Avoid the Scam – Hair Transplant Bait and Switch

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

Scam AlertI saw a patient last week who had a hair transplant surgery from a local doctor. He went in for a 400 graft procedure and during the middle of the procedure (while under sedation), he was told that the doctor was able to remove about 1000 grafts more than he paid for. He was asked if he wanted to pay for the extra grafts for a special “deal”, because the alternative was to throw them away. What would you do? He was sedated, but he wasn’t crazy to let the hairs go to waste. So he reluctantly agreed to pay more for the hair.

As a surgeon, I understand that the harvested grafts cannot be an exact number that was planned. While it does happen on occasion, the actual harvested grafts are either over or under the estimate. We (NHI) do not throw away any grafts (even if the patient cannot pay) and we clearly inform all our patients well before the surgery, before they are sedated. We account for every single graft and if the actual number of grafts is short by even one, we give the appropriate refund. I have always made this point clear to my patients and for those who are on a tight budget, I try to keep the estimated harvest amount slightly under. But if the actual number of grafts is over the estimate, then it is my issue and I do not let the patient worry about the fate of those extra hairs while they are still under sedation. I transplant the extra grafts for them. The point I am trying to make is that it should never come to this, and the patient and doctor should know what to expect and the range of payment before the surgery is even considered.

Shady business practices are unfortunately a hurdle in our everyday lives. Physicians are generally held to a higher standard and are more trusted by the general public than most professionals, so it is disappointing to hear stories like that. Even hair transplant surgery is a buyer beware market.

Tags: hair transplant, hairloss, hair loss, surgery, scam

Enlarged Vein After Hair Transplant

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

I am a 45 years old male who has underwent over the years several HT procedure. Since my last procedure April 2010 I noticed en enlarged vein in the left temporal area which I believed is an av fistula. I have two questions. Will this resolve over time? If not what corrective procedures can be taken to fix it?

Thank you

This is a very important point: If you had surgery with a doctor, you absolutely need to discuss any concern and issues with that doctor (especially if you had the procedure just recently). It is not because I do not want to help or I am trying to pass it along, but your surgeon knows your case and your issues the best. Baldingblog is not a place to get second opinions or get medical diagnosis.

With that being said, if you really do have a AV fistula it will not resolve on its own. Complications can include bleeding, an aneurysm followed by rupture, and internal bleeding below the skin. This can be a complication of any surgical procedure. For more information, please see:

Tags: surgery, hair transplant, complications, fistula, arteriovenous fistula, hemodialysis, hairloss, hair loss

Rogaine Worked Well at First, Then Stopped Working After 6 Months!

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

H I’ve been using rogaine for 6 months now, at first it worked very very well. A little time to get use to a routine but I stuck to it. I did shed at first in the first month but it grew back and it was great however in the last month I’ve started to shed again quite rapidly badly and I don’t understand why. I apply it exactly the same as I did before but I’m becoming very concerned about this. I’m not stressed at all all and live a healthy lifestyle

I’m coming to a conclusion that body is finally rejecting and genetics is winning, and I feel I should just stop (and save what I got left) but on the hand I’ve read numerous and numerous of horror stories that when stopped it gets even worse which I know is a fact – but then again I don’t know if it can get worse. I’m a 24 year old male, with everyone in the family having a health head of hair except my dad.

Thanks for taking time to read this!

Rogaine (minoxidil) typically does not work so fast, but it often stops working and it is not a truly reliable drug for treating hair loss, as the typical response is quite variable between different people. It usually takes about 6 to 12 months before you see some benefit. It seems you are having a different experience than most, but I doubt that the medication just “stopped” working. I would continue for at least one year.

Rogaine, however, is not the ideal treatment for hair loss in a young genetically balding male (your age). Finasteride (Propecia) addresses the balding problem directly and is the treatment of choice for your problem.

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

Kidney Disorder, Propecia and Rogaine?

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

Hi Doc
Can a person with Kidney disorder take Propecia or can he apply Rogaine.

Thanks

Finasteride (Propecia) is metabolized in the liver so the presence of kidney disease is usually not a problem for taking this medication. For liver disease, finasteride could be a problem and you must check that out with your doctor.

In the case of minoxidil, the presence of kidney disease will cause more retention of the drug in your body, so there could be a greater impact if you take regular doses of minoxidil as the blood levels may rise.

Tags: finasteride, propecia, minoxidil, rogaine, kidney, liver

Finasteride Dosage and Body Weight?

