Using Concealers After Hair Transplant

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

A few of us on a HT site have been debating if there are any adverse effects to the scalp when using concealers such as Dermatch, Courvre, Toppik. Personally, I have used Dermatch and have not experienced any accelerated hair loss. What do you recommend to your patients, and how long after a HT is it safe to use one.

Thanks for this great site, I just found.

Many hair transplant patients use a hair piece after their surgery or agents that cover the scalp with a powder or paint type of product such as Dermatch, Courvre, or Toppik. We usually recommend waiting 5 to 7 days post surgery to start wearing hair pieces or using concealers. I generally like to see the ‘scabs’ gone before the use of Dermatch, Courvre, Toppik, etc, because the grains of powder can lodge below the scab and become an irritant. After a week, when the individual hair follicles have taken hold in the scalp, these agents can be used as needed.

Hair Transplantation in Women

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

Hello,

First of all, I wanted to thank you for this informative blog. I thought I was the only woman going through hair loss. But here I have found I am not alone.

I have always had very fine and thin hair. I never really had a lot of hair, but I had enough that I didn’t notice it thinning. That was until I was 20 years old when my hair started to fall out. It would fall out a lot when I showered or combed it. So, it go to the point where I was afaid of even touching my hair. I went to the doctor and they ran some tests and I was told that it was a hormone imbalance and I was put on birth control to correct this. My hair stopped falling out and I didn’t notice it for the next five years.

That is until last year when I started noticing that I could see my scalp more. And I would have to make a consious effort of styling my hair so that it didn’t look too thin. I went to my doctor (a new one since 2000) and she ran tests. She said there was nothing she could do, but told me to take iron pills (since my iron was a little low) and to use Rogaine. I have been doing this for 6 months and I have realized that my hair is thinning out a lot more. As you can imagine this has seriously depressed me. Especially with our socity’s obsession with big hair on women.

My question, is there something else I should try besides Rogaine? I will be scheduling another appointment with my doctor and maybe see a dermetologist. However, I have started looking into hair transplants. But my question is, how does the new transplanted hair not start to fall of just like the old hair? And why do some women’s hair never thin out? My mom has a full set of hair at 56 yrs old and my dad is balding, but that started more when he went through chemo.

I will be going to my doctor to discuss my hair loss. Can you please let me know what tests should be run and what questions I should ask? The first time I went, I was a novice and was told to just use Rogaine & take iron pills. But since then I have tried to become more informed.

Sorry for rambling!

Beware of hair transplant doctors who specialize in female hair loss and transplanting many women. The truth is, female hair loss is complex and is very difficult to treat with a hair transplant. Although we do perform hair transplants on women, in all honesty we turn down many women because most are poor candidates for transplantation. What makes them poor candidates is that the rich donor supply area we find in men is heavily miniaturized in most women with female genetic hair loss. That means that a transplant will move ‘sickly’ hair from the back of the head to where it is needed. If miniaturization is 80% in the ‘donor area’ (the area where the hair is taken from), that means that 80% of the hair that is moved is of a poor quality and in the transplant only 20% of the hair has good value.

Minoxidil (Rogaine for Women) may work, but more importantly, you are also doing the right thing by seeing a dermatologist. A good dermatologist can check your blood work or check the health of your hair under a microscope to map your hair loss for miniaturization. If that leads you to a dead end, you can make an appointment with a good hair transplant doctor, but keep in mind what I said at the beginning of this answer. Most women just do not have good donor hair, so a good doctor knows this and does not recommend surgery just to make a buck. As you indicated that you are in the Los Angeles area, I would like to invite you to setup a free consultation with me at my LA office. You can call 800-NEW-HAIR or request a consultation online.

Thank you for the compliments on the site and good luck.

Excessive Shedding with Propecia

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

I started taking propecia 3 weeks ago but i’m still seeing excessive shedding. I think i am losing more than 200 hairs a day. I think i have lost around 50% of hair density in 1 year. Strange thing is if i lightly pull on my hair in “usually non balding areas” (near the ears, or back of neck) hair
is coming out massively. Today from those areas i probably pulled out 200 hairs (they come out with the white part at the end). Can this mean my hair loss is medical (since traditionally non balding areas are losing the most hair) I am 23. Thanks.

Some people have reported increased shedding after starting Propecia. One medical explanation for this reflects accelerated hair cycling. Hair goes into various phases, producing growth (anagen) or regression (catagen). If cycling is accelerated to bring in more anagen hairs, then regression may be seen to cycle into more anagen hairs. You must stay on the course you have started on. This accelerated cycling may last 3-4 months (rare) but if you do not keep to the pill regimen, then you will lose the value of what you started. Alternatively, you could be going through an accelerated cycling from the balding process. In either case, stay the course. For information on hair cycling, see DermNet NZ.

