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This analogy on the subject of FUE really hit home:

…Your donor is like a grid of marbles. FUT is basically a line through the middle (strip) which is closed up leaving the grid uniform and balanced but when using FUE, you are removing marbles at random from all over. It is much harder to keep the grid “balanced” with FUE…

So Doctor…..when a patient elects the FUE procedure to restore their hair, is there considerably less total donor hair available?

I have heard only half as much as with FUT. Say it ain’t so!

“It ain’t so!”

I suppose your donor area can look patchy with little white dot scars if you have 3000+ FUE grafts extracted. This occurs when your original density was average or less than average. People with high density hair often will not show the white scars (dots) at all. Even with 1000 FUE grafts, you will notice these patchy white dot scars if you shaved your scalp, but in general, even with 3000+ FUE grafts, the scars and the less hair volume will be hard to notice (depending how close you cut your hair).

Remember — not all FUE or FUT (strip surgery) is the same, and not all patients are the same with healing. I have seen awful FUE scars and great FUT scars and vice-versa. Each and every patient needs to talk with their doctor and understand the unique advantages and disadvantages along with the risks and benefits of the surgery. This may sound like generic advice, but many patients who seek out FUE choose to go ahead with a FUT procedure after understanding the limitations of FUE and FUT.

With regard to your main question about which procedure will get you more hair (strip vs FUE), I think that the answer is probably strip surgery. Many doctors now doing FUE surgery actually get the hair outside of the fringe area, which means that the hair is not permanent. Some doctors (who think about $$$ above all else) will push the FUE harvest area to meet the projections given. The donor area has about 20,000 hairs in it and if an FUE procedure harvested 1/3rd of the available supply (assuming average density of the hair in a Caucasian male), that would be about 6,500 hairs or 3,200 grafts on average. All of the higher number we are reading about reflects, most probably, non-donor (non-permanent) hair.

I heard of a technique where your own bodily fluid is injected into the male pattern balding spot and is supposed to grow hair. Can you tell me what you know about this treatment? Is it for real, is it permanent, is it for the frontal part of the scalp etc.?

I don’t know of injecting body fluid (???) in your scalp to grow hair… but I do know some clinics offer platelet rich plasma (PRP) into the scalp in hopes it will provide faster healing after a hair transplant. Some dentists use it for faster healing after a dental procedure. I asked a few dentist friends, one of which is a professor at UCSF, and she believes PRP is controversial even in the dental field.

In the end, this method has never really been proven to grow hair on a bald scalp. If anyone can find a well controlled study for hair growth from PRP, please let me know. Some doctors charge hundreds or thousands of dollars for PRP, but I remain a bit skeptical. The patients we’ve viewed in the office haven’t had the results their doctors promised.

I had gone to dermatologist for the hairloss problem. He prescribed Finasteride along with Beclomethasone Dipropionate lotion. I want to know how does this Beclomethasone lotion function. Any side effects of it and for how long it has to be taken ?

Finasteride 1mg is for traeting androgenic alopecia (genetic hair loss in men). Beclometasone dipropionate is a corticosteroid that is used to treat skin disorders, like eczema or psoriasis… and is not usually used for treating androgenic alopecia. Do you have a skin disease?

Perhaps you should ask your doctor, since he/she is the one that prescribed it to you. I can’t give you advice on how much or how long to use a prescription medication, as I didn’t prescribe it and I don’t know what you’re treating.

I experienced a chemical burn from a relaxer almost seven years ago and a section in the front of my head is still thin and patchy from the hair loss. It is also still pretty sensitive and itchy. I saw a dermatologist/trichologist and she recommended fluocinonide, which only irritated it further. She was not at all helpful, or professional, and she is supposedly one of the top in the industry. It really bothers me to look at it and I just wear weaves to hide it though it isn’t terribly noticeable. Is there anything that will regrow the hair? Should I try rogaine or hair transplant surgery? I really can’t afford to continue throwing good money after bad! Any advice is greatly appreciated.

