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Appropriate Amount of Grafts in Frontal Area

Dear Dr Rassman,
I am a 24 yo male who has experienced hair loss in the frontal region and am told that i am a Norwood type 4. I went to see a surgeon/dr in Australia. He told me that the best treatment was to have one large megasession and that he would use 2500 grafts on the frontal region. I am curious as to know whether this is an extreme amount in that region and your feelings on megasessions. I was also wondering that given my age how many sessions in my lifetime will i need and how frequently do people my age have to have more done. If i had a megasession would there be enough hair in my donor area if i did suffer more hair loss. Is there any way of doing a procedure, where you have existing hair, to transplant it to that area to prevent it if it was to fall out. Does one procedure in people’s liftime exist if they stay on propecia (which I am on, and doesn’t seem to be working that well).

Sorry for so many questions Dr Rassman. Thank you very much for your time.

For a Norwood 4A balding pattern, 2500 grafts in a single session sounds like a reasonable number that might meet all of your needs, depending how large the area is. Most people have about 6,000-8,000 grafts available in their donor area, but the actual number may vary. That is why we measure everyone’s density to determine a Master Plan for the worse case scenario of hair loss. Your age is a bit young, but if the pattern of loss is relatively complete and did not reverse after taking Propecia on a trial basis for 8 months, then a transplant could be reasonably done. Hopefully with Propecia that is consistently taken, the hair loss will at least slow or stop, stalling any need for further transplants for some time. Provided that you keep the work done to the frontal area, there is little worry about running out of donor hair for most people. I would discourage work in the crown at your age.

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Appropriate Propecia Dosage

I was prosribed propecia two months ago to have every other day. My hairloss already seems to be beginning to stabilize over this short time. Hopefully I might get some regrowth in the coming months! I was told the 5 alpha reductase reduction with propecia is still just as effective as if I was taking it every day. However I have read elsewhere that you need to take it every day. While I don’t doubt the advice of my medical professional, I have read here, and elsewhere that I need to take it every day to get maximum benefit. Are there two schools of thought as to the appropriate dosage? Or is it that, as the onset of my MBP is very recent my medical advisor is of the view that I would get an effective response on a less frequent dosage. He claims to have many patients who get a good response taking propecial every other day. Thanks for your help

The recommended Propecia dosage is one tablet once a day.

Some doctors may prescribe half a tablet once a day or one tablet every other day, however these are not the official recommended dosages. One reason is that official clinical research has found that the once a day dosing gave the maximum benefit from male pattern hair loss. Another more important reason is that the half life (the time it takes for half of the drug to be eliminated by the body) is only 5 to 6 hours. So theoretically on the days you do not take Propecia, your thinning hair will have no benefit from the drug. You should always follow the advice of your primary doctor and discuss these concerns with him or her, especially before stopping or changing any drug regimen.

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Appreciation

Yesterday I had a visitor from Saudi Arabia, a well known woman who is actively involved in the womens’ rights movement. She was sent to see me for thinning hair by a former patient I did some 10 years earlier. She came with a message for me, “Tell Dr. Rassman that for the past 10 years, I have been enjoying the hair that he gave me more than I would have ever expected”.

This message epitomizes what I experience every day, a sense of worth communicated by heartfelt patient appreciation.

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Appreciation email from Reddit poster

I wanted to voice my gratitude for your posts! You are seriously one of the most helpful posters and it even makes me a bit emotional that you’re willing to make those posts day in day out. Hair loss can be terribly confusing, but your insightful posts about the current understandings make everything much clearer. Sorry if this message comes across a bit awkward but I really just wanted to let you know you’re very much being appreciated

Thanks. I have worked hard for people impacted by genetic balding for years and have published extensively in the peer reviewed medical journals educating doctors and bringing breakthroughs in the field. Posting on Reddit has given me great satisfaction as it does on baldingblog.com. It allows me to give back some of the things I learned and help a lot of people who are ‘lost’ the hair hair loss conundrum where few doctors seem to understand hair loss. I do this because my patients have made me so successful in the field.

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Applying the Rogaine Liquid is Difficult!

My boyfriend has just started using the generic Rogaine from Costco in liquid form, and I have been helping him since depositing a dropperfull of liquid on the bald spot is not an easy thing to do alone. I use the dropper to distribute the liquid around the spot, but no matter what we do it seems that much of it runs off down his neck or forehead. The rest sits in the few hairs he has left in little droplets.

My questions:
– are we doing this wrong somehow?
– should I be putting on a latex glove and trying to spread the solution around with my fingers?
– would the foam work better? He has the typical bald spot at the crown of the head, with just a few fine hairs and mostly just scalp. But I have found in my research that an awful lot of guys say the foam just melts from your body heat and runs off anyway…

Suggestions or pointers to articles would be much appreciated!

