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Snippet from the article:

Just after Michael Jackson’s sudden death in June last year, rumors started circulating that the late singer was severely emaciated and bald. Although such allegations were frequently shot down, the coroner’s report released on Monday confirms them, and adds new, graphic information.

Sixty-one photographs of the former pop prince were taken prior to and throughout the procedure. According to the report, Jackson’s hair was “sparse and connected to a wig.”

“There is frontal balding and the hair can be described as short and tightly curled,” the report claimed. Jackson hair line was tattooed on, as were other facial features.

Read the rest — Michael Jackson Balding, Incredibly Thin and Had Tattooed Facial Features

Michael Jackson had 3rd degree and 2nd degree burns to his scalp which, I assume, caused considerable hair loss and scalp loss. It shouldn’t come as a shock to anyone that he had a quite a bit of plastic surgery, but I’ve also heard that he had transplants, although having not been there when they were done or being able to review the results, I am not in a position to determine their value.

If the coroner’s report states that he wore a wig and had his hairline tattooed, it could be that he had the transplants in an area so that the wig could be attached better — or maybe the transplants weren’t as successful as he’d hoped. This is just more speculation, though. The skin of third degree burns does not support transplanted hair grafts. Without examining him, I can not tell for sure what was done or what benefits he received, if any. And since he’s deceased, I’d imagine an exam isn’t going to be a likely possibility.

I stopped taking propecia 6 months ago, after having taken it for 18 months. I believe the drug did stop my hairloss and I may have even gained some growth. I stopped taking the drug however, as I became very uneasy with it and the side effects. I am now using regain extra strength. My hairloss has returned and continued as expected. I am now seriously considering a transplant, but do not wish to go back on propecia. As my hairloss is very slow (over the passed 17 years), is it okay to undergo a transplant, but not use propecia?

Propecia is a great medication, but to a minority of patients the unwanted side effects may be an issues (as it is in your case).

You do not have to be on Propecia for a hair transplant surgery, but if you are under 30 years old and started to lose hair in the past 5-8 years, you run a risk of developing hair transplant shock with loss of hair from the transplant. I don’t know your age, but you mentioned losing hair for 17 years, so I’d assume you’re over 30. You still run the risk of shock loss, but it is less. Plus, without the medication the progressive nature of hair loss will cause your native hairs to continue falling out. As long as you know these facts, it is a decision you and your doctor need to make together.

I’m a celebrity gossip fan (for better or worse). I know you recently wrote about Jon Cryer from Two and a Half Men, but I just saw this new photo of his balding pattern. It is way worse than I originally thought!! What Norwood Class would you estimate he’s at? I’m just curious.

TMZ: Jon Cryer — Out in the Open

The last post we made about Jon Cryer was just couple months ago, and at that time I wasn’t sure what was going on from the photos I was shown. From these pictures, his hair loss pattern appears to be at least a Norwood Class 3A, if not more advanced along the type A patterns or even the 4-6 pattern with high miniaturization; however, without a top down view and a rear view, I really can’t make the diagnosis.

Photo from TMZ via INFdaily.com

Hello Dr.

Do you have any opinions on chewing up Propecia vs swallowing it? Is it true if you chew it, there is better change of all getting absorbed? Or would chewing it somehow ruin in the inherent chemical makeup? Thanks.

Some medications are meant to be chewed, but if the medication is meant to be swallowed, I would swallow it as it is written in the instructions. Propecia is one of those medications that was meant to be swallowed. I really do not believe it would help with the absorption if you chewed it, plus, I don’t think it would taste all that great.

Hello Dr. Rassman! I’ve found your blog to be extremely helpful and I’d like to ask you a question:

I’m 19 years old, and I’ve noticed thinning at the corners of the hairline, with thinner, shorter hairs, extending (as far as I can tell with close inspection - no microscope available yet unfortunately) about 1.3″ above the highest crease of the wrinkles at the corners, and it doesn’t seem to go any further than that (the hair also feels thinner at the corners) and the middle of the hairline has settled two thirds of an inch above the highest crease without thinning behind it.

I’ve come to understand from various blog posts that there are more smaller (or vellus) hairs at the hairline than at any other spot on the head, which leads me to my question: If developing a maturing hairline means the hairline moves back an inch or so, does the mature hairline position have the vellus hair common in hairlines before/during the maturation, or do some of the hairs in the mature hairline become vellus hairs during the maturation process?

I hope you find the time to answer this question, with kind regards from Israel.

Vellus hairs are short, fine, light colored, often barely noticed hairs, which develop on most of the human body… and on the scalp they are part of the follicular unit. Some people might call it peach fuzz, and these hairs are not only on your frontal or maturing hairline, but they’re also found almost everywhere on your body — except lips, backs of ears, palms of hands, soles of feet, certain external genital areas, navel, and scar tissue.

The leading edge of any hairline has hairs that are often thinner than the hairs further back. That is why a doctor must create a transition zone when he/she transplants the frontal hairline, or the transplanted hairline will look like unnatural. Obviously, nobody with a hair transplant wants the world to be able to tell their hairline was created by surgery. As you are only 19 years old, determining your future hair loss prospects may be a bit difficult just by trying to judge the frontal hairline and seeing fine vellus hairs. You probably need a miniaturization study, a physical exam, and a good family history to start any sort of guess work.

