February 2009 – Page 8

February 13, 2009

After 10 Years on Propecia, I’m Seeing Hair Loss Again – Hair Loss Information by Dr. William Rassman

Hi:

I am a 30 year old male that started taking Propecia 10 years ago. For almost that entire time, I have been very happy with the results. However, starting just 6 months ago, I have noticed a considerable amount of daily shedding, especially in the shower. I have also noticed a great deal more of recession in the hairline. To help combat this, I have started applying Rogaine Foam, and taking Procerin tablets regularly.

I am sure I will have to wait a little longer to see if the added products help combat the shedding, but my question to you, is should I increase the Propecia dosage as well? Right now I am only taking 1mg. Hair Loss is common in my family, as my two older brothers are almost completely bald. I’d like to do what I can to avoid ending up there myself. If you could share your initial thoughts with me, I’d appreciate it.

Thanks

The 1mg dose recommendation is across the board, but it might be worth a try at 2mg as more and more doctors are now trying a slightly higher dose. Double check with your prescribing physician, but if you do not have side effects, go for it.

We really do not know how finasteride will alter the long term (15+ year) balding pattern. We are hopeful that it will slow the balding down, but the real question is, “Will you still eventually wind up at your final hair loss pattern?” Propecia has been on the market only about 12 years, so we don’t really have the experience over a 20 year time period.

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February 12, 2009

Hair Loss InformationWoman with Corner Balding – Two Weeks After Hair Transplant (with Photos) – Hair Loss Information – Balding Blog

This patient has 1235 grafts placed into the corners of her hairline. The After photo was taken when she was 2 weeks post surgery. She showed many people and most people did not believe she had a transplant. None of the hairs have fallen out yet, although I would expect that the shedding of the transplanted hair would occur at between 2-3 weeks.

One of the most frequent requests we get are about how you can expect to look after a hair transplant, and many people imagine a deformed, scabby area. But our post surgical patients usually have no scabbing if they wash their hair diligently as we’ve defined it.

I’m sorry about the slightly different angles on the before and after photos. I messed up when taking the after photo so this is the best I’ve got until I see this patient again… but this still gives a good idea of what one can expect just a couple weeks after surgery. Click the photos below to enlarge.

Before on the left; After 1235 grafts on the right:

February 12, 2009

Vitamin C Supplement Ester-C and Hair Strength – Hair Loss Information – Balding Blog

Ester-C has greatly reduced the amount of hair that I naturally shed. I have tried this three times and have experienced the same results. There are several people that have witnessed my results. Shedding has been reduced by approximately 80%. I also take Avodart, but it is the Ester-C that has had this effect. I haven’t noticed any increase in actual hair growth from Ester-C. I just seems to make the hair stay in the follicle better. To sum it up, by taking Ester-C my hair would survive a pull test far better. This is factual information and could easily be proven.

Thanks

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I am unfamiliar with the connection of vitamin C to hair loss prevention or increasing the strength of your hair while pulling on it. Maybe the use of Avodart (dutasteride) is somehow potentiated by it, but that is like playing roulette and any guess is as good as another one.

February 12, 2009

Taking Propecia and Applying Revivogen / Minoxidil Combo – Hair Loss Information by Dr. William Rassman

Dear Dr, Rassman,

First of all i’d just like to say what a source of support your blog has given me over the past year, when i first noticed my hair loss. Being resident in the UK, we really are in terms of awareness, knowledge and treatment of hair loss years behind america! To give an example, my GP had never even heard of propecia! So thank you for creating such an informative forum that really helps people such as myself, educate themselves about the multitude of issues and treatments regarding MPB.

I staerted noticing about a year ago that my hairline was begining to receed above the temples, i was 23 at the time. I went to see a trichologist within a month of this and basically, was given so called “snake oils” and high frequency treatment which i payed a lot of money for. When i look back on this, i cannot believe how naive i was to trust that this approach would work. Basically i was scammed! and i believe wasted precious time, which could have been spent pursuing one of the 2 medically proven treatments.

I’d say in the last year the hairline has gone back about half an inch on the left side, but hardly moved on the right side, but the hair there seems less thick. To be sure i’m doing everything i can to provent further loss- i started propecia 2 months ago, and apply revivogen (natural DHT blocker, medically unproven, but i’m a medical student and have read the trials revivogen performed on its efficacy cf. propecia and they looked promising) once a day to the hairline along with minoxidil 5 per cent 3 hours later daily.

