Hair Transplants to Face

/by William Rassman, M.D./0 /

I am a 33yr old, health male, with no health problem. I am interested in getting facial hair augmentation. I am missing large clumps of hair which have never developed on my face, much like hair growth patterns seen I have seen in Asian men. I would like to complete the hair line from my sideburn to my chin and then up around to add to my mustache.

It is possible that you have either a late onset beard that you understand may still yet develop. It is also possible that your genetic pattern has produced this facial hair distribution. What does your family look like? Are there relatives with this beard pattern? Is there Asian genetics in your family line? The dilemma here is to differentiate genetics (most probable cause) from other causes. Before embarking on such a path there are a number of steps that you need to get done. These steps are:

  1. Establish a relationship with a doctor where mutual trust is established. The doctor must feel comfortable with your goals and expectations and they must be realistic from the doctor’s point of view. You must understand all of the risks and downsides of such a procedure.
  2. Get testosterone and DHT blood tests to determine hormonal issues related to the facial patterns of hair distribution.
  3. Get an assessment of the status of your eventual hair loss with a close examination of your scalp under high-powered magnification.
  4. Get a second opinion from an endocrinologist to determine if exogenous DHT is available and/or advisable.

First, of course, I would start with #1, then work with the doctor you selected and extend to the rest of the list. If I was the doctor and agreed that this is a procedure I would be willing to perform, then I might start by extending your sideburns down the face and if that met your needs, I would consider another more aggressive step. I would love to engage you with further dialogue.

For examples of transplanted sideburns, please take a look at:

Hair Regrowth After Waxing Scalp

/by William Rassman, M.D./3 /,

I recently had a minor accident with hair removal wax. Well to make a long story short, it ended up in my hair on my scalp. It has been five weeks and the regrowth has been pretty sparse and not at all in some areas. I was wondering what the chances are that it will still grow back, and if not what I can do about it. thanks

Wax only removes the hair shaft, not the entire root. Thus, your hair should grow back. It may take up to a few months for hair regrowth unless there is more to the story which I am not understanding.

Hair Loss After Brow Lift

/by William Rassman, M.D./3 /,

I really appreciate your informative and straight-forward approach to our hair concerns.

I have had a brow lift a little over a month ago. While the surgery was for the most part very successful, I was not prepared for the hair loss that preceeded it. I was told by the surgeon that my hairline would actually be lower afterwards. That was NOT the case.

The hair loss is along the incision line. It is more “loss” than just thinning. I was told not to worry that it would grow back.

My questions are:

1. What is the chances that the hair will return?
2. Would Propecia help?
3. About how long does the scalp normally stay numb?
4. How long should I wait to see regrowth before having hair restoration to correct it?
5. After hair restoration, how long will it be before I can do strenuous exercise and swim?

Thank you

There is a good chance that some or all of the hair will return, but brow lift scars are often detectable due to some widening of the scar when the incision was done behind the hairline and hair loss risks when the incision is done in front of the hairline to lower it. Sometimes during the type of procedure you had, the blood flow to the hair follicles can be interrupted resulting in a temporary loss. Occasionally it is permanent, but in most cases you should be able to see some regrowth within 3-6 months. Most doctors will wait up to a year before giving up on seeing some growth return, and that is about the time you can consider a hair transplant surgeon to correct it if needed.

As for your other questions, if you had a hair restoration procedure, you would need to wait a week before resuming very strenuous exercise and you’d need to wait until the wound has completely healed before swimming. Propecia is a DHT blocker which prevents male pattern/genetic hair loss and it is not proven safe for women, so it will not help. The scalp numbness does not usually last more than a year (often weeks or month and is rarely permanent). Finally, time is really the most important commodity for you to evaluate your loss/regrowth. Wait for the regrowth and follow-up frequently with your surgeon.

Of interest, this complication is the most common reason women get hair transplantation (at least in our hair restoration practice), which does not reflect its incidence (of let’s say in 100 women with brow lifts), but it does tell you that it is not an uncommon problem.

