. So a lot of my listeners are really bested in what you're going to tell us today. But it's the same for hair, right? Do you think that no one teaches you about hair either?

Omer Ibrahim, MD, FAAD (: 37:44

Yeah, so they're not new agents, but there's a poly l lactic acid again. I won't mention any I won't mention any brands but poly l lactic acid or PLLA has been around for decades. it's not it's not new at all. But I say I joke and I say in the last 12 months, I've injected more PLLA than I have in my entire career. We are in a by swear we are in a PLLA Renaissance because

Dr Sameena Rahman (: 37:56

I mean, maybe.

Omer Ibrahim, MD, FAAD (: 38:13

because it's a bio stimulator. So it's a bio stimulator that reportedly, according to their studies and their histological studies and their FDA indication is they're injected in areas where you need to plump and improve, plump up the skin, but also improve the skin texture, elasticity. And so you inject it, it's done in a series. You do like three, at least two to three treatments separated by four to six weeks. It builds collagen.

It builds sort of your own fat. So it's really just stimulating your own body to produce what it can and then what Remains what you have left is like you have it for the next anywhere between two to five years. So it's long lasting However, people come in and they say that's the natural alternative to filler. It's not natural because the PLLA is not natural It's still synthetic But i've seen a lot a huge increase in PLLA injections and I mean, I love PLLA there

Dr Sameena Rahman (: 38:50

Yes.

Dr Sameena Rahman (: 39:02

Yes.

Mm-hmm.

Omer Ibrahim, MD, FAAD (: 39:13

is if you go on social media there is a subset of there is a and they're usually plastic surgeons that really are saying we're doing too much in terms of fillers and Sculptra and we're scarring people from the inside. I don't buy all of that but that's their school of thought and they are actually some of them are pushing for earlier facelifts and things like that and there are people in their 40s so pick your poison. don't I don't use a

Dr Sameena Rahman (: 39:16

Yeah.

Omer Ibrahim, MD, FAAD (: 39:43

I use a needle. At the end of the day, it's a personal choice.

Dr Sameena Rahman (: 39:51

And probably a lot of patients are discounted. That's what I hear from the ones that even come to me. They're just like, know, just supplement biotin. was recommended, you know, like these other recommendations that maybe not already even legitimate when it comes to the research.

Omer Ibrahim, MD, FAAD (: 39:53

Exactly. And like here, throughout here, the jawline, I just find it's like, I think for me, hyaluronic acid fillers build a foundation and then the PLLA fills the gaps. It's sort of like the structure is the hyaluronic acid fillers and then sort of the grout and everything in between is the PLLA and the volume that that builds. All the time.

Yeah. Yeah. Not a lot, but like many people do both, but yeah, but not at the same time. It's just like mixing and matching depending on what they need at that point and their budget, of course.

Dr Sameena Rahman (: 40:27

Yes.

Omer Ibrahim, MD, FAAD (: 40:40

Not really. ends up being about the same amount. It's not, yeah, because people say, this bill's my own college and it lasts three to five years. Is it like $6,000 a syringe? Absolutely not. Each vial is just about as much as a syringe in terms of cost. So yeah, they just do different things. Yeah.

Dr Sameena Rahman (: 40:48

Yeah, like now. Yeah, yes.

Omer Ibrahim, MD, FAAD (: 41:03

Right? Right? We have all toys and gadgets that we can play with.

Dr Sameena Rahman (: 41:04

Yeah, no, think that's, and I think that's probably the limitation in so many practices, right? This is what we see in menopause care and in the sexual medicine world is that, you know, it's like 90 % of the answers come from the story that you can hear from, that you elicit from a patient. And you don't have that hour to elicit the story, then you're done.

Omer Ibrahim, MD, FAAD (: 41:37

Exactly, because at the end of the day, it is a skill and it's not just the skill to know how to do it, but also, God forbid, when disastrous outcomes happen or something catastrophic happens is knowing how to deal with it. Knock on wood, I have not had a catastrophic outcome and we're talking like.

Dr Sameena Rahman (: 41:44

Absolutely. Well, let's get into it a little bit because well actually tell I mean I gave a little intro to your to who you are and where you trained and everything but do you want to tell us what brought you into the hair world?

