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.

Hair loss from weight loss or illness, how to treat it?

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

If you get a patient who is experiencing hair loss after an event like an illness or a diet change/weight loss or medication-related, how do you reverse hair loss in such cases? Is the hair loss medication the same?

First you tackle the cause like stabilizing weight loss with a good diet or treat whatever the illness was that precipitated the hair loss. Most of the time the hair loss will reverse unless, for example, weight loss induces genetic hair loss that was hidden from you.  Then we use the standard medication for hair loss such as finasteride and/or minoxidil (topical or orally).

Did I ruin my hair transplant?

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

I am 13 days post FUE. On 11 days post FUE (Friday) I started taking some adderall at night and drinking. I ended up staying up all night then taking more adderall the next day until I passed out into Sunday. On Sunday I drank more. I smoked cigarettes as well. Did I kill all the transplanted hair? I don’t know what to do

At 13 days, everything should be secure. I doubt you damaged anything

How can you tell FUE donor site depletion?

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

Take a look at this photo. There is an area on the top that shows the normal density (click on the photo to enlarge) where hair was not removed hair by hair group as in the main donor area shows. It should be clear from this normal section of hair what a normal donor density looks like prior to an FUE being done.  Donor site density reduction occurs in every hair transplant regardless of the technique.  Depletion is used when the density reduction achieves a clinical state where there is less than adequate coverage for the donor area and as a result, one can either see-through it, or there is clearly less bulk present when the hair is grown out longer. I will discuss this below.

Donor site depletion is not necessarily a numbers issue. For example if one has 3500 FUE grafts removed from the donor area, is that number adequate to produce donor site depletion?  In some men with a coarse hair, 3500 removed FUE grafts may not cause visual loss of coverage for the donor area with hair that is 1-2cm long. Likewise, 3500 FUE grafts removed for someone with fine hair will find significant donor site depletion with hair that is 1-2cm long. For someone with an average hair weight, 3500 grafts may be a reasonable limit before one sees donor site depletion with hair that is 2cm long.

Some surgeons do strip surgeries which also deplete the donor area.  Assuming that there is no significant scar (less than 3mm wide) then the donor area stretches with removal of 3500 grafts.  Assuming that the area where the stretches is spread over the entire scalp, it impacts the scalp in the back of the head and that the stretch extends upward from the point where the strip was removed to all of the remaining untouched hair in the back of the head. If the person had a full Norwood Class 7 pattern of balding, the 3 inches of scalp remaining will have a reduction of density that is 84% of its original density or a 16% reduction in density.  The difference between the FUE surgery example and the strip surgery example would be in the uniformity of the donor site’s appearance. There would be no gaps in-between the follicular units in the strip scenario unlike the FUE scenario which clearly would have gaps rather than uniform stretching.

The two procedures are not really comparable because the surgeons often selectively remove the follicular units with more hair with FUE than the strip surgery (i.e. more 3-4 hair grafts).  So the person with 3500 FUE grafts harvested from the 3 inch high donor area most likely will lose more hair from the donor area than the person who had 3500 grafts from the strip surgery. It is the hair bulk that is left behind that determine if there is donor site depletion and this is an individual call for each patient who has had any hair transplant surgery. The patient in the picture could be donor site depleted with the standard of 1-2cm long hair or not. I personally would like to see his hair grown out to a length of 2cm and then make a value judgement.  Do you copy that?