Hair Restoration Blog

Q:

Dr. Mohebi, this may seem like an unusual question, but I’ve been hearing a lot about Prince William’s hair loss and wondered if you wouldn’t mind letting me know what treatment option(s) you’d recommend. Rogaine? Propecia? Hair transplant surgery, and if so, how many grafts?

Thanks so much!

A:

Prince William is a class IV hair loss in Norwood classification with significant thinning on the top area that indicate he will be heading toward class VI if he does not use any treatment for his hair loss.  Looking at Prince William pictures, you can see that he has had the initial signs of hair loss in his early twenties that is typical for Caucasian hair loss.

Although you may argue that wearing the crown will eventually cover the balding areas on the top, he may still have a few more viable options.  Prince William needs to be on some sort of medical treatment, either Propecia or Rogaine, to minimize his hair loss or at least to prevent or slow further thinning.  He should also consider a hair transplant surgery to reinforce his hairline and add density to his corners.  Restoring his crown balding spot will be the next priority and I think if his donor quality is good all of those goals could be achieved in one session.

I think with one hair transplant he can eliminate the appearance of balding while he might need another procedures to thicken up the frontal density and add more to the volume of top and the crown area.

Q:

Dear Dr. Mohebi,

I’m in my sixties and  consulted with you a year ago at your clinic, and had tests done, all normal.   I have had hair loss ever since I was nineteen years old.  The onset  was when I traveled to Europe, and it never stopped until in two cases:

1. With each pregnancy my hair loss almost completely stopped and gained a lot of hair back, but fell out after a few months during the period I was nursing my babies.

2.  About twenty years ago, I saw Dr. XX XX in Beverly Hills who prescribed Rogaine a solution that at the time wasn’t available over the counter.  After six weeks of application, I saw results, and after about four months I gained abundance of hair back, but started itching of scalps, and discontinued it.  When after being out of town for a while, I started seeking help, he had moved away, and couldn’t find that doctor.

For the past ten years or so that Rogaine has been readily available, I attempted using it even at the strength of male 5%, but have had no results.

Hair loss has been in my family, from my grandfather, on mother’s side, to my mother, and to me and now to my children.

My main questions are:

1. What was in the initial solution of Rogan that worked, and then over the counter ones didn’t work?
2. What is the latest preventive measures/solutions/hopes for this type of hair loss at least for my children’s generation?

Thank you kindly for your response,

A:

Hair loss medications such as Rogaine work only if you have active hair loss.  The effect is mostly preventative, but since it may make some of the miniaturized hair (finer hair that is in process of balding) thicker, patients may experience some enhancement in their hair bulk only for the first year of its use.

Some women with genetic female patterned hair loss may be good candidates for hair transplant surgery as long as they have protected (Permanent) hair on their donor area on the back and sides of the scalp.  Hair transplant in this group of patients should be done only if they are trying to reinforce a limited area of scalp.  However, a hair transplant is not a good idea if their goal is to increase hair density throughout a large area or entire scalp.

To be able to say what options are out there for your children, they need to be individually evaluated by a good dermatologist or a hair transplant surgeon and treatment options should be tailored to their individual needs.

Q:

Hi doc?  could Rogaine foam have adverse effect on hair transplant result? some say it helps for hair growth, some say it does not add to hair growth, but have you seen any where saying it might prevent hair growth on men with hair transplant? thanks.

A:

Rogaine (minoxidil) can be used after hair transplantation (only on the newly transplanted area) to protect the native hair and not to promote the growth of transplanted hair. Transplanted hair does not need any medication to promote permanence or grow and if chosen correctly it is considered to be a permanent hair loss solution. I personally recommend Propecia to protect patient’s existing hair against shock loss (losing native hair) after hair transplant on men. It is proven that this medication works better than Rogaine for shock loss prevention and has had remarkable results in those patients who have used it as directed. Women cannot use Propecia and I tend to offer them Rogaine as an alternative for the few months following their hair restoration.

hey doctor!

As I read through forums and articles, people mention that propecia works better in conjunction with something else, such as rogaine for exmaple. At the moment, the vertex area of my scalp seems emptier than than the crown and minoxidil works well with the vertex. Do you recommend me go back on minoxidil for the vertex, or should I just focus on propecia?

Answer:
I generally prescribe finasteride to most of my patients who have significant miniaturization whether they are getting hair transplants or not. There are several studies on using Rogaine (minoxidil) and Propecia (finasteride) as single therapy and in combination with each other or with other medications.

Comparing minoxidil and finasteride for treatment of male pattern baldness clearly shows that treatment with only finasteride is more effective than treatment with only minoxidil. Combination of finasteride with minoxidil and with some other medications shows improved outcome, but the rate of improvement is not significant enough that I can convince myself to prescribe combination therapy to all my patients for the rest of their lives, considering difficulty of using topical minoxidil (topical spreading of medication twice a day on the balding area of scalp).

If you want to do everything possible to prevent or slow down further hair loss and maybe grow some, you can consider combination therapy, but remember when you start minoxidil you are committed to continue it for the rest of your life or until there are better alternatives.