Balding Blog

Thank you for this blog. I have a question for you: is it worth getting a hair transplant without taking minoxidil or finasteride after? I’ve tried both, and react poorly. Minoxidil foam irritates my eyes, and I can’t use it; while finasteride just kills my libido.

I’m seriously considering a hair transplant but wondering if it’s all for naught if I can’t maintain it with these drugs. I’m about a Norwood 3V right now.

The decision to have hair transplant surgery has nothing to do with taking Propecia or Rogaine. You don’t have to take Propecia or Rogaine to have hair transplant surgery.

Some doctors may recommend that you take these medication but it is not mandatory.

Reader Tom asks…

My hairline has been receding for a number of years, I am now 62 and recently had a heart attack. It seems to me that the hair loss has accelerated since that trauma. My hair now has sort of a trough down the middle that was not there before, but it was thinning. My question is, Can a heart attack cause acceleration of hair loss and can hair replacement techniques be employed to reverse it? Thank You

Hi Tom, thanks for writing.

There are generally four causes of hair loss in men. Genetic inheritance and male hormones are the two most important. Time and stress are the other two. Typically, genetic hair loss occurs well before 35 years of age, and in most people it slows down with time. There are some older men who start showing the hair loss over the age of 45, although this is more the exception to the rule. Don Ameche, a popular film actor in the 1930s and 40s, was a hairy sex idol even at the age of 50, but was bald at the age of 75 when he had a prominent role in the movie Cocoon. So, he had an ‘expression’ of his genetic balding late in life. Your heart attack certainly brought on ‘STRESS’ and with a delayed genetic expression, probably precipitated your hair loss. I have seen this in illness or even divorce, both of which are heavy stress induced initiators for hair loss in the genetically prone man.

As your hair loss is recent, I would probably recommend that you go on the drug Propecia, because continued hair loss is possible. This drug may slow or stop the progression of the hair loss and it might even reverse it. If it does not do the trick, then a hair transplant works wonderfully.

Hope this answers your question.

Received this email yesterday…

Why would someone who has been in Cardiac, Orthopedic and General Surgery be doing Hair Transplants? Did you fail at these other fields?

I would start off saying that I was very successful in every field I have been in. Part of the reason that I moved around a great deal was general boredom or lack of stimulus. In the hair restoration field, I have had the opportunity to become intimate with my patients. I have had similar intimacy with my patients when I treated their cancer, but the involvement with them was make the best out of a bad situation. If they survived the cancer, they wanted to forget it and I was more part of that period of their life (where forgetfulness is part of the denial process).

In hair restoration, the entire process up-scales as it progresses. The further down the path you take it, the more the intimacy and the pure pleasure you get with each milestone the patient achieves. First, getting to establish rapport is a challenge. Two people getting together, one with a problem and the other with a potential solution. The prospective client wants to determine: “Can I trust this doctor to do what it is he says he can do?” Once the relationship is cemented in place, you plan together what you are going to do. You share his/her intimate thoughts and fears and guide him/her though the plan like an architect experiences when he/she shows the plans for a new house to a home buyer/builder. This is a wonderful experience that for me only gets better as I deliver what it is I promise to deliver. While waiting out the growing stage, like a find lawn and garden, it takes time for the brown dirt to turn green and for the flowers to bud and bloom. But when the hair comes in, wow, what a HIGH it is for the doctor and patient to share.

I have been in the unique position of having done some of the most difficult surgeries on the human body. Early in my career, being able to perform them competently was my goal. The intimacy part of the process in the world of difficult surgery does not have the same significance with it as in the hair restoration business. The general surgery focused for me on issues of technical competence in the first half dozen years. Once I had proved to myself that I could perform almost all of the difficult surgery before me and treat the sickest of patients, the process becomes a matter or routine. Every sick patient in Intensive Care is so sick that they are as far from their normal selves as they could be. Aortic Aneurisms are the same. The ones that are acutely life saving (like those that are rupturing) brings up the adrenaline in the surgeon. Like a ride on a roller coaster, the feeling is frightening and wonderful, both at the same time. But the anxiety of holding a human life in your hands, no matter how exciting, still produces bad outcomes and brings heart break to surgeon and families. Half of all ruptured aortic aneurism patients die within a day of the event, even in the hands of the greatest surgeons. Hair, on the other hand, is almost a complete opposite experience for the surgeon. The results almost always come out the way a good surgeons predicts that they should. The key to success, like aortic aneurism surgery, is skill and in building a good surgical team. The hair restoration business is no different on this technical end where skill and team building is critical, but the patient is always awake and he/she is coming to see the doctor because he/she wants to be there (not has to be there like a ruptured aneurism). My days in the office make me feel that I have great value to people and because of the trust that is built, I have looked at many of my patients as friends for life.

What is the limit for transplant densities?

Hair can be transplanted at a density that approaches 35% of the original density in many people. The ability to place such densities depends upon many factors which include: hair thickness, skin characteristics, the size of the instruments for making sites, the skill of the surgical team at placing grafts tightly together and the processes that reflect the quality management of the surgical team. Not all doctors can place, for example, two hair grafts into a 0.9mm recipient site. Even in the hands of a good surgical team, not all hair grafts can be placed into a 0.9mm recipient site. So there is a balance between what can be done and what should be done. A surgeon with considerable experience in hair transplantation dense packing is best able to make the judgments required for maximizing hair densities. I pioneered Dense Packing with the first published mention in a 1993 article in the Hair Transplant Forum and have been using this technique ever since. More recently, we have moved to combining Dense Packing and Large Session surgeries to maximize yield and reduce the number of surgeries required to get a person to his goal faster.

I just got word that the local NBC affiliate in Los Angeles are going to air a piece about the FOX™ Procedure tonight (April 11) on the Channel 4 News at 11pm. Readers from the LA area should try to watch (or set your TiVo).

Update (April 13, 2005):
Found an article on Los Angeles NBC News

Update (April 12, 2005):
Here’s the video from NBC News in LA.

Read more of “April 11 on NBC in Los Angeles”…