Omer Ibrahim, MD, FAAD (: 41:58

necrosis and blindness and things like that. just knowing how to treat that's what a lot of these like med spas don't realize a lot of these. And a lot of the patients that go to these med spas, these people that don't know what they're doing. It's one side of the coin is yeah, just knowing how to do the procedure. The other side of the coin is managing the side effects and potential complications, whether it's a nodule, or whether it's filler accumulation or migration, or whether it's something catastrophic. That's 50 %

of the education and the learning and 50 % of what you're paying for, but people don't realize that.

Dr Sameena Rahman (: 42:36

Yeah, embrace it.

Omer Ibrahim, MD, FAAD (: 42:44

Yeah, and that's the part I love the most about what I do, at least in the aesthetic world, is when you use fillers and bio-stimulators and stimulators and lasers and things like that, it's just being able to restructure, recreate something artistically. It's a challenge, it's fun challenge.

Dr Sameena Rahman (: 42:48

Yes.

Dr Sameena Rahman (: 42:56

Yeah.

Omer Ibrahim, MD, FAAD (: 43:08

You're sweet. You're sweet. You don't need much at all, trust me, if nothing. Part of it's prejuvenation, that's what we're doing.

Dr Sameena Rahman (: 43:15

And I think, you know, it's, like I said, the two areas we treat are so intertwined because when, you know, women don't feel good about who they are, don't have, they have poor body image, then their sexual function goes down the drain too. And I think then there's all these medications that are used that might impact sexual function too, which.

You know, we always talk about like, know, sprenolactone is really good for the androgenic alopecia, but it's really bad for like your vulvar vestibule and your sexual function because it can really deplete testosterone, which is so important for, so it's always this balance, right? Over like.

Omer Ibrahim, MD, FAAD (: 43:55

Yeah, absolutely look at their training. So number one, especially when it comes to hair thinning, look at their training, number one. Number two, come in armed with questions. Don't come in like ready to fight, but when it comes to your hair loss visit to get the most out of it, come in armed with questions. Say, hey, I've heard of oral minoxidil, I've heard of spondylactone, I've heard of this, what do you think about it?

give your provider the grace of, know what, I'm going to reserve my hair loss visit, or my hair loss concern for a completely other visit. Yes, it's another copay, but trust me, it will be the best spent copay you've ever done. Because if you want to get the most half aid, I'm not gonna say the word, but if you want to get a half aid sort of treatment for your hair,

Dr Sameena Rahman (: 44:34

Yeah, well I want to talk about a couple different stages that I see as a gynecologist when patients come in and it's a big concern. Obviously I don't deliver babies anymore. I stopped when I started my solo practice in sex and menopause, but I do see postpartum and fourth trimester patients a lot. And you know obviously, you know, I've been postpartum three times. I know the amount of shedding that comes from like, you know, the hair. So.

Omer Ibrahim, MD, FAAD (: 44:47

it on to the end of a visit. Make sure it's its own visit come armed with questions, listen, give it time. When it comes to aesthetic procedures, hands down, you need to look at their credentials, you need to look at where they did their training, look at the before and afters, and when you go to your consultation, ask them about, what have, you know, because I've had very savvy patients ask me this, they say, well, do you know how to treat complications? Have you had complications? And have you known how to

Dr Sameena Rahman (: 44:59

Can you address that and what are the best ways that you usually talk to, either talk patients off a ledge or talk to them about how you talk to them about postpartum hair loss?

Omer Ibrahim, MD, FAAD (: 45:17

them. These are questions to be able to decipher if someone knows what they're doing or doesn't know what they're doing.

Omer Ibrahim, MD, FAAD (: 45:34

Yeah. Yes, yes. Yep. Traction alopecia. Yeah. So traction alopecia is, we just don't know how to treat it. It's most commonly seen in most, I should say it is most classically seen in black hairstyles or African hairstyles with lots of tight braiding and

Dr Sameena Rahman (: 45:48

stop.

