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i had a hair transplant in 1987. I only went for one session. Now, I have plugs near the temples on both sides of my head. I have shaved down the plugs but there is the “cobblestone” scars
left. Is there anything that can be done to remove these scars. I don’t want to shave my head completely, just get rid of the “cobblestone” scars. Thanks

These cobblestone scars can be excised one-by-one. With a well done procedure, the scar from an excision will not be as bad as what was originally there.

Dear Dr,

Thank you so much for the great website. I have two questions. Firstly, is there any chance that Propecia can lead to infertility in men?

Secondly, if the ‘theory’ behind hair multiplication is sound is there a type of ‘gold rush’ to get this to the market place? I only ever hear about aderans and intercytex. Surely, there must be more companies looking for a cure. It seems that intercytex has had ‘relatively’ good results so far in its trial for hair multiplication. Do you believe we will ever see a complete cure for baldness? Not just stopping people going bald but allowing extensively bald people to regrow hair. For example bruce willis regaining a full head of hair.

I do think there will be a cure for baldness, just as I think there will be a cure for cancer and a cure for a rash of other diseases and ailments. When that will be is anyone’s guess, but science progresses all the time. It won’t be within the next few years, but we can all hope for the best. I have no way of knowing if it’ll help Bruce Willis regrow a full mane of hair, though. We could speculate all day, but it is just a pipe dream at this point. Hair loss isn’t a life threatening disease, so you’re not seeing yellow plastic bracelets and pink ribbon stickers everywhere with people showing their desire to help fight against balding.

Aderans is a huge Japanese company with significant funding, and Intercytex is also well funded, so the market has space, but it isn’t just something any company can rush into without a whole lot of money backing them up unless they want to just fizzle out. I’d guess that many companies will wait until the technology is proven safe and effective (if it ever is) and take it from there. I mean, just look at the rush of products that came out containing minoxidil once that was available as a generic. There is just not much that is worth my time to evaluate at this stage. When it gets to the level where the FDA has to review it for clinical testing, then there will be a track record of science that got it there and as this will always be public information, we can assess the technology at that time.

Dr. Rassman,

I was on propecia for about 6 weeks over the summer and experienced erectile dysfunction while on the medication so I decided to stop taking it. 3 months after stopping the medication I am still experiencing erectile dysfunction, and prior to taking propecia I did not have this problem. The dermatologist that prescribed me propecia said that the side effects of propecia will go away shortly after stopping the medication, and I am beginning to wonder if this is really true.

Have you have ever had a patient who has experienced permanent sexual side effects from taking propecia? There is no doubt that propecia greatly helps people suffering from hair loss, but do we really have a clear grasp of the side effects of this drug?

Sometimes finasteride can bring out an ‘under the cover’ case of erectile dysfunction (ED) that would have happened anyway. Best to see your doctor for an assessment of ED as this is unlikely the side effect of the drug this far out. There have been a number of published studies on this medication, coupled with my own experience in talking to patients, which is why I believe we do have an understanding of the side effect potential. As for permanent side effects — not in any of my patients. If you rely on random anonymous web forums, I’m sure there are many posts out there that will tell you the opposite.

1. Jezebel.com gets in-depth on one of the real issues facing people all over the world — the investigation of what’s going on with rock star / reality star Bret Michaels’ hair.
2. Los Angeles Times is skeptical of the Laser Comb.
3. Hair Loss and Replacement for Dummies press release is in the wild! Buy the book!
4. AskMen.com put together a list of future balding treatments that may or may not ever become reality.

Hello Dr. Rassman and staff,

Doc thank you for your time, you speak your true feelings and I appreciate it. Ok, I started losing my hair around 19, which wasn’t very fun. Within a few months, I did start taking Propecia. I’m 21 years old right now, Propecia has been working for me but the damage was done early enough. I would say I’m a Class 3 on the Norwood Scale and would someday hope to change that. Personally I would love to have all of my hair back right now but it doesn’t look like that will happen too soon, but I’ll live. The hair loss process actually hasn’t been all bad; it actually has been a good humbling experience for me, although, in the end I plan on winning the battle.

