2013-12-13 12:00:482013-12-12 12:52:09Copper Peptides For My Itchy Transplant Scar?
The patient elects to wear a hair system, which explains why it appears that he has a full head of hair in the After photos. The system, however, doesn’t extend to the sides of the head / temple peak area, which was the targeted transplant area. He had exploited his donor area with many transplant procedures and the available donor hair was limited. The areas which were circled were plugs that came down below the leading edge of the hair system and these were removed at the time of the transplant. These are very difficult reconstructions and your surgeon and his team must be experienced when balancing risks and rewards. Harvesting a tight donor area in particular, has wound risks. This patient has extremely fine hair and the density of his donor area was poor. These two issues (hair thickness and donor density) produce a great challenge and in this patient required two surgeries to achieve his goals. Click the photos below to enlarge.
After (two procedures totaling 2151 grafts):
Before:
dr rassman
in your experience is it always evident that the earlier the balding process begins the more advanced the pattern will be? or can an individual simply be limited to losing only his crown at 20 years old then have the hairloss stabilize?also when someone is diagnosed as having 50 % miniaturization does that refer to their entire scalp or a specific area (ie the crown is 50% miniturized)
It is possible that you could start losing hair early and have it stabilize. When Dr. Norwood did the original study for classifying hair loss, he did note that of those men who progressed to a Class 6, the hair loss started in their early 20s. But, your hair loss pattern is decided by your genetics. Or in other words, if you lose your crown hair at 20 years old it doesn’t necessarily mean you’re going to be a Norwood 7 by the time you’re 30.
But in your case with 50% miniaturization, I assume whoever did that test was talking about the entire scalp, not just the crown. I don’t know how the measurements were taken, though. If you have 50% miniaturization throughout the top of your head, you’re likely going to have a large balding area. I generally measure each area in the balding patterns so that I can predict where the patient might go as they lose their hair. From these numbers, i will re-look at the patient in a year and see if there were benefits from medication and assess what the value of the drug was in modifying the hair loss pattern and rate of appearance.
Hello Dr. Rassman,
I have been following your blog for over two years. I appreciate the work you do.
I had a question about hair transplant procedure. I understand that before or during hair transplantation, patients are prescribed propecia to help with the results. How would the results be affected if someone opts to get into hair transplantation but does not take propecia.
Your input will be greatly appreciated. Thank You.
Some of my patients do not take Propecia (finasteride 1mg) by their personal choice. It is your choice as well. The risk is that you may have increased shock hair loss without taking Propecia before surgery. Shock hair loss is common in men under 30 years old or those who are losing their hair actively when they have a hair transplant. Propecia will prevent this complication in most men.
My personal opinion is that you are investing a lot of money in a surgery to have hair so why not try to maximize your return by taking Propecia?
I have a very important question?
After my surgery, i started getting scabs (crust- normal), which lasted about 10- 12 days. After the 12th day, i decided to massage the scabs with oil. I did that for two days and further massaged it with my hands in the shower, used shampoo to wash it up. Now, i feel like i have made a mistake. massaging the scabs away? does it mean that my hair follicles are also damages and my hair transplant is a failure? I am scared and confused. please reply ASAP
We performed a study on grafts being secure after a hair transplant by pulling our grafts on successive days. We found that at 12 days, the grafts are secure. If you were gentle on the washing technique, usually the scabs that remain will loosen easily with soap and water. I don’t think you did anything to be concerned about.
You can read the article in PDF format here — Graft Anchoring in Hair Transplantation
I understand that you have answered questions about pregnancy and hair loss but I was wondering what preventive measure I can take to avoid prolonged hair loss or hair thinning as I already have thin hair.
I am 23 years old and nine months pregnant and I have wonderfully thick hair right now, due mostly to the lack of hair loss that pregnancy can cause and also, I think, to the daily prenatal vitamins I have taken, since I never used any before. My older sister started her family at age 29 and after each of her four children experienced about 6 months of hair thinning and loss. Our family has thin hair already, so I’d like to avoid this as much as possible.