Omer Ibrahim, MD, FAAD (: 46:02

cornrows and sew-ins and things like that can put tension on the hair. Chronic tension can lead to traction alopecia, which is a scarring type of alopecia. Once the hair follicle is gone, it's gone. And it's very hard to regrow the hair in that area. And yes, and we're seeing it more and more common in Caucasian and patients of other descents because, you know, sew-ins and wigs and weaves is becoming more, you know, accepted and used across all

Dr Sameena Rahman (: 46:22

Mm-hmm.

Omer Ibrahim, MD, FAAD (: 46:32

cultures, but you can see it as young as six, seven, eight years old. Like when I'm walking down the street and I see a little young little girl with tight braids and you can tell it's straining, I just want to say take those out. Save her hours and years of misery. Just take those out. As soon as it starts hurting, that's your hair follicles screaming for help. Remove them.

Dr Sameena Rahman (: 47:00

Thank

Omer Ibrahim, MD, FAAD (: 47:01

Yeah, once what if it's hurting it's yeah, and it's and honestly and it's man it makes the hair easier to manage especially for You know curlier hair drier hair. It's it makes it easier to manage from day to day But there are some hair follicle Saving and hair follow like hairstyles that are more natural. They're easy easier on the hair follicle than those tight braids and trite rows because those are

Dr Sameena Rahman (: 47:30

Is there a time in that one year postpartum, in that one year after they give birth, that you'll say, okay, if this doesn't stop at this point, what's your timeline for your patients?

Omer Ibrahim, MD, FAAD (: 47:31

just a death sentence for hair follicles.

Omer Ibrahim, MD, FAAD (: 47:42

Yeah, no, no. Exactly. Yeah.

Omer Ibrahim, MD, FAAD (: 48:00

Yep, so there are a couple. So one is alopecia areata, is, which is what Jada Pinkett Smith, think she's the one that says that she has I'm not convinced it's alopecia areata to be honest. It is she says I have alopecia, which just means hair loss. But alopecia areata is a non scarring autoimmune type of hair loss is found in 2 % of the American population. have it myself. It is one of those it's an autoimmune that's

Dr Sameena Rahman (: 48:21

And I mean I think what's problematic or complicated about the postpartum is there's so many like factors and variable variability not only about breastfeeding there's issues about lack of sleep you know are you getting enough nutrition are you are you under there's so much new stressors in your life relationship stressors like and the sleep factor how would you like those all obviously play into the equation

Omer Ibrahim, MD, FAAD (: 48:30

non-scarring, meaning your immune system attacks your hair follicles, leaves big round spots. Sometimes it takes out your hair from your scalp down. We call that alopecia universalis, from your scalp down to your toes. We call that alopecia universalis. And thankfully, within the last two years, we finally have medications that are FDA approved to treat this and they're oral medications and they, compared to what we had before, which was nothing really, they work relatively and actually very well to treat alopecia.

in the, these are the, the Jack inhibitors, yes, the biologics.

When it comes to autoimmune hair loss, and this is specific to peri and postmenopause, there is a specific type of hair loss called frontal fibrosing alopecia or FFA. This is an autoimmune hair loss that's almost exclusively found, classically I should say, found in the postmenopausal patient. It involves hair recession, hairline recession from here backwards. This is also a scarring alopecia and is very insidious.

I've had this for a year. You look at them, you're like, uh-uh. You've had this for at least a few years. This is where your hairline was. Because people don't notice a couple of millimeters of their hairline moving back until they look at a picture from 10 years ago. They notice that it's moved back two centimeters. And when it moves back, it replaces the hair with scar. So it's shiny, sort of skin, no hair follicles. We have zero clue what really

really causes it, we know hormones play a huge factor and we know that of course genetics play a huge factor as well. And there might be some environmental effects because they used to think that Botox causes it. They used to think that sunscreen causes it. All of these anecdotal reports and studies are very poorly designed, so you can't really take much away from it. But there might be something that we are doing to ourselves, either topically or ingesting, that

Dr Sameena Rahman (: 50:17

And what, and I guess depending on if they're deficient in something, you will recommend supplements, where, when they're not, or if it's like stress, you know, and that's the biggest thing, what are your go-tos in terms of helping them? Because I mean, obviously that's, de-stress is one thing, but are you gonna get that hair back from that loss that you had with the stress?

