Transplanting Men In Their Early 20s

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

Dr. Rassman,
I am about to turn 23 and recently (though I believe it started a year or two ago) I have noticed more and more that my hairline is thinning and receding. The recession isn’t in the dramatic “m” pattern, more of a general recession all the way across, though when pulled back can definitely see the edges going back further (the furthest on the left, the hairline all the way across has become a bit uneven and can see lone hairs as well as other thinned hairs).

My main question is what your feeling on a hairline transplant would be for someone my age. I think I would be more than happy with a transplanted area about a half inch wide or so across the forehead(i’m not sure how many graphs this would approximate to…essentially lowering my hairline a half inch or so). The rest of my head, both behind the hairline and on the crown seem to all be fine. I know I saw a video on newhair.com which showed the results of someone 24 who had a transplant which prompted me to inquire for myself.

I greatly appreciate your time and information

I have transplanted hair in men of your age. There is no 100% applicable age rule, but there are some requirements that must be met, including:

  • Maturity
  • Realistic expectation
  • Being on Propecia
  • Enough balding to make a difference
  • Enough donor hair to do the short term and long term job
  • A pattern of hair loss that I can anticipate

It would be best to come to an open house event where you can meet with myself or Dr Pak, meet directly with a dozen patients who had the surgery, and view an ongoing surgery that day. There is no better way to do your research in my opinion.

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

High Altitude and Hair Loss?

/by William Rassman, M.D./5 /

Hi,

I have been using rogaine for many years. I have never been close to bald, but I started using rogaine as soon as I noticed small amount of hair loss. However, I am now shedding hair fast. In fact, at the current rate I will be bald within a couple of months. Is this normal? I am thinking that I have developed a tolerance to rogaine, maybe?

I moved from sea level to high altitude to live about one year ago. The excessive hair loss started about a month after moving to high altitude. Could living in high altitude (5000 feet) cause the hair loss? When I moved here my hair was very thick but one year later I am close to being bald.

PlaneI highly doubt high altitude has to do with your hair loss. Otherwise, being a pilot may be a risk for balding. I’ve read nothing about this phenomena (you’re the first person to ask this question) and I’ve yet to experience this in my one-on-one with patients over the years.

The most common cause of hair loss in men is genetic male pattern baldness. It is in your genes and it can happen relatively quickly. While it may be possible that you may have built some tolerance to Rogaine (minoxidil), the hair loss should not be as drastic as you describe it, especially if you are still using the medication.

Tags: altitude, hairloss, hair loss, minoxidil, rogaine

Antihistamine and Hair Loss

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

Im a 30 yr old male who just recently discovered a small round bald patch on my beard about 3-4 months ago.

I am an asthmatic and suffer from Seasonal Rhinitis (Hayfever). for the allergies, i take various antihistamines daily, namely Loratadine (Claratin) or Pseudoephedrine based ones…

My hayfever has been pretty bad over the last few months and i am taking a pill at least once a day round about the time this patch formed…

What started out as a little round patch grew over the last few months into a golf ball sized patch with no hair at all and im starting to notice very small dots forming on other parts of my beard as well as a small one on the front of my hairline.. Im really starting to get worried. I went to see a dermatologist who gave me topical steroid cream and minoxidil 5% as well as a zinc and vitamin C supplment which ive been using religiously over the last 3 weeks, but it has not slowed down the growth of the alopecia.

Last night i read on the leaflet for the antihistamines i take (Loratadine) that some of the adverse reactions to it is Alopecia. Ive also read on tihs site that a few people complained about the same thing, losing hair because of Claratin. I have not found much conclusive evidence online which link antihistamines with alopecia, but as of yesterday ive stopped taking the antihistamines and continuing treating the patch with the oiintments etc.

Is there any proof that there is indeed a link between antihistamines and alopecia..?

There is no proof there is a link between antihistamines and alopecia. Many drugs can cause hair loss as a rare side effect, but by far, the most common cause of hair loss in men is genetic balding. What you’ve described is patchy hair loss (even around your beard). This may be alopecia areata, but I would follow up with your dermatologist for a diagnosis. I did write about Claritin and pseudoephedrines before here.

