Good Surgical Candidate Vs Bad Surgical Candidate

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

Dr. Rassman,

Thank you for your very informative blog, it’s a daily read for me.

My question for you is simple. I’ve heard Dr. Bernstein say that one of the reasons why he has not undergone a surgery is because he is not a good candidate.

First, what makes him a bad candidate, and second, at what age would it have become apparent that he would become a bad candidate? I’m only 29, and although I’ve been told that I’m a good candidate for surgery now, I worry that down the road I’ll turn into a bad candidate because of future loss or donor thinning.

There are many things that make someone a good/bad candidate for hair transplants. A key problem for any candidate is a low donor density and a large balding area, which may mean the donor supply is insufficient to address the needs of the recipient area. I have had many patients that ran out of donor hair before they completed the transplant procedures they could’ve used. That is why I always stress a Master Plan for anyone undergoing a hair transplant.

Someone like Dr. Bernstein, with low density and a very large bald area, needs a great deal of hair to achieve any degree of fullness. The most he could have accomplished is to transplant the frontal area and leave the crown bald, so maybe he felt that the benefit was just not there. Dr. Bernstein is happily married and is not motivated to change his look. He looks handsome with his short hair style and is satisfied with that.

For you, at 29 years old, with the early use of Propecia you may slow down or stop the process and if your hair loss is confined to the front and top, then transplants may offer you a good option later if needed. Too many doctors want to push patients towards hair transplants because that is what they do for a living. The not-so-good doctors just do transplants without a Master Plan communicated to the patient. Many patients want hair, will pay for hair, want a bargain for the graft cost, and really have no concept of a plan.

In reality, they get no bargain and will pay for that ignorance in the future when their hair loss gets out-of-control and they find themselves out of hair and money. I see people every day in this situation and somehow I can not get the message out there that everyone needs to plan ahead for their worst case hair loss, because they will continue to lose hair for the rest of their lives. The question that should be addressed, as you so nicely pointed out, is about what you will look like 5, 10, 20, 30, and 40 years later.

Tags: surgical candidate, hair loss, hairloss, hair transplant, hair restoration

Using Chest and Back Hair When Scalp Density is Low?

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

I am Norwood 6/7. I had a nice transplant to the front 1/3 of my head, which frames my face well. Unfortunately, the density of my donor area is on the low side. I have VERY heavy body hair on my chest and back.

Would this be an acceptable situation to transplant body hair to crown area?

Body hair is a difficult call for me. I have tried using it and have not done well with it. Aside from the physical characteristics of the body hair, the growth cycles are different from that of scalp hair.

There are a few doctors who claim to specialize in using body hair for scalp transplanting, but I am skeptical that the results are as good as claimed. The patients I’ve seen in my office with body hair transplanted to the scalp at other clinics have been less than impressive. If you’re considering body hair transplants, just be sure to meet with patients that have had it done by the doctor you’re considering so that you can see the results for yourself in person.

Tags: body hair, bht, body hair transplant, hairloss, hair loss

Taking Finasteride After Kidney Transplant?

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

Hi
I had a kidney transplant 5 years ago. I use immunosupresants (Tacrolimus 2 mg/12 hr and micofenolic acid 1 g/12 hr). And im balding :(

Is it safe to use Finasteride to help regrow some hair?

Finasteride is a safe medication, but before you start or stop any medication, check with your doctor who knows your medical history and medications. This is not a place to receive personal medication reassurance or endorsements.

You may not even have androgenic balding and finasteride may not work for you. I don’t know enough about your medical or hair loss history to make that determination. Since finasteride is a prescription medication, your prescribing doctor will be able to tell you.

Tags: finasteride, propecia, kidney transplant, organ transplant

Did Propecia Just Go Up in Price?

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

Hi Doc.

My Propecia price have just been raised almost 20% from one day to another. We have a different currency in my country, but the price was 79 US-$ before pr. month and now it’s 100 US-$. This seems extreme. I’m buying Propecia on prescription and at a pharmacy so I’m buying it legal. Have you heard anything about this???

Please help!

Best regards!

I don’t know anything about international Propecia pricing. You might want to call around to different pharmacies to see if perhaps it isn’t increased everywhere. Any international readers out there experience a recent price increase?

