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What Caused My Transplanted Hair to Thin 6 Months After My Surgery?

I’m 6 months into my hair transplant and it seems to be getting thinner from about 2 months ago. I was under a great deal of stress a few months back. Could that cause a thinning of the newly transplanted hair. I use Rogaine and Avodart every day. The doctor said it was ok to use on the new hair. At the 4 month mark it really looked promising. However it has definitely thinned since then. Any suggestions on the cause?

Hair transplant surgery is highly variable in terms of the individual patient, as well as the techniques used by clinics and doctors. Many people who have a hair transplant will actually lose some of their original hair and that may be the cause of what you are seeing.

The general estimate is that it can take 4-8 months to see results, and usually the majority of the results are visible by the 8th-12th month. I’d follow up with the doctor that did your surgery.

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Headaches from Rogaine Foam?

Hi, i’ve been using rogaine foam for about 7 1/2 months, and started using nioxin system 1 shampoo and coditioner. i’m starting to get a lot of head aches i think from the foam (since i think i’m using too much) and i’m not sure i’m getting much results, so i was thinking of starting using propecia, except it’s costly and i’m afraid of the side effects, seeing as i’m only 22, male. i heard the younger you are though, the less likely you are to have side effects from propecia, is that true?

i’ve been reading around and would like to only use .5mg, by cutting themin half. is it safe to just take a knife and cut them in half though? and i’ve heard using nizoral shampoo along with the foam is considered the “big 3” and has shown a good amount of results for people, do you recommend using all three products?

HeadacheHeadaches may be from the hypotensive impact of minoxidil (Rogaine), which does drop blood pressure in some people. You may be using too much of it, or may just be too sensitive to it.

If costs on Propecia is too much, you can get a prescription for the genetic finasteride 5mg tablet and cut it into quarters. At our local Costco, the cost runs about $5/month for the 5mg generic. With regard to halving the dose, the financial solution to your problem is discussed already with the generic finasteride… and why take half when a full 1mg dose is better? Side effects are rare in men of all ages, but I don’t recall seeing statistics about side effects relating to age.

You can use Nizoral, but aside from being a good shampoo, I’m not sure it’s going to regrow your hair. If you’ve got the financial means to do so, you can continue to use all three products.

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What Do You Think of Hair Graft Calculators?

This doesn’t work because there are other factors that are not being taken into account, such as: (1) Donor density (available hair that you have now) to cover the hair loss you have now, and will develop in the future, (2) the thickness of your donor hairs, (3) the color/contrast between hair and skin color.


2020-01-20 11:21:37What Do You Think of Hair Graft Calculators?

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Help, I’m 16 and Balding!

Hello Im balding as a 16 yo guy. My temples are already norwood 2 (but it doesnt matter as my hair covers it) BUT now recently I started shedding in the crown. When I brush my crown I find 5-7 hairs everytime. It didnt used to be so much a few months ago. And This is scary as fuck. But I dont know what to do. Should I start minoxidil? Please note that my crown balding isnt really visible yet and seems more like a cowlick, but this is terribly scary.

Im also concerned that minoxidil wont stop the shedding, will destroy my collagen and make me look older. Of course finasteride and other DHT related meds are out of the question here because of my age. What should I do?? Im really lost here, nobody believes me from my dermatologist to my family, they are all in denial.

Start off by getting a HAIRCHECK test ( https://baldingblog.com/haircheck-test-how-it-is-done-and-what-its-value/ ) to find out if you are really balding and then with a metric, you can follow the process over the years with yearly tests. As you treat the hair loss, you will know what is happening with the impact of the treatment.

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What Hair Can Shock Loss Effect? — and the Cost of Hair Transplant Surgery

I can only afford to have my bald patches of my hairline transplanted (FUE) so no other areas of hair will be near. Will the shock loss only affect the donor follicles? or does all of your head hair fall out?

While price/cost is a factor for any cosmetic surgery, it should not dictate the surgery itself. Having cosmetic surgery is not like shopping for the cheapest loaf of bread, laundry detergent, or shoes.