Omer Ibrahim, MD, FAAD (: 50:37

causing an increase in these different kinds of hair losses and autoimmune type of hair losses specifically the hormone driven ones like FFA. Yeah.

Omer Ibrahim, MD, FAAD (: 50:52

I have no clue. Wild Wild West. I'll be doing tests from my garage.

Omer Ibrahim, MD, FAAD (: 51:22

Absolutely, I appreciate it.

Omer Ibrahim, MD, FAAD (: 51:39

Well, thank you for having me. I absolutely loved it.

Dr Sameena Rahman (: 52:58

Wonderful. Are there any supplements out there that you particularly, I know you probably can't verbally endorse like certain brands that all my patients are on by the way, certain brands.

Dr Sameena Rahman (: 53:50

Yeah.

Dr Sameena Rahman (: 54:35

Well, that's great. I think, so, you know, that's a lot of the postpartum patients that I see. You know, I don't think I asked you what your background is. I'm South Asian. And so I see, you know, a lot in our South Asian community. you South Asian? you're Egyptian. Okay. I wasn't sure. Okay. But, you know, in the community, we do have like one in four South Asians have, you know, PCOS, right? There's a lot of underlying...

issues with, you know, and I think a lot of my patients are like, well, we're supposed to have the best hair because, you know, all the wigs come from India. But like, I feel like the PCOS factor comes into the equation a lot from some of my patients, not only because of like acne, facial hair, all that stuff, but really the hair loss is pretty dramatic for some of them. And so can you talk us through like how you approach PCOS if you see it in your office?

Dr Sameena Rahman (: 55:37

Yeah.

Dr Sameena Rahman (: 55:45

think I can't hear you as well anymore.

Dr Sameena Rahman (: 55:51

It might be my room, but okay. Yeah.

Dr Sameena Rahman (: 57:55

you

Dr Sameena Rahman (: 58:28

Yeah.

I think that's the challenge because treating the PCOS patients, I I feel like there's so much there when it comes to their, like, know, androgenic features that it's really hard sometimes to get it under control. And I think the hair thinning, like I can usually help them with the acne and the, you know, sometimes facial hair getting, you know, getting them to a good laser person to take care of that. But I think that thinning is what kind of literally, and then, and then a lot of them go on GLP ones and then they have the whole like.

Dr Sameena Rahman (: 59:06

you

Dr Sameena Rahman (: 59:37

Yeah, absolutely. And so, you those two areas I think are pretty much a lot of what I see other than the menopausal patients, right? The perimenopausal patients, which I think we should delve into too, because obviously, what is it? Is it like 50 % or something like that of perimenopausal? Yeah.

Dr Sameena Rahman (: 01:00:08

huge. So, you know, obviously everyone's looking for the youth serum, you know, isn't always estrogen, but I think that we do see...

that is probably multifactorial related to some of the hormonal shifts, but you're right, like a shit storm of stuff happening at once that causes all these problems for them. What kind of guidance do you give your patients who are in their midlife experiencing pretty significant hair loss? They're already kind of dealing with all these hormonal shifts and feel like they're going crazy on top of the fact that they're having painful sex, on top of the fact that they're dealing with this weight gain, this stubborn,

section fat that comes up. you know midlife women start feeling like crap very quickly and don't have a lot of confidence over time so you know I do my best to restore. What do you do to help them in that respect? what's your I mean not algorithm because I know it's so nuanced but like how do you look at it overall?

Dr Sameena Rahman (: 01:01:49

Yeah. Yeah.

Dr Sameena Rahman (: 01:03:39

Yeah, what are your thoughts on that? I was going to ask you about some of these procedures.

Dr Sameena Rahman (: 01:05:38

Alright.

Dr Sameena Rahman (: 01:05:43

Right. Yeah, they're hot right now. Yeah, yeah.

Dr Sameena Rahman (: 01:05:54

Thank

Dr Sameena Rahman (: 01:06:26

Wonderful. And where do you think, like we spoke a little bit offline about just hair transplants. Do you see a lot of women getting those? I've had some patients getting them and with some variable success.

Dr Sameena Rahman (: 01:06:52

Yeah. Yeah.

Dr Sameena Rahman (: 01:07:04

Hmm.

Dr Sameena Rahman (: 01:07:16

Sorry.

