This is a review of female patient who wanted a more rounded (feminine) hair line. Sometimes it takes more than one surgery to give the perfect rounded shape. Dr. Jino Kim of New Hair Institute in Seoul Korea was able to accomplish the goal with one surgery!
QUESTION FROM THE PAST
I have been taking Propecia for just under a year with really no ill effects, and some good results. But in early November 2006 about 5 weeks ago I noticed discomfort and some swelling in my right nipple. I had a sonogram and was put on two different antibiotics for one week, each to no avail. The doctor thought it was mastitis or a staph infection. I had blood work done and all appears normal. I spoke with a surgeon today and he said I had Gynomastia and needed surgery next week. I want another opinion.Can I simply stop using propecia and substitute with another treatment? Must I have the surgery? Please help thanks
It is very difficult for me to judge your nipple problem over the internet. My answer therefore will be in the general view, not specifically targeted to give you a medical opinion. If I were to examine you directly, my opinion would be based upon having all of the facts, which is simply not the case right now.
There is usually no rush to tackling even a small nipple mass in a young male when there is pain present. Stopping Propecia is a reasonable thing to do first and if the nipple pain is induced by the drug, then the pain might go away in a week or so. Ask your doctor why he feels that there is some urgency to the problem. Some men with breast pain from finasteride (Propecia) may not see it go away by just stopping the medication, but stopping it is a reasonable first step.
QUESTION FROM THE PAST Please help me – I’ve been suffering from hair shedding since Aug 2007. I was on the pill for 12 years and came off in august just after my wedding to conceive. I concieved straight away and am now 7 months pregnant. In Dec 2006, I was in hospital for a day with an infection which caused a hemorrhage. The shedding does seem to have slowed down now so losing about 25 after washes and I feel spiky bits all over my head. This has lasted about 7 months now and just wanted to know how long it usually last for and if it will stop? Will I ever get the thickness back in my hair?
I’m so depressed about this and would be grateful if you could help me. Thanks
You have many potential causes for hair loss, including:
- Pregnancy, which can cause hair loss that should reverse after about a year
- Changes in your hormones from the withdrawal of birth control pills
- Illness from the infection that put you into the hospital
It is likely that this process will reverse. You are not alone and the experience of others with this problem have been far from hopeless.
I started to lose your hair this July. About that time I also went on hormones, DHEA, and antibiotics. Could these medications have caused my hair loss. I recently stopped taking these medications and think that the loss may have slowed and some reversal may be going on. Is this possible
I believe that considering the short period of use and the known relationships between DHEA and hair loss, it is reasonable to expect that the hair loss you had might be related to the medication. You think that the hair loss is reversing upon stopping the medication so it is reasonable to expect that your progress will continue. You need to determine the status of your hair in and around your head, get the hair and scalp mapped out for miniaturization and if this is normal, that would make the process most probably reversible.
In 2006 I had a hysterectomy (uterus only). This past July my doctor put me on 1 mg. of Divigel. I’ve noticed the past couple of months that my hair is falling out. I don’t know if it is the hormone replacement therapy or not. I should note that when I’ve had surgery or a stressful time in my life, I tend to shed, but the hair comes back. I’m wondering if my “empty nest” this fall or the Divigel is causing the hair loss. Any ideas?
Stresses (emotional, surgical, medical, etc) can all cause some degree of hair loss. It usually takes about one year or so before you notice the hairs regrow once the stress is under control. Or, it could be the medication you’re on. Divigel (estradiol gel) does list mild hair loss as a common side effect.
