I Had Brain Surgery and Want to Fill in the Scar, But I Also Have Early Balding

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

I have a scar from a previous brain surgery. I went to hair transplant surgeon and he estimated that it would take about 300 to 400 grafts to adequately cover the scar.

However, I am 18, and I’m already experiencing balding. My dad (and most of my male relatives on his side) are diffuse NW6s, so I’ll probably be heading in that direction. Furthermore, I have straight black hair and brown skin, with a lower-than-average density.

Would it be smart to put off the filling in of the scar?

Basically, I don’t want to unnecessarily deplete my donor supply.

At NHI, we have good experience in addressing brain surgery / craniotomy scars with hair transplants. In general, patients usually need more than one surgery to be adequately satisfied, so be prepared.

If you are balding to a Norwood class 5 or 6 it may not be advisable to fill in the scar unless you plan on having a full hair transplant surgery and have adequate supplies of donor hair.

Tags: scarring, brain surgery, hair transplant, hairloss, hair loss

How Is it Even Possible for Finasteride to Worsen or Accelerate a Receding Hairline?

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

Some claim that finasteride has, overtime, worsened and accelerated their receding hairlines. Is this medically possible? Or is what they’re seeing just a result of aggressive MPB that hasn’t responded to the drug?

Thanks!

I do not know why finasteride would worsen hair loss. It is a drug treatment that slows down hair loss. Finasteride does not work well on frontal hairlines, but this does not mean it makes it worse. Perhaps in the process of slowing down the top/crown area drastically with not much effect on the front hairline, the overall perception may seem as if the front is worsening faster. I really do not know, though. This is just my speculation.

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

If a Man Gets Castrated While Losing Hair, Does the Loss Just Stop Immediately?

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

Doctor Rassman and Pak

I have a question about castration. Does castration only stop hairloss if a person were to be castrated before puberty(hence before male pattern baldness starts), or does it also stop hairloss once hairloss has started as well? for example lets say there is a 30 year old with active hairloss, he gets castrated, does the loss stop, or will it still continue regardless of the castration?

Im not thinking about castration lol, just want to know for knowledge purposes

My educated guess is that once the hair loss starts you cannot completely stop the process even with castration for the hair that is scheduled to be lost (i.e. apoptosis). I could be way off base, though. I’m not going to suggest castration to prove it one way or the other.

Tags: castration, hairloss, hair loss

Is Having 3600 Grafts Transplanted in One Procedure Safe?

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

Hi Drs. Rassman and Pak:

I was concerned about the recent story you posted today (8/9/12) of the guy who had a 3,000 graft transplant that failed. I consulted a very reputable transplant doctor in La Jolla (who will remain unnamed) who was/is prepared to transplant 3,600 FUs in one session on me because I have good scalp laxity and a good donor supply (I’m 54 by the way and never had any hair loss until about age 45 or so).

But now I am worried. Is this safe to do (3,600) in one procedure? Don’t you usually limit your procedures to about 2,000 grafts at a time, give or take (that’s all you did for Jon Gosselin on the TV show that was broadcast)?

Incidentally, and I don’t know if this is important, but I am one of those anti-Propecia people. I want hair, but not at the cost of taking Propecia. Never took it and never will. I’m not trying to stir that pot again, so don’t get me wrong, and I know many people disagree with me and that is fine. But I have made the decision never to take Propecia, ever. It’s just a horrible drug, in my opinion. If other people want to take it, that’s their business, it’s their funeral as far as I’m concerned and I couldn’t care less. Another way of looking at it is it’s none of my business.

So again, is 3,600 FUs all at once over the top, crazy? Risky? You know what the great British entrepreneur, Freddie Laker (of the now defunct Laker Airways fame),once said, “The only way to get ahead in life is to take a little risk and have a little luck.” I think that is very true. True with hair transplants too.

Thanks for the great blog.

