Hi Doctors,
I’m schedule for surgery with Dr Pak and the last time I was there I forgot to ask to see an example of what I might look like a week or so after surgery. I’m taking a week off from work since I have a ton of vacation time saved up anyway so I’m not concerned about what my scalp will look like during that time. I just didn’t want to go back to work with a swollen head or something. Can you post some photos of a patient that Dr Pak has done? Thanks

Here’s a recent patient of Dr. Pak’s that has agreed to show his full face (and results) to the world. He’s very excited about the future of his hair, and although these photos are only 10 days out of surgery, you can see that he’s on the right track. There’s no redness, no scabbing, no swelling (nor did he have any swelling immediately after the procedure)… things are looking great. This is typical with follicular unit transplantation surgery in the hands of an experienced doctor and team, and of course with proper aftercare washing. The patient has a Norwood Class 6 hair loss pattern and had a single procedure of 2468 grafts. I’d like to point out that the grafts were kept at a 1/4″ length at the time of transplant.

Click the photos below to enlarge.

Before:

10 Days After:

Stats: Male, 26, 156lbs., 6′1″

Dr. Rassman,

I’ve been diagnosed with low testosterone, and I have had low testosterone since I was a teenager. As of a year or two ago, I started taking dutasteride. My DHT tests at 6 on a scale of (20-60.) To me, this sounds like the ideal envrionment for an absence of hairloss, or at least /very/ slow hairloss. However, my hairline has been receeding ever since I hit 19. I find this alarming, as testosterone and more specifically the metabolite DHT have been widely generalized to be “90%” of the cause of MPB.

Have you ever heard of a case of low testosterone and very low DHT levels STILL causing progressive hairloss? Have you any idea why this might occur?

You can have a very HIGH level of DHT and still have NO hair loss, so while DHT is a cause of male pattern hair loss, you must have the gene (or genes) for hair loss. Unfortunately for you, it seems you do have the genes for hair loss and these genes could be very active. If you have the hair loss genes, than even low levels of DHT will cause hair loss.

Did your doctor prescribe dutasteride to you? Considering your age, I would not be taking dutasteride as it is not yet approved by the FDA to treat hair loss and the long term effects are not known. Amongst the side effects are sterility in a small number of men on that drug. The drug is FDA approved to treat prostate issues, and the ages that were part of the drug studies were of an older set (double your age) that had a need for prostate medication.

Hi Doctor, I’m currently using Finasteride 5 Mg (divided into 4 equal parts) and its been more than 2 months i have started using this and it seems my hair loss is not arrested. I had taken a head shave 4 months back and my hairs were not falling out as it was short and now it has grown and im experiencing the hair fall nowadays. I’m counting the falling hair follicles every time i get up from my bed and every time when i comb it (looks like its 20 - 25 follicles per day). I strongly believe finasteride will work for me (Just being +ve) but I’m also worried. Does it take some time for my body to get adjusted for this medicine or is it not working for me ? To add on to this, i notice that i have the same libido and im not experiencing any side effects. Overall Im confused but i have not stopped taking finasteride daily…..

It takes 8-12 months to see the benefit from finasteride on miniaturization, not necessarily on the amount of hair that falls out. Some people believe that there is no impact on hairs falling out because the normal daily shedding of hair averages about 100/day. In other words, the benefits of Propecia are on the miniaturized hairs, which either will grow thicker, or hair may even regrow if it has recently been lost.

My advice — wait it out, as two months is way too early.

I am now two weeks post op from my forth HT. I have had great results the last three times with the same doctor. This time he did some temple work. It is now day 15 and both my temples are still red and I have a slight cobblestoning look. I know that cobblestoning in it’s true form was mainly due to large grafts, grafts too large for the incisions ect. I also understand that a this is what really sets aside a good transplant doctor from another. Is it normal for me to still have reddness and some slight elevation in the temple area after 2 weeks. I was told that while the graft area still should be red now the skin should have smoothed out to an even level by now and I should have no traces of elevation in the transplanted area. If this is true does this mean that I’m going to have a permanently detectable transplant in the temple area?

thanks

Cobblestoning, in my experience, does not occur in follicular unit transplantation. In some patients redness does last weeks or even months, but with those who have had prior transplants, the history of redness from previous transplants should tell you what you need to know. I am unwilling to give you treatment recommendations without examining you. Check with your doctor about your concerns as your recent experience seems different.

(female)
Previously someone mentioned she had had surgery and was losing hair. The reply was something about stress and medications, and a predispostion to balding. My question is how long does the stress and medications phase last? There does not appear to be a predispostion to balding to any of us in the family. I had a craniotomy 2 months ago and I now have a bald spot in the middle of my head about the size of four quarters. It seems to want to grow and then bends and breaks off. Now what? The reply also stated to see a Dr., but what kind? I have asked my neurologist and my PCP - neither has seen this before and the only response I get is “I think it will grow back.” Not an answer, if they haven’t seen this before. Would a dermatologist work? (I also have what looks like dandruff that attaches itself to the hair. But I can actually hear it when it hits the sink (I take a comb to it occassionally to help remove it.).)

