Concerned 22 Year Old Getting a Hair Transplant

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

I am a 22 year old man who recently signed up for a hair transplant. While I really don’t have a spot on my head that is bald, I can tell that the day will be coming when they will be. My question is how noticable is the donor area damage directly following the procedure? If I return to work in a few days will people be able to tell? I am so nervous about the procedure. I have visions of the procedure going well and having a nice head of hair for several more years. I also have visions of being scarred and worse off than when I started. Please write back as soon as possible, I look forward to any advice and answers you may be able to give. Thank you for your time.

Please think this through. Are you on Propecia? If you aren’t on Propecia because your doctor did not put you on it, he is not a good doctor and you should run for the hills, not for a hair transplant. Assuming that you have no visual balding, then doing hair transplants on a non-balding 22 year old for prevention purposes is malpractice. You are in control of this. Send me some good quality photos and let’s talk this through.

Why the rush?

Tags: hair transplant, hairloss, hair loss, propecia

Gray Hair in Young Man

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

I am 23 years old and have a worsening problem with grey hair. At 18, a few strands of hair slowly started to turn grey from the tips (not the roots). The graying would spread to the rest of the hair till it was completely grey. Over the past 5 yrs the grey hairs have increased and I now have about 30 grey strands all in the same area, in an area of about a few square inches. I don’t have grey hair anywhere else on my head and do not know how to stop it. I have been taking multivitamins and get plenty of exercise as well. Also, it seems odd that the grey hair is all concentrated in one area. Please advise me as to what you feel could be causing this and what I should do to treat it.
Thank you.

People gray in sections of the scalp before it spreads to other areas. I have seen people who had a single patch of gray hair in an otherwise normal head of hair that is dark. This could be in people who are very, very young (children have it at times). This is a genetic variation when it occurs. Other than the use of hair dye, there is nothing that can be done. You call this a problem and from a social point of view it clearly can be, but from a medical point of view, the hair at this point on your scalp is completely normal. If you do not like what is happening to you, you can use a variety of safe hair dyes to solve the problem.

Tags: gray hair, grey hair, dye, hair color

Taking Propecia for Telogen Effluvium

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

If a male is suffering from a bout of Telogen Effluvium rather than MPB, would taking Propecia be either harmful or is it just totally benign, outside of the possible latent benefits for his prostate.

I doubt that taking Propecia (for men) would be harmful. However, I have many questions that were raised by your question, such as — How did you make the diagnosis of TE?

Tags: propecia, finasteride, hairloss, hair loss, telogen effluvium

Any Products That Work Around the Temples?

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

Hi,

I have recently been placed on a treatment of Propecia for a receding hairline and first stages of thinning of the crown. After reading information on this drug I have noticed that it apparently has no proven effect on hair loss around the temples. What products would be useful to use along with Propecia to increase my chance of actual hair growth and/or thickening? Thickening shampoo’s? Serums? Vitamins?

Thanks.

Propecia, I am certain, will slow down or stop the hair loss in many areas where genetic balding from the effects of DHT is occuring — that includes frontal and temple hair. As I have said before, many patients report that the frontal and temple hair loss has stopped with Propecia. I have seen two patients with full reversal of frontal hairloss, although this is unusual. Merck (manufacturer of Propecia) can not promote it for something that is not documented for in the FDA studies. The other cosmetics/shampoos/conditioners that thicken hair shafts by making them absorb water or vitamins will not impact the hair loss process.

Tags: propecia, finasteride, hairloss, hair loss

Weaved Extensions Caused Hair Loss

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

I have recently taken out weaved extensions (conrows) that I have worn for over 3 years. I have lost almost all my hair in the back where the braids were. Do you think this will be a permanent loss and it’s too late now?

I also just started using rogaine extra strength (5%) for men, even though I am female (since like I said I have a ton of hair loss), is this okay to do, and do you think it will help in my case of all traction loss?

It sounds as though you indeed have traction alopecia from your braids. Given that you recently took the braids out, your hair may grow back. It is too early to tell as it could take several months to see new growth. I do think minoxidil is a reasonable choice in the meantime. However, the male version of rogaine 5% is oil based and makes hair styling more difficult. The female version is alcohol based and tends to hair styling a little easier.