I plan on breastfeeding which is supposed to help limit hair loss. Are there any vitamins, minerals, treatments, foods or natural methods to encourage hair growth or prevent hair loss in the year following pregnancy? [Note: I’m not going to ‘stop having kids’ so I’ll use your advice after future pregnancies too :)]
There is little that can be done to prevent pregnancy related hair loss. Fortunately, it does not happen to most women. It is normal, though. You can learn more at the American Pregnancy Association.
Unrelated to your question though, I wish you good luck and hope everyone is happy and healthy.
This is in response to Why Don’t More Men Get Their Hair Back? —
I believe that for many it is also the fact that the coverage and density you get from a hair transplant is not considered sufficient.
If you look at photos/videos of men having hair transplants, the density is at times not great – i.e. very much see through.
If density + coverage was good (cloning?!), then I believe alot more men would go and get it done even though the price would be fairly high.
The amount of hair that is generally needed to give a man the coverage he wants/needs is upwards of 25% of his original density. As each man is different, the coverage of a single hair (one out of many) reflects:
… so the hair requirements must be tailored to the particular patient. At our Open House events held each month, there are often 2 patients who stop by with black hair/white skin and a medium hair weight, and their results are spectacular. Sports news personality Steve Hartman had it done in one session and he does not have a see-through look, probably because his hair character is very good and wavy.
Generally, I tell patients to visit an Open House event so that questions such as those that you raised can be answered by meeting patients who have already had the procedure done. You are correct, of course, that people with fine hair may not get the fullness (density) they want and need, but such issues are best raised with the transplant surgeon.
I have been using Propecia for five years with great results. I have been reading about the significant side effects. I have started to use Rogaine and plan to come off of Propecia. As an aside, I would like to start a family with my wife, which is the catalyst in my decision.
Will I keep all the good results from Propecia
I am a little confused. You’ve taken Propecia for 5 years without side effects, and you are now stopping the medication because you’ve recently read about potential side effects (that you don’t have)? If you stop taking Propecia, you will lose all of the results and the hair that has remained with the help of the medication. Rogaine will not keep the hair grown that you saved while you were taking Propecia (and Propecia won’t keep any grown by Rogaine).
As for starting a family, I’m not sure what you’ve been reading, but I’ve written about this many times before. Here’s one from Merck, the drug maker, about this very issue.
Hello Dr. Rassman,
In your opinion, would avodart as a substitute for propecia in my situation be ok to take & would the avodart dosage be more effective in stabilizing hair loss? I’m in my 60’s & the avodart sterility side effects don’t concern me. I have been taking propecia for approx. 8 years, & have been experiencing substantial hair loss in the last few years of even previously transplanted hairs from two HT’s as I was a Norwood 6-7, & had very thin, fine hair in my donor site, & quite bald on top.I’m out of state now, but my surgeon is very well known & extremely skilled & I respect him & was enormously happy with my HT’s I had 7-8 years ago. I’m assuming my donor hair is one of the few cases where it wasn’t destined to last a lifetime. I still some have hairs on top, but quite thin & sparse.
I realize you won’t give specific suggestions concerning Avodart, but any direction would be appreciated. I don’ want to go back to wearing a hairpiece (over 30 years)! Thank you!
Taking Avodart (dutasteride) for a man over 55 years old and not concerned about fathering more children is a reasonable approach. I have heard from the transplant physician community that when hair loss is not stopped with Propecia, the use of Avodart may help.
I am curious about the loss of your transplanted hair, however. This should not typically occur and should be discussed with your surgeon. Don’t just assume! Talk to your doctor!
I’m thinking about an HT, and after reading all your topics I see my biggest concern is shock loss. I’m a 61 year old male and have a high degree of miniaturization in the proposed recipient area. In one of your responses, I believe you recommended not having an HT for thinning hair?
You often recommend Propecia for younger men and say it might prevent shock loss for possibly 90+ cases? You also recommend taking Propecia 2 weeks to a month in advance of the HT(but even the day before the HT is better than not at all?). Would this advice apply to an older guy like me? Or if I’m correct that you would not advise cases of older age onset thinning to not seek HT?
Propecia works at any age to prevent shock loss. It is best to use this medication in advance of the surgery (at least 2-4 weeks). Older men generally have less hair transplant shock loss than younger men. I would need to know more about your miniaturization and your last 1-2 year history of hair loss. At 61 years old, few men are actively losing hair.