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

Hi Dr Rassman,
I am a big fan of your site, and you have answered couple of my questions via your blog.

I am 24 and been using finasteride 1mg generic per day for the past 14 months. I have got a receding hairline and vertex and it is on norwood 3 vertex. After started fin, there is an increase in the hair density at the hairline but vertex is continuing receding. I am obese and weighing 124 Kg (273 lbs) and my height is 5 feet 10 inches (177.80 cns). So based on BMI, I am weighing almost double than that I should be. I have gone through your site to find is there any relation between finasteride dosage and body weight. But I was unable to find an answer. should I consider increasing the dosage to 2mg per day to hold the hair I have. Waiting for your suggestion. Thanks a lot once again.

There is no evidence or reason for adjusting finasteride to body weight, but there is no harm doing it provided that you do not develop side effects (which may increase with a larger dose). I realize hair loss is an important issue to most readers here and most readers want to maximize their treatment, but increasing the dosage does not always mean better results.

Tags: bmi, body weight, hairloss, hair loss, finasteride, propecia

Propecia Is Growing Hairs, But Can I Still Have a Transplant?

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

Hi Dr. Rassman! Propecia is slowly regrowing some hair on the front half of my head, and even a few in the hairline. If I were to get a transplant to “fill in the gaps” one the new hair is regrown, will it go through shock loss or should the Propecia protect it like it usually does?

Yes, you can have a hair transplant to the balding area while you are being treated with Propecia. The drug should prevent shock hair loss if you do have the surgery, but the timing of transplants should be tied to a Master Plan which will ensure your long term results. The timing includes just how much of the balding area is transplanted and this depends upon not only the donor density, but the size of the balding area now (and in the future) as defined by a good mapping of your scalp for miniaturization. I cannot answer your specific question as it applies to your problem without an examination, because really it depends on:

  • Your expectations.
  • The degree of miniaturization you currently have and the extent of that miniaturization process.
  • The length of time treated with minoxidil and/or finasteride.

Your worst case scenario should be put in front of you, and this will depend upon your age, your expectations, possible donor scarring for strip harvesting, your family history and who you take after, etc. Get the point?

Tags: propecia, finasteride, minoxidil, hair loss, hairloss, hair transplant, surgery, shock loss

I’m Seeing Extreme Body Hair Growth from Propecia!

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

Hi Dr. I have gone through your response for this thread:

now this is my situation. I am also taking finasteride 1mg for the past 15 months and am taking fin only not minox .also experiencing the body hair growth. Before taking fin i was having more hair in my body than any one in my family. and now fin is worsening the situation. Actually am happy for what fin is doing for my head. But the effect of it on my body, am fearing of being called a MONKEY MAN!!. By the way am indian aged 24. on norwood 2 with thinning on crown and forehead.

As stated in my previous post: “Propecia (finasteride) blocks DHT. DHT is known to be responsible for secondary male characteristics, such as body hair. At least in theory, if you block DHT you would have less body hair. I have heard and seen on several occasions patients stating they got less body hair after a year of taking Propecia.”

Now you would be the 2nd person that has mentioned seeing more body hair as a direct result of Propecia. It’s interesting, but this can also be coincidence as well. As I indicated in the prior post, the increased body hair may also be due to the fact you are maturing into your secondary sex characteristics, since like the original poster you are also in your early 20s.

I’ve still yet to get any reports of this from one of my own patients, but I will make a note of your experience.

Tags: propecia, finasteride, body hair, dht

Accidental Double Dose of Propecia

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

What are the possible negative consequences of accidentally double dosing Propecia? Taking Propecia every morning has been part of my morning routine for about a year now. The other day, I’m about to leave for work and blanked out on weather I had taken my Propecia pill before I got in the shower (my usual pattern), and so I took what might have been a second pill in one morning. Should I be worried, can I ruin the effectiveness of the drug that way? I’m a 30-year old male, been on propecia since May 2009.

Taking a double dose of Propecia will not harm you or your hair and you should not be worried. There are no negative consequences. For that matter missing one dose would not harm you or your hair either. We are all human and we make mistakes.

Also remember that many men take 5x the Propecia dose everyday for certain prostate problems with only a slight increase in side effects. In fact, research has shown that 5x the dose of Propecia prevents certain types of prostate cancer…. but taking more will not make your hair grow better (in case you were going to ask).

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

Woman Losing Eyebrows Overnight!

