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I want some genuine advice. I have been using Rogaine (5% minoxidil) for one year. The first 7 months I applied it twice a day but when I saw results, I quit using it twice a day and for the last 3 months I have applied it only once in the morning.

Right now it’s shocking for me because I’ve started seeing hair loss again and my doctor suggested that I use minoxidil 10%. Is 10% going to give me my hair back and is it more effective than 5%? He also suggested that I take Propecia (finasteride) but I’m worried about side effects.

Is minoxidil 10% going to help me regrow hair? Thanks in advance!

The clinically proven and FDA approved dose of minoxidil for hair loss in men is 5% twice daily. Some hair loss sufferers have used greater concentrations of minoxidil but there is very little data available to prove that increasing this percentage beyond 5% is more effective for hair growth.

I recommend returning to twice daily application of 5% minoxidil. You may not get all of your hair back but it will probably retain the hair you have and increase density.

Additionally, finasteride when combined with minoxidil is arguably the best medical hair loss treatment currently available. There is a lot of fear and misinformation online about the side effects of finasteride but, according to clinical studies, less than 2% of men will experience severe sexual side effects.

So I’ve had one of the worst cases of hair loss that I have ever seen on someone my age. My hairline started to go back when I was just 16/17 years old. Now I’m 19 and beginning to weigh out my options.

I now regularly take Biotin (3K MG) and a DHT blocker. Also just started using Rogaine extra strength for the top of my hair to try and fill it out. For my hairline, which is my main issue and bugs me day in and day out, I’m gonna use Rogaine Foam. I am also strongly considering a hair transplant to fill out my hairline on the sides and just keep taking further steps to keep the hair I have now.

I believe you are too young for hair transplant surgery at this time. You will likely lose more hair and restoring your juvenile hairline will almost certainly result in a lack of donor supply to address future hair loss.

Planning for a successful hair transplant means a delicate balance between the area that needs to be covered and the available donor supply. This also means that many surgical hair restoration patients must choose between density and coverage.

In May of this year, recommended hair transplant surgeon Dr. Parsa Mohebi of US Hair Restoration in Los Angeles, attended the ISHRS 2nd Mediterranean FUE Workshop in Madrid, Spain.  The three day workshop focused on the specialized donor harvesting technique of follicular unit extraction (FUE) and included 9 live surgical procedures by some of the world’s finest FUE practitioners.  The following is a summary of the FUE hair transplant workshop according to Dr. Mohebi.

The program began with an introduction and welcome by Drs. Jose Lorenzo and Alex Ginzburg. After a brief discussion of the evolution of follicular unit extraction as a hair restoration procedure, each peer session instructor summarized the following methodologies and instrumentation that would be demonstrated during the live surgical presentations.

• Dr. Jim Harris (the S.A.F.E. system),
• Dr. Jean Devroye (motorized extraction)
• Dr. Miguel Canales (the ARTAS robotic system), and
• Dr. Koray Erdogan (manual extraction)

FUE Research Committee Members from left to right: Drs. James Harris, Bijan Feriduni, Marcio Crisostomo, Alex Ginzburg, Jean Devroye, Jose Lorenzo and Parsa Mohebi

There was also an interesting panel discussion on selection criteria in FUE procedures, including the quality of donor area and the potential complications and disadvantages of FUE.

Additional live sessions were conducted on succeeding days by Coalition physicians Dr. Bijan Feriduni and Dr. Jean Devroye as well as Dr. Koray Erdogan. The intricacies of placing the grafts with implanter were demonstrated and discussed in these cases.

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

I’m thinking about undergoing hair transplant surgery soon, and was wondering if it is necessary to take antibiotics after the procedure?

Unfortunately, the best available answer for this question is: it depends.

All hair transplant surgeons are different and run their practices in a unique and distinct manner. Because of this, all physicians provide patients with a unique set of post-operative instructions as well. In these post-operative guidelines, physicians share their antibiotic instructions.

Some hair restoration physicians believe antibiotics are necessary, and claim that not taking antibiotics after hair transplant surgery is an “unnecessary risk.” While these physicians believe there is some risk of infection from the procedure itself (though this is traditionally very low), they claim the real risk comes from patients repeatedly touching the donor area with unwashed hands during the early healing phase.

Other physicians don’t believe antibiotics are necessary, and do not provide them to patients after hair transplant surgery. These physicians state that there is no research demonstrating lower rates of infection and better outcomes in hair transplant patients who receive antibiotics versus those that do not. What’s more, some surgeons (who do not provide antibiotics) state that the significant amount of blood flow to the scalp greatly decreases the chances of infection.

This question, asked by a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair restoration physician Dr. Timothy Carman:

Dr. Carman, I just looked at some of your cases. They look good. Your hairlines are more aggressive than some hair transplant surgeons, but still look natural on the cases that I looked at.

What goes into your decision process for making a hairline? Is there a distance you measure? Is it based on the existing line? Thanks.

