Your hair loss questions, answered daily.

 

I had an FUE transplant of 1000 grafts to my hairline 4.5 weeks ago. I’m a 40-year-old man and up until now, I’ve never had sensitive skin or allergies. Most of the scabs fell off two weeks following the procedure, but some scabs remained into the third week. The scabs that did stay then developed into red shiny scar-like tissue with some whiteheads. I reported it to the specialist over the phone and via email, but cannot visit as it was not a local clinic.

At first they advised me that it was not a major concern and instructed me to apply a Heparin cream to the affected areas. At that time, most of of the transplanted hairs were still there. A few days later, I sent photos to the specialist as the inflammation had not changed and they told me to continue with the Heparin. Into the fourth week, when the situation had still not changed and a significant amount of the transplants had fallen out, they referred me to a local dermatologist. She looked at it and didn’t know what to suggest as she has little knowledge of transplants, but she did advise me to switch shampoos, from a general over-the-counter baby shampoo to one that she was more neutral.

Today, they advised me to begin applying an antibiotic steroid cream (flumetazone[?] and neomycin). Three days ago a lot of the transplants fell out.

At this point, I don’t entirely trust their opinion anymore and I’m hesitant about the steroid cream, though I did apply it today. I’m extremely worried that this is going to be a failed transplant and suspect I’ll have to do it again.

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You need a good evaluation and examination of your scalp by a doctor so you can get a diagnosis of what is going on. It is unfortunate you do not trust the surgeons who you paid thousands of dollars for your surgery.

The best advice is seek a local doctor who will see you and examine you. Your family doctor should be able to make an ‘infection diagnosis’ if that is a concern. I do not diagnose or give personal surgical advice on Baldingblog.

In general inflammation can be a sign of infection and you should get this confirmed before you treat the issue.

 

I’ve been tempted to try Propecia for a while now (to reverse my Norwood 2 hair loss) but I’m concerned about the side-effects such as erectile dysfunction.

Are there any natural supplements you can recommend? I’ve tried TRX2 and it was completely ineffective. It absolutely nothing for me.

HR23+ is a supplement that comes with good reviews and really good ingredients for hair. Even though it’s classified as a hair health supplement, do you think it can help with my balding?

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First and foremost you need a correct diagnosis of your hair loss. Second you need to see a doctor and understand treatment options available. Third Propecia does not usually work for frontal hair line loss and it does not usually reverse corner hair loss either. If you are demonstrating the appearance of a maturing hair line, even Propecia will not impact it that is why seeing a doctor is so important. Finally natural supplements or Internet advertised products do not work clinically from what I’ve seen. It does work well on decreasing the bulk of your wallet. You can always try it but I really cannot endorse any products here.

 

The idea was to put hair ends into the scalp with the machine that is illustrated in the article. Very interest and of course, it did not work.

http://paleofuture.gizmodo.com/the-first-hair-plug-machine-looks-absolutely-horrifying-1688228821

hair transplant

 

I’m 48 years old. I was on 1 mg per day of finasteride for some 13 years, with no loss of hair over this period. Last year, I perceived a reduction in libido, and consulted my prescribing doctor. Together we agreed that I would try a lower dose (0.25 mg) to see if my side effects subsided. It has now been 7 months since I started the new dose. My libido is comfortable for me, and I don’t believe that I have lost any hair. My question is, if I’m going to see any ‘catch up ‘ hair loss associated with a dose reduction, in your experience, within what time frame does this normally occur?

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Propecia is a great drug (the only FDA approved oral drug) that really works for male pattern balding. But it doesn’t always completely stop the balding process. Your genetic predisposition will eventually win out. Some men do have great long term effects. The sexual side effect of libido or erection associated with Propecia is about 1 to 2 percent and after 10+ years of use it’s hard to imagine that one might start having the side effects of the drug after 10 years. (But it is possible) More probable is that men in their late 40’s would likely have issues with libido and erection due to their age. This is something that must be sorted out between you and your doctor. I am not disagreeing with your course of action as you are under the care of your doctor.

