You absolutely should not get a hair transplant. Drugs like finasteride and/or minoxidil might work. Wait until you see what you look like at the age of 26 when your balding pattern will become more evident. Then work with a good doctor who understands the concept of a MASTER PLAN for hair loss and if transplants are warranted then, you can consider it.
Great piece. I tell the exact same story so I fully identified with your analysis. It is good to draw these conclusions from a successful experience rather than listing all of the mistakes you made (even though the mistakes can be deduced from what you say here). I would add that a Master Plan is critical for anyone considering a hair transplant because hair loss continues even after you have a hair transplant and if you don’t plan for it correctly, waste your donor hair on your immediate needs, when you need more in 10 years, you can be in big trouble. Thanks for writing such an elegant piece.
Top Ten Things to Know about HT from Someone who Had it Twice from tressless
2019-08-12 16:18:462019-08-12 16:18:53Ten things to consider before getting a hair transplant (from Reddit)
Hello. I am a 17 year old male that maybe hair transplantation is the answer to my problem. So heres what happaned. This was about 6-7 years ago when i was a young boy i used to pull on the front part of my hair. I know thta is one of the hair problems children face (Alopecia Trichotillomania), but i was doing that for a really short period of time. After about 2 weeks of pulling I had completely stopped pulling on my hair. After a long period of time most but not all of my hair grew back. Its been 6 to 7 years now and i have a few bald spots that have been bothering me ever since. I have one a little less than a dime, and my hairline isnt shaped right, and scattered mirco tin bald areas. Also, I would like to know from an estimate, how much it would cost for this procedure, and what is the difference betweeen FUE, FUT, and a hair transplant. I live in the los angeles area. I really want to fix my hair problem. Thank you.
Your first step should be to get a diagnosis. Small bald spots may reflect alopecia areata or ringworm and neither of these should be transplanted. There is no substitute for a diagnosis by a good doctor.
Assuming that you are a candidate for a hair transplant, it is difficult to estimate the cost of something that I have not seen. If you can send me pictures or give me some way to understand the size of the bald areas, maybe I can estimate the job. If it is small, use coins to tell me (e.g 3 dime size areas or one silver dollar size area). On that basis, I can estimate the job. Picking or pulling out the hair (trichotillomania) must be under absolute control or it will happen again. The picking must be solved before you transplant it. I can always tell if there is active picking going on in your head.
As you are in the Los Angeles area, pay me a visit and I will determine what the problem is, its scope, and what to do next.
Doctor; I had my 4th hair transplant last October with the same surgeon who had done the prior 3. No complaints the first 3 sessions; I had decided to do a final “touchupâ€, filling in the front a bit more and adding to the crown.
Big Mistake.
My donor area on the left side was totally butchered; a patch about 1 1/2X 1 1/2 inches totally barren and badly scarred. I knew something was wrong immediately after surgery. The hair was gone the next day-immense pain and tightness was in the wound and there was redness also there. On the left side, there was a scab in the middle of the patch that took 2 months to heal.
The right side was similar but not quite as bad. The hair eventually grew back on the right side around 2 1/2-3 months. Its now been over 7 months; I do not expect anything will ever grow on the left side. The sutures seemed placed extremely high above the edges of the wound, also suspicious. I was told by the surgeon that everything was fine; these things “always resolve”.
Finally a month ago, after seeing my predicament, he tepidly agreed that re-growth wasn’t in the cards. He said he would do “Scar revisions”? This did not seem right, so I sought 2 other opinions, both saying scar revision considering the circumstance was definitely the wrong way to go, and that transplanting hair into the area, in 2 small sessions, was the best way to handle it.
Do you have any advice for me?
Scars from any surgery are unavoidable. When I performed general surgery, people would judge the surgeon by the appearance of the scar after the surgery. If the scar was barely detectable, then the surgeon was great, but if the scar was stretched or obvious (for example) the surgeon was terrible. If I did 100 appendectomies, about 10 would have a widened scar and 90 would have a barely detectable scar. Was I a great surgeon 90% of the time? How did I select who got the bad surgery? The question sounds silly, but as a surgeon I am humbled all of the time that anything ever healed and I live in a constant state of awareness that there are many things that I can not control. Scarring is just one of them, but I do not abdicate on the awesome responsibility upon me to try to get perfect scars 100% of the time.