Dr Sameena Rahman (: 01:07:22

Yeah.

Dr Sameena Rahman (: 01:07:28

Next.

Dr Sameena Rahman (: 01:07:43

Yeah, that's true.

Yeah.

Yeah, absolutely. think that's what sometimes you don't get told when you're some these procedures. I was telling you, I was like, oh, I didn't know that.

Dr Sameena Rahman (: 01:08:05

Right.

Right, right. It's kind of like how people go into laser hair removal thinking that they'll never have to remove their hair again.

Dr Sameena Rahman (: 01:08:25

Are there any, because I remember a few years ago, because I used to like, you know, get a lot of laser reps come through my office. And so there was some laser that was being used like some sort of radio frequency device for hair thinning, I think.

Yeah.

Dr Sameena Rahman (: 01:08:52

It might have been ultrasound. I can't remember.

Dr Sameena Rahman (: 01:09:03

Yeah, that's what I

Dr Sameena Rahman (: 01:09:08

Right. Yeah,

Dr Sameena Rahman (: 01:09:18

Mm.

you

Dr Sameena Rahman (: 01:09:24

Yeah.

Dr Sameena Rahman (: 01:09:33

Right.

Dr Sameena Rahman (: 01:09:47

And even you have to be so vigilant about the number of procedures. It's not like a one and done usually, right? And what do you think is new on the horizon when it comes to hair restoration for women? The exosomes, obviously.

Dr Sameena Rahman (: 01:10:19

Yes.

Dr Sameena Rahman (: 01:11:01

you

Dr Sameena Rahman (: 01:11:06

Yeah.

Dr Sameena Rahman (: 01:11:12

Yeah.

Dr Sameena Rahman (: 01:11:26

Yeah. Right.

Dr Sameena Rahman (: 01:11:38

That's really cool and hopefully it actually work. It's kind of like when we collect cord, when I was doing OVNs to collect cord blood and people would store it hoping that they could use that cord blood for...

Dr Sameena Rahman (: 01:12:03

you

Dr Sameena Rahman (: 01:12:07

Great, okay, that's what I thought. Awesome. And so, what was my other question to you? I'm gonna ask you something that was on the tip of my tongue. See how I perimetaphyl, brain fogs. What was I gonna say?

Okay, we're talking about exosomes. think that I'll have to tell Kara to delete that part out because I'm trying to figure out. There was another question I had and I can't remember now. Do you do anything with any like vulvar skin conditions or do you just do like mainly?

Dr Sameena Rahman (: 01:12:45

really just niche up.

Dr Sameena Rahman (: 01:12:51

I think a lot of the preventative stuff is kind of like how people you know get 20 and 30 year olds to do like Botox to prevent like

Dr Sameena Rahman (: 01:13:05

Yeah.

Dr Sameena Rahman (: 01:13:27

Yeah, I agree with you actually. Because I think a lot of people are posting about their filler mishaps or, you know, the mishaps that happen with Botox.

Dr Sameena Rahman (: 01:13:43

Yeah. Yeah.

Dr Sameena Rahman (: 01:13:48

I agree. Do you do any of the face stuff too? Like the injectables? do.

Dr Sameena Rahman (: 01:13:59

What's your, and I think now with even fillers, like aren't there some other new agents that are being utilized instead of like more to be like foundationally like.

Dr Sameena Rahman (: 01:14:17

Yeah, that's what I was thinking. can't remember.

Dr Sameena Rahman (: 01:14:25

Dr Sameena Rahman (01:14:34.949)

Really?

Dr Sameena Rahman (: 01:14:39

I need to hear about this. Okay.

Dr Sameena Rahman (: 01:15:32

Yeah.

Dr Sameena Rahman (: 01:16:06

I've that too. Right.

Yeah.

Absolutely. And the PLLA is injected in the same place where you would do the derm fillers, right? Like in the nasolabial folds.

Dr Sameena Rahman (: 01:16:48

Do people do both in that respect? Yeah, okay. So you would do both and then fill the area.

Dr Sameena Rahman (: 01:16:59

Yay.

Dr Sameena Rahman (: 01:17:04

Yeah, because I imagine PLLA might be a little costly to.

