Hair Restoration Blog

Today, technological advances in medicine have opened up new options in all areas of medicine. We have watched the evolution of glasses to hard contacts to disposable contact lenses to Lasik surgery. The benefits of these new procedures empowered many to change their destiny. People do not have to live with conditions like eye problems, obesity or baldness that strongly effects and influences their self-esteem and quality of life.

In my experience as a hair transplant surgeon many women will reject men only because they are bald; many others associate baldness as being less masculine. Now this is not true for all women, but certainly there is still a palpable negative social stigma associated with baldness.

I had the opportunity to study, research and publish on the psychology of hair loss and hair restoration. Today, we know that hair loss is a real concern affecting many men and women’s well-being  This is a social reality. More importantly it is fact that medically we now have amazing solutions for many types of hair loss conditions.

The advance in hair transplantation technology over the past decades makes available procedures like FUT, FUE for hair restoration procedures that provide natural and proven results. I say: why not use it? A lot of people are doing it, and nobody knows if their hair is native hair or transplanted hair. The key point here is: they are not bald anymore and they feel good about themselves. People with today’s natural and permanent hair transplants face the world happier and more confident people.

Here is what I recommend: Be yourself and do whatever makes your heart happy. No matter what you do with your life, there are going to be people who may not like it. It should not influence your decisions. If you think an elective surgery such as hair transplant can drastically improve your life don’t hesitate. Seek a professional consult from a hair transplant doctor. Let baldness be only a thing that our ancestors had to experience.

Q:

I have read online that Propecia can cause depression as a side effect. Some articles I read say it is a very rare side effect and others say it can occur in 75-80% of the time. Which is correct?  Thanks.

A:

The primary clinical trials on finasteride (Propecia) were conducted with a large number of patients over a period of 5 years. These initial trials did not reveal any evidence of depression in the participants. However, subsequently a few more recent reports indicate the possibility of depression occurring after taking finasteride.

A prospective study on 174 young men in 2004 suggested a higher chance of depression in men who used finasteride. The authors of the study concluded that finasteride might induce depressive symptoms. The recommendation from this study was that finasteride should be prescribed cautiously in patients who have higher risk of depression. This could be further underscored by the studies on psychology of hair loss and hair transplant in patients which notes alteration in self image and esteem and possibility of improvement of depression. The 2004 study emphasized that further clinical research is necessary to evaluate the behavioral effects of finasteride in higher doses in patients who are more susceptible to depression.

Based on the results of this study, we cannot suggest a percentage for depression in patients taking finasteride. Obviously, if you are experiencing mood disorders or any other symptoms while taking finasteride, you need to discuss it with your doctor for further diagnosis and treatment.

Who is going to win the 2012 Presidential Election?

President Barack Obama and Republican Nominee Mitt Romney have great heads of hair. Unlike many men in their relative age brackets. Is this why the polls are so close in this election?

We have published an article on Psycho-social impacts of hair loss and hair restoration on people’s lives in 2008. Observing the most recent presidents and or candidates Clinton, Gore, Kerry, Bush thick hair has been the order of the day. John McCain a much older man had notably thinning hair but styled to reduce the look of baldness.

Does hair really count for our social status and public approval? When it comes to presidential election which one do people trust more; a person with full head of hair or a bald person?

Harold Stassen, who is known as the country’s most failed presidential candidate, ran for presidential election nine times.  He wore a hair piece in most of those elections.  He chose not to be seen with a bald head in his presidential races. Wearing a toupee no matter how unnatural was safer than presenting himself with a naked scalp.

America has had more than five bald Presidents in the past, mostly before the time of the TV and visual public media. Americans haven’t voted one bald president in fifty six years.

Steve Rushin the author of this article from Time Magazine says: “As a realist, I know I can never be President, will never be part of the American HAIRISTOCRACY.

The presidency is not one of those high-profile jobs in which you can sneak by with a paisley head scarf (think Steven Van Zandt of the E Street Band) or a pompadour wig (think Steven Van Zandt of The Sopranos).”

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Bibliography

Rushin, S. (2007, October 25). Bald Truth. Time Magazine

Q:

I am to have a hair transplant surgery with you this early July. I’ve noticed increased shedding lately and thus have been researching additional pharmacological adjuncts to add to my daily regimen. I am currently taking 1.25 mg Finasteride and shampooing with Nizoral 2% a few times a week. I’ve read online that topical Spironolactone has been used by some with some results, and wanted to know your thoughts. I’ve also found other topical medications ( especially Monoxidil) that I cannot use due to my daily use of concealer. Are there any other medications, topical, shampoos etc. that you can recommend?

Thanks ,

A:

Minoxidil and finasteride are the only two FDA approved medications for hair loss treatment.  Nizoral (ketoconazole 5%) is an antifungal and anti dandruff medication that can also affect hair loss in male patterned baldness.  Nizoral is not one of the FDA approved medications for hair loss treatment.  Spironolactone or Aldactone is primarily a medication for treatment of hypertension, but it has some anti-androgenic effects.  Systemic administration of spironolactone has been shown effective in some forms of female hair loss. Spironolactone in its systemic form is not recommended in men due to its side effects such as sexual dysfunction.  There have been limited studies on the topical spironolactone for treatment of acne and hair loss so we don’t recommend topical spironolactone for treatment of hair loss for androgenetic alopecia in men.

