Category: Uncategorized

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First patient identified taking 0.625mg oral minoxidil daily and developed Pericardial Effusion

Dr. Robert Haber had a 67 y/o female patient for two years and she was taking 0.625mg minoxidil/day. She was in a minor fender bender accident with no evident physical damage or harm from the accident and no airbag deployment. She developed chest pain and in the Emergency Room after an extensive examination demonstrated that she has a pericardial effusion (‘water around the heart in the heart sac’). The doctors did not connect the accident and the cardiac problem identified, but knowing that oral minoxidil can produce this complication, her minoxidil was immediately stopped. Slowly the effusion subsided. This is a warning that a is known complication of minoxidil on higher doses. It was previously thought that doses 2.5 mg or less per day was safe from this complication. This may not be the case even at doses under 1mg/day. This is a risk everyone taking minoxidil should know about.

Now with that said, it is possible that this patient could have had Covid which is known to cause pericardial effusion. Even the vaccine has, in rare cases, caused pericardial effusion so maybe, just maybe the pericardial effusion was from another cause other than minoxidil. Here is an article that suggests a connection with Covid and pericardial effusion: https://www.statnews.com/2021/06/10/officials-higher-than-expected-heart-inflammation-cases-covid-19-vaccination/


2021-06-16 12:33:09First patient identified taking 0.625mg oral minoxidil daily and developed Pericardial Effusion

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Styling After a Hair Transplant

Hello doctor

I see a lot of HT photos, a lot of the patients seem to have their hair up and raised back like they’ve been in the wind. Is that just the way they style it? If I was to have a HT I’d want my hair down towards my eyebrows..

Is every patient different?

Regards

Hair normally grows forward in the front (parallel to the ground when standing upright). As one moves back from the frontal edge, the angle starts to change with hair pointing a few degrees upward until it reaches the front of the crown, where the frontal pointing hairs are about 35 degrees to the ground. So you see, the hair when placed by the surgeon is never placed perpendicular to the horizon. At the crown, the hair changes direction in a circular pattern (swirl) and as you look further back, eventually the hair points down and away from the front.

What you see in our patient photos reflect each patient’s styling (or lack of it), not something we do. I always put the hair back in the direction it would have been had they never lost hair and depending where I am working on the scalp, the rules I discussed above are followed with every hair placed by me. Patients generally like to play games with their hair and although a few comb it forward, most do not. Some comb it to the side with a part on one side, others comb it back with some product that they apply to the hair. Some just let it stray, taking on the character of the hair itself. If the hair is curly, then the natural state will look less groomed than if it is straight or has a nice wave to it. If you want to comb it down to cover your forehead and point to your eyebrows, you can do that also.

Every patient is different and the results we get depend upon texture of the hair, density at the area we are looking at, thickness of the hair shafts, the degree of curliness (or lack of it with very straight hair). But the hair transplant you get will be your hair, and it will bring all of its characteristics that are present in the back of the head where the hair grafts are taken.

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Follicare and Propecia

Is it ok to take propecia and follicare together, since there is a vitamin you take when using follicare

I have reviewed the “supplement” listed at the Follicare website for ingredients. I can say, right off, that they seem to have put everything but the kitchen sink into the product. I do not believe it will be harmful if taken with Propecia.


2006-11-14 14:34:10Follicare and Propecia

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Suicide from bad hair transplants

I am devastated. Three days ago one of my patients, who had been badly operated on in Turkey, committed suicide. I had seen him in emergency following his bad operation and had proceeded to remove part of the grafts. I saw him again via skype a few days ago and he exclaimed “my savior” …. There was still work to be done and I was enthusiastic about the idea of completing the correction work….
This isn’t the first time I’ve heard about suicide from patients who’ve been badly operated on, especially when it comes to beards. It’s a terrible ordeal for them to have this bad work in their face. I have a terrible grudge against all those who work badly and who shamelessly and remorselessly ruin the future of young men….

I had a long talk with his parents this morning. They explained to me that their son was consumed with remorse at having been taken in by dishonest people. The sad thing is that correction was possible. He was very concerned about the depletion of his donor area. And he asked me to bring as many grafts as possible to the scalp donor area. The first part of his correction went smoothly, with very good healing of the face, but the feeling that he had mortgaged his future was stronger. He left a long, beautiful and dignified letter which I was unable to read, but which comforted his parents. I think it would indeed be good for the ISHRS and for fight to fight to do an in memoriam to give an example of the psychological risk a patient can take by putting himself in non-expert hands.