We have performed as many as 5400 grafts in one surgery at NHI. That particular patient had an unusually high donor hair density and very loose scalp laxity. In general, a 3600 graft procedure is considered a high number, but along with this high number of grafts comes the price of a longer and/or higher scar. As I’ve written on this site before, I’ve had three strip surgeries totaling 2200 grafts and have a barely detectable scar. If your laxity allows it and your donor supply is good, the 3600 grafts in one surgery might be achievable.

I hope you can realize that every person is unique, and their goals and needs are highly individualized. Some people may not care and want one large surgery to be done with the process. Some people choose to have the procedure in stages (multiple procedures over time). This is why choosing your doctor and having them explain all these options is critical.

I often get emails from patients who are price shopping and care only about the monetary cost involved. They miss the point that cosmetic surgery / hair transplant surgery is not like buying a car where you get the same vehicle at a variety of dealerships.

Tags: hair transplant, hairloss, hair loss

FUE Without Shaving the Donor Area for African Americans?

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

Hi Dr. Rassman,

I want to thank you for developing the new FUE technique that does not require shaving the donor area. I am wondering if this technique has been tried and tested on African Americans given the curly nature of their hair. When I came for my FUE, I actually had to keep indoors and avoid contact with the general public.

I would certainly consider this technique for future transplants if it works for African Americans.

Thanks

I have not tested or tried the long hair FUE procedure (mini FUE, mFUE) on the kinky hair character of African-Americans. I do not see any barriers for the technique itself as we have been doing this type of surgery (FUE) on African-Americans for many years.

The difficulties of performing FUE on kinky hair should be the same with the hair long or short. In general, FUE on kinky hair is difficult for the obvious reason that the hair turns into a ‘screw’ shape below the scalp skin.

Tags: follicular unit extraction, fue, hair transplant, african hair

I Was Diagnosed with Telogen Effluvium a Year Ago, But My Hair is Still Falling Out

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

Hello

I am a 30 year old woman and I have been experiencing hair thinning especially in the front. I did a hormonal test a couple of years back and it came ok. Last year a dermatologist in Atlanta did a Hair and I was diagnosed with TE. He did nothing but to prescribe vitamins. My hair loss has not stopped. What shall I do? can you suggest a doctor or a treatment?

You should perhaps consider seeing another doctor for a second opinion, though I don’t have any personal recommendations in the Atlanta area.

In general, there is no definitive cure for women’s hair loss once other medical causes have been ruled out (anemia, thyroid conditions, etc). If you do have telogen effluvium, hair generally grows back after about one year.

Tags: telogen effluvium, hairloss, hair loss, female hair loss

Should I Bother with Medication If I’m Only Experiencing Corner Recession?

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

Dr. Rassmann:

My corners appear to be receding, but I don’t seem to have hair loss anywhere else.

I know you’ve said that Propecia and Rogaine’s effectiveness is limited to the crown and the top area of the scalp. But I don’t seem have any miniaturization in those areas.

Should I even bother exploring treatment with Rogaine or Propecia if I’m experiencing only corner recession?

The best results from these medications are seen in the crown / top, but there are definitely cases with visible regrowth in the hairline. I wouldn’t suggest that it is likely for most men to see that type of result, though. In other words, it’s rare for decent hairline regrowth to be seen… but not impossible.

Tags: hairline, hairloss, hair loss, propecia, finateride, rogaine, minoxidil

Do Actors Get Their Hairlines Transplanted Back to Juvenile Levels?

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

Is it common for actors coming to you and your contemporaries to ask to have their juvenile hairline back? Do you do agree with this procedure and can it be made to look natural? (I’m assuming a movie star would need a completely natural look).

Thanks!

Many men want their juvenile hairlines back. They do not have to be actors. The relevant point is whether they are mentally and psychologically prepared to have a juvenile hairline for the rest of their lives. There have been actors that requested this, but so do some men of many different professions.

