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Is Taking Propecia to Prevent Shock Loss an Indefinite Necessity?

Hi Dr Rassman,

Fantastic site, and I’m really enjoying your cautious matter-of-fact coverage of the new A-Cell technology!

I’m a 28 year old male, slowly but surely experiencing diffused patterned alopecia. So far it’s not visible except when wet, but miniaturisation mapping shows I’m probably headed for a NW7.

I’m interested in whether you think it’s possible in theory for a surgeon to insert A-Cell treated hairs into the balding areas, thus gradually replacing the DHT-affected hair with permanent hair, and ensuring coverage “continuity”. Obviously this will depend on whether the A-Cell hair is in fact permanent.

Also, I believe you indicated in a previous post that finasteride is recommended to prevent shock loss. Do you believe this will be an ongoing necessity? i.e. assuming the new hairs take root and are unaffected by DHT, would a patient need to remain on finasteride indefinitely or only for the months following surgery?

Perhaps you need a good diagnosis of what you have. Do you have diffuse patterned alopecia (DPA) or androgenic alopecia (AGA)? I suppose you can have both, but that would be rare. It’s important to determine the proper diagnosis, because diffuse patterned or unpatterned alopecia is generally a contra-indication to a hair transplant surgery. The donor hair area is questionable in its permanence in those cases.

Thus, even ACell technology would fall into the same uncertainty. In other words, the hairs transplanted with ACell may not be permanent if the donor hair is not permanent. The technology is so new that I do not have an answer for you.

Finally, Propecia (finasteride 1mg) is recommended for men with androgenic alopecia (AGA). Patients who take Propecia need to take it indefinitely if they wish to slow down or keep the hairs that are at risk from falling out. Many doctors (including us) recommend Propecia to decrease the risk of shock loss. For practical reasons, patients who do not want to be taking Propecia indefinitely (but wish to decrease the risk of shock loss), usually take the medication for about one year. Once they stop taking the Propecia they risk the same ‘catch-up’ hair loss phenomenon. The main thing one needs to understand is that Propecia is an OPTIONAL medication and the only thing that we (doctors) can do is to recommend it.

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Is Success is More Important Than Hair? (from Reddit 6/12/19))

Wanted to share some insight with you, in light of all the Incel BS that has been going on in this sub. I will try to make it quick. DISCLAIMER: I know that hair is important and balding sucks and I’m not saying don’t worry about your hair at all, but you need to know one thing. I live in Manhattan, I’m 27. When I first moved to NYC I signed to a modeling agency and did some modeling part time to make some extra money. This is not to brag and I’m by no means even a successful model (I don’t even do it anymore). During my time modeling in NYC, I’ve been fortunate enough to be around some of the most beautiful women in the world, and even been able to date some models here and there.

I want to make one thing very clear. The majority of the models I have met (especially ones in the 24- 30+ range care WAY more about success, confidence and personality, than they do looks. Sure, for a hook up here and there, they may go for the hottest guy, but the overwhelming majority of these girls end up In actual relationships with: entrepreneurs, bankers, business owners, Managing directors I.E confident successful men, most of whom are very average looking and a lot of them with bad hair (I’ve seen this over and over again with my own eyes) Actual beautiful women who can get any guy they want, care way more about their future with a guy than their looks.

The take away here is, if you’re going to put all your time and energy into something, put it into bettering yourself and trying to be super successful and don’t let MPB be the end-all be of your life. I know a lot of you already know this, but a lot of you also really need to hear it.

I believe that a good woman will care more about what is in your head than what is on top of your head. I totally agree with this post but the problem many men have, is that because of their hair loss, they lose confidence in themselves. I remember a young actor on one of the morning daily soap TV shows, a long running show in which he played the young man that the married women wanted to seduce. He came to me at the age of 20 telling me because he was losing his juvenile hairline and was developing a maturing hairline, that he was going to be terminated the next season. So he asked me to reinforce his juvenile hairline so he could keep his job as a ‘sex icon’. After the hair grew in, they renewed his contact which was for over $1 million/year. Another actor, came to me for hair loss in the frontal area and I put hair there. In just one surgery he radically changed his look. He landed the big leading man roles. He told me that it was not just his hair, but his self-confidence that changed and the combination of the two is what made his career. Everyone knows him today and he is a well known leading man in some great films. Self-confidence is hard to come by when you are losing your hair and you are early in a career without accomplishments, so the boost of some hair make the world of difference for some men.

