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I have heard alot about the Implanter Carousel which i find very interesting and a great method of preserving the hairs and keeping them moist in the ‘carousel’ unlike the choi implanter were the hairs are left on a tray open to drying with warm air until they are put into the implanter. If you dont mind me asking, was the choi implanter an influence with its design and was the carousel, put simply, designed to better the disadvantages of the choi implanter. As they are an automated method of implanting the hair would that not take remove the artistry of a manual job. You once said on a answer to a blog on the subject of ‘The choi implanter’, ‘The Choi implanter is just a surgical tool. It makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills with the more traditional transplant tools used throughout the world. An instrument is only as good as the person using it, so I can not package the tool with the technique. The Choi generally requires ‘skinny’ grafts, which tend to dry out more easily, therefore, this instrument requires special skills, different than those that do not have to make the grafts skinny’. My question is how is the carousel different in the sense that an automated implanter such as the choi implanter makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills. Thank you, for all your advise.

It sounds like you know all the technical difficulties associated with follicular unit transplantation — are you a hair transplant surgeon?

As you mentioned, I wrote about the Choi Implanter before — What is the Choi Implanter?. There’s nothing else I can really add to that. The Hair Implanter Carousel was patented back in the 1990s and it works distinctly different from the Choi Implanter. It was designed to take advantage of a ‘machine gun’ approach to loading the grafts for implantation and percutaneous use and keeping them moist (as you wrote). I’ve used both and found the Carousel to be much easier than the Choi. The drying of the grafts was not a problem for the Carousel as it was for the Choi. Unfortunately, the instrument manufacturer was unable to produce a consistently high quality product and we ended up in court trying to get my money back for the build out of the Carousel, rather than getting the tool into the transplant surgeons’ hands.

A paper about the Carousel was published in 1998 and three videos of the instrument can be seen below:

Read more of “Hair Implanter Carousel (with Videos)”…

Dr Rassman,

As part of your occasional series discussing the hair jobs of celebrities, could you take a look at this (rather unflattering) article on Sylvester Stallone in London’s Daily Mail?

Link: Daily Mail

In short, he does look very good for his age — until you check out the closeup of his hairline. In your opinion, what technique is responsible for that restoration job?

Thanks for your time

Yikes! What I see in the link you sent appears to be a harsh hairline. Even with the limitations of the photos, I think I am able to see some of the older type of work, some large grafts mixed with smaller grafts — so in my opinion he looks transplanted. I have no firsthand knowledge and am basing this on Mr. Stallone’s appearance in this photo. The older (and larger) grafts are relatively easy to detect and reflects more than one surgery, one of which may have been done years ago, prior to the advent of the modern Follicular Unit Transplant technique that we defined in 1997 in the published literature (see links below).

• The Aesthetics of Follicular Transplantation
• Follicular Transplantation: Patient Evaluation and Surgical Planning?

Hello doctors.

I’m 34 and started using Propecia at the first sign of hair loss six years ago. The results have been fantastic and I have experienced no side effects. My wife and I are planning on starting a family soon and even though I’ve read on your site and others that it’s safe to keep taking propecia, I do have my concerns. I am also concerned on the lack of long term propecia studies. If I just want to maintain my current hair, or at least slow down the loss of it, do you think switching from Propecia to Rogaine foam would do the trick? Or would all the hair I’ve kept because of being on Propecia still fall out in less than a year?

Thank you very much.

Propecia has a very short half life of 4 to 6 hours, which is the time it takes half of the drug to be cleared from your blood stream. Therefore, it should be out of your system in one day. There is no evidence to suggest that it would affect your fertility or have an impact in conceiving a child. The results of studies on the drug crossing from your semen to your wife are (according to what I read in the research papers done by the drug company) almost nill. For those patients who are still wary of whatever side effects it may possibly have on their unborn child, I generally recommend that you do not take Propecia for one week prior to the act of conceiving, during your wife/girlfriend’s very fertile period, which is about a week long. This should not have any deleterious effects with your hair loss.

This is a follow up to “I Was Diagnosed with Mild Alopecia Areata After I Was Prescribed Propecia” The dr never did the biopsy because he said there was strong evidence that I had alopecia areata due to small patches on my face and amount of grey hair present. He wanted to try the simple stuff and since my hair has yet to start falling out again didn\’t feel the need to do one. However I have yet to see regrowth in two months of being told to stop using the topical. It was Fluocinonide .05%

The hair loss from alopecia areata may take months or years to reverse — or it may not reverse at all. You need to have good communication with your doctor on this issue. The diagnosis does not require a biopsy, as a good doctor knows what to look for in most situations. Patience is a virtue in waiting out the course of this disease. Topical steroids have value when used by a knowledgeable doctor and some may use fluocinonide (a prescription item) as one of these steroids. See Wikipedia for more on fluocinonide.

Dear Dr. Rassman,

My question is: might minoxidil work for a bald spot caused be trichotillomania? Is this worth a go? If so, have you heard of the product ‘Kirkland Signature’ who are a cheaper alternative
to Regaine?

Many thanks.

Trichotillomania produces hair loss from traction, which can kill the hair follicles that are under constant attack. Once they die, I would think that the follicles can not be brought back to life, and as such, I would not expect that minoxidil will have a benefit in the areas where balding is produced from trichotillomania. I have heard of the Kirkland brand, which I believe is just a generic minoxidil.

I am transgender male to female, and have male pattern thinning. I have been on hrt and antiandrogens for 2 years and Proscar and Minoxodil for 8 months. I consulted a hair transplant surgeon about transplants on the crown and top of my head, and after a video microscope evaluation he said that he cannot do transplants as there is no room for grafts. He stated that I have not really lost any hair and have great density, just that the calibre of the hair had diminished. Do you think given more time on hrt, antiandrogens, proscar, and minoxodil, that the miniaturized follicles may recover to terminal thickness and if not what other options do I have?

If your hair is miniaturizing, then the hormones and complex medications you are taking may be the cause of your problem. Hair transplants, where there are normal densities of hair, may not help solve your problem. I couldn’t tell you if more time will for sure help your hair.

i have been taking proscar for probably 7 or 8 years. a few years ago i had a pretty bad shed. freaked me out. however the hair did come back. again, i am having another shed and i\’m pretty stressed about it. is it normal to have sheds periodically even while on proscar?

It is important to realize the the genetic hair loss has its own course, independent of the effects of the drug. What you think is shedding from finasteride, is probably more genetic hair loss. Hair loss goes in waves and cycles of loss (shedding) most likely be due to your genetics, not the finasteride. You should discuss this with your prescribing doctor.