Tags: antihistamine, claritin, hairloss, hair loss

I’ve Shaved My Head for 10 Years, I Think I’m Norwood Class 7 — Should I Bother Taking Avodart?

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

Dr. Rassman,

I am considering asking my doctor to prescribe avodart, I began balding around 19-20 years old. I shaved my head for past 10 years and now would like to explore my options. I am most likely Type VII but can see many blond immature hairs so makes me believe follicles aren’t dead. Do you think its even worth trying? And if so, what do you recommend? I am 31 if that makes any difference.

Norwood 7Let your hair grow out for about 2 weeks and then get an examination. You should get your hair mapped out for miniaturization to see where your balding pattern is now, since you don’t seem sure of your pattern and I’d guess that you haven’t had a doctor actually look at your scalp in quite a long time. Avodart (dutasteride) is yet to be FDA approved to treat hair loss, so if you have a doctor that is willing to prescribe it to you, it could be worth trying — but I couldn’t say without seeing you.

Tags: avodart, dutasteride, hairloss, hair loss

Using the Restroom During the Hair Transplant Procedure

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

Hi Dr Rassman,

I am a male and recently discovered i have interstitial cystitis. Am using minoxidil but cannot take finasteride anymore. So my questions is the following: During a HT session and when one is awake is it possible to do the procedure on someone who would have to use the restroom or are there ways to work around it?

Our patients have a private restroom available to them right outside the operating room next to where the transplant is done. Getting up during the surgery to use the facilities (as long as you let us know and don’t just jump up from the chair) is not a problem.

Tags: bathroom, restroom, toilet, insterstitial cystitis, hairloss, hair loss, hair transplant, hairtransplant

After 3 Weeks on Propecia, I Noticed New Hair Growth on My NOSE!

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

Hi Doc

About 3 weeks ago i started taking propecia(1mg) and roaccutane(20mg). I am 21 years old and yesterday i started noticing hair growing on my nose and lots of new hair on my head, its quite visible from close and it looks quite thick. I haven’t had hair on my nose before this… Should i continue taking the medication?

Propecia does not grow hair on your nose but it may stop hair from growing in your nose and in your ears if it has not started doing that yet. Minoxidil might produce hair loss in other parts of the body, but you are not taking it — and although Roaccutane (accutane / isotretinoin) can cause hair loss, some abnormal hair growth has been reported on that drug.

Tags: propecia, finasteride, hairloss, hair loss, roaccutane, accutane

I Have No Hair Loss, But I Want a Forelock Transplanted to Frame My Face

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

I would like to first say how much I appreciate your site here and how valuable a resource it is.

I am now 24 and have been fortunate to not have any experience with any extensive hair loss. It is not in my families history but I do take avodart at 2.5 mg just in case that I inherited the genes my uncle on my father’s side has. Strangely he (my uncle) has almost completely lost all the hair on the top of his head while my father has almost retained his preadolescence hair. They are both about the same age and well into their 60s. Anyways, I am seeking advice about something I would like to do about getting a forelock. I know this sounds strange but I am really into the look and being of the theatrical I would like to go into acting and I think a slight forelock at the front middle would frame my face nicely. Having some experience with photoshop I think I have a pretty good idea about how this would turn out. I think the look suits me (much as it does other actors such as Colin Farrel, but would not want mine to be so blunt). I would not mind sending you pictures of the befores and afters I have done.

I know it is risky even with medication but I am absolutely certain that I would like to have the procedure. Thank you for your time and feel free to get back to me at your convenience.

First of all, if you do not have hair loss, I would highly advise you reconsider taking Avodart (dutasteride) 2.5mg. I can’t see how your doctor could’ve possibly prescribed this to you! Not only can it affect your sperm production and the long term effects in young men are not well established, but as far as I’m aware, the dosage that has been commonly used (off-label) for treating hair loss is 0.5mg — so you’re taking 5x the dosage and you’re not even losing hair, I’m worried that you’re going to end up getting yourself in a corner. It is simply not a medication that has been FDA approved for treating hair loss despite the fact people do take it off-label.

If you are considering a hair transplant to your forelock you should start off by seeing a good hair transplant surgeon that you trust. If you are not balding and want a strong forelock (not a widow’s peak?), then it is pure cosmetic surgery, which is something that we do. I really cannot advise you on what you are doing or what my opinion is on your goal, because I really don’t know if you have realistic expectations and/or goals. These are things that need to be done during an office visit.