I’m not really looking for a hair transplant in the near future, from what I have read on your website almost every 21 year old isn’t a good candidate. Although, is age always so relevant? I would think the biggest factor would be the donor density. Lets say you have two men who both have the same amount of hair loss (Norwood 4), one in his early twenties and the other in his mid thirties to forties. Wouldn’t a healthy 22 to 24 year old with a high density be a much better candidate than a person who is 35, 40 with an average density?? What’s your opinion on this, also where would someone go and get their hair density tested, would a dermatologist typical offer some type of test?

Donor density and where you are on the balding process are two different variables. Maturity of the balding pattern is also important for that 21 year old you referenced. There are no absolute rules with regard to having a hair transplant, but a bond between doctor and patient is critical in understand the meaning of all of the variables (age, donor density, hair characteristics, donor laxity, etc…) including the maturity and financial stability of the patient considering a hair transplant.

(female)
Hello! i use to go and get my eyebrows waxed. The last time i did was about 7 months ago and every since then they haven’t grown back, they are very thin (it looks like i dont have any eyebrows) and there are a few bald spots.. What could of caused that? and is there anyway i can get them to grown back?

If you pluck out your eyebrows all the time, eventually some hairs may never grow back. Think of it as causing small trauma to the hair follicle over and over and eventually the hair follicle will stop producing hair. Wait it out for a full year. If it does not return, you can have a hair transplant to put them back, using hair from your scalp.

Hi Dr.,

After much consideration, I’ve decided to stop using minoxidil. And, as expected, I am now losing hairs the minoxidil was saving. But I suspect that some of the hair I’m losing now will grow back later.

My guess is that minoxidil lengthens the anagen phase for all hairs - indiscriminately - thus delaying those hairs’ telogen phases. And so, some of the hairs I’m losing post-minoxidil are “healthy” hairs whose telogen phases were delayed. Thus, I should regrow at least some of the hairs I’m losing post-minoxidil.

Do you agree?

No, I do not agree. People who develop minoxidil dependent hair will lose their hair if the drug is withdrawn and it will not grow back. If you don’t believe me, just wait a few months and I am sure you will be converted to my thoughts on your problem.

Dr, I stopped using minoxidil 5% 3 years ago but am still suffering from black rings around my eyes. Has any more information come to light since this was first reported? Thanks

I don’t know more about this condition other than what I have written before on this site. I did a Google search to see if I could find other cases and only saw a couple of posts with a question almost identical to yours (so I assume you asked your same question elsewhere). If more information comes available, I’ll certainly post it.

Hi Doctor,

If one were to get a FUE or FUE2, and in the future decide to shave it all, will there be left over dotted scars in the back from the donoring?

What kind of scarring can one expect from FUE or FUE2?

Thanks

Yes, any incision made to the scalp will result in a scar of some kind. It is not an entirely scarless procedure and any doctor that tells you there are no scars is feeding you a load of bull. Scarring for FUE will be a small pinhole… like a pencil mark. If your density is low, scarring can be a problem with the follicular unit extraction (FUE) procedure, because the amount of hair to cover the donor excisions will be less. If the density is high, it hides well. Shaving your head like your facial hair, will leave ‘dots’ of white circles measuring between 0.7 - 1mm wide, or if your surgeon used a wider instrument, it will be even wider.

I just saw a patient who had 3300 grafts with a FUE technique by another doctor and the back of the head looked like he was shot with 3300 holes from a pellet gun; few of the grafts grew after a year. Your skin and other factors will determine how visible these scars are with your head completely shaved to skin level — but why would you bother getting a transplant if you’re just going to shave your head anyway?

I’ve read that finasteride reduces something called prostate specific antigen (PSA). What role does PSA have in hair loss? I’ve also read that PSA is a misnomer as it’s not really only in the prostate. This article says that saw palmetto does not lower serum PSA levels: AAFP.org

But propecia does lower PSA levels. Do PSA levels have any relationship to hair loss? In other words, if saw palmetto does work on the prostate but only in the prostate, does it not have any effect on male pattern baldness?

PSA levels should be very low in people without prostate cancer and higher than normal in those with prostate cancer. PSA has nothing to do with hair loss, it is just a protein found in the blood in high concentrations in those with prostate cancer. I have also read articles on saw palmetto that indicate that the mechanism of action is different than finasteride and the fact that it does not impact the PSA levels shows that.

Some people feel that saw palmetto has value in balding prevention, but I really do not know the answer to that point. Not enough studies have been done that have met my satisfaction.