The most important factor is estimating (based on age, current hair loss pattern, familial history, etc.) projected future balding and establishing a safe total area of transplant that can be supplied by the always limited amount of donor. I like to call this the patient’s “lifetime supply-demand” ratio, as best can be determined.

This guides each and every hair restoration case as to what is possible design-wise and will look natural not only a year from the hair transplant, but into the distant future as well.

Once that is established, the contour/shape/density all have to be designed so as to “fit” the variables involving bone structure, hair type, ethnic background, and overall facial character.

Dr. Timothy Carman
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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

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Alan Feller:

Dr. Feller how long do you think it is best for a hair transplant patient to usually wait between strip procedures? I know there might be many variables and no set rule.

I had a 4352 graft procedure in August 2012 and would like to have a followup procedure to get more grafts placed in my crown. Are risks of shock-loss and scar stretching lessened by waiting 2 years vs say a year?

I would give the scalp a minimum of 8 months before round two, but optimally a year and a half. By then the recipient area is revascularized and the donor area is stable.

If your hair restoration physician plans to work in a completely untouched area then you can cut that time down considerably.

Dr. Alan Feller
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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

Technorati Tags: hair loss, hair transplant, hair restoration

Recently, recommended hair transplant surgeon Dr. Shelly Friedman was featured on “Sonoran Living” – a local news segment filmed in Scottsdale, Arizona. During the feature, Dr. Friedman had the opportunity to discuss Low Level Laser Therapy (LLLT) and its use in female hair loss sufferers.

In the segment, Dr. Friedman discusses two different modes of LLLT: the weekly laser treatment available in his office, and the Capillus at home laser cap. Dr Friedman explains how using the in-office laser treatment on a weekly basis or the Capillus cap for 30-60 minutes a day every other day may help revitalize miniaturized hair follicles and reverse signs of hair loss. During the interview, Dr. Friedman focuses on how the laser therapy may be especially helpful for the estimated 40 milllion American women struggling with their hair loss each day, but also states that the treatment can work in males as well.

Traditionally, LLLT has been met with skepticism in the hair restoration community. Some hair loss experts believe the claims that LLLT can rejuvenate miniaturized follicles and restore the appearance of hair are dubious, and don’t think the procedure has a place in modern hair restoration. Others, like Dr. Friedman, disagree, and think anecdotal evidence suggests that LLLT is an effective hair loss treatment. Dr. Friedman notes that the procedure is especially effective in women, and explains a variety of “before and after” images displaying noticeable improvement with LLLT.

I had a hair transplant almost one and a half months ago. I took extreme care, however all the hairs shed away within the first month. Now I look pretty much as before. After one month I also had a few cigarettes (1 per day). Kindly suggest whether I will get visible results or not as it is really depressing for me.

I’m always surprised when recent hair restoration patients request information about the hair growth timeline after surgery. Your hair restoration physician should have discussed with you when to expect visible results. One and half months is much too early to be looking for new hair growth.

In the first weeks after surgery, it is perfectly normal and expected for the newly transplanted follicles to shed. Given that some patients also experience additional shock loss, it’s common for some to appear even balder during this time than they did prior to the procedure. But, I assure that this hair loss is temporary.

New hair growth should begin to appear between the third and fourth month post-op. However, all of your grafts will not begin to grow at the same time. Instead, the new growth may appear fine and uneven. Don’t worry. It will eventually fill in but the final results will take one full year to materialize.

While smoking can have a negative impact on the healing process, I highly doubt that one cigarette per day beginning one math post-op will affect your results.

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Carlos Wesley:

Dr Wesley, has there been any sign of donor regeneration from the application of ACell to the donor?

We’re certainly looking at it closely and have effectively adopted the use of both ACell and platelet rich plasma (PRP) into our patients’ follicular unit extraction (FUE) donor healing.

Although we haven’t initiated any formal investigation, there is anecdotal evidence that it can help regenerate hair follicles (hair duplication) from transacted hair fragments in the hair transplant donor area.

Dr. Carlos Wesley
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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

Technorati Tags: hair loss, ACell, platelet rich plasma, PRP, follicular unit extraction, FUE, hair duplication, hair transplant

This hair loss question  was answered by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  

Is there any advantage of ARTAS over manual follicular unit extraction FUE? Is it only for easing the job of the hair restoration surgeon or does it have advantages for the patient himself? Can you explain more? So far it looks to me that it’s a tool designed for the fatigue of the surgeon. Is this it and nothing more?

It is true that by using the ARTAS robot there will be less fatigue of the surgeon and that is a good thing. Even though we all like to think we do our best all the time, we all do a better job if we are less fatigued. But if that was the only reason for using the ARTAS we would not have invested in it.

We are using the robot because we feel it has the potential to be superior to all other methods of follicular unit extraction hair transplantation. The robot has two punches. First, it makes a scoring punch with a sharp punch and then it makes a deeper punch with a dull punch. We believe this method, using the robot to visualize and guide the punch has the potential of yielding superior follicular unit grafts with less transection and more tissue around the grafts.