July 2006 – Page 8 – Balding Blog

July 18, 2006

Is There a Pill to Prevent Shock Loss? – Hair Loss Information – Balding Blog

What is fallout/Shockloss? Is there a pill or something I can take after surgery to prevent it, or is it temporary and nothing to worry about?

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I just made a post related to this yesterday (see How Long Should I Take Propecia Before Transplant to Prevent Shock Loss?).

Shock loss occurs when the follicle becomes ‘insulted’ by swelling and inflammation, causing the hair to shed from the follicle. The follicle then enters a resting state and may never go back to an active state (if there is genetic balding in that particular follicle) or after a period of time it may go back to an active state and grow normally again. We suggest taking Propecia before the surgery to help minimize shock loss after hair transplantation because the hairs that are genetically impacted have the greatest risk of permanent loss from the shock of the hair transplant process. Propecia minimizes this risk.

July 18, 2006

Newly Transplanted Hairline is Uneven – Hair Loss Information by Dr. William Rassman

I’m a 49 yr old male. My transplant is a month old [editor’s note: not with NHI], and the only thing that bothers me is that the hairline is not even. It looks not receding enough on one side and too receding on the other. I’d rather have two receding sides. But that would mean removing some of the plugs? Is this possible and would the scars be very noticeable?

At a month, the hair transplants can not be removed. I would suggest that you wait out the period that it takes for full growth to occur. It will be easier to accept the lower hairline and move the higher one down to it, rather than the reverse.

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July 18, 2006

My Hairline Was Too Low, So I Plucked Some Hairs – Hair Loss Information by Dr. William Rassman

When I was 19, I thought my frontal hairline was a little too low, so I unthinkly grabbed some tweasers and plucked out some of my hair from the left towards the middle of my frontal hair line (on more than one occassion).

Ever since then, my hair has not looked quite the same in that area and I occassionally experience a slight burning sensation there.

I am now 22 and am wondering if there is anything I can do to ease the burning sensation around there as well as encourage the regrowth of hair in that area. It just does not look quite natural and like it did before I did this plucking.

Have you heard of a situation like mine and do you have any specific recommendations for a situation like this?

I would really appreciate your help and advice.

Local irritation from plucking hair is common in people with chronic picking of their hair (trichotillomania), The hair loss from your frontal hair line is likely permanent, especially if you have transitioned from a childhood hairline to a mature hairline which is normal at your age. You should see someone like me (or find a doctor in your area at ISHRS.org) to determine a long term plan defining what to expect.

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July 18, 2006

How Long Should I Take Propecia Before Transplant to Prevent Shock Loss? – Hair Loss Information by Dr. William Rassman

Dear Dr Rassman,
I have been reading your blog for quitesome time and have benefitted a lot from it. I have leant from you that propecia is helful in preventing shockloss. I’m planning on a HT session say like in a month. Would it help me in countering shock loss if I started using propecia today?…or should I be on propecia for a specific period of time say like 6 month, before I go for a Transplant.?

If you have been evaluated by a doctor and have a diagnosis of male pattern hair loss, Propecia may benefit and prevent or reverse the hair loss. Propecia may also prevent shock loss from a hair transplant and I generally recommend that it is best to take it one month in advance of the surgery if possible. Certainly, being on it as early as possible is best, but even the day of surgery will work better than none at all. The enzyme that makes DHT is at work all of the time and blood levels of Propecia are achieved in an hour or two, so hopefully some value should be there even if first taken the same day of the transplant surgery for the prevention of the transplant shock you asked about.

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July 18, 2006

Hair Loss Acceleration from Propecia Means It’s Working? – Hair Loss Information by Dr. William Rassman

Dr. Rassman, thank you for your very imformative site!!

If after starting Propecia, one’s hair loss temporalally accelerates, would this be a sign that the drug is working and that regrowth is likely (i.e., would one be better off if they actually see accelearted loss versus not seeing it)?

When regrowth occurs with Propecia, is the initial hair very fine or does it grow back as normal hair?

Sometimes it is thought that Propecia, when it is working, may accelerate the cycling of the hair. If this happens, there is a possibility that hair loss might worsen temporarily after starting Propecia. Most people who are responding to Propecia should be minimizing or preventing further male pattern hair loss and that is what most people tell me.

