June 2009 – Page 11 – Balding Blog

June 5, 2009

Is Propecia Good for the Top of the Scalp and Bad for the Hairline? – Hair Loss Information by Dr. William Rassman

Hi doctor how are you?

This is my question regarding propecia.

Most people think only DHT destroys hair but the follicles are sensitive to testosterone as well. Its interesting to note the first thing that goes on most guys is the hairline mostly the juvenile hairline which is often made up of small vellus like hairs. This is because they are sensitive to testosterone more so than DHT. And we all know finasteride lowers DHT and raises testosterone.

Can that make a persons hairline even worse by trying propecia or can propecia help maintain it? Basically is propecia good for one thing on the scalp and bad for other areas such as the hairline.

I would really appreciate if you could answer my question, because I have searched in your blog and haven’t found a clear answer when regarding testosterone and hairline balding and not DHT.

Propecia has the same impact on the frontal hair and the crown hair, but it appears that it is less effective on the frontal hair, which is often caught later after the hair loss is detectable. The crown seems to have a slower loss rate and that is probably why Propecia (finasteride) works so well in the crown. Finasteride is not bad for frontal hair and I have even seen people reverse frontal hair loss with it in the very young man, although it is rarer in the front than the crown.

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June 5, 2009

I Shaved My Head and Am Monitoring My Hairline – Hair Loss Information by Dr. William Rassman

I recently shaved my head and began closely monitoring my hairline. There are a few follicles that stood out from the rest because they were isolated and a bit lower than the front of my hairline. I recently noticed two that had stunted growth and formed what resembled a blackhead. After “popping” them the hair has still not grown back. Do hair follicles have a dormant stage or does this signal that the follicles have died and that I am beginning to lose hair?

Read about hair cycling here. If you monitor your hairline this way, I would suggest that you (1) always lift your brow so as to see the highest crease and (2) collect serial photographs with your brow lifted. Good luck to you, as the quest may take a few years to understand what is happening to your hairline.

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June 5, 2009

Hair Loss Information » Andractim for Treating Gynecomastia? – Balding Blog

Dear Dr. Rassman,

I’ve got some puffy nipples since I was 15 (now I’m 22) and after 4 months using Propecia it seems that they are a little larger. (anyway not a big change). I’ve read about this gel “andractim” and seems it’s a good treatment for those who have slight gyno. I don’t want to stop using propecia, cause it works really well for me. The thing is andractim is a topical DHT… which should be applied on your nipple area, so maybe will stop propecia from working. Do you know any way to keep taking propecia and not making my slight gyno/hair fall worse?!

Best regards!

I can not tell you what using Andractim (topical DHT gel) will do for your gynecomastia. This condition is common in boys of your age as the hormones your testicles produce along with other hormones are all over the place while you are maturing. I doubt that the topical medication will hurt you or make Propecia stop working, but I would not go along using it for too long without having your doctor examine you and determine just what is going on.

June 4, 2009

Throbbing Pain Weeks After Hair Transplant! – Hair Loss Information – Balding Blog

Hello,

I’m a 30 year old male who had my first hair transplant when I was 26. I flew to Thailand and had a 2000 graft strip excision procedure done. The first week was hell but the transplant turned out to be good, but in need of obvious density. I decided to return 4 years later and get another procedure. I was thinking of going to another doctor but the last time he provided great service even though I suspected the 2000 grafts could have looked better.

Fast forward to now, I thought I needed between 1000-1500 and he immediately said 2000. I didn’t think about until after the procedure that this is too much. After the 2nd procedure which I am currently 15 days after the healing process is not going as well as the first time. I will run down the issues and you can tell me if I’m royally screwed or not.

My whole scalp is super tight. I can feel a constant tension ring from ear to ear and even my temples. When I lift my eyebrows all the way up I can even feel it. The most disturbing thing is every time I walk slowly up a flight of stairs I get a throbbing headache/pain which feels as if I’m going to pass out.

The scar (trychophyic closure) is not healing. On the right side there is a indentation with a huge scab (I think that gauze stuff?) which is surrounded by inflammation.

I have this dull ache in my throat when I swallow. It has never happened ever before and started after this procedure.

My questions are:

Will this throbbing pain while walking up stairs go away?

Is the dent and bump in my head going to heal? Is it swelling and or skin just pulled together from the wrong angle?

Is there anything I can do to help the wound heal?

I’ve been using propecia for 4 years now, and just started 5 sprays of minoxidil on recipient area. Please help this is extremely disconcerting because I’m a triathlete who routinely has 3 hour workouts in the gym, and I fear I will never be able to compete again. I would try to talk to the doc thailand but his English isn’t very good and kind of sent me packing without letting me know if I have a normal future. Thanks for reading, I will also try to send pictures although it may be a few weeks (moving, camera packed, etc.)

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From what you described, there are clearly problems. Over time things should get better, but you should get an assessment for baseline purposes to plot progress or lack of progress (objectively) over time. It would be best that you be seen by me if you want a better assessment. The exam will be free, but I’m in Los Angeles, so you’ll likely need to do some more traveling. Drugs like minoxidil and Propecia will help prevent further hair loss, but not reverse what has already occurred.

