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I am a female who had a hair transplant last week with the FUE method. I have FPB and a very thin donor area. I was told that on the day of operation and too far into the procedure i dont have thick donor hair so the coverage wont be very good. I am concerned now as i wonder will i get shock loss too as i have weak hair then and will i be balder then before.

• When will the hair fall out now it is placed and how can i look after what i have to look like a normal lady?
• Can i use Regaine as that did work when i used it last time but it irritated my scalp?
• Should i take extra vitamins?
• Shall i just say a wig and be done with it?
• Does FUE not work for FPB then?

First off, if you are female with a poor donor area, why would you even consider follicular unit extraction (FUE)? That surgical technique is mainly for people who want to cut their hair very short (like a crew cut) and not see any scar or just might want to shave their head, not likely for a female. If you are a woman, a scar (large or small) on the back of your head should be inconsequential and will never be noticeable with long hair covering it. I generally try to convince my females patients against FUE.

I am outraged and you should be furious. How can one have surgery and not understand what to expect?! It seems that you got conned into doing a surgery by an unethical doctor. The doctor should have told you about this before you underwent the surgery. Now the problem you face is waiting for complications of the transplant such as shock loss, accelerated cyclical loss, failure to grow, and on and on. If you were told that the surgery you are having won’t give you good coverage while the surgery was being done, then you might have a malpractice claim against that doctor if you are worse for doing it!

Vitamins will not help with your surgery. The wig is up to you, but it could ultimately make your loss worse from any traction alopecia that could develop. I would not use Rogaine (minoxidil) if it irritates your scalp. Let us hope you have no or minimal shock loss from the surgery itself and you can at least achieve some coverage. Only time will tell.

For the rest of the readers out there — beware of unethical doctors and do your research. Use this guide to help select your hair transplant doctor. We generally believe that 80% of female patients do not make good hair transplant candidates, especially if their donor hair shows diffuse thinning.

Snippet from the article:

An FDA advisory committee has voted against approval of two drugs for the prevention of prostate cancer because of a link to increased risk of high-grade, aggressive forms of the disease.

GlaxoSmithKline’s Avodart and Merck’s Proscar are approved to treat benign prostatic hyperplasia (BPH), or enlarged prostate, which is common among men over the age of 50. In studies, both drugs showed a nearly 25% reduction in the risk of developing low-grade forms of prostate cancer compared to participants taking a placebo.

FDA medical officer Yang-Min Ning, MD, PhD, says such forms of cancer “propose very little threat to men during their lifetime.”

Read the full text at WebMD — FDA Panel Rejects Drugs to Prevent Prostate Cancer

There is a great deal of politics going on that I really do not understand, but even with this panel rejection, I would not advise my own son to stop taking 1mg finasteride to treat his hair loss.

It is clear that finasteride at the 5mg dose seems to prevent prostate cancer to some degree, but it wasn’t enough for the FDA to label it as a preventive medication for prostate cancer. People will ultimately need to make their own decisions in regards to this medication, but keep in mind that at the 1mg finasteride dose that is prescribed to treat hair loss, there is really no evidence one way or the other that it could be a problem or even if it will prevent prostate cancer. More will be written by other societies and I will fill in the readers of this site once we know where it all “falls out”.

Hi doctor,
Great site. My question is about ACell and all the other in development treatments like it. Will this in theory work for those who have dupa or fpb? I mean I understand the are years away and a big ? If they will even work. But if they do will the help those individuals as well. Eventhough there us miniaturization in the donor, or is there no hope for us?

Please answer… Thanks again.

Clearly, ACell will not impact DUPA (diffuse unpatterned alopecia) or female pattern hair loss unless it was used in conjunction with an auto-cloning procedure. We need to take one step at a time. We still need to see how well ACell works when used in an auto-cloning fashion. We do not know if you pluck a hair from the permanent zone that is not miniaturized in a person with DUPA or female balding, if that hair will grow at all. How it would be compared with a plucked hair in a non-DUPA patient is yet unknown.

