Author: Dr. William Rassman

This is a review of a patient who was happy with his hair transplant results but his linear hair transplant scar bothered him when he wore his hair short.
We kept his hair long (not shaved) and performed the SMP procedure under local anesthesia. The following results were immediately after the first session. He will need a follow up session for better blending.

Apologies in advance for yet another question on this drug, but I cannot seem to find a good answer to it!

I am just wondering how the dosage of minoxidil has an impact on the hair. The Rogaine 5% minoxidil foam I use recommends 1g twice a day. This seems to be based loosely on expected application to the vertex/scalp.

Now, like so many people out there, I predominately use it on the hairline (though I know results can be hard to come by here). I have some moderate, uneven recession which may just be maturing, but I know maturing can quickly shade into MPB, and I have balding in the family.

Since the corners of the hairline make up a smaller area than the vertex/crown, is it still appropriate to use the full 1g? Does it matter if the full 1g is used in a more concentrated, smaller area? Does using more than the recommended 1g per application dosage ONLY increase the risk of side effects, or can it also have adverse effects on the hair?

In other words, is 1g simply the limit they set to to achieve maximum effectiveness whilst limiting side effects (similar to how 1mg is used daily for finasteride), or does going beyond that have adverse effects?

I only ask because I tend to use the full 1g (half a capful) to cover both corners (0.5g each corner), sometimes more, and I worry this may do more harm than good if I am using too much!

On the flip side, I wonder how people with more advanced/diffuse thinning manage to use half a capful to cover all the effected areas, and achieve good scalp penetration? It doesn’t seem enough!

I think it should be quite simple by using the medication as directed. Rogaine 5% is a topical medication and it is to be used twice a day on the area of balding on the scalp. Applying it, unfortunately, is not a science especially when you have to put it one in areas you can not see easily. It is used for balding on the top and crown areas where it is most difficult to apply and it probably does not really work well on the frontal corners. I realize some people use it for growth on the frontal corner areas in hopes it may work. There is nothing wrong with this. If your head is big or the balding area is big, I would use more to cover the areas needed. I do not think there is an absolute limit that you can realistically apply and what you apply needs to get on your scalp, not your hair. I also realize if you use too much you may have some side effects such as a drop in your blood pressure so use your good judgement.

I am going bald in a pattern for sure but still got hair on the balding area, just thin hair! Can you transplant in to an area which still has hair. On my head I don’t see much space to put new hairs in. Would a transplant damage the hair I still have? So do I have to wait? I am mid 40s

You can transplant hairs to thinning areas and the hairs will grow. But your miniaturized hairs that are at the end of their life, may fall out as a result of the transplant. But you and your doctor need to discuss the potential for shock hair loss, how to prevent it and its risks versus the benefits. You need to be examined by a doctor and have a Master Plan for what you are trying to accomplish with the correct set of expectations. Hair transplants may or may not fit into you Master Plan.

It took me 4 months to figure out that flax seed and fish oil can cause the most severe shedding I’ve ever experienced in my life. I lost so much long beautiful hair that it hurts. I will work on restoring it now with onion and ginger juice rub and other supplements. Thank u for having this website.

I am not sure how onion and ginger juice can restore hair loss, but I also am not sure how flax seed and fish oil can cause hair loss either. Maybe it was coincidence?

There are many anecdotal stories on the Internet but I just want to make it clear that while personal experience and stories may be true to the individual, such results may be coincidence for you and it not necessarily mean it is true for others. There is no scientific basis for hair loss or hair growth from fish oil, flax seed, ginger, or onion. Sorry.

I’ve had DUPA for around 8-9 years now, during that time I’ve tried finasteride and Minoxidil for periods over 12 months with no success. I’m not that hairy so even a BHT is out of the question. Lately I’ve been visiting some wig stores, i must say, I’m very impressed by what i saw and tried on, my only worry is traction alopecia, i was wondering if shaving my head could help prevent any damage caused by wearing the wig? the type of wig I’d go for would be a full wig (including nape and sides) glue and tape would be used to secure the wig.

I often get similar questions asked about finasteride and minoxidil use with DUPA. They do not usually work. Hair transplants might work if the balding area is relatively small (like a Class 3 balding pattern). Using FUE, one can select the good hairs from the donor area and use them in the small recipient area.

Wigs are one alternative for men and women with hair loss. But as you point out you may get traction alopecia and there are no particular wigs or tapes that I know of that can prevent it. You can also shave your head (as you point out) or apply tape to affix a wig (hair system) to your scalp but some people get scarring and discoloration with long term use of any device that affixes a wig to your scalp.

Another alternative to wigs is scalp micropigmenation (SMP) if you like the shaved look. You will not make your DUPA worse with SMP and if some new treatment or cure comes out in the future, you can always take such a treatment. If your hair is thin, SMP may also make it look thicker. For more information you can see my website here.

My daughter has ectodermal dysplasia. When she was young, she had a bald crown which was covered with a good combing style. Her hair is brittle and she still has some bald areas. Can she have a hair transplant to deal with the bald areas?

This condition is congenital (for our readership) and its hair symptoms manifests by a lack of hair density, and dry brittle hair (see: http://en.wikipedia.org/wiki/Ectodermal_dysplasia). Her hair densities may be too low for a hair transplant as she might have a poor donor supply; however, there is no substitute for a visit to a hair transplant specialist’s office to find out where she is on the wide spectrum seen with this condition.

Is the chlorine in municipal water likely to speed up MPB in those that are predisposed to the condition?

Chlorine has been in use with public water since the early 1900s to kill disease-causing pathogens. I do not believe it speeds up balding. Male pattern balding is caused by a gene you inherited. It impacts men with different patterns (thus term “Pattern”) and different severity. Most of the hair loss happens to men in their 20 and 30s. Aside from the genetic predisposition, anabolic steroid use can sometime speed up the process.

This patient’s review of SMP is based on a long hair thinning. He actually had a successful hair transplant but wanted a fuller look.

He also had scars from his prior hair transplant surgeries which showed when he had his hair cut short or if his hair was not combed properly.

SMP took care of the scar and thinning.

This is a man in his early 30’s and in the movie industry. He always kept his hair buzzed as long as he can remember and states he will always keep this style. The issue for him was the front corner recession that crept up in his 20’s. His exam shows that he will not likely to extend beyond a Norwood Class 3 or 4A pattern. He had SMP done which extended to the front areas. We blended the area which was thin in the forelock area. The photos were taken after the 1st SMP session. He will need one to two more sessions to blend in better with his natural surrounding hair. He stated he may want to slightly lower the hair line on his next session as well.