The short answer to your question is that catch up hair loss usually happens with in the first 6 months. It has been reported that a lower than the recommended 1mg dose of finasteride is still effective for the treatment of male pattern balding and the low dose may be working in your case. You really won’t know the subtle changes unless you have a metric to document the changes (such as a miniaturization test or bulk studies).

 

You say that the earlier in life the balding process begins, the likelihood the sufferer will lose a lot of hair, but you also say that if a man has not started balding in to a norwood 6 – 7 type by the end of his 20s, then it is unlikely that his hair will degenerate to such a pattern. My brother has a norwood 3 vertex pattern and is 31. I know you can’t know for sure, or predict the future, but does that at least make it *unlikely* that he will advance to a 6 – 7 type, or can we expect the process to continue. As far as I am aware, he hit the vertex point at around 27. The balding process seems to have slowed or even stopped for some time.

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You are right! I am not a fortune teller and I cannot predict the future. Thus, I cannot predict your brothers hair loss pattern. Especially without even an exam. With that said, we can predict the hair loss in a person once they have started the hair loss process, even if one can’t see it with the naked eye. This includes the young men who are worried about hair loss because of their family pattern. We can determine the hair bulk in different parts of the scalp and any significant hair loss, even the hair loss that can not be seen, can be measured with this instrument. We call this test a hair bulk analysis.

You are also correct in that most men have a certain Norwood pattern that they fall into where a Norwood 3 don’t suddenly morph into a Norwood 6.

 

Is it possible to START prematurely balding at the age of say, 17,18,19,20 or below the age of 25/30 if there is no family history of STARTING balding below the age of 35? Also, does hairline maturing occur at a similar time frame as predecessors or does it have it’s own time frame?

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Genetic male pattern balding may start with puberty. You may be well on the way to being bald in your teenage years or in your 20s or 30s. Anything is possible. In general most significant genetic hair loss occurs in your 20s and 30s and usually the balding process slows down past 35.

You don’t have to have a “family history” because it does not completely follow a direct and predictable inheritance pattern.

 

If someone in his twenty’s heading towards norwood 6 and you know he don’t have sufficient donor hair, and more add to it the patient don’t want scalp micropigmentation. in this case would you advice him to transplant in front and use wigs to hide the balding behind? assuming the patient is non-responder to medication.

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Everyone’s goals and expectations are different so my answer is a generalization. If you look at many before after photos on my website many Norwood 6 or 7 patients have received great results. It may not always be covering their full head but it is always a cosmetic worthwhile difference for them. If you do not have sufficient donor hair to cover the entire head then you can focus on the front hair line for a non-balding “frame” to your face and accept you will be bald on the back crown area. If this not acceptable then you can choose to wear a wig on the top as some of my patients have. If none of this is acceptable, then you should not have surgery. The key is understanding what is possible and forming a long term Master Plan with you and the doctor.

Today, many patients are taking another step, the step to have Scalp Micropigmentation (http://scalpmicropigment.com/) and they elect to shave their head and have the appearance of a full head of hair. With a shaved head, scalp micropigmentation can give a Class 7 bald man the appears he had if he shaved his head when he was 16.

 

Hi Dr.Rassman,
I’d be very grateful if you could reply to the following questions:

1. How do the technicians slivering the donor strip record the Follicular Units. Is this done as a running total on a sheet of paper for type 1, 2, 3 units? Is the total of these units then recorded?

2. How do the placers, placing the Follicular Units record the Incisions created. Is this similar to Q.1 above.

3. Is it true that each incision site created can only contain ONE Follicular Unit graft? Otherwise, more than one would be compressed, traumatized and die??

4.If the Incision count is LESS than the Grafts extracted from the donor strip, what would that indicate.

5. What would increase a hair transplant procedure between 2 patients having the same amount of grafts transplanted and the same number of medical staff in attendance? For example, if one of the patients had blond hair, would it be more difficult to see such grafts under a stereomicroscope?

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I often get these type of questions asked in different ways. It is a very good question that also can be seen as a trust between doctor and patient. In other words, how do you know if you are receiving the number of grafts agreed up on (which relates to how much you paid for).

