Can You Get More Grafts from Strip or FUE Over a Lifetime?

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

Many thanks doctors for providing help to all of us!! Your blog is very interesting.

How many grafts it is possible to extract from a caucasian male with an average donor supply over the course of his life? Does it make a difference whether it is a FUE or strip? 9,000?

This is a debate among many hair transplant doctors themselves. In my opinion, you would get the most number of grafts and hairs with the strip procedure over a lifetime to make an overall cosmetic difference. FUE (follicular unit extraction) grafts can sometimes have less hairs per graft than those harvested using the strip method. So over a lifetime FUE grafts may produce less coverage.

For maximum harvest in a theoretical scenario, you would maximize the grafts with the strip then use the FUE method when the donor area is more limited.

Tags: hair transplant, techniques, fue, strip surgery

Xanax and Propecia Drug Interaction?

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

Hi Drs. Rassman and Pak:

I take 2.5mgs of Xanax once per day, in the morning, prescribed by my psychiatrist for anxiety and panic attacks. Is there any drug interaction between Xanax and Propecia? Also, would the sexual side effects risk be increased by taking Xanax? I have no side effects with Xanax, by the way.

Propecia (finasteride) does not interact with Xanax (alprazolam).

In general, I do not know of ANY drug that has a truly bad interaction with Propecia. Interactions can be found here, but there’s nothing all that common and nothing I can see that is alarming. As always, ask your prescribing doctor and be sure to inform your doctor about what medications you are on.

Tags: propecia, finasteride, xanax, alprazolam, hairloss, hair loss, interaction

What Percent of Your Propecia Patients Find Lumps in their Chests?

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

Dear Dr Rassman, thanks again for the great blog and thoughtful responses.

Afraid I have yet another propecia related inquiry! I noticed in a recent post you informed another reader that there have been cases of your patients on propecia developing lumps in the breast region and that your are now working with another Dr to treat this side effect.

While I’m aware these are not necessarily related to their propecia course I was wondering if you could give an approximate indication of what percent of your patients have suffered this side effect?

Many many thanks again

I believe what you are referring to is gynecomastia (enlargement of breast tissue). They are not necessarily “lumps”. I believe the reported incidence is about 1 in 300 to 1 in 700 or so. In my clinical practice I think the incidence is lower.

Tags: gynecomastia, breast enlargement, gyno, propecia, finasteride

Announcing Mini-FUE (with Video)

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

For those that didn’t see our announcement last week, check it out here — Breakthrough FUE Announcement by the New Hair Institute.

Below is a one minute video of our new technique for doing follicular unit extraction (FUE) that allows you to keep the donor hair long. We are averaging about 300 grafts per hour. Some patients are more difficult than others, so our hourly extraction ranges from 200-500 grafts per hour, depending upon the patient. With a traditional FUE when we do not have to deal with the long hair, our speed goes up considerably.

We use a specialized instrument that we have created for all of our FUE procedures and it has worked well for us for quite some time. So you might ask, “What is the difference between the standard FUE and the mini-FUE?” Simply put… we will not have to shave your donor area, as no haircut is required to get to the donor grafts. You can go back to work the very next day without the potential of anyone seeing a shaved area at the back of the head. What is mini about this procedure? It is smaller than our usual FUE so we call it a ‘mini’ procedure (mini-FUE).

All of the benefits of FUE without the downside of the social disruption. As you look at the video, note that the grafts are coming out with a long hair, so you see that no shave was done. Contact us at NewHair.com to schedule a consultation.

Watch the clip below (caution – surgical content):

Tags: fue, follicular unit extraction, hair transplant, hairloss, hair loss

I Have Scars from Where My Plugs Were Removed — Can I Do Anything to Smooth Them Out?

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

Is it possible to smooth out just a small area where old hairline used to be that was damaged from surgically removing old plugs? I am a 45 year old male who had a hair transplant in 1984. I had one session (47 plugs, about 8-10 hairs each plug) around the frontal-hairline part. I did not like it as the result was not what I had expected so did not go back for another one.

In 1988 I had all of the plugs surgically removed. For the most part it looks ok except for the right side above the right temple but close to the forehead. In certain lighting you can see the scarring and tell that it was where the old transplant hairline was as they fall in or pitted is the word used to describe it (where 5 plugs were removed on this side). So instead of having cobblestones I now have the opposite.

I would be interested in seeing if just this area can be improved by either laser therapy to smooth it out or to do a surgical scar repair and pull the skin tighter on these 5 only or any other recommendation? If it improved just 50% it would be a great improvement. I would not be interested in another hair transplant. I keep my hair long enough so the donor area is ok as is.

Also, would massaging this area help smooth it out or make it worse? Thank you and your site is amazing and very much appreciated.

