Should you be shedding in areas of your head where you weren’t shedding before?
You must keep in mind that genetic balding is the enemy, which is a progressive process in ALL men- so when you see new shedding, think progression, not finasteride as the cause.
2020-03-12 04:00:062020-03-12 10:30:32Is it possible that finasteride can make hair worse?
Dear Dr. Rassman,
First I would like to take this opportunity to thank you for this great website.
I have two questions and i would be very greatful if you can answer them :
1. I had an FUE procedure done on the front area (frontal hair line)with approx. 1200 grafts before three months ago, the strange thing that i am experiancing is some hair loss in the area behind, which is in the mid-scalp area, is this shock loss? shedding period? or the normal genetic hair loss pattern? and how can i tell the difference between them?
2. If your answer to question no.1 is shock loss then can you tell me what is the solution for it? and is there any chance of hair regrowth for those that were lost? (By the way i have used propecia for 12 months before a few years ago but with no success and i experianced terrible testical pain)
Thank you and Best Regards.
If you were not on finasteride when you had your FUE procedure, it would almost be certain that you had shock loss. You should have worked this through with your doctor prior to having the surgery. I always assess the status of the hair behind the transplant recipient site and if it showed significant miniaturization, one could have predicted this outcome. I would need to see you and understand what the loss area shows now.
I would also have considered lower doses of finasteride, which may have allowed you to use the drug without the complication. One quarter of a pill finasteride (0.25mg) can be effective at minimizing hair loss from shock.
2009-06-12 14:36:582009-06-11 14:38:51Could This Be Shock Loss Behind My FUE in the Hairline?
Hi Doc,
Is anything known about the permanence of the sexual side effects of Propecia? I’m concerned about serious fertility problems if I start using this drug, and I’m skeptical of Merck’s claim that all side effects go away quickly once you stop usage (how would they know? Propecia hasn’t been around that long). I’ve just been browsing comments about Propecia on the web and, from reading about various people’s experiences with it, it’s not so clear to me anymore that this drug won’t cause a permanent problem.
I’ve written a lot about Propecia on this site. Please do a search for Propecia or Propecia side effects to read my many blog entries about this. Quite simply, if you do not trust the drug company or the FDA, then you should not take the drug. In fact, do not take Propecia or any drug unless you have confidence in the information sources; in this case Merck and the FDA.
Based on the questions and answers on your excellent blog, you seem to have taken an ambivalent position on creatine and hair loss in the past. I am 25 and very athletic, and I have a medical background so would never consider taking steroids or other dangerous substances. Creatine is a safe and effective athletic supplement that I have been taking for some time, but a recent study published in the Clinical Journal of Sports Medicine found that creatine raised serum DHT by 40 percent when taken at the moderate dose of 5 grams per day. In addition, creatine has recently been shown to increase the ratio of DHT to testosterone in young athletes. Do you think this is sufficient evidence for young hair loss sufferers to entirely avoid this otherwise excellent ergogenic aid?
I found the study you’re referencing — Three Weeks of Creatine Monohydrate Supplementation Affects Dihydrotestosterone to Testosterone Ratio in College-Aged Rugby Players
The study was very limited (only 20 men) and the amount of creatine taken can vary wildly amongst those that use it, but I would avoid creatine if it indeed increases DHT levels in the body and you’re worried about possible hair loss. The study itself concludes, “Further investigation is warranted as a result of the high frequency of individuals using creatine supplementation and the long-term safety of alterations in circulating androgen composition.”
I appreciate you bringing it to my attention.
Pictures say it all, right? The reports on the value of pepperment oil seem to do better than minoxidil at least on the mice. The reddit posts seem to suggest that it has great value for patients who use it as well
2020-01-31 04:36:032020-01-31 07:50:24Photos of peppermint oil best for hair loss in mice testing
I recently had a hair transplant done and I was curious about the way my doctor had done it. I naturally have had a widow’s peak but it has receded some. The way the doctor put the graphs in was sort of also in a M shaped form just out to the sides. Will this restore my natural hairline?
