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August 31st, 2010

Q: I am a 34 year old male and my dermatologist prescribed Propecia for me today. Most of my hair loss is at the hairline, but there is some loss on top as well. It’s not bad, I just want to stay ahead of it. If I get a transplant I want to get it at your clinic, but I will give the Propecia a try first. I am going to be overseas for a couple of months starting this Sunday and I was wondering about the necessity or desirability of having someone measure my hair density prior to starting the Propecia. Would you advise waiting to start the Propecia until I come back in two months and having my density examined at your clinic? — M.R., Great Falls, Virginia

A: I would start Propecia as soon as possible. What is important for a hair transplant is the density in the donor area and this is not affected by Propecia (or minoxidil). Your donor density can be measured anytime at an evaluation prior to surgery. If you want to wait to see the effects of Propecia prior to the hair transplant, you really should wait a year; since growth, if any, can take this long. If you just want to have Propecia on board for the hair restoration procedure, or to make sure you don’t have side effects, then generally a month will do. If you would like to do a photo consult through our website to get some preliminary information about how many grafts you might need, you can do that at your leisure, but start Propecia now since the longer you wait the less effective it will be at regrowing hair.

August 27th, 2010

Q: I have been taking one tablet of Propecia daily for the past 5 years, with good results, until May of this year. At that point I started to experience some hair loss and so you recommended that I switch from Propecia to generic finasteride and increase the dose to 1/2 of a 5 mg pill per day. I started taking the 1/2 tablet of finasteride daily one month ago, and for the past 2 weeks I have seen a lot of hair in the bathtub and on the towel after taking a shower. I have not made any other changes in my diet or my shampoo, and I do not have any conditions on my scalp. Please advise me on what needs to be done. — C.C., Floral Park, New York

A: Just continue the medication at the higher dose. Either the finasteride hasn’t started working yet or you are getting temporary shedding from the medication (which means that it is working).

August 25th, 2010

Q: Is transplanted hair the same length as existing hair? — G.E., Buckinghamshire, UK

A: The hair is first clipped to about 1-mm before it is transplanted. The transplanted hair will look like stubble for the first few weeks after the hair restoration procedure. It is then shed and the newly transplanted follicles go into a resting phase for about two months.

August 23rd, 2010

Q: I’m concerned that finasteride might result in unwanted body hair on the arms, back, etc. Is there any truth to this? My thinking is that since finasteride blocks the enzyme 5 alpha-reductase which converts testosterone to its more active form, DHT (dihydrotestosterone), is it possible that it might actually have some effectiveness in ameliorating unwanted hair? — P.P., Stamford, CT

A: Yes, finasteride does have some ability to decrease body hair, since growth of body hair is stimulated by DHT. However, the effects of finasteride are mild and not observed by everyone, so if you have unwanted body hair you will probably need some other means to remove it such as waxing, laser hair removal or electrolysis. The important thing is that finasteride doesn’t increase body hair.

August 6th, 2010

Q: You mentioned that the hair at my crown and other areas where I now have baldness hasn’t really fallen off but has thinned to a great extent and that taking Rogaine and Propecia might help increase their thickness. If the medications do restore the hair thickness, I’m curious why you said that I could look like how I was 1 to 2 years ago. Technically, shouldn’t I be able to regain much more of my hair (and look like how I was longer than before that) since the follicles are all still there? — H.D., Park Slope, NY

A: Although Propecia is much more effective than Rogaine, even when used together, the medications are just not that effective in reversing the miniaturization process. They may bring you back to the way you were a few years ago, but will not restore your adolescent density.

August 4th, 2010

Q: Is it recommended to wait for 1 year after starting Propecia, when the effect of the medication kicks in and improves density of donor area, and then perform the surgery? — Z.B., Bergen County, New Jersey

A: Propecia will not affect the donor area, as this area is generally not impacted by the miniaturizing (thinning) effects of DHT –- the hormone that Propecia blocks. The purpose of waiting the year is to possibly regrow hair in the recipient area. If regrowth is significant, a hair transplant may not be necessary. If a person’s hair loss is extensive and there is little chance that Propecia will grow a significant amount of hair back to give a satisfactory improvement, then waiting the year is unnecessary.

July 30th, 2010

Q: You said I was not a good candidate for a hair transplant because my donor area was too thin. Since finasteride and minoxidil can increase the thickness of the hair, could it make a hair transplant possible?

A: Unfortunately, the medication will not affect the donor area and, therefore, not make a person with low donor density a candidate for a hair transplant.

July 28th, 2010

Q: I have read that a lot of doctors today administer Midazolam (Versed) to sedate the patient. I have two questions in reference to this drug: 1) How does the doctor determine how much of a dose to administer to the patient and 2) is the drug administered all at once, or intermittently throughout the procedure? — D.D., Bronxville, NY

A: Each doctor has a different protocol, so it is hard to generalize. At Bernstein Medical we usually use Versed 2 to 4 mg IM one time 10 minutes prior to giving the local anesthesia. The dose is not repeated.

We also use Valium 5-15mg by mouth. I determine the dose of each based on body weight and history of sensitivity to sedatives.

July 23rd, 2010

Q: I had a hair transplant in 2004 of mostly plugs. The plugs are in an angle which doesn’t really look natural, far from it. I have lost a lot more hair since I did the hair restoration procedure. I regret ever doing a hair transplant. I prefer to reverse the surgery. I have read a lot about repair work on the net, and I have come to the conclusion that using FUE to take the plugs out, and put them back into the scar might be an option, but it may just make it worse on top. Also I can do electrolysis to remove the plugs, might be better because the possibility of scarring is smaller, and as I already have a lot.

A: If you had plugs, then a graft excision with suturing will generally give a better result than FUE, since a graft excision removes the underling scar tissue as well as the plug. FUE only removes the follicles, but leaves the underlying scar tissue. In addition, the shape of the follicles in scar tissue is often distorted, making extraction difficult and leading to more transaction (damage to follicles).

July 21st, 2010

Q: If I want to use a laser to try and stimulate my hair to grow, should I use one of the hand-held units, such as the LaserComb or X5 Laser, or use a helmet?

A: Of the hand-held lasers, I feel the LaserComb is most effective. With the helmet units used in salons or doctor’s offices, we recommend the Revage. There is no evidence that the helmet lasers works any better than the LaserComb.

Some patients prefer a helmet, such as the Revage, since they can just relax and don’t have to worry about using it correctly or concentrating on reaching every spot. Others prefer the hand-held unit since it is less expensive and can be used at home.



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