It is best to discuss your concerns with your doctor that is treating you. On top of the stress and medication, there may be other medical issues that you are not aware of as well. In the end, hair loss for women is very frustrating for doctors and patients alike. There is no one magic bullet or a defining cause. And worse yet, there is no definitive treatment (let alone, a cure). Good luck.
i am a 24 yr old sikh male living in the uk. up until the age of 18 i had long uncut hair but then in 2003 i cut my hair. my hair has always been thin in texture from a young age. at first when i cut my hair it seemed to be quite thick on top and didnt seem to concern me too much. however after a few months of getting it cut i began to realise that a lot more of my scalp was visible, particularly in well lit areas.
so in following summer of 2004 i shaved my hair off completely in hope that it would grow back thicker which was really a waste of time. by summer 2005 i had realised that my scalp was a bit more visible than before so then i made the decision to start using rogaine. this seemed to work at good effect and by jan 2006 i had grown my hair a bit longer and had a new style cut. my hair appeared to be a lot better than before and a lot of people did notice. this however may have been due to the new style as well. but by summer 2007 i began to realise that my hair was appearing to be thinner again and i also noticed that at my crown the balding area had increased. the fact i have got a double crown does not help appearance either. so in late december 2007 i decided to switch rogaine for a private minoxidil 5% containing MPG. this too at first appeared to have made a slight improvement, and is a lot easier to apply than the rogaine. however by now in may 2008, i am still not to happy with the density of my hair. i went to a trichologist late last year, he advised me that i should not consider a hair transplant until i am least 25 and that i still have a bit too much hair for a HT. he advised me to take propecia, however i am scared of using the drug due to all the reported side effects. i would be willing to use the propecia, preferbly in a few years and after marriage! both my mother and fathers family have cases of hair loss, my father is bald apart from the hair on his back and sides. both my sisters have fine hair aswel, but they have a full head of hair.
i have seen pictures of hair transplants on patients who have diffused thinning and this would be my preferred method of sorting my hair out, however i am aware that i need to consider the long term instead of the short term. can you please give me some advice on what to do? thanks.
I don’t know what I can say that hasn’t already been said on this site —
I’m not sure I quite follow the logic about waiting until after marriage to start Propecia (finasteride 1mg). The side effects from Propecia occur in less than 2% of men and most claims you read about on the Internet are unsubstantiated. Without seeing your hair, I couldn’t tell you if you’re a transplant candidate, but if you’ve already seen a doctor and were told that surgery was not recommended, I’d listen to him. You could’ve very easily gone to someone that would’ve taken your money and performed a surgery on you just to appease you. I don’t know which doctor you went to, but by not doing surgery on you, he likely did you a favor. You are, of course, entitled to go to another doctor and I’m sure eventually you will find a surgeon that is more than willing to take your money.
See the following for more:
- Dr Rassman, Why Do You Insist on Young Men Taking Pills Rather Than Just Get a Hair Transplant?
- The Truth About Cheap Hair Transplants
I had a hair transplant 3 weeks ago and the scabs are still present. I can not take off my hat. As an executive of a large company, I took off the first 2 weeks, and had to go to work with a baseball hat on. Having a hair transplant was a terrible decision. Whey don’t you guys tell people like me what to expect? I think you can tell that I am angry as hell.
I am certain that we did not do your hair transplant as our patients are devoid of any major scabs after about a week if washed twice a day. More importantly we make every effort to educate our patients of what to expect.
In fact, my wife (Mrs. Rassman) had a hair transplant in the frontal hairline just a few weeks ago, and the transplant was barely detectable by the first day after surgery. The key to keeping a hair transplant less noticeable is to have a washing program that keeps the scabs off. Most of our patients leave the operating room without much evidence of the surgery because we wash the scalp very thoroughly before leaving the operating room. We have the patient usually come back the next day and we wash their hair ourselves and instruct the patient in the washing process. The old adage that cleanliness is close to godliness, applies here in the post operative care of a hair transplant. Your doctor should have explained this to you.
When Can I Scrub My Hair After A Hair Transplant?