I cannot answer your question without seeing a current photo and comparing it to what you looked like before you lost your hair. More importantly, you should have addressed this before the surgery to make sure that your doctor understood your goals and expectations.
The standard practice at NHI is for the physician to draw a hairline with an erasable marker prior to surgery and have the patient look at the general shape and position so that he/she can approve or modify what the doctor planned. Generally this take a few minutes as the patient has specific concerns and requests (such as adding a widow’s peak). In the end, both patient and doctor are on the same page in agreement before the surgery starts and we take good pictures to document what we had agreed to. After the hairs grow in, we can then go back to the drawing on the head and see if the hairline we had tried to produce, was actually produced.
Doc,
I have a similar question to the person who asked “about scarring in the donor area”. I had a hair transplant on 5/16/2006, and had my sutures removed on 5/30/2006. I went to my Dr’s office on 5/25, and showed him my scar which I felt was becoming infected due to me being too agressive in cleaning the area. I felt what seemed like pimples in the area.
At that time my Dr., said it looked fine but on when I went to have my sutures removed on 5/30, the outer level (he stated he stitched below the skin as well) of sutures had become loose in some areas. He again said he had seen this before and it was nothing to worry about and would not cause the scar to be wide or hypertrophic. He popped some of these pimples in the donor area and prescribed me an antibiotic for 10 days as “a precaution”.
It has been approximately a week since I had the sutures removed and the scar is very pink and at times I feel sudden, slight, yet sharp pain the area. I think part of the problem is that this doctor excised a previous scar from a previous HT.
My question is do my symptoms sound normal to you, and have you heard of using an antibiotic as “a precaution”
PS If I ever decide to have a third HT, I think I will fly to California to meet with you in person. I regret not finding your site and this blog sooner.
What you are telling me sounds ok. Recent wounds feel different with different people. You can not really wash too vigorously on the donor wound (reasonable washing is probably what you did). Don’t blame yourself here as everything sounds OK. If there are real pimples in the donor wound, possibly suture abscesses may be occurring. A culture taken by your doctor with follow-up antibiotics are the regular approach to this type of problem. With the sutures now out, most of the pimples should be gone by the time you read this response.
Good luck.
2006-06-07 11:36:352006-06-06 08:58:05Pimples in Donor Area After Transplant
Hi Doc. Really nice blog! Been so helpful!
Just want to know. Is it normal to see hairloss several years before your dad did? I’m balding in the age of 20. My dad began losing hair in his late thirties.
All the best!
It seem you are an early bloomer. Hair loss can start as early as teenage years and doesn’t necessarily follow the exact timeframe as other family members. I suspect what you are going through is normal… for you. You need a good diagnosis with a doctor who will map out your hair for miniaturization to help make the diagnosis. Drugs like Propecia can slow or stop the balding process and change the course of hair loss over time.
2010-06-08 08:46:462010-06-04 08:55:33Dad Lost Hair in His Late 30s, I’m Losing Mine at 20
If I were to pluck some of my surgically implanted hair in order to achieve a balanced look, would they eventually grow back over time? So if I then decided to get another transplant to balance things out, I wouldn’t regret doing it?
If you pluck out transplanted hair it should grow back just as if you pluck out normal (non-transplanted) hair. However, if you keep plucking out the same hair, eventually it may never grow back, which is what happens with trichotillomania.
First, please read the article from the Associated Press here: Wife Files Suit After Husband’s Dies During Hair Transplant Operation.