In general, scalp scars (or any scars really) are very difficult to treat. If there is something that can be done, it would involve understanding that the outcome will not be perfect.

You are asking a very specific question for a case that is likely quite unique. You would need to visit a doctor one-on-one and have him/her examine you for their assessment and recommendations. Since you indicated that you’re in New York, you could check with Dr. Robert Bernstein.

Tags: scarring, hair plugs, repair, hairloss, hair loss, hair transplant

How Many Days of Forgetting to Take Propecia Will It Take Before I See Catch-Up Hair Loss?

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

I have been on propecia about 6 years. Over the past 5 months I have probably missed 7-10 days a month. The past month I have noticed alot of shedding and am concerned I am experiencing catch up hairloss. Have I missed enough days that this could be the case? If this is the case, will I recede the point of never having started propecia or to the point of when I first began treatment. If the former is the case, should I quit treatment and accept my fate? Thanks.

I wouldn’t worry about missing a few days of the medication. It generally takes weeks or months of consistently not taking Propecia for catch-up hair loss to be evident. There is tissue fixation at least for a week, if not more. Talk with you doctor regarding your medication and clinical decisions.

Tags: propecia, finasteride, hairloss, hair loss

Are We Any Closer to Finding the Holy Grail (Hair Cloning)?

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

Hello Doc
I first discovered your blog in 2006 when I began to notice my hair was thinning. I was very interested in the ‘holy grail’ that was the potential if hair cloning/multiplication. Six years have passed and it doesn’t seem we are any closer. Are we any closer? There must be discussion between you and other doctors of whether it will eventually become a reality. Do you still believe we will see this solution ? If so how long do you honestly think it will be before it becomes a quality solution to balding? Also are there any other drugs/solutions in the pipeline. Thanks

I believe we are closer… but there is nothing in the “pipeline” that I am aware of for a short term answer. There is ongoing research and scientists are working on hair loss / cloning / multiplication. We are all still waiting.

Tags: hair cloning, hair multiplication

Keeping Your Hair Through Chemotherapy with the Cold Cap

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

A previous post from a few months back talked about a way to prevent hair loss when a patient is going through chemotherapy by using Cold Cap Therapy. Chemo is used for treating many types of cancer, and many of these treatments cause hair loss.

I am happy to report that the patient discussed in May has just finished her chemotherapy, and she sent this email to me with permission to post it on this site:

Wow – it is good to be looking at the end of the chemo cycle (six treatments in an outpatient facility). I am finally seeing my energy beginning to come back. This cycle had more general fatigue and much more muscle fatigue which is slowly waning. I am thinking that I should be 90% to my normal state by the weekend. I can report that my hair is holding – we sent back the cold-caps with a fond farewell.

Overall I’ve had about 20% hair loss over the therapy course and my hair is growing normally. I may have lost 20% (my estimate) of my original hair and the new hair is already growing back. I want to put the word out that if you know anyone who is looking at chemotherapy and wants to avoid hair loss that they should contact me [note: BaldingBlog will make the connection to this patient].

I have put together a guide to using cold-caps based on my experience which I think will be helpful. It is only hair but it makes a difference to know I look healthy and when I looked in the mirror through this period of chemo, having my hair kept my spirits up. Please tell others to contact me.

If you’d like to contact her, send us a message via the Contact page and we’ll make sure the email gets to the right place.

Tags: cancer, chemo, chemotherapy, cold cap, hairloss, hair loss

My Dermatologist Pushed Propecia For My Thinning Scalp, But I Don’t Think I’m Losing Hair

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

The top of my hair looks like it’s thinning when it’s wet or when you apply gel (can see the scalp). Currently I’m 24, and when I looked back to pictures from 8 years ago, it seems that I had the same thing. I went to a dermatologist who mentioned mild miniaturization and pushed propecia.

My question is it possible my hair has always been like this, and there is no hair loss or miniaturization at all? He did not want to look at any pictures from my young age. I recently took notice because I have friends losing hair and became fixated on it. When my hair is dry you cannot see my scalp.

Propecia is an elective medication you take for treating androgenic alopecia. If you do not believe you need it, do not take it. If you do not want to take it, do not take it. If you think your doctor is wrong, then get a second opinion. I’m curious to know why you saw a doctor for thinning hair when you didn’t think your were losing hair.

Some hair styles can cause your hair to look thinner. Direct light can also do that. Perhaps your hair gel is sticking your hair together and causing more scalp to show through, giving the illusion of thinning. I really have no way to know.

Tags: propecia, hairloss, hair loss

Is Minoxidil Not Intended for Men Over 50 Years Old?

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

Hello. I want o try using Regaine (called Rogaine in the USA) for hair thinning around the front and temples. I have read it’s not intended for men over 50 and I am 54. I am otherwise fit and healthy but could it harm me?

