Category: Uncategorized

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Frontal Fibrosing Alopecia – FFA (Commonly Found in Women) – (Photos)

This woman had hair loss and went to a surgeon a few years earlier who recommended surgery. Her condition is a clear diagnosis to a doctor with experience, a disease called Fibrosing Frontal Alopecia, which will cause any hair transplant to fail. Although this occurs more in women then men, it does occur in men and an astute doctor who is knowledgeable is critical before you get a hair transplant that will fail if you have this condition.


2020-01-11 07:37:05Frontal Fibrosing Alopecia – FFA (Commonly Found in Women) – (Photos)

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Switcvhing from oral finasteride to topical finasteride

If half-life of fin is 6-8 hours in the blood but 5-6 days in tissue (scalp) why don’t people apply topical every 3-4 days to minimize systemic?

Topical finasteride goes systemic. Perfect Hair Health has shown the relationship between systemic DHT level drops with higher and higher topical finasteride dosages as the effective topical dose increases. For men highly sensitive to finasteride, the standard topical finasteride will not change their problems by switching unless it is the liposomal preparation. Tissue levels remaining after stopping finasteride. Officially symptoms’ like sexual side effects should disappear within 6 days, but from my experience, it can last a month or more.

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FUE Failures – Follow Up

This was a question posted in the comments of this post about FUE failures:

Dr…You mention the many small dot scars with FUE – does this just come with the territory or can a good DR minimise this? I have very fine hair which I like to clip quite short and as such would never want a strip procedure. I assumed that an FUE would be ok.

It comes with the territory. All FUEs produce punctate scars. Just as in strip scars, there are some people who heal better than others. Some of these people will stretch the punctate scars. In those that stretch the scars (particularly in people with fine hair) the larger the punctate scar, the more detectable it is with a close buzz cut. Fine hair just does not hide the scars as well as a coarser hair would. With these statements, I can not state with 100% certainty that the larger scars are strictly the results of the differences in healing.

There is another variable here that should be mentioned — the size of the punch. I believe that the smaller the punch used to extract the graft, the less likely the scar will stretch. The range of punches used today are from 0.5mm – 1.5mm. I believe that the punches which are under 1mm will usually scar less than those over 1mm; however, with that said I don’t have personal experience with punches over 1mm.

Dr. James Harris, who uses 1.25mm punches with the ARTAS FUE robot, tells me that the scars are not worse than those produced by using punches under 1mm, so as I respect his opinion, I report it here for you to judge. We use 0.9mm punches with our FUE procedures.


2012-10-10 10:52:43FUE Failures – Follow Up

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Taking 2.5mg of Finasteride and Exercising

Hey Doc – I emailed you a while back and wanted to thank you for your response on the blog. I recently upped my dosage of finastride to 2.5 mg proscar after a 10 yrs of propecia (1mg), based on my HT surgeons advice. My hairloss had really progressed so this was a clear course of action. I intially had great results on proetica in my early 20s.

  1. My first question was related to dosing – I lift weights/workout intensely 6 days per week (often twice per day) and wondered if it would behoove me to split this dosage – 1.25 prior to weight lifting in the early evenings and 1.25 first thing in the morning, as recommended in your book.
  2. My second question was, does taking Finastride with a multivitamin, a vitamin C, a vitamin E, vitamin D, Potassium, Magnesium, and Calcium – all in seperate pills, and a protein shake (organic from non hormone cows) in the morning before I do some intense cardio (I eat no real food till I come back from the gym) have any impact on Finastride absorbtion/effectiveness?

I have read your book and realize it is ok to take Finastride with food but this may be a tad different.

Thanks in advance

  1. If you can keep up the regimen of taking a pill twice a day without forgetting, then go for it! Theoretically, it should give you a consistent level. Be sure to talk to your prescribing doctor to clarify this.
  2. I do not believe taking finasteride with your supplements or food or exercise has any real impact on its absorption.
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FUE Questions

Hi,
I am seriously thinking of having a FUE procedure during the next 2-4 months. I’ll appreciate if you can please help me with the following info.
1. How do i know if i am a suitable candidate for FUE?
2. How long do i have to wait after the test to have the procedure?
3. how long do i have to wait after the surgery, before i can go about my business?
4. I see that you have a special offer going on now, what is the final per graft price after taking into account the travel reinbursement and your offfer?

