I Don’t Want My Hair To Recede To Reveal My Transplant Scar

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

I have had 2 transplants since 2000 and have noticed that I am losing more hair at the back of the head. My concern is that the scars left from the surgery will eventually be exposed if I continue to recede. I would say that they it is 2 to 3 inches away from the first scar. Is there anything I can do to conceal the scar? Is it time for another transplant?

Thanks

As long as the scar is in the mid region of the permanent zone, I don’t think that the scar will be revealed. That is assuming that the scar width is not excessive , though most wide scars can be managed with a corrective procedure. It’s difficult for me to even try to conclude where your recession will end since I haven’t seen photos or met with you, so you may want to get a second opinion and even a third to better determine if your scar will possibly be exposed in the future and what can be done about it.

Propecia Stopped Working After Years — Time for Avodart?

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

I have wrote to you before about Propecia losing it’s effectiveness for me after 6+/- years.

I have had just about every blood test done which were all in a normal range. Thyrioid is OK.
The only thing that appeared high was my Estrogen/Estradiol levels.

Last stop was an Endrocinologist who thought the level was a bit high but not horribly high.

The problem is my hair is just coming out daily. I can pull on it and get a shed. Wash it and get a shed. Nothing is slowing down the loss.

My question is, should I try Avodart since nothing else seems to be working.

I am 40 and basically a healthy guy.
But I am desperate as well.

Is it normal for all of the top to just go in such a short amount of time (6+/- months)?

Hair loss is an ongoing process with or without using Propecia. However, hair loss may slow down or temporarily stop once on Propecia. Avodart appears to be a longer acting drug in the same class as Propecia. I am not certain if it will be better than Propecia. I need to see more data before recommending you to try it, but without the FDA’s approval, I am not willing to recommend it yet. Despite the theory behind Avodart, there is no concrete study out there to prove that this drug is better than Propecia.

How Long Does Minoxidil Stay In My Body?

/by William Rassman, M.D./7 /

Dr. Rassman,
I have been taking 2% topical minoxidil since late December 2005. I have ALWAYS taken more than the recommended doses. I would estimate at first 2-3 times the amount, later on 4-5 times the amount. By mid March I noticed my sex drive was really low and and I had a harder time getting and maintaining an erection. I read online from the Mayo Clinic that too much absorption of topical minoxidil can lower sex drive and performance. I have stopped taking it for a week and sexually I’m better, but not quite normal. I also still have some heart palpitations. Could you please tell me when my body will “clear-out” the excess minoxidil?

Some drugs are metabolized fairly quickly, while others can take a long time before they are eliminated. We quantify this with the use of the term “half-life.” The half-life of a given medication is how long it takes for the body to get rid of half of the dose. When the patient is taking a medication on a regular basis, there is an ongoing process of drug absorption in the form of each dose of the drug and, concurrently, an ongoing process of drug removal with the drug’s metabolism and clearance. Eventually, there comes a point when the amount of drug going in is the same as the amount of drug getting taken out. We call this “steady state.” It takes somewhere between 5 and 6 half-lives for a medication to reach steady state. Thus, medications with short half-lives reach steady state relatively quickly, while those with long half-lives take a long time to reach steady state. Minoxidil has a blood half-life of about 4 hours, but I can not determine how long it hangs around the kidney, heart, or other organs when it is out of the blood. Most of the good studies are on oral administration of the drug for treatment of high blood pressure and here is what I read on RxList.com: “The extent and time-course of blood pressure reduction by minoxidil do not correspond closely to its concentration in plasma. After an effective single oral dose, blood pressure usually starts to decline within one-half hour, reaches a minimum between 2 and 3 hours and recovers at an arithmetically linear rate of about 30%/day. The total duration of effect is approximately 75 hours. When minoxidil is administered chronically, once or twice a day, the time required to achieve maximum effect on blood pressure with a given daily dose is inversely related to the size of the dose. Thus, maximum effect is achieved on 10 mg/day within 7 days, on 20 mg/day within 5 days, and on 40 mg/day within 3 days.” This may be more than you asked for.

If you have heart palpitations, you should be seeing a doctor about that. This is a worrysome problem, something that is far too important than to take it to a doctor like me who advises on general questions over the internet. Minoxidil may be out of your system by now and the fact that you are getting better is good, but having a heart problem needs prompt and proper medical treatment, so get it to see a doctor ASAP.

