Exercising After a Hair Transplant

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

First of all, a great blog – so thanks and I hope you get lots of patients from it!

I’m a 35 year old male. I had a hair transplant 10 days ago (1400 grafts) and am due to have my stiches out on day 12 (the doctor said that 10 days is ideal – but today’s a Saturday).

I’m a regular gym-goer and would like to know when I can hit the gym to my usual intensity. My doctor said that I should exercise only lightly initially. But I’d like to get back to my usual heavy weights. When would you generally say is safe to lift heavily?

Many thanks!

Exercise after hair transplant surgery is a concern for many people who are physically active and want to get back to their normal routine. You are facing two risks after a hair transplant:

  1. The risk of losing new hair grafts from scratching or rubbing the skin of the recipient area. If the hair and scalp are washed well after surgery, the risk of graft loss after 3-5 days is small, as the risk occurs as long as the scabs are present.
  2. The incision in the donor area, which is primarily closed by sutures or staples. The body takes 3 weeks on average for the wound to be reasonably secure. The healing of the incision of the donor area follows a general wound healing process that is standard no matter where the wound occurs. The process of healing starts from the moment the wound is closed. The body lays down the supportive infrastruture of fibrin from which the stroma for a secure would builds. Any vigorous activity should be avoided within the first week and then any aerobics can be done as long as the wound is not stressed (no heavy weights at all). After 2 weeks, the strength of this newly healed skin is not anywhere close to its final level, but between weeks 5 and 6 it reaches better than 80% internal strength. You can probably start your regular aerobic activities after the first week (the sutures should hold the wound together), but no weight lifting should be undertaken for 4-6 weeks. The process of wound maturation takes up to six months after the surgery.
Tags: hairloss, hair loss, hairtransplant, hair transplant, exercise

My Daughter Had Lice and Is Now Losing Hair Where the Infestation Was the Worst

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

My 10 year old daughter had head lice at the beginning of the school year–shortly after, like 1 week, I noticed that she was very rapidly losing her hair..It appears to be concentrated around her ears and back of head, where the lice were the worst, and she scratched the most!! I took her to a ped dermatogist..she diagnosed her with alopecia areata..All the lab work was done, and it was negative.. I am not convinced that she has alopecia, I feel it is related to the lice!! Either an infection, or reaction from the Nix!?? Would love your opinion, please!! Thank you

Infestation with lice can cause itching due to an allergic reaction and inflammation to the bites. This is a known cause of hair loss. Any irritation of the skin in patients who are prone to alopecia areata, can aggravate its occurrence. Clearly the differential diagnosis is alopecia areata in conjunction with lice or lice by itself. If you cure the lice (easy to treat) and the hair comes back, then the diagnosis will be evident. Hopefully, if she has been harshly scratching the scalp, that could have caused the hair loss.

Tags: hairloss, hair loss, lice, infestation

Is Shock Loss Always Certain Without Taking Propecia?

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

Hi Doctor, im a 20 year old male and am going to get a transplant in a couple of weeks. The doctor is in India and seems to be pretty good. But my main question is regarding shock loss. in one of your posts you said that without taking propecia, shock loss could be permanent in the transplanted or balding area. is that a 100% case. If it’s temporary,what can be done to prevent or lessen it because if suddenly after shock loss there is nice coverage then people would be able to tell that something has been done. that defeats the whole purpose of a transplant. your opinion….

Shock loss, as was referred to in previous posts, is a state of losing miniaturized hair in the recipient area that could be seen after hair transplant surgery. It also can accelerate hair loss that occurs in prone individuals who are young (like you). Its occurrence is multi-factorial and may have to do with the patient’s individual susceptibility, degree of miniaturization, type and extent of surgery, and clearly, age. Some patients may never show shock and the loss may be negligible. As stated previously, using Propecia (finasteride 1mg) significantly reduced the rate of shock loss in our practice, and we recommend it to all of our male patients before surgery.

I have concerns that at the age of 20, without taking finasteride daily for a year or so, a hair transplant is something you may regret. I would strongly recommend that you not have a transplant without giving the medication a year to see what it would do. You have your whole life to do a transplant, but you can not undo it once it is done.

Tags: hairloss, hair loss, shockloss, shock loss, hairtransplant, hair transplant

Generic Finasteride Approvals

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

Hi Dr. Rassman,

I have been reading some things on the internet and I’m confused about whether the FDA really approved a generic for Finasteride last summer. I thought that Dr. Reddy’s Finast was approved, but I am not seeing it available yet. Any news on this?

All pharmacies will now fill generic finasteride prescriptions of the 5mg dose. There appears to be two producers for this medication, one comes from India and the other from Israel. The cost ranges between $54 (at Costco) to as high as $90 at some pharmacies. These pills can be cut into quarters with a pill cutter.