It is also a great question merely from purely a technical point of view of how one keeps track of thousands of grafts and incisions on one’s head.

I cannot speak for all the hair transplant doctors in the world as there is no standardization on how one keeps track of grafts. I will try to explain your question from a general perspective as well as what I personally have been doing in my practice for the last 23+ years.

1. Our staff keeps track of each graft dissected on a paper as they cut about 25 to 50 grafts at a time. They record and sort out single hair to multiple hair grafts individually as they dissect the grafts. A team leader then double checks the numbers as the day progress and add up the total number of grafts on a master sheet. Finally when all the grafts are dissected, another accounting in made on a computer Excel spread sheet. Usually we double check numbers with another staff individually adding up the numbers separately.

2. The placers do not keep track of the grafts being placed. Instead the doctor keeps track of how many incisions were made. If there was 1000 grafts cut, the doctor makes 1000 incisions and the placers have to find individual incisions to place the grafts. It sounds tedious and difficult but that is why the experience of a good staff and the reputation of a medical practice is important. This is one of the critical steps in the hair transplant surgery where this task need to be completed as fast and most efficiently as possible to accomplish a successful surgery. Longer this takes, your hair grafts may not grow to its full potential as it is kept out of your body and handled by an inexperienced staff trying to find the incision.

3. One incision usually has one graft. Sometimes where there is an over abundance of single grafts, the doctor instructs the staff to place two single hair grafts in one incision (or one single hair and one double hair grafts in the incision). If the staff is experienced there should be no issue with compression (we call it “piggybacking”) and trauma to the grafts. If the staff is inexperienced they may inadvertently place on graft on top of one another and cause trauma and poor growth. If the doctor is planning on “doubling” grafts he appropriately makes less incisions than the grafts that are being cut. He also makes the incision differently with a different needle to indicate to the staff where the double grafts should go. This a very subtle thing that has huge implications and requires a very well trained staff.

4. If the incision count is less than the grafts extracted, then more incisions have to be made. Or if the grafts are less than the incisions made then more grafts have to be harvested or you have to leave the incisions empty. Another subtle thing that takes coordination between staff and doctor.

5. Every patient is different even when the same number of grafts are planned (even with same colored hairs). In general curly hair and white hair is more challenging. Some patients have different textured scalp which cause the grafts to “pop” out and not stay in its place.

 

I have had several transplants over the years and have lost about 30-40% of them due to thyroid related conditions. My main concern is if this continues will the transplant scars at the back of my head become visible. Some of the pictures posted on your blog shows promising ways of disguising these scars using SMP. Is this a one-time procedure or something that has to regularly undertaken?

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NHI_SMP_to scar

NHI_SMP_to scar

The photo here is an example of what is possible with SMP on hair transplant scars.
SMP is generally a one time procedure and the longevity is similar to any tattoo. As with any tattoo you may want to have it touched up after several years.
If you would like more information, you can always give us a call to speak to our

 

I am 24 years old and now have advanced my balding to include the front and the crown. I don’t want to be bald like my dad who is probably has a Class 6 pattern of balding. He said he got most of it when by the time he was 35. What if I started taking Propecia when I was 18, would that have preserved my hair?

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That is a great question. Most advanced balding pattern patients have their pattern established in their 20s. Despite that almost 20 years that Propecia has been on the market, we really do not know if the progression could have been stopped had you taken the drug when you were 18. There would have had to be controlled clinical trials where one group who had advanced balding in their families were put on Propecia and the other group not. In that situation, we would know the answer to your question, but no such study has ever been done.

I suspect, however, that had you taken the medication when you were 18, you would have slowed down the progression of the balding and most of such young men in the 18 year old bracket, would not develop their final balding pattern for many years. i doubt that the final pattern would have been thwarted, but for such men, delaying into their 30s could give them the benefits for possibly another decade of so. We will probably never really know the answer, but for many men who I placed on finasteride (Propecia) I have seen the process slow, stop or occasionally reverse. Better to do it than not to take the drug if you are one of these 18 year old men. At 24, it can’t hurt and probably will help.

 

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