Ervamatin

/by William Rassman, M.D./127 /,

I’ve been seeing lots of ads of Ervamatin. As a person who is not allowed to use finasteride due to liver problems, is it safe to use Ervamatin? It’s made by Amazon Health Care.

I have done some extensive research on this herbal medication. I am not convinced about this drug until I see more concrete medical data. Finasteride was first discovered in South America in a plant extract by a group of primatives who normally ate large amounts of it in their diet. They had children that were hermaphrodites, as the pregnant mothers ate the extract in their daily diets at very high concentrations. I must warn you about herbal medications, because some of them can be toxic to your liver as well.

Prescribing Avodart for Hair Loss

/by William Rassman, M.D./0 /

Dear Sir:
Thank for writing your informative blog. I find it very useful. I am a 34 year old physician; I have been on Propecia for 3 years and am pleased with the results. In preparation for the future, for when Propecia might stop working, are there any doctors you might recommend who feel comfortable prescribing Avodart for off label use in treating male pattern baldness. From reading your posts, I am assuming it is unlikely that Glaxo Smith Kline will see enough of a profit margin in Avodart in investing in a controlled trial to get FDA approval for avodart to be used for male pattern baldness.

Thank You in Advance for your response

Prescribing this drug for off-label use is not an issue if the patient is well informed about the risks and has read much of what I have written on these pages. I believe, like you, that it is unlikely that Glaxo Smith Kline will see enough of a profit margin in Avodart by investing in a controlled trial to get FDA approval for treating male pattern baldness. You sound well informed.

Transplanting the Crown

/by William Rassman, M.D./0 /,

Greetings,
After seeing Steve Hartman of CBS/AM570 in person I am amazed at the process of his hair restoration. My situation is the typical male pattern baldness on the top and back of my head, not the front. How do you handle that?

Steve Hartman’s hair transplant procedure is what I like to refer to as the fast-track approach. With his situation, one surgery did the job he needed and if he stays on Propecia, hopefully he has seen the end of any more than this one surgery. For transplanting the crown, I have general reservations in the very young men (under 30) unless there is very good donor hair density and good laxity (looseness) of the scalp in the back of the head. Other elements of the supply/demand formulae must also be accounted for and those men with good quality hair and skin color tend to do better than those without either when the hair must be distribued to cover a wide balding crown. I am always worried that the crown will take all of the donor hair and when the front balds, then the patient may run out of donor hair. There are many times, however, that crown transplants are appropriate. In those men over 35 (for example) with a 3 Vertex balding pattern (frontal corners and crown only balding) or those with pure crown (vertex) balding in people like me. I had 1600 grafts into the crown and my frontal hairline is normal without any balding. I use Propecia to maintain any further hair loss and I have been stable for years since my transplants were done in the late 1990s.

Propecia is the mainstay for hair restoration in the top and crown (particularly for the younger men whose final pattern is not predictable), so you should first get assessed for miniaturization and then go on that drug if appropriate. Transplants rarely will be needed if you catch the top and crown loss early enough.

Aminexil, Propecia and Erectile Dysfunction (ED)

/by William Rassman, M.D./4 /,

Hi doctor, A doctor in france suggested to me to use Aminexil SP94(by Kerastase) capsules (commercial name:”Vichy Dercos”) applied on the crown area and the shaded are of the head directly. I noticed from many people’s feedback in France that dermatologists there recommands to apply Aminexil as a safe alternative to propercia since it doesnot have any sexual side effects,and that Aminexil actually stops the thining of the hair caused by dihydrotestesterone ( it does not stops DHT like propecia), rather it thickens the hair follicle which becomes resistive to DHT. What do you recommand doctor i need please your advice please(ie: I used propecia from several weeks and i have serious sexual problems). Thanks A lot

I looked up Aminexil and found that it is basically a minoxidil compound with the type of results that minoxidil gives. The question of course becomes, “Is it better than minoxidil by itself?” I would think that no one really knows the answer to that question, because they may not want to know. The general thought about minoxidil is that it may impact the length of the hair cycle by increasing it, amongst other benefits. That would add more hair, as less hair would be in the catogen phase and more hair in the anogen phase at any one time.