You should not treat yourself. If you weren’t satisfied with your dermatologist, get a second opinion! I’m sorry I don’t have a clear cut answer for you, but this isn’t something I can make recommendations for over the web. A good dermatologist in your home town is the person to see.

A prominent HT doctor recommends using transplanted nape hair at the hair line to soften the look of the hair transplant and make it look more natural. This seems to make sense as often hair transplants look like the hair strands are too thick where transplanted and not natural. You mentioned that nape hair is not permament. Does this mean it might fall out over time and even if it does is it still worth it for the cosmetic effect in creating a more natural hairline?

I recently saw a patient in my office who asked me this same question and asked about the doctor. In case you are the same person, my answer was as you correctly state — nape of the neck hairs are not permanent. Some patients actually come to have hair transplants to the nape of the neck, as they are completely bald from below the ear level.

Thus, your nape of the neck hairs that are transplanted elsewhere may fall out over time and it is not worth the surgery. More importantly, even with the FUE technique there will be scarring that may show at the neck with white pale dots if the nape hair falls out over time. If you are considering this type of surgery I would ask that doctor if you can meet with a patient who has had it done to see what it looks like. When the donor area is from the nape of the neck with strip surgery, most of the time the scars are prominent and wide. Scars like these are not amenable to repairs and even with FUEs placed into them, they can not really look normal.

If you want a softer hairline, regular donor hair should be sufficient if done right with single follicles that are finer and grow naturally that way. If the staff and the doctor are good, they will pick out the smaller caliber single follicles for the very front.

Hello!

I have been using propecia 1mg for a little over 10 months now, my hair has not got any worse, i would say an improvement but nothing drastic! so where do i go from here? i would like to try and thicken the hair on my crown, should i try Regaine 5% foam? or just carry on with propecia usage? obviously want to keep a HT as a last resort as im 25 years old!

another question, i live in the UK how difficult would it be if i decided to got with NHI for a HT? can consultations be done using pictures etc etc…?

many thanks!

Thickening the hair can be accomplished with hair thickening agents available at your hair stylists or in the drug stores. No one can second guess the impact of Rogaine in the crown. Many patients use both minoxidil (Rogaine/Regaine) and Propecia together.

If you can make it to this office (I realize it is quite the trip for you from the UK), we can do a bulk measurement assessment and put numbers to your hair loss so that the impact of time and even the use of Rogaine can be measured. We do offer photo consultations though, and even have a travel discount if you decide to have surgery with us.

I’ve previously had scalp reductions and a flap hairline performed in the early 1990’s.

I recently in Feb 2010 had a 2000 hair (not graft) procedure performed by the same doctor who was responsible for the scalp reductions and flap hairline in the 90’s to address the lack of hair behind the flap which looked strange. It is now 12 months since the procedure and it appears only half of my hair in the triangular area behind the flap has grown, it is very patchy and is more scalp than hair. Could the fact that the previous scarring from the scalp reduction and flap hairline be causing this skin zone to not grow transplanted hair properly?

The funny thing is that several of the hairs transplanted into the actual scars have grown quite well and show thick well developed hair shafts. But as mentioned before the triangular shape of bald scalp behind the flap is completely surrounded (an island of forelock scalp) by scarring from the old surgery. Could this zone be of limited blood supply due to these scars or does the scalp still get enough blood supply anyway? Also could 12 months be too soon for me? The island of scalp behind the flap hairline has sensation although somewhat reduced sensation but the skin goes white than straight back to pink when pressed. I have compared my post op photos with my current photos and it appears that only half of the hair has grown. I can email a couple of photos if you wish, I have not been back to the doctor since my 1 week post op check up (for personal reasons). it was about 1000 grafts I think. I will get back to him when I feel ok about it, thanks

Prior scalp reductions are not a reason why a hair transplant surgery would not work. Many patients that had scalp reductions in the 1980s and early 90s followed them up with hair transplantation with relative success (growth was fine, but they were the pluggy look from back then).

