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I am sure you guys see a lot of patients, and I just read an article on CNN about a site that lets doctors complain about pushy patients. Do you have any horror stories about patients that gave you a hard time? Here’s the article: Are you giving your doctor a headache?

From my regular reading of this blog I can tell there are plenty of people out there that fancy themselves as “experts” when it comes to hair loss and love to show off their armchair medical degrees that they earned by surfing the web for a few hours. Its great to try to learn as much as possible about various problems one might have, but at what point does it become a headache for you when the person insists a medication is causing their issue or insists that their hours of research are more accurate than your many years of treating patients in person?

Thanks and keep up the great work!!!

People are people and they come in all personality traits. As a doctor, you expect to see a wide variation of patient personalities, and if you didn’t, you should not be a doctor. I demand that doctors treat every patient with dignity and respect. If a patient does not behave properly or is disruptive to the goals of a first consultation, I use my people skills to try to end the interaction with a frank discussion that maybe we (doctor and patient) are not compatible. This has been very rare for me to find such a patient.

What usually happens is that if there is a patient who is upset about their hair loss circumstances, or afraid of an uncertain future, or were treated with less than proper respect, or achieved less than the results than they expected from a surgery with another doctor, then my job is the communicate with them. Many times what is thought to be a difficult patient, actually turns out to be a patient who is just afraid and if I take the time to listen to them, I almost always calm them down.

I believe that all people deserve the best efforts I can manage and I approach everyone that way. Sometimes I look back upon the interactions with patients and laugh to myself at the happenings. I remember one patient, for example, who had a hair transplant with me and the next day came in with a poster sized blow-up of his transplanted scalp with individual pins placed into every graft in the head that he could see. He claimed that I cheated him and overcharged him for the number of grafts that were given to him the day before. I sat down calmly with him, showed him grafts that he did not see (no pins in the picture) and suggested that he come in another day so I can show him a live surgery and demonstrate why the picture did not really show the actual hair graft count. He did just that and everything was fine after. Especially difficult patients produce difficult challenges and it is the doctor’s job to address the needs of the patient, always.

Sir,
Recently I had chicken pox and it caused a lot of scars on my face. So for the last 2 weeks I have been using a cream named Dr.Reddy’s Venusia (vitamin E cream). After the application of the cream my hair loss rate increased drastically and I really doubt its the effect of the cream. I apply it on every night on my face. Plz help me to clear of this doubt!

It’s possible that your bout of chicken pox may have been a large stress, causing you to lose hair or to accelerate an inherited genetic pattern. I don’t know anything about you though (age, for starters). I really can not help you without seeing you. Plus, I only deal in hair (not face) problems, so a good dermatologist might be a better initial choice.

Dr. Reddy is a large Indian generic pharmaceutical company that has run into problems recently with the FDA relating to their Mexico manufacturing plant. With that said, I wouldn’t expect that the Vitamin E cream they produce is the cause of your loss.

I am in my early twenties and am in Type II of my hair loss. I started losing here about 2-3 years ago and in the past year it is becoming quite noticeable, i am losing hair at a faster rate then ever and am concerned that I will end up like my father (type 6). I have been staying away from Propecia and Rogaine due to their irreversible side effects concerning sexual dysfunction. Is there no viable alternative other than hair transplant for me?

Nope.

Side effects are not proven irreversible from Rogaine and Propecia, but if you don’t want to try either of the two FDA approved hair loss medications, that is your choice. Unfortunately, hair transplantation is the only permanent solution at this point if you do not want to manage your balding problem with medication.

A doctor via CNN wrote about a young child with gray hair. I thought it might be of interest to you and the visitors of this fine site. Thanks for everything, doc

Link: Why does my 4-year-old have gray hair?

Thanks for sending this!

The article was written by a pediatrician for CNN and contains some good information for parents of children with gray hair. Causes for graying hair in a child can range from anemia to genetic causes. Check out the article for more info.

Hi sir:
I just found this site and you have pretty interesting material. I would like to know if you know of any intentional delays in hair cloning/multiplication access caused by the FDA, corporation or any other very influential source because it seems like a mighty slow process compared to even bigger breakthroughs science have accomplished. Thank you.

How do you really expect me to answer this question? If there is a conspiracy, how would I know this? But really, the question I must ask — Why would there even be a conspiracy? Why would corporations intentionally delay the cloning? What is the motive? Sometimes I can’t tell if someone is joking around or if they truly believe something as nutty as this.