Tags: finasteride, propecia, proscar, hairloss, hair loss, generic, costco, pharmacy

I’m Using Olive Oil in My Hair

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

Olive oilMy hair is still thick, but it’s slightly receding on the left side, and a little from the front. I’ve using olive oil once a week, it seems like it’s ok, do u think I should keep doing that???

Do you use extra virgin?

I would add a bit of balsamic with a pinch of onion powder to make a great vinaigrette. All jokes aside, olive oil has been used as a wetting agent for the scalp. It has no value for hair loss, but if you like it, you can continue to use is relatively safely.

Tags: oliveoil, olive oil, hairloss, hair loss

Taking Biotin to Prevent Hair Loss?

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

I am a 22 year old male, and have just recently started noticing minor thinning in the front of my hairline. Male-pattern baldness runs in my family. I consulted a stylist who told me that taking a supplement with Biotin can prevent hairloss. I am not worried about regrowing any hair, as it isn’t a problem yet, only maintaining what I currently have. I ordered 3 month supply of Provillus, which contains both Saw Palmento and Biotin. My plan is to see if it has any effect or not. Is this a good approach and also what else could I do if this doesn’t help?

Why experiment when we know that if the diagnosis of genetic hair loss is confirmed, then finasteride works? Every day, every month, and every year you experiment, you will allow your irreversible hair loss to get worse and worse and worse and worse. Stop playing Russian Roulette. Biotin is no answer to your problems, unless you are deficient of biotin.

Tags: biotin, hairloss, hair loss

Bald People are Bitter and Mean Spirited

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

Dr. Rassman,

Why are many bald people bitter and mean spirited?

I haven’t been aware of that concept being part of the myths that are associated with bald men, but there are stereotypes that are unfortunately part of our culture. Some are realistic based on history, e.g. the man sick with tuberculosis would frequently become bald because of the wasting nature of the disease, so women looked for hairy men to avoid getting men who would not live long enough to support them and their children. Of course, women with TB also became bald, but as they were not looking to marry other women, the observation never took hold as part of the culture of the times.

Hollywood may be partly responsible for some typecasting. The romantic lover in films almost always has a full head of hair. The audience associates a full head of hair with virility and a high sexual drive. In old Hollywood films, the castrated priests (eunuchs) were often portrayed as totally bald men (this is not genetic unless they have a form of genetic alopecia that is relatively rare and takes the eyebrows, underarm and the pubic hair as well), linking the image of sexual impotency to their appearance, but that was a razor cut by the Hollywood make-up artist, not the impact of genetics.

Prejudice: In an issue of Men’s Health Magazine a few years ago, a study of the linkage between successful politicians and hairiness was made. Less than 10% of bald men got elected and made it to their political office. We see the same prejudice in job promotions, which seemingly ties trustworthiness to appearance. Could this have been the result of some defamatory movie, play, or novel that worked its way into our culture?

Bald men, unfortunately, take more than their share of hits. In the young man who is sensitive to balding changes, all of the issues involving health, sexuality, and styling come forward and feel ‘second class’. They feel excluded from the norm. When there is not enough maturity or a poor self-image, balding becomes a curse in the very young men. Imagine a lion without its mane (it would look like a lioness). For those targeted as victims of this typecasting, please realize that bigotry is bigotry and unfortunately it flies in the face of logic and common sense.

Tags: bitter, bald, men, hairloss, hair loss, mean

If I Lower My Hairline Now, I Won’t Have Enough Hair for the Top When It Balds

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

Hi Mr. Rassman,

A very worried man is writing to you. I am a Sikh and used to ties a turban for 8 years, but last year I decided to cut my hair. My hairline has receded considerably, and the hair on top is not thick, when light shines then alot of my scalp can be seen. However, there is too much hair on top for HT.

My worry is that if i lower my hairline, and dont have enough hair for the hair on top when its bald, then i will be left in a huge predicament.

You need a Master Plan for your hair loss. First I would need to know your age. Then I would want to know to what degree other men in your family have lost their hair. Next, I would want to determine your available donor hair supply so that I understand what you can depend upon for hair transplantation. I totally agree you need to balance the supply of donor hair with the worst case demand you might see from the balding. I would map out your head for miniaturization to determine where you are in the balding process and if you have your family pattern. Then, and only then, if you meet all of my requirements for a hair transplant candidate, I would plan out a ‘look’ with a hairline that will respect your long term ‘worst case’ scenario for hair loss. I generally like to put the hairline back where it belongs in a mature male hairline, but this does not include male Indians who have unusually youthful hairlines like what they had when they were 8 years old. Your concern of a hairline put too low for long term donor supply has not happened for me in all of the years I have been in this business and it should not happen to any competent doctor in the field either.