Tags: hairtransplant, hair transplant, avodart, dutasteride, hairloss, hair loss, forelock, widows peak

Master Plan for Hair Loss

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

What is the “master plan” you keep talking about?

The Master Plan I often refer to is what you will be able to accept in the future with respect to your hair loss. It is simply anticipating for your future hair loss pattern and having a “plan” to stay one step ahead.

As an example, if you are 21 years old and currently a Norwood Class 3 hair loss pattern and want a hair transplant in the corners of your frontal hairline, it may be easily achieved. However, as you age you may progress to a Norwood Class 5 hair loss pattern and you will be left with only that permanently transplanted corner hairline as you lose the surrounding hair. In other words, you would look like a freak! Your master plan should have been made to consider the possibility of future hair loss by mapping your scalp hair for miniaturization patterns. The master plan may have also included consideration for postponing a hair transplant surgery for a few more years or starting on a FDA approved hair loss medication such as finasteride (Propecia) or minoxidil.

Tags: master plan, hairtransplant, hair transplant, hairloss, hair loss, propecia, finasteride, norwood

In the News – Restoration Robotics and the Automated Hair Transplant

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

From the article:

A robot that can pluck and move individual hair follicles on a person’s head makes hair transplants look more natural than those performed by humans, a US company claims.

The robot can also perform the procedure twice as fast as human clinicians, with less pain and scarring for the patient, says Restoration Robotics of Mountain View, California.

Read the full text at NewScientist.com – Surgical robot gives hair transplants a natural look

I am well aware of Restoration Robotics. They approached me a year or so ago to obtain rights to use our U.S. Patent to perform such surgery. Dr. Pak was the engineer back in 1998 when he helped me design the first prototype. I am eager to finally see this project get on its way.

I must disclose that if they succeed, I have a financial interest in their success from the license grant.

Tags: fue, robots, robotics, hairtransplant, hair transplant

Over 2 Months After Transplant, I Colored My Hair and Now My Scalp Is Scabby and Raw

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

Hi, I am a male 25, I have had two previous hair transplants in the FRONT of my scalp..turned out GREAT. On March 4th 2008 I had my THIRD hair transplant on the CROWN area..I had 1500 grafts, its been two and a half months. On April 18th I coloured my hair. i didnt leave it on that long (10mins)… on the crown area I have scabs still and when i wash them off, the crown area is extremely pink and RAW with puss. Is this normal?

Also I lost MORE hair around the crown then before my surgery? no hairs have grown yet..is it normal for me to have puss and scabs two and a half months after surgery? Thanks

You seem to have two problems going on. Concerning the dye, you may have sustained a chemical burn and this can cause permanent hair loss. If you are losing more hair since the transplant I would want to know if you were taking Propecia (finasteride) before the surgery to protect against shock loss. The chemical dyes may have also impacted the hair you have in your crown area. See your hair transplant doctor and ask him/her to examine you and render an opinion. Pus and scabs two months after surgery is not a normal occurrence.

Tags: hairtransplant, hair transplant, coloring, dye, propecia, finasteride, chemical burn, burn

I’m Losing Hair on the Sides, But the Top and Front Are Fine

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

I’ve noticed lately that the sides and the lower back of my hair have gotten a little thinner in density. However, the front and top and upper back (crown) have remained the same density. Also, I there isn’t any receding in the front of my hairline or any loss in density there either. Looking through your website I saw something about DUPA and I was wondering is it possible I have DUPA? Is the loss of density on the sides of my hair a sign of balding ? Because the top and front and crown look fine and I thought balding occurred there first. I also recently lost a lot of weight and am continuing to lose weight could hair loss on the sides be because of that?

Thanks for any help you can give.

Typical male pattern baldness does not occur on the back and sides of the head, but I couldn’t say what you have going on without seeing what you’re talking about. To get that diagnosis, you absolutely need to get your scalp hair mapped out for miniaturization. This can be a serious problem, so do it right and have a good doctor manage you.

Tags: hairloss, hair loss, dupa

Does Scalp Tingling Mean Propecia is Working?