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

(female) i woke in morning to find out that i lost 20% of my left eyebrow. my family doctor said it’s autoimmune problem and it can be solved with dermatologist and it will not move to other eyebrow. after almost 1 week my right eyebrow start getting thinner I’m so scared .what is that and do i’ll lose both of my eyebrows

i’m so panic

It would be incredibly odd for you to wake up with 20% of your eyebrow gone in one night, unless perhaps you applied hair remover to your eyebrow before you went to bed…

I would follow up with your dermatologist and get a confirmation of the diagnosis. Don’t panic, but just take it one step at a time. Some people seem to have the outside 1/3 of their eyebrow thin as they age. This may be genetic, but it wouldn’t occur all in one night.

Tags: eyebrow hair loss, eyebrow, hairloss, hair loss

Using Rogaine After a Hair Transplant

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

I was using Rogaine with some moderate success. However, I have just had a hair transplant. If I start back using Rogaine, will it: harm the newly transplanted hair? stimulate the new hair’s growth? have no effect?

Thanks!

If you saw benefits from Rogaine (minoxidil) prior to the hair transplant, you should get back on the drug since withdrawal may cause reversal of those benefits (meaning hair loss). The transplanted hair should not be impacted by minoxidil, but waiting until the scabs fall off is probably the best timing I might suggest. Or you may wish to talk to your transplant doctor about the best timeframe for restarting the medication.

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

Are There Downsides to Starting Propecia Early?

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

Here in England a nationwide pharmacy is running a “hair retention scheme” which basically seems to be a way to prescribe propecia. I went along for an appointment but was told that I was a Norwood II and I’d have to wait until I was a Norwood III before they would prescribe the drug.

Reading previous answers I assume this is because propecia does not seem to effectively regrow hair at the temples and because of issues around mature hairlines vs balding. I am a 20 year old male who has noticed a big change in my hairline over the last 18 months, including large amounts of hair shedding. Furthermore my father, who was very bald by 24 or 25, first noticed he was going bald when he was 20.

Would propecia be beneficial for a person in my situation? What are the potential downsides of starting it now? I have read a lot that as soon as you notice hair loss you should try and do something about it but my experience so far doesn’t seem to chime with that.

PropeciaI looked up the hair retention program you mentioned, and it sound like it is just Boots pharmacy’s way of marketing hair loss products.

Propecia is a medication that needs to be prescribed by a physician and it is for the treatment of male pattern hair loss. It works mostly on the crown area (rarely in the front corner areas for men with Norwood Class II or III) and it likely will not reverse the maturing hairline that we see in young men between 18-30 years old. That being said, many doctors prescribe it for this early frontal hair loss or maturing hairlines because they do not look for miniaturization, the cardinal sign of genetic hair loss and balding. Many men take it out of fear of losing their hair or on the recommendation of doctors who do not know much about the diagnosis of genetic balding. It does not work for frontal hair loss in most instances other than possibly slowing the process down, but is it the only real medication to address what you are going through.

There really is no downside to taking Propecia early on in the hair loss process, but if you are not balding why take a medication you don’t need? In the end, these choices are something you and your doctor need to discuss and come to an agreement. It sounds like there is some disagreement between you and your doctor.

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

Could Minoxidil and Finasteride Benefit the Same Follicles?

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

Dr Rassman,

My question is: does finasteride play any role in maintaining minoxidil dose-dependent hair?

I got started on 5% minoxidil topical in early Feb, 2009. My derm prescribed Finasteride oral 1mg/day too, but I did not pursue that medication due to the usual side-effects related concerns. There was an initial minox-induced shed: not a massive one, but scalp showed. Things started looking up 4 months later but then again in July/August a bout of minor shedding ensued. Survived that too. In November yet another shed started and this one was bad; short fine hairs all over the pillow in the morning. Scalp showed yet again, as bad as after the first shed in March. In December, I panicked, decided that Minox wasn’t working for me, and got started on Finstaride 1mg.

By mid-Feb this year, there was a sort of minor miracle on the top of my head. My hair is looking its best in maybe two years. I hope you agree with me that it’s unlikely that Finasteride started growing hair within 10 weeks of beginning its use. My (semi-literate) guess is that Minox first grew “peach fuzz”, which gave way to intermediate hair, which then was replaced by terminal hair. I suffered synchronized sheds, the last one being the shedding of intermediate hair. Maybe more sheddings are in store for me, maybe not.

To get to the point, I am so pleased with the result that I’ve gotten greedy: I want Finasteride growth too. No sexual side-effects so far. I’d like to press on with Fin, and reserve the option of discontinuing it in future if side-effects show up. I understand that that would result in catch-up loss, but then probably I’d be content with the hair that Minox grew for me.

