Category: Uncategorized

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How Long Should I Wait Before Considering Filling In My Strip Scar with FUE Grafts?

Thanks very much for the informative blog.

Say a strip patient is about 6 months out from FUT surgery and now has buyers regret (please, no reminder about thinking things through first!), and wants to fill in the scar with FUE/beard hair/etc. Is there any advantage to do it at this time or does one need to wait one year. I wonder if scar is more or less vascular when healing. Thanks.

If the donor scar has healed, you don’t need more surgery, and the scar is narrow, then follicular unit extraction (FUE) to the linear scar is possible. FUE does not fill in wide scars well, though. Scalp MicroPigmentation (SMP), on the other hand, may be a better approach. Explore it all.

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I have white bumps surrounding each FUE graft that was transplanted. Why is that? (photo)

I fished up a photo from the internet of a patient that had FUE grafts in the frontal recipient area. Two things worth noticing: (1) the grafts are elevated and (2) there is skin in the graft that is as wide as the graft itself.

The skin will survive the transplant and the elevation will produce small, subtle white elevated bump surrounding each group of hair from the recipient area (called cobblestonning) and I believe that is what you may be seeing.

I do this differently than the doctor who did the patient in the photo, as I trim off the skin of the grafts before placing them and then place the grafts flush with the surrounding skin so that these white area are not present in our grafts. Click on the photo to enlarge it.

Screen Shot 2018-12-12 at 8.52.52 AM

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How many grafts do I need? I’m 23 years old (photo)

I think that 23 years of age is too early because your final balding pattern doesn’t usually show up until you are 25-26 years of age, and even at 26, it may not show up. When I do a hair transplant, I prefer men over 25. The number of grafts depends on four factors: (1) the size of the area being transplanted, (2) the location of the transplant (frontal hairline or not?), (3) your donor density, and (4) your hair mass per unit hair. With that, I can build a personalized Master Plan for any patient, which will consider what might happen to them as they continue to bald (as every man who is balding does).

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How many grafts do I need? (Video from Reddit)

Before you go for a hair transplant, I would be sure that you maintain minoxidil and finasteride for at least a year as it may be reversed on this combination of medications in a year or so. How old are you?

https://www.reddit.com/r/tressless/comments/b513fq/how_many_grafts_do_you_think_ill_need_for_thinned/
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Why Did I Start Balding at Age 15?

Dear Dr. Rassman,
I am a twenty-seven year old man, and I began to lose my hair at age 15. I went to several doctors when I was younger but they all told me the hair loss was male pattern baldness and not the result of any health problem. I am already as bald as my father, who is thirty years older than me.
When someone begins to lose hair at the age I began to lose mine, will the baldness progress until all of my hair is gone? Will I ever be able to use a hair transplant system? And what the heck would cause my male pattern baldnes to start so early anyway?
Thanks.

Androgenic hair loss or male pattern hair loss starts as males enter puberty, as their testosterone levels increase, bringing on voice changes and pubic hair and other male sex characteristics. Although it is usuual to start the genetic process at 15, the DHT is clearly working on young men of that age. There is an issue of ‘gene expression’, which means that the trigger for the gene may have started early on you. Unfortunately, some men have the gene that causes male pattern hair loss to trigger earlier, while others do not see this until later in life. For example, Don Ameche, a popular old-time movie star in the 1930s and 40s known for his perfect hairline and good looks, started to bald after the age of 50 (late onset trigger for gene expression) and was almost completely bald when he was in his mid 70s (and starred in the movie Cocoon in 1985).


2006-04-12 08:56:24Why Did I Start Balding at Age 15?

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How Many Pumps of Minoxidil 5% Spray?

I just started using Minoxidil 5% spray, but I’m not sure how many pumps I should use on the affected area (front). The directions just say apply it to affected area and my dermatologist didn’t say anything either, just to use it twice a day. I’ve been using 5 pumps in the front and one in the back for good measure. Is this fine, too much, or not enough?

If 5 pumps is enough to put over the affected area, I would think 5 is your magic number. There is no absolute number. Obviously, don’t drench your scalp with it as a light covering should be adequate.

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Why Do You Only Recommend Starting Propecia and Not Minoxidil Too?