Would wearing a ‘head buff’, like they do on Survivor cause more hairloss?

as in suffocating the scalp etc. my whole head would not be covered I would wear it like a thickish headband. I am thinning all over/crown, and desperately need to cover up. They are microfibre with no seams. They are very light fabric, I would just wear it as a wide headband sort of thing.

regards

I do not believe wearing a “head buff” or any form of head gear, bandana, helmet, or hat would cause hair loss. You cannot suffocate your scalp. If you want to go to the extreme and wear a very tight head gear everyday for hours at a time, you would (over the course of several weeks or months) cause traction hair loss.

Hi Dr. Rassman,

I’ve been taking finasteride (1 mg tabs of propecia) for 3 years with great success. Recently however I switched to Procar with a pill cutter and am horrified to read from the proscar finasteride package information for users leaflet:

“If you partner is pregnant or planning to become pregnant you should use a condom or other barrier method of contraception when taking proscar. This is because your semen could contain a tiny amount of the drug and may affect the normal development of the baby’s sex organs.”

This is news to me after 3 years of using fin. I know of the dangers of women handling tabs but have never read anything about this. Is it only relavent to the 5mg doses of proscar? Your professional opinion is highly respected. Please advise.

Kind regards

This is news to me, too.

We have known about problems arising from a fetus exposed to finasteride — the US leaflet for Propecia states, “If a woman who is pregnant with a male baby absorbs the active ingredient in Propecia, either by swallowing or through the skin, it may cause abnormalities of a male baby’s sex organs.” — but this is a warning for women that want to take finasteride or handle crushed pills.

As I’ve understood it, finasteride does not have any significant concentration in a man’s ejaculate. In my searching, it appears that this line about a condom is only in the UK Proscar leaflet. This wording is not seen in the US or UK Propecia leaflet, and I’ve not seen this in any of the literature before. Although it is the same drug (finasteride), Proscar is 5 times the dosage of Propecia. Merck’s official word is that Propecia poses no risk to unborn children.

I will have to ponder this one for a while, as it is against what has been revealed to me in the past.

Hi,

Love the site and the calm measured manner you guys take to things. I’m finding the Acell stuff really fascinating for a lot of reasons beyond my own hair concerns. I had a couple questions and was hoping you might be able to shed some light on them.

From what I understand, one of the many unanswered questions in the auto-cloning process is whether or not a plucked hair from the balding-immune donor zone, implanted into the bald area will continue to be fully immune to balding because of the mixed biological source nature of the hair/implant zone/newly generated follicle. Theortically couldn’t this issue be circumvented thusly :

1) Use standard FUE/implant techniques from donor areas
2) Depending on scalp availability, reseed these areas with acell plucked hairs
3) Harvest established acell hairs for further implanting
4) repeat until desired results

Not to get into totally wacky territory here, but is there any investigatory efforts to see if Acell plucked hairs can be implanted in other areas of the body and harvested in that manner if scalp tightness is an issue? For instance, growing a crop of donor hair via auto-cloning on the arm/back/leg, and taking them for standard implant from there?

Perhaps you are misunderstanding what the auto-cloning technique with the ACell product is all about. The research we’re conducting is basically plucking out hair from a donor scalp area (where hairs are considered immune to genetic balding), applying the ACell products, and transplanting to an area of scalp where there is balding. We are not harvesting hairs to be multiplied in a lab. Growing a crop of donor hair is not what this is all about.

Finally, we still do not know if the transplanted ACell plucked hairs will continue to survive years down the line as if they are immune to genetic balding like standard transplanted hair follicles. We are all assuming that it will be just like transplanted hair follicles, but this has yet to be proven. That proof will come many years from now where we can follow those transplanted patients.