If you are 21 years old with early balding, you would not know where your hair loss will end up, but I understand that such a young man would remember very well where his hairline may have been just a few years before. For this and other reasons, most of the time I advise against putting back the juvenile hairline. But there are patients that insist and are fully accepting to the permanence of a juvenile hairline.

If I am comfortable that the patient will not develop an advanced hair loss pattern (higher than a Norwood Class 5) and I’ve estimated that the donor supply is adequate to follow the worst case pattern that the patient might develop (my opinion), I would consider creating a juvenile hairline on the patient. It’s really a case by case scenario, though.

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

I’m 17 Years Old And Wonder If My Hairline Will Get Worse (with Photo)

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

Hi Doc,

I am 17 and I have been very anxious recently about a receding hairline and I am wondering if it will get any worse.

I have what appears to be a NW2 hairline with very fine thin hairs around the corners of the hairline which have receded. My hair is already very thin and fine and when I was younger the corner of my hairline where blonde as opposed to my dark brown hair which I’m unsure if that has any significance. Thanks.

Is there a chance I am not balding or will I see more hair loss in the future?

Link: Photo

It is clear from the picture, your age, and your concern that you need to see a good doctor to help you. At 17 years old with what appears to be a Norwood Class 3 balding pattern, it is a concern to me as well. It’s possible you won’t lose more hair, but there’s no way for me to know that just based on a hairline photo. You need to have an examination.

Since you indicated you’re in the UK, Dr. Bessam Farjo has offices in London and Manchester and I would suggest that you contact him, as he is local. You should also get a parent involved.

Tags: hairloss, hair loss, hairline, teenager

Does Early Success with Propecia Give Any Indication on the Future?

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

Doc,

Thanks for the great blog.

I started taking Propecia about 7 months ago at age 21 and have had great results. I’ve had some regrowth even at my hairline.

Is early success any indication of future effectiveness/longevity? I’m trying to gauge how much time I can expect Propecia to hold off baldness. Have you found any sort of correlation with your patients?

Thank you.

It appears that people who had a good response to finasteride early do get better long term results. Like I’ve said before, I’ve had patients on this medication for over a decade with continued great results. I won’t be able to know what kind of time frame of success you’ll have, though.

If you’ve had regrowth at the hairline, that is fairly rare, but exciting!

Tags: hairloss, hair loss, finasteride, propecia

Would a Doctor Prescribe Finasteride to Maintain a NW1 Hairline?

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

Dr. Rassman,

It seems there are a lot of young men frequenting your site, myself included, that are concerned about hair loss.

My questions is how much recession from a juvenile hair line must occur before hair loss can be diagnosed and a treatment can be issued.

Would a responsible doctor issue finasteride to maintain a Norwood 1 hairline?

Finasteride does not usually bring back frontal hairlines and I do not prescribe it to men who are not balding. Norwood 1 or 2 patterns are not considered balding.

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

In the News – Baldness Cure is 2 Years Away?

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

Snippet from the article:

They are already talking with pharmaceutical firms about making the product, which would work by stopping the effects of a single guilty enzyme.

US-based dermatologists announced earlier this year that they had found that an enzyme, called prostaglandin D2 (PGD2), instructed follicles to stop producing hair. They identified it by screening 250 genes implicated in hair loss.

George Cotsarelis, head of dermatology at Pennsylvania University, said the one responsible for levels of PGD2 played “the major role”. He said he was now talking with several drugs firms about creating the anti-baldness product.

Read the rest – Baldness cure could be on shelves in two years

Two years seems like a bit of a stretch, considering there is no actual product yet… but the media is easily excited about hair loss “cures” as anyone that has been waiting for new treatments has surely seen. Apparently this new hype is based on a study of 17 people, but I don’t know where this idea came from about a proven safe and effective product being available by 2014. Whether or not PGD2 will be the next great hair loss treatment, there’s a lot of work that needs to be done first.

