Hair Loss Information – Balding Blog

Received this email yesterday…

Why would someone who has been in Cardiac, Orthopedic and General Surgery be doing Hair Transplants? Did you fail at these other fields?

I would start off saying that I was very successful in every field I have been in. Part of the reason that I moved around a great deal was general boredom or lack of stimulus. In the hair restoration field, I have had the opportunity to become intimate with my patients. I have had similar intimacy with my patients when I treated their cancer, but the involvement with them was make the best out of a bad situation. If they survived the cancer, they wanted to forget it and I was more part of that period of their life (where forgetfulness is part of the denial process).

In hair restoration, the entire process up-scales as it progresses. The further down the path you take it, the more the intimacy and the pure pleasure you get with each milestone the patient achieves. First, getting to establish rapport is a challenge. Two people getting together, one with a problem and the other with a potential solution. The prospective client wants to determine: “Can I trust this doctor to do what it is he says he can do?” Once the relationship is cemented in place, you plan together what you are going to do. You share his/her intimate thoughts and fears and guide him/her though the plan like an architect experiences when he/she shows the plans for a new house to a home buyer/builder. This is a wonderful experience that for me only gets better as I deliver what it is I promise to deliver. While waiting out the growing stage, like a find lawn and garden, it takes time for the brown dirt to turn green and for the flowers to bud and bloom. But when the hair comes in, wow, what a HIGH it is for the doctor and patient to share.

I have been in the unique position of having done some of the most difficult surgeries on the human body. Early in my career, being able to perform them competently was my goal. The intimacy part of the process in the world of difficult surgery does not have the same significance with it as in the hair restoration business. The general surgery focused for me on issues of technical competence in the first half dozen years. Once I had proved to myself that I could perform almost all of the difficult surgery before me and treat the sickest of patients, the process becomes a matter or routine. Every sick patient in Intensive Care is so sick that they are as far from their normal selves as they could be. Aortic Aneurisms are the same. The ones that are acutely life saving (like those that are rupturing) brings up the adrenaline in the surgeon. Like a ride on a roller coaster, the feeling is frightening and wonderful, both at the same time. But the anxiety of holding a human life in your hands, no matter how exciting, still produces bad outcomes and brings heart break to surgeon and families. Half of all ruptured aortic aneurism patients die within a day of the event, even in the hands of the greatest surgeons. Hair, on the other hand, is almost a complete opposite experience for the surgeon. The results almost always come out the way a good surgeons predicts that they should. The key to success, like aortic aneurism surgery, is skill and in building a good surgical team. The hair restoration business is no different on this technical end where skill and team building is critical, but the patient is always awake and he/she is coming to see the doctor because he/she wants to be there (not has to be there like a ruptured aneurism). My days in the office make me feel that I have great value to people and because of the trust that is built, I have looked at many of my patients as friends for life.

Hair Loss Information – Balding Blog

What is the limit for transplant densities?

Hair can be transplanted at a density that approaches 35% of the original density in many people. The ability to place such densities depends upon many factors which include: hair thickness, skin characteristics, the size of the instruments for making sites, the skill of the surgical team at placing grafts tightly together and the processes that reflect the quality management of the surgical team. Not all doctors can place, for example, two hair grafts into a 0.9mm recipient site. Even in the hands of a good surgical team, not all hair grafts can be placed into a 0.9mm recipient site. So there is a balance between what can be done and what should be done. A surgeon with considerable experience in hair transplantation dense packing is best able to make the judgments required for maximizing hair densities. I pioneered Dense Packing with the first published mention in a 1993 article in the Hair Transplant Forum and have been using this technique ever since. More recently, we have moved to combining Dense Packing and Large Session surgeries to maximize yield and reduce the number of surgeries required to get a person to his goal faster.

Inderal and Hair Loss

I know Inderal can cause hair loss, but I only use it when I perform on stage. So I go weeks without using it, then maybe have 20mg at a time for performances. Would this limited usage still cause hair loss? Thanks

I doubt that the schedule in which you are using Inderal (propranolol) would cause hair loss, but you should speak more with your prescribing doctor about your concerns.


2007-11-27 08:35:55Inderal and Hair Loss

Independence Day Weekend!