Unsatisfied With Hair Transplant, Should I Use Laser Therapy?

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

Hello Dr. Rassman,
I Recently had a Hair transplant that was performed back in July of 05. I started taking Propecia a month before surgery. I must say I am extremely dissapointed in the results of both. I feel as if the head trauma that was endured during the surgery made me lose more hair. When I inquired with the doctor he said the hairs that fell out will regrow. My hair gets thinner by the day and I dont see Propecia working from keeping the hairs I already have. My question is, there is a laser therapy used for a skin disease that also helps alopecia patients regrow full heads of hair. Is this a something I should test out? It is not covered by insurance because it would be considered cosmetic. And in the mean time, I have heard of taking daily doses of copper peptides and emu oil help the follicle and assist in regrowth of dormat hairs. Is this another route I should take? Thank you so much for your time doctor.

First I would want to know if your expectations were set correctly. You say you are disappointed, so I ask why?

There is a suggestion in your question that your hair is continuing to appear thinner. Did you experience shock hair loss (rare with a person on Propecia, but more common in young men under 30). I do not know your age and I have no idea where was your starting point and where you are now. I would suggest that you go back to your doctor. Your doctor is vested in making you happy and making sure that what he represented to you was what you got. Your best starting point is a face to face meeting with the doctor who did your surgery. I personally love talking to my patients and although few are dissatisfied, I always feel ownership. I make unusual efforts to be sure that expectations are properly fixed to what the end product will be like and that is the main value of open house events for people like you, to avoid being disappointed, because what you see is what you are going to get. I do not think that playing around with things like lasers or other regrowth formulations have value for you now, that is, until you know what happened and why the surgery failed to meet your needs.

Emotional 13 Year Old Girl

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

hi. right now, i have a perm from curly to straight. i am 13 yrs old girl and if would be cery nice of you if you would pleeeease help me. i went on a winter vacation with my family for 3 days. the second day i went to the pool with out a cap. after a while i went up to my hotel room by myself, then i blew dry my hair. after the vacation was over i went home to wash the chlorine out of my hair which were V05 conditioner and shampoo. after i washed it, i blew dry my hair some more. later in about a few weeks, every time i comb my hair a whole chunk of hair came out every single day for 3 weeks. it came from the back of my head. i just noticed when my hair dresser said it looked like a short boys hair cut and i started to cry for weeks. i did not want to go out in puplic expecially in school where my friends had good looking then i did. i felt jealous and lonley because a few had longer hair than me, straight with out a perm. and i don’t really want to show my natural hair because it’s crazy looking. so if you would pleeeeease help to grow it back faster i’ll feel much better again and take better care of a perm. thank you so much

You sound very emotional, and that is understandable seeing as how you are a young teenager. When my daughter was your age, I saw these range of emotions firsthand. Please know that losing hair is normal (average person loses about 100-150 hairs per day) so that if you are seeing such numbers of hairs being lost, you are just seeing something that you may not have noticed before. If you are healthy and have no medical problems, then there is no reason for significant hair loss. First, you need to talk with your parents and tell them what you are experiencing. Then they may take you to a good dermatologist who can evaluate your hair to find out if the loss you are experiencing is above the normal daily loss for an adult. The best advice I can give you is to reach out and ask those who love you to help you through this experience.

Female Started Losing Her Hair at 13

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

i am a 17 year old (almost 18) female and have been experiencing hair loss since i was about 13. i used to have thick curly hair and now its very thin, i have to wear it half up in a clip to keep the thinning spots hidden (even though my whole head is thinning). my father is going bald and his brother and father are completely bald. i do not have any thyroid or hormone problems nor do i have any iron problems. i have been to dermitologists and they perscribed me monoxidil which i used when i was approx. 14 and stopped after about a half a year to a year because i hated using it and my hair loss was not completely noticble. now at 17 its pretty bad and i began using the monoxidil again, i started about a month ago. no one can explain my hair thinning and why a lot of it falls out after i shower and brush it. at first when i was 13-14 i didnt care because it was not noticable, but now i cant take it, im in high school almost uniiveristy and i dont know what to do! its been happening for 5 years without slowing or stopping..is there anything you can offer that will help me? pleasee im desperate, all my friends have thick hair and i hate the fact that i dont and mine falls out and is noticibly thin.