My costs for Propecia have not changed in a while. The price did go up about a year and a half ago, but currently we sell it for $190 for a 3 month supply (which breaks down to about $63/mo).

Tags: propecia, finasteride, hairloss, hair loss, medication, cost

My Doctor Said I Have TE, But I Haven’t Seen Regrowth in a Year

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

Dear Dr
I was last september diagnosed by a GP and dermatologist with TE on a degree of MPB. To date I do not seem to have seen any regrowth. I was wondering what my chances of recovering my hair are given the combination of the 2? How long can it take and will all the lot hair regrow as minituraized?

I have a bald father so the MPB gene is in the family. I have recently started to try propecia in case the TE hair loss is permanent.

Thanks

Telogen effluvium (TE) is diffuse thinning of hair which can last 6 to 12 months before you see some improvement. Often times I have found that the improvement is not dramatic and many patients complain that their hair never grew back to its original density. Propecia or any other medications do not help with this type of thinning. TE resolves on its own with time, so any products you try will just be a waste of money.

Male pattern baldness (MPB) is patterned thinning — hair loss from this is permanent, though the pattern depends on what you were predisposed to genetically. Propecia or Rogaine can help with treating MPB, but neither medication will stop or reverse the process forever. In the end, hair loss it is a genetic trait you were born with. In other words… the medications delay the process, but they aren’t a cure.

I realize this may not be what you want to hear, but you need to know the facts as well. There is no prognosis I can give you, because everyone is different. The best person to speak to is your doctor who has examined you and made the diagnosis. You are welcome to visit us or go to another doctor for a second opinion.

Tags: mpb, telogen effluvium, hairloss, hair loss, propecia, minoxidil

Are My Antibiotics Causing Hair Loss? I Read They Can Cause Growth!

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

Doc,

Was put on antibiotics for a persistent infection. After 3 weeks of cipro was switched to doxycycline. 2 weeks into that noticed extra hair loss. one week was looking at my hair commenting how well it was doing and a week later noticed much more thinning at the hairline and crown. Are you familiar with any connection between these drugs and hair loss in clinical practice? I suppose any drug could cause TE, huh?

Ironically on some hair loss sites I’ve seen references to monocycline to actual hair growth.

Thanks

Why are people so caught up trying to associate hair loss with a certain medication? First of all, you’re taking antibiotics to treat an infection. It is just a wild guess, but have you considered other reasons why you would be losing your hair… such as the infection that you are taking the antibiotics for, or genetic causes, or just coincidence?

While it’s not out of the realm of possibility that the medication could be the cause of your hair loss, neither doxycycline or ciprofloxacin list hair loss as a common side effect. I don’t know that either officially list “hair growth” as a side effect either, but it wouldn’t be the first time someone attributed weird side effects to various treatments.

Tags: antibiotics, infection, hairloss, hair loss

Does Cutting a Month of Proscar Really Lose Effectiveness?

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

Does cutting Proscar a month’s in advance really reduce its effectiveness?

Cutting a month of Proscar pills (5mg finasteride) in advance could reduce the effectiveness like any pill would if exposed to air and humidity for a prolonged period of time. I don’t know what the exact point is that the medication starts to degrade, but that’s why I suggest splitting one pill at a time. The protective coating on the outside is what extends the life of the medication, and a cut pill obviously loses some of that.

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

My Hair Seems to Be Getting Thicker After Stopping Propecia

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

I have quit taking propecia for 2 weeks after being on it continously for 4 years. The past year (while on it) my hair on top seems to be getting thinner. I am Norwood 2 and age 41. These past 2 weeks off it my hair on top seems to be getting thicker. I am confused because I cannot find any research to confirm this could happen. Any ideas?

I don’t have a clue. This is definitely something that you should talk with your prescribing physician about, as it is most unusual. Something doesn’t add up…

Tags: propecia, finasteride, hair loss, hairloss

My Donor Hair Got Weaker After My Hair Transplants!

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

I’m a year post-op on my 2nd HT procedure, 6300 grafts total including my 1st round.

While my results are dramatic and I am quite pleased for the most part, the crown area is still somewhat sparse, and upon my recent 1-year follow-up, I am told there is the issue of some donor hairs that have, according to my doc, become thinner in diameter or possibly even miniaturized due to genetic programming that came with those grafts (in other words, at the time the grafts were transplanted, they were of even diameter and size, but some weakened and shrunk according to him). He took some extreme closeups and showed me the photos on a computer.