If you want to do everything possible to minimize the hair loss, you can add minoxidil to your daily regimen of finasteride.  Minoxidil is recommended to be used twice a day, but once a day could be used as well.  You can use it in the morning before you put on the concealer or at night after you wash them off.  Minoxidil does not double up the effect of finasteride but can add to it as an adjunct treatment.

 Also See:

Finansteride, Minoxidil Or Both and  Ketoconazole for Male Patterned Hair Loss

Male Patterned Hair Loss Treatment – Webinar by Dr. Mohebi

The most common type of hair transplantation surgery procedures performed are for men suffering from Male Patterned Baldness (MPB). Dr. Mohebi discusses the effects balding has on men and the solutions available to restore their lost hair.

Q:

I went to a couple different hair transplant doctors for evaluations when I was 24/25 and was told I have a juvenile hairline and that i have a good donor area and scalp laxity. The doctors recommended around 2000 grafts to fill in the diffused area at the time.

One of the doctors I visited told me to give propecia another try which I did for an additional six more months, but stopped because it seemed to have no effect and from my understanding it doesn’t really help with hair in the frontal area which was my main problem. I also did not want to risk getting any more health side effects from taking propecia.

During this time I was also taking biotin supplements which I had read are good for hair but they didn’t have any noticeable effects. I decided against getting a hair transplant because of my age and I wanted to see if the hair might grow back naturally (some people who have lost hair from accutane reported regrowing their hair several years after taking the medication).

I have a history of MPB in my family but it seems to be hit or miss. My grandfathers both had full heads of hair, my dad and 1 of his brothers are completely bald but another brother has a full head of hair. My mom has 1 brother who is bald and another with very thick hair and a low hairline (which my hair most closely resembled before taking accutane). I also have a brother who is 21 and has extremely thick hair like I used to with no signs of hair loss whatsoever.

A:

Male patterned baldness (MPB) is a progressive condition and it generally won’t get better without treatment.  The medications that are being used for the treatment of hair loss are generally for maintaining your existing hair and have preventative effects rather than restoring your hair at its full thickness like what you had in previous years.

A good hair transplant surgeon can help you realize what the best options for hair restoration are; whether it is a surgery or medication.  Using Accutane could cause hair loss as one side effect, but that is reversible within a few months after stopping it.  That is the most common case for medication related hair losses.

It is important for you to develop a good relationship with a qualified hair transplant surgeon whom you can trust.  Then let him walk you through this process.  Using medications for a while is a good idea and some patients respond well to using them.  Unfortunately the results are not permanent and most hair loss sufferers continue losing hair, but at a slower rate.

You can use medications such as Propecia or Rogaine to minimize the speed of hair loss. When it is the time for a hair transplant you can consider that as another option as well.

Q:

My doctor put me on propecia at 21 when I told him about the hair loss and I took it for about six months but it had no effect on my hair loss. I also started to use rogaine around age 23/24 for a couple of months but stopped because it made my hair loss worse (before rogaine the majority of my hair loss was in the front area of my head and after using rogaine I started to lose hair on my crown as well). My hair loss has been pretty stable over the past 2-3 years and I have continued to lose some hair but nowhere near the amount I lost initially.

I wash my hair every 2-3 days and only notice about 20-30 hairs lost compared to the hundreds I lost early on. My hairline has not really been effected at all and my hair loss doesn’t seem to match any on the norwood scale, it is just diffused loss throughout and matches the description of many accutane users who have lost hair. I have also been using the ProThik concealer spray for the past 3 years which works great because my hair loss is diffuse and makes it unnoticeable, but the process of applying it in and combing through it causes my hair to get tangled and pulled out so I think over time that has also contributed to my hair loss. I lose far more hair putting in the concealer than I do washing it and combing through it naturally.

For the first 2 years of using it I would wash my hair and re-apply it daily, although over the past 6-8 months I have gone 2-3 days between washing and reapplying it and only lose 10-20 hairs when I comb through it in the morning. I am not sure how much of my hair loss in recent years has been caused by this but I suspect that is has had some effect, especially during the time I was applying the concealer every day.

A:

Many young hair loss patients may start taking finasteride or minoxidil when they see the signs of active hair loss in their early 20s.  That is the time most people lose hair at its maximum speed.  Medications such as finasteride or minoxidil are only to prevent hair loss or even in some cases slow down the process.  They are not to bring your hair back to where it was before you started the process of hair loss.

I recommend you visit a hair specialist who can perform microscopic evaluation of your scalp (miniaturization study).  That can give you more information about the type of your hair loss and the treatment methods. Having regular follow up visit with your hair doctor helps you to know whether or not your hair loss medication works.  You may also need a hair transplant when the time come and the time and type of the restoration surgery could be discussed with your hair transplant surgeon.