I think the best thing for you is to follow up with your doctor when you are ready. Maybe you took pre-operative photos, but your doctor should have one (or more) as well and it may be useful to compare what you have now and what you had then. There are many factors that can be the cause of a hair transplant failure and that is why you need to see your doctor for a better understanding.

Snippet from the article:

A postal worker from Londonderry has suffered burns and lost clumps of his hair in what is understood to have been a practical joke gone wrong.

He discovered the hair loss when he took off a motorbike helmet he had taken from the staff locker room at Royal Mail’s delivery office on Great James Street on Wednesday afternoon.

It is believed that an acidic substance had been put in the helmet.

Read the rest — Derry postal worker loses hair in ‘practical joke’

A joke gone too far. I only hope this man wasn’t already losing his hair from genetics. What happened to using a Whoopee cushion?

Note: BaldingBlog often receives incredibly insightful emails from our readers. The following comments echo many of my thoughts on the subject of Xandrox and Dr. Lee. The writer wishes to remain anonymous, but he’s contributed posts in the past about the FDA and I want to thank him for taking the time to elucidate the issues so clearly.

This is a follow-up (for those that missed it), about the FDA stopping Xandrox sales.

—

The post about Xandrox requires clarifications and additional information about physician prescribing and the FDA. It is correct that Dr Lee makes unsupported claims about his products (whether it is his unregulated herbs or regulated medicines sold online). However, a more likely reason why the FDA intervened to remove sales of Xandrox (containing 15% minoxidil and finasteride) is that a potential for increased risk (i.e., a safety concern) existed. Even with substances that do not normally fall under FDA jurisdiction (e.g., herbs that do not require regulatory approval for sale), the FDA can intervene if a health concern exists. A good example is when concerns regarding the safety of ephedra supplements (and potential cardiac deaths) led the FDA to ban the sale of ephedra-containing supplements in the United States in 2004.

 
The poster asks whether prescribing Xandrox in this manner is acceptable because it is off-label. “Off-label” use presumes use based on a specific scientific rationale and sound medical evidence (data on effectiveness and safety of Xandrox is absent). While most off-label use is the same dose and formulation for a different indication (thus allowing for an understanding of the likely safety profile), the FDA legally allows and classifies off-label use as below, which can include different doses:

“Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgment. If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, and to maintain records of the product’s use and effects.”

With Xandrox, there is zero data available on the safety and efficacy of the formulation and one wonders – especially with high-dose topical minoxidil – what cardiac issues could result. But, who knows. Data (and thus informed decision-making) for the user is not available. This is the antithesis of “evidence-based” medicine: “Here, buy this because I said it does A, B, and C – don’t worry about any evidence.” Or better yet, “I’m getting great results…I haven’t had a problem (yet)”.

Hi Dr Rassman,
my question is the following : How often do you see people with Norwood “A”-pattern hair loss that reach Norwood 7 (or 6) AND how difficult is a 5a pattern to treat with transplants (can they get full coverage). Seeing that you now offer SMP. Because I’m a Norwood 5a patient who recently had a FUE hair transplant with Dr. Pak in your Los Angeles office it’s was about 1,200 grafts and I have to tell you it was the best decision that I’ve could’ve made!! I’m thinking of having another FUE procedure, so I was thinking of having the FUE & SMP done together to get more density.

I would really appreciated if you could let me know what you think about my question.

Thanks for everything you do and keeping us informed. Oh and 1 million thanks for a great job and keeping up the great work!!!

I am pleased that you are pleased with Dr. Pak’s work!

The Class 5A pattern does not evolve into a Class 6 or 7 pattern. The original chart by Dr. O’Tar Norwood showed that the patterns defined in the diagrams are the end stage, particularly the “A” series. I like to work on the “A” pattern patients, because there is usually enough hair to give them whatever they want (that is, unless their original density is very low).

Scalp micro-pigmentation (SMP) with follicular unit extraction (FUE) is a great combination treatment where you can achieve the dense look with SMP and a natural real hair line in the front with the FUE.