With regard to sexual side effects from Propecia, they are very rare (less than 1%) and much of it may be the power of suggestion as we men are very sensitive to anything that MAY impact the performance of our penis. It is great to blame Propecia for erectile dysfunction (ED), when in actuality it may not be the Propecia, but rather psychological or relationship issues associated with social issues that occur. That is clearly not always the case, but I suspect that it is mostly what is being reported on the sexual erectile dysfunction (ED) issue.

Higher Strength Minoxidil?

/by William Rassman, M.D./0 /,

Dr. Rassman,

My hairline continues to retreat. I have been using Propecia and Minoxidil 5% for more than 6 years with some success. What do think about using additional topicals such as Spironolactone 5% and higher strength Minoxidil? Have these topicals proven to be worthwhile? Should I just accept the continued loss of my hairline?

Thanks

There are mixed feelings about higher doses of minoxidil, mostly positive providing that the skin irritation and other side effects do not increase significantly. As you may know, minoxidil can drop your blood pressure and make you light headed and it is a skin irritant. Be sure that the side effects do not become a problem.

With regard to Spironolactones, see my previous blog answers here: Spironolactones

Systemic Lupus Erythematosus and Hair Loss

/by William Rassman, M.D./0 /,

Several years I had hair loss patch the size of Half dollar and my two end finger nails were lines and pecked. I was diagonosed as having alopecia areata. Treatment w/ cortisone shots did not help. in last year or so I developed more of these loss of hair and sometimes it itches. I had biopsy done and the results “the findings are suggestive of (but not diagonostic for) collagen vascular disease such as lupus erythemaous. The blood test shows that I’m negative for Lupus. What is the outlook in terms of medication, regrowth and outlook? Is there any thing to grow hair? will a transplant work?

Sometime blood tests for SLE (Systemic Lupus Erythematosus) are not completely accurate. I recommended that you visit a rheumatologist to further your evaluation process. SLE is one of the many causes for hair loss. Hair can regrow if your cause is due to SLE or any reversible disease that arrests and then subsides. Some people will have lost their hair permanently, even if the disease goes away. Hair transplantation will not work if you have an active disease causing the hair loss, but if the disease is known and is not active, then a hair transplant will work, that is, unless it gets reactivated. Again, it is best to see a rheumatologist and a perhaps even a good dermatologist who focuses upon such problems.

Zelnorm, Birth Control, Diet and Hair Loss in Teenage Female

/by William Rassman, M.D./0 /,

i am 19 years old / female. when i was younger, in my middle teen years i had thick, thick hair, now its so thin. whenever i take a shower i lose so much hair its ridiculous. i’ve been using mousse for my hair for a long time. i started really using it when i was about 14-15 years old, but now i use it frequently in my hair but i never put in on my scalp. i always put it in the middle to the ends of my hair. i colored my hair once and that was when i was 15-16 yrs. old, and i’ve been smoking marijuana for about 2-3 years, but not every day. i also started two new pills, one is a birth control pill levora. i’ve been taking that for a year and the other the one is zelnorm. ive been taking that for 4 months now. my question is what could be the cause of this? my mother has noticed my hair loss, and i’m scared i could go bald at a young age. i’ve lost so much hair in the past year or two. could what i’m doing or taking be the cause or what????