Rogaine / Regaine / minoxidil does not work well (and is not labeled for use) in the front and temple areas. It is mainly for treating the top crown.

There is no age limit I am aware of, though the medication does reportedly work best in men under 40 with recent hair loss. As with any medication (prescription or otherwise), read the directions included with it or talk to your doctor.

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

If I Skip Propecia for a Couple of Weeks At a Time, Do I Increase My Side Effect Chances?

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

I travel abroad a good deal, often for long periods and for indeterminate periods, I therefore regularly miss my propecia intake for a couple of weeks up to a month every, for example 6 months. Am I increasing my chances of side effects or the drug becoming ineffective by doing so?

I do not believe you would be increasing the risk of side effects by failing to take Propecia for several weeks, but you may be increasing the risk of the drug not doing its intended job (of keeping your hair). Perhaps you should make a note to pack your medication on your travels.

Tags: propecia, finasteride, hairloss, hair loss

I Have Issue With Any Doctor Who Would Perform Surgery But Refuses to Prescribe Dutasteride

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

I appreciate all the good work surgeons are doing in the field of hair restoration, but I would consider a hair transplant only after pharmacological means have left me unsatisfied. Then I seem have no other solution than to try dutasteride and see if that would eliminate the need for a transplant, if finasteride doesn’t really help the front corners, seeing that I have no family history of andgrogenic alopecia other than corner recession (of mature hairlines) and having NW3-ish thinning myself.

I am aware that dutestaride is not FDA-approved and I accept the risks of side-effects, so I will certainly have an issue with any doctor who’d be willing to perform surgery, but refuse a dutestaride prescription, if those are my options. Who’s going to tell me that I should instead just go straight ahead for a transplant?

You must understand and accept that maybe your surgeon, who went to years of medical school with post-surgical training and experience, has some value in his/her professional recommendation.

Avodart (dutasteride) or Propecia (finasteride) both are unlikely to work for front hairline regrowth, especially for Norwood class 3 patients. It may help to slow down the loss a bit, but these drugs are mainly for the top crown areas.

There are still unknowns with using dutasteride to treat hair loss and some doctors aren’t comfortable with prescribing it for off-label use. I am sure if you look hard enough you will eventually find a doctor who will give you that prescription for dutasteride, but I probably would not be one of them.

Tags: dutasteride, avodart, surgery, doctor, hair transplant, hairloss, hair loss

Lasers Used in Hair Transplantation?

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

Do you know if Laser Hair Surgery requires you to go under anesthetic? I have a real phobia of anesthesia, so would prefer not to get knocked out during surgery!

Laser hair transplantation was used in the 1990s, which had a laser cut into the skin, then the grafts were placed into these laser-created wounds. The wounds produced a surface that would not allow the grafts to be held into place, so they just slipped out. Also, the laser burned the skin at the wound edge, creating a great deal of damage and producing wound healing problems. It was largely abandoned by every doctor who promoted it at the time.

As for sedation in hair transplant surgery, we’ve written about that here. Different clinics may offer different sedation options. You don’t need to be completely knocked out during a hair transplant.

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

Switching Back and Forth Between Propecia and Avodart

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

I have been taking avodart for about 4 years, previously on propecia for 6 years. I believe avodart has worked great but for a long time have always felt that their have been sexual side effects from both meds. I am switching back to propecia to see if they resolve and actually only taking half a pill instead of a full one. My question is:

  1. in the long run, does propecia prove about roughly as beneficial for maintaining hair loss as avodart, (or should I expect a large/small shedding of hair from the switch)?
  2. will propecia be less likely to have sexual side effects compared to avodart?
  3. should I expect the side effects to resolve/ or permanent and how long (2 weeks, month, ect) till I would notice?

1. I don’t know. Your guess is as good as mine.

2. Yes, and a half a pill will be better than a full pill to lessen side effect risk… but no guarantee.

3. Avodart (dutasteride) has a 5 week half-life, so it might take months (in the order of 20-25 weeks) for the side effects to reverse. It may occur earlier. Propecia (finasteride) has a 6 hour half-life, so this drug’s side effects are less long lasting as a rule.

Tags: avodart, dutasteride, propecia, finasteride, side effects, hairloss, hair loss

Strange Ingrown Hairs?

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

What is the longest/strangest INGROWN HAIR you have ever seen/removed?

I asked as that I sometimes get them in my neck and on my chest and they are indeed funky upon removal. I know. Random question, but it’s better than all the crybaby Propecia questions you seem to get these days.

Thanks again for the good work.

That is a random question. The longest ingrown hair I have removed was about 2 to 3 inches long. As for the strangest ingrown hair… well, it’s just a hair. I don’t know what would qualify it as “strange”.

Tags: ingrown hair, hair removal