You have done your research concerning female hair loss. Have the dermatologist biopsy your scalp to see if you have an inflammatory process occuring which cause your hair loss. Find out if there are there any miniaturized hairs in the donor area, which is in the back of your head, and how much miniaturization you have everwhere else on your scalp. Are there any noticeble spots on your head? Has your hair loss been stabilized or has it become more progressive? I am limited to what I can do over the internet. Be sure to get a good, caring doctor to help guide you through what you are now experiencing.

15 Year Old Male Wants a Lower Hairline

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

I read the article regarding the 15 year old with a high hairline. I have the same problem (I am male) but when I read your response, there was nothing saying what there is out there to fix the problem. Would you please let me if there is hope for myself. I comb my hair forward too, to cover it up but I am tired of having to do that. Please let me know. Thanks for your time, I will be looking forward to your response.

At 15 years old, you are too young for hair transplants or hairline lowering procedures, because you do not know what will happen with regard to balding in your future. Such surgery, although it might work well today, may make you look abnormal if you should join the balding men out there (almost half of the male population in adulthood). Are you sure that you have a high hairline and not a maturing hairline which normally develops between the ages of 17-29? You must be seen in person to map out your hairline and entire head to determine if you truly have hair loss, a congenital hair hairline, or just part of the maturing hairline process.

Rain, Wind, and Sun on a Bald Head

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

Will hair transplants protect me from getting a sum burn on my bald head?

Burning HeadA patient recently wrote to me about this very point. His answer defines the impact of the elements on balding heads and the benefits of hair transplants, and he has given me permission to repost this part of his email:

“I wanted to thank you for the wonderful, life changing experience you gave me. I used to be conscious about weather and that bothered me more than any single issue I can point to. When it rained, my comb-over fell apart, the wind would also destroy my morning efforts to keep my hair orderly and in the hot Florida sun, my head would burn badly. It seemed like any weather made me aware of my balding head. Now with hair on my head, styling is something I do not focus upon and the freedom it allows me is most responsible for the change in my individual confidence. Although my wife supported me in the hair transplant decision, my balding never bothered her as it did me. “

More Crying About Hair Multiplication

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

Your a funny guy Dr.Rassman I like the way you put on this innocent act of looking like your not trying to lure people into your office for a Hair transplant. We all know that the most propecia does is stop hairloss and maybe regrows it in a small few then it’ll begin again after a few years and is a poor excuse for hairloss cure. Anyway I just thought I’d say you have the style of a used car sales man you are indeed very cunning.

Telling people HM is 10 years away at least but you know your little comments like this are complete BS. Also I liked that you said something like HM would have to go through congress to get approval very sly indeed the only government organization needing to give it approval is the FDA and thats it period. Anyway I hope HM comes out very fast and puts dishonest doctors like you out of work. I know I won’t be putting my head on your chomping block.

I suspect that the flood of harassment I’ve received through emails and site comments from this person and perhaps one or two other individuals with internet rhetoric and just enough information to become an “expert” makes this site and my job a bit exciting. What you don’t seem to get is that I have everything to gain by hair multiplication when it comes out. There would be few more enthusiastic people than me if it were available for clinical release, because people like me would be expanding their business to offer these services. As a well known person in this industry, I am constantly informed about what is happening out there. I do read a great deal, but wasting my time with focused bigots like the one who wrote this email to me will not consume this blog. I aired his complaints and inappropriate comments, deleting some of the foul elements that are really not needed to get his point over. Maybe he is selling some HM process and is not impartial in the slightest?

By the way, the expression is “chopping block” — “chomping” is something Pac-Man did.

Does Minoxidil Eventually Lose Effectiveness?

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

i’m an avid reader of your blog. a lot of people claim that minoxidil loses it’s effectiveness after used for awhile.

does that mean that minoxidil stops growing new hair after awhile or does it mean that minoxidil can’t help you maintain your regrown hair after it’s effectiveness has runout?

i hope that makes sense. thanks.

