Hairline is too straight and donor area patchy

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

I don’t believe that this man who thought he had good work done will be happy with these results. His hairline is straight (no hairline is straight) and the donor area has a large number of patchy areas reflective of a surgeon who used a large punch to perform the FUE. This is a post-operative photo (possibly 1-2 weeks after the surgery) with a lot of scabs sill on the recipient area. The man posted this photo on a forum, but he was proud of it.  Detectable hair transplants are never good and this man shows the transplant with an abnormal perfectly straight frontal hairline with straight temple peaks and a  see-through donor area from possibly too many FUEs taken for harvesting his donor area. It would have been nice if this man posted a better photo.

 

Microneedling needle depth

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

What in your opinion would be the ideal needle depth and frequency? Every two weeks? 

I am not an expert on microneedling; however, it makes sense that needle depth should be 1-1.5 mm to reach through the epidermis and impact the stem cells which are found high in the dermis. The frequency is purely an intellectual guess. I am seeing that many of the Reddit posters are doing it weekly which sounds ok to me. I am certain that once a hair cycle has passed, the growth from microneedling will be undone unless more microneedling is performed.

 

Does fin affect athletic performance negatively, positively, or at all?

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

The World Health Organization’s Adverse Drug Reaction Database contained 508 reports of serious muscle-related side effects suspected of being linked to the use of finasteride, mostly atrophy, weakness, myalgia and sudden, strong muscle tightening (spasms).

Results newly reported in JAMA show that the muscle mass of men is not affected by inhibition of 5 alpha-reductase, the enzyme that produces the androgen 5 alpha-dihydrotestosterone (DHT) from testosterone

I had 2500 FUE grafts, can I repeat it again?

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

The picture shows heavy donor site depletion suggesting that the 2,500 grafts you had were too many for your donor area density. This suggests that you had a lower original donor density prior to your original FUE and any more FUEs taken from your donor area will make you look balder in the back of the head.  A strip surgery is an option but this is something that you and your doctor need to discuss. You might consider a strip surgery for more grafting.

See here for the limits for FUE surgery defined in one of my previous post in the Hair Transplant Forum:  https://baldingblog.com/2017/07/21/many-fue-grafts-many-fues-grafts-one-know-safe-limits/

depleted donor area 9

 

What meds can produce hair loss?

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

Drug side effects — Hair loss can be a side effect of certain medications, including lithium, beta-blockers, warfarin, heparin, amphetamines and levodopa (Atamet, Larodopa, Sinemet). In addition, many medications used in cancer chemotherapy — such as doxorubicin (Adriamycin) — commonly cause sudden hair loss affecting the entire head and some of these medications can actually trigger the genes for hair loss in men and women.

Symptom of a medical illness — Hair loss can be one of the symptoms of a medical illness, such as systemic lupus erythematosus (lupus), syphilis, a thyroid disorder (such as hypothyroidism or hyperthyroidism), a sex-hormone imbalance or a serious nutritional problem, especially a deficiency of protein, iron, zinc or biotin. These deficiencies are most common in people on restrictive diets and women who have very heavy menstrual flow.

I can’t write a book on it, and I am sure that there are MANY drugs that I have not mentioned in this group.

How to tell puberty is over for taking finasteride

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

I’ve read that many doctors prescribe finasteride to patients as young as 16, so my question is how do doctors safely establish that suppressing DHT in patients so young won’t be a problem?

I don’t believe that depressing DHT impacts the body significantly in men over 17 who are well past puberty. By this, I mean, growing your height has plateaued, facial hair may have started to grow.  Most boys will stop growing taller by age 16 and will usually have developed fully by 18.

We see more testosterone production with finasteride. I have had many patients over 17 on finasteride and most are fully grown. You do raise important issues that should be discussed with your doctor

Prolactin levels and hair loss

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

Can Prolactin in a Male, Like a Spike over 6 months caused by a medication cause some loss? I’m curious. I still have a full head of hair, but was wondering about that.

Elevated prolactin levels in association with diffuse or androgenetic hair loss can be neglected as causative for the hair loss, because there is no evidence that they have an influence to the pattern

Going back to work after a Hair Transplant

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

For anyone who has had a hair transplant or known someone who has, what was the experience like once returning to work?  Did people ask questions? Was it super noticeable? My idea is that you just have to own it I guess, which sucks when working at major companies.

Most people can get away with a hair transplant never being detected. First you have to have all of the crusts washed off the first day so that there are no scabs on your recipient area, just a short beard. Second, if you are very bald, let your beard grow out so people will focus on your beard, or if you have a beard, shave it off. People pick up big changes and facial hair so let it grow to create big changes. The need for facial hair may not be required if you have some hair to use as cover. Be creative. Everyone I have done hair transplants made it work for them.