Dr. Rassman’s comments: In the early to mid 90s, I had three patients that were suicidal as a result of the big plugs that they received for a hair transplant. In those days it wasn’t Illegal Clinics in Turkey, it was American and European doctors that did the deforming surgeries. One young man who committed suicide, Affected me greatly. I Remember talking to his parents before the suicide trying to work with them and comfort him. I offered my services free of charge to fix it. But he couldn’t deal with the stress and prior to the scheduled surgery with me, when he was about to fly out to see me from Ohio, he committed suicide. The family called me to thank me for my efforts. It didn’t make me feel better. The other two got help that I arranged for them. None of these three patients were in California where I practiced. A forth developed Alopecia Areata within a week after his Hair transplant. Dr. Ron Shapiro and I worked with a psychiatrist and prevented the suicide arranging 24/7 care for him after he was properly medicated. He did fine. Bad surgery is not confined to Turkey Black Market Clinics, it happens in our own back yard with poorly trained surgeons offering hair transplants without understanding the fundamentals. Shame on them.

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Forehead Feels Cool, Seeing Wrinkles After Using Minoxidil

I have used minoxidil for my hair thinning on the vertex and hairline and it is working great! Except I’m noticing a disturbing, growing sensation on my forehead since I have been using it.

Whenever I would apply the minoxidil, my forehead would have a cool, wet sensation for about 20 minutes as if cooled water was running over it but it wasn’t the minoxidil or water. Nevertheless, I have been using it for 2 months and my forehead feels STIFF and I’m noticing wrinkles! I’ve read the 2 archived topics about wrinkles & minoxidil (i.e.”Using Propecia at Temples, Wrinkles From Minoxidil…” ) but I found documented studies about how it effects collagen synthesis (see: Medscape & Investigative Ophthalmology & Visual Science)

I’m assuming that minoxidil would be the cause of my facial stiffness (so bad, it feels like my forehead is duct taped) and gradual appearance of wrinkles. I’m a 25 year old male. I would greatly appreciate it if you could reply. Thank you so much!

Aside from that previous post from a reader, I’ve never heard complaints about wrinkles being caused by minoxidil. None of my patients have reported that to me. The studies you sent are interesting, but I’m not convinced that minoxidil will cause wrinkles. You might have some kind of allergic skin reaction to an ingredient in your formulation of minoxidil. I’m just speculating, of course.


2008-09-16 15:45:05Forehead Feels Cool, Seeing Wrinkles After Using Minoxidil

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Swap from topical to oral finasteride

I apply at a .25g dose so the bottle lasts about 3.5 months so the prices doesn’t bother me, and I’m not bothered by applying topicals. Just wondering if there’s any point as I see loads of people be like blah blah it goes systemic just the same no point etc etc

Yes, you should be able to switch from the topical form of finasteride to the oral form without consequences.


2021-01-23 10:45:10Swap from topical to oral finasteride

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Frontal and crown reconstruction in 50 year old male

 

Over 20 years, this patient lost a lot of hair and as it was filled in, he ended up with a total of 7635 grafts, 2000 to achieve the goals shown below. His last procedures is show here, which reflect before and after pictures on moving his hairline down and filling in the crown. Clearly, he did not dye his hair in these after pictures.

tj crown before tj front before

tj fromt and crown

 

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Switching topical to oral minoxidil?

It’s been 5 months since I’m applying topical minoxidil, now planning to switch to oral as it’s much more simpler to pop a pill, What all things should I consider before switching to oral and hope it’s safe to take oral and there are enough studies for same.

The oral is fairly safe, provided that your dose does not exceed 2.5mgs. Look up the side effects on Google, well defined. The worst of the side effects are cardiac, so make sure that if you get swelling of your feet and legs, that you speak with your doctors and probably stop the oral minoxidil.

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FUE Failures Continue to Happen

Last week, I met with a patient who had two follicular unit extraction (FUE) procedures at a clinic, but came to see me to find out why his grafts hadn’t grown in. After an examination, I’d estimate that 90% of the grafts did not grow. The patient told me that his surgeon thinks there might be a problem with his skin, but I told him the real problem was the doctor couldn’t deliver what he was supposed to give him with a good survival.

In another conversation on the same day, I called one of the most prominent hair transplant surgeons in North America about another issue. Our conversation drifted to FUE failures, and he named three doctors who are FUE promoters whose patients have been in his office because of high failure rates. I know about these same three doctors. There are no secrets to the community of skilled and honorable surgeons of who are the unreliable doctors; however, I can not come out with their names publicly here or I would be the subject of a slander lawsuit. I can only be vague, which I know isn’t always the most helpful, but I needed to post something.

I’m disappointed that I can’t name names, because I know that many patients will be harmed by those less-than-honorable doctors. All I can do is continue to post about what you should do to become a more knowledgeable shopper — research the doctor you choose, ask to meet with his/her patients so you can see the results in person, and remember that this is a surgery that will be with you for the rest of your life (for better or worse).

See this post for more about FUE failures.

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Taking 1mg finasteride, told by doctor to add topical finasteride

That makes no sense to me, as adding topical finasteride while you are taking oral finasteride at the 1mg dose, will add blood levels of finasteride. With topical finasteride, the drug will come across the scalp and go into your body. There is therefore no reason to add topical finasteride once you are on the proper dose of oral finasteride.