Taking Estrogen Blocker with Propecia

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

I had a transplant done 2 months ago at a hair transplant office. Right now I’m in the waiting period to see any growth. I’m also on propecia for one month. I love working out, but I have some preexisting gynomastica (not sure how to spell it). I have ordered and estrogen blocker to help prevent anymore possible gyno. I was wondering if taking this product will at all interfere with any propecia results or results from my transplant? Any info would be greatly appreciated. This estrogen blocker also acts as a testosterone booster as well. That is what makes me wonder the most. Thank you for your time.

The permanent hair from the donor area is usually not affected by hormones, so I would expect that it would not impact your hair transplant, but it might impact the other hair in the vicinity (the original hair is at risk here). Any testosterone booster will work against your goal and contribute to more hair loss. Get in touch with your doctor and get his guidance.

Distributing Minoxidil Evenly On Scalp

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

Hi Dr Rassman!

I’m 27 this year and my hair has been thinning since I was around 20 years old.
Just a couple of questions for you:

  1. Could you tell me whether minoxidil has any success in slowing down the rate of hairloss and if so – what is the best way to apply it? Can you buy a cap that distributes it evenly on your head? I realise Propecia is more effective at achieving this aim – although I’m not keen on the sexual side effects (I’m quite a suggestive person!)
  2. Do you know of anywhere in the UK that offers hair mapping for miniaturisation? I have tried a handful of dermatologists to no avail.

Thanks once again for this blog – it is so refreshing to find such an informative and unbiased database of facts all in once place!

  1. Minoxidil is not the best approach to genetic balding and you have too much to lose if you go that route. Propecia does have possible sexual side effects, but the percentage is very small (less than 1%). You may want to try it first and see. You may want to check a hair salon or beauty supply store for a cap to cover your head when applying the Rogaine if you’re concerned about that.
  2. A good hair transplant physician should be able to map your scalp for miniaturization. You can try checking the ISHRS site’s physician search to find a doctor in your area.

Doctor Blasted the FUE Technique

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

Dr. Rassman,

Thank you for your fantastic website and exciting blog! I am currently looking to find the best way to address my hair loss situation. It appears that I am, on the Norwood scale, a Type III vertex. At this time, I am seeking to have the FUE procedure done, however, I continue to find all kinds of conflicting information on the Internet, and was hoping you could give me a breakdown of what are the most important things to look for when choosing a clinic/doctor to do the procedure.

Additionally, I am confused by the various FUE methods, such as the FUE plus, FUSE, etc. I just don’t understand much about the differences and what is best for me.

Furthermore, I read an article in 2002 (https://www.hairlosstalk.com/newsletter/article181.htm) and found that Dr. Limmer, the creator of the Follicular Unit Method, blasted the FUE technique saying that it is “the equivalent of looking like you were shot in the back of the head with a shotgun.” This obviously is pushing me to reconsider any procedure since I will not consider the FUT. Please help!

Note: If possible, please e-mail me your response as well. Thank you!

There is much on this blog about FUE and I would suggest that you take a look at the FUE category to see what I wrote here in great abundance. Follicular Unit Transplantation was first introduced by our medical group, not Dr. Limmer, but with that said, Dr. Limmer made wonderful contributions on the value of the microscopic dissection which led us to the discovery referenced here. I have great respect for Dr. Limmer, but it takes time to change and adapt. He originally did not like the megasession and made statements against them — now he does them. He waits until the technology is well tested and safe before jumping on to any new bandwagon and I agree with him that it may not be the best approach for many doctors doing this work and their patients who might look like their head was exposed to a shotgun. But with that said, I do not think that in good hands, this will be a problem. You are rightfully confused, because the doctors who push these techniques often promote rather than educate, inventing marketing terms to claim notoriety for themselves rather than teach and all of this just confuses people. I am a little guilty of this myself, as I did create the name FOX Procedure as the type of FUE technique that I use — but at the time the name was coined, there wasn’t all of these various terms out there because I was the first. Although I also coined the term FUE procedure, when you sound it out, it sounds terrible, so to make the name more respectable I came up with FOX. But, to clear up some of the confusion, I use the term FUE on this blog to hopefully make it clear to people looking for information. This is a wonderful procedure in the right hands by honest doctors who have mastered the procedure. The patients who I have performed FUE surgery have loved it.

