Post Hair Loss Questions and Get Answers

This question comes from a member of our hair loss social community and discussion forums: 

Recently, I scheduled hair transplant surgery, and I was surprised to hear the doctor recommend that I start finasteride (Propecia) and minoxidil (Rogaine) as well. If I’m fixing my current baldness with surgery, why would I take preventive hair loss medications as well?

This question brings up several very important points about hair loss, hair transplant surgery, and the comprehensive treatment of thinning hair.

Hair loss (specifically androgenic alopecia or genetic patterned hair loss) is a progressive condition. This means that an effective treatment for hair loss involves two important steps: halting the progressive thinning of hair and regrowing/restoring the hair that is already lost. Hair transplantation is an excellent treatment for restoration the hair that is already lost, but it does not treat progressive hair loss. If hair is transplanted to one region of the scalp, but no preventive treatments are started, the rest of the hair around the transplanted region is likely to recede. If the rest of the hair around the transplanted hair is lost, the remaining implanted hair will be surrounded by bald scalp, and this creates an unnatural appearance.

In order to avoid this phenomenon, hair restoration physicians usually recommend preventive hair loss medications like minoxidil (Rogaine) and finasteride (Propecia). If these medications are taken in conjunction with hair transplant surgery, the transplanted hair will fill in the gaps where the hair is already lost and the medications will prevent the surrounding hair from falling out. What’s more, the preventive medications may also thicken the remaining hair and cause some potential regrowth of hair that was previously lost.

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeons Dr. Ron Shapiro and Dr. Glenn Charles:

During a recent hair transplantation consult, the physician told me that he will create an “irregular hairline” during my hair restoration procedure. However, I’m wondering why he would chose to do that? Wouldn’t a straight hairline look better? Why create an irregular hairline during hair transplant surgery?

The goal of any hair transplant procedure is creating natural, realistic results. A very important aspect of achieving subtle, realistic results is recreating a natural hairline. Though many individuals assume that hairlines unaffected by hair loss are straight and regularly shaped, this is not the case. In fact, in order to create a realistic hairline, hair restoration surgeons must utilize an irregular, “zig zag” design.

In fact, according to Dr. Glenn Charles:

The term we often use to describe the hairline approach is creating a “regular irregularity.” Meaning there has to be a certain degree of randomness to give a natural appearance. However, there also has to be some method to the madness. You could also call this “Zig Zag” hairline design.

Dr. Ron Shapiro agrees, and said the following:

This comment, from a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. William Lindsey:

Before you start shouting Nizoral and Selsun Blue, hear me out. Since I started Propecia (finasteride), my scalp has been itchy. I soon went for the Zinc Pyrithione, Selenium Sulfide, etc., but that seemed to make things much itchier.  I then reverted to regular shampoo and things got a bit better.

My hairdresser mentioned that my scalp looked dry rather than it being dandruff.  I then started using hydrating conditioner which has helped a lot, but my scalp still itches intermittently. I’ve Googled for scalp moisturizer but haven’t found much. Do you guys have any suggestions?

I think a trial of Neutrogena T/Gel shampoo, available at most grocery stores in our area for about $9.00, is worthwhile. I find that it solves most dry problems. If it doesn’t help in a few weeks I’d see a dermatologist.

T/Gel shampoo has tar in it so it’s not the best smelling. Not a problem for old married guys but if you are single you may want to pick up a better smelling shampoo or conditioner to use after the T/Gel.

Dr. William Lindsey – McLean, VA

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

It’s 8 weeks after my hair transplant and last night in my sleep, for the first time and probably due to dry scalp and itchiness, I scratched my head so much that in the morning I noticed there was a lot of hair shedding with the bulb but no bleeding. However later on that day I scratched my head again and I noticed there was minor bleeding here and there. I am worried that I have damaged the grafts and may have lost some. Could you let me know if this is the case?

By 8 weeks after hair restoration surgery, there is little to no danger of harming the follicular unit grafts by scratching your head one evening. However, if the itchiness persists and your repeated scratching results in scarring of the scalp tissue, you can certainly cause permanent hair loss.

To reduce the itchiness and related scratching, I recommend using a dandruff shampoo like Nizoral or simply applying aloe vera gel to your scalp.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

Get Proven Treatments at the Best Prices by visiting our new online hair loss treatment shop.

Technorati Tags: hair transplant, hair restoration, follicular unit, hair loss, Nizoral

This question, from a member of our Hair Loss Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

I got a follicular unit hair transplant approximately two months ago by the strip method. I got a wound closure called trichophytic and self-dissolving stitches. The donor area felt pretty sore for a while at first and I found it somewhat difficult to sleep as one would expect. However, this subsided greatly after a month and it would have seemed to have healed up very well so far.

On a few occasions, including earlier this evening, I picked at some scabs in the donor area. A few times the scabs that came off in my finger had hairs in them. They were purely white flaky scabs with absolutely no blood. It would seem that the hairs were going through the scabs.

Could somebody please tell me if there is a possibility that I pulled hair follicles out from my head when picking at these scabs or are the hairs that I see interwoven in the scabs simply hairs only that will grow back again?

You cannot pull out the hair follicles at this point (1 month post-op). I do agree with gentle rubbing/messaging to get the scabs off.