There are many things to consider before deciding on any hair restoration procedure. I’ll answer your questions on FUE (Follicular Unit Extraction) first…

  1. At NHI we use the FOX™ test to determine if you are a candidate for FUE. The FOX test lets us know how easily viable grafts can be extracted. If there is a high percentage of viable grafts, you would be ‘FOX positive’.
  2. The FOX test can be performed any time before surgery. There is no waiting period once you have had the test.
  3. Patients have different tolerances for surgery. Many patients go back to work the next day, others wait a day or two. As long as you follow the post operative instructions, you can resume your daily routine as soon as you are ready.
  4. The 2005 summer special fee applies only to traditional strip surgery. Travel expense reimbursement is up to 5% of the cost of the surgery.

Some of the other considerations to keep in mind are FUE is a good choice for patients who:

  • Need a small amount of grafts
  • Do not have an advanced balding pattern
  • Those who want to wear their hair very short
  • Those who have a very low donor supply, a scarred donor area, or very tight scalps
  • Patients who tend to heal with wide scars
  • Athletes who must resume full activity soon after the procedure

BUT, most importantly, continue to research, make sure all of your questions get answered, insist on seeing patient results in person, and make sure that you choose a doctor who has your best interests in mind.

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FUE vs Strip — A Technical Analysis (Continued)

A couple weeks ago, we wrote a post titled: FUE vs Strip — A Technical Analysis. In it, we discussed how the anatomy of SOME follicular units in SOME patients get disrupted, stripping off the fat from the lower part of the hair follicles.

We had two patients this week that provided some good examples we can delve into —

1. Patient #1 had a strip surgery, and we harvested two 2-hair grafts and two 3-hair grafts for this example. Note that all of the anatomy is present (sebaceous gland, fat to the bottom of the hair follicles) as shown in the photo below (click to enlarge):

 

2. Patient #2 had FUE performed, and if you look carefully, the bottom of the grafts have some missing tissue on them. This resulted when these grafts were pulled from the scalp after the FUE was cored. Parts of the end of the graft (surrounding the bulb) are devoid of the capsule and fatty covering that can be seen in the strip grafts. The photo below shows 7 follicular units extracted by FUE in a FOX negative patient (click to enlarge):

 

From the left, grafts #1-3 had loss of fat with intact follicular sheath (glistening membrane surrounding the hair follicles). These grafts should grow well; however, no studies on such grafts have ever been done.

Grafts #4 and #6 showed that some hairs were pulled apart within the follicular unit, probably when it came out of the scalp (a common occurrence in FOX negative patients). The missing parts of the lower half of these follicles were probably not transected with the punch instrument and will not produce hair; however the remaining follicles should grow. Again though, no studies on such grafts have ever been done.

Grafts #5 and #7 show intact follicular sheaths; however there is some mechanical “fracture” at the end of the intact hair shafts. We do not know if this will impact graft growth, but these changes are not uncommon in the FOX negative patients. These grafts should grow well, but… well, no studies on such grafts have ever been done.

 


There’s also Patient #3 that we performed surgery on some time back with FUE2. Notice that the fat remains around the follicular units:

 

Patient #1 (strip) and Patient #3 (FUE2) are essentially the same quality of preserved anatomy, though Patient #2 (FUE) seems less than ideal. The question here is whether Patient #2 will grow every follicular unit with a normal hair shaft thickness. Clearly, the grafts that have missing hairs will not grow those missing hairs. The grafts that have fully intact hairs will probably grow these hairs; however, there is no certainty here and it is possible that the quality of the grafts that lost their fat from the lower half, if they grow, may grow a shaft that is less thick.

Everything about Patient #2 and the success of these grafts are unknown. In Patients #1 and #3, virtually every graft should grow to their normal potential.

I hope that these photos help you understand the fine nuances that differentiate the various forms of FUE and strip procedures, and the difference in patients as seen when comparing Patients #1 and 3 to Patient #2.

