Category: Uncategorized

How is the donor area approached and managed for a hair transplant based on the balding pattern? What I mean is the donor area for a Norwood 4 is going to be larger than for a person with a Norwood 7 whose crown dips down and cuts into much of the donor area.

A good doctor will plan for the unexpected balding pattern that might sneak up on his patient. That means that the Personalized Master Plan that I write so much about expects a Class 7 pattern of balding on each and every one of his patients. This is what separates the great doctors from the poor ones.

Doctors, I’m confused as to what Haircheck is and how it’s different from the miniaturization mapping. Can I get some more info please?

I’m going to try to clarify the usefulness of this tool as best I can. I saw a patient (we’ll call him John) that came to see me after I started him on Propecia a year ago. At the time I prescribed Propecia, I noticed he had miniaturization to 50% in the top of his head. I measured this when I used the video microscope, but there was no see-through appearance as his hair had a good weight to it so with the naked eye and I did not see miniaturization, nevertheless, the hair looked normal but with the microscope. It was clear that he had early balding when measured by the HAIRCHECK instrument. The HAIRCHECK instrument measures hair bulk and puts an actual number to it. From a visual appearance, there was no sign of balding on John (just like a year ago). The main reason for taking the test at the office on this visit (as with the last one) was that John saw hair on the pillow case indicating that he was losing hair. The HAIRCHECK device confirmed his concern that he was losing hair.

The measurement of hair in the mid-head (between the ears) at, 17 cm just above the glabella (just above the nose), was measured for hair bulk and compared with hair from the donor area, just above the occipital notch, in the back of the head. The measurements of the hair on the back of his head should reflect his normal hair bulk. If the area between the ears had the same bulk as the back of his head, I would tell him he did not need Propecia and was not balding. But last year we saw a reduction in hair bulk determined with the HAIRCHECK instrument in the top of his head indicating that he was balding. One year ago, John has a measurement showing that he had lost 45% of the hair on the top of his head. On today’s visit John had a bulk measurement of the hair at the exact same location (in the middle of his head) and a bulk measurement indicated that on this visit, John had a hair loss now of 55% of the hair on the top of his hea (between the ears), a clear sign of more hair loss and a progressive process.

When he comes back in a year, if his number may drop further because hair loss is progressive. Fortunately, many men stop their hair loss with the drug finasteride (Propecia). Let’s assume that in 1 year it drops to 35% of the bulk, and in three years it drops to 25% of his hair bulk when compared with the back of his head. If this becomes his case, then the idea of the Master Plan that I have been pushing for many years is just what should he needs, as this plan will define a path for him to take. At some point, his hair loss will become obvious to him. My job is to follow the progression of his hair loss and build a plan for him on what to do. There are many options, but I will not write a book on it for this blog post.

I hope that this blog post gets the message across that everyone needs a Master Plan for his hair loss and it must be with a good doctor, one that can be trusted to always act in the best interests of the patients.

This is an interesting twist from what I normally have read. The article in a very prestigious journal, analyzes the connects between 5-alpha reductase inhibitors to possible benefits on psychosis

https://www.nature.com/articles/npp200839

Some doctors had lawsuits when someone claimed that they lost their sex drive permanently. The risk is far less than 1:1000 but some doctors put their fears in front of patient’s welfare. What I do is inform my patients of all of the risks then prescribe it. It is the patient’s decision to take or not to take the drug. My son took finasteride for 15 years so far, and he told me that his sex drive went up when he went on the medications. I take it with no problems. Of course, internet forums only want the bad news, so you rarely hear about the other side effects. Any doctor can prescribe it, even your family doctor.

I saw many side effects in fin and minoxidil. I just want to use dermaroller for my hairline. Does this work?

There is good evidence that just microneedling and the wound healing that happens after that will produce hair growth without finasteride and minoxidil. The addition of those two drugs increase the effectiveness but are probably not critical to it.