(female) I was put on 40 milligrams of prednisone after I got out of the hospital from a major infection… ulcerative colitis. I was on predisone for a month. Well, a month later after I stopped it, I starting losing my hair. Could this be caused by the prednisone? (I was also on Asacol too.)
The entire stressful experience may have precipitated a telogen effluvium. Hopefully it will reverse on its own in 4-8 months. Both medications and the illness you had could have caused the hair loss.
Hello Dr. Rassman. I am in my early thirties and thinking of getting a transplant done. I have been on finasteride for quite some time with decent results. However, in the last few years my hair loss picked up in the front hair line but has slowed down up to this date. Should an individual, like myself, try ALL the available non surgery options like avodart, minoxodil, nizorol etc before going the hair transplant route?
Most of my hair loss im the frontal area. I still have decent coverage but I am thinning. Would I be at risk for severe shock loss even though I am on finasteride? Thank you.
Medications do not usually work to regrow hair in the frontal hairline, but hair transplant surgery generally address this area well. Whether you are ready or should undergo hair transplant surgery is between you and your doctor, and part of the Master Plan. Each and every patient is different, with different goals and expectations. There is no right answer to your question.
Many patients come to me and worry about shock hair loss, but this is part of the individual risk versus the benefit… as we discuss in the Master Plan. Most men in their 30’s with long term finasteride (Propecia) use and who are not rapidly losing hair, do not usually have shock loss. An ethical doctor would not recommend surgery to a patient if they feel the risk of shock loss is significant. I know I am a broken record on this, but this is why choosing a doctor and having a good Master Plan is very important.
From the photo, it is evident that this poor woman experienced a terrible hair transplant result from what is a very straight forward hair transplant in the hands of a skilled and experienced surgeon. The surgeon who did this clearly did not understand the basics of hair transplantation. In away she was lucky as many of the grafts did not grow so the repair will be easier. The repair would be to remove each of the grafts (one by one) and then reconstruct the entire hairline in the proper location with hair placed in the proper direction, burying the scars that remained so that she should end up with a normal looking feminine hairline.
2019-12-19 04:36:122019-12-19 10:58:52Female hairline lowering hair transplant that went wrong (photo)
Dear Dr. Rassman,
I found this blog a very interesting read, and I appreciate you taking the time to answer questions online like this. It has been a wonderful resource in coming to terms with the somewhat shocking discovery of my hair loss.
I am about to start treatment with propecia for my thinning top, but there’s something that has been nagging me:
I want to heed this blog’s earlier recommendation and wait until after a year on propecia before trying Rogaine. But isn’t it “the earlier, the better” even with propecia working in the background? Wouldn’t this delay risk my potential for improvement? Wouldn’t it risk killing miniaturized or dormant hair?
It is my hope to completely eliminate the visible thinning with medical treatment. I realise my odds aren’t super great, but I also feel it wouldn’t take much improvement to achieve this. My hairline has receded to mature levels but seems stable. I will be 25 this year and I only noticed my thinning a month ago.
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Generally, when I recommend a medical treatment for androgenic alopecia (AGA), I only have two proven medications I can recommend: (1) Rogaine (topical minoxidil), and (2) Propecia (oral finasteride 1mg). While you can start taking both treatments at once, it would be difficult to assess which medication had more or no benefit. So I usually give the patient a choice on one medication and they use it for 6 to 12 months to assess how it is helping their hair loss issue before we add on the second medication.
Also, in practical (real world) terms, it is a hassle for men who are not used to taking any medication to stick with the regimen of taking a pill every day (Propecia) and putting on a topical medication twice a day (Rogaine). Before they know it, most patients get lazy, forget to take the medication, or forget to resupply the medication when they run out. I find that in a good percentage of time, the failure of a medication is related to the poor compliance issue. This not only applies to Propecia, but many other medications.
So yes, while starting both at the same time allows you to potentially see your maximum benefits begin sooner, it’s a lot for most men to keep up with every day. And who knows — since you just noticed your thinning, only one of the meds might be all you need.
I have a full head of hair which is shoulder length. However due to many years of wearing a pony tail, I have developed a mild traction alopecia around the neck line and slightly behind the ears. Because of this, I am not able to wear my hair up, or side swept which limits my hairstyles. I was wondering if I may perhaps benefit from follicular hair transplant?