Without knowing more I’m just able to give general info, but here’s a try at your questions:

Pain from damaged nerves may or may not get better depending upon whether or not the nerve was cut.
Dents in wounds, may or may not get better as more healing goes on.
Generally, there is nothing to do to help wound healing. Some readers will likely argue that, so please feel free to leave comments with your wound-healing advice.

June 4, 2009

Chemical Burn from Clorox – Hair Loss Information by Dr. William Rassman

my hair accidentally touched (clorox) while cleaning bathroom. it began to fall, and brake. my doctor said its a chemical burn and i need 2 months to feel progress. my hair from one area is broken and falling. i take tablets called (multihair). will my hair get well again?

If you just got bleach on your hair you’re likely going to be fine. It just takes time and patience, so follow your doctor’s advice and wait for the regrowth process.

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June 4, 2009

Best Post-Op Shampoo? – Hair Loss Information by Dr. William Rassman

Are there any post op shampoo’s and/or conditioners better than others? I am currently using Nizoral, but I thought I read somewhere it has not shown to be productive in maintaining hair loss? I have had two follicle transplants and it seems the hair that was in place has thinned even more. I am hoping once the new hair gets into place it will appear much fuller than the previous transplant.

Also, I have heard that some anti-inflammatory organic products with Tea Tree oil and Rosemary can be beneficial. Is that true?

Topicals in shampoos, including tea tree oil and rosemary, will not impact the rate of hair loss. After our surgeries, we use Progaine and supply one bottle of it to the patient. You can find it for sale online at Amazon.

Update: Sorry, I had a brain fart. We use GraftCyte and provide that to patients.

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June 4, 2009

BaldingBlog Tip: Email Questions that Contain Actual Information – Hair Loss Information by Dr. William Rassman

Just this morning, I received a reply from a reader that didn’t like a previous reply I had given him via email. Here’s what he said:

Wow, you’re a lot more helpful on the e-mails you display on your site than the ones you actually send. What a big surprise.

Dr Rassman For every one email I post on the site, I probably answer 10-15… and even then, I can’t get to all of them. There have been a high number of people writing in asking for my opinion on this or that, and their email usually focuses on just one thing. In some cases, what that ends up doing is raising a lot of questions for me to ask back to them so I can help get them an answer. To render an opinion and help those that email the site, I must have lots of information and sometimes even good photos (and permission to publish them is encouraged). All too often there is nothing of the sort. I don’t want to be rude by simply saying that “you” need to see a doctor, but this is not a guessing game for me and while I do want to help, reason must prevail. Bottom line… if you are writing to BaldingBlog, make your case as concise as possible with as much relevant information that you can provide. It might sound like a contradiction, but I’ll try to clarify if you need more help. I enjoy writing the blog, but I can only answer what I’ve got to work with, so keep that in mind if you don’t get the reply you were hoping for.

Also keep in mind that I’m not diagnosing people online, but just providing general information. Please don’t write to me upset that I’m just trying to pass you off to your doctor. I can’t legally do what you want me to do, and most times an in-person examination with a doctor is the best way to go anyway.

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June 3, 2009

Transplanting Conservative Hairlines – Hair Loss Information – Balding Blog

On the NHI patient photos site, patient DTA has had a significantly improved hairline from his previous norwood 3 hairline. I was under the impression (from reading this blog) that your clinic took a more conservative approach to hairlines than other clinics but from the results it appears the hairline was significantly improved.

Could you please inform me on what type of method was used (FUE, strip or both), how many sessions such a hairline took to complete and how many grafts?

Thanks

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Before

After

This patient had 4 procedures totaling 7390 grafts, all using the strip technique. The lack of graft and procedure count was an error on the NHI site that has since been corrected. He started getting transplanted before the FUE technique was available. Many times the patient just wants more fullness, so the graft count goes up.

As for the conservative hairlines, we create hairlines for men that frame the face and look masculine, like the patient above. I don’t understand why some doctors will transplant a straight line of hair for a 40 year old man (for example), when that type of hairline is usually seen only in children and women. See also: If I Get Transplants, I Want a Perfectly Straight Hairline.

June 3, 2009

Swimming in the Sea After a Hair Transplant – Hair Loss Information by Dr. William Rassman

Hi Doctor,
Does swimming in the sea(since summer is hot here) can affect the 7 months transplants? Thank you

You can go into the sea anytime after 3 weeks safely (possibly earlier). I tend to play everything on the conservative side.

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June 3, 2009

Should I Avoid Surgeons That Use a Multi-Blade Scalpel? – Hair Loss Information by Dr. William Rassman

Why do so many “consumer advocates” on the forums and other so-called “experts” advise when choosing a hair transplant surgeon to avoid one who uses a multi-blade scalpel?

Everyone says a surgeon will obtain better results when using a single-blade scalpel and that all the better surgeons use them. I found this not to be true, because I know at least a few “world class” hair transplant surgeons who prefer the multi-blade knives.

Does it really matter? What do you use and what are the pro and cons, if any, to the use of each tool?

When a strip is cut out, there is a cut on the upper edge of the strip and on the lower edge of the strip, so one or two blades will accomplish the same thing provided that the double blade knife is designed to cut along the angle of the hairs. When additional blades are used (8 blades for example) there is more damage created, because the inner blades are blind cut and the surgeons has no control of them. I generally estimate that the upper and lower cut lose about 2% of the total hairs in the strip, so if you use 8 blades, then 16% loss could occur from the blind cutting.

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