Read, read, read what is on this blog and you will learn what you need to know. We show patients off at our open house events who had the FUE procedure to help assure people like you see that you will not look like a leaking, sinking lifeboat.

I’m Female and My Doctor Prescribed Finasteride

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

Hi, i’m a female 47, have been visited by a dermatologist who prescribed finestride 0.5 mg daily. As far as I’ve seen in an internet search, this drug is only for men so I doubt to use it. Would you please tell me what to do, I will appreciate that , thank alot.

Finasteride is not recommended for women. There is no data on safety concerning things like cancers of uterus, ovary, cervix, or breast. Although pregnancy may by unusual for a 47 year old, it does happen and this medication will probably produce sexual growth problems in the fetus. The results on experimental finasteride for women is not clear nor is it statistically significant. Read Finasteride for Female Hair Loss for more info.

Why Would Proscar and Avodart Not Work For Some People?

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

Hi,

I’m curious.If drugs like Proscar and Avodart do inhibit DHT in the blood why whould they not stop male pattern baldness for everyone who is experiencing thinning from a true genetic disposition??I realize people thin for various reasons but if it is genetics why do some individuals not respond.

-Thank you.

Honestly, we just do not know all of the answers. These medications attack the DHT, but it is not 100% effective at blocking it. The balding genetics in some people is very, very strong and it may not be effectively treated with these drugs if you are looking for reversal of the balding, but I am certain that there is a slowing effect on ALL genetic balding men. Just slowing or stopping hair loss is not what some people may be willing to accept, though.

Should I Be Proactive?

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

Dr. Rassman,
I have been figting the good fight (against Hair Loss) for years. I first noticed thinning temples, and a “thin-spot” on the front middle section of my head, around the age of 19. I saw this as a warning sign(since my father is very bald)and began using propecia when I turned 20. I know that this led to a thickening of the ‘thin-spot” and a slow down of thinning. I managed to maintain my hair between a norwood II and III throughout my twenties. After many years of peace I am noticing a renewal of the “thin-spot” and new thinning in scattered areas like the temples and sides of my head. Some of these areas were not a an issue before. I find myself stressed out by styling and seeking new hair products. I worry that I could quickly become a Norwood III – IV if I don’t take action as I did when I turned 20. I would like to explore all options and I am very interested in Dutasteride. I like having hair… although I don’t look like I did when I was twenty anymore, I would like to keep/possibly thicken what I still have. Should I visit you at NHI? I would rather visit proactively than for a transplant later.

Thanks

I have an office in San Jose (where noted as your location) and would be happy to map your scalp for miniaturization and make a diagnosis. I would not rush off to non-approved drugs for genetic hair loss if that is what you have. Let’s get a diagnosis first and go from there. Proactive is good. If you would like to setup an appointment, you can call 800-NEW-HAIR or visit my Request Info page.

I Have a Small Scar On My Head from When I Was a Child

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

(female) I have a small scar from a cut I got when I was younger. Hair doesn’t seem to grow there anymore, and I was just wondering if there is any procedure I could get to fill in this scar. It’s very small, but it bothers me, because it is on my part. It’s noticible when I want to part my hair down the middle. What can I do?

A small hair transplant into the scar should solve that problem. This is easy to do and should take under an hour (depending upon the size you call small) in a skilled specialized office.

Are My Grafts Coming Out?

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

I had my hair transplant a month ago and i did not touch the grafted area once for the first 10 days except for tincing it with water mixed with shampoo. After the 10 days I started to shampoo the grafted area directly. I also noticed that the scabs where starting to flake off and li looked like I had dandruff so i would vigorously run my hands through the grafted area to get rid of the scabs. I also from time to time pick at the scabs. Sometimes I pick a scab and it has a hair with it a few time i picked a scab and there was a black dot in the center of it. does that mean a graft came out? I am scared no that i may have picked out a graft. How can I tell if I the grafts also come off with the scab or is it generally safe to do so. I have been quite aggressive with rubbing my hair and the little hairs keep falling off. Also during the first 10 days someone touched me on my forehead and the front of the donar area. i felt a sharp pain on the grafted area where the hand was put against the flow of hair but there was no bleeding so does that mean that no grafts where damaged from the front.

