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I had 3 FUT sessions from a respected doctor, about 2/3 of the donor scar turned out acceptable but 1/3 is widened enough to be annoying — I can’t keep my hair any shorter than 7/8 of an inch without visibility, and even then it’s visible when the hair is wet. In a recent follow-up visit, the same doctor said 150-200 grafts in 1 FUE session will take care of the scar. Does that sound realistic?

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FUE is one way to address scars. Depending upon your hair type, one or more sessions may be required to get the needed fullness to conceil a scar. It would be difficult for me to judge how many sessions it might take without examining you, but hopefully you have selected a good doctor who knows what he is doing.

 

Hi Dr. Rassman.

I was hoping to get your honest opinion.

I’m a 23 year old male, in the best health of my life. I work out 6 days a week, and have a healthy diet. But my hair troubles me a lot.

I have a normal hairline, but thin hair, resembling a Norwood 5. My father was bald (norwood 7), and growing up, i kind of expected to go bald eventually. My dad started to lose his hair around 35-40. I have an elder brother who’s 30, and has a full head of hair.

I first noticed the slightest amount of thinning shortly after my 19th birthday. I was in college, and everybody (boys and girls) complained of losing hair, so i thought nothing of it. But the thinning proceeded, till about 2 years ago, when i suffered from a severe stomach infection. unfortunately my university was in a small town in india, so proper treatement wasn’t available. I somehow managed to finish the semester, and return home for treatement. I was diagnosed with systemic edema of the alimentary canal, and had gastritis, oesophagitis, deodenitis, etc. I also had a H. pylori infection. Till then, i was experiencing massive hair loss. I was shedding like a dog on a couch. My pillow and bed used to be literally covered with hair. Thing is, some days into my treatement, my hair stopped falling off. My haemoglobin is slightly low, which my gastroenterologist supposes is due to retarded iron absorbtion due to my stomach condition. However, 10 months later, my haemoglobin is still 12.8, and MCV of 51, and MCH of 51. Not much of a change since then.

I thought my hair would grow back once i got better, but this has turned out not to be the case. Personally, I’m confused as to what i’m suffering from. Is it androgenic, since my hairline is intact? I do have norwood 5 style loss, but it is thinning, not totally gone.

I think 23 is too young for my level of baldness. Maybe at 40, but not 23. I have been seeing a homeopath about this matter for the last 8 months, and haven’t noticed any difference. I’m not even sure if minoxidil will help me.

What do i do?

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It sounds like you had a series of health problems and you also have genetic male pattern loss. Heath problems (just from stress) can accelerate the genetic balding pattern. When the hair is lost from genetic causes in men, it rarely comes back, even if the health problems are ‘fixed’. This is not always the case with women’s genetic hair loss. The key is to go on the drug Propecia (finasteride), as that is your best option to stop hair loss and delay it’s restart. Some men at your age may get regrowth of the hair. There is no down side to this treatment. In the United States it requires a prescription.

 

I have a couple of questions about androgenetic alopecia.

1. How fast can the onset of AGA be? Is it possible to have AGA and notice dramatic loss/thinning within a three-month period or less, without any previous awareness of a problem?
2. Can AGA involve some patchy hair loss, in addition to the thinning hair? Or would the patches have to be due to a separate disorder happening at the same time?

Thanks very much.

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AGA is often first noticed after 50% or more of the hair loss has already occurred. This is unfortunately a common finding. Men deny or refuse to see the hair loss in its earliest stages. It is not something normal men look at unless they are unusually primed by balding in the family or amongst friends.

Patchy hair loss can be associated with diseases and should be looked at by a good hair doctor or dermatologist. The two can happen at the same time, but the diseases that produce patchy hair loss must be diagnosed.

 

Hi DR,
I bought rogaine and I am using propecia as well. is this ok? im using rogaine twice a day.

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It is not a problem to use both, but make sure you are not spending your money unwisely. If you have been taking Propecia for at least 9 to 12 months, you should be seeing the results, so taking Rogaine now to see if it will enhance those results is reasonable. If you have only just started on Propecia, taking Rogaine may cause confusion. Which is the product that is giving you the results? You may just be setting yourself up for a lifetime of paying for both, for fear that the one you stop taking was the only one working!

 

doctor, im 21 yrs old and have been experiencing thinning of the hair and a receding hairline recently. i am in no means bald, but suspect my hair loss is becoming rapid. how do i go about choosing the right treatment product for myself? i need something that will not just cure hair loss in the vertex area on top of scalp, but also help with thinning of hair. since there are so many products available from rogaine/revivogen/propecia etc., what would u recommend. please let me know. thanks.

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Sometimes, hair loss occurs in very young people. First, get a good doctor to diagnose you and if you are into genetic hair loss, get good baselines to determine the rate of balding. There are scientific tools that will do this, something we do all of the time in our office. Not many drugs work well for hair loss in young men, though the best of them is the drug Propecia, which (assuming that you have genetic hair loss) hopefully will slow down or stop the hair loss.

