Month: May 2007

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Difference Between Norwood Class 7 Patients (with Photos) – Hair Loss Information – Balding Blog

Why is there such a difference between these two previous post’s photographs. They are both, by your report, Class 7 patients.

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Norwood class 7 Thanks for asking this great, insightful question.

The rim of hair in a Class 7 balding pattern contains about 30,000-35,000 hairs. Considering that the normal total hair count of an adult is about 100,000 hairs, the only permanent hair that is never lost in any balding man, is the 3 inch high rim of hair schematically shown on the right (Norwood Class 7 pattern). The art of hair transplantation that I will show you below, reflects the way the surgeon redistributes these 30,000 (or less) hairs so that it looks like more than it is. The surgeon needs all of the help he/she can get from the characteristics of the hair on the patient’s head, including the quantity that can be safely moved.

The texture of the hair in these two patients is very different. The white/grey haired man (let’s call him ZU) has a hair shaft thickness that is easily three times the hair bulk (weight) as the blonde fellow (and for the sake of consistency, we’ll call him BF). The hair of ZU has a good character to it and holds a wave nicely, while BF has hair that lies limp and wimpy. Also, the donor supply of ZU is easily twice as good as BF and has a loose scalp which allows the surgeon to redistribute more hair from the permanent rim of hair around the sides and back. ZU received almost 10,000 grafts with easily 23,000 hairs in these grafts, while BF had only 4500 grafts (about 8,000 hairs). BF’s scalp was tight and his hair density was not as good as ZU. With that understanding, re-read the blog post titled Patient’s Guide — How Many Grafts Will I Need?, and it should be easy to see that we are not all created equal and the surgeon’s hands are ‘tied’ by patient’s hair characteristics (weight, texture, color, quantity) and therefore the hair transplant surgeon is not in control of every variable he/she needs. When putting the patient’s final results side-by-side, ZU has easily 8-9 times the amount of hair bulk (# of hairs and bulk) as BF. What is very important for you, the reader, to recognize here is that even BF is thrilled with his results. The thinly covered crown in BF (both men use a comb-back hair styling technique) is not of a concern for BF, because he looks at the man in the mirror and does not see his hair from behind. ZU also has a comb-back (which I showed in these photos by allowing the hair that is combed back to separate so you can see the scalp) with much better coverage of his crown area. ZU also had a considerable amount of hair transplanted into the crown, making his grooming easier and his crown looking fuller. From BF’s point of view, that man he sees in the mirror has a full head of groomable hair, just like ZU.

It is also important to note that these men started getting hair transplants at different points of their hair loss. ZU was already completely bald when he started getting transplants, where BF was thinning rapidly and on his way to being completely bald (it happened a few years before Propecia became available). So ZU had nothing on his scalp when we began transplanting his head, and BF eventually lost all of his natural hair up top (so what you see in the photos for both men is all transplanted hairs). If you took BF’s hair transplants away, he would look like ZU’s before photo.

This is reality and that is why I appreciated this question when it came in yesterday. People with a Class 7 balding pattern will never have enough hair to replace what was lost (and if any doctor said he/she can give such a person a full head of hair, well, he/she clearly is must be GOD). The key to a good hair transplant is the artistic hand of the surgeon and good styling from the patient, no matter what balding pattern exists.

ZU (before on left, after in middle, after crown on right — more photos here):

 

BF (before on left, after in middle, after crown on right):

 

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Hair Loss InformationMy Worst Mistake – Switching from Propecia to Avodart – Hair Loss Information – Balding Blog

Dear Doctor,
just to share something and also post an enquiry. January this year, after seeking advice from a dermatologist, I decided to take the plunge and switch from propecia to avodart. It has got to be the worst mistake I ever committed. since the time I stopped propecia, hair shedding started about close to a month after switching. In a matter of 5 months, my hairloss progressed drmatically and I have now a very noticeable receded hairline. I should have stayed on propecia, although it didnt regrow a lot of hair I have expected, but It did regrow decent amount and most importantly, maintained what I had. Looking back, I could only blame myself for all reports that supported Dutasteride were either small scale, or short-term. I have since switched back to propecia a week ago after seeking a 2nd medical opinion.

My question would be that, is my shedded hair all lost and not returning? Notice I am not like the typical propercia user who quit due to side effects, I switched to a more powerful anti-dht and am not switching back propecia. Bearing in thought that all the while I had decreased DHT in my body, and during that 5 months, decrease up to 90%.

Thanks!

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Thank you for sharing your experience with Propecia (finasteride) and Avodart (dutasteride).