Hence the question: do minox and Fin have a cumulative beneficial effect on the same hair follicle? Will minox-dependent hair too be lost in catch-up loss if Fin is stopped? If the answer is in the affirmative, I’d probably be better off stopping Fin right away, since I’ve been using it only for 3 months.

Thank you for a patient reading, and thank you for your time.

You would have to poll each hair follicle and ask them what they liked better. If you can not communicate with them, then you are like me who frankly does not know the answer to your question. My best guess though (keep in mind I could be mistaken) is that because the medications work in different ways and finasteride will not keep hair grown from minoxidil and vice versa, that the benefits are independent of each other. Many men do use both medications concurrently, and as long as you can afford both (and maintain the regimen) I say go for it! It’s ok to be greedy and want your hair to look as great as possible. If the meds work well for you, that’s great news!

While it is unlikely that any major hair growth you’ve seen in just 10 weeks occurred from finasteride, you could’ve seen benefits from the medication that have helped your hair look better overall.

Tags: finasteride, minoxidil, hairloss, hair loss, propecia, hair growth

Years Later, Is Hair Cloning Any Closer?

/by William Rassman, M.D./9 /

Dear Dr,

I remember first coming to your site back in 2006 when I first started noticing that I was thinning. I was obviously upset by this, but was excited about the possibility of hair cloning being 5-10 years away. The idea that you could get all your hair back was very appealing. Now 4 years have passed and I feel frustrated that very little has advanced in this field. I have seen the likes of Aderans, Intercytex, Histogen and Follica all make statements that they are on track to solve the problem, but no one seems any closer.

Do you think we are ever going to see this come to fruition or is it too difficult to crack? Also, what other potential ‘cures’ are being developed? Surely if someone achieves this they will become a billionaire. There is obviously lots of incentive. If you believe we see a ‘cure’ when do you think this will be. By cure I mean someone with extensive baldness being able to get all their hair back.

As I’ve said many times before (which is usually met with much criticism by some readers that think they know better), I wouldn’t hold my breath. We all want to wait for the next breakthrough, the next best thing, the next version, etc.

The idea of being able to clone hair for infinite supply is tantalizing, but I have not seen anything remotely close on the horizon. Based on press releases, some of these companies seem to be making small steps here and there, but we’re a long way off before seeing successful hair cloning available to the public. I do hope it would be in my lifetime, because my business will sky rocket! I mean, who better to do these cloning procedures than experienced hair physicians?

Tags: hair cloning, cloned hair, hairloss, hair loss, cloning

New Results from Histogen Announced

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

Dr. Rassman

I´ve found this new updates from Histogen(with pictures) and all this sounds very promising from my point of view. What is your opinion on this? Thank you for your time.

Histogen.com

An interview with dr. Gail Naughton: here

The new Histogen Hair Stimulating Complex (HSC) results come from a pilot study of 24 people, but I have no idea how many of those were treated with a placebo, how many actually saw results, if the results were sustained over time, if there were adverse reactions, etc, etc. Their site says Histogen will present the study at a conference in May, so I guess these questions won’t have an answer until at least then.

Tags: histogen, hairloss, hair loss, histogen hsc

Can Propecia Keep Frontal Hair?

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

Hello Doctor.

I’m 18 and my hairline, while naturally high, has been receding, especially at the temples. It is thankfully not noticeable at the crown yet. I’m in my school show and am forced to have a combover which is slightly embarrassing because it clearly displays my receding temples (although they have always been high) plus my hair is wavy/curly, so that just makes it look worse. Fortunately i don’t normally do a combover and just have it all combed towards the front… but anyway, im seeing a dermatologist on Tuesday. I’ve read that if caught early enough MPB can be slowed or and even halted when DHT is blocked, and that Propecia can do this. I just had a question about it.

I know its not proven to regrow frontal hair, however can it help KEEP the hair that is still currently there? And perhaps thicken the amount still left so it looks healthier? Also, what should i be sure to discuss with the dermatologist on Tuesday? To make sure i receive the best benefit as possible (no surgery please!) Thank you for your time!

Propecia does not usually regrow frontal hair, as you know. It may slow the recession a bit, but in general Propecia is not known to work well in the front (especially the corners). That being said, if you have genetic balding (your dermatologist can determine whether it’s MPB or a maturing hairline), I’d still get a prescription for Propecia since it may help slow your balding process down.

Tags: hairline, hairloss, hair loss, teen, propecia