Your hair loss is an ongoing process with or without using Minoxidil. Minoxidil may stop further hair loss or slow down the inevitable process of hair loss. Can Minoxidil stop working after a certain amount of years? Almost certainly. We do not have studies that go out for decades yet.

How Can Follicles Be Unclogged?

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

Dr. Rassman-

Is it possible for hair gels or styling products to have any effect on hair thinning? Could they hasten the hair-loss/thinning process? I recently read on your website that chemicals could possibly seep into hair follicles. How can these follicles be cleared out or “unclogged”? Thank you for your time and insight.

It would be unusual for hair gels to be the cause of hair loss/thinning. Yes, certain chemicals can seep into your follicles and cause damage, but these are not the simple typical over-the-counter products you see at the drug store on the shelf, but things like dyes and chemicals that straighten or color the hair. The chemical has to be toxic to your follicles to impact their growth or the character of the hair. Good washing should suffice to keep your scalp clean of sebum and other oils.

Is Hair Loss from Stress Easily Reversed?

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

When stress is responsible for the acceleration of hair loss, is it more easily reversed than typical MPB after alleviation of the responsible stress?

The best I can predict is that if the stress is managed successfully, the impact will be less. If there are other changes like taking Propecia (men only) added, it may be possible to reverse, particularly if you are younger than 30. The younger you are, the more likely the reversal, but when the balding process starts in men, unless something major occurs (like Propecia) the best you can hope for is that the balding cycle (and it is a cycle of rapid loss moving to no loss) will calm down and go into remission. In women, on the other hand, releasing stress is more often able to reverse hair loss that is induced by stress alone.

Black Scabs Months After Hair Transplant

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

2 very important questions:

It’s been 6 months after my hair transplant and I have seen good results but I am still looking for further improvement in my hair as expected. Will there be more improvement coming in the next 2 or 3 months or I have already got my results and there won’t be any further new hair growth?

Another question is that I just noticed that I still have black scabs with a hair growing on the top of it and it just fell in my hand with the scab and the hair stuck to each other. These scabs where in hundreds after the hair transplant which is normal. But is this normal after 5 months of hair transplant?

thanks

By the 8th month, you will have >80% of hair growth. By 1 year, you will have >95% hair growth. If there were hairs in the scabs, I do not understand it — they should not be there. Maybe you are not really telling me what you see properly, for anything that lasts after 5 months may reflect the old grafts that did not shed. Perhaps you may have further hair shedding in preparation for further hair growth? Try washing it more vigorously and see if that makes the scabs fall off. You might consider sending me good digital pictures to the address on the contact page.

Is My Hair Loss from Nizoral?

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

Hi dr. Rassman. recently I was prescribed an antidandruff shampoo called nizoral 2% ketoconazole. I used it religiously and initially felt some relief. but i was only supposed to use it 2-3 times per week and instead i used it every day. now i have noticed tha ti have a bunch of white hairs or hairs that are both white and black on the same follicle or new brown hairs. I have also noticed that i have lost quite a bit of hair on one side in the front and increased itching/burning in that area. I am only 17 years old and am positively not suffering from male pattern baldness ( i have hair like growing down to my eyes). but I am wondering if you think that the hair i lost in front with nizoral will grow back or if i permanently damaged my scalp beyond repair. Also note that there is no pain anymore that i have discontinued use of it for a month. but the shedding associated with it only stopped a couple of weeks ago

Possibly, you are allergic to the chemical in nizoral (2% ketoconazole). If your hair loss is due to an allergic reaction to medication or “chemical irritation,” then it will likely return back in 6 to 8 months after the offending chemical has been removed. Check back with me if there is no regrowth after 6-8 months.

Propecia and Breast Enlargement

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

I’m 26 years old now and I’ve had gynecomastia for as long as I can remember. It’s not something I’ve liked but I’ve gotten used to it, tho I do plan on having it corrected surgically in the future. I’ve recently noticed hair thinning/shedding and am curious if taking 1mg propecia could make my pre-existing gynecomastia worse.

You should treat your gynecomastia problem with surgery if that is what has been recommended by your doctors. Taking Propecia may not make the situation worse, so you can take it and see if it makes it worse. If it does make it worse, then stop it. The doctor who prescribes the Propecia should be able to monitor this with you.