I had always believed from my research, that miniaturization is halted or cannot occur in transplanted hairs. Is this not true, and what do you recommend to protect my investment other than finasteride and/or minoxidil?

It’s difficult to provide an accurate answer to your question, because I do not know what you have…

Donor hairs do not normally miniaturize for men with male pattern baldness (MPB), so I must assume there is something more going on or there’s something that wasn’t diagnosed. I would ask your doctor about the cause of your problem and what you can do to for it (in other words, you need a diagnosis). If you do not receive a satisfactory answer, get a second opinion from another physician!

For example, I have seen a few patients over the years who had hair transplants by other doctors, but didn’t know that they had diffuse unpatterned alopecia (DUPA). Their donor hair had significant miniaturization and the transplanted hairs eventually were also miniaturized. I am not implying that you have DUPA, but this gives you an idea of how things are not so simple when undergoing a hair transplant.

Tags: donor hair, hair transplant, hairloss, hair loss

How is a Year of Finasteride Just 60 Bucks?

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

Hello Doctors,

I would like to comment on a response from a doctor to a previous post, which stated:

“If you cannot afford Propecia (1mg finasteride), there is generic 5mg finasteride for sale at a cost of around $60 a year. Yes, a year. Any pharmacy will have this 5mg generic. You just need a doctor that will prescribe this higher dose to treat hair loss (it’s a prostate medication otherwise), and you’ll need to cut the pill into 4 pieces (easier than cutting into 5 parts).”

I would like to know if Dr. Rassman or Dr. Pak prescribe a generic of finasteride? Also, can you provide more information about the generic that costs $60 a year (sound too good to be true).

Thanks

We do prescribe the generic 5mg finasteride to patients that request it. The pills are quite low cost and since they need to be cut into 4 pieces, it makes a 90 day supply turn into a 1-year supply.

The 1mg finasteride (Propecia) is not available legally in the US due to patent laws, but I read that the patent is expiring in late 2013. In the meantime, the 5mg dose is available in a generic at any US pharmacy… you just need your doctor to prescribe it to you with the knowledge that you’ll cut the pill before taking it. The 5mg is available because it is a prostate medication… 1mg is for treating hair loss.

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

Teen Girl Losing Her Widow’s Peak

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

dear doc,
i am a 15 year old female and im starting to bald. its scaring me very much. i have a not so noticable widows peek and im thinning really bad rite there. also on the side of my head by my temples and a small patch on the back. if you could please please answer me back that would be great!!

I tried replying to you directly, but the email bounced back. Folks, if you want a better shot at a response, use a real email address please.

There’s many possible causes of female hair loss, including birth control, stress, malnutrition, iron levels, etc, etc. You can learn more about this here. You should talk to your doctor about this and get a parent involved. There’s no easy answer I can give you, unfortunately.

Tags: widows peak, teenager, female hair loss, hairloss, hair loss

Hair Loss from Coronal Brow Lift Scar

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

I had a coronal brow lift in Feb. 2009. I had a wider than desired scar. I also had a spot the size of a quarter of permanent hair loss. The plastic surgeon who performed the brow lift has tried to do a scar revision by excising the scar. But I am 3 weeks post revision and I see where all along the new revision scar I have hair loss. The line where he cut is pencil thin, but I have hair loss in front of the scar.

Is this going to be permanent like before? I thought that maybe the staples I had in initial surgery were the problem. But he used sutures to do revision and I still had hair loss. Why is it that every time my scalp gets cut I have hair loss in front of the scar? And what can be done to fix this?

Thank you

This is a real problem. You must wait out the course (about 4-6 months) and then you will know if the surgery succeeded. I suspect that you will see that the scar is the same or worse and the hair loss may not go away. I see many female patients with this problem and end up transplanting most of them with good results.