Hair Shedding for Past 2 Months — Should I Get Transplants?

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

I’m 33 and my hairline has been slowly receding over the last 10 years. By slowly, I mean very slowly. I never even gave it much thought until about a year ago. Within the last 2 months, my hair started shedding without any real reason. I went to my doctor to make sure there wasn’t any serious issue causing the hair loss and all my tests came out negative.

I don’t want to lose my hair and am now considering hair transplants. My question is: when should I get them? Do I need to wait until I’m bald?

First, I would ask if you have been losing hair for a long time and just noticed it. That would be evident if you already have one of the balding patterns (see Norwood Classes). If you are considering hair transplants because of one of these patterns, you should set an appointment with a hair transplant doctor for a formal consultation to map your hair loss for a href=”https://baldingblog.com/2006/02/07/hair-mapping-for-miniaturization/”>miniaturization to find out if you have male pattern balding. There may be other options that your doctor may recommend, such as taking a medication called Propecia (finasteride). You do not need to wait until you are bald to start this medication and if you have early hair loss, then this drug may reverse it. Not using Propecia would be similar to waiting for a heart attack before you start doing something about coronary artery disease. Perhaps not as drastic, but you get the idea. Then again, I am often surprised that hair loss can sometimes be a life and death matter to some people.

A hair transplant should not be your first option. Get a diagnosis first, determine if the hair loss is reversible with a drug like Propecia and then if the hair loss is cosmetically a problem and does not respond to Propecia or if the hair loss has gone too far, then and only then should a transplant be considered.

Is Brittle, Dry Hair a Condition of Genetic Hair Loss in Women?

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

Hi I read the post about tamoxifen and hair loss. I’ve been on it almost 4 years and over time my hair has become dry, brittle, and thin. It seems to be noticeable only to me. My fingernails are also cracked and flaky. (I’ve read about many many other women having this problem on tamoxifen). Some women seem to have improvement when they go off tamoxifen and/or switch over to one of the newer hormonal therapies like Arimidex or Femara. But in your opinion, is this side effect just an exacerbation of a genetic condition (no females in my family have thinned hair) or potentially the result of some undiscovered effect of the drug, like impaired thyroid function? (I’ve heard that tamoxifen may heighten the body’s level of retinoic acid?) Thanks for any help.

You seem to be well aware. Many drugs, such as Tamoxifen, can cause hair loss or even change hair/skin conditions. Judging from your limited history (and without the benefit of seeing you in person), it is difficult to judge the exact nature of your hair loss/ condition. You should be evaluated by a qualified dermatogist or internist/family doctor for a full medical work up.

What Questions Should I Ask My Doctor?

/by William Rassman, M.D./1 /,

I’m african american, cherokee, and chickasaw indian and i’ve been natural since 2001. The last perm I had before that wasn’t rinsed well and left on my scalp. I went home and washed it. I thought everything was fine until 2003 when I noticed hair loss and gradual thinning from ends to root but growing length hasn’t been a problem. I’ve taken blood tests and found everything to be normal though the hemoglobin was 11.3 and b-12 374pg. Now the hair near my scalp looks as though it will disappear any minute now. I’ll be seeing a different dermatologist soon. How will i know what questions to ask to be aware that the doctor is being thorough? Please help.

It would be unlikely that anything left on your hair from two years earlier would be responsible for your present hair loss. A good doctor will lead the questions and get responses from you. The doctor will know what to ask of you, what tests to perform on you, and what to examine. That is your doctor’s job, not yours. Reading what is on this blog (see Female Hair Loss category) will give you insights into what you may experience with your doctor and what other women’s questions were. See what makes sense to you and then you can ask these questions of your doctor if you feel that he/she may need more guidance.

FUE After Strip Procedure

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

You mentioned, “If you have already had a strip procedure, it would be less expensive to do it with another strip procedure. An FUE procedure will work as well, but at twice the cost.”

Does this mean that once you’ve already had one strip procedure there’s no compelling logical reason to move to FUE since you’ve already got a scar from the first procedure? Or is there a chance that having a second strip procedure could make the first scar more noticeable or do more damage to the donor area?

Thanks

The beauty of the FUE / FOX Procedure is the fact that there is no linear scarring or the stigmata of a hair transplant scar (the linear scar in the back of the head). The scar that occurs after a traditional strip surgery rarely exceeds 2-4 mm in height, and such a scar is easily covered by the hair in the donor area.

You are correct, that the downfall of the FUE/ FOX Procedure is that it costs twice that of a traditional strip procedure, and the number of hairs transplanted in one session is usually much less . The FUE procedure has time and labor constraints involved. Thus, if there are no compelling contraindications to not have the same procedure, the advice was do the same procedure for your next hair transplant procedure.