Q:

Hello. I am considering getting a hair transplant and had some questions for you. I am 27 years old and began losing hair around age 21 immediately after using the drug accutane. I was on a very high dose and took more than the recommended amount during those couple weeks because I thought I would get better results. Within 3-4 weeks of starting the medication I lost an incredible amount hair. After losing the hair I read online that hair loss is a possible side effect of accutane and stopped taking it immediately . My hair went from being as thick as possible (my barber would using special thinning scissors because it was so thick) to being able to see my scalp within a month. The hair loss started in a diffuse pattern about 1-2 inches above my hairline and initially the affected area was about the size of my hand. Over the next 6-12 months I lost a ton of hair and was probably shedding a couple hundred hairs a day. I also had a burning sensation on my head for several weeks after I stopped using the medication. The shedding gradually slowed down over time but the hair I lost did not regrow.

A:

Many medications like Accutane may have hair loss as one of their side effects.  If your hair loss was only because of the use of this medication, it should have been improved after stopping it.  You  started losing your hair at the time that most people show early signs of Male Patterned Baldness (MPB).  Being on Accutane may have accelerated the pattern that you were supposed to develop, but probably was not the only reason for your hair loss.

Alopecia areata (AA) is a type of local hair loss due to autoimmune reaction of the patient’s body against hair follicles.  Alopecia Areata generally presents as circular coin shape hair loss lesions, but it can progress to involve larger areas of the scalp (Alopecia Capitis) or even the entire body (Alopecia Universalis).

Several treatment options are recommended for inducing hair growth for treatment of alopecia areata. Some patients may recover spontaneously over a period of time; because of this patients should be evaluated and selected carefully.  It is important that the options to forgo treatment are reviewed with the patients, as well as discussing the high failure rate of all the various options available.

Most people who have hair loss on the hair line prefer to treat this condition more aggressively with a variety of medications.  The chance of spontaneous recovery appears to be more in patients who have smaller and fewer hair loss paths.

• Topical Steroids

Topical steroids for treatment of AA has been widely used with little evidence of success.  They are easy to use and more affordable to many patients. However, the current lack of evidentiary success does not make this a valuable recommendation for patients.

• Local Injection of Steroids

Infiltration of long acting corticosteroids into the AA lesions has been studied with some degree of success.  Patients with smaller lesions of alopecia areata may respond better to local steroid injections.

This type of local injections of steroids is most desirable for limited lesions of cosmetically sensitive areas like hair lines and eyebrows.  The most common used medication is Triamcinolone acetonide (5-10 mg/mL).

• Systemic Steroids

Systemic treatment with steroids may stimulate hair regrowth in a limited number of patients.   Continued use of steroids is generally needed in most of these patients to maintain the level of hair growth.  Pros and cons of long term use of steroids should be discussed with these patients before initiating systemic steroid therapy.

• Topical immunotherapy

Topical immunotherapy utilizing allergens has been studied and proven to have some success in patients. The protocol for contact immunotherapy using DPCP has been recommended. Continued use of DPCP is needed to keep the skin irritated for a long time.  The inflammation seems to be able to change the progress of immune reaction that causes hair loss in alopecia areata.

Treatment should be discontinued only after full regrowth is apparent.  This can take an indeterminate length of time, and during this period patients may have to tolerate inflammation of the skin.  A high rate of relapse after discontinuation of treatment makes this option less desirable for most hair specialists.

• Other treatments of alopecia areata

Other medical treatments such as phototherapy, photochemotherapy, minoxidil and dithranol  have shown limited improvements.  Finally patients with extensive stages of hair loss with no response to treatment options may use wigs or hair systems.  That is more desirable for many women with extensive hair loss due to alopecia areata that are having zero to minimal response from any other treatments.

Q.

Hi Dr. Just got back from my vacation in XX, had a good and relaxing time. While I was gone for 2 weeks all the scabbing from my hair transplantation is pretty much gone in the donor scar and the implanted areas. Also I noticed that I did lose hairs as you mentioned would most likely happen. the hairs that fell that looked like the grafts were just the hair shaft that I saw fall. I did not see skin attached to the end of the hair shaft so I assume the follicle survived in the skin where it was implanted. not all have fallen but I did notice a good amount. I also notice small dark hairs sprouting in the implanted area. I assume these are coming from where the originial grafts shed?
 
Its almost a month post op and I feel no pain and have all feeling back on my scalp. I pretty much wash and style my hair as usual.
 
Is all this normal progress after the surgery?
Thanks.A.

It is good that you had a nice vacation! 
 
One month after hair transplant surgery is the general time which you should have lost most of your transplanted hair shafts.  The follicles are now part of your scalp and will be growing new hair in 2-3 months.  Your inflammation should be subsided on both the transplanted and donor areas.  Minor itching might be noticed at this time which is a good sign of the scalp wound healing.  You may have lost or will soon lose some of the bulk of your existing hair due to the shock loss.  Using finasteride can significantly minimize it.  You will be noticing new hair growing in 2-3 months from now and the hair shafts will continue getting longer and thicker till about one year from the time of your hair transplant.