Author: Dr. William Rassman

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I Have a Lot of Scabbing a Week After My FUE Procedure (with Photo) – Hair Loss Information – Balding Blog

Hi Doc,

I had a FUE done with 3000 grafts exactly 8 days ago (photo attached).

My concern is that there seems to have been a lot of scabbing or crusting (what is the difference between the two anyway?).

The scabbing/crusting started coming off in places near the restored hairline and it now looks like a river delta (i.e. lines where there is no hair/crusting/scabbing with pockets of crust/scab/hair).

Is this normal? Or is it due to trauma (e.g. scratching) or bad surgery? I know when I am awake, I do not touch the area (I have worn a bandana lightly from the day after the surgery, but only for a few days and first 2 nights). Sometimes at night, I inadvertently brush my hand against the recipient area and wake up.

My doctor advised me to start washing once a day from Day 2 onwards with a spray bottle with a mixture of baby shampoo and water (and rinsing with plain water from the spray bottle) which I have done.

Should I be trying to get rid of the scabs/crusts with light finger pressure when shampooing or should I wait for the 10th day before trying any of this? It is difficult to see the hair due to the black scabs/crusts, but the transplanted hair is there.

Thanks!

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The crusting is very bad, which means that your management of your scabs was not good. We rarely, if ever, see this degree of crusting. How is the scabbing in the donor area at the back of your scalp?

Be very careful not to rush to take these crusts off. Use a shampoo and leave it on for 10 minutes and then gently, very gently rub in the shampoo. The crusts will slowly loosen and eventually they will come off. Give it another 10 days and hopefully the problem will be gone.

The scabbing/crusting (interchangeable words) is pretty intense, but hopefully there is no problem with the grafts because of it. Of course, follow up with your surgeon if you are concerned.

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Using Minoxidil and a Concealer – Balding Blog

im using minoxidil 5% but i want to also use prothik concealer,can i use both at the same time and does prothik clog the pores and cause further hair loss. thanks

Be sure to apply minoxidil right after a good shampoo and wait at least 15 minutes before using the concealer products. Clearly, you should apply the minoxidil to the scalp, not on top of the concealer.

ProThik (or any other similar products like Couvre, DermMatch, and Toppik) doesn’t cause hair loss.




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Balding Forum - Hair Loss Discussion

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If I Have Side Effects from Propecia, Would I Have Them from Dutasteride? – Hair Loss Information – Balding Blog

Hello,
I’ve been reading your blog for a long time and really appreciate the time you take to help inform people about hair loss. I’m 22 years old and have some extensive MPB-caused hair loss (started balding around age 18). I have seen numerous dermatologists and have been prescribed Propecia for the hair loss. However, I always have negative side effects when I take Propecia (pain in testicles and frequent urination), and have been unable to take the medication for more than a week before having to stop. I have even tried lower does (.5mg and .25mg) and still had the side effects, so I know that I cannot use Propecia

However, my question is related to Dutasteride – especially because of the new report you recently put on the blog. While I understand that the proper/safe dosage for taking Dutasteride is unclear at this point, I was wondering if you think that someone (like myself) who has had negative side effects from Propecia, would be likely to have negative side effects from Dutasteride?

Does having negative side effects from Propecia make it likely to have similar negative side effects from Dutasteride, or do the medications work differently and create different responses in patients? I would like to try a small dosage of dutasteride, and that is why I am writing to you with this question.

Thanks so much for your help!

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Dutasteride is similar to Propecia (finasteride) in its mechanism of action, so if you have side effects from one you would likely have the same side effects from the other.

Of note, dutasteride has a HIGHER percentage of side effects than Propecia. How that translates between one person taking the two medications and its side effect profile is not clear. It would be an assumption that you would have more side effects if you switch from Propecia to dutasteride.

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Will an Orchiectomy Stop My Hair Loss Completely? – Hair Loss Information – Balding Blog

hello doctor, i am currently undergoing MTF hormone replacement therapy. i have been taking both spironoactone and estridol for about six months. not only this but i have recently had an orchiectomy. before i began i was at around a norwood 2 or 3 and am currently 24 years old. i was wondering if i can expect that my hair loss to permanently halt after such an experience.

at the moment i am also curious as to if the spiro is still needed after an orchiectomy or if it will still halt without the further use of the spiro. i ask this on account of the many myths associated with this and was hoping you could speak from any experience you may have had with similar individuals.

Thank you for you time

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I have never seen or treated a balding patient with an orchiectomy (removal of the testicles). In theory, it should help with respect to male pattern androgenic alopecia. Time will tell.

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Hair Loss InformationSMP Questions – Anesthesia, Aging, Hairlines – Hair Loss Information – Balding Blog

dr. rassman,

can general anesthesia be used for SMP procedure?

