Author: Dr. William Rassman

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After Care for Scar Revision

Everything seems very promising at this stage, two weeks after a scar revision procedure. I am wondering whether there is anything proactive that I can do to help minimize the presence of the new scar. (Besides avoiding exercise involving unexpected head-turning.) Such as:
– applying onion-based anti-scarring ointment; or
– not applying onion-based anti-scarring ointment;
– or using or not using some other topical thing.

Thanks for everything!

I think that patience is a virtue and if the surgery was done well, that should suffice. Applications of any topical ointment may be pointless at this time. If hypertrophic scarring should occur, then you may need to take a look at it as it forms. Stretching of the scar will take time, as stretching usually starts to become evident at about 6 weeks. Keep in touch with your doctor if anything worries you.

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After Taking Propecia for 6 Years, I Began Noticing Side Effects

Doc, I am an active, healthy 37 year old. After taking Propecia for 6+ years with little side effects, I started to notice a decreased libido, difficulty maintaining an erection, no morning erections, a smaller penis in the flaccid state and a feeling of “disconnect” (mind from penis). I stopped taking it 6 weeks ago and have not noticed a change, other than my hair loss has increased again. I have read on other sites men complaining of similar symptoms and claiming they are permanent. I have considered getting a testosterone level, A DHT level, FSH/LH, E-2, and Prolactin levels. I haven’t mentioned any of my concerns to my (female) physician. Any suggestions (other than discussing them with her? -which I will).

Decreased libido and difficultly maintaining an erection are reported side effects that occur in 1 to 2% of men taking Propecia, but the same symptoms are prevalent in more than 2% of the men who are NOT taking Propecia. You may have other unrelated health issues (undiagnosed diabetes, blood pressure problems, etc) that can also contribute to this. That is why you are doing the right thing by seeing your primary care physician. See Propecia Gave Me Side Effects — How Can I Get My Sex Drive Back? for more.

As far as the DHT and testosterone or FSH/LH tests, I really don’t have an opinion, as your endocrinologist will be better suited to advise you on whether you need those tests. With respect to a smaller penis size, I highly doubt a drug is shrinking your penis… just as there is no drug that grows your penis size. With respect to a disconnect with your penis, you may want to see a counselor. I highly doubt this problem is from Propecia. I wonder what Sigmund Freud would say…


2008-11-20 10:22:52After Taking Propecia for 6 Years, I Began Noticing Side Effects

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After Taking Propecia for Years, Should I Up the Dosage?

Hi Doc. Right know I’m on Propecia for 3 years, but I’m noticing some thinning in the frontal area. Would it be effective to start to take 2 mg a day? Thank you.

Increasing the medication dosage will not necessarily slow down or help stop the hair loss process. Propecia is a good medication, but it is not the magic bullet. It does not completely stop hair loss and different people have different results with the medication.

As Propecia is a prescription medication, talk to your prescribing physician about changes in dosing. If he/she decides you should, that’s between you and your physician.

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What Age Would You Try to Classify a Young Man’s Balding Pattern?

Hair loss classification was created to discuss the end stage of hair loss. Many people will thin their hair as they get to their end stage. Of interest, Class 7 pattern, the most advanced pattern, usually is present by the time a man reaches his late 20’s because the genes for hair loss are very strong. Young men who have a Class 3 pattern of hair loss, when checked with the HAIRCHECK instrument, often show thinning elsewhere on their scalp that they can’t see and may not see for years because it can be a slow process. A good doctor who sees a young man under 25 develops a MASTER PLAN for him that will follow the changes I just discussed above, offering transplants only after the man is 25 or 26 if it fits. Medications, like Finasteride, as well as topical or oral Minoxidil, work to stop or reverse the hair loss. Therefore, a good relationship with a doctor who has built a Master Plan for you is essential to your future well-being. The use of the HAIRCHECK instrument has great value in reporting the degree to which your hair loss exists that may not be obvious to the naked eye.

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After Hair Transplants, many doctors ignore patients’ questions – why?

Almost every day I get emails (because of my internet presence) from patients who had surgery and find their doctors don’t seem to answer their concerns and questions. Many of these men see an abrupt change in the doctor when compared to before their surgery. I guess it is like being sold a used car and the salesman is all over you, attentive to your every need, until…. that is, you purchase the car and have problems. As they already got your money they don’t to have to be responsive anymore.

Being a good doctor means taking care of the patient and all of his/her needs before, during and AFTER the hair transplant. I find, however, that I am stepping up to help those whose doctors just don’t seem to care about them after their surgery. This may be more of a problem as Medical Tourism is becoming very common (I get both types of post-surgery emails). If for example, you go to Turkey and have a surgical procedure, then go back to your home country, local doctors will have no interest in you and the doctors in Turkey (assuming that they were doctors – which is often not the case) certainly have no structure put together to help you in your home country.