Tags: hairtransplant, hair transplant, hairloss, hair loss, hairline

Propecia Recently Has Lost Its Benefits — Should I Consider Avodart?

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

Hi Dr,

I’m a 41 year old white male who began to lose hair (rapidly)before the age of 28. I suffered through it until Propecia became available in January ’99. I had great success with it for several years. So much so that people thought I had a HT. Well, I eventually did have a procdure done, actually three,in ’01, ’02 nad most recently in November ’06. Most recently, Propecia has lost most of its’ benefits for me and my hair loss backward slide has led to the need for the 3rd procedure. Here is my question: Should I seriously consider Avodart?

Propecia has its maximum benefit after being taken on a daily basis for 1-2 years. It still has benefit by slowing your hair loss process. No drugs available today (Propecia or Avodart) will predictably reverse hair loss. It will only slow the process down with some predictability. You need to see a doctor who can discuss the risks and benefits of different medications. Generally speaking, we do not usually recommend Avodart because its long term side effects are not well studied and it is not FDA approved for the treatment of hair loss, but some of the reports coming out do show better results with Avodart when compared with Propecia.

Tags: propecia, finasteride, avodart, dutasteride, hairloss, hair loss

Diabetes and Hair Transplant Complication

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

I have a related diabetic question and would like your opinion… I am diabetic, and I had a 1000 graft procedure done at a reputable shop. I had a severe complication, my scalp ulcerated, the “skin” just disappeared and left me with a large hole. I then had to have balloons placed under my scalp to stretch the skin and two surgeries under general to close the hole. Do you have any knowledge or experience with such a disaster?

I generally tell my diabetic patients that they are no more at risk from a hair transplant than any other person. I would want to know more about the surgery and what happened at the time of the surgery. This complication is one I have seen before when poor decisions were made at the time of the surgery by inexperienced doctors. I am not saying that this is your situation, but if your doctor was a good and experienced hair transplant doctor, I would probe more about why this happened to you.

Tags: hairloss, hair loss, hairtransplant, hair transplant, diabetic, diabetes

Adrenal Gland and Hair Cycling

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

I have a follow-up question to your Dec. 5th entry entitled “Olux Foam and Dandruff”. I was wondering if the use of the topical steroids to treat psoriasis affects your hair loss. Like, does impacting your adrenal gland as you describe change the way your hair cycles? Can these foams do anything to your hair follicles?

Steroids can get absorbed through skin if being used on a large area of body surface, or if they are used with occlusive dressings. In these situations, the blood steroid level may go up and it will cause suppression of the adrenal gland. Steroids that are being used for autoimmune diseases like psoriasis shouldn’t affect the hair growth cycle if used conservatively and topically. On the other hand, anabolic steroids (another group of steroids), which are being used for muscle building, will increase speed of male pattern baldness. When too much of the steroids are used, hair loss might occur.

Tags: hairloss, hair loss, adrenal gland, cycle, steroid

Vitamin A – How Much is Too Much?

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

Dr, how much is too much vitamin a. I take supplements and a few of them have large amounts of vitamin a like 5000 iu of vit. a.

For most people, up to 25,000 IU (7,500 mcg) of vitamin A per day is considered by some authorities to be safe, but the Food and Drug Administration has established a daily recommended allowance (RDA) of 5,000 IU for vitamin A. Toxicity in the fetus of pregnant women may occur in doses above 10,000 IU. A complete analysis of vitamin A is presented in Solgar Healthnotes.

The dose should be adjusted for pregnant women and children and a doctor should be involved in that. If vitamin A is being used for treatment of vitamin A deficiency, higher doses are required and it should be done under a doctor’s supervision. Complications (overdose) include liver damage, hair loss, blurred vision, and headaches. Sound like you are in the normal dose range.

Tags: vitamin a, vitamin, supplement

Alternative to Propecia

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

I do not want to go on medications for the rest of my life. What are the alternatives to DHT blockers like Propecia (finasteride)?

Alternatives for finasteride (approved by FDA for treating hair loss) and dutasteride (not FDA approved for treating hair loss):

  1. going bald
  2. getting balder
  3. getting thinner and thinner hair
  4. receding hairline or hairless crown

The choice is yours!

Tags: propecia, finasteride, dutasteride, hairloss, hair loss

Hair Loss During Pregnancy

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

i’m in my 28th week of pregnancy and me and my husband whose a doctor noticed recently more hair loss and increase in body hair growth. i’m very concerned and worried. please help. Thanks in advance

I am assuming that the hair loss on your head and the growth of some body hair will be a temporary finding, which should stop once you deliver and reversal is most probable in the months following delivery. There are many hormonal changes that occur during pregnancy, so I would not get alarmed.

Tags: female, women, woman, hairloss, hair loss, pregnancy, pregnant