Dr Sameena Rahman (: 01:17:20

that's filler. okay.

Yeah, okay, wonderful. Well, that's exciting news for people to listen to. Yeah, I think that's great actually. Yeah. But it's hard to keep up with it, you know, like when I was first starting out, I had just moved from LA and I actually learned how to do like facial botox and fillers like 15 years ago.

But it's like you have to, if you want to do aesthetics, you got to be like all in, keep up with, it can't be like a, know, so for me I was like, I'm just going to focus on the sex with menopause. But I feel like, you know, when I was initially learning it, I was very intrigued by it. But then I was like, if I'm not going to be doing this day in and day out, like you're not going to be good at it.

Dr Sameena Rahman (: 01:18:21

Yes.

Dr Sameena Rahman (: 01:18:29

Right.

Dr Sameena Rahman (: 01:18:35

Yes.

Dr Sameena Rahman (: 01:18:47

Exactly. Right.

Dr Sameena Rahman (: 01:19:01

Right. And it's, it is a skill. It's not only a skill, it's an art, I think, you know, like you really have to be able to visualize someone's face and think, I can see what, you know.

Dr Sameena Rahman (: 01:19:33

Well, I've seen your work. It looks like you're good at it, so I've checked out your website. So you'd have a new patient obviously. It's preventative. It's all preventative. There we go. All right. Well, thank you so much for being on. Is there anything else like, in terms of trying to find the right person, like I just said, like I think, you know, there are a lot of

pop-up clinics doing a lot of the stuff. But what kind of guidance would you give our listeners about how to find someone to really have a good understanding and a good skill set? Obviously, there might be years of experience involved, but what would you tell someone who's looking for someone that they wanted to help with rejuvenation and hair loss and all the things?

Dr Sameena Rahman (: 01:21:03

Yes.

Dr Sameena Rahman (: 01:21:51

Yeah. you know what? remember what I was going to ask. know, I have a now six-year-old girl, and sometimes we'll put her hair up into tight buns. But I remember at the lecture that you were talking about the traction hair loss. I mean, does that start at as young as her age? Really?

Dr Sameena Rahman (: 01:22:29

Yeah.

Dr Sameena Rahman (: 01:22:34

Yeah.

Dr Sameena Rahman (: 01:23:05

Dr Sameena Rahman (01:23:12.549)

Yeah. Just take it.

Dr Sameena Rahman (: 01:23:19

Right, and it hurts, like it hurts to get them placed in anyway, you know?

Dr Sameena Rahman (: 01:23:28

See, there you go. Cause it looks cute, but like not.

Dr Sameena Rahman (: 01:23:41

Mm-hmm.

Dr Sameena Rahman (: 01:24:02

Yeah, that was one of the points I wanted to make sure we talked about because I see that and so sometimes I'm like trying to push her hair up into a tight bun and then I'm like, no, abort, abort. Sorry. Abort mission. And then the other issue I wanted to just briefly mention is the ones related, like the hair loss related to autoimmune disease. Cause we see that, I think we've seen some, you know, actresses come forward with that. Can you address that briefly as well?

Dr Sameena Rahman (: 01:24:37

I think, yeah.

Dr Sameena Rahman (: 01:24:41

truck.

Dr Sameena Rahman (: 01:25:30

These are the biologics, like some biologists. Jack and Hibbender too.

Dr Sameena Rahman (: 01:27:15

Well, hopefully we can we get some more research in the next few years, but who knows what their new administration Yeah, exactly Yeah, exactly Anyway, thank you. I want to be a cognizant of your time and I appreciate you know dropping all your knowledge amazing

in the show notes we'll put in where everyone can come see you so you can have a flood of new patients to come. I appreciate you. And you know, hopefully we'll have you back on at some point to talk more about other things. But I love that you were able to tell us what's new and upcoming, because that's something I'm always getting asked about, but I always just like to know for my own selfish reasons.

Dr Sameena Rahman (: 01:28:11

Awesome. Well, thanks guys for joining us for another episode of Gyno Girl Presents Sex, Drugs, and Hormones. I'm Dr. Smeena Rahman. Remember, I'm here to educate so you can advocate for yourself. Join us next week for another episode. Yay.