Update on Dutasteride

Finasteride, which is the generic name for Propecia, has been approved for the treatment of Male Pattern Hair Loss since 1998. Finasteride works by inhibiting the enzyme ,5 alpha reductase type II, that forms DHT. There has been a lot of interest by both patients and physicians in dutasteride, which is a drug that inhibits both type I and type II 5 alpha reductase enzyme. Read more

Hair Transplant Strip Scar - Can It Be Repaired?

I was left with a ear to ear, 1/2 in wide scar after having a mega session in 1996. It is impossible for me to hide the scar and the company who performed my hair transplant insists that they did nothing wrong. This has been a nightmare for more than a decade. I currently wear my wife’s eyeliner makeup to camouflage the scar which works O.K. but I would really like to fix the scar now that I have a little extra money. Is this possible and how much does it cost? Read more

Difference Between FUT (Strip Method) and FUE (Follicular Unit Extraction)

What’s the difference between the Strip method and FUE (follicular unit extraction) for getting the donor hair?

First and most importantly, I make sure my patients understand the greatest limit to any hair transplantation is that there is a fixed and limited amount of good genetic hair that we can transfer to the balding areas.

With that in mind, I explain that no matter how experienced the surgeon, when I remove the donor area with either method, I am removing it blindly (i.e. – I can not see under the skin until after the donor tissue is removed). The problem is that I can not see if the follicles have been damaged or transected until after it’s been removed. So it’s best to have as little tissue as possible exposed to any device removing the tissue.

With the strip method, we minimize the amount of donor area being exposed to the risk of damaging hair follicles while obtaining the donor hair. With F.U.E., the patient no longer runs the risk of having a linear scar on the back of their scalp, but there is a significant increase in the amount of surface area being blindly dissected and with that a significant increase in potential damage to the hair follicles.

While I use both methods to obtain donor hair, I make sure the patient understands the risks and implications of both and I help the patient make an educated decision.

Paul J. McAndrews, MD
Senior Medical Advisor, IAHRS

14 Years old and Losing My Hair - Can I Use Propecia?

I’m a 14 year old high school freshman and I think I’m losing my hair. Is it possible to go bald at such a young age? Can I take Propecia or do I have to wait until I am 18?

While it is unusual to lose your hair at such a young age, I have seen a number of such cases. And usually, I have found there is a very strong family history of extensive hair loss in such situations, although this iscertainly not predictable. I am not comfortable prescribing Propecia or any other DHT blocker to a young man Read more

My 52 Year Old Mom Had A Terrible Hair Transplant

My mother had a hair transplant with terrible results. She is 52 years old was was told by her hair transplant surgeon that she was a perfect candidate for the operation. She has lost so much hair I the last year and the transplant looks very unnatural and sparse. She is very depressed to say the least and wishes she never had the hair transplant. Do you think it was the doctors fault that the hair did not take or is it my mother’s age. Can anything be done to rectify the situation. Thank you for your help.

Hello. I’m very sorry to hear you mom is disappointed with her results. I’m going to make the assumption that we are, in fact, dealing with female pattern alopecia in your mom’s case when I answer your question. However, I just want to say, in an effort to be thorough, that you mom should be checked out by a Dermatologist to rule out other causes of alopecia in women. And this might include blood tests and a scalp biopsy as well as a thorough medical history. So assuming your mom is suffering from female pattern alopecia, what could have gone wrong? Or did anything go wrong? I have found that it is quite common for women to have extreme “shock loss” following an initial hair transplant procedure, so I always advise them of this and the fact they are very likely to require an additional procedure or procedures to achieve reasonable cosmetic density.Now since “shock loss”generally affects hair that is destined to fall out anyway, the procedure did not “cause” the hair loss, but it certainly did speed it up. Assuming your mom has sufficient donor hair available an additional procedure or procedures should help your mom achieve reasonable cosmetic density. Soassuming that all the grafts transplanted did grow, my only concern would be that these issues were not discussed in advance in a frank and professional manner. Doctors can’t always tell you what you what to hear, but we can make very sure that we tell you the absolute truth.

Gregory Pistone, MD
Member, International Alliance of Hair Restoration Surgeons

Wife Won’t Let Me Take Propecia - Can Women Touch It Safely?

I want to try Propecia but my wife is afraid to have it in the house since women are not allowed to touch the pills. Are her fears valid and if so why can’t women handle Propecia?

The official warning is that women should not touch or handle crushed or broken tablets. Finasteride is also used for enlarged prostate gland in men. Some elderly men in long term care facilities or nursing homes that can’t swallow have feeding tubes and finasteride is crushed into a powder to put into feeding tubes to be administered orally. This warning stems from the possibility of a pregnant pharmacy worker who is crushing finasteride tablets to be exposed to a large amount of the powder on her hands with the risk of absorption in amounts that may affect the male fetus. So you wife’s fears are not valid. The intact pills can be touched without the possibility of absorption. There is no reason for a female to touch the pills. Women should not take Propecia and its use is absolutely contraindicated in women who are pregnant due to the possible deforming effects on the external genitalia of an unborn male.

Bradley R. Wolf, MD
Medical Advisor, IAHRS

Recent Hair Transplant - Losing A Lot of Hair | Shock Loss

I recently had a hair transplant, about 5 months ago and I think I’ve lost a lot of hair. Is it possible for a hair transplant to make your hair worse?

“Shock Loss” after hair transplantation is a well known phenomenon and occurs with loss of existing hair in the recipient site. Generally shock loss is temporary and reversible. Whether it is reversible depends on thecause or causes. There are a number of possible causes of shock loss.

1. Existing hair is cut above the surface during making of incisions. This is like a hair cut and 100% reversible.

2. If a lot of hair is present prior to the transplant (existing hair) and care and time is not taken to preserve existing follicles during the making of incisions, these follicles can be damaged with the instrument that thephysician uses to make the recipient sites. This loss of the follicles can be permanent due to direct trauma.

3. Hair follicles normally cycle into the telogen (resting) phase. From 50-100 hairs are normally shed each day. By spraying and wiping during the surgery to see the spaces between hairs to avoid damaging the hairs,paradoxically, hairs which would normally shed in the future are essentially pulled out on the day of surgery. This cause of shock loss is completely reversible.
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