These are the questions you should be asking your doctor. At a month, I am certain that the grafts are secure and that what you are seeing is the failure to achieve good hygene. Washing your hair is critical and these flakes that you see are now just shedding skin. You need to see or speak with your doctor and get your washing routine worked out. All of our patients wash their hair the day after surgery, get the recipient area clean and keep it clean with one or two washings per day. By a week, you should just look like your hair is shaved, with no evidence of any transplant visually evident.

Update:

I took this photo yesterday of a patient 12 days after his procedure (around 2100 grafts). I just wanted to show what a typical patient’s recipient area looks like in such a short amount of time.


Whole Raw Eggs for Hair Loss

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

hi
i am writing this letter to you asking for advice .

I have been eating whole raw egg for the last two years for good health. Suddenly after two years i realized sudden slow hair loss. i used minioxidil but its still falls out. kindly advise me with what to do.

Whole raw eggs are good if you like your protein and fats that way. The relationship between raw eggs and hair loss are not there. Minoxidil is not the best first approach to genetic male hair loss. Get your hair mapped out for miniaturization and then with a diagnosis in hand, you can be smarter about your hair loss and approach it correctly.

Hydroxyzine, Chemo, and Female Hair Loss

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

I have a good quarter size balding spot on the top back of head. I am a 44 year old woman, along with this ,I have been experiencing itching on skin as well as head. I am 5 years out of remission from Lymphoma, in which I had chemo and radiation……is this linked? Doctors purscribed HYDROXYZINE…every 6 hours..25mg…it makes me drowsy, but, if I don’t take regurally, i found after 3days..i stopped, the itch comes back…more and more hairs fall from my head…seems only these from the top spot…help

It is not clear from your question if the bald spot came on after the chemotherapy and radiation. If it did not and the cancer has not returned, then I would doubt that these are connected. If you scratch over and over again, you can break off hair and produce a bald spot. You need a good doctor to put the story together and examine you, then you will know what is happening.

My Wife Is Pushing For Me To Get a Facelift

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

I am a 55 and my wife is 45. She wants to do a face lift and is pushing me to look into it as well. I feel that I am too young to get a face lift and that it is a better surgery for a woman than a man. Are we too young for a face lift? Is it better to undergo a surgical procedure (i.e., facelift) at a younger age when the skin elasticity is better or at an older age when everything hangs down lower?

My feeling is that one should only undergo surgery when one is excited by the prospect of change and feels that he or she will benefit maximally from the procedure (physically and emotionally). Feeling compelled to have a facelift at an earlier age is ill-advised. The key is to get a good doctor and bond with him/her to help you decide if this is the right decision for you at this time. More and more men are getting facelifts today and the results can be as dramatic as the results we get on women.

This question was answered by Jon Perlman, M.D.

Plugs to Bald (with Photos)

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

I hate my look. I answered an ad in the newspaper when I was in my early 20s and very depressed about losing my hair. It was not bad then, just starting to thin in the front. The doctor’s sales guy came in and did a job on me, telling me that it was on special and that he would give me 50 free grafts on top of the reduced price and I would never have to deal with the balding again. I scheduled for surgery done the next morning. This was 8 years ago and have hated myself ever since. I did not see how bad they looked until the hair fell out in the front, all within a few months of the surgery. Now I just want to become bald. Can I do it?

My astute readers will notice that this is the 3rd blog entry I’ve made in the past week relating to this very issue (see also: Alas, Bald Again and Years After Transplant, I Want To Shave My Head ), but it is very important to drive home the fact that hair transplants are forever. I know that these deforming surgeries are what most people think that a hair transplant is, but based upon what I see in these pictures, I would expect that you had this 15 or more years ago, not 8. This is malpractice today and I believe even so 8 years ago. The way the doctor unleashed the salesman on you was downright immoral and I would report that doctor, at the least, to the medical board of the state. In California, the medical board takes responsibility to protect consumers against such behavior.

