Author: Dr. William Rassman

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I can’t go to work looking like this and my boss won’t allow me to wear a hat, what do I do?

You should have washed off these crusts on the day after surgery, but now that they formed, you will have to wait a full 12 days before trying to wash these crusts off by leaving the shampoo on for 10 minutes at a time. Once these crusts are water logged and it is past 12 days, you can gently rub them off. Repeat twice a day until the crusts are off.

The patient on the right has 3250 grafts 6 days prior to shooting these photos. Notice, all you see is a small beard growth and he went to work within a day of the surgery. This is the way it should always be.



2019-10-16 10:17:22I can’t go to work looking like this and my boss won’t allow me to wear a hat, what do I do?

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I Can’t Handle Propecia!

Hello Dr. Rassman,

This is without a doubt the best hair loss site on the web. I have learnt a lot over the last year or so. I really hope you can find the time to answer my questions.

I am 28 and have noticed that my hairline has receded on either side of the widows peak and even the widows peak looks thinner and see through now than it did 3-4 years ago (when I believe the changes started). I can feel my hair has thinned in a norwood 3a pattern although this is not noticable to others yet.

My question is regarding propecia. I have tried to take it but no matter how little a dose I tried I had the same side effects (low libido and erectile dysfunction). I tried 1mg daily, 0.5mg daily, 0.5mg every other day and 0.25mg daily but just could not adjust to it. What would be your suggestion for me and others in my situation as I would really like to try and combat the hair loss? I have been using minoxidil but is there anything else I can do as I really can’t handle propecia?

Also with regard to balding patterns you have said that the final balding patterns become evident for young men that start losing their hair early but as mine started at 24-25 when would you expect my final pattern to be evident as it is not obvious yet but I can only guess at a Norwood 3a as the hair still feels very thick past this point?

I would really appreciate if you could take the time to answer my questions. Thanks

Compliments will get you a long way with me, but not long enough to solve your Propecia (finasteride) problem. While I don’t know how long you were on the medication before each of your dosing changes, you could just be one of the men who just can’t tolerate even a small dose. Minoxidil is likely your only other option, aside from perhaps a hair transplant. You indicated that you’re in the UK, so I’d get yourself followed by a good doctor like Dr. Bessam Farjo, who is located in your area.

It’s really difficult to say when your final pattern would be evident without any real history to look back on. Unfortunately, I can’t give you any kind of realistic estimate on when your hair loss will stop.

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I Can’t Take Propecia, I Don’t Want to Bald

Dr. Rassman, what approach do you take with young men who are not able to take Propecia. Do you never do transplants in them? Do you sometimes do transplants? I am a norwood 2 going on a norwood 3. I am considering getting small transplants to keep up with my hairloss starting in about a year when I will be 23 years old. Is is a bad idea? Going bald is not an option for me, so its either transplants or a system.

I hope you read the blog entry from last week where a patient whom I did not recommend getting a hair transplant was not happy with my recommendation and got a hair transplant from another doctor. Now he is worse off and more bald because he lost more hair due to shock loss.

I would not normally recommend a hair transplant to a Norwood class 2/3, but every patient is different and it would be impossible for me to give you personal medical advice without a person to person consult. You may be a Norwood 2/3 now but without a good exam and a good medical history, there is no way of knowing what Norwood class you would be at the age of 50 (this is where the Master Plan comes in). If you have miniaturization in the areas behind the frontal corners (like the top and crown of your head), then it would be suggestive that you are in for a lot of balding in your future and fixing a Class 2 pattern may not be good timing just now. Alternatively, if there is no miniaturization in the rest of your head and your family history does not show advanced balding, then maybe with the right doctor / patient relationship, a hair transplant could be considered. I am not excited about the idea of doing a hair transplant on someone with such a pattern and at your age, because the pattern of your future hair loss is not going to show up for another few years.

I would also question why you are not able to take Propecia.


2006-05-09 12:46:18I Can’t Take Propecia, I Don’t Want to Bald

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I Can Only See 1% of My Grafts 5 Months After My Hair Transplant!

Hi Dr Rassman
I had a hair transplant done 5 months ago by a board certified doctor with lots of experience. I recieved 1750 grafts (aprox 4300 hairs estimated). After 5 months it looks like maybe 43 new hairs have shown. The only difference between now and before the procedure, is that now I have a donor scar on the back of my head keeping me from shaving it all. I am very discouraged/upset by this.