Dear Dr. Rassman,

I’ve been reading your blog for about two years now since I started dealing with hair loss, thanks so much for donating your time to the public in this way. I have a question that I haven’t really seen addressed in past postings: Just how accessible are you to the average working guy who wants a procedure with you? You seem to be at the forefront of your field, I imagine you’re services are quite in demand and I’m not a pro athlete, movie star or CEO.

What are my chances of being able to get through and have a consultation with you? I/m 31, I’ve been maintaining an almost full head of hair with propecia, which grew back a lot of my crown where I was thinning. But I imagine somewhere down the line I will want a procedure, particularly if things like A-Cell pan out to make transplants less invasive.

Thank you

Contrary to what you may think, I am available to anybody who wants to see me for a consultation. In fact, many of my patients are just the “average Joe”. Anyone can call 800-NEW-HAIR to setup an appointment.

Since you indicated you’re in the Bay Area, you can also see my associate Dr. Jae Pak, as he flies up to our NHI office in San Jose every Wednesday. While I usually spend my time at our Los Angeles office, I am also available in San Jose on occasion when Dr. Pak takes a break from his schedule.

i have a 1 inch scar on my head just above temple. my hair surrounding the scar is thinner than the corresponding hair on the otherside.

i was wondering is it normal for hair to be thinner around a scar.

It may be just a perception of thinning hair, because you have less hair on the scarred area. I doubt that each individual hair strand diameter is thinner. In other words, when you got your scar you may have lost some surrounding hair contributing to less ‘bulk’ of hair in the region.

hello Dr Rassman,
i have a question about hairlines. although it does concern an unlimited donor supply my question is indirectly related to a hair loss cure.

Would you restore juvenile hairlines on patients who requested this if there was an infinite donor supply? like do your concerns simply stem from the finite amount of hair an individual has available for redistribution? or is it an appearance issue?

thanks and props to all the doctors who make this site what it is!

Hair transplant surgery, just like any cosmetic/aesthetic surgery, is a situation in which the patient chooses to alter his/her appearance. Thus, if the patient wants to have their juvenile hairline back and there is enough donor hair available, I see no reason why a doctor cannot accommodate the request. The caveat is that even if there is unlimited donor hair, you must consider the future of how that patient may continue to bald and that patient must prepare to have more surgeries. We keep referring to this as the Master Plan.

If the person was 20 years old, I might suggest that he wait 10 years to be somewhat certain he will not be balding. If he is 30 years old without signs of balding, then this could be looked at as if it was a safe decision and probably will not bald.

All of this is hypothetical, of course, because even if auto-cloning is a reality you would need multiple procedures to get that amount of hair distributed to cover the area you want to the density you desire.

Dear Dr.Rassman

First I want to thank you for your awesome blog, I am a regular here for almost a year and the information you have provided prevented me from taking many wrong decisions in my battle with MPB. And now for my question:

I am a nw3 and used 3% minoxidil for 6 months along with Finpecia and saw very good results on temples, it almost filled entirely although not very thick but all my temple area was filled with newly grown hairs. it made a real different visually.

Then for past 2 months or so I switched to 5% Minox to see even better results but to no avail! during this time i saw massive shed and almost lost all my previously grown hair on my temples and lost even more ground in my hairline. now my hairline is very thin in front and I am starting to freak out since its getting worse everyday. now what should I do? switch back to 3% or continue 5% Min?

Your opinion on what should I do next is highly appreciated. Thank you very much in advance. Best Regards

I do not know what to tell you. If you follow this site, I’ve said many times that there is no cure for genetic hair loss. So all I can offer are hypotheses. Maybe it is just coincidence you are losing more hair on 5% minoxidil. Maybe switching to 3% may (or may not) help. Maybe you are noticing the shedding that many people report from starting on minoxidil.

My best advise is to not freak out and make harsh decisions based on emotions. Weigh out your options and choose your course. There is no wrong answer. Have you thought about seeing a physician and finding out what a professional thinks your course should be?