Birth control pill could potentially cause hair loss. However, Zelnorm does not directly cause hair loss. Zelnorm is for (Irritable Bowel Syndrome) IBS with constipation symptoms. Patients with IBS may have a nutrient deficiency leading to hair loss, so a focus upon your diet may be appropriate. There are many causes for female hair loss. I recommend that you visit your physician for blood work to rule out anemia and hypothyroidism, which could also potentially cause hair loss. The general causes for hair loss are hypothyroidism, alopecia areata, androgenic alopecia, repeatedly over plucking, eyebrows lifting, trichotillomania, stress, chemotherapy, radiation, eczema, seborrhea, scleroderma, lupus, hormonal imbalance, psoriasis, parasites, fungal, autoimmune disorders, poor diet, poor nutrients, burn, trauma, leprosy, and drugs. The common medications which may cause hair loss are beta-blocker, coumadin, oral contraceptive pill, antibiotics and chemo-medications.

Genetic hair loss starts in some women as early as 17-19 years of age. You need a complete examination for miniaturization to make the diagnosis, one way or the other. Get a good hair doctor, as that is critical for you to have a better understanding of what is happening to you.

Removing a Widow’s Peak

/by William Rassman, M.D./2 /

Hello Dr. Rassman,

I am a 22 year old male with a widows’ peak that I would like removed. I also have bad acne if you take care of that at all. Please let me know costs, etc…

Thanks

Removing a widow’s peak is not easy and has side effects which include scarring, depigmentation, pitting, etc. That of course, depends upon the mechanism that you chose to remove the widow’s peak. FUE works, but may leave small depigmented areas, just like electrolysis might do. Laser hair removal may work but also runs the risk of depigmentation and the failure rates with laser hair removal and electrolysis is higher than 50% per hair treated.

With regard to acne, you need to see a good dermatologist. Costs are not appropriate to discuss at this time, because there is much to do to determine if you are a candidate for any of the treatments I discussed above. At 22, I am concerned about a focus to remove a widow’s peak.

Compassion for Balding Men

/by William Rassman, M.D./0 /

I am down right angry about everyone targeting balding men as the butt of jokes. People do not understand that behind every bald man, is a feeling sensitive man and I wish that people will stop jabbing at us.

In this week’s issue of The New Yorker magazine (January 9, 2006; pages 43-48), there is an excellent article about hair loss titled “The Power of Hair”, by Burkhard Bilger. There is a great quote in the article from an anonymous source that says, “The man who isn’t bald never thinks about baldness. The man who is losing hair never thinks about anything else.” It is full of wonderful stories about balding looking backward in time, and looking forward to genetic cures, cloning, and some of the recent work done on an experimental basis. The article is worth reading, concluding from a patient who had a hair transplant, “Having hair on your head, you feel like you’re still young. You feel like you’re alive. Nobody wants to look old, man. Nobody want to look old.”

Removing Transplanted Hair

/by William Rassman, M.D./0 /, ,

Dear Dr. Rassman,
I am 22 years old and had a hair transplant last year when I was 21. Unfortunately, I am quickly thinning everywhere that I did not get the transplant and I am very dissapointed with the way I look. I wish I hadn’t jumped to this descision and had just accepted being bald. I read your articles on FUE’s to revise the scars on the back of the head. Is using laser hair removal as well as laser resurfacing practical for removing the hair and fixing the scars where the transplants were placed? Please respond as this issue is extremely troubling to me. Thanks.

At 22 years old, it is easy to sell ourselves on a solution that seems easy. I always tell people that hair transplants are permanent and that is the good and bad news. For you in your present situation, it sounds like bad news. You may compound your situation, making it worse with things like laser hair removal, trying to undo the transplant with FUE and the like. Some of these things, depending our your specific situation, may work. FUE can take out the grafts, but it may not fix any skin dimpling you might have or wipe out the scar if you plan on shaving your head. Skin resurfacing sounds great, but it changes the texture of your skin, possibly making it worse than where you are now. You should see a real expert and with good guidance and good medication (like Propecia), you might want to consider another hair transplant (this time with a Master Plan) as an option to doing it right this time. Just how bald you will become is critical for the plan you need to make. I would personally love to work with you, as I have three sons in their 20s and early 30s and I seem to understand men of your age. Just be careful and do not make another bad decision without every piece of information you can put together in hand, and this time command what you learn. As I’ve said before, you are in the driver’s seat, so drive carefully.