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

I ave now been on Propecia 1mg a day as prescribed by my Dermatologist. My hairline is not receeding, but the entire scalp except the sides and back is thinning to the point where you can see scalp at all angles. I have been on propecia since April, 22 2008. My question to you is is there a phase where the hair becomes thinner before propecia begins to work? I have felt tingling in my scalp since i have started it and was wondering if that’s a good sign that propecia might be working.

Thank You

You’ve only been on Propecia for about a month, so it is too early to see results from the medication. Wait out a full 8-12 months to determine what is happening to your hair and your response to Propecia. Tingling has nothing to do with hair loss or hair growth

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

Experiencing Regrowth with Propecia and Minoxidil Years After First Use?

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

Can a person still experience regrowth even after 2 years on Propecia and Minoxidil. And how long does it take for an intermediate hair to turn into a terminal hair with Propecia and Minoxidil?

It sometimes takes more than a year to get detectable results. Getting a ‘terminal’ hair where a previous miniaturized hair was before, has never been proven 1:1. We are guessing on what we see.

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

Propecia Estimates and Other Related Questions

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

I know you’ve treated many men with thinning hair. For men in their early thirties like me, what can you estimate are:

1) The success rate for stopping hairloss with Propecia alone
2) Cosmetic regrowth with Propecia alone
3) Reports of sexual side effects or discontinued use from Propecia alone?

How many patients do you have taking Propecia for more than 5 years?

I tried 1/4 Proscar daily but had awful side effects, and I believe Merck’s side effect percentages are low. My hair loss is in the “early” phase and only really noticeable to me when I obsess, but I’d really like to not have a noticeable bald spot any time soon!

You take Propecia, right? How long? What else do you do for your hair?

Thanks!

I have been taking Propecia (and no other medication to treat my hair loss) for over 5 years.

The success rates of Propecia depend on what you consider success. You will still continue to lose hair if you are genetically prone to losing all your hair but it may slow to a crawl. Propecia can reverse hair loss, stop hair loss, or slow it down. A small percentage of men (I really cannot give you a number, but it is probably greater than 10%) have good growth and some reversal on the top/crown area. A larger percentage of men (about 90%) have slowing of hair loss. Many of my patients have been taking Propecia for over 5 years without side effects. I routinely look at my patients’ hair under a microscope for a miniaturization study to document the progression.

You are asking a question that is tailored specifically to you and this is impossible because everybody has different results. Try to understand the “big picture”. Propecia is not a magic pill that cures hair loss. NOTHING does! Propecia is the best medication we currently have to treat male pattern baldness, though. You need to sit down with a physician and talk about all the risks and benefits and come up with a Master Plan for doing something (or nothing) about your hair loss. I know you are looking for specific suggestions by me, but you are not my patient and I can not examine you over the Internet.

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

Sleep Apnea, Milk Thistle, and Hair Loss

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

What a great web site you have here. I need your help. I’m 41 and have a good amount of hair. My hair is actually a little thinner on the sides and back then the top.(strange) I have been on Propecia with good results. My question is I sometimes wake up in the middle of the night with SEVERE scalp itch on the side and back of my head. I went to a derm and he told me to use Head and shoulders. That really hasn’t helped. I also have sleep apnea I think…(untreated right now). Can this cause hair loss? It is strange that my hair has seemed to thin in the donor area and not as bad on top.

As a side question I have elevated ALT liver test. I want to start taking Milk Thistle. Can this make hair loss worse or could it help? Thanks for all the great information on your site.

I highly doubt sleep apnea causes hair loss.

I’m pretty sure milk thistle will not cause you to lose hair, nor make existing hair loss any better. Milk thistle (also known as Mary thistle, holy thistle, or silymarin) is used by some to treat various liver ailments, but there’s no scientific proof to substantiate that. See National Center for Complementary and Alternative Medicine for more.

I don’t really know the status of your hair loss pattern other than what you describe. Perhaps you don’t have the typical male balding pattern? You mentioned thinning in the donor area (back of the head) — and this is not a typical balding pattern. I would express these concerns to your doctor who is treating your medical conditions. It seems you are trying to connect and associate everything with your hair.

Tags: hair loss, hairloss, milk thistle, liver, sleep, apnea, silymarin