 

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Is Stress Scientifically Proven to Increase Hair Loss Rates?

You’ve mentioned a few times that stress can increase the rate of balding in those with the genetics for MPB. Is this scientifically proven?

By what mechanism does this happen or is this not known? (i.e does stress increase levels of DHT?)

thanks

Stress has been observed by many doctors as a cause contributing to the hair loss equation. Keep in mind that hair loss has other genetic factors that are influenced by environmental factors, and stress is one of the more obvious mechanisms. I do not believe stress increases DHT levels.

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Is SMP Worth Doing?

Scalp Micropigmentation (SMP) is a cosmetic tattoo. It is not hair and should not be looked at as if it was hair. However, for people with thinning hair, SMP may be the single most effective approach for treating diffuse thinning, giving the patient more value for the amount spent doing it. Hair transplants are much more expensive than SMP. When thinning hair occurs in many people, hair transplants work poorly, particularly when the thinning is diffuse (covers much of the scalp). Many doctors who do not know how to do SMP seem to gravitate to what they do know. So, these doctors recommend hair transplants rather than SMP, even though an SMP procedure would be better for the patient. For diffuse thinning (a common finding in 50% of women with hair loss), hair transplants can’t obtain enough grafts to increase the overall density to a level that will satisfy the patients. SMP, on the other hand, reduces the contrast between hair and skin color so well that it increases the appearance of fullness to a normal level in most people. A comparable hair transplant, if a patient have enough hair, could cost tens of thousands of dollars. Even if one could afford the procedure, few people have enough hair to fill in a diffuse thinning hair pattern (in either women or men). So, we offer SMP for patients with thinning hair, regardless of the cause. These patients are the happiest patients we have. I would say that our overall satisfaction rate far exceeds 95% because, unlike hair transplant where the hair loss continues to progress, SMP addresses the entire thinning problem in the short time frame while it is being done, regardless of the hair loss progression that may be present. Patients who had SMP rarely return for more treatments once the process is complete.

 


2018-06-22 11:48:35Is SMP Worth Doing?

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Is SMP risky for people with hair?

Looking to get the opinion of Males or Females that have gotten it. I find SMP to be riskier than a transplant, half the People who are bald and get it regret it. There aren’t a lot of stories of people with hair that get it.

We have done quite a few men and women with thinning hair applying tattoo pigments with great responses and happy patients, see here: https://scalpmicropigmentation.com/gallery/thinning-hair/ . It is a great adjunct for people with thinning hair especially for women who have no other options when they are post-menopausal.


2020-11-04 08:46:59Is SMP risky for people with hair?

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Is SMP Basically a Permanent DermMatch?

Hello dr Rassman
Am thinking about having SMP but am not sure if i will get the same result as dermmatch. i had HT about 8000 grafts, and now when i use dermmatch with a little of toppic fiber my hair looks perfect but i want something permanent. so please i need help to decide.

DermMatch is a kind of powdered paint (albeit a crude description) — it is not permanent and while it is not detectable up close when applied correctly, you can feel it and it does come off on your pillow and hands if you rub your scalp. Toppik is a similar temporary camouflaging product, but it adds little fibers to existing hairs to provide a visual bulk.

On the other hand, Scalp MicroPigmentation (SMP) is permanent, you can not feel it by touch, and if it is done by someone that knows what they are doing it should not be detectable up-close. Everyone is different and whether this is what you want to do is a something you’ll need to decide on.

What I would suggest is that you attend one of our Open House events in Los Angeles. We hold them every month in our office and we show off actual patients who have had SMP done so you can see it being done, feel it (with the permission of the patient) and look at it up-close to judge the answer to your questions yourself. Seeing and touching is believing.

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Is Shock Loss Permanent?

In the interest of keeping things as private as possible, I have removed the Doctor’s name from this email I received…

Hi Dr. Rassman,
I read your recent comment about young guys under 30 years old who get an HT and are not on Propecia. I fit into that profile. I recently had a HT with [another doctor] and its 4 months post -op now. had a lot of shockloss of original hair post op and am really concerned now that I read your comment online [see: Hair Loss After Transplants]. Since I had sexual side effects when on Propecia, I had to quit it and cannot tolerate being on it.