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Here’s my in-depth 2 cents:
This is a tragic and unnecessary death and my heart goes out to the family. According to the article, this actually occurred a year ago today (April 27, 2006), but the case was just filed in Los Angeles Superior Court, and thus made public. From what I could get out of the court filing I read, there was an overdose of some medication (I believe it was Lidocaine) and the response of the professionals in attendance was inadequate to address either the medication that was overdosed or the proper management of the critical emergency with basic life support activities. Why did it happen? Is it a real risk for people wanting to undergo a hair transplant procedure? Are hair transplant procedures any more risky than other plastic surgery procedures or even a dental office procedure? These questions have been raised because of this news release and I would be remiss not to discuss this at some level of detail.
Why this happened is something that we will not know until all of the facts of this case are revealed in the legal proceedings, but I can tell you that I am unaware of any death other than this one (in anybody’s hands, anywhere in North America) that has occurred in the years since I have been a hair transplant surgeon (1991 to 2007). Hair transplantation, or any surgical procedure, has its greatest risk associated with the anesthetic used. If the patient only has local anesthesia, then the risks should be almost minimal, yet this patient apparently died from the simplest form of local anesthesia. But, like any medication, there are known risks of Lidocaine. eMedicine says, “If untreated, local anesthetic toxicity can result in seizures, respiratory depression or arrest, hypotension, cardiovascular collapse or cardiac arrest, and death.” This begs answers to questions which have not yet been posed. I am resolute in stating that local anesthesia is absolutely safe, provided that the person administering it does so in a competent manner. Tylenol, aspirin, vitamins, alcohol and other such substances should be absolutely safe, but on very rare occasions, each of these can kill. When used in ‘overdose’ and untreated, these medications (including Lidocaine) can be lethal.
How does an ordinary person know if the doctor he chooses, the facility the doctor practices in or the track record of the doctor’s previous history is ‘clean’? You can go to the medical board of the state and find out if the doctor has a clean record (available online in most states). You might be surprised to find that your doctor has been in trouble and has a well ‘marked up’ record of infractions. Doctors who are known drug addicts, who had sexual misconduct, or who have been disciplined by the medical board for any reason, create a public record which you can get access to. If the doctor practices in a certified surgical facility or hospital, you can assume that the doctor’s work is overviewed by a ‘peer review’ process which holds the doctor accountable for his actions and his surgical results. Doctors who confine their work to their offices or those who do not seek out national certification and peer review are not accountable to an official ‘body’. Just because they are not reviewed by impartial third parties does not necessarily mean that these doctors aren’t any good. It means more that those doctors who are reviewed and are held accountable for the quality of the medical care they administer, may reflect upon the style of their practice which is open for criticism by accrediting organizations. I personally welcome such a review, as it gives me a check on my own personal belief that I am doing everything possible to deliver the best medical care that I can. Had I unknowingly used doses of medications that were dangerous, for example, the reviewing physician who checks my use of medications during an inspection would have identified a problem in my drug use routine and notified me of the need to re-examine what I was doing.
Sudden death:
People die in their sleep, when exercising, running a race, working under stress, having sex, going to the toilet, etc. Many of these spontaneous deaths are caused by a heart rhythm problem where a heart stops beating from something called spontaneous ventricular fibrillation (SVF). As this can happen anywhere and at any time, each of us should be prepared to act, to save a life, because that life could be your father’s or mother’s or your child’s. The EMS (or EMT or paramedics) know how to maintain an open airway, administer cardiac massage and perform more advanced life support, which would be appropriate in such SVF situations. Many lay people are also trained at performing cardiac and airway life support at the most basic level and death can be delayed and possibly prevented as more sophisticated care is administered. For those of you reading this, you should be able to perform basic life support services just in case someone near you undergoes SVF. This means that you can pump a chest (perform external cardiac massage) in a person whose heart stopped and you can administer respirations while keeping the airway open. Simply calling 911 (at least in the US) can bring you sophisticated life support services (in most cities) within 5 minutes. We should expect that your doctors, nurses, medical technicians and every person working in your medical office will know the fundamentals of at least basic life support. Certainly, when a doctor gives any anesthesia, that doctor must be able to manage a worst case scenario and direct the entire process where life support services meet the standards of care for a medical facility. That doctor should also be intimately familiar with the drugs he/she uses, in case some rare side effect should occur.