Tags: hairloss, hair loss, alopecia, minoxidil

Restarting Minoxidil Months After Transplant

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


I had a transplant procedure (approximately 1600 grafts) 4 1/2 months ago mainly to the thinning crown of my head but some to reinforce the frontal hairline. The frontal grafts are beginning to show evidence of growth. The crown graft areas are causing some problems with redness and some sore spots that have been addressed elsewhere in this blog. The itchy red patches have made it impossible for me to continue using Minoxidil. As the patches eventually resolve am I likely to experience benefit from restarting Minoxidil even 5+ months post surgery? I am female and had one transplant 10+ years ago which was very effective at the time and from which I did not experience the same degree of problems with an itchy red scalp. It should be noted that I am 56 years old, with very fair skin and have had fine texture hair throughout my life. I was carefully evaluated prior to this procedure and determined to be a viable candidate for the procedure again. I did find a reputable transplant surgeon.

Thanks for your help.

If you have confidence in your tranplant surgeon, these are issues that the surgeon should address. You need to be examined to make sure there is no chronic infection (folliculitis) or other problems. It is always important to achieve a good patient to doctor relationship and these problems and concerns should be mentioned during your meeting.

With regard to restarting minoxidil, that is not a problem as long as the itching and active inflammation are gone.

Tags: minoxidil, hair transplant

Norwood Classes vs Mature Hairline

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

I am a 28 yo male who’s hairline has been receding at the temples since I was around 16 years old. It is now at around a Norwood 2/3 although there is very little recession at the front. I realise it is either slow mpb or a mature hairline from reading your very informative answers to other guy’s questions but I wanted to ask you whether its possible to recede to a Norwood 3 and remain there? I noticed miniturisation in the areas which have now receded but there doesn’t seem to be any further miniturisation. Also there is no hair loss at the crown area (yet!!)

Everybody is different! You may recede to a Norwood Class 3 and stay that way for the rest of your life. Your hair loss should stablize by your late 30’s. If you are still concerned about hair loss, you may benefit from seeing a doctor who can quantitatively record the miniaturization of your scalp hair and give you more information on its extent. If the miniaturized hair is only found in the frontal area, then you may be more confident that the hair loss will probably not progress significantly beyond what you have already experienced. On the other hand, if there is miniaturization in the crown or further back in the front (even it there is no balding at this time) then the prognosis may not be as good. In this later situation, the drug Propecia (finasteride 1mg) is the best way to arrest the process.

Tags: hairloss, hair loss, propecia, finasteride, norwood, hairline

16 Year Old Girl Wants Lowered Hairline

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

Okay so, I am a 16 year old female and I have done constant research on lowering of the female hairline (which is very difficult to find, most sites only direct me to men with balding patterns) and I am desperate to know if there is any way to lower the hairline without grafts while still looking natural. Due to my high hairline, my forehead looks rather un-shapely. I envy those beautiful girls with such a proportionate face and wish that I did not have the haunting insecurities of my own. I have brought this up with family since I know I am very young for something drastic like this. Please help me. I appreciate your time and am looking forward to your reply. Thank you.

There are procedures to lower a hairline and this procedure is often done on women. It is a more complicated procedure than a regular hair transplant surgery so a standard hair transplant surgeon may not be comfortable performing it. Some (like me) are not uncomfortable doing it. Most of the doctors that perform these types of sugeries are plastic surgeons. I would consider performing the procedure on a 16 year old female, provided I see maturity, understand the motivation, the teen shows a normal and healthy mental state, and have parents who understand what the procedure is and what it means with all of the risks associated with such a surgery. In other words, I want to be a good doctor that does what is in the best interests of his patients.

Tags: hairline lowering, female, teen, hairloss, hair loss, hairline

Ingrown Hair or Abscess?

