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Hello Dr.,
Thank you for answering all questions and thank you for this blog.

You have mentioned that catch up hair loss could be very dramatic after stopping propecia. Do you have any examples that you can provide us? (i.e a NW 2 going to a NW6).

Thank you

Let’s say you now show a Norwood Class 3A pattern and have been on finasteride for 10 years. Upon stopping the medication your hair could remain the same… or you could begin to show progress to a Norwood Class 5, 6, or even a 7. The catching up of the hair loss just means you’ll go to the pattern you would’ve been had you never taken the medication in the first place. So what you are asking is a look into your future, but you’ll need to see an experienced gypsy for that.

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Hi Doc,

I am 27, and stupidly got two procedures (~800 grafts each) done about three years ago. Have been taking propecia since the age of 18 and just started on rogaine a few months ago. I guess I’m about a Norwood 3, moving towards a 4 (except no thinning on crown).

Anyway, the problem is that the transplanted hairs came in much thicker and more wiry than the natural hairs, and they were not always individual hairs, so I’m about a year into getting them removed as best I can via electrolysis. The skin is slightly scarred, but I’m unsure exactly how it will end up looking once it gets time to really heal and start to fade.

I’m trying to weigh my options for proceeding as my hairline continues to recede, and am deciding if I should continue to get the rest of the plugs removed as my natural hair goes or if it’s worth more transplantation but done with more care. The question is really do you have any knowledge about different types of hair responding differently to transplantation? My hair is dark brown and curly, would it be more susceptible to coming in thick and kinky than someone with finer straight hair? Because the last thing I want to do is get more transplants and have them be obviously fake and just compound my problem!

Thanks a lot, and I love your site.

As I’ve said many times before, the good news about a hair transplant is that it is forever… but if you have a bad hair transplant, then you probably aren’t looking at that news as being too good. Even removing the hairs may still leave a scar and cause an unnatural hairline, as you’re noticing with the electrolysis. Something concerning me though is that you’ve had 2 procedures at 27 years old of what you describe as “plugs”. I hope you aren’t referring to the ugly, old hair plugs that you commonly see in men that had surgery decades ago. Perhaps you’re just using the wrong term and you meant “grafts”, which are made up of 1-4 hairs. Modern hair transplants will look natural and the hair shouldn’t change character or color.

There are still options even though you may have a bad transplant, but BaldingBlog is not a place for second opinions. You’ll need to have an evaluation to see what options are available to you since each repair case is unique, so you should see a hair transplant physician (just don’t go to the one you already had two surgeries with, obviously). If you want to come out to Los Angeles, our consults are free and we have plenty of experience with patients who are in your situation. We have performed corrective procedures on many sub-par hair transplants.

See Dean’s Story for an example of a repair process, and check the Repair category for even more posts about this.

I’m 43 years of age. I just quit drinking 6 months ago, my liver was in bad shape to the point my doctor didn’t think I was going to make it. Since then I changed my diet, abstained from using alcohol and anything else that might be hard on my liver. Blood tests that I’ve got recently show my liver to be functioning normal. My health according to my doctor is good. All symptoms like extreme bloating, sight loss due to water leakage from blood vessels, and anxiety attacks, which was the reason why I started to drink in the first place, have gone. The problem I have is that I’m losing hair in large amounts. I NEVER had any noticeable hair loss before and this started 3 months after all my symptoms of alcohol abuse were gone. I still smoke (trying to quit). I take vitamin supplements. my diet is good. what can cause this? Stress?

Diet and an adequate daily intake of vitamins are often a problem with alcoholics, and as you appear to have started to address these issues, it will hopefully become better in the long term. This is a complex problem in that you may have genetic factors in addition to what has impacted your general nutritional issues in the past.

A good examination by a competent hair doctor will show the degree of miniaturization and balding you may have, the status of your donor hair as compared with the areas of loss, and the presence or absence of a telogen effluvium can be evaluated. The long term impact of your past drinking history may still have ramifications for you. I can not help you more directly without examining you.

After reading your blog, I understand your concerns over prescibing Avodart for hairloss. However, if someone were to make an informed decision to switch from Propecia to Avodart for hopefully better results, would you advise them to switch immediately or stop taking Propecia for a while before taking Avodart? Lastly, would the switch in medication return the user to stage one i.e. they would be starting to tackle hairloss all over again, or would the Avodart immmediately “follow up” or add to the effects of the Propecia in limiting DHT etc?

When switching from Propecia (finasteride) to Avodart (dutasteride), I wouldn’t think that any waiting period is needed. I’m not sure how informed your decision in switching medications is since dosing information hasn’t been established when taking Avodart to treat hair loss, but since both are prescription medications I’d hope these are things you and your physician have worked out. For those curious, you will not need to maintain the Propecia upon switching since Avodart is also a DHT blocker. The two medications work in similar ways, so I’d guess that it would just pick up right from where Propecia left off.

Hello,

I an from India and wish to get a HT done. I approached [a doctor] but I found out that the medical trip could be quite above my spending capacity and also I cannot find enough time fo the same. There is a new surgeon in India who is a ISHRS fellow and incidentally also happened to work under [the other doctor] (according to his website). I have also seen her results and I find them better than what others in India have produced.

The only thing that stops me from going to her is that she is into practice less than a year(but i don’t have any information about her past experience). Can I trust her bald head to this new doctor or should I wait for a while and get it done abroad?

Regards

I can’t tell you who to trust. I’m not familiar with that doctor or her work, so you might want to use Google to research the doctor a bit more or ask around in various hair loss forums. Be sure to ask the doctor herself for any information about her past experiences that you wish to know. Also, ask to meet with live patient models so you can see the quality of her work in person (this is better than just seeing photos).

Don’t rush into surgery because the price is cheap. Go with whichever doctor you’re most comfortable with (and results that you like), and if it means you have to wait to save up your money, then you should do that.

I had 2 cysts on my scalp removed at Easter and one has healed quite well but the other has left a bald spot about the size of a 50 cent peice. The skin is more pink and shinny. Will the hair grow back? There doesn’t appear to be any re-growth? Should I be seeking some form of treatment? What can I do to look normal again? This is not a good look for a female. Thanks.

You’ll have to allow more time to see if there will be regrowth. Being patient is all you can do at this point. If after a year the bald area is still the size of a half dollar, then you might have lost hair permanently… and a very limited hair transplant would likely solve the problem.