My advice for anyone reading this post is to meet and speak with patients who had surgery with that ‘doctor’ you are considering before you make the decision to go with that doctor or that clinic. Their patients will always share with you what their experience was, so this way you hear it first hand and will avoid the problems if you listen to what you are told.


2019-12-12 11:51:46After Hair Transplants, many doctors ignore patients’ questions – why?

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After Taking Finasteride, I’ve Shed Short Hairs Near My Sideburns

Hello, I am 21 years old and have been on Finasteride for three months now. Since that time, I believe I have seen benefits from the medication (I no longer pull out any ‘stray’ hairs whenever I run my hands through my hair). However, I have been shedding some short, thin hairs on the sides of my head, specifically above my sideburns. The hair on my sides has always been a bit thinner than the rest of my hair, so is it possible that the medication is reacting harder to regions that are genetically weaker than elsewhere on my head?

Thanks.

I haven’t heard that before. Anything is possible, but likely not probable. Perhaps there are other issues and you do not have the correct diagnosis of androgenic alopecia.

There is also a rare condition known as triangle alopecia where men lose hair on the side of the scalp in the shape of a triangle at or near the temple peaks on the side of the head. This condition is usually genetic and may impact only one side. Generally Propecia does not work for triangle alopecia, and if this is what you have, transplants work well for it. This is all guessing on my part. You should follow up with your doctor.

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After taking finsteride and minoxidil

This man started a heavy shed after starting to take minoxidil and finasteride. This is not uncommon; however, is a dramatic change. I expect the hair he lost before the shed will return over the next few months. He has to stick to the program.


 

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After Taking Propecia Daily for Years After My Transplant, I Think I’m Losing Hair Again

I have had two procedures in the past at Dr. Rassman’s NHI facility. The first about 8 years ago, the second about 6 years ago. I have used Propecia, or Finasteride as a substitute, religiously since before the first procedure.

About a year ago I started to notice substantial thinning in the areas that had become filled in from the procedures. I have assumed this to be loss of original hair. Is it common for Propecia/Finasteride to stop working at some point? Does substituting Finasteride have a negative effect?

Last, I have read that Propecia (Finasteride) dosage can be reduced from 1 mg a day to .2 mg per day with no negative effect, and that it may be possible to take the med every other day. True?

Hair transplants are permanent and lifelong, but those remaining hairs you had in the balding areas (not the transplanted grafts) will continue to fall out. When you have surgery, we transplant the hairs in between any existing hair to blend it in so that if the existing hairs fall out years down the line, you will still have the transplanted hairs to keep things looking natural without an abrupt demarcation.

Propecia is just a brand name for the finasteride (in 1mg dose). There should be no difference between generic and brand name other than possibly the strength in dose of the active ingredient. It’s possible that there are different fillers. Propecia/finasteride does help hold on to the existing thinning hair as long as possible, but eventually your genetic predisposition catches up with you. This does not mean it just stopped working, but rather, you are getting older and your predestined hair loss fate is winning the battle.

The medication is about 70 to 80 percent as effective at half the dose of the recommended 1mg daily, so you can theoretically cut the pill in half (0.5mg) and still see some benefits. There have been some patients who have seen side effects, and cutting the dose in half has allowed them to experience good results without the side effects.


2011-10-25 12:45:38After Taking Propecia Daily for Years After My Transplant, I Think I’m Losing Hair Again

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Age Limit for Hair Transplants?

My wife passed away early last year and I just started to date on the internet. There are a lot of ladies out there, but my bald head makes me look too old, more like someone’s great grandfather. I want to be a lover and to be that, I got to look like that. Is there an age limit to get a transplant? I am essentially totally bald (except for my sides and back and scattered hairs in the front that seem to be holding on for dear life). Can hair transplants work for me at 84 years old?

Your question brought a smile to my face. I have done hair transplants on many men in their 80s and they were driven to have a hair transplant after either divorce or the death of their spouse. Men of all ages want to look young and looking young makes you feel young, so why not get your hair back and get your youth back? I have done surgery on many people with the most advanced hair loss pattern. Clearly, we are not all equal and some balding men just don’t have the supply, while others do. I always start by suggesting that you come in to the office to be evaluated. Rather than overwhelm you with lots of text, I thought I would point you to two patients who allow me to use their photographs. The first is a very bald man in his late 60s (happily married), before and after a hair transplant and the second is a man now in his 80s, that had one transplant procedure and started dating in his late 70s. The photos show his hair loss progression since the 1940s.