Scrubbing it tends to pull out hairs that are miniaturized or those near the end of their normal cycle. After a hair transplant, if there are no scabs present within a few days, the grafts are secure and will not come out with gentle washing. We wrote about this and published a hair pull study after hair transplants here:
Maybe I”m off but if technicians are doing most of the procedure I would think the rate of transection would be high. I don’t know what kind of training they’ve had. I assume just in house training. Obviously they’re needed considering the number of grafts but it’s a concern of mine.
In the United States and most of the world, only licensed physicians can perform hair transplant surgery. Doctors make incisions, harvest the grafts, harvest any FUE grafts, and they also make the hundreds or thousands of individual incision of where the hair follicles need to go. The technicians sort the grafts and individually insert the grafts into the pre-made incision sites that the doctors created. For strip surgery, the technicians also dissect the harvested grafts under the microscope into individual follicles. The technicians are trained to perform this highly specific task and the doctors oversee the process. For FUE, a doctor must be the person performing this step, but many doctors just can’s do this very well, so they use someone on their staff (not a doctor) to do the FUE extractions. This is frankly illegal, but as the State Medical Boards are not in the operating rooms, the doctors get away with it. On the other hand, some doctors who purchase an Artas® Robot, can use technicians to operate this machine. That seems to be accepted as legal, although the medical boards in most states have not ruled on this.
At our office, we do the FUE manually with instruments of out own design. Although we ‘invented’ the optical technology for the Artas® Robot, at $260,000 plus $1/graft, that would drive the prices too high for our patients, so we have continued to advance our manual technology which is faster and more efficient (in our hands) than any Artas® robotic surgery. We feel that the Artas® Robot and our manual technique are comparable in quality, but our manual technique is much faster and more efficient in our hands than what we have heard about the Artas® Robot.
Aside from the individual task of each team member, hair transplant surgery is a team effort. It takes a highly coordinated team to execute a successful surgery. That is why the reputation of the medical group or clinic is just as important than just the name of the doctor.
I’m 28 years old. I got a hair transplant done in November 2013. After the transplant, I lost some hair and seemed to be more hair loss in the first three months. Now that i’m approaching my one year period soon, why is it that the amount of hair that was planted has not grown? I was expected a least twice of what i see. When i comb myself i still look like someone who is losing is hair, and i hate it, especially when i go under a light or out in the sun. What is your suggestion to my situation.
Setting expectations is as much the ‘art’ of what I do as doing the surgery. That is why I have open house events every month, so that people who are going to have surgery can see and meet someone with a similar balding pattern and hair color and ask them about their experience. It is possible that you lost a considerable amount of hair from the hair transplant surgery and the transplants actually grew but because of your shock hair loss, the net gains was zero (worst case). If you were on the drug Propecia (finasteride) it may have helped but that is hard to tell.
If the hair did not grow, then the question should be ‘what went wrong?’. Maybe it did grow but your expectation was unrealistic and the communication between you and your doctor may have been an issue. You can always get a second opinion, but first, ask the doctor who did it and find out if your doctor’s expectations were met and ask him/her to examine you for the results of the hair transplant.
Repeat From Archive
We have been getting a great number of questions about hairline hair loss. Basically the questions relate to the slow appearance of the mature male hairline. The pictures in this post show a young man in transition between his juvenile hairline and his mature hairline. Note that the corners are moving up and that there is some thinning of the leading edge of the hairline. What you see here is not balding, just maturing the hairline.
Please note that we do not generally diagnose hair line questions. However due to the increasing daily emails with photos of young men concerned about their hair line, we will soon be rolling out a new website where you can submit your photos and have others rate the hair loss. Stay tuned!
Hey doc, there is a new hair laser on the market. What do you think?
This space age design and the small case “i” in-front of the name does not add value. The FDA clearance means that it is safe. I really do not understand the FDA as effectiveness has not been proven in the one example mentioned in the article. I have not seen any definitive clinical research that proves that these lasers have any value at regrowing hair. Even the recent article in the Dermatology journal stated “further study is needed”.
What Is The Best Way To Diagnose Hair Loss?