Does the pigment ever stretch as the patient ages, like how a tattoo on a 70 year old looks?

can the hairline be made to look natural, i have seen “his hair” procedures in which it looks like a line is drawn on the forhead instead of a natural shaved head look.

i can send you a couple photos of my balding, im 26 and have beeen since i was 18 but the past 2 years it seems to have slowed a lot. i do not take propecia, and do not want to.

i want a good smp procedure to give me back a symetrical face. Can smp go with a “number 1″ buzz cut or is it used with a “no guard” buzz cut.

thanks

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We offer local anesthesia for a pain free experience. We also offer light sedation, but we do not offer general anesthesia (where you are completely out).

The pigment, like all cosmetic pigment or tattoos, fade and spread over time. We have techniques to minimize this as much as possible. The length of hair you need for SMP varies from number 1 guard to a shave.

If you would like a photo consultation, you would need to email photos and call (800) NEW-HAIR to speak to me or Dr. Pak.

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Hair Loss InformationCould Propecia Have More Impact as You Age? – Hair Loss Information – Balding Blog

Hi Dr.Rassman,

Thank you for this great blog. I have found it to be very honest and informative. My question is regarding Propecia. I hear everyone talk about how it is wearing off or losing its effectiveness, etc. It is possible that Propecia works better for some over time? I have been on the drug for 8 years and i notice from pictures my crown looks better than it did 3-4 years ago. Keep in mind, I never did an actual hair count, but I take pictures in identical settings (same spot, lighting, no flash) every year to keep track of my hair loss.

Even in that small 10 year study, there was a significant portion of people who actually looked better than the 5 year mark. They’re reasoning that MPB is a slow progressive process, reversing it can be a slow process also. Or something along those lines. I’m 38 years old and I know that MPB starts to slow down at this age. I was just also wondering if Propecia would have more impact as the person gets older?

Thank you so much.

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We actually do not know the answer. People respond in different ways. Some people remain sensitive to the drug for years and they are the ones that probably get the best results. If it is working, just stay on the plan to keep taking it. When and if it should reduce its effectiveness, certainly go back to your doctor and get his/her advice.

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Does Propecia Work in Cycles? – Hair Loss Information – Balding Blog

Is it possible for Propecia to work in cycles? It would be great to get an opinion on my experience:

Month 1-3: Hair felt and looked thicker, barely any falling out or shedding.
Month 4-6: Thinner hair and a lot of shedding. I thought it had stopped working. But then…
Months 7-10: Same feeling as months 1-3, thicker hair and i was excited that the drug was working again.
Now I am in Month 12 and my hairline has never been receded further and I have more scalp visible on the crown than ever.

Is it possible that these are natural hair growth and hair loss phases? I dont know if the drug has just stopped working or will start up again because nobody seems to experience this. Thanks for your help.

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Propecia does not work in cycles, but your hair grows in cycles (with or without) the medication. Propecia does not just stop working. It is that everybody responds differently to medication.

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Guest Post – Popular Baldness Causes and the Lack of Evidence – Hair Loss Information – Balding Blog

This post comes from Dr. Richard Shiell:
–

    Dr Masumi Inaba, who wrote a book on Androgenetic Alopecia (Springer 1996), was firmly convinced that the increase in Western style animal fats was causing an increase in baldness in young Japanese males. I am not sure that his statistical method would stand rigid scrutiny however.

    The same lack of good statistics applies to all the popularly believed “causes” of baldness. Forty years ago when I was a young HT surgeon, the patients all blamed the wearing of hats in the Army or Police Force as the cause of their baldness, when I am sure that it was just that they entered these institutions at the precise age that severe AGA usually kicks in (19-21 years old).

    I certainly believed throughout my career that “gym-jocks” lost hair more quickly than their “lay-about” brothers and cousins. The problem is that many were taking steroids and other “dietary supplements” so it was a very confusing issue to ascertain causality.

    I had one of a pair of 25 year old “identical” twins who had lost significantly more hair than the other. When I spoke to the more hirsute twin about it he laughed and said it was because his brother was married with a child and mortgage, and had more stress. So there you have undeniable evidence from a large series of ONE case!!

    Hair loss is the results of many complex things. For example, dietary supplements like whey and a variety of branched amino acids including creatine, push up men’s testosterone levels (and their DHT levels), which in turn accelerate hair loss. We are what we eat, I just wish I understood all of the complexities of diet as it impacts the hair loss we see.

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If I’m Splitting the 5mg Finasteride Pills, Are the Side Effect Risks Greater? – Hair Loss Information – Balding Blog

I’m turning 26 years old soon and been on Propecia for 4 years now starting in mid July. For over 2 years I been cutting generic fin in 4 pieces and have saved tons of money. If you are cutting fin you are taking a slightly higher dose can it give you side effects? Because when cutting those pills the dose can be sometimes from like 1mg to maybe 1.5mg it’s hard to cut it accurately! And even if you do you be still taking 1.25mg!

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Unless the pieces are perfectly symmetrical and you didn’t lose any crumbs in the cutting process, you probably aren’t getting a full 1.25mg finasteride dose — and like you said, splitting it accurately is difficult.

But let’s assume you’re getting an average of 1.25mg per day. I suppose taking that dose by cutting a 5mg tablet can theoretically give you a slightly higher risk of side effects than taking a premade 1mg finasteride pill (Propecia)… but in practice, we have not seen this.