Dr. William Lindsey

Take a chance,

There is the additional benefit with proscar/propecia of prostate health, thus lots of guys in their 50's and on, get on and stay on proscar for decades.

But, there is some controversy that early studies suggested that while the incidence of prostate cancer was decreased with proscar, the cancers that did develop were more aggressive. Various propecia reps have told me that is not true with longer studies, but something for a patient and doctor to discuss.

Dr. Lindsey McLean VA

Dr. Carman makes a good point. Everyone is an individual and having a good rapport with your doctor will get you a result that you want..for the right reasons. I see men all the time and have to convince them that although they are "buying the transplant" at age 30, they need to look normal at age 50 too, and to plan for some fronto-temporal recession in hairline design.

I am a "frame the face" doctor, and for most men of average stature, feel that the crown thinning is not a big problem...unless the patient "sees" that in every picture of himself and can't ignore it.

One final issue. God doesn't make straight lines on people. And if you don't believe in God, then straight lines simply don't occur on people. So we make a strong effort to draw a straight line hairline for the patient to approve the location, and then we irregularize it with protrusions and recessions of a few millimeters so that it looks natural.

One of the threads on this site discusses the pro's and con's of one of the political candidate's hair transplant results. I would suggest that it is a perfectly straight line, rather than the wall of hair in front of bald scalp, that calls attention to the previous procedure. I personally think its a good result, except for that perfectly straight hairline.

Dr. Lindsey McLean VA

Latinlotus,

By blocking DHT production, your testosterone may actually increase abit. Although I had that side effect none of us want, my bench press went up while I was taking propecia. Again, I have no idea if it was in my head or real.

When I discontinued the med, my hair worsened, my benchpress slowly came down, but that pesky side effect was gone.

Hard to tell. Everyone is different.

Dr. Lindsey McLean VA

Bill is on the mark. You have 4 choices. 1. Ignore your hair loss, it won't kill you.

2. Camouflage it with toppik, or hair pieces.

3. Medical therapy with Rogaine or DHT blockers like propecia.

4. Surgery.

I don't want to start a big fight about vitamins and supplements, and I have stated my opinions on that previously; but, just eat a normal american diet and DON'T spend lots of money on things not on that list above. If you are stressed, try to reduce stress as best as you can, and use a shampoo that doesn't irritate your scalp. I get samples of everything, and I personally buy neutrogena tar based shampoo at the grocery store. It controls dry scalp skin for me better than anything, and at 9 dollars a bottle, lasting 2 months, has a price that is right.

Obviously being a hair surgeon, of those choices, I prefer #3 and #4 or both. But if you have a choice of spending lots of money on things that have never been shown in any scientific controlled study, published in US literature (lasers, lotions and potions to "grow hair"), or spending that same money having fun--my recommendation is to go have fun and when you are ready, see a reputable doc for #3 or #4.

Dr. Lindsey McLean VA

I think its a variety of things. I just last week asked a man who was almost a year out, to go back on the forums and describe his experience. He found me through the forums when I just started using them and I know that he blogged a bit in the early recovery phase.

I also know that he is happy, as he emailed me and asked if I wanted to see him as he was surprised at the result in under a year(which will only get better over the next 4 months or so).

So when I asked him if he would go back on the sites he told me "maybe in a few years when and if I need some more work", but that now he doesn't feel like he has any reason to go on the sites. Says his free time is now occupied by all kinds of activities, like basketball, swimming and dating. I told him that while I might take some credit for him having more confidence and dating more, that the other activities weren't the result of his hair. He disagreed, saying that his increase in confidence is allowing him to pursue things he hadn't done in years. I told him THAT is exactly the Cinderella story I wanted him to share online...not just for my practice's benefit, but also for the benefit of some guys out there who are trying to decide if they want to move forward.

He said he appreciated the work, but had "moved on" from the hair forums.

That may or may not be representative of why folks quit the sites, but I would guess it is some factor for many folks.

I used to post on some guitar sites when I was getting back into guitar playing, to get tips etc. Then after a few months I found that it was more fun to play than post. Same deal with hair sites I imagine.

Dr. Lindsey McLean VA

Both Drs Alexander and Shapiro do excellent work.

I have posted alot on this site on techniques to use to TRY to get the best scar possible. Everyone heals differently, but the 2 docs you mentioned do great jobs.