Corporations will win by making money with the new technology. The doctors will make money with performing more cloning surgeries. Balding men will benefit in managing their problem possibly without surgery. The technology is slow to develop, but treating hair loss is a multi-billion dollar industry, so it would make no sense for any for-profit company to delay a new treatment if it were ready to market.

Then again, perhaps there is a secret club of men with full heads of hair who do not want social and economic competition from their bald counterparts. Something to think about…

I’m wondering, is it very rare for a man to go both gray and bald before his 40’s? I mean, I’ve never seen a 20′ish or 30′ish male balding/graying at the same time. Is there any famous person who’s got these two genetic conditions?

Thanks in advance

Balding and graying are independent genetic traits. To see this for yourself, go to a busy shopping mall with an upper level and look down on the men who pass under you.

Just because you’ve never seen it, that doesn’t mean it isn’t possible. Men tend to start seeing gray in their 30s, but it could start at any age (depending on genetics). I can’t name any famous balding and gray 30 year old, but that could probably be due to younger actors dye their gray hair to stay looking young. If I come up with a name, I’ll update this post.

Hi — I have a question about Rogaine.

I’ve read that Rogaine can make things worse before better. I’m OK with that risk. But is it possible that Rogaine could make things worse, and then NOT be effective for me, i.e. things would not get better again? So I’d just be left worse off than without using Rogaine at all? Thanks for your time.

Rogaine (minoxidil) is marketed for hair growth — not hair loss. There are occasional reports of increased shedding in the first month of use, but this is just temporary. Many people panic when they see increased shedding and stop the treatment so I suspect it would be a negative outcome if you look at it that way.

[tag]rogaine, minoxidil, hairloss, hair loss[/tags]

Hello Doctor

I understand that the “clogged pores due to dirt and buildup” is a hair loss myth. But what about open pores? Is it safe to use things like a spray leave in detangler, right after a warm head wash?

Pores are there to secrete oils to coat your skin and hair. Hair spray, lotions, and leave-in detanglers should be safe to use.

This is a follow-up to a post from last week:

Hello!

last week a question was posted about Prince William which you opened your doors to William if ever he decided to go down the hair transplant route…

my question would be - What would you do for William? we can all see where his future lies with his hairline, obviously we do not harvest an adequate amount of donor hair to cover the whole of the balding area, what would be the way forward for william in your opinion?

and also off the subject, i picked up on the comment made by the blogger, something to the tone of “feeling sorry for william on his wedding day, his looks seem to have diminished due to his balding process……” have you seen his wife? hes not doing to badly!

I’m sure you’ve heard the saying, “Bald is beautiful“. With respect to Prince William, I am sure if he is bothered by his hair he would have done something for it. He looks like an excellent candidate to take finasteride and see what happens with the medication alone. One reader commented that they didn’t like Prince William’s thinning hair and wondered if he would be a candidate for hair transplant surgery. Yes, he’d likely be good candidate if that is what he wanted to do about it.

So hypothetically, assuming he has an average hair density and scalp laxity (the ideal scenario) he could cover the entire scalp with two surgeries. The first procedure would be the most dramatic, giving him a non-balding hairline with a frame to his face and some fill for the thinning top and crown. I couldn’t get too into specifics, as I’ve not met Prince William.

When and if he came to transplant, we would do almost exactly what we did for reality star Jon Gosselin. He had only one surgery and we did not address the continuing hair loss to the top crown area, which appeared to worsen. Jon has a similar hair loss pattern, but his hair is black as opposed to the royal’s blondish-brown hair. Since Jon’s hair loss gives less contrast to his skin, Prince William should attain better results.

Do you have any knowledge or opinion about prosthetic follicles? I was imagining a tiny hypo- or non-allergenic device of plastic, silicone, etc that could even eject broken hairs and be reloaded. If they can replace heart valves and if they can make silicon wafers with microscopic transistors, artificial follicles hardly seems unfeasible. I googled my idea and actually found something:

A hair prosthesis consisting of allogeneic hair and polypropylene mimicking follicular units: long-term result and histocompatibility in rabbits

This sounds wonderful for balding or bald rabbits. There’s still a lot that needs to be done before it is shown to be safe for humans.

There is reasonable experience in artificial hairs and the history is not pretty, with infections that really mess up the scalp. I have personally seen the results of artificial hair over the years and have removed them in patients I’ve seen, but the problems never seem to clear. They look good when they are initially done, but hopefully people will live long enough to regret the decision to do this.