I want to know how the scar impacts your styling and your ability to function daily. Since we are talking about visible scars in most situations, we are talking about the ability for the hair around the scar to cover it adequately. The thinning of the hair in the donor area is unavoidable and as more surgeries are done, more thinning can be expected and the scarring risks rise (non-visible and visible scarring are separate issues here). Think of it as follows:
Some patients have poor healing wound characteristics in their collagen and as such, become set-up for stretching scars. Unfortunately, these patients may not be obvious in advance of a surgery. For a repair, the surgeon has to decide just how far to push the skin removal process; in other words, he must determine with each surgery just how much skin to remove. If the surgeon takes out too much skin, then the wound may be too tight to close without tension. High tension wound closures are the greatest cause of scarring and reactive hair loss. Sometimes, people just get reaction to the sutures, or the surgery, or they might even get an infection (clinically evident or sub-clinical). Sometimes, scars just happen, not on the first procedure, possibly not the second, but maybe the third. When the scars form, then each patient has to be assessed by a skillful surgeon, hopefully one you trust. I always tell my patients that a surgeon and a patient have a partnership. A good partnership means that the partners stick together in good or hard times. I tell my patients that if anything ever goes wrong with a surgery done by me, any complication from infection to scarring, I am the best partner that they can have because I take full ownership of the responsibilities of the partnership. Money or time has no meaning for me if things went wrong, so I tend to be there to stand by the patient and do whatever is necessary to manage the process. As a general surgeon, I lived with death from accidents and the outcome of cancers that were incurable, but I was a dedicated partner to each and every patient I took on as a surgeon.
First, ask yourself if your doctor is a real partner with you in this process. Then, if he is, discuss the issues so that you understand his thinking. His analysis and what he will do should depend upon the ‘tension’ on the wound when it was closed (at the last surgery) and the dimensions of the strip of skin that was removed. Decisions on how to repair such problems vary with the conditions of the donor area and the scarring above and below the surface. Does you surgeon suspect a reason that the scar formed? If it was very tight and immobile, then removing the scar may not work as a primary surgery for the repair process? How is the hair around the donor scar? If it is good, then the approach will be different than if it is poor. What are the dimensions of the donor scar (the wider it is, the harder it is to remove)? What is the proposed surgical correction and if it is done, why would the surgeon expect a better outcome for the repair than he had on the surgery that produced the problem? What are the alternative approaches to removing the scar? Transplanting the scar may work, but where will the hair come from and what is the risk of the removal of still more hair? Is a balloon a better approach (definitely for the very bad scars) and what about FUE surgery?
It is impossible for me to determine your exact situation without examining you and seeing (and feeling) the status of your donor area. Be sure that the doctor you have is experienced in these repairs and can show you what type of results his experience with such repairs have produced (like showing you other patients who have had such repairs). I can tell you that the only surgeons that never see scarring in surgery are those that do not perform any surgery. Every surgeon sees scars. In standard hair transplants with today’s newer closure techniques, obvious scarring should be present in less than 2% of those undergoing a standard strip excision transplant. Solutions to transplant scarring are there almost all of the time. An alternative solution for you to consider are FUEs (Follicular Unit Extractions) where each hair grouping is removed one at a time and then transplanted into the scar. The use of balloons can produce miracles for the worst of the scars. Both FUE and balloon use require specialized skills, not common to most hair transplant surgeons.
For more info on FUE, please view the FOX Procedure.
Hi. I am 21 years old. About 9 months ago I noticed that my hair was thinning at the top. I consulted my GP and he said it was male pattern baldness. He prescribed propecia but after 7 months of taking it I experienced side effects and did not see any improvement. I lift weights for 30 mins 3 times a week and have a protein shake daily could this have any effect? Any advise would be greatly appreciated. many thanks
I doubt that there is any connection unless your protein shake has steroids in it.
I’ve been taking propecia and using Rogaine for 8 months now with great results. Recently, I purchased and started to take a natural testosterone supplement. Within 4 days I witnessed an enormous amount of hair loss. I immediately stopped taking the product and since then my hair has stopped falling out. Will the hair I lost every come back? Will I recover from this stupid mistake?
While in theory what you describe is conceivable, it seems very strange a supplement can cause such rapid (in 4 days) hair loss — even if it was a testosterone supplement. I really do not have an opinion on whether your hair will grow back, since I really don’t know what caused your hair loss. You may consider seeing your doctor for his/her opinion and an in-person examination.
2008-02-11 11:32:052008-02-09 12:31:24Testosterone Supplement Caused Massive Hair Loss Within 4 Days
The body of a supercentenarian expands science’s appreciation for the physiological limits of aging.
This article was Published in The Scientist:
Two interviewers chatted with the now 113-year-old van Andel-Schipper back in 2003. The interview was also repeated at age 111 (neuroscientist Gert Holstege) and again at 113. She was amazing with memories going back to the details of a soccer game in 1898 when she predicted that her favorite soccer team was not going to be successful and she was right.