To answer your question in perspective, there is no magic pill or drug to cure or reverse hair loss. If you are genetically predisposed to hair loss, Propecia will only postpone it as long as possible. For some men this may be many years. For other unlucky men this may be a few months or a few years. This does not matter how much DHT you block. Most men who do this also get a drop in their sex drive as Avodart has a higher sex drive suppression than Propecia.

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Hair Loss InformationScalp Massage After Hair Transplant – Hair Loss Information – Balding Blog

Dear Doctors;

I have two questions.

  1. Can you scratch your scalp with the tips of your fingers a month after your surgery? Very gently, not using the nails.
  2. How long should I wait to massage my scalp? I had my second surgery three months ago.

thank you so much.

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You should always find this out from your doctor, but I will try to help you…

  1. Yes, you can scratch your scalp a month after surgery with your fingertips, but it is something that I would rather see you not do. Generally, hair follicles are set into the recipient area after between 3-10 days and you would have to work hard to dig them out. The hair grafted skin should always be handled carefully for a few months after the recipient areas have been placed, because the skin is more prone to damage and infection.
  2. What kind of massage do you mean? Generally, you can massage your scalp a month out from surgery. After about 3 months or so, it may be a good idea to do exercises to loosen up the scalp. Ask you doctor how to do them.

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Hair Loss InformationWhat’s the Average Hair Transplant Patient Age? – Hair Loss Information – Balding Blog

hey doc, i’m considering a hair transplant down the road. whats the average age of transplant patients ? I am in my early 50’s and have been a nw 6 since my thirties. I am trying to decide if there is any point in getting a hair transplant at my age. I would just be doing it for myself and not to impress anyone

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22 years oldThe average age by my estimate is in the 40-50 year old range, but many young and older men will have hair transplants. I have done transplants on men as young as 22 (see photo of 22 year old patient at right) or old as 89 (see late 60s year old patient ZU). In the end you need to have a Master Plan for your hair loss. Most men decide on having a transplant not as a vanity issue or to impress others. It is mostly a personal issue about how it makes them feel and addressing something that has been bothersome to them for many years. I often hear regret from patients that they should have done it earlier than later on in life. It takes courage for a man to admit to themselves that they are vain, and to have a surgery to do something about it. There is a great deal of justified fear based upon the number of sleazy doctors in the field, but you need to do your research, for there are many good doctors as well.

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Hair Loss InformationFemale Hair Loss After Surgery – Hair Loss Information – Balding Blog

I recently had surgery and after that noticed a lot of hair loss. Would the surgery and medication for being ‘put under’ have an effect on this. I’m also in my first year of menopause and do not take medication for it at this time. I’ve always had thick hair. Pleae help. Thank you.

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Stress from surgery and medications can be a precipitator for hair loss in those who are impacted with a genetic predisposition to balding. To add to the insult, menopause can also cause hair loss in that subset of the population. Unfortunately, once it starts, it may be difficult to stop and there is no acceptable cure. At the least you should see a doctor to find out if there is an underlying medication condition for your hair loss that may be treatable (such as anemia, thyroid conditions, etc).

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Hair Loss InformationMy Doctor Said My Hair Is Fine, But I See Thinning – Hair Loss Information – Balding Blog

Wondering if I could get some advice. I had a physical this last week and asked my doctor about my hair. I am 32 and I feel I’ve started to lose some hair. He examined me and said there is “slight” thinning on top from age, but that it is not even noticeable. He said there is no beginning of a “spot”. So, he said for now he would not prescribe anything for it and that we’d simply monitor it. I like my doctor a lot and respect him, but he is not a dermatologist, and I am wondering what my course of action should be. Even if the thinning is slight, I don’t want to thin more. Should I simply monitor it, per his advice?

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You are obviously concerned about hair loss and your doctor does not share your concerns. You should start by having a miniaturization study (the most definitive way to monitor your hair loss). You may be a candidate for medication treatment such as Propecia (finasteride 1mg). I cannot speak for your doctor, but hair loss is not at the top of the list of medical problems for general doctors who have only 5 minutes to see a patient.

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Hair Loss InformationEsomeprazole, Omeprazole, and Hair Loss – Hair Loss Information – Balding Blog

I have acidity problem and I’ve taken omeprazole for 2 months then esomeprazole for another 3 months. This results in great loss of hair from my scalp. Now I stopped these drugs and trying with conventional antacids. Should I get back my loosing hair?