Thank You

Hair loss in random patches about the size of a quarter sounds like alopecia areata that can be precipitated by surgery or stress. Also included in the differential diagnosis is telogen effluvium (see article). Your description and condition sounds a bit more complicated than just that, though. You had a craniotomy and there are other issues (things falling from your scalp that makes a sound when hitting the sink?!). I would definitely see a dermatologist.

I recall reading a couple years back that some doctor interviewed in a mens health mag said that taking a baby aspirin is recommended as it increases blood flow which may be of benefit to men losing there hair

your thoughts on this theory? as well as the whole concept of blood flow bringing nutrients to the hair? perhaps MPB is directly correlated to poor blood circulation? ok this is far fetched but can it be ruled out?

I do not know of a scientific correlation. The concept of blood flow contributing to hair loss has been well disproven. The hair gets what it needs, but the genes that cause balding will cause the cells to die (medical term is apoptosis — see ResearchApoptosis.com).

I was wondering. When some of my hair falls out when I’m drying it with a towel, I notice some hair strands are thicker than others. Is that a sign of miniturization? Or am I just paranoid?

Hairs normally fall out at a rate of about 100/day, more when you wash your hair. The hairs that fall out as part of the normal hair cycle are usually normal thickness hairs, but if you lose a miniaturized hair, say goodbye to it, for it may not come back.

Hey everyone!

Well, I’ve been basically dealing with very heavy dandruff and mild scalp itching for the past year or so. I was wondering if there were any particular shampoos which would help my condition. And Im also wondering if it is okay to scrape the scalp with my finger nails lightly when im washing my hair, to remove some of the dandruff.

P.s I am a 19 year old male.
THanks !

Dandruff (pityriasis capitis) is present in about half of the human population. There is an associated small yeast cell associated with it called pityrosporum ovale which multiplies as the dead skin in those with dandruff is higher than in those people without it. The pityrosporum ovale yeast form a cake of sorts with the dead skin cells that cause the classic dandruff flake. You can nudge off the flakes when you shampoo your hair, but be careful not to pick too much on them as you can produce hair loss from picking them.

There are many dandruff products out there and some work in different ways than others. For example, there are shampoos that contain zinc pyrithione, selenium sulfide, ketoconazole, salicylic acid, and tar. CNN has a nice list towards the bottom of this page — Dandruff. I do not recommend any particular dandruff shampoos. More popular shampoos include Selsun Blue (with selenium sulfide), Head and Shoulders (zinc pyrithione), Nizoral (ketoconazole), and Neutrogena T/Gel (tar). You should try a few (or all of them) and pick what suits you the best. As each person is different, one type of shampoo may work better for you than another.

Hello,

I began taking propecia when I was 20. Within 1 week, I was experiencing loss of libido and erection difficulties. I continued the drug, and within a month these sexual side effects disappeared. I continued using the drug for the next 3 years with an incredibly high libido. I just could not curb my sexual hunger.

However, suddenly in June 2007 I lost my ability to achieve erections for no apparent reason (i.e. it was a very happy time in my life). I lost all my morning erections. I have had morning erections everyday of my life since puberty. So I stopped propecia and temporarily regained my libido and erections for about 1 week, but there has been a slow decline in it since I’ve stopped propecia.

Its now been 14 months since I stopped propecia and my morning erections and libido have completely disappeared. My penis feels “detached” from my brain. I can now go weeks without ejaculating. Its just unreal. I’ve seen numerous doctors with no success.

I understand that thousands of people use propecia with no problems, (as I did for 3 years) but there seems to be a minority of us who are experiencing prolonged sexual side effects. These side effects have not subsided months to years after stopping propecia. I assure you that this is not psychological issue! I’ve been very open to that, but the reality is I am suffering from zero libido.

There are others like me at www.propeciahelp.com

Please help us.

While sexual side effects (both positive and negative) are reportedly associated with Propecia (finasteride), most men do not realize that erectile dysfunction is an independent problem in itself. In other words, you cannot always blame the drug. A reason Propecia is a prescription medication is so doctors can help deal with problems like yours, answering questions that you may need to have addressed. With a good doctor you must also explore or accept other possibilities as well. Discuss these issues with your prescribing physician. For more on erectile dysfunction, see the past post, Propecia Gave Me Side Effects — How Can I Get My Sex Drive Back?

I’ve seen the PropeciaHelp site and have commented on it in the past — here, here, and here.

Is laser assisted hair transplant better than those done without lasers. It is said that minute 0.6-0.9 mm can be evenly placed over the bald (recipient) area with the help of laser technique. The other hair transplant doctor that I met said he needs at least 2 mm space between hairs to place grafts. Since I am not completely bald but with severe thinning should I go with the laser technique. Your thoughts?

Here is the link: http://www.drbnrskinhospitals.com/html/treatments/hairtrt.asp

There was much hype about using lasers in the late 1990’s to make incision sites, but lasers are not used anymore in the United States because it burns the skin. Much about lasers is about marketing, not medicine.

Also, this might say something about the company doing the procedure — in the week or so since you wrote me about this, the site has already disappeared and is now just filled with advertisements. Did the doctor go out of business? Forget to renew his domain name? I don’t have the answer to that, but it doesn’t change the fact that the laser-assisted hair transplant does not make a better hair transplant.