October 2007 – Page 15

October 2, 2007

Post-Op Questions After Hair Transplant 6 Weeks Ago – Hair Loss Information by Dr. William Rassman

I recently had a hair transplant (approx 6 weeks ago). The doctor cut 5 strips and transplanted into the vertex and front hairline, leaving the top of the head alone.

Since then I have noticed a lot of shedding (counting about 50-60 hairs in the shower as opposed to the typical 10 before). I realize there will be shedding after a procedure, however, I notice considerable thinning directly on the top of my head. A lot of the hairs that are shedding are long and thick.

I have 2 questions:

Is it common for hair not in the donor site or the recipient site to shed so much?

How much longer is this going to keep going on for?

Assuming you are male, then you may be experiencing shock loss, as it seems to relate to your recent hair transplant. Shock loss in young men often does not reverse. Were you taking finasteride (Propecia) which tends to protect against shock loss? Most importantly, I think these questions should be addressed to your doctor who performed your surgery and/or these things should have been explained to you in advance. At the very least, they should’ve been written out in your pre and post operative hand out.

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October 2, 2007

In What Case Is Avodart Better than Propecia? – Hair Loss Information by Dr. William Rassman

Hi Doc,

In what situation do you think that Avodart may be better than propecia. For users of propecia who have been on it for more than 5 years and its effectiveness diminishing do you think that switching to avodart is ok? Obviously if propecia was still working then there would be no need to switch but what if propecia results were fading?

I am just speculating here, as I don’t have the definitive answer to your question. Avodart (dutasteride) may be more powerful that Propecia (finasteride) in treating hair loss at higher doses than are usually used (2.5mgs/day rather than0.5mgs/day), but it almost certainly has more side effects as well including significantly reduced sperm counts. The best dosing is unknown in the use of Avodart as a hair loss treatment and until the manufacturere comes up with a recommendation that the FDA will accept with regard to effectiveness and safety, the drug must be assumed not be be safe for young men who wish to have children. It is quite possible that many doctors are overdosing the medication at this point as the known half life of the drug is 5+ weeks. If/when the FDA approves this medication, more information will be available.

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October 2, 2007

Hair Loss Around Punch Biopsy By Dermatologist – Hair Loss Information by Dr. William Rassman

Hey doc, about two months ago the dermatologist gave me a punch biopsy on my right temple. Since then there is a red spot on where she did the punch biopsy from and I’m getting a little hair shedding only from the right side on where the punch biopsy was taking. My left side is perfect infact the left and the right side does not equal since I got the punch biopsy. what do you think the problem is? because the dermatologist said to wait 6 months after the punch biopsy to see what happens.

Thanks!

You may have lost hair around punch biopsy area for two reasons:

Shock loss, if your hair in that area has been prone to balding. Irritation of the wound healing may have aggravated the loss of hair in that area. This could be reversible to some degree with no certainty depends upon the weakness of your hair in that area to start with. If it reverses, you will see the reversal within 8 months after the biopsy.
The punch biopsy may have transected some of the hair follicles if not done in the same direction as the hair shafts. This condition may be permanent and you should not expect to grow any of those hairs back.

In either case it won’t hurt to wait 6-8 months as your doctor told you to do. If you don’t see any growth during this time, your hair loss is probably permanent. At that time you can see a hair transplant surgeon if it is bothering you. The balding area could be filled with hair transplants if need be.

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October 2, 2007

Biotin and Propecia – Hair Loss Information by Dr. William Rassman

Hello Dr. Rassman,

Would there be a negative effect in taking Propecia and a dietary supplement called Biotin 2500, which has about 2500 mcg of biotin, at the same time?

Thanks for your time.

I do not see a problem combining Propecia (finasteride 1mg) with biotin.

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October 1, 2007

Hair Loss InformationWhat Dosage of Beta Blockers Triggers Hair Loss? – Hair Loss Information – Balding Blog

Dear Dr. Rassman, I’ve read on your blog that beta blockers can accelerate hair loss in men with MPB. Is there a specific amount (on average) of this medication that usually triggers balding? For example, someone taking beta blockers for high blood pressure would probably take a higher dosage than someone taking it for performance anxiety. I take it for performance anxiety. Are the people who take a higher dosage for blood pressure the people who usually see hairloss as a result?

Also, do certain types of beta blockers cause more hair loss than other types?

Thanks!