“She knew exactly what was going on in politics, in sports,” recalls Holstege”… “She could explain … exactly what happened in 1898 when Wilhelmina became queen [of the Netherlands].” She remembered the details of the parties she’d gone to with Dutch soldiers as WW1 began in 1914. “She was completely alert.” She died at age 115.
I (Rassman) had a great grandmother who lived to 114 years of age and I remember her well. Like Andel-Schipper, her brain functioned reasonably well, but unlike her, she was not in a nursing home. She lived with her daughter (my grandmother). Every Sunday, the family would get together with her. She was born before Lincoln became president and was alive when I went to medical school. She gave me the following advice. “Marry a rich woman until you get established and she puts you on your feet. Then get a divorce and marry for love the second time.” It could be modern day advice for many of our peers.
As the doctor who pioneered the FUE, I can tell you with authority that 6000 FUE grafts will deplete your donor area and produce a see-through donor area. This is not a fixable situation as once the hair is moved, it will not regrow there. What is the doctor’s plan other than to get your money? What happens if you continue to bald over time, what then? Have you thought through this process?? If you are under 25, then you are about to make a terrible mistake.
Dr Rassman,
My question is: does finasteride play any role in maintaining minoxidil dose-dependent hair?
I got started on 5% minoxidil topical in early Feb, 2009. My derm prescribed Finasteride oral 1mg/day too, but I did not pursue that medication due to the usual side-effects related concerns. There was an initial minox-induced shed: not a massive one, but scalp showed. Things started looking up 4 months later but then again in July/August a bout of minor shedding ensued. Survived that too. In November yet another shed started and this one was bad; short fine hairs all over the pillow in the morning. Scalp showed yet again, as bad as after the first shed in March. In December, I panicked, decided that Minox wasn’t working for me, and got started on Finstaride 1mg.
By mid-Feb this year, there was a sort of minor miracle on the top of my head. My hair is looking its best in maybe two years. I hope you agree with me that it’s unlikely that Finasteride started growing hair within 10 weeks of beginning its use. My (semi-literate) guess is that Minox first grew “peach fuzz”, which gave way to intermediate hair, which then was replaced by terminal hair. I suffered synchronized sheds, the last one being the shedding of intermediate hair. Maybe more sheddings are in store for me, maybe not.
To get to the point, I am so pleased with the result that I’ve gotten greedy: I want Finasteride growth too. No sexual side-effects so far. I’d like to press on with Fin, and reserve the option of discontinuing it in future if side-effects show up. I understand that that would result in catch-up loss, but then probably I’d be content with the hair that Minox grew for me.
Hence the question: do minox and Fin have a cumulative beneficial effect on the same hair follicle? Will minox-dependent hair too be lost in catch-up loss if Fin is stopped? If the answer is in the affirmative, I’d probably be better off stopping Fin right away, since I’ve been using it only for 3 months.
Thank you for a patient reading, and thank you for your time.
You would have to poll each hair follicle and ask them what they liked better. If you can not communicate with them, then you are like me who frankly does not know the answer to your question. My best guess though (keep in mind I could be mistaken) is that because the medications work in different ways and finasteride will not keep hair grown from minoxidil and vice versa, that the benefits are independent of each other. Many men do use both medications concurrently, and as long as you can afford both (and maintain the regimen) I say go for it! It’s ok to be greedy and want your hair to look as great as possible. If the meds work well for you, that’s great news!
While it is unlikely that any major hair growth you’ve seen in just 10 weeks occurred from finasteride, you could’ve seen benefits from the medication that have helped your hair look better overall. The two drugs work differently. Minoxidil will grow new hair but the quality of the new hair varies in individuals from thin and poor, to strong and good (less than 15% of people). Finasteride probably does not grow new hair, but most likely works on the miniaturized hairs that we see in male pattern balding as it progresses. This is why finasteride (Propecia) will have no effect on the new minoxidil produced hairs. Minoxidil has not been shown to work on miniaturized hairs, at least that is what is presently understood.
In my general surgery practice, I met a man who had burns on his chest during an examination for an elective surgery. I asked him about it. He said that he got fainting spells with heart palpitations and one day he fell against the electric fence and it reversed the fainting spells and the heart palpitations. That was in the 1940s, so he put electric fence wires around his property and through his house and every time to had a ‘spell’ he would shock himself. I believe that this man actually discovered cardio-conversion before the medical profession did. The burns were from the electric shocks and his entire chest was covered with old and fresh scars. Don’t laugh at the value of electricity, it might save you life and your hair.