If what was reported in the case filing of this death is correct, the doctor and all of the support people on his staff failed to meet the fundamental standards for basic cardiac life support. Still worse, is the suggestion that the responsible medical personnel may not have been what the patient who died had expected. John Lord (referred to as a “doctor” in the court action) is not a medical doctor. I personally have complained to the Medical Board of California on a number of occasions about Mr. Lord’s activities that were reported by ‘patients’ of his, his credentials, and his practice. Anyone can check online records to find that there is no licensed MD or DO named John Lord in California and the suggestion that he was a licensed physician performing surgery as claimed in the civil suit purports possible criminal activity [Update: John Lord plead guilty to a felony count of practicing without a license]. Many things are claimed in the legal action, much of which (if proven in court) makes this case unique and beyond a simple case of malpractice. If he was a doctor, Mr. Lord could be tried for malpractice — but he’s not. Does that mean that this is a matter for the ‘state’ attorney and if so, is it a criminal matter (practicing medicine without a license)? We must, of course, let the legal process work its course and basic to the constitution, these defendants are innocent until proven guilty. But the more basic question that must be asked is, “What is being done to protect the public now if these accusations are proven true in the months or years yet to come?”
I have reviewed the medical literature on the subject of death in a doctor’s and dentist’s office to try to find out what the experience has been across the United States. None of the improprieties of possible criminality are discussed in the brief review I have put together here. I have focused on the data which address the risks of death in an outpatient setting. Florida, Oregon, and Texas have provided a review of some of their experience over many years. These reviews, in part, have included dental office procedures as well. Most patients who died had preexisting conditions, such as gross obesity, known cardiac disease, epilepsy, chronic obstructive pulmonary disease, and liver disease that can significantly affect anesthesia dosage and care. In the dental office, while under sedation/anesthesia, insufficient or inadequate oxygenation arising from airway obstruction and/or respiratory depression was the most common cause of life threatening events. In all of these cases most of the adverse events were determined to be avoidable with skilled medical care. When age is factored into the risk formulae, risks go up significantly in patients who fall outside the healthy, young adult category typically treated in the surgical/dental outpatient setting. In the death under discussion here, the patient appeared to be a healthy man, so his risk of death should have been negligible.
In the state of Florida (over a 6 year span), a total of 46 deaths related to office procedures were reported. Twenty of those were “plastic surgery procedures” and 11 people died in the immediate treatment period (first 24 hours). The most common cause of death reported were from blood clots (most probably from the legs). Most of the deaths involved non-board certified plastic surgeons. The 46 deaths were among over 600,000 surgeries. This puts the risk at 0.00077 of patients. Unfortunately, the one who dies has a risk of 100%.
44,000 Americans reportedly die annually as a result of medical errors. Medical mistakes are the eighth leading cause of death in the United States. When surgery is performed in an office-based setting, the risk for serious injury or death comprises a 10-fold increase when compared with a certified ambulatory surgical facility. At the New Hair Institute, we have maintained a certified ambulatory surgical facility since 1996. I am proud to say that we may be one of very few hair transplant centers that is fully AAAHC (Accreditation Association for Ambulatory Health Care) accredited. To be accredited and certified, the doctor and facility must meet the highest standards for safety, cleanliness, and the use of proper standardized procedures. The facility must undergo inspections by highly trained physician specialists to determine (by independent medical record review) that all of the standards are met, and that the complication rates (infection and surgery) fall within national standards. The doctors and staff must be trained in life support and at least one physician must be trained in Advanced Cardiac Life Support (all of our doctors are so trained). I must reflect on the Hippocratic Oath: primum non nocere (“first, do no harm”). Patient safety must be the foremost priority in any surgical procedure and that means:
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Update on Friday Evening, April 27th:
ABC News just announced that John Lord plead guilty to a felony for practicing medicine without a license.