Tight pony tails or ‘pig-tails’ can cause traction alopecia (hair loss from constant pulling). Of interest, the ‘falls’ that women use to add fullness to hair are a frequent cause of hair loss in women who use them to make their hair appear fuller. The more the use, the thinner the hair gets and the cycle of more use to treat thinner hair produces more thin hair.
With that said, the traction alopecia may not be permanent, that is, if you stop putting the traction on it. To find out, you would need to stop using a ‘pony tail’ for at least 6-8 months. What hair does not come back is probably permanent. There is a difference in the hair at the nape of the neck (which often has a different genetic ‘permanence’) then other scalp hair. Hair in the nape of the neck is generally more fragile and can be lost with stress (like traction).
We have extensive experience with treating temple hair and hair at the nape of the neck. The neck transplants were usually secondary to scarring from flap procedures which were surgically induced. The temple hair has been done in many, many patients wanting to move the temples forward or replace them from thinning. Send some pictures to me and I would be happy to give you an opinion. My email address is on the Contact page.
I have had several large hair transplant procedures. Subsequent to my last 2 hair transplant procedures I experienced a good deal of shockloss from existing hair which took months to grow back. I am interested in having SMP and was wondering, if because of my previous shockloss experiences from the last 2 hair transplants, would I be suseptible to shockloss from the SMP procedure?
Thank you
If you are considering Scalp Micropigmentation (SMP), you would need to arrange a consultation with us. Shock loss after SMP is rare, but is a risk you should consider.
Today, I performed a HAIRCHECK test to see if there was any evidence of hair loss present in this 33 year old male. He went on Finasteride 11 years ago and was convinced at that time that he had hair loss. However, the doctor who prescribed it did not really examine him and make an objective assessment of his “hair problem.” Since then, he has been worried about his hair loss. He knew that Finasteride could contribute to a reduced risk of prostate cancer, and since his father has prostate cancer, he is happy to stay on the medication today, even if he is not balding. He has no sexual side effects or any other side effects from the drug since the time he started it, 11 years ago.
It is my firm belief for those of you who read this post, before you start the drug Finateride, to get a HAIRCHECK test. It will help determine:
Knowing what is happening to you is very important from a Master Plan perspective because hair loss is progressive in 100% of men who have genetic balding. The HAIRCHECK on this patient showed that his hair bulk in the front, top, crown and back of the head was equal by HAIRCHECK measurements.
2018-06-29 06:36:562018-07-20 09:52:50Has Been on Finasteride 11 Years and Has Absolutely No Hair Loss. Should He Stay on Finasteride? (Photo)
i had a HT on my crown area. Last night i rolled much in my sleep and i saw i lost a lot of hair in my crown because of the rubbing against the pillow. Can you still damage the grafts at day 20th?
Use an airline pillow and put a pillow on both sides of you so you sleep on your back. Take a good dose of medication to put yourself to sleep. Keep this up for a week. If this happened at day 20, then there is nothing to worry about as the grafts are fully secure by this time.
What do you mean that after 18 months of finasteride it wont fully stop hair loss anymore and just slow down? i thought finasteride efficiency never deteriorates for decades
Finasteride will not hold off hair loss forever, but it does slow it down for many, many years in some men.
2020-02-11 04:00:312019-12-09 15:12:52Finasteride After 18 Months
The idea I had is, that I want to implant hair into my frontal micropigmentated area, but since I am young(only 23-Norwood 3 almost 4),I know that I will keep on losing my hair and the donor area is limited, so I am interested in speaking with my HT doctor, and convincing him to transplant me a smaller amount of hair only enough to give the impression of hair which will be accentuated by the micropigmentation. I think this could be a good idea, as I am ok with having a short haircut, like in the photos.
My problem is that I do not know if it would work for my frontal balding area, as most people who have combined SMP and HT seem to have had it done in their crown area.So I am really curious if any of you guys could give me any advice or opinion, as I am sure most of you know how depressed this whole ordeal this can make someone feel ,and any response would be greatly appreciated. I will try posting some photos down bellow of me and the length of hair of hair I’m interested in keeping and the bald/micropigmented area.
If you do Scalp Micropigmentation on the areas you showed, you must shave your head or it will not look good. I would advise against a hair transplant at this time. If you have a hair transplant later on, you can do this on top of your SMP. I just did someone this week who took this route. Having had SMP a few years ago, he decided recently to transplant the hair he needed above it so he could let his hair grow out.
2019-12-17 04:00:462019-10-26 13:07:20SMP First, Followed by a Hair Transplant (Photos)