We need to have comparable grafts studied from the ARTAS Robotic System to compare apples to apples. I suspect that the ARTAS system will produce grafts that are less than perfect in the FOX negative patients.

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Taking Propecia While Trying to Have a Baby

I have been taking Propecia for about 8 years. My wife and I are anxious to have another child. I completely stopped taking Propecia for about 5 months when my wife and I started trying to have our first child two years ago as I was afraid of side affects. He is perfectly healthy. Was that necessary or advisable? Should I stop taking it while we try to conceive again? Thank you.

There are many answers to this question depending upon the doctor and his interest in practicing and giving advice on what could be sensitive medical legal issues which are at time at odds with what is in your best interests. Very little, if any, Propecia comes from the sperm into the woman’s womb. Merck (the manufacturer of Propecia) does not warn men wishing to have children to stop taking the medications for your situation. That, in itself, tells much of the answer to your question. Some doctors, however, tell their patients if they are worried to do the following:

  1. stop taking the Propecia during the one week that fertility is present or stop it through the entire period from conception to the delivery of the baby
  2. use a condom when your wife is pregnant
  3. stop the drug completely during the entire pregnancy

I feel that the first part of #1 may be wise if you do not trust the drug company disclosures and to adopt #2 if you are really worried. These two steps are extreme, while #3 is almost crazy because you will abandon all of the benefits of the drug and get progressive hair loss during the 9 month pregnancy period, based upon no evidence that this is a problem. See my previous answer to this question here: Taking Propecia While Starting A Family.

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FUT or FUE Hair Transplant for a Diffuse Thinner?

Diffuse thinning should generally NOT be treated with a hair transplant. Why do you have diffuse thinning would be my question? Did someone give you a proper diagnosis? A good doctor might do a HAIRCHECK test (https://baldingblog.com/haircheck-test-how-it-is-done-video/) as well as miniaturization analysis of your hair and look to see patterns of hair loss.

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Techniques to Minimize Donor Area Scarring

All skin incisions produce scars, including those made by the best surgeons. Traditional hair transplant donor scars have a width of 1-3mm in 95% of patients and 2-3% of patients may see their scars even wider. The key to minimizing scar visibility is to directly address the factors contributing to a widened scar, like the healing characteristics of head tissues and collagen. Fortunately, the New Hair Institute (NHI) uses many surgical techniques to minimize scarring and scar widening.

Fascial Closure Technique: A fascial closure can be utilized to reduce wound tension when two skin edges are brought together, therefore reducing the likelihood of scar stretching. Before exterior sutures or staples are placed, we imbricate (or overlap) the underlying fascia, which is the fibrous tissue network located between the skin and the underlying structure of muscle and bone beneath the skin. (Fig. A) A more complex fascial closure is made when tunnels are created below the fascia to further reduce tension upon closure. (Fig. B) The final sutures or staples on the skin are not shown in the diagrams.

Trichophytic Closure Technique: A trichophytic closure, “hair loving” in Latin, promotes hair growth directly through a healing wound. For many years plastic surgeons have used this technique while repairing hairlines during brow lifts or in conjunction with face lifts. A small piece of one wound edge, as well as the corresponding hair, is removed. When the wound heals and a scar is formed, the buried and partially cut hair follicles will begin to grow through the scar. (Fig. C) Since hair follicles cut in this manner resume growth, there is no unnecessary follicle waste. When scars are wider than the 2 to 3mm range, this closure technique is less effective, because it typically promotes hair follicle growth only within a 2 to 3mm width where the trichotomy was done.

However, both of these techniques do not account for patient variability. The physiology of wound healing and scar formation is a very complex matter with numerous books devoted to the topic. Some patients heal with a virtually undetectable scar, less than 1mm, without any special closures while others form a wider scar despite fascial and trichophytic closures. Scars within the 2-3mm range are widely accepted since surrounding hair growth usually disguises any scar formation and few of my patients ever complain of a 2-3mm scar (Fig. D) that they can not see.

Update: Please see Trichophytic Closure Photos

Illustrations by Jae P. Pak, M.D.