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July 18, 2006

Can I Tell If I Have MPB By Pulling? – Hair Loss Information by Dr. William Rassman

I was wondering how to actually notice hair loss. When I was 25 I remember visibly seeing hairs in the shower and in my sink. Since then I have slightly receded but that is it. I am now 31 and I notice one or two hairs when I put gel in my hair and a few on the floor in my bathroom. I also notice I can slightly tug a few hairs out every once and a while. It just as easy to pull them from my sideburns as the top of my head. No one on either side (first and second generation) is bald in the back of the head. All related men do have recession and slight thinning (which I think is common). It looks like pattern 2. Is the fact that I notice the hair in my sink, tub and by pulling a sign of hair loss or MPB?
Thank you!!

No, you cannot tell if you have male pattern balding (MPB) by simply pulling on your hair. It is normal to lose 100 hairs a day. You may be able to see MPB pattern under a hair densitometer, which is a special microscope for the hair, by demonstrating miniaturization of hair. To make the actual diagnosis, the patterns of thinning and miniaturization can be mapped out for predictive purposes.

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July 17, 2006

Minoxidil Dependence – Hair Loss Information – Balding Blog

I’ve been reading a lot about one’s thinning hair becoming dependent on minoxidil on this blog. How long would one have to use minoxidil to become dependent on it?

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Minoxidil dependence only occurs in hair that sees benefits from using the medication. The better the hair gets, the more the dependence upon minoxidil. I would imagine that if there is dependence, stopping it will cause any benefits to disappear and return your hair to its state prior to taking the minoxidil, plus adding whatever hair loss might have occurred from the time minoxidil was started until the time it was stopped. Generally it takes many months for the benefits to be seen, so I would expect that the dependence upon it takes many months as well.

July 17, 2006

No Hair Anywhere on Body – Balding Blog

My brother has lost his entire body hair at the age of 6, due to medication. He had been suffering from typhoid and small pox at the same time then. Since then we had tried lot of medications, both homeopathic and allopathic. He had a patchy growth of hair during these medications at the age of 18+. Right now he is totally bald, no body hairs and no eyelashes and eyebrows. He is of 26 years of age now.
Can you please help me out.

It seems your brother may be suffering from a condition known as alopecia universalis or alopecia totalis. There is really nothing much you can do in terms of regrowing or transplanting hair.

You may find more information on this topic at the following websites:

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July 17, 2006

FUE – Is There a 0.75mm Dull Punch? – Hair Loss Information by Dr. William Rassman

Is there a 0.75 mm dull punch? Or is it possible to use Dr. James Harris’ two step technique with a 0.75 mm tool, so there would be a lot less transected follicles?

Follicular extraction is a very delicate and technically challenging process with its transection risks. As you can imagine, smaller diameter instruments will have more transection rates. It is a balance between technology and technique that will ultimately determine the acceptable transection rate. I have personally developed and used a 0.75mm and even a 0.70mm dull and sharp punch utilizing many techniques (including the two step technique). It is my opinion that the technology has not been perfected to my satisfaction for the entire Follicular Extraction process and damage with the an instrument of this size is generally unacceptable. With the current state of technology, acceptable FUE procedures can be done with a 0.9mm diameter punch.

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July 17, 2006

Fine Hairs at Hairline – Hair Loss Information by Dr. William Rassman

Dear Doctor,

Firstly, many thanks for your highly informative website which separates myth from fact!

I am a 21 (almost 22) year old male and I am a clear class two on the Norwood Scale.

I have also read several posts on your site, and my current hairline complies with your stated rule that the distance between chin and nose tip; and eye gully to hairline are roughly equal.

However, I wear my hair reasonably long, and have noticed that at the tip of my hairline, a lot of hairs are significantly shorter than those on the rest of my head, although their thickness appears to be similar to the rest. Could this be evidence of miniaturization or is this part of the normal hair growth process?

Furthermore, there seems to be quite a lot of “fluff” just in front of my hairline. Are these the remnants of previously healthy hairs?

Many thanks in advance for your assistance.

The shorter hair and the “fluff” in the front of your scalp just may be new hair changes in the hairline indicating a shift to the mature hairline. Although you did use one of my rules for measuring hairline location, please furrough your wrinkled brow. The childhood hairline touches the highest crease in your wrinkled forehead. The mature hairline usually is about 1/2 inch higher than that line. If these short hairs reflect the maturing hairline, shorter and either slower growing or non-growing hairs could explain everything you are seeing. Check for early signs of miniaturization in these short hairs and I suspect they will be miniaturized.

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