Dr. Rassman,

I’m a 32-year-old with a Norwood 2-3 pattern in the front and some very mild but immistakable loss in the Crown. I very recently started taking propecia and am strongly considering trying that in conjunction with Rogaine Foam. Your esteemed colleague, Dr. Bernstein recommends the use of both of these products simultaneously, right off the bat. You suggest that one hold off on Rogaine until propecia has been shown to be ineffective, as it causes “dependencies”…

Not to create friction, but what is the source of your disagreement on this? What do you mean by “dependencies”? I don’t understand because doesn’t propecia create a dependency as well? (i.e. if you stop taking it, you lose all of the benefit)…

There is no disagreement. I would also recommend Propecia and Rogaine. But, think ahead for a second:

  1. Once you start both Propecia and Rogaine, you need to take both for life.
  2. You will never really know which medication is working more or less if you start both at the same time.
  3. Rogaine can be difficult for many men to follow the twice a day application (a pill like Propecia is easier to deal with and faster to take).

If you can accept the above, I agree you should take both Rogaine (minoxidil) and Propecia (finasteride 1mg). Both create the same dependencies and I’ve never tried to downplay that. If you stop either medication, the benefits received (maintaining or regrowing hair) will be lost, therefore you will depend on both to keep your hair loss in check. The medications work differently, so finasteride can’t retain hair grown by minoxidil and vice versa.


2008-01-25 10:57:42Why Do You Only Recommend Starting Propecia and Not Minoxidil Too?

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How Rare Are Permanent Side Effects from Propecia/Finasteride?

The science papers suggest that the sexual side effect (the focus of most men on this site) are less than 2% and are reversible if stopped early. The nocebo effect is much higher as young men bring on their sexual side effects by obsessing over taking the drug, and reading forums that suggest that this is a common occurrence. The greatest concern of most young men is the condition called Post Finasteride Syndrome which if real, may reflect a 1% risk at most. There is controversy over the existence of this condition within the medical community, but it is nevertheless important for any man considering this drug


2020-03-23 15:54:06How Rare Are Permanent Side Effects from Propecia/Finasteride?

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Why Don’t Studies Discuss Type I or Type II DHT?

In all of the studies trying to determine whether natural supplements like saw palmetto or green tea block DHT, they never refer to Type I DHT or Type II DHT — just DHT. Why is this? Good question, huh?

Good question. Propecia (finasteride 1mg) blocks mainly DHT type II, and Avodart (dutasteride) blocks both DHT type I & II. You would think if you block ALL the DHT it would be better against androgenic alopecia. Dutasteride is three times more potent than finasteride inhibiting the type II enzyme and 100 times more potent than finasteride inhibiting the type I form of the DHT producing enzyme. There are clinical observations that suggest that dutasteride is better than finasteride, but it is not approved for hair loss by the FDA and the long term safety on human reproduction for dutasteride (reports of sterility is a complication) have been suggested in some rare patients. We have received many reports by varying doctors who switch people from finasteride to dutasteride and get a better response. The next logical question should be: If we increase the finasteride dose to 5 mg or so, will it be better to treat hair loss? I don’t know if anyone really knows that answer for sure. Some of the original studies on finasteride suggested that the 1mg dose is the most universal dose, but it may be that a high dose in those who are refractory to finasteride may help. Some doctors are using a higher dose of finasteride on long term users. It’s a prescription drug, so I’m not suggesting you should take a higher dosage. The problems for either finasteride and dutasteride is that side effects rise when increasing dosages.

To get back to your question though — it’s been proven that type II is linked to male pattern baldness, but type I hasn’t been linked yet (though it’s possibly just not been proven yet). I couldn’t tell you why the studies out there don’t provide a breakdown by type, but I have not found scientific evidence that saw palmetto or even green tea actually block DHT anyway. And even if it did block some DHT, there is nothing in the literature that shows saw palmetto or green tea being effective for treating androgenic alopecia. I don’t mean to be a pessimist, but even Propecia does not completely stop androgenic alopecia.

The real quest should be finding other (non- DHT related) mechanism for androgenic alopecia. DHT is not the only solution out there… we just haven’t discovered the other yet.