Just to sum this article up — apparently we went from a small study on PGD2, all the way to the miracle hair loss “cure” being on the shelves in a couple years even though there is no product just yet. I’ll believe it when I see it.

Tags: hairloss, hair loss, cure, PGD2

I’m Shedding Hair Months After Taking an Oral Corticosteroid for Breathing Problems

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

Hello Dr,

I was prescribed an 8 day cycle of an oral corticosteroid containing 20mg of prednisolone to treat a mild breathing problem. 2 or 3 days after the treatment ended, a massive hair shed started along with acne and seborrheic dermatitis all over face and back. I used to loose around 10 strands of hair when showering and this number raised to more than 80 after the treatment.

3 months have passed and my hair hair is still shedding. My hairline receded more in these 3 months than the whole last year (I have been diagnosed with MPB 1 and a half years ago and been taking finasteride for a couple of months now).

What happened after I took the corticosteroid, will this shed ever stop? I’ve been to several doctors and no one believes me or gives me a reasonable explanation, I am kind of lost. What can I do to regulate my body back to normal and stop the shedding? The hair I lost is gone for good?

I have a hard time believing that you can’t get straight answers from doctors, particularly the doctor that prescribed you the corticosteroid. There is a well known connection between exogenous steroids and hair loss where the drug triggers genetic predispositions to balding. I can not tell you how long this might go on, as this is an individual genetic issue in each case.

Tags: hairloss, hair loss, corticosteroid

Cyberchondriacs Trust Online Forums More Than Medical Professionals

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

In a recent comment on the blog, a reader brought up a term I wasn’t familiar with — cyberchondria — which is when a person will escalate their concerns about symptoms based on what they’ve read online. It seems like half the questions this blog gets are from cyberchondriacs, or rather, people who tend to play armchair doctor or fantasy biochemist when it comes to medicine and disease.

Have you noticed an increase in know-it-alls coming into your practice in recent years? It’s always good to educate yourself, but are we starting to get to a point where a doctor is just someone we need to see in order to get a prescription for something that we’ve already diagnosed ourselves with?

That is a good point. “Cyberchondria” is not only limited to BaldingBlog. With the rise of the Internet, doctors battle with patients that diagnose themselves on a day to day basis. Of course it is good to educate yourself, but I would think hypochondriacs and/or cyberchondriacs make for a formidable nightmare for a lot of doctors.

Tags: hypochondriac, cyberchondriac, hair loss, hairloss

Can It Take 6 Years Before Propecia Side Effects Show Up?

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

I started using Propecia when I was 27 and I am now 43. I didn’t really notice any side effects until I was 33. I started having erectile difficulties then which are offset by daily Cialis use. The difficulties were loss of erection during sex and reduced ejaculate. Is it possible that it took 6 years for the sexual side effects to kick in from Propecia?

The drug has definitely helped me prevent hair loss and I would like to keep taking it but I have also dealt with some anxiety and depression issues over the last few years.

The basic question is: Can it take that long( 6 years) for side effects to show up?

You need to see a medical doctor and have a physical exam. Many men in their 40s or even 30s have erectile dysfunction (ED) without ever taking Propecia. It’s just that they do not openly talk about it. You might also have undiagnosed medical conditions (diabetes, high blood pressure, high cholesterol, obesity, etc) that can cause ED. Or you can be taking other medications (blood pressure, anti-depressants) or drugs (marijuana, cocaine, etc) that may be causing the ED. Maybe you smoke cigarettes or you drink alcohol. I don’t know enough about you and since you’re not my patient, I’m just taking wild guesses here as to possible causes.

I suppose it is possible that after 6 years in a healthy man with none of the things discussed above, some sexual side effects may develop over time. That being said, it is more likely that if you were going to have side effects from Propecia, they would appear within the first few weeks.

I’ve written about this before here.

Tags: erectile dysfunction, hairloss, hair loss, propecia, finasteride