I think that going backwards and becoming bald may not be your best choice, because even if each of these plugs were removed, the scalp skin would then show the individual scars from each excision and the reflection of any light in the room would show the deformity. I suspect that the situation can be improved as shown in these articles and this patient example (see Dean’s Story link below).

You need a good doctor working with you one-on-one who has the experience to address YOUR needs. This requires both a very experienced hair transplant surgeon, one with good communication skills, compassion, and understanding. Then the two of you can work out what your real options are. For those readers who are seeing this scary picture, don’t think that this is the standard of care (take a look at what is the standard of care today in our Photo Gallery).

Note: This work was NOT performed by New Hair Institute. Click the photos to enlarge.




Transplanting Hair on 74 Year Old Woman

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

My mother who is 74 is experiencing hair loss. It’s in the range of your grade one that you show on your website. Anyway, she’s in wonderful health so we’ve ruled out any medical conditions that may cause hair loss. She was taking medication for her menopause (primpro) that she’s been off of for approx. 2 years now and isn’t taking any other medications that include hormones of any sort.

My question is..recently her and I went to a company here in Brea, California to see about transplants or any other methods of hair restoration. They told her that because of her age, the doctor wouldn’t even consider giving her transplants cause if the hair wouldn’t grow on the top of her head now naturally, it wouldn’t even if they did do the procedure. Is this true?

Any information would be greatly appreciated!

Hair loss in women needs to be evaluated first, from a medical point of view. If the loss is recent, she may have an underlying medical problem (such as eczema, malnutrition, autoimmune disease, drug reactions, infections, many other problems too numerous to mention). Then she needs to have her hair mapped out for miniaturization so that a diagnosis is made. With all of that in hand, you need to then make decisions. Medical health issues must be addressed first, then the doctor who maps her scalp for miniaturization (often a good ethical hair transplant surgeon or dermatologist) can make a decision about hair transplants. From the little you are telling me, I would guess that hair transplants may not help her. Her age is not the issue, for I have transplanted people as old as 89, but the value of hair transplants must be weighed so that the total picture is the patient, lifestyle, health, etc. The value should not be determined by how much money the surgeon makes, but how much value she would get from doing a hair transplant.

Liposuction

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

Some people tell me that liposuction could leave them with an imbalanced look. Might fat “go elsewhere” if I undergo liposuction?

If you regain weight after liposuction through an imbalance between diet and exercise, the body will find remaining areas of fat cells (that were not removed with the liposuction) to enlarge to take on additional fat. This may be unnoticed if it spreads through several regions, but it could be localized, creating a new bulge or area of thickening in an undesirable area. If there are not enough fat cells in the ‘love handle area’ that was removed in a previous liposuction, for example, fat may accumulate in the under-hanging arms. Liposuction is often performed by region and with some regions untouched, it could pick up the excess fat you eat and store if your gut liposuction was successful.

I Want Even More Hair (with Photos)

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

I have wonderful results from the transplants you have given me, but now I want more hair in the crown. Can I do it one more time?

This is not an uncommon question. I have shown his before and after pictures here, with permission. He has received 3,218 grafts in three procedures. The first procedure was a limited FUE surgery placed into the corners with 484 grafts. This gave him a nice result, but he wanted more fullness so another procedure was performed in the front to finish out the hairline reconstruction. Had he elected to allow me to dense pack the frontal hairline and use a more traditional approach (strip harvesting), I would have done the entire procedure in the front (1391 grafts) in a single procedure, but the FUE limited the harvesting in the early days (2001) when this was considered a large FUE procedure for me. He elected to come back a third time now to address the top and back of his head. His third procedure had 1,827 grafts and it achieved wonderful, natural results. Now he wants a tighter swirl in the crown and a second procedure into the crown (a 4th procedure overall) will finish the job.

A good Master Plan might have reduced his entire process to two procedures (front and back), but sometimes it takes a slower approach to make the patient feel comfortable with the process. He now has 3,218 grafts total and will receive another 1000 in the crown in the very near future.

Before (click photos to enlarge):


After: