My Doctor Gave Me Fluocinonide After My Barber Cut My Scalp

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

hello Dr. Rassman,
About a few months earlier, I had a stop at my barber and they accidentally cut my hair straight to the scalp. When I got home, at first it was just a tiny spot where there were no hair, and a few weeks after it started to grow bigger and bigger, it’s getting out of control. I went to my physicians and they gave me Fluocinonide to put on; it seemed to worked a little. It’s been a long time now and the tiny bald spot is no longer small. The hair around that spot are starting thin itself and turn white.

In addition, I sometimes comb my hair but my wife accidentally combed her hair with my comb and she also witnessed the same problem but it’s not as bad. It disappeared after a few days.

Please help me, thank you!

Fluocinonide is a potent steroid, and that alone can cause hair loss. I am not sure what your doctor was treating. Did you have a gash in your head that created scar tissue? This is not rocket science, but I can not tell what is going on without seeing you. If you doctor doesn’t tell you what is happening to you and what he is treating, then get a second opinion.

Tags: steroid, fluocinonide, hairloss, hair loss

If I Travel for SMP, How Long Do I Need to Stay in California?

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

Aloha, I’m interested in having the SMP procedure. Can you tell me the cost of a procedure, and how long would I have to stay in California since I’ll be flying in from Hawaii. Thank you.

Some men can just fly in and leave the same day for Scalp MicroPigmentation. It depends on how much time you want to spend on a plane in one day — and how long your SMP procedure takes.

If you need a second process, you can come back anytime at your leisure with the same travel schedule. Call our office at 800-NEW-HAIR if you’d like more info on scheduling, or send a good photo or two before then and we can talk.

Tags: scalp micro-pigmentation, pigment, smp, hairloss, hair loss, travel

Hair Loss and Getting Older

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

Hey Doctor Rassman,

Got a few questions:

1. Can you explain to me the link between aging/being older and male pattern baldness?

2. Do you think that any lifestyle or diet changes are effective at preventing MPB? Other than surgery and medication what else do you reccomend? Aerobic exercise? Lowering insulin levels?

3. I have heard that is better to start dealing with hair loss before it has begun. Is this true or even possible?

4. Have you had a HT yourself? You look great btw.

Keep up the good work.

1. Hair densities and thickness of the shafts can change with age. In some very elderly men, we see a condition looking like diffuse unpatterned alopecia (DUPA), which produces a see-through appearance of the donor area. Some doctors refer to this as senile alopecia.

2. Nothing that can be done with diet or lifestyle to fully prevent genetic hair loss. Just maintain a normal and healthy nutritional status.

3. From a social point of view, the earlier one starts medications like finasteride, the less advanced will be the hair loss. Hair transplants are another option that can and should be explored, but they are not for everyone.

4. Thank you. Yes, I had a bald crown. There are photos of my non-transplanted hairline and transplanted crown here.

Tags: hair transplant, hairloss, hair loss, diet, aging, ageing

How Long Could I Continue to See Amazing Finasteride Results If I Started in My Mid-30s?

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

Hi Doctor, Im writing you from Argentina. First Id like to thank you for such great information you provide here. Ive been using finasteride for about a year and a half and the results are amazing. No more hair loss and even some regrowth until the point that no one can tell that I was balding. Id like to ask you, because of your experience, how long do you think I can keep the benefits from the drug, right now Im 37, not planning to quit never!. Thanks a lot from down here!

It’s great that you’re seeing amazing results! I have had some patients taking Propecia for over a decade with good results maintained, but the amount of years that the regrowth will sustain really just depends on the person. Just because you started taking it in your mid-30s doesn’t necessarily mean you have more or less time to see benefits. It depends more on how deep you were into the hair loss progression when you started the drug.

Not every patient will have the exact same benefit over the same amount of time, so I couldn’t tell you how long you’ll continue to see these full benefits. Keep your fingers crossed that you have continued success for years and years to come!

Tags: propecia, finasteride, hairloss, hair loss

Lack of Donor Hair?

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

How common is it for a patient to be lacking in donor hair when needing a transplant? I hear a lot about issues of lack of donor hair and I was wondering if the majority of significantly balded patients actually face this problem.

The great majority of men have a good donor supply (I’d guess in the 99% range). The question that needs answering is — how does the supply balance against the needs for the hair based upon the degree of balding?

In men, under 1% have a condition called diffuse unpatterned alopecia (DUPA) where the donor supply and much of the recipient supply is poor, because of medical and/or genetic conditions. Documenting the presence of DUPA is critically important before a hair transplant is done, or the results will be a failure and the donor area becomes scarred.

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

My Doctor Said I May Have Finasteride Induced Telogen Effluvium

/by William Rassman, M.D./8 /,

Dear Dr Rassman,

I am a 21 year old male and have been aggressively losing my hair for just over 2 years. Since February, I have been taking Propecia daily to combat the loss. However, after about 1 month on propecia I have been heavily shedding my hair and this has been confirmed by a dermatologist who said I had a strongly positive pull test and a very high amount of telegon hairs. He stated that I may have finasteride induced telegon effluvium as well as accelerated phase male pattern balding considering my very heavy hair loss (have gone from a norwood 2 to norwood 4 in about 9 months).

Do you believe this could explain this heavy loss and is there anything else I can do to combat such such aggresive balding at such a young age? After 6 months on the drug, Propecia appears to make me lose more hair, minoxidil causes an inflammatory response on my scalp and a transplant is out of the question given my loss and age. I am at a loss as to what to do and it is severely impacting upon my life.

Many Thanks for your time

I would have to see and examine your scalp to understand what you are reporting. This could be just rapid hair loss from your genetic pattern and have little to do with the drug. Or it could be a shedding process that some people have reported after starting Propecia. It is a rare occurrence, but we’ve written about it before.

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

Can Pseudopelade Scars Be Cut Out?

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

Hi, I’m curious to find out if it is possible to cut out small scared areas when doing a transplant. I’m a 21 year old male and have many burnt out scars from the last six years of living with Pseudo-pelade.

It seems to have been inactive for a number of years and I’d like to get transplantation to get the density of my hair back with transplants into the small effected areas (about the size of a pen tip), however, is it also possible to make larger scars (about the size of the tip of the little finger in size and shape) made smaller by excision since I understand it is hard to transplant hair into large scars?

Thanks

Brocq Pseudopelade is a scarring alopecia and is difficult to treat. If the disease has taken its course and not changed much in the past few years, the objectives for a local small surgery are clearly defined, and if the area being addressed is located in a place that tends to heal well, then surgery may have value – provided that your expectations are not great.

For the general audience, take a look at this condition to appreciate the area needing treatment (photo link).

I just performed Scalp MicroPigmentation (SMP) on a very extensive case of this and although he would not grant me permission to post his before and after photos for this post, I have to say that the results were spectacular. Of course, this man had been shaving his head and was used to making everything seen uniform.

Tags: scarring alopecia, pseudopelade, hairloss, hair loss

I Am Worried About My Results After Switching from Name Brand to Generic Finasteride

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

Hi Dr.Rassman,
I am a 35 year old man. I used propecia for two and a half years, three months ago I switched to 5 mg generic finasteride because of the cost. The generic finasteride that I use is manufactured by TEVA and I bought it at walgreens. I have a few questions.

1) is this a genuine medicine? or should I change to name brand of finasteride (proscar)?

2) The reason I asked the question above is, I am cutting the 5mg finasteride into four peices and take one piece a day, I have noticed that the four pieces are not exactly the same size. However my concern is I ‘think’ my hairline is receding and my hair is thinning after switching to generic finasteride. is it a negative placebo affect? I would love to keep using the generic finasteride because of the cost but on the same note I dont want to lose my hair either.

Thanks

If the drug is not counterfeit, splitting the pill into quarters should not product a problem. You bought it at Walgreens, so I’d expect the medication is fine. Teva is the largest generic pharmaceutical maker in the world.

Cutting a 5mg tablet into 4 pieces would make each part 1.25mg, which is a little more than 1mg Propecia. That shouldn’t be a problem though, as you’re probably not going to get a perfect cut each time and will even lose a crumb or two in the process. It’s much easier to cut into 4 pieces than it is to cut into 5. If you’re concerned though, speak to your prescribing doctor or pharmacist about a different generic finasteride brand.

Tags: finateride, teva, hairloss, hair loss, proscar, propecia

I Starved Myself and Work Our for Hours a Day, Now I See Hair Loss!

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

I am 21 year old male. i started dieting in march this year….i was literally starving myself. add to that, i was spending 2 hours in gym (extreme workout). lost about 36 pounds in couple of months. as i was into 4th month of my diet, i began to loose hair, hair fall is still happening. its so extreme that i can see my scalp. i have no history of balding in my family. i am worried to death. i had such thick hair that i always did thinning shears.

actually it all became visible when i did thinning shears third month into my diet. maybe my hair had gotten very weak by then. meanwhile i did my thyroid test last week and was told that i have hyperthyroidsm. my tsh is 0.04….so what is wrong with me ?i see no regrowth till now, i am going to get bald.

plz help,plz plz plz

Your rapid hair loss can be caused by rapid weight loss. Starving yourself is not healthy or smart, and can lead to a variety of problems (hair loss being the least of your concerns). Hyperthyroidism can also cause hair loss.

I would want to know what else is going on with regard to your health. See a doctor who understands hair loss.

Tags: weight loss, diet, hairloss, hair loss, thyroid

Hair Loss After Open Heart Surgery

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

(female)
I recently had Open Heart Surgery (4/25/11) which lasted 2 days, I now have a mechanical aortic valve and have notice hair loss over the past few months. Is this common, especially since surgery lasted 2 days? I was sedated thru the night and surgery continued the following day.

Stress from a surgery can induce hair loss in predisposed people. Is the hair loss all over (telogen effluvium) or is it localized in a pattern? This is what a good doctor can tell you and then, after a proper diagnosis is in hand, treat it appropriately.

Tags: stress, heart surgery, hairloss, hair loss, female hair loss

Please Explain How Balding Skips a Generation

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

What exactly is meant by the phrase “balding/hair loss sometimes skips a generation”? I know it’s very complicated to say if this is true or not, but I was wondering what exactly it means. For example, if a family has 2 sons, one age 26 and one age 20, does it mean only 1 of them may keep their hair if balding skips a generation, or both? I hope you can clarify this a little bit as I am very curious as to what is meant. Thank you.

Not everyone in a balding family has the balding genes. Genes have “expression” which means that the way it shows up (for genetic balding) appears at different points in the life of the person carrying the gene. You might have the gene, but not show the balding until you are 25, 30, 35 or 40 and so on.

You may also have the gene and not express it at all. Or you may have the gene, but it is not dominant in you, so you will not show balding… but can pass it to your children who can then show balding. Without getting too deep into evolutionary biology, I hope this short answer does not confuse you further.

If you really want more details, research the work of David Balding, a UK-based professor that has written multiple publications about statistical genetics.

Tags: statistical genetics, hairloss, hair loss, family history

Hypothetical Transplanting of Thick vs Fine Hair

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

If two patients with similar hair loss patterns were to get a hair transplant, one with very thick hair, the other with finer hair but greater density, who would come out with the best results, and would the patient with thick hair end up paying less?

This is a great question. The more coarse the hair the greater the fullness, transplanted hair for transplanted hair. People with fine hair usually get the “short end of the stick” since they require more grafts and therefore (as the price per graft is what you pay for) the costs run up.

When a person with a medium hair or greater thickness comes in for frontal hair transplants, these patients often are easily completed in one session… while the person with a fine or ultra-fine hair will often require more procedures to achieve the fullness that they may want.

Tags: hair transplant, hair character, hairloss, hair loss

Spontaneous MPB Reversal?

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

In your experience, have there ever been any documented cases of ‘spontaneous’ male pattern baldness reversal? That is, are you aware of any cases where a bald male’s hair regrew without use of any treatment for hair loss?

No, but if you are aware of any complete reversals, I would love to know.

I have seen near complete reversal in some rare cases where men under 35 years old have reversed their balding after taking finasteride. Some men with telogen effluvium may lose hair temporarily, but it is rarely in a typical pattern and is more diffuse.

Tags: hairloss, hair loss, mpb

Bell’s Palsy and Hair Loss?

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

Hi doc, i have had a case of Bells Palsy due to extreme stress 1 year ago. After that experience i have had my hairline on the RIGHT recede. Is this due to Bells Palsy? does it have any connection with hairloss? Or is it because im constantly stressing about my condition of Bells Palsys? i have yet to recover 100%. I am about 85% and this is as far as will ever recover. Also the Bells Palsys affected my right side of my face. Please, any help would be great help as i am only 23 living day to day to try and hide my hairline. thank you doc.

Bell’s palsy is probably a viral condition. Extreme stress can cause acceleration of genetic hair loss, so that is how these two conditions are probably linked.

Tags: hairloss, hair loss, bells palsy

Some Men Still Want to Take Propecia “Just In Case”

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

Say if, hypothetically, finasteride would be effective for me between the ages of 20 and 30, would starting propecia at the age of 30 mean that it’d be effective until I’m around 40, or would the age of 30 just be the definite age where the drug stops working? I was wondering because I am unsure if I am losing hair or not, but thought that taking propecia would be a good precaution. However if it turned out I wasn’t experiencing any hair loss, but then later in my life started to thin out, would I have wasted my ‘effective propecia years’?

I have had some patients on finasteride (Propecia) for more than 13 years with benefits that still haven’t subsided since they first began. There’s no definitive timeline that you’ll see benefits, but the best time to start it is when the hair loss is in the early stages. Some men notice some hair loss again sometime after the 5th year of taking Propecia, and maintaining all of the regrowth for a decade or longer isn’t guaranteed… but each person is different. If you took the medication for years, saw benefits, and then stopped the medication once you thought it wasn’t working anymore, your hair loss would accelerate to the point that you would’ve been at had you not taken the drug at all.

If you are uncertain if you are balding, you should see your doctor. Propecia is a prescription medication, and your doctor will be able to determine if you’re losing hair and are a candidate for the medication. Otherwise, taking a hair loss drug if you don’t have balding makes no sense to me. You shouldn’t take it for preventive measures.

Tags: finasteride, propecia, hairloss, hair loss