I can not stress the importance of not being your own doctor because you are an amateur and the consequence of failing to get prompt, efficient, and effective treatment is permanent loss of your hair. It may happen anyway if you are balding at 21, but please get yourself examined by a competent doctor who will quantify the rate of miniaturization in your balding area and give you a diagnosis. It is important to get good baselines because when you start on the drug Propecia, you will have to find out if it is working and by how much. I would hold off on Rogaine until a good baseline is in hand and the rate of hair loss is documented.

 


Double click on this photo after you read this. When I met this person I assumed that he had a bad frontal hair transplant that did not take, but he informed me that he had lost his hair naturally and never had a hair transplant.

So what are we looking at? The hairs that are left in the front have full normal, coarse diameters to them. That is why I thought that they were hair transplants. This is not the normal balding mechanism. Normally, the hairs become thinner and thinner and then fade away, yet this did not happen to the hairs that remain after balding. Many prospective patients tell me that they can always tell a transplanted hair line from a normal non-transplanted hair line. I always tell people that 90% of the time I can not tell a transplanted hair line. In this person (picture above) it is exactly the other way. A normal balding hair line is shown and it looks like a transplant (which it is not).

This is just an unusual case that I thought would be of interest to the readers of this blog.

 

I just started loose my hair from the front side.Male pattern(Type 1). I am 28 years old and i started to use propecia 3 months ago. There is no proof that propecia stops balding on the front of the scalp. I feel like it is not helping. My father and my uncle they had lost their hair untill they are 45 and now they have type 3 male pattern baldness, no baldness at the top. We all have very thick hair. I just want to know,if their is anyway to stop hair loose. I am not worry about bring them back.At least for now.

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Propecia has been proven to stop or slow hair loss down, provided it is started early enough in the balding process. The term ‘early enough’ varies with the genetics of the individual. Based upon the ‘Class 1’ pattern, you may just be migrating your frontal hairline to the mature position. If your father and uncle had a Class 3 pattern, the slowing of your hair loss is highly probable, but three months is just not enough time.

Many men do not notice their frontal hair loss until hair miniaturation is almost complete, and by that time Propecia will not be effective in the front. Since balding in the crown is generally slower, starting Propecia when it is too late for the frontal area, may still be early enough to work for balding in the crown.

As you have only been on Propecia for three months, you may want to give it some more time- it can take nine to twelve months of staying on Propecia before you will see the difference. I also suggest that you take a photo of your frontal balding now with your brow lifted high so that the creases show up well. Once a month photographs with comparasons over time will show subtle changes we might not see on close daily inspection.

 

Hello Doctor. Recently I had a hair transplant in NJ with a very respectable Dr., someone you have worked with, lets leave it at that. I was scheduled to have 1500 grafts, but after taking the string, the doctor came back in and said I have to cut another piece because we could not get 1500, so in total at the end of the operation I recieve 1800. I was alittle upset, because I had no choice of paying the additional 300, they gave me 100 free grafts for free, so I only paid for 200. Not only did this happend, but my original scar probably grew by another 2 to 3 inches. But anyway. It has only been 2 1/2 months and to be honest, I have less hair than I originally did. My original hair was evenly spaced, now, after the surgery it looks like I hae patches of hair. It looks so weird. To be honest, I have not seen such great results, I know that 2 1/2 months is nothing but so far I am displeased with the results. My question is, when you have results such as mine, and if you are displeased, should I contact the doctor, and if I should, why should I explain that I am not pleased with the results so far?

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Sometimes an initial estimate of a patient’s density is quite different from what is actually obtained during the hair transplant procedure and this affects the amount of hair that is harvested. When this happens, the surgeon may take more tissue to obtain additional grafts to more closely achieve the patient’s desired results. Additional grafts can be obtained by going back over the same area or extending the initial incision to one side. The surgeon makes that judgment based on factors noted during the surgery, such as scalp laxity.

Hair doesn’t generally begin to grow after a hair transplant for two to three months and when growth starts it is characteristically uneven. Although it is way too early post-op to have a sense of what the transplant will look like, it is still best to contact the doctor that performed the surgery with any questions you may have, as he would best be able to answer these questions and explain the reasons why specific things were done. I would encourage you to do this.

 

To round out the collection of Minoxidil questions I’ve received in the past few days —

Hi Dr. Rassman,
I have recently decided to move to the Re-Mox III 15% minoxidil lotion for my frontal hair loss. Is there a danger to using such a high concentration of Minox? if not, why can’t one find this concentration in rogaine or other branded minox in the stores? Do you know of any side effects? Thanks!

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You must remember that Minoxidil is a known anti-hypertensive and can cause low blood pressure and other reported side effects. Any medication that you get at the normally prescribed concentration will be worse in side effects at the higher dose. 15% Minoxidil must be formulated -I do not know where to get it. A pharmacist must prepare it if it is to be legally obtained.

 

When on a topical such as Rogaine does the “new” hair initally fill in as a finer thiner hair that thickens up over time —-or should the “new” hair start out as a thick terminal hair ? Thank you

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I believe that it starts off finer as a rule, then it may or may not thicken. Please see the below blog entry for more on Rogaine / Minoxidil.

 

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