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There is no particular dose of beta blockers that would cause more hair loss. More importantly, you may be confused by my prior posts. Many drugs can cause your ot lose hair, but medication is the LAST thing on the list of other, more common causes of hair loss. Medications (including beta blockers) do not cause androgenic alopecia (AGA) or male pattern balding (MPB).

You should not start or stop or change any medication regimen without consulting your doctor.

October 1, 2007

Herbal Shampoo and Rogaine for Women – Hair Loss Information – Balding Blog

my mother takes rogaine. i have found a herbal shampoo system that is supposed to enhance hair growth.

the ingredients are: cetearyl alcohol, dimethicone PEG-8, meadowfoamate, cocamidopropyl, pg-dimethiconol, lecithin, borago officinalis seed oil, caprylic/capric triglyceride, retinyl palmitate, tocopheryl acetate, ascorbyl palmitate, phosphatidyl choline, panthenol, glycerin, phopholipids, niacin, sodium riboflavin phosphate, calcium pantothenate, pyridoxine hcl, carbomer, papain, hydrolyzed algae extract, biotin, salvia officinalis(sage) leaf extract, ezuisetum hiemale extract, juniperus communis fruit extract, hypercium perforatum extract, arctium lappa root extract, symphytum officinale extract, m humulus lupulus(hops) extract, uirtica dioica(nettle) extract, thymus vulgaris extract, serenoa serrulata fruit extract, yucca schidigera extract, glycyrrhiz glabra extract, rosmarinus officinalis leag extract hydrolytzed wheat protein, benzyl nicotinate, guar hydroxypropytrimonium chloride, citric acid, hydroxyethylcellulose, safflower, sessssssssame seed oil, stearamidopropyl dimethylamine, quaternium-80, methylchloroisothiazolinone, methylisothiazolinone, butylene glycol, menthol, mentha piperita.

can she use this with the rogaine?

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Yes, I don’t see why not.

October 1, 2007

Management of Progressive Balding – Balding Blog

Dear Dr Rassman,

Your blog entry of 17 July 2007 includes before and after pictures of a man with a receding hairline who has been transplanted on. I am curious what his Norwood classification was before he had the corrective transplants. Is balding in this particular pattern common? Am I right in assuming that most men with this kind of hair loss will need more transplants later on as the balding progresses?

His before photo is on the left; after photo on the right. Click the photos below to enlarge. For more photos, see Results After a Single Session.

This patient has a Norwood Class 3 balding pattern, and yes, it is quite common. He is over 50 years old, so I would not expect his pattern to advance much at all. If he was 25 years old he could lose hair behind the transplants, which may require another procedure, but taking Propecia (finasteride 1mg) may help to prevent that. I don’t like surprises and nor do my patients, which is why miniaturization mapping and a good Master Plan in the hands of a caring, experienced and focused doctor go together hand in hand.

October 1, 2007

How Long For Grafts to Take Hold After a Hair Transplant? – Hair Loss Information by Dr. William Rassman

I have a question after the procedure of a hair transplant.

How many days does it take for the bulb/graft to take and settle? So even if the scabs and hair fallout it won’t be a problem.

THANK YOU FOR YOUR TIME

Dr. Bernstein and I wrote an article in the February 2006 issue of Dermatologic Surgery that essentially says that when the ’scabs’ come off, the grafts are anchored. That can take 3-14 days and is determined by the aggressiveness of your washing process. The abstract of the article is available here — Graft anchoring in hair transplantation.

In an ideal world, the grafts are relatively permanent after the first 48 hours unless you actually work them out. In the real world, I would generally say about a week (just to be safe). If you are determined enough, I am sure you can get a tweezer and pick them out, though I’m sure you are trying to avoid doing.

October 1, 2007

Hair Loss from Braids? – Hair Loss Information by Dr. William Rassman

I washed my hair one day after pulling out braids. I went to my personal hairdresser to get my hair redone only to be told “Honey you know you have a bald patch” then she proceeded to rub it with her finger. It was as smooth as could be. It now has a few strains of hair and i have bought things specifically described for hair loss near to the neck. It itches a the bottom of the spot. Just tell me what exactly to do please cause it really bugs me out.

You describe a condition known as traction alopecia, where hair follicles are permanently damaged with constant traction (in your case braids). That area may never grow hair back. You need to see a hair specialist (a good hair transplant surgeon may help), but you should wait for 6 months to see if it does grows back.

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