When shock loss occurs, it may be the result of the anesthesia given to numb the head for the transplant and may cover a large area of the scalp, not just the area where the grafts are placed. The mechanical impact of the transplant may not be the cause of shock hair loss. You also have to look at the big picture. We call this the Master Plan. Surgery must be placed along your hair loss timeline and it will be progressive. In other words, you can’t just transplant hair to the small bald patches and expect that to solve your problem, as the balding process is regional. What if you lose more hair around the transplant and behind it as your balding continues? A good doctor should give you insight on your worst case scenario and plan for such consequences. After all, you don’t want to have small patches of transplanted hair scattered around your bald scalp in the years down the line “IF” you were to go bald.

To answer your question in further detail, shock loss is a concern… and while it may not happen, it is a risk. I have addressed your question with the assumption that you have genetic male pattern baldness and not just a patch of bald scalp (which is very rare in genetic balding). Either way, you need a Master Plan created with a doctor (not just me on the Internet) who is willing to look at your hair loss problem as a long term process.

For the follicular unit extraction (FUE), you need to understand it does not work to fill in the scalp balding areas like a patchwork quilt. Do not let the cost of FUE be the primary reason in your decision making process as to what to do and where to put the hair. It is better to be bald than be disfigured with a half-ass surgery.


2009-10-13 18:57:27What Hair Can Shock Loss Effect? — and the Cost of Hair Transplant Surgery

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High-Fat Diet and Hair Loss?

Hello doc,

I found this text on a website recently “If you look at Japan, male pattern baldness was almost unheard of prior to World War II. The Japanese diet is now far more fatty and Westernized, and Japanese men are going bald everywhere. It’s clear that a high-fat, meat-based diet raises testosterone levels, and that may adversely affect hair follicles.”

– Do you have any information about this? Could this be true?

CheeseburgerWhile it is true to some degree that we are what we eat, hair loss comes about because of four components. Our food intake (if normal nutrients are ingested) is not one of those four. They are:

  1. Genetic elements for balding
  2. The male hormone in adequate quantities for healthy men
  3. The time the hormones and the genetic defect interact
  4. The amount of stress in the life of the person

I have a problem when someone is comparing early 20th century assessments of hair loss and modern 21st century assessments of hair loss. I also have a problem with the comment that ties healthy diets to hair loss in any way. The “authority” seems to originate from a talented man and nutritionist, Michael A. Klaper, M.D. He does not cite any evidence for his opinions and uses the term “may” when commenting on the connection between meat in the diet, testosterone, and hair loss. In my opinion, a statement like, “male pattern baldness was almost unheard of prior to World War II,” really can not be based upon any reasonable scientific observation and if I am wrong, I would want to see it. Who would be making such an assessment in a closed, almost feudal society like pre-war Japan? Balding is big business in modern Japan, which supports the largest hair wig manufacturer in the world. Many of the people of Japan still maintain the more traditional diets (they are not hamburger freaks) yet they lose hair. Studies have shown that there is little difference in balding statistics between races.

The website which originated these comments appears to be MotherNature.com and it does not show any convincing evidence to support the posted statement. Show me the science and I would be willing to change my mind.

However, it is documented that daily vigorous exercise (like endurance training) and lower fat/total calorie intake will decrease the free testosterone and DHT levels, and you can assume that this can decrease hair loss (see Relationship between stress hormones and testosterone with prolonged endurance exercise). Does a low fat diet alone decrease the levels of testosterone and DHT? That is not clear.

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What If Dr Rassman Retires Before I’m Old Enough for a Hair Transplant?

Dr.Rassman are you the only person who performs transplant. If not i would rather have you do it as you are well respected, i wouldnt feel as happy if anouther surgeon at NHI did my surgery. Also can you see anytime in the future were you may retire and if so will NHI still be in buisness, if so how could you replace yourself with someone as good as you. If you left i probbaly wouldnt get surgery at NHI. Im 18 and have a receding hairline, im worried that by the time im 25 and want a transplant you may not be doing transplants any more.