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

I had an emergency c-section almost 9yrs ago.. prior to.. another c-section 7yrs ago thru the same vertical scar that never healed right..its very wide towards the bottom. my question is, i shave down there and ive noticed 2 ingrown hairs that have grown thru the bottom of my scar. They honestly have been there for about 6months.. because i didnt know what to do about them. But now, one is very badly infected and is swollen. so much infact, that my scar is looking more wide. its very sore and im scared and dont know what to do about it. how can i ease the pain and maybe help the swelling to go down so i can get a doctor to pull the hairs at my next appointment (aug 1st). thank you for your time.

You need to see a doctor. I do not know how bad your “ingrown” hair looks like, but you may have an abscess or a wider scale infection developing. Of couse, these are the worst case senarios. I would call your doctor to move up the appointment or visit a walk in clinic.

Tags: infection, hair, ingrown hair

Pseudopelade and Hair Loss

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

Please supply info on pseudopalade and what are the chanches of hair transplants. This diagnosis was made by a local dermatologist in South Africa where I live.

Pseudopelade is a peculiar form of scarring alopecia resembling alopecia areata. It is unclear if it is immunologic (your body thinks your hair is foreign and kills it) or genetic in nature. Unfortunately the condition is not amendable to hair transplantation, because you would run the risk of more hair loss and failure of the transplanted hair to grow.

Tags: hairloss, hair loss, pseudopelade, alopecia

Tramadol, Pain Killers, and Hair Loss

/by William Rassman, M.D./38 /

Hello Doctor, I was wondering if the drug Tramadol, or any other perscription pain killers (possibly even neruontin) could cause hair loss? I took Seasonale for one month about a year ago, and my hair was falling out in chunks. It slowed way down after that, and I am now on Yaz (like Yasmin) which I heard is good for women with that kind of hair loss. But I have taken Tramadol pretty much every day since last september for chronic pain, and since then I noticed my hair is a lot thinner on top, mostly in the front but its thin all over. I just stopped taking my tramadol a week or two ago and the hair loss has decreased by about half. Do you think this is just a coincedence and that I truely have female pattern baldness, or is there any correlation between pain medication and thinning hair and if so will it grow back? Thank you so much!

Many medications can cause hair loss. It is virtually impossible to tell if Tramadol is causing your hair loss especially when you are taking other medications. Moreover, stress and chronic pain can also be a factor with your thinning hair.

Tags: hairloss, hair loss, tramadol

Starting With Propecia and Minoxidil 12% with Azelaic Acid

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

Hi,

I am based in London, UK and I just had a first evaluation session with a center specializing in hair loss.

The trichologist has evaluated that I was genetically pre-disposed to hair loss. I am now 37 and vertex 3, so nothing dramatic; I just want to stop the balding process.

Now, I have been prescribed Propecia 1mg + Minoxidyl 12% with Azelaic Acid. I am a little bit surprised to immediately start with the highest level of Minoxidil as I’ve read that you after time you need to increase the dosage. If in a couple of years, Minodixil 12% has decreased effect what stronger will I have to take? Also, are there some studies which show the dosage of Minoxidil has to be increase.

Thank you for your help.

You should talk with your doctor to address these concerns. When topical minoxidil is used for male pattern hair loss, some doctors may prescribe a higher concentration formulation. I like to start one medication at a time. I do not like what your doctor has given you with the ‘nothing dramatic’ view of your problem that you hold. You should be aware and informed about the potential side effects of any medications that you are prescribed. Once started on the minoxidil and the Propecia, you may be ‘hooked’ on both, for life. That is, you may be inclined to take both since you won’t know which medication is contributing more to the benefits you may see.

Tags: minoxidil, finasteride, propecia, proscar, rogaine, hairloss, hair loss

Coloring Hair Before Hair Transplant

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

I color my hair, would this be a problem if I wanted to get a hair tranplant down the road. Would it have any effect on the procedure?

Coloring or dying your hair should not have any significant impact on a hair transplant procedure. I generally tell those people who do color their hair, to have it done within a few days prior to the HT procedure.

Tags: hair transplant, color, dye, hairstyle

Propecia and Frontal Hair Loss Over Time

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

Hi, I am 24 years old and am experiencing some frontal hair loss. Nothing major, but my hairline has receded a few centimeters beyond what I would consider a mature hairline. On my mother’s side, my grandfather still has his hair as do most of my uncles. My father also still has his hair, but his father went bald in front.