Your problems are well shared by many users of liquid minoxidil, thus Rogaine Foam was created so that the medication stays on the area you want to treat. It may “melt” and run off as you say, but it is better than the liquid in my opinion. If you still want to use the liquid (or your boyfriend does, more precisely), you can apply the liquid with a gloved hand. That might be best anyway, since you’re not using the medication.

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Applying Betadine After a Hair Transplant

after hair transplant about 15 days, I have been infected with pimple not sure it is folliculitis or not. My doctor let me take doxycycline and use betadine leave it for 5 minutes and wash. If I use betadine 2 or 3 times a days can it affect graft survival?

Betadine is a strong antiseptic containing an iodine solution that will significantly reduce the presence of skin bacteria. Infections 15 days after a hair transplant rarely are caused by skin bacteria. Many times the cause is as simple as scratching the scalp, thereby breaking the skin and introducing a source for skin bacteria to invade into and through the skin. When applied topically, Betadine will not hurt the grafts at this stage.

I am not sure what the problem is that you’re experiencing, so it is impossible for me to comment on a treatment. At the least, a picture may help. But since you’re under the care of your doctor, I’d go with his/her treatment plan.


2013-06-08 10:59:31Applying Betadine After a Hair Transplant

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Do I apply minoxidil twice a day, really!

I’m planning to start minoxidil but not sure if I can manage applying it twice a day. I can apply it in the morning but my schedule is random everyday. Most days I don’t get home till around midnight so if I have to apply it then I’d have to wait till 2-4 hrs before I can sleep.

Once a day at night is fine. I recommend that you take a hot shower and then apply it before bedtime. The heat will open the porse in the scalp and increase the circulation so that more of the minoxidil will be absorbed.


2017-12-16 06:55:42Do I apply minoxidil twice a day, really!

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I Applied Minoxidil 5% to My Scalp – It Worked to Bring Scalp Hair Back, but My Face Developed Hair as Well

Minoxidil, when absorbed through the skin of the scalp, will produce body hair. Facial hair is a known side effect. Either reduce the dose or stop the medication to reverse the facial hair growth. With good results on your scalp, I understand how difficult this will be for you. You must make sure that the liquid does not get on your forehead or face when using it.


2018-05-18 08:49:28I Applied Minoxidil 5% to My Scalp – It Worked to Bring Scalp Hair Back, but My Face Developed Hair as Well

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Application of minoxidil, finasteride and the use of Dermaroller (called “The Big 3”) from Reddit

This is a combination of treatments commonly used by many young men on the Reddit post. There is evidence that minoxidil plus the Dermaroller works by itself to some degree but adding finaseride makes is a more certain response as shown here after 5 months of use.


2019-02-12 06:40:17Application of minoxidil, finasteride and the use of Dermaroller (called “The Big 3”) from Reddit

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Appearex

Hi,
I’m a 40 year old female experiencing severe hair loss. I’ve had problems with hair loss for the past 13 years but last summer I went to a local salon to have the graying covered with some highlights. Whatever she used burned it because after that the hair strands are very thin and dry. I use alot of conditioner and it doesn’t help. I noticed that when after she washed the hair that it was severly tangled which resulted in her having to cut 3 inches from it to get the knots out from the burning. My hair was at that time past my knees with very few split ends. It is now around knee length and I keep it pulled up in a clasp. I have enclosed some photos to show the hairline-thinning-damage. I’ve been prescribed (Appearex) and don’t know much about it. Does this product actually help the hair as it states on the box that it’s a nail product? I have taken Lupron injections in the past and not sure if those created some of the hair loss but the problem is getting much worse and I don’t have a clue what to do about it. Thank you for taking the time to help others, and any advice you could give would be greatly appreciated.

Appearex is a dietary supplement. Its generic name is biotin. Biotin is a water-soluble vitamin component of the vitamin B complex. As an essential nutrient, biotin acts as a coenzyme for the body’s carboxylation reactions and is a factor in maintaining healthy muscle, hair, nails, and skin. If you are Vitamin B complex deficient, then this may help your problem, but few Americans have such Vitamin problems with any reasonable American diet.

Because dietary supplements are essentially unregulated in the United States, you can not be sure what you are getting when you buy an over the counter supplement product. There are many preparations on the market (prepared or manufactured with different techniques that are not fully disclosed or regulated with different additives). With different preparations, the same supplement may not have the same effects or equal potencies. Because there is no regulation, the efficacy or the validity of such ingredients cannot be guaranteed. That is why you sometimes hear it is a “buyer beware” market.

There are many causes for hair loss. You should be evaluated by a medical doctor to rule out a medical cause for hair loss. If you are still not satisfied, you should see a hair transplant doctor to map your hair for miniaturization and a possible pattern for your hair loss.


2006-04-06 13:36:13Appearex