I know that the sooner you catch the hairline recession the more chance you have at getting results- as theres a smaller window of time to restore the hair follicles in the frontal region, as i understand it. What i would really appreciate is your advice on the steps i’ve taken (after noticing minor recession in the past year) have i done the right thing? and in your experience, would you say that if you catch frontal recession right at the beginning, can it be controlled?

I would really appreciate your expert opinion on this, as we don’t really have many specialists in this field in the UK and in general GPs are clueless about hairloss! Having your assessment would really mean a lot to me and take away some of the anguish i have at the moment as all the doctors i’ve consulted up until now have been completely clueless.

thank you in advance

You’re still in your early 20s with early hair loss — so yes, it does sound like you’re doing the right thing by starting Propecia. Having only taken Propecia for two months, you aren’t likely to see any benefits just yet, but stick with it. The Revivogen/minoxidil combo isn’t something I’ve heard tried before, but best of luck with that. It sounds like you’re taking proper steps and even being a little creative with your approach. As long as you’ve got the finances to handle so many treatments at once, then go for it.

I’m glad you’ve found this site helpful in the time you’ve spent here, and I hope you continue to enjoy it. Thanks for your kind words.

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February 12, 2009

Minoxidil Just Stimulates Growth, Right? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman, my question concerns minoxidil. I have been using propecia for 3 months to treat the slow progression of a receeding hairline. I realize that it is too early to tell if it has been effective so only time will tell. Obviously, i want to maximize my chances of maintaining my hairline at its present state and want to feel like i am doing everything possible to ensure this. I have mild minaturization of hairs along the frontal and temporal hairline and am wondering if i should additionally use minoxidil to try to restore these hairs to a cosmetically viable state.

As i understand it, propecia is a DHT inhibitor and will act to maintain the hair you have and not regrow it. Minoxidil on the other hand, is a growth stimulant? is this correct? What i really want to know is, in your expert opinion and experience, would combining a topical application of minoxidil to the hairline be worth it? or will propecia restore the minaturized hairs- if indeed i am a responder?

thank you so much

Many doctors recommend the use of both Propecia and minoxidil at the same time. I tend not to do this, because it would addict the miniaturized hairs to minoxidil, possibly unnecessarily. Plus, if you do see hair regrowth while using both medications, you won’t truly know which one is showing the benefits and will essentially be stuck using both forever, for fear of stopping one and losing benefits. It is possible that both will give you benefits, though.

Minoxidil will not impact normal hair and as such will not stimulate it in any way. Combining the two could be worth it, but it’s ultimately up to you.

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February 12, 2009

In the News – Study Shows Multivitamins Aren’t Necessary – Hair Loss Information by Dr. William Rassman

Snippet from the article:

Middle-aged women who swallow multivitamin supplements are not doing their health any favours – and are just creating expensive urine, according to the world’s largest study into the subject.

Researchers who examined the pill-popping habits of nearly 162,000 American women aged 50 to 79 found that although they swallowed dietary supplements by the bucketload, there was no sign that they reduced common cancers, heart disease or deaths.

Read the full article — Multivitamin supplements a ‘waste of time’

I know it’s yet another non-hair related news clip, but this is an important study, because we are wasting our money in the hope that we will all live longer and healthier. A long and healthier life really reflects more on how we eat, what we do (sedentary vs active lifestyle), and something about our genetics (family lifelines). What you can do is exercise, eat better (less grease, fats, fried foods), and take in a balanced diet with a good assortment of vegetables.

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February 12, 2009

Can I Apply Minoxidil 5% Four Times a Day? – Hair Loss Information by Dr. William Rassman

Dear Dr.

i want to know, if i apply minoxidil 5% solution 4 times per day, will it = applying a minoxidil 10% solution twice daily? which will have better result? i ask this question, as i found that the higher concentration, like 10% or 12% or 15% is much more expensive than the 5% one!

I don’t know the answer to your question, as I’ve not experimented with 10% minoxidil on my patients. Remember, minoxidil is a hypotensive drug and more frequent use could lead to more low blood pressure side effects.

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February 12, 2009

Can a Craniotomy Scar Be Avoided? – Hair Loss Information by Dr. William Rassman

My son is worried that after he will have craniotomy, (and it is to remove the lesion) and having a big scar, it will be very noticable and hair will not grow at the scar. Can it be avaided? What can he do before? Any recommendation? Also, can you make hair grow on scar tissue? What is the success rate?

Talk with his surgeon and let him know of your concern. Worst case scenario and there is a linear area that won’t grow hair after all is said and done, I have fixed many craniotomy scars with hair transplantation.