Doctor,

Love the site, check it out routinely.

I noticed someone previously had written you having had bad side effects from Propecia. You said for him to send you what the effects were to see if he was doing enough to counteract them.

Well, I tried three go-rounds with finasteride. Twice via Propecia (for about 1 year each), and once via Xandrox 15% w/Finasteride as a topical solution. All three times I experienced noticeable mood changes; I would describe it as almost a mild-depression as well as loss of libido. What do you prescribe for patients like myself with these problems to counteract these side effects?

Thanks

Coincidentally, I was going to post something today about a recently published article in Prague Medical Report discussing the relationship between finasteride and depression in some people. From time to time I’ve gotten comments about changes in mood, possibly resulting from finasteride use. Although these are reported in the Merck studies, there is not much information on the mechanism of such side effect possibly because they are very rare. I found this quote from an abstract in a medical journal, which might shed some light on the mechanisms of finasteride action…

“In the course of finasteride treatment the decrease of the concentration of circulating steroids with known inhibitory activity on GABA-ergic excitation in the brain is very probably an important factors contributing to the development of the symptoms of depression seen in some isolated cases of finasteride administration.”

Read the full abstract here — Finasteride treatment and neuroactive steroid formation.

I’m a 61 year old male and began using Provillus treatment about two years ago. The results were encouraging and after about four months, I felt lots of new hair growth all over my scalp, about 3/4″ long. Some if this fell out but enough continued to grow to make a real difference and I was happy with the result.

I continued using the product for about a year with no problems. Then I re-ordered the product gave me severe rash all over my scalp and hair in some of the really aggravated areas fell out or at least has stopped to grow. I queried the supplier about the product because of the rash and also because the viscosity of latest shipment was decidedly higher than the original. The advice was there was an improvement to the product which brought about the change in fluidity. Obviously this was the end for me using a scalp treatment (I experienced the same effect later with Rogaine)

Not wanting to take defeat just yet, I’m thinking about trying a laser comb. Do you have any advice for me? Thank you

It sounds like you have developed a skin allergy to the product. This can happen. Perhaps you’re allergic to an ingredient in the Provillus, particularly if you say they changed the product before you ordered another shipment. I really don’t have any way of knowing. You can try using regular minoxidil, which is the active ingredient in Provillus. Then again, minoxidil itself is known to cause skin irritation in some people (see side effects). It’s worth a shot, I suppose.

With respect to the LaserComb, it is our feeling that it does not work. We’ve written extensively on this subject. See those posts here.

My question is what to do about gynecomastia from Avodart, which stays in your system for months (maybe even a year) after discontinuation. Since the usual treatment for drug induced gynecomastia is to stop taking the drug, this is essentially not an option with Avodart.

My doctor feels otherwise, but wouldn’t you think a more aggressive treatment such as tamoxifen would be warranted? There is already a lump you can feel, and my understanding is that this will become permanent if it lasts more than six months.

Any advice what I should do?

You need a doctor to guide you in a direction here, and your prescribing doctor is the one to go to. I would probably suggest that you just discontinue the drug, maybe switch to finasteride in very low doses, but I am not your doctor.

I don’t have experience with using tamoxifen as a treatment, as described here. Hair loss is listed as a possible side effect from tamoxifen, by the way.

After a year on Propecia, my hair loss has slowed to the point that its virtually noticeable. My hope is that my hair loss will incur very slowly over time, thus losing my hair on a more age appropriate time-line. Losing my hair now, at such a young age, will probably bother me more than losing hair 10 years from now.

The only side effect I experience is increased tear production. When I am having an emotional dialog, my tear ducts are more active. This has been a very strange experience! Even so, my Doctor is unsure whether or not Propecia is the cause. The problem is not nearly severe enough for me to consider stopping the medication. Overall, Propecia has been working great!

I would challenge your first paragraph, as men of all ages are impacted by hair loss… and no one likes to look older because of balding.

I am not familiar with tearing problems from Propecia. I don’t recall ever reading any report of this or having any patient mention it. I’d check with an eye doctor.

If Hair Transplant is so safe, why do clinics require patients to sign “disclaimer” before surgery? I was quite freaked out seeing the paper basically saying ‘Oh, BTW, you could die and it won’t be our fault’. Not the best thing you do right immediately after popping Valium and right before heading for the chair.

I agree disclaimers can be a bit daunting and scary when you read each and every line. While we live in a litigious society that necessitate us from signing disclaimers, it is also a way to give full disclosure of all risks involved.

Signing a full disclosure or a disclaimer after taking a Valium (while you are intoxicated) is probably unethical and against the law, but it is something that should be discussed with you before any surgery or any activity when you are in a clear state and of sober mind. In my practice I mail out full informed consent documents days before surgery so my patients can have a chance to read it in the comfort of their home. We also review the entire consent form on the day of surgery before any medications are given. There should be no hidden surprises. This is how it is (or how it should be) for all medical centers and hospitals.

By the way, yes, you can die from a hair transplant surgery. This happened just a few years back (see here). To be fair, there were special circumstances behind that death, as the transplant itself is a very safe outpatient procedure with patients fully awake during the surgery. Unless someone has a heart attack or a stroke during the surgery, a hair transplant in itself is not a life threatening procedure.