I just started taking Propecia this week to prevent further loss. In your experience, have men in situations like mine managed to keep their frontal hair after taking Propecia for a long period of time? Or should I simply consider Propecia a stop-gap measure?

As a side note, I noticed on your blog that you suggested Propecia can only slow down frontal hair loss in most cases–that is, it will continue eventually. But I recently looked over a study on Propecia’s effects on frontal hair loss and the results seems more promising than you suggest (you are probably already familiar with it). Here’s the link: https://www.hairlosstalk.com/download/finfront.pdf

According to this study, investigators and a global assessment found that almost all the people on Propecia halted frontal hair loss (about 94 and 99 percent) over a one year period–and the study suggests that the effects even improved after a 24 month period.

Has this also been your experience?

In my experience with patients taking Propecia, I find that Propecia generally has better observable effects on the crown than the frontal hairline. I have little doubt that Propecia slows down frontal hair loss if it is clinically indicated and I have seen good results from it in the frontal area, therefore agreeing with your reference. I have seen a very small number of young men actually reverse frontal hair loss.

Tags: propecia, finasteride, hairloss, hair loss

The American Board of Hair Restoration Surgery

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

Dr. Rassman
Firstly let me tell you how much I have enjoyed your blog comments for the many young men and women suffering from hairloss. I am a 33 yr old male, who is scheduled for hair transplant surgery in a month. I have learned from your comments and want to ask you some questions. I have hair loss in the frontal/tempural area with thinning in the crown area. The thinning has improved since I started taking Propecia last year, no side effects thank God.

  1. Is 33 a good age?
  2. My doctor is Dr. [name removed] and he is a Diplomate of the American Board of Hair Restoration Surgery. Can you give me an opinion on this qualifications?
  3. I was concerned with scars, and felt comfortable since he is also a Plastic Surgeon, is my assumption correct?
  4. I am also concerned with shock fall. Is it permanent? How much help does Propecia offer?
  5. My doctor has not done a miniturization study on my scalp, that concerns me, although he did examine me the first time and I am scheduled for anohter consult. Should I request this?
  6. I also use Nizoral shampoo, and it seems to help, what have you heard about the benefits of this product if any?

Lastly, coming from a father that is a Vascular Surgeon, I know that confidence in the physician is important. I just did not get a second opinion, and have been trying to educate myself as much as possible. I feal my chances are pretty good, I hope to get strong results. I thank you again for your comments and help you offer on-line…..with the high pace life physicians lead its unlikely. I commend you for that.

Your father is correct in stating that confidence in your physician is very important. That being said, BaldingBlog is not a place for a medical second opinion. You should either address these issues with doctor or formally make an appointment with another hair transplant surgeon for the second opinion.

Credentials are important and being a member of the American Board of Hair Restoration Surgery may make it more probable that he is a good doctor. I am familiar with doctors with such credentials who I would not have as a surgeon, though. I, for example, have refused to become a member of the American Board of Hair Restoration Surgery because there is no formalized training for the accepted doctors and no peer review for what they do. When I received my credentials for General Surgery, I had completed 5 years of formalized, supervised training before I was allowed to take a series of written and oral examinations. The American Board of Hair Restoration Surgery credential only requires that the surgeon does 100 surgeries (without any supervision) and pass a written (very easy) examination. That does not make them qualified in my eyes. Now with that said, many of the doctors who have received the American Board of Hair Restoration Surgery credentials are good doctors and quite competent, while some are not. It continues to be a buyer beware situation for the hair transplant buyer (see: The Truth About Cheap Hair Transplants).

I have addressed shock hair loss before. Propecia in a balding male will reduce the risks of shock hair loss. If Nizoral shampoo is working for you, then use it. I feel strongly on the mapping out of the scalp for miniaturization. I do not like doing things blindly, because then I really could not lay out a good Master Plan.

Tags: hairloss, hair loss, abhrs, hair restoration, hair transplant, doctor