Dr. Lindsey McLean VA

I agree with Dr. Feller. Hair patients are not the only group being deceived by this type of scam. A variety of facial rejuvenation options touting the miracle of sitting in front of an LED screen are available.

In an office I used to work in, we had such a device. I challenged all of the staff to follow the company's protocols, and sit with their eyes closed,in front of the screen for 40 seconds, once a week. After 4 months, of the entire group of 6, only 2 felt they had any improvement, and they couldn't convince the other 4, nor me, nor the secretaries that didn't participate, of any change. Mind you, that actual paying patients were to pay 125.00/ per 40 second treatment!

As a contract doctor at that facility I had no decision to bring on that device, I didn't make any money from it, and as a big skeptic to anything that sounds too good, I only wanted to test this on a "control group" of office staff volunteers.

The hype about light therapy on hair strikes me as the same scam, so I challenge anyone to post their before and after pics. Convince me that it is not a waste of money, or a ploy to get patients into a hair practice for conversion to transplants when the results aren't visible.

Dr. Lindsey McLean VA

Good thread. Smoothy you hit the nail on the head. I am an FUE fan...in select patients. The density reduction in the back is an issue; as is the scar tissue that forms which can limit further FUE's in the future or limit the harvest of a strip.

The toughest time that I have is when I see a 24 year old, who has a family history suggesting that he will wind up with Class 6+ hairloss; and he wants to do FUE for his frontal hairline. It is almost impossible for me to convey to him that we may need all of his donor in a few years, just to frame his face; and that doing 1500 fue now, will severely limit our strip options down the road.

I am just starting to see a few patients who have had FUE Megasessions at a nationally advertised "chain" and are facing this problem with frustration.

Dr. Lindsey McLean VA

Mr Sporty,

You and Spex are both right. Consult your urologist. I would bet that if you stick with the medicine for a few weeks that the side effect goes away...mostly.

Only you and your urologist can determine if the side effect continues, whether the benefits of proscar outweigh this side effect; and if viagra is indicated.

Dr. Lindsey McLean VA

Godzluv69

Post some pics of yourself now, and then again in 6 months. We may all learn something, and if you need that "guarantee", you will have excellent documentation, plus lots of guys may comment on how well it works; or that you should get your money back. Either way, we will all learn something.

Dr. Lindsey McLean VA

Glajo,

Bill is correct that laser combs are a very polarizing topic amongst hair tranplant surgeons. An excellent debate on this forum a few months ago between Drs. Feller and Baumann as heard on The Bald Truth radio program is just one example.

To summarize, there are 2 camps. Doctors who use laser comb devices, and those of us who don't. The second group, of which I am a member, point to the complete absense of PUBLISHED, REPRODUCIBLE results, of success in humans, in any PEER REVIEWED JOURNAL; and the lack of patients walking in our offices as successes of the laser combs(but rather frustrated laser comb patients who tell us that they felt the laser comb was an expensive ploy designed to get patient traffic into an office for later conversion to hair transplant procedures by the doctor.

I realize this may generate controversy so I would ask members of the first group (laser comb believers) who feel like responding to send before and after pics so that we can all be persuaded, and/or referenced peer reviewed journal articles or their titles.

Bill is right, shock loss will return unless those hairs were "going" anyway.

Good luck to you, and since you are committing to the laser comb for a year, post your current pics now and periodically.

Maybe we can all learn from you.

Sincerely

Dr. Lindsey McLean VA

We have a fair amount of guys who fly in to DC for hair procedures and we generally advise the following.

If at all possible, spend the first night(of the procedure--we have several hotels nearby and 1 in walking distance)--and come in the next day for a check prior to leaving. I don't think we have ever HAD to do anything, but it reassures the patient, particularly if they are going a distance and we might not ever see them again in person. It also gives patients a chance to ask any questions they came up with that first night, usually involving "when can I shower?".

Next, if folks can stay an extra day we will check them both days and they can sight see around DC. That also allows folks to walk and move around which may decrease the chances of deep venous thrombosis(blood clots in the leg veins) which can occur with sitting in the same position for long periods of time, like on an airplane flight of 17 hours.

There have been threads discussing DVT(blood clots) on this site before and we make folks get up and walk around the office every hour or so; so the risk during our procedure is far less than the flight home--which is pretty safe as well.