FUE is not necessarily better just because it is new. It has its indications and specific benefits. Scarring risks do rise with additional surgeries, but very minimally. If a scar is present, then it can be addressed easily for most people.

I Can’t Visit A Specialist — How Do I Know If I Am Balding?

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

Dear Dr. Rassman
It is not possible for me to visit a specialist to have my hair mapped for minaturization, but would like to know if I am balding. I am 32 years old and over the last 4 months have noticed about 20-30 hairs on my hands everytime I wash my hair (every other day), although there is rarely any hair on my pillow. This is something new to me and I would like to know if this hair loss is temporary. I have thick hair, and for this reason, about 1 year ago I had a hair cut to really make my hair actually thinner to achieve the style I wanted. Is is possible that the hairs that were not cut, have reached then end of there growth cycle and are falling out? I am asking this because most of the hairs on my hands after washing are the longest hairs on my head, namely the ones at the front. If so when can I expect this cycle to stop?

Also I notice a few red spots and dryness on my scalp. Can this be related to the hair loss?
Thanks for any help

I am sorry to say, but at 32 years old you should be able to find the means to visit a specialist if you are serious about wanting to do something for your hair loss. Are you unable or unwilling to take charge of your hair loss? I would want to know why you can not connect to a good doctor to help you. I recommend that you review some of the past entries on this blog to find the answers to your questions. We all lose 100-150 hairs per day so if you are counting hair on the pillow and in the comb, you may be over reacting. That is the start of an answer that has already been posted many times here on this site. After a year or so, your hair should have grown to styling length, but as you get older, the hair may develop a different hair characteristic secondary to thinning of the hair shafts, common also with aging. In answer to your last question, red spots can be a reflection of folliculitis, vascular skin irregularities, and many other conditions that go beyond the scalp. If there are really a problem, again, see a doctor.

Propecia and Shock Loss

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

Thanks for your wonderfully informative blog. My question concerns shock loss. In your experience, does Propecia guard against shock loss even in transplanted regions in which the native hair is miniaturized? I was recently evaluated as a possible Norwood 6 though I’m currently 34 with only some thinning at the front and at the vertex. I’ve responded well to Propecia the last 2 years and was only interested in strengthening the frontal hairline but the doctor who examined me urged against it and didn’t mention Propecia’s benefit against shock loss. Please clarify if you can. Would the surrounding miniaturized follicles be at risk even on Propecia, especially in the front?

The miniaturized follicles would be at risk, but Propecia would definitely minimize that risk. Propecia has been shown to decrease the incidence/degree of shock loss and protect the existing native hair and for that reason I generally recommend it. Incidentally, transplanted hair is already naturally resistant to shock loss and very few patients find that shock loss is a problem in an area that has nothing but transplants.

Why Am I Losing My Eyebrow Hair?

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

Dear Doctor,
I am losing my eyebrows hair (23-male).

  1. Can dandruff be a reason for it?
  2. Do you always recommend scalp hair for translpanting to eyebrows? Can chest hair be used? Or armpit hair?
  3. I have always heard about scarring at donor site. Are there scars or marks at recipient site ever?

Thank You very much indeed.

There are many reasons for eyebrow hair loss, including hypothyroidism, plucking, trichotillomania, psoriasis with scratching, dermatitis, infection, any inflammation process, and a series of autoimmune problems including alopecia areata/totalis. Using hair at the occipital area to transplant by single strands to the eyebrow areas is the best way to do it.

  1. Dandruff is not the cause for it.
  2. Experience with other body hair (armpit, chest hair, leg hair) is not well documented and must be looked at as experimental at this stage.
  3. I have never seen scars in the recipient area.

Matthew McConaughey’s Hair

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

I read somewhere that the actor Matthew McConaughey restored his hairline with “regenix”. What is that? His hair looks great and a lot fuller than a few years ago. I also read that you did a hair transplant for him. I know you can’t tell, but if you did, congratulations on an excellent job.

Matthew McConaugheyFunny you asked about Matthew McConaughey. I saw his new movie this weekend, Failure to Launch.

I must thank you for the compliment, but I cannot take the credit for his hairline. I do not personally know Mr. McConaughey, nor do I know if he had a hair transplant, and nor do I know if he uses “Regenix” (though I did see him mention it on the Letterman show). That being said, even if I did work on him, I could never divulge such confidential information. I did, however, pay particular attention to his hairline (which seemed very natural) in the movie, while my girlfriend was probably paying attention to his body. Your guess is as good as mine with respect to a hair transplant. A good hair transplant should not be detectable. I could have made that hairline, but alas, no I did not. You might ask: could this be a good hair system, a mesh or some wig attachment? The answer is absolutely a yes to that question as well, although you did not ask it.

