About 2.5 months post op from my tranplant (4,000 grafts) I developed a case of Seborrheic Dermatitis. Medicated shampoos were not working so my dermatologist prescribed a desonide/ciclopirox cream (mild steroid/anti-fungal) to be applied 2x per day. Will a cream block my pores and stunt my transplant growth?
Since it’s already over 2 months since your hair transplant, I wouldn’t be concerned. You should play it safe and talk with your surgeon about this.
We’re taking a long weekend for the Thanksgiving holiday and will be back on Monday, November 28!
What’s up with comic book legend Stan Lee’s hairline? I’ve been watching a show he hosts on History Channel and his hairline is bugging me. Is it a flap or something? It looks like there’s a white line right around the edge of it. It’s a very unusual shape, but if it was a flap wouldn’t the color on top be the same as on the sides? I guess he could dye it though. What do you think?
Years ago, there were a variety of surgeries that produced many deformities in people that wanted to get hair. They were courageous enough to “lead the pack” of people getting hair transplants, but the worst of the deformities were the old plugs (pencil size grouping of hairs put into corn rows that looked like doll’s hair).
Since I entered the hair restoration field 20 year ago, I have treated many men who had these procedures in the 1950s – 1990s. Most of these men sought a fix-it solution, with the two most effective being:
Fortunately, many of the old plugs did not have even a 50% survival of the hairs, so the impact was benefited from the poor techniques of those original transplants. Despite this, the skin from the transplanted grafts lived, creating a cobblestone effect on the scalp that added to the ‘dolls head’ deformities. These unfortunate pioneer recipients of hair transplants suffered ridicule by everyone — their friends talked behind their backs, and those who were in the public eye were tagged with not-so-pleasant names. One celebrity that comes to mind told me that comedians were very cruel with their jokes about his hair plugs. In the first 10 years of my practice in this business, I performed hair restoration repairs on many men, making great friends along the way, including this one particular celebrity whose nightmare ended after the transplants grew.
Based on some photos I’ve seen using Google Image Search, I believe that Stan Lee had some corrective surgery to fix what might have been the old type of plugs. There’s a high-resolution photo here. The scar in front on the left side and the imbalance between the two sides suggest this to me. If I were to see him and could find enough hair still present, I would excise the plugs that remain and rebuild a new hairline in the normal position. With his white hair, this should be relatively easy.
I have a Class 6 pattern of balding. Which is the best procedure for me? An FUE or the strip FUT?
For someone with Norwood class 6 pattern balding, the FUT (strip) technique will allow the entire job to be done in one or two sessions easily, allowing for ranges of between 2500-3500 grafts per session. A class 6 patient needs somewhere between 4,000-6,500 grafts. The wide range of transplants reflect the variations seen in the Class 6 patterns and the quality/thickness of the hair shafts. Men with fine hair, generally require more grafts but those with more confined Class 6 patterns and with medium or more coarse hair, can often get away with just one session.
The other technique, contrary to what you may read or hear, are generally limited to 1000-2000 grafts per session in the best of hands. For ideal work, you need to have a good quality of hair and enough donor density to allow for a safe surgery.
Hi doc,
If you have very early bulk reductions in a certain area of the scalp, does this necessarily mean that you will be bald in those areas, or can someone’s final pattern only reflect thinning in certain areas? I am a NW2-3 with very early bulk reductions on the top and crown of my head, does this mean I am destined to be at least a NW6?
We all have some genetic pattern, but not all balding men will develop advanced balding patterns. These patterns are often final, so a class 3 may remain a class 3 pattern for life. This is why I’d want to perform a bulk assessment of the hair on your head, everywhere on your scalp. If the bulk is reduced, that may point to the final pattern you will develop. Also, by making these measurements, we can follow the success or failure in the treatment of hair loss with drugs like finasteride (Propecia).
Stop worrying and get yourself evaluated. We are often more frightened by what might happen than what will happen.
Dr. Rassman, I have a question regarding a statement you made on your Q/A blog. You said: “I wouldn’t allow any doctor to transplant into an area that has not fallen out under the excuse that there’s anticipated hair loss (behind the leading edge of your loss), as this will only accelerate the thinning. Some doctors do this, and it isn’t in your best interest, only serving to put your money in his pocket.”
I have had in-person consults with Dr. Pak in the San Jose previously. During the consult when discussing what I’d like done and the procedure itself, Dr. Pak has mentioned that he has to consider my future hairloss when he’s doing a procedure. He said he would work within my current frontal hair to add density to what I have.
So when considering what you stated in the above quote, how does that comport?
Thanks
Almost everyone we transplant has a zone between the bald area and the balding area. We allow the transplant to ‘spill’ into the balding area just in the areas that are evidently in the balding process. We never go back behind it into the area where the hair is normal and not miniaturized.
What I see often is someone with an early Norwood class 3 balding pattern who has some minimal miniaturization behind it (let’s say 25% miniaturized hairs). I might transplant hair about 1/2 – 1 cm behind the posterior bald edge, but not far into the area where there is 25% miniaturization.
