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Hello Dr. Rassman:

Thank you for your blog; it has answered many of my questions. At this time I appear to have most of my head of hair. I do have thinning in the Crown region. I was told by a very respectable physician in Vancouver that I am not a good transplant candidate because I have diffused minaturization with a Norwood 6 - likely 7 pattern.

Understandably, I was taken aback, given that I’m 32; and this level of balding isn’t all that obvious amongst the men in my family. The hair surgeon recommended that I continue with my proscar (I’ve been on it roughly 2 years with pretty good results - i.e. stability).

My question is 1) given that I am 32; my hair loss appears to have stablized but I have diffuse minaturization, what is my timeline, i.e., will I be a slow progressor to Norwood 7? Does the fact that I have minaturization mean that the propecia will not be able to assist me with those hairs?

Also, with the doctor’s advice, I’m increasing to half or 2.5 mg of proscar.

Finally, what is the status of Acell? Do you think someone like me (Norwood 7) will one day be a good candidate for a hair transplant?

Cheers

First, you need a good Master Plan. You seem pretty lost without one, unsure about what to do or where to go next. I have no idea what kind of timeline you’re looking at, but why would you want to have surgery when your hair loss is stable? It sounds like you’re considering surgery to prevent hair loss, which shouldn’t be the case.

1mg is really all the finasteride you need for treating genetic androgenic alopecia. Taking more will not necessarily help. No matter what you do, if you are going to lose hair, it will happen. Doubling a dose of medication will not guarantee it slows down, but you will increase the risks of a drop in libido. I’m not sure why your doctor is advising you to increase the dosage. I’d follow up with him about that.

The ACell study is still unproven and we will likely not know until the end of 2011 if the study was a success. We’ve received a lot of emails about it, and we’ve only been tight-lipped because there’s nothing to report at this time.

Dr. Rassman, my daughter is presently attending college in Houston Texas and was just diagnosed with Androgenic Alopecia. Her dermatologist came to that conclusion after she did a biopsy. What concerns me is, she prescribed a treatment of Minoxidil and 0.5 mg of Propecia daily. I understand the Minoxidil but I thought Propecia was for men only?

She did inform her of the pregnancy risks associated with taking the drug but it has me concerned and I asked her not to take it until I get more info. I’m not questioning this doctor’s diagnosis of the problem, just her remedy. Would you think an appointment with a proven hair loss professional would render any alternative advice? It seems this sort of hair loss in women is difficult to treat but I would think there are options available other than Propecia. Do you have any colleagues in the Houston area you might recommend? We may just wait a couple weeks and make an appointment at your office when she comes out for the summer. I appreciate your time.

Androgenic alopecia is not diagnosed with a scalp biopsy! More importantly Propecia (finasteride) is not to be taken by young women! It may cause birth defects if they get pregnant. There are a minority of women past their childbearing years who do take finasteride for very specific reasons, but even those women have equivocal results. Unfortunately, minoxidil is the only FDA approved hair loss treatment for women.

Perhaps your daughter should get a second opinion by another doctor. I don’t have any personal recommendations in your area, but you can check for physicians using the doctor search at ISHRS.org… or of course, contact our office for an appointment here in Los Angeles.

I have used Minoxidil for 2 years with no results as my hair is not very thin will I start losing more hair than I was before using this product or has Minoxidil kept me from losing more hair and would my hair then become thinner. I would really like to stop.

What can I tell you? You won’t know until you try. There’s simply no way for me to know if you’ve seen any benefits. If minoxidil is helping with hair growth, then if you stop using it you will suffer the consequences (you’ll lose the hair the medication had grown).

If you are determined to stop using minoxidil, then try slowly weaning off of it (rather than abruptly stopping it).

Out of curiosity, is it possible to artificially create a cowlick using transplantation? Have any patients ever asked you for this?

Yes, creating a cowlick is possible. I have done a few of them, but it is rarely asked for. Many men hate their existing cowlick.