Lastly, we do have people who come and spend the week in Washington and have their sutures removed prior to departing.

Dr. Lindsey McLean VA

I can't speak for Dr. Feller, but I was at the beach last week tanning my crown area.

Dewayne, I appreciate you looking for my posts, and I think that I posted 3 or 4 cases before leaving for my 4 day trip. Feel free to check them out and comment on them in the "posted by clinics section" of this site.

I have a few more cases ready to post but am waiting until after labor day. Looking at the number of views on all of the topics on this site suggests to me that alot of guys are on vacation too, or like me, are spending internet time getting our kids to football practice etc.

Thanks for the interest, and check out what I did post if you can. More coming after the long weekend.

Dr. Lindsey McLean VA

andyuk

put up some pics and see how different docs would address this. you may get several approaches. if you do, put up the plug scars AND your donor area.

dr. lindsey mclean va

PGP

I agree with you not putting retin a on the scalp after a hair transplant. But, retin a, or the newer version called Tazorac, is modestly effective in reducing skin damage from previous sun exposure and wrinkling (but most folks would use it on the face, not scalp). I personally have used them for 14 years.

However, I used to give a lecture back in the late 90's which had data that clearly showed that Retin A could reverse some early pre-cancerous changes in sun exposed skin, and I have a nearby dermatologist that still treats balding scalp with retinoids and sun avoidance(which you correctly point out--as retin a actually thins the protective layer of dead skin and increases your sun exposure).

So you are right on with your sun avoidance and Rogaine suggestions.

Dr. Lindsey McLean VA

Spex highlights an excellent case by Dr. Feller.

Regarding Try Again's thread, I do NOT think that you need a facial plastic doctor to get an eyebrow repair. You need a hair doctor who has artistic aptitude.

I am a facial plastic surgeon, fellowship trained, previously on faculty at 2 teaching universities, and I have done LOTS of eyelid, eyebrow, forehead, and face procedures along with hair which has become my focus. And do you know how many eyebrow cases that I have seen? One. And that was a result of trauma. Now if you have an area disfigured by trauma, then a face doc like me would be important to get the area prepared for the best outcome from a transplant, and since I can do FUE, I probably can do the entire procedure well.

But, for your average female that over-plucked for decades, you need an excellent FUE doc, who will be honest enough to explain to her that scalp hair and eyebrow hair are very different. What we can offer is an acceptable option, but it will require upkeep, trimming and will never look as good as the hairs that God designed for eyebrows.

I have seen some fairly aggressive ads recently and had the opportunity to meet a patient (also a relative) of a doctor that promotes eyebrow transplants as a fantastic option. While everyone views things differently, I don't think that one of his "best cases" lived up to the ads or my expectation after hearing him tell me about the procedure.

So for a patient like Dr. Feller shows, this is an excellent option; but for the average female, I still think that there is work to be done in improving the state-of-the-art.

Dr. Lindsey McLean VA

It might be a disolvable deep suture. Give your doctor a call. We see this in 1 in 30 patients with deep sutures, whether it be in hair, facelifts, or cancer reconstruction.

Despite this, the deep sutures lend a better result to scarring and are worth this occasional problem.

Dr. Lindsey McLean VA

I agree with Dr. Shapiro's staff above. We post our prices right on the website. Additionally we tell folks right up front, that if we are shooting for 2000 and my strip gets us 2080, those 80 are free. We don't stick it to the patient that "hey we can throw these away or you can pay us 10 dollars a hair" as I have heard from some patients that a couple of clinics here in the mid atlantic supposedly do.

Also, patients should make sure there are no hidden fees. I have heard of patients being charged to take out sutures, have postop visits, and being charged for office meds used in the surgery!

Dr. Lindsey McLean VA

That is a very interesting case. Please post the 6 month pics and I bet they will look good.

Dr. Lindsey McLean VA

Often with large volume liposuction, fairly dilute lidocaine is placed, mixed with lots of saline, to tumesce the fat; which is then aspirated with the patient under anesthesia.

That is very different from hair anesthesia dosages and the risks are therefore very different as well.

WHL

I place about 1/2 to 2/3 of grafts at my office and think that it helps with quality control and lets me get to know the patient a bit more; and usually that translates into the patient telling a friend or 2 that they ought to come see our practice. BUT, I place primarily because I want the staff cutting grafts--a skill that I do not have--and once we see the light at the end of the tunnel, the staff can place and I can see consults.