I received a total of 3366 grafts in total. Am attaching Before Hair transplant pictures with this email and 6 weeks post op pictures. According to [my hair transplant doctor], he feels that the shockloss will mostly come back and eventually I will have good results. He recently asked me to take Saw Palmetto and see if I can tolerate being on it. Started taking 320 mg of Saw Palmetto twice a day recently.

Please advice what I can expect from the procedure. Do you think that I will permenantly lose a lot of original hair that has fallen due to shockloss for good? Or will it mostly come back?

I’m seeing growth in the 4th month but not sure if the shockloss hair is coming back or it is the new grafts that are growing in. To highlight my case, I mostly had diffuse thinning in frontal 1/4 of my scalp. The hair that was there was strong and had a thick shaft, there might be other miniaturized hairs, but looking at my pre-op pictures you will get an idea of the state of the existing hair follicle.

Thanks a lot for your time and effort.

My current regimen includes : minoxidil 5%, topical Spironolactone 5% cream from Lee’s, 3000 Mg of MSM, 2% Nizoral trice a week, Recently added : betnovate topical lotion, 320 mg Saw palmetto twice a day, Folligen lotion.

I have had an opportunity to review your questions and photographs. For our general audience who are reading this, I will summarize the salient points.

You appeared to have a large surgical session with dense packing based upon the number of grafts reported by you. The frontal area appears to have been shaved for the procedure and the growth of the hair does not reflect the normal growth that one would expect in 3 months. This is a case of hair loss transplant shock in a young man, just as my previous responsive email reported to another young man. There is a possibility that the hair that you lost may come back. Most likely though, it will not return. Other medications have not been shown to be effective (like Propecia). In people like you, I generally try to cover the short term transplant period with half of the Propecia dose, even if it causes some drop in sexual performance just to protect the hair.

The good news however is that the new grafts that you had done should (hopefully) more than offset any loss you may have. You will know reasonably well at about the 7-8th month by comparing the two sides. The left side that seemed to suffer more of the reactive hair loss needs to be compared to the right side. If the hair loss was reversed, the densities of the two sides will be the same. Please drop me a line or send me photographs at the 7-8th month and I would be happy to give you further insights. Good luck.


2005-04-20 15:38:33Is Shock Loss Permanent?

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Is Scarring Common at the Recipient Sites?

Thank you for the time and effort you put into answering all of our questions. My question regards scarring. I have heard some people say that scar tissue forms where the hairs are implanted during a transplant, and that this can result in bumps or raised spots on the hairline. Is this true? If so, is it common? If not, why don’t scars form where the hairs are implanted? After all, a wound of sorts must be made to implant the hair, so how would do you prevent hundreds or thousands of scars from forming after a hair transplant?

With the technique we pioneered, we do two things that minimize recipient site scarring —

  1. We make very small wounds in the skin, essentially slits that approximate the size of the grafts. These heal very fast.
  2. When preparing the grafts for implantation, we cut off the skin disk at the skin level. To minimize the skin disk, we remove the top layer of the graft skin from the surface of the graft. This prevents the skin from surviving the transplant which could, in some individuals, produce the bump seen in recipient areas. The same process is done with grafts taken from strip surgery.

When doctors use grafts that have a larger surface area than what I described above, the bumps you referenced get more prominent. We have seen from the old days when plugs were done and the graft sizes ranged from 3-5 mm across, the skin always was deformed. Clearly the more skin that survives at the top of the graft, the more detectable will be the existence of the transplanted graft.

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Is Saw Palmetto a good drug for blocking DHT?

Hi, I didn’t understand if Saw Palmetto can decrease dht levels in blood and if it can do a visible results in hair health. Because i know that finasteride is the n#1 remedy used for AGA. Saw Palmetto should be a sort of ‘natural propecia’, less effective but without relevant sides as finasteride. But i really don’t understand if a man can have results in hair density and regrowth taking only saw palmetto. I mean if the starting situation of hair is not so bad (a little thinning hair but not bald at all).

There are many studies that show that Saw Palmetto is a very weak and poor DHT blocker for hair loss. Intersting read: https://baldingblog.com/general-questions-on-dht-blocking-supplements-have-birth-defect-risks/