Just to make this perfectly clear — I’m not retiring anytime soon!

Yes, even if/when I do retire, NHI will be in business. Dr. Jae Pak (whom I’ve known and worked with for over 10+ years) was personally trained by me and is a great transplant surgeon. He and I both do hair transplant surgeries at New Hair Institute. You will be in good hands with Dr Pak.


2008-05-21 10:48:12What If Dr Rassman Retires Before I’m Old Enough for a Hair Transplant?

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Histopathology of Non-Scarring Alopecia

Hi Dr. Rassman, I was wondering if you knew the histopathology of non-scarring alopecia in a 21 year old male? My dermatoligist said I had diffuse hair loss and non-scarring alopecia and prescribed me Propecia; I am also taking Rogaine. Additionally, what do you think of spirinolacatane as a topical treatment as an anti-androgen for this type of hair loss?

Thanks

The histopathology of non-scarring alopecia is just as it states — When you look under a microscope of your scalp biopsy there is often cells seen that reflect some autoimmune disorder, but no scarring where there is hair loss. Examples include anagen effluvium, androgenetic alopecia, chemical alopecia, folliculitis (mild), inherited disorders of the hair shaft, telogen effluvium, alopecia areata, and traumatic alopecia.

Of the list above, the most common non-scarring alopecia is genetic balding (otherwise known as androgenic alopecia — AGA; otherwise known as male pattern baldness — MPB). And since your dermatologist prescribed Propecia for your non-scarring alopecia I would guess that your dermatologist thought you had MPB. It probably would’ve been much easier if you were just told that you have male pattern baldness. If you have diffuse unpatterned alopecia (DUPA) then the donor area behind your head would have substantial miniaturization. Speak with your doctor about how he/she arrived at the conclusions.

Finally, spironolactone has anti-androgenic properties, but clinically there is little good evidence that it helps with MPB.


2008-02-20 17:14:36Histopathology of Non-Scarring Alopecia

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What Is Body Dysmorphic Disorder?

My doctor told me that I was body dysmorphic. I looked it up and got upset with my doctor. It suggested to me that he thought I was crazy.

There is a psychological condition know as “Body Dysmorphic Disorder” which cosmetic surgeons of all kinds (i.e. not just hair surgeons) have come to be familiar with. It is characterized by a feeling that one is deformed or very odd looking in some way when in fact one’s appearance is normal. Manifestations can range widely, from believing that one’s nose is malformed (anyone famous come to mind?), to perceptions of imperfection in one’s hairline. These patients have a preoccupation with their appearance that borders on obsession, and they often have multiple cosmetic surgeries to address the “problem”, often moving from surgeon to surgeon. Since the “deformity” is really a problem with self-perception, and not with the body itself, surgery rarely cures and often exacerbates and reinforces the individual’s feeling of deformity. The key to diagnosis is the dramatic disconnect between a normal appearance and the patient’s exaggerated feeling of being defective. A normal patient usually looks to improve their normal appearance, and they do not believe it is a deformity.

Some people (like Jimmy Durante and W.C. Fields – very old movie stars) played up their huge and pock marked nose deformities and exploited them for profit as part of their persona. This is not Body Dysmorphic Disorder, but just simple good business exploitation of a body part, similar to what Marilyn Monroe or Brigitte Bardot did to another extreme.

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How about doing a small hair transplant? Is this reasonable?

I don’t need a hair transplant now but maybe in the future I will. If that happens, do I start off with a small hair transplant and then get more as the balding progresses? I’m curious if in the future I ever do need a small one. Whats the minimum amount of grafts you can have for a hair transplant or the minimum they would be willing to do (provided of course you only needed a very small amount obviously and had very minimal hair loss)

I always tell patients that a hair transplant should be part of a Master Plan for genetic balding that is a progressive state in all men. There is no such thing as being a ‘little bit pregnant’ so if you are going to do a hair transplant, plan it and take your time. A good decision today is a good decision tomorrow.


2019-05-19 10:23:30How about doing a small hair transplant? Is this reasonable?