These two unfortunately patients had some operator who painted their scalp under their hair. When good SMP is done, you don’t see it because they are small dots mixing with the base of the hair shafts and they are not taken up to the frontal hairline. As a consumer, you must be on guard against this type of work. The best way to protect yourself, is to ask to meet comparable patients to what it is that you are going to do with SMP.
Do miniaturized hairs from AGA always end up dying of apoptosis? In other words, when the hairs from DHT susceptible follicles miniaturize, is it guaranteed that they will always end up falling out permanently and those follicles end up dying and not growing any new hair? Or can hair miniaturize and remain that way indefinitely without eventually permanently falling out and dying? I ask because most bald men that I see, even those who are older and whose hair loss has been stabilized or remained the same for decades, they usually still seem to maintain some hair in their bald
I have seen men with a Class 7 pattern that keep a few miniaturized hairs on their scalps, often right in the middle of the bald area. Human scalps have some areas of remnant hairs that never die and seem to never go away. Is that what you are talking about? This is not the usual situation. Most miniaturized hairs will eventually die off.
Yes, 1 mg every other day is about 82% as effective as the full dose. Enough finasteride is attached to the receptors to last 1-2 weeks safely, so stopping finasteride for a week is usually not a problem.
https://www.foxbusiness.com/lifestyle/kim-jong-uns-newest-problem-growing-hair-loss-among-north-koreans-lack-effective-treatment
North Korean men are like men all over the world, with genetic balding presenting in about 50% of the population. There is only one race that I know of that never had balding, and that race was the American Indian who migrated from the Alaskan bridge and didn’t interbreed.
Is it necessary to discontinue oral minoxidil for a period of time after hair transplant. Someone said I should stop oral fin for 15 days and oral Minox for 3 months after procedure but I don’t think that’s right? Can you clarify please? Thank you Doctor.
I generally tell my patients to take minoxidil until the day before surgery and restart it one week out.
I called an office near here to discuss options to stop my hair loss. One being hair transplant and the other finasteride. They told me that finasteride is required before they even would let me consider a hair transplant. Which, fine with me, sounds fair. However, here’s where it seemed too good to be true. They told me that if I get a hair transplant and stay on finasteride, I’d keep 100% of whatever hair is transplanted on my crown and at least 80-90% of whatever is transplanted on my hairline. Is that true? They said it had something to do with how DHT affects those two areas. It felt a bit like a sales pitch but seemed a bit far fetched that finasteride would allow me to keep 100% of the hair on my crown. Can’t anyone confirm or deny that?
I have been doing hair transplants for 33 years, pioneering modern surgery, even FUE. After you get a crown hair transplant, if you are on finasteride, it is more likely than not that the native hair that is there will stay longer than if you were not on finasteride. That doesn’t mean that taking finasteride will guarantee that the native crown hair will not fall out in time, which is what will probably happen. Some doctors use salesmen to represent their communication with patients, and too often, these salesmen invent the science to meet their sales goals. The buyer must always be on guard, even in a doctor’s office.
Can you tell my why my oral minoxidil protocol is making me grow hair halfway down my forehead but not in my widows peak area towards the middle of my hairline?
This is a complication of minoxidil, not a treatment outcome. Also, the widow’s peak rarely is recovered if it is lost as it doesn’t have the classic DHT/Genetic elements that is present on the full receding mature hairline.
Transplanting near native hair should not be a problem unless that native hair is miniaturized and on the way out. Shock loss occurs when your hair is miniaturized and a transplant is performed. Taking finasteride often blocks such loss, and I recommend it regularly to my patients, especially those under 35 years of age. Men over 35 often don’t have much miniaturization present, but if they do, I again recommend taking finasteride.
I’m afraid I have to disagree. Both drugs work the same way. Dutasteride is 85% effective as a competitive inhibitor of DHT compared to finasteride, which is 70% effective; however, you pay a price for using or adding dutasteride, which is its long half-life. Dutasteride has a half-life in the bloodstream of 5-6 weeks, while finasteride has a half-life of 4-6 hours. What does that mean?” If you develop significant side effects, stopping finasteride will get it out of your bloodstream in a day or two at the most, with some finasteride sticking to the receptors for a few weeks. On the other hand, dutasteride will stay in your bloodstream for months, possibly remaining in your tissues at the blocking site for up to 1/2 year or longer. There may also be other effects on dutasteride because it blocks more than one receptor. What else could it do, this a good question to probe. Getting rid of the effects by stopping the drug is more ominous for dutasteride than finasteride.
The severe cardiac complications of oral minoxidil are very rare when dosed at 2.5 mg or less. I often prescribe 1/2 pill at a 1.25mg dose. Too many men use high doses of topical minoxidil, which get into the body and can cause cardiac complications.
Unfortunately I (21m) am gonna be unable to take finasteride for up to a week because the delivery has had issues. My hair loss is pretty aggressive (as hair loss tends to be for younger people who have it). Is the lack of fin for 5-7 days likely to affect my hair loss?
Enough finasteride is attached to the receptors to last 1-2 weeks safely, so stopping finasteride for a week is usually not a problem.
The original Merck studies showed that 1mg finasteride is as good as 10 mg dose of finasteride for hair loss. Stick to the 1mg dose.
Caucasian and Asian follicular units are straight; however, in African individuals with coarse, kinky hair, the curl seen above the skin is also present below the skin. That is the only difference between African hair and the hair of other races. Getting these out with FUE requires a lot of experience, and placing them into the recipient site could be challenging. For many experienced surgeons, that challenge has been addressed. The photo on the left is a typical follicular unit excised with FUE. Note the curl in all of them and that in this sample, they only have two hairs in each graft. The photo on the right shows Caucasian follicular units, with 1, 2, 3 and 4 hairs in the grafts shown. Count hairs in the grafts yourself.
To determine the value of the donor area, you need to measure the donor density in the donor area as well as the value of each hair in terms of donor hair thickness. These two numbers will allow you to know how good your donor supply is and how many grafts you can move safely, now and in the future. I routinely measure these numbers; see here: https://baldingblog.com/creating-a-personalized-master-plan-for-present-and-future-balding-photos/. I also have be suggesting that you purchase a micrometer from Amazon (only $22) to measure the thickness of single hair shafts in the back of your head. The product I use can be found here: https://www.amazon.com/dp/B09964YBMF?psc=1&ref=ppx_yo2ov_dt_b_product_details
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