I am well aware Mr. McConaughey has been a popular topic in such hair forums, hair related websites, and even this blog. If he is reading this and if his hairline is just a great hair piece, I would like to meet him (professionally of course), as would my girlfriend and my entire office staff who are fans (non-professionally I am sure)!

The questions never seem to end when it concerns hair and the famous men in our society. Many of our readers may be jealous and the high interest reflects the many questions that we keep getting. I’ve previously posted about Matthew McConaughey here and here.

Doctor Recommended Against Propecia

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

i am writing this for my 19yr old son. He has lost a lot of hair at the sides and is thinning at the top. His GP told him to try rogaine, although he didn’t hold out much hope for it. He only suggested rogaine because we told him we had been looking on the internet and we came across propecia and rogaine. My son did want to try propecia but his GP advised against it due to hormones relating to female breast tissue? You are the expert in this field. Which one would you recommend to get the best results?
– from a very concerned and worried mum

It is true, one side effect of Propecia is gynecomastia, which is a benign enlargement of the male breast resulting from a proliferation of the glandular component of the breast. It is reported in a very small pecentage (approximately 1 in 300) of patients using Propecia. Of note, many other drugs (such Advil or Motrin) also cause gynecomastia. The good news is that most of the time, gynecomastia is reversible.

Your GP may or may not be familiar with male pattern baldness (MPB) and may not feel comfortable prescribing the drug Propecia. Propecia can only be prescribed by a medical doctor, so I if your son is concerned about hair loss, he should see a qualified hair transplant doctor or a dermatologist. For male patterned genetic hair loss, Propecia is the only FDA approved drug that will prevent, slow down, or reverse hair loss. Rogaine does not act in that manner with any predictability.

Chemical Trauma, Stress, and Hair Loss

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

Hello Dr. Rassman,

I’m 18 years old, female, and over the past few months (I’d say about 4-6 months) I’ve been noticing my hair thinning above my ears and towards the back of my head. Over the past 4-6 months I had a terrible hair dye job occur when I was forced to get my hair bleached in order to remove the colour, in turn my hair turned a greenish/red from the bleach so I had to go BACK in to have it re-dyed. I’d say I’ve had it fixed about 3-4 times within the past couple months. Could that play a role as to why it is thinning? I’ve spoken to my Doctors and my blood tests for Anemia, Thyroid Dysfunction, Liver & Kidney disease all came back within normal limits.

I’ve been experiencing tremendous problems with my IBS as well. Seems as though these past couple months have been some of the most stressful I’ve ever had. So basically, could the chemical trauma my hair has been through more then likely be a result to my hair thinning? I’ve been taking vitamins with Biotin in them, about 6mg a day. And I’m going in to my stylist to have a foundation treatment done on my scalp.

Am I going in the right direction considering taking action for my thinning hair? Any suggestions or advice?

Thanx so much! this site is great!

I am sorry to hear there has been so much stress in your life. Emotional stress in itself can cause hair loss. Added to that, IBS (Irritable Bowel Syndrome) has also been linked with hair loss. To make your situation worse, chemical hair dyes and bleach can also be a cause of hair loss. It seems that you are taking the right approach to promote a healthier hair/ scalp environment. However, it is not a guarantee for hair growth. The best thing going for you is a good bill of health from your doctors. Your body should hopefully take care of the rest. Keep away from the chemicals for your hair and you might have to wait a full year to see the benefits of time.

Female Temple Hair Loss

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

Approaching high school my hair started to thin in the temple area. I am female, African American and No one in my family has genetic hair disorders or anything but, I believe very strongly that ever since I started to relax/perm my hair, is when my temples started to fade.

With relaxers, you have to keep putting them in every couple of months otherwise your hair will fall out. I do put my hair in a pony tail a lot, but instead of brushing and pulling backwards, I brush down to cover my temples and then put it in a ponytail.

Without the option of Hair transplant surgery or wigs for right now, how can I get my temples to grow back? Will they always be this way or get worse?

Sometimes people describe the corners of the forehead as their temples (which is incorrect). If you are losing hair from the corners of your forehead, you may have male pattern balding. If you are losing hair above your ears, up to the corner of your frontal hair line (your temples), you may have hair loss from the use of topical chemicals to ‘relax’ your hair. You may also have a condition known as diffuse alopecia areata or a known genetic condition where the temples themselves will fall out (Triangular Alopecia) without other areas of the scalp being impacted, but we need to review your pictures to help make this diagnosis as it has a characteristic appearance. You should be evaluated by a qualified doctor for a definitive diagnosis if this problem continues to be an issue for you. If you send us pictures, we may be able to help further.