Unfortunately, many doctors will transplant 1-3 inches or more behind the bald area, suggesting that it would be to prevent future balding, and it is that process that I warn about. I have recently seen a patient who needed about 800 grafts for corner balding in the frontal area, but his doctor put in 3500 grafts to prevent the balding from spreading. Not only did that cost the patient a bundle of money, but it also almost certainly damaged hair in the normal areas that got the grafts and did not need them.
Hi Doc
I’ve been reading that forum for quite a time, and i am still a bit messed when it comes to long term propecia (finasteride) efficacy. In one of your last posts you wrote ‘The problem is that many people who see it stop may find that it picks up again years ”
when you say ‘many’ i guess you take it from your practice over the years, do you keep firm statistics about that like what percentage of your patients is that. Another important thing is when you say ‘picks up’ does it mean that there are people who went completely bald while on finasteride or they just lost some small percentage of their hair? thanks
The quote you’re referencing is from this post, which wasn’t about finasteride. I was answering a question about final hair loss patterns. So what I was talking about was that for those men with hair loss that has seemingly stopped on its own, they may see additional hair loss as time goes on.
I don’t have firm statistics to share regarding my patients that have seen their hair loss halt and then eventually start again while they maintained finasteride use over years. Not every patient comes back in for follow-ups. As I’ve written before, you can look at it like a tug-of-war between finasteride and your genetics. Eventually, the genetics will win out. To what degree and when, I have no idea. If you stop finasteride, the tug of war will end faster in the direction of more balding.
Hi Doctor,
Thank you for the great blog. I was curious about your big-picture opinion — do you think it is possible/likely that a significant breakthrough in treating MPB will come along in the next decade? I was wondering about your perspective on this, based on your experience and what you hear from colleagues / journals / etc.
We can hope that this will happen. Knowledge is increasing logarithmically, so whatever breakthroughs we have seen in the past 10 years should be 10 times that number. There is work going on in cloning and the financial rewards are certainly there to make the required breakthrough. This means to me that something will happen sooner rather than later. But if I had cancer, I would not wait for a cure while it grew in my body. I would treat it when I made the diagnosis. The same applies to hair transplants — you could wait until it all falls out or you can treat it with drugs (like finasteride) or surgery (like a hair transplant).
Dear Dr Rassman
Im a keen reader of your website and user of Propecia. Interesting article in the Daily Mail UK.Link: How Wayne Rooney’s hair loss cure could help boost your performance
I’m not sure about the extra muscle mass but the other effects apply to me. Though as the article suggests they could be psychosomatic.
Best Regards
Increased confidence and self-esteem in oneself is probably the most common result of a hair transplant or a successful reversal of hair loss with drugs like Rogaine and/or Propecia.
I will tell you about a man I transplanted some years ago. He was a very successful man who made millions of dollars taking over troubled companies and turning them around. He presented as a Norwood class 4 pattern balding patient who had two hair transplants over a one year period. He was a happy camper after his hair restoration. If you put him into a room with 100 men (even before his hair transplant) his dynamic personality would project so well that people would gather around him hoping that this charisma would rub off. That part of his career did not change after his hair transplant, as he was (and still is) a dynamic person.
One day, some two years after his second hair transplant, his wife was in Los Angeles on a family trip. She stopped by my office to see me. She told me how adamant she was against her husband having a hair transplant, and how they fought about it up until he had the first procedure. I remember her saying something to the effect of, “I told him that I loved him with or without hair and that having a hair transplant was foolish. I really did not think that he needed it and he was handsome with or without hair. Now I am here to tell you what I never told him, that I was wrong about my stance against the surgery. He changed after his hair was restored, and the man I married, the man I fell in love with, returned. I just want to thank you for what you did for us.”
Hair loss impacts our psyche in many ways. Over the years I have done transplants on thousands of men, and some of these men had successful careers after their transplant. Many of these men are household names (CEOs, celebrities, heads of state) and some of them have even given me credit for launching or resurrecting their careers. While I have been honored by that, I am certain that what happened to these men is that due to their self-confidence significantly improving, their ability to tackle their careers was unhampered by the energy they used to spend focusing on their hair loss.
So is this the case with Wayne Rooney? It sure sounds like it.
Any news on the use of Botox in treating hair loss? I read something a couple years ago about it and saw it advertised recently. Thanks
We addressed a press release we found back in 2009 that Botox was being used to reverse hair loss. Since then, there’s been a pilot study of 50 men, but nothing I can find beyond that.
The rationale for using Botox as a hair loss treatment is that when the muscles are blocked, the blood flow in the scalp increases and bathes the damaged or thinning hair follicles. If this catches on, there could be a rush to get Botox in the scalp by some of the many balding men and women. I do not endorse this treatment at this time without more convincing evidence that there is value in the use of Botox for this purpose.