Keep in mind that, for the first few months after the procedure, the original hair in the areas that were transplanted and close to donor wound are more fragile.

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Hi, I’ve been using minoxidil for approximately two years and was quite happy with the results until I went two weeks without using it. After that I noticed a lot of hair loss! I’m still continuing to use it but now wondering if I’ve completely wasted my time and money for the past two years as I’ve heard you don’t regrow hair when you’ve had a break in the routine. Is that true?

I would not say that you’ve completely wasted your time. However, it is likely that some of the hair that shed will not regrow. Even so, I would venture to guess that restarting Rogaine (minoxidil) has continued to preserve hairs that would have been lost otherwise. It’s always the best option to continue use.

Unfortunately, there is really no way to know for sure. Only time will tell how much hair growth will return.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

Get Proven Treatments at the Best Prices by visiting our new online hair loss treatment shop.

Technorati Tags: minoxidil, hair loss, regrow hair, Rogaine, hair growth

I’m interested in the hair transplant surgery without a rear scar. Please tell me what the next step is. Is it possible to do the procedure with long hair? Please note that I am not completely bald and I use Toppik hair loss concealer.

It’s important to note that there is simply no such thing as completely scar-less surgery. However, it seems that you are referring to Follicular unit extraction (FUE) hair transplantation.  This procedure avoids the strip scar associated with Follicular unit transplantation (FUT) via strip excision and can, under the right conditions, result very minimal scarring, allowing the patient to wear a closely cropped hairstyle without detection.

Unfortunately, FUE will require you to shave your donor area and, in some cases, your entire head. To learn more about these techniques, click the links above and also research on our hair restoration forum.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

Get Proven Treatments at the Best Prices by visiting our new online hair loss treatment shop.

Technorati Tags: hair transplant, bald, Toppik, hair loss, Follicular unit extraction, FUE, hair transplantation, Follicular unit transplantation, FUT, hair restoration

This common question comes from a member of our hair loss social community and discussion forums: 

My father has an advanced balding pattern (likely a Norwood Class VI), and I’m wondering if this is how my hair loss will eventually progress? Will my balding pattern match my father’s? Is it possible to predict hair loss based upon balding patterns in other family members?

Hair loss sufferers (or individuals concerned about hair loss) often assume they will inherit their father’s, brother’s, or grandfather’s balding pattern. However, this is belief is not completely accurate.

Patterned hair loss (androgenic alopecia) is a complicated genetic and biochemical condition. However, most experts agree that the physical expression of the hair loss trait is “polygenetic with variable penetrance.” In laymen’s terms, this means that the genetic component of hair loss comes from a variety of genes and can technically be inherited from either your mother or father. Additionally, the term “variable penetrance” means that the hair loss gene is expressed differently in each individual. This means that one individual with the hair loss genes may exhibit a Norwood Class VI balding pattern, while another person with the same genes will only become a Norwood Class II or III.

Propecia (1mg finasteride) is arguably the most effective non-surgical hair loss treatment currently available for men with androgenic alopecia (genetic hair loss).

Androgenic alopecia is a genetic form of hair loss dependent on the hormone DHT (dihydrotestosterone). DHT is produced in the body as a result of the male hormone testosterone and 5-alpha-reductase enzymes coming together. Finasteride works to slow or even stop further hair loss and improve hair growth in balding men by inhibiting type 2 5-alpha-reductase enzymes, thus minimizing the amount of DHT in the body. Finasteride however, does nothing to inhibit type 1 5-alpha-reductase enzymes. A study conducted by University of Oklahoma Health Sciences in 1999 attempted to determine the effect of finasteride on scalp skin and serum androgens.

Along with finasteride (Propecia), minoxidil (Rogaine) is one of the only medications approved by the U.S. Food and Drug Administration for the treatment of genetic hair loss (androgenic alopecia). Although both drugs are proven alopecia treatments, many hair loss sufferers worry about the potential side effects; specifically, the reported sexual side effects associated with finasteride.

Most studies believe sexual side effects occur in approximately 0.3-3% of Propecia users, and agree that most dysfunction subsides after stopping the medication. However, unlike Propecia, the potential for sexual side effects with minoxidil usage has not been extensively studied. So, this leaves many individuals wondering: can Rogaine (minoxidil) cause sexual side effects?

To answer this important question, Coalition hair transplant surgeon Dr. Paul Rose researched the issue, and published an article about minoxidil and sexual side effects at our Hair Restoration Discussion Forums:

Dr Rose:

In the fall of 2012, researchers at Johns Hopkins University made a startling discovery: finasteride, known most commonly by the brand name Propecia, appeared to cause long term sexual side effects for a number of males who were using the prescription medication to treat hair loss.

Prior to the study, it was well-documented that finasteride could cause a number of sexual side effects during use. After the study, however, a small body of research indicated that males who take the popular hair loss medication could suffer with sexual side effects long after use was discontinued. The study analyzed only a small number of patients, and many hair loss professionals believe rigorous follow-up studies are needed to better understand the long term side effects of finasteride. Nevertheless, the study sparked concern among men and women who suffer with hair loss, particularly those who currently use a non-surgical method of restoration.