Tags: brow lift, browlift, coronal brow lift, scarring, hair loss, hairloss

Graft Counting, Large Session Discounts

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

Hello Doctor,

How are ya? I’m 26 year old Male and have been using the Finasteride (5mg cut into 5 pieces) over past 2 years. I’m very happy with the results so far. Although the side effects are very mild, I wish it could reach absolute Zero. I had miniaturization of 65% in frontal region two years ago, I use to see my scalp under normal sun light and it was very awful. Now i believe my miniaturization is less than 65% (not sure as i have not consulted NHI) and follicles are more thicker and stronger, However i can see my scalp under certain circumstances (when its Wet/Windy/bright light)

I’ll be get getting married in 2 years and i’m considering hair transplant for thicker, natural looking hair. I wanna consult you or Dr.Jae Pak so that i can get better idea (i stay in TX and have to plan my travel, i’ll be SF from 9/30 – 10/4 but will be missing the open house event on 10/7, I couldnt get an appointment within that time).

My question to you is, Would it possible to reduce frontal hair line, as i have M shaped hairline? Also would it be possible to do a transplant in between existing hair follicles? (i have a thin frontal region) Also if i do continue using Finasteride would it be possible to reduce the shock loss to 0%?

I have another question about the fees for the hair transplant. The website says Dr.Jae Pak charges $6.00/graft for the first 2500 grafts and $2.50/graft over 2500. Simple math its gonna cost me $6000 for 1000 grafts and $6250 for 2500 grafts. what if dont require 2500 grafts to cover my bald region? choosing 2500 grafts is good value for money. Also during the transplant how do you count exactly 2500 grafts? to put an another way how can i make sure you transplant 2500 grafts.

Thanks in Advance.

You got the math wrong. It would be $6/graft up to 2500 grafts. On graft #2501, 2502, 2503, and any beyond the 2500th graft, it would be $2.50 per graft. It’s a discount for larger surgeries after you reach a certain graft number, but it doesn’t make all the grafts cheaper once you reach a threshold. So if you schedule surgery with Dr. Pak for 2500 grafts at $6 each, it would be $15,000; for 2502 grafts, it would be $15,005. If your schedule is flexible, NHI also has Standby pricing at $5/graft (plus the large session discount of $2.50/graft for those grafts above 2500).

I’m sure we can lower the hairline, but without seeing you first I can’t make any suggestions on where your hairline should be. Shock loss can be reduced with finasteride use before surgery, but I don’t know that it can make sure that every single existing hair stays in. Your hair normally cycles anyway.

As for graft counting and making sure you get what you paid for, see here: Hair Transplant Doctors That Charge By the Session vs By the Graft.

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

How Can I Thicken My Side Hair to Blend with My Hairpiece Better?

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

I’ve worn hairpieces for years and have been generally satisfied with them. As I’ve aged (now in my 60’s) my side hair has also thinned considerably–but it’s still there and I wonder if anything can stimulate its growth? I don’t expect crown hair, of course, but thicker side hair would make wearing a hairpiece much easier and more natural, as there’d be a better base to “comb into”.

Any thoughts or suggestions will be much appreciated. Thank you.

Usually you cannot thicken or regrow hair on the sides unless you have a hair transplant to add the hairs to those areas. Sometimes minoxidil might work. These are generalizations though, and your case may or may not be amendable to either of these two approaches. You should speak with a hair transplant doctor to get a better idea of what your options are.

There are significant number of patients who do have hair transplants to augment their hair piece. Some have hair transplants to the frontal hairline so that at the start of the hairpiece it would look more natural.

Tags: hairpiece, hair growth, hairloss, hair loss, toupee, wig

After 8 Years on Propecia, I Think Stress is Causing Noticeable Thinning

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

Dr. Rassman,
Thank you for providing this informative blog.

I have a question, I have been taking Propecia for 8 years now. But in just the last 3 months I lost hair noticeably in the entire area from the mid section to the front hairline. I think this is the result of stress, lack of proper sleep and not using Minoxidil since the beginning of the year. Can I “hope” that if I start Minoxidil 5% (I had used 2% for over 12 years), reduce stress and get more sleep, I may see some of that hair back? My experience so far is that once I lose hair, it’s gone, I just try to keep what is there.

I’m 48, male, and have had 5 transplant procedures over the last 14 years.

Thank you!

There’s no clear cause for the rapid hair loss you’ve seen in the last 3 months. Since you have had multiple hair transplant surgeries, perhaps you should follow up with your transplant doctor and get a good examination.

The hair loss could be stress related, but it can be anything. You can try getting your stress under control to see if that helps slow the loss down, but I cannot provide more input from such limited description.

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