In your experience, or to your knowledge, do some people not respond to hair transplants (the new hairs don’t ever grow)? If this is not reported as so, then does the length of time before ANY new hair shows ever take longer than 5 months? I realize it generally takes 9 months or so for the hair transplant to be fully realized, but I was told (and read) that by month 5 significant new growth should be visible. Your answers and info is much appreciated.

Thanks

Take a look at this patient and watch his hair grow over time. At 5 months after his single hair transplant procedure, he had some short hair growing… and by the 7th month it was styling length. Some people grow faster or slower (by about 2 months). Ask your doctor in another 2 months to judge if your hair growth met his expectations and match it to yours.

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Ran out of Dutasteride for 5 days. What Is My Risk For Not Taking It?

Dutasteride has a long tissue fixation period lasting a good month, so missing a dose for 5 days is not an issue. Also note that the blood half life for dutasteride is 6 days, which means that half of it was in your blood when you stopped taking it. For the few men when I prescribed dutasteride, I advise taking it just twice a week because the half life is so long.

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I Can’t Get Propecia in Dubai

hi there
just an update i had a consultation in London, i was told that due to my age i was likley to lose more hair, we have already established that. I was given the option of just having my hairline restored, and think about having the crown area’s filled in, at another 2 -3 years time when i will be at least 25 and my pattern hairloss will be evident as to what way it is declining towards. My gp will not precribe propecia to me, as i told you i am located to Dubai do you think i could purchase it over there. My plan is to try propecia for 6 months or so and see what happens. although hairline is more important to me, i know propecia can restore that, then what can propecia do for me on a realistic level. Is it guarnteed to work for everyone or it is a chance of luck and variency? Is the drug relatively safe i mean the drug will be stored away, but as a user i can still handle and pick up kids cant i? please tell me the best option , and if propecia works where am i likely to see results on the scalp?

You are 23 years old and it is not good medical practice for you to transplant early hair loss. You should take finasteride 1mg for one full year, then reaccess your situation. It works in young men to reverse hair loss, slow down the hair loss, or(3) stop the hair loss. Why rush doing hair transplants? You have your whole life to live and a wrong decision now will impact your whole life.

Propecia is safe and it will not impact anyone else by simple touch. Generally, you can buy Proscar or generic finasteride 5mg and cut the tablet into 4 pieces, taking one piece of a pill each day. Generic finasteride is available in practically every country that has men with prostate problems, UAE included. I am not sure why your physician will not prescribe it — you should ask him/her why.

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I Clipped Some Hairs for a Homemade Miniaturization Test

Would alternating between different shampoos help stop hair loss?

Also, I recently did a homemade minaturization test. I clipped some hairs from my donor zone, and they were thicker than the hairs I clipped from just above my crown. Is that a sign of MPB?

Clipping your hair in different areas will tell you just how much miniaturization you have. The donor area should have the thickest hair, but if you do not have male pattern baldness, the same hair thickness should be every other place (front, top and crown).

As hairs miniaturize, the thickness in some of the hair shafts is finer. This creates a see-through appearance if there is enough miniaturization present.

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I Consider a Hair Transplant Best To Get Hair

What If the Donor Area Is Not Particularly Dense Though?

I always measure the donor area density and total supply and then match the donor area to your ‘worst’ case possible hair loss. I always create a Master Plan individualized for each patient so that they always know what is going to happen to them. This is critical in hair transplantation because both doctors and often patients rush to use up all of their donor hair before the balding pattern is complete, leaving the patient stuck with an incomplete job.


2020-02-21 06:12:48I Consider a Hair Transplant Best To Get Hair

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I Chemically Relax My Own Hair and See Hair Loss

Hello. I am a 42 year old black female that is experiencing hair loss. I am wondering if this is due to me chemically relaxing my hair myself. I do have a low thyroid condition that I take medication for daily. Could this be contributing to my hair loss. It seems to be getting worse. I recently permed my hair but I burned my scalp pretty bad. Will my hair grow back? Could you give me any suggestions of products to use that might help? Thank you

Chemical damage and thyroid conditions can both contribute to hair loss, and there’s no way for me to try to pinpoint the cause via email. Try stopping the chemical use on your hair and give it a year or so to see if there is improvement. The hair could regrow, but it depends on the severity of the burn. At this point, all you can really do is wait it out to see.