Happy birthday, USA! It’s BBQ and fireworks time, so to celebrate July 4th we’re taking a long weekend.

We hope everyone has a happy and safe 4th of July! We’ll be back here on Tuesday.


2010-07-03 17:28:49Independence Day Weekend!

Increasing Propecia Dose — Should I Take Half Early and Half Late in the Day?

Great information given by you and your staff. I know sometimes patients have been put on a higher dosage of propecia after years of being on the medication due to loss of effectiveness. If you were to go from a quarter pill to half a pill would it be better to take two quaters at different times throughout the day due to propecia’s short half life.

thanks

First of all, I’m assuming when you say you take a quarter pill, you’re talking about the 5mg Proscar… not a quarter of the 1mg Propecia.

Secondly, you must understand Propecia doesn’t actually lose effectiveness over the years, but rather you’re losing the battle as your genetic predisposition is showing through. It’s the classic game of tug-of-war. You cannot cheat genes. Now there are a few patients who do elect to take an increased dose of finasteride, but I often find that this is hit and miss as for additional benefits.

As for your question on dividing the dose to twice a day, I would think it would make better scientific sense to take it all at once, especially since you would want (in theory) a higher concentration in your body. If you break it down to twice a day, you will lose the advantage of the higher potency (all assuming this is going to work). If you take it in the morning, your testosterone level is highest, so it just might be more effective.


2011-01-20 13:24:22Increasing Propecia Dose — Should I Take Half Early and Half Late in the Day?

Increased Sex Drive on Finasteride and Watery Semen, Should I Keep on It?

The response to finasteride is variable long term. Everyone is different. I tell people that it is a balancing act, balancing the positive benefits and the negative side effects against each other. The decision here is, therefore, yours to make. If you had ED problems that got worse, I would tell you to stop the medication for risks of PFS, but for people with increased sex drives, there is no evidence that prolonged use of finasteride is a problem.


2020-05-11 09:07:04Increased Sex Drive on Finasteride and Watery Semen, Should I Keep on It?

Increased My Finasteride Dosage and Saw Breast Enlargement

Hello. I have been using finasteride (1.25mg) for around 10 years and it has worked great. Recently however i started to notice an increase in shedding and increased my dosage (2.5mg). About 6 weeks later i unfortunately noticed palpable breast enlargement. I immediately went off the medication. It has been 3 weeks now and I have noticed very little regression, if any. My questions are: Will my chest return to its original state? How long does it generally take for regression to occur? Can I be off of finasteride for a couple of months without drastic consequences to my hair. Thanks for your time. I’m pretty depressed about this.

Increasing your dosage of finasteride will not cause you to grow more hair, but it will give you a higher risk of side effects. Besides, you should discuss any changes in your medication regimen with your prescribing doctor. I do not know if your chest will return to its original size, but it should. Also keep in mind that breast enlargement (while a side effect of finasteride) may not be related and there may be another serious underlying condition. I’m not trying to turn the attention away from finasteride as a possible cause, but don’t rule out that it could be a coincidence. I would suggest you see your doctor to explore your options, your risks, and your benefits.


2008-12-08 13:17:22Increased My Finasteride Dosage and Saw Breast Enlargement

Increased Body Temperature with Propecia Use

I had used propecia about three years ago but I stop using it because it caused gynomastia. At that time I expierence thick and full regrowth in three months with no shedding or scalp discomfort.
I decided to try it again recently and the gynomastia did not reoccur. now I have been expirencing some shedding and a slight scalp discomfort on my first week of use. Is shedding a good sign or would this be an indication that I am a poor candidate for propecia. I have also been expirencing an increase in body tempreture 24 hour a day. my face is flush or red since starting on propecia.

You should go back to the doctor who prescribed you Propecia and address these concerns. The shedding you are talking about is something that I have heard before and the thought is that you may be experiencing accelerated hair cycling, a precursor to increased growth which may be following in a few months. Hang in with the hair loss, because it should be temporary (see: cycling).

I have not heard of facial flushing or hyperthermia (increase in body temperature) with Propecia use. You may have an underlying medical condition that may be coincidental to Propecia use.