Hi Dr.Rassman. If you were to incorporate one of those fue robots in your practice would it lower the cost of an fue session? I know time limit would be lessened. Which method of the fue session is most labor intensive, the extraction process or the implanting one? I heard you have an interest in the success of these robotic systems. Please educate the public docter.

I am told the robot will cost about $250,000. I think that this has to be paid down and the result should be a more expensive hair transplant. At least initially. I am just speculating, though, as we don’t have the robot in our practice.

This may be an issue of quality, not cost alone. Don’t focus on costs. A poorly done FUE procedure will cause permanent loss of your donor hair (not uncommon) and that costs you much of your future hair supply. How does one put a price on quality?

Note: The robot at the right is not going to be doing the FUE procedure, though it would be kind of neat to see.

I have been on generic propecia for almost a year now. I have been purchasing the medication online. After about 6 months people have been stating they thought my hair was looking fuller and darker. I took this as a great sign. Up until about a month ago, when switching from one online company to Cheapodrugs.com, I noticed I entered the shedding phase again. If the drug is counterfit, could I lose what I had gained that quickly? Or can the drug just stop working on some people after they had some decent gains with the product? Or is it possible to enter the shedding phase again after switching prescriptions? I am at a loss, as I thought I had temporarily found a cure for me hair loss.

Thanks

You bought prescription medication via an online pharmacy that illegally sold it to you… and saw the effects subside soon after. I think you can already guess as to what I think about that.

1mg finasteride should contain the same active ingredient and dose, regardless of the maker. Switching from one manufacturer to another shouldn’t make a difference as long as the active ingredient is the same. So if I had to guess, I’d say the drug you got is fake.

(female)

Hello,
I have been suffering with traction alopecia for 3 years on the hairline. I would really like to undergo the hair transplant surgery, however I have keloid type skin. I went to a doctor who performs this surgery and was recommended not to go through with it because of my skin and was told that the existing hairs around the bald areas would fall out. Would I ever be able go through with the surgery with keloid type skin?

I have never seen a true keloid in the scalp. If I were your doctor, I’d perform a series of biopsies to determine if you form keloids in the scalp. I would wait 8 months… and then if you did not develop keloids, I would consider doing hair transplants on you. I don’t know what else to say. I have performed surgeries on men who form keloids in other parts of the body and the results were good! Everyone is different and there is no way to completely predict the outcome.

Hello Doctor

a very well known doctor claims that he was able to harvest 7600 grafts from a patients beard and transplanted it to its scalp. Now is that possible?

I have done several beard to hair transplants and they are relatively easy, but I really don’t know if the beard contains 7600 movable grafts. Is it possible? I suppose. Some people may have very high density hair in their beard.

This patient received 1260 grafts in 1998, but over the years he continued to thin in the front and top of his head. He came in last month for Scalp MicroPigmentation (SMP) in hopes of adding fullness to the area immediately behind the frontal hairline. The results are spectacular and he avoided another surgery as a result.

The use of SMP for patients who were previously transplanted to create the illusion of fullness in areas where there is existing hair is nicely demonstrated with this patient. Click the photos to enlarge.

AFTER SMP:

BEFORE SMP:

Hello, I was wondering if it would be possible to transplant hair from the arms or legs (or other parts of the body) into the scalp. If not physically possible, than please state why?

Second question: If I had a willing donor, could I get hair grafts from him, and take organ-rejection medication for the rest of my life to stop the loss of these new hairs? I know these meds may cause hair loss but wouldn’ts till I come out ahead, keeping most of the donor-transplanted hairs?

Body hair transplants are possible, but the texture of the hair will be different and arm/leg hair doesn’t grow to the same length as scalp hair. So while it is possible, the results aren’t as natural looking in my opinion.

Person to person transplants are also possible with anti-rejection medication, but the health risks from those medications are too great. These anti-rejection meds are reserved for life saving transplant patients, not for cosmetic procedures. I can’t imagine any doctor willing to do this, knowing the patient’s health would be put at a tremendous risk.