As I get a larger staff, I doubt that I will continue to place as much, but more than likely I will come in and place for a while at the beginning and middle of the case, just to make sure things are going like they ought to be doing.

I don't think that having the doc place is key, having the doctor inspect progress is the key.

So I agree with Bill and others that some excellent clinics don't have doctor placement at all, but I bet that those docs are supervising and have confidence in their staff.

I enjoy placing, and am both good and quick at it, but a few of my techs are just as good.

The real skill at the doctor end of hair transplantation is not placing, but patient selection, surgical planning, scar management, and hairline/slit placement. That's what the patient pays for.

Dr. Lindsey McLean VA

Vitamins may rank up with laser combs as the top of the list on the Fleecing of America.

Although there are exceptions to the rule, if an american is healthy and eats a reasonable diet, extra vitamins are not necessary. Lots of the foods we eat daily are fortified with extra vitamins.

Remember than other than vitamins A K E and D, you Pee ALL of the other vitamins out daily. And for A K E and D, if you take too much of these(fairly hard to do but doable) you can have real problems as these vitamins are stored in fat.

Do NOT spend your hard earned cash on expensive hair growing vitamins. Eat a normal diet and spend the money on girls, or cars, or van halen tickets, but not expensive vitamins. And if you have to use vitamins, 1 a days are cheap and have everything the average healthy person could need.

And lastly, vitamins and herbs thin blood; and make surgery much harder. Check with you doc and stop them 10 days preop.

Dr. Lindsey McLean VA

John

If you are doing research and found only 5 cases of liposuction death attributed to lidocaine, your search is not complete. But Lipo and hair procedures are VERY different.

Your doctor should not offer you the procedure if you aren't reasonably healthy. If you have a bad heart etc, get a medical clearance and make sure your doctor understands these issues.

Second, lidocaine toxicity is real, but doses generally used in hair procedures are way below those kind of levels.

Figuring a typical male weighs 180#, with our usual mixture of lidocaine I can inject a healthy person with 8 or 9 syringe-fulls before I have to worry.

In 13 years, and all of the hair cases that I have done, and all of the facelifts and reconstructions that I have done, I don't recall ever going over 4 syringes spread throughout the entire procedure.

Now body lipo is a different story and large volumes are used with much higher risks not just limited to lidocaine.

So ask your doctor about these issues, but if you are healthy, your risk is minimal. Not zero, but minimal. DHoose's statistic is probably not far off.

Dr. Lindsey McLean VA

Also Fusion,

It depends on your particular needs and your donor supply. I had a fellow in Saturday who had seen a national chain for hair restoration clinics and they offered him a very large strip (larger than I think he needed but commissions need to be paid) or a relatively small FUE. I had to explain to him that those 2 options were as dis-similar as a prius and a suburban. I felt he needed around 1500 grafts, and he would be best suited to a 1 stop strip and come back later as he continued to lose hair and do another strip. He was a young guy with a peach-sized crown area with very miniturized hair only, and a family history suggesting he will lose more in the next decade. Or, if he were adamant about an FUE, we could do 2 750 graft cases, but I explained that for his particular needs, I felt his interests were best served with a strip---not only in terms of cost (money and donor hair) but also in terms of scarring of his donor area at its impact on future cases.

So Fusion, get a couple of opinions, and see what is best for YOU, not all comers.

Dr. Lindsey McLean VA

I agree with the docs above. Online serves for a framework for discussion. In person consultatons may or may not correspond with what a doc thinks of a few pics. Just in the 8 months or so I have been participating on this forum, I have been surprised at the difference between a patients pictures and their history compared to what walked in the office.

It kind of reminds me of a nearby church-going lady that I did a facelift on about 5 years ago. She got a great result, let me use her pics to show others etc; yet came back unhappy that her online dating was not going well. It turns out that although she was in her 50s, she was using her college pictures on e-harmony! and found that dates were surprised to see her natural appearance.

That is just one case of the difference between what you see online and what may actually be in the office.

So while online discussions are good to get a feel for the doctor and patient to get to know one another a bit, THERE IS NO SUBSTITUTE FOR FACE TO FACE consultation. Even if you travel far, come the day before the procedure to make sure you know what the plan is, and to allow the doctor to plan as well.

Dr. Lindsey McLean VA