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February 11, 2009

Hair Loss InformationDoctors vs Technicians – Who Does More in the Hair Transplant Procedure? – Hair Loss Information – Balding Blog

Dear Doctor,

I have been doing a lot of reading about hair transplants because I see one in my near future. I have heard enough horror stories to know the importance of choosing a great transplant surgeon.

It just seems to me that the doctor’s role is “overrated.” I certainly do not mean any disrespect by that, but it seems that the transplant technicians have more of a role in the outcome, whether it be good or bad, than the doctor himself.

From what I understand, the doctor justs removes the donor strip, sutures the incision and makes the recipient sites. I may be ignorant of the matter, but this seems like something any general surgeon can easily do. The technicians though are responsible for dissecting and actually placing the grafts. If a transplant’s outcome is judged to be a success or not by the number of grafts that actually grow, then it seems that the technicians were more responsible for the outcome than the surgeon who merely made the holes in the person’s head.

I hope you don’t take anything I wrote as a slight against you or your profession, but if what I wrote is not true, please tell me what am I missing in my thinking?

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The role of the technician is very important. What they do requires special skills that are tedious and at times require years to perfect. The hair that is cut from the strip must be efficiently dissected under the microscope and handled efficiently. Such work is best for a technician who has these functions as their sole activity. It takes a certain type of personality to be able to perform this type of work, great dexterity, and hand-eye coordination. Not to say no doctor has these things, but the complete skill list is honestly not the type that most doctors have. When I started to do the hair transplant procedures in larger and larger sessions, I originally participated in the cutting and placing the grafts, for it was I who defined the standards that the technicians would be held accountable for. So in the early days (1992-1993), I was the fastest graft preparer and the fastest graft placer, but as the graft counts went into the thousands of grafts, the work required more and more labor. Four or five technicians are a minimum number required for a large case of over 3000 grafts in 6-7 hours.

If I was to do this myself without the technicians, it would take me more than 24 hours and I would be exhausted, my eye strain would be incalculable, and the grafts may have died off by the time their turn came to placing them. If a graft is out of the body more than 8 hours, the death rate for the grafts runs 1% per hour. One could say, “Hey, lets get 5 surgeons to replace the 5 or so technicians,” but what that would do is:

Slow the process down, as doctors are generally not good at such disciplines.
Reduce the quality of the work, as doctors can not do repetitive work reliably for they often lack the patience.
Drive up the costs substantially out of the reach of most recipients, as doctors make more money than technicians.

Those reasons, in a nutshell, are why technicians are used throughout surgery. Another example where technicians are used in surgical procedures — open heart surgery. It is the pump technicians that control the patient’s circulation.

Now with regard to what the surgeon does, it is not as simple as you suggest. There is a special skill required in planning the surgery, and I suppose to prove this you’d have to spend a day with me to see the many patients that come in for repairs with results reflecting a lack of strategy in their hair transplant procedure. When a doctor just looks at it as cutting out a strip and putting holes in the head of the patient, the results can be frequently substandard. So while I don’t take what you said as a slight, I hope this helps explain things a little better.

February 11, 2009

Minoxidil with No Propylene Glycol? – Hair Loss Information – Balding Blog

Doctor,

What do you think of minoxidil products sold by doctors with little or no propylene glycol? Do you think they’re still effective as long as minoxidil is the main active ingredient? (Tried Rogaine foam, very hard to apply through hair to the scalp)

It appears on the internet a large number of people are only using minoxidil once a day. Usually at nite. Do you see that at your practice? Are they having results or developing dependency?

Also, it appears I can only handle .5mg of Propecia due to side effects. I think you’ve stated it’s about 80% effective at that dose. Have you seen that 80% result in your clinical practice?

Thanks for taking the time everyday to answer everyone’s questions. I’ve learned more than anywhere else on this blog.

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I don’t see why the lack of propylene glycol would make minoxidil ineffective. The propylene glycol is supposed to help the minoxidil penetrate the scalp better, but it isn’t used in the Rogaine Foam or in the Women’s Rogaine liquid (which is good for those that may have allergies to propylene glycol), so I’d expect that other delivery mechanisms, such as alcohol, work relatively well. I really have no opinion on the various ways the doctors make their minoxidil formulas. The recommended use is twice a day, but many people do use it once a day. I can not tell if once a day works across the board.

My comments on the 80% effectiveness of 1/2 mg of finasteride came out of a conversation I had with Dr. David Whiting (and might’ve been in something I read), not my own clinical study.