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There is no way to tell if omeprazole or esomeprazole (Prilosec or Nexium) were responsible for hair loss. There is no way to tell if you hair will grow back. I do not suspect your hair loss was a side effect of these drugs, but if it was, your hair should grow back. You may have a component of male pattern hair loss. You need to be diagnosed by a competent doctor.

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Hair Loss InformationSteroids and Propecia – Hair Loss Information – Balding Blog

Hi Dr. Rassman…
Thanks for the input. i have some friends who work-out and take steroids or HGH and they believe if they use Propecia it will offset any negative effects of the HGH or steroids on their hairloss. Your thoughts sir… please respond
thanks

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There might be some value to taking Propecia, but it won’t stop the hair loss and probably will see acceleration with the steroids anyway.

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Hair Loss InformationWhy Take Propecia Rather than Cut Proscar Into Pieces? – Hair Loss Information – Balding Blog

I had a visit last week from a Merck executive and while talking with him, I realized that I could ask some sensitive questions about why they hold the price for Propecia (1mg finasteride) much higher than Proscar (5mg finasteride). It is not uncommon for a Merck representative to visit various physicians’ offices, and because of my position in creating this website I had an executive pay a visit so he could meet me face to face. His focus as an executive of the manufacturer of Propecia is clearly focused on maximizing the value to the company (as it should, of course). These are their arguments for taking Propecia, rather than cutting Proscar into quarters:

  1. Propecia gives you a certainty on the dose. 1mg is 1mg, but if you cut a Proscar into quarters, you are never completely sure of what the dose that you are taking might be.
  2. Some people try to put Proscar through their insurance. This is not only illegal (if hair loss is not a covered benefit), but the insurance company can come back on you for the money they laid out for Proscar if they wish to enforce their rule that hair loss is not a covered benefit.
  3. If you get a prescription and process it through your insurance, you may be deemed to have a pre-existing condition (Prostatic Hypertrophy is usually the reason that a Proscar prescription is written by the doctor). If your insurance company puts that in your medical record, this pre-existing condition may impact your ability to get insurance if you switch your employment. Once you get a ‘pre-existing condition’ label, it is often near-impossible to get the diagnosis reversed in the insurance company database records. I don’t know if this is a real concern, but it is something that people who process Proscar through their insurance should be aware of.
  4. The FDA has only authorized Propecia for treating hair loss, not Proscar.
  5. The cost of Propecia is subsidized by Merck at $25/3 month supply, which means that there is a $100 rebate per year. They feel that these incentives make the drug more affordable.
  6. There is a one year full money back guarantee if you feel that you did not get a benefit from Propecia. See their website for details.

I asked about the problem with women handling Proscar and cutting it in quarters for their husbands. I was given the example that if a woman who handled finasteride, then gave birth to a male child with a genitalia defect (e.g. hypospadias), Merck could be held accountable for the birth defect if they did not take a legal position on this subject beforehand. I probed them one more time about doing a study on touching the pill, cutting a 5mg pill into quarters and seeing what level of absorption of the drug would occur through the fingers. Essentially though, there is no reason for them to do this. The 1mg dose pill is already available on the market and all this would do is undermine the sales of Propecia.

With all this being said, Proscar and Propecia are still the same drug — finasteride. They are just in different dosages, obviously. If you want to ignore Merck’s perspective and stick to Proscar (or the generic Proscar) for treating your hair loss, and your doctor will prescribe it to you, that is your prerogative. I’m just showing both sides of the coin — the benefits of taking cut Proscar tablets (price) vs the benefits of sticking to the actual Propecia (as outlined above). I’m all for a drug if it is proven to work… and finasteride works.

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Epididymitis and Propecia – Hair Loss Information – Balding Blog

At ~18 yrs old I underwent surgery due to a severe case of Epididymitis (left testicle). As a result of that condition and surgery (removed damage tissue), my left testicle decreased in size, to a point where only my right testicle remains functional. I’m 37 yrs old now and just recently started taking Propecia to treat mild hair loss. After only two days I felt a difference in my sex drive and decreased ability to achieve an erection. I immediately stopped using propecia but my symptoms continue after a week. Should I expect everything to go back to normal or could this be aggravated by my medical history?

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Propecia is cleared from your blood stream after a day. Any Propecia side effect should have resolved, especially after a few weeks. One testicle should be as good as two testicles, as the output of testosterone from the one testicle goes up to compensate for the missing one. You may have an underlying medical problem or a psychological problem. Men are very suggestive when it comes to sex and if you feel like less of a man or are sensitive about it, that in itself could be responsible for your loss of libido or erectile dysfunction. Please see your doctor for further evaluation.