We addressed this question before HERE
I personally believe that the HAIRCHECK instrument is a great instrument to put numbers (an objective measurement) to the balding process. When repeated yearly, you will know how your hair loss is standing up to treatment such as Propecia (finasteride) or just the normal progress balding men experience routinely. We perform HAIRCHECK measurements and MINIATURIZATION MEASUREMENTS (with a microscope) on most of our patients who are balding and those who go on the drugs so we can see gains or losses over time. The measurements are limited in certain cases when the hair is too short.
I am scared to death that I would have a hair transplant and everyone would know because it would be so obvious. What do people do to hide it? Do they live in a hat?
I could write a book about this subject. Many years ago when larger grafts were used, it was impossible to hide a hair transplant because the wounds were large (between 3 and 5 mm). Large wounds, are obvious and at the time that these were done (late 1980s and early 1990s) the typical patient had to use a hat (baseball hat most common). When I innovated the small 1mm grafts in the early 1990s (I started doing hair transplants in 1992), I focused on this problem. There are two parts to this problem. The first reflects the post surgical period of a few weeks. The small 1mm grafts healed rapidly and with good post-operative washing, the surgery could be undetectable within a few days. Swelling was also a problem immediately after a hair transplant, one we solved with the judicious use of corticosteroids which reduced the post-operative swelling plaguing our patients. In the early 1990s as the number of grafts in my practice rose into the thousands (2000, 3000, 4000 and 5000 grafts), careful focus on post-operative washing and the use of single large doses of steroids brought undetectability within a week or so. Most patients were able to go out into the public within a week, once we mastered the post-operative care.
The second concern was how did a man go from a completely bald look (Class 6 or 7 patient) to a hairy look. Here I have many stories and I will mention only a couple of them here. A Class 7 patient of Indian decent, let his beard grow out just before the hair transplant. To his and my surprise, his beard was white so everyone he knew laughed at his ‘Santa Clause’ appearance, but no one, observed his hair transplant or the change in his look from bald to hairy. He shaved off his beard and no longer paid attention to his hair. Like grass growing, you never see it grow. The second patient was a 55 year old male with a Class 5A pattern. His hair was prematurely white and his balding pattern was very obvious. His post operative care paid attention to his wounds and in a few days, his hair transplant was barely seen. He has rapid growth of the hair, an unusual rapid course. At Christmas, his daughter who knew her balding father, picked up the new hair on first meeting after a year of not seeing him. She said, dad, take off that silly wig. He told her that it was not a wig. Then she reached up to his hair and tried to pull off the wig. Of course, it did not come off because it was his own naturally growing hair. “Come-on Dad” she said, Yoy never had hair before. Where did it come from? He remained silent and then she said, Is that Rogaine that you used? He smile and acknowledged her comment. As a nurse, she followed, “that is the most amazing result of Rogaine I ever saw”. There was little else to say.
Even FUE procedure where you shave your head can be easily hidden in a few days
According to the Wall Street Journal (9/15/14) There was a 39% increase risk of developing aggressive prostate cancer when compared to non-balding men. This was the result of a questionnaire given to 39,000 men and fom this reason, the patients actually determined their balding pattern and their perception of the aggressiveness of the cancers. The conclusions expressed here should be evaluated with a more scientific clinical study; however because prostate cancer in the #1 leading cause of cancer in men, it may be worth taking note of this possible association. It seemed that the greatest risk may be with those men with frontal balding (what we call a Norwood Class 3V pattern) however, since this was done by self diagnosis, one can not be sure about the association. The American Cancer Society estimates that a man’s lifetime risk of developing prostate cancer is 15.3% and it carries a death risk of 2.7%. The article was written by Peter Loftus.
We reported a similar finding here
In another post on baldingblog, we wrote about a somewhat controversial article which contradicts the Wall Street Journal article is here
We have seen well documented associations between crown (vertex) balding and heart disease which we reported here
What is clear between the two subject article is that nothing is clear.