Dr. William Parsley

I have never been too excited about postop pictures alone. But Dr. Carman has shown that his good postop pictures have turned into excellent results. Very impressive. He studied under one of the best- Dr. Bill Reed. My vote is an unqualified yes.

Dr. Stough is the co-founder of the International Society of Hair Restoration Surgery and one of the most respected hair restoration surgeons in the world. Hot Springs was the sight of some of the earliest hair seminars, and doctors from all over the world came to these meetings. Dr. Stough was also Forum Editor for 3 years and has written a major textbook on hair transplantation. Obviously,he is an excellent surgeon.

Danger, I have treated many patients with finasteride and have never had a complaint of joint or tendon problems- nor have I heard of any other doctors having any complaints. To my knowledge there have been no official reports either. Your problems probably come from overuse injuries or something else, not finasteride. So don't stop taking it. Have you been on Cipro (an antibiotic)? It is known to cause those problems. Dr. Parsley

I know Dr. Martinick and am familiar with her work. She is top quality and you would do yourself a favor to consult with her.

Rogaine and Propecia both work on the front in addition to the crown. During the studies, Rogaine was used on the crown for standardization, and were surprised that the FDA told them that they could only say it helps the crown. You are too young for a transplant, but a wonderful candidate for medication.

You are 23 and are losing hair in the front and crown. Hair transplantation would be very risky at your age. However, medications could be very effective. Consider Propecia and Rogaine in combination as these work really well together- and the results could be far more dramatic than transplantation as well as being far safer. I would not recommend transplanting at this time, and certainly not into the crown. Most don't transplant crowns until age 45.

dave r I doubt that weight lifting will cause any significant problems. DHT, in addition to being produced in various areas of the body, is produced in the hair follicle itself and is difficult to measure. It may be that the local production is very significant. Just don't take any hormonal supplements as they will have a negative impact for sure. The little white bulbs at the end of your shed hairs are normal. Pigment production shuts off right before the hair enters its resting phase.

Ray F You most likely have alopecia areata, a condition in which the body is reacting against its own hair. It will most likely regrow, but treatment with topical and intralesions steroids helps. It would be best to contact a local dermatologist. An outside possibility is temporal triangular alopecia, but it is unusual for it to develop at your age- medical Rx for this doesn't work. Celiboy, You also need to see a dermatologist and possibly have a biopsy. I think temporal triangular alopecia is most likely. It usually develops at age 3-6 years, but can develop at birth up to the 20s. Once it develops, it is stable and doesn't occur elsewhere (like AA can). If that is the correct diagnosis, hair transplantation works very nicely, but be careful if you have a hereditary tendency for baldness, as later the transplanted area can be sitting out there by itself.

Lea, I am a transplant doctor, but can't answer your question better than Arfy. If you are losing that much at 23, there is a good chance you aren't a good candidate for transplanting. Whatever you do, let nature play its cards first- then you can decide with your doctor if transplantation is right for you. You read a lot about the different techniques, etc., but the most important skill for the doctor is to make good judgments before he ever touches an instrument. An unsuitable candidate is going to fare badly even with the most skilled doctor. Stick with the medications for now and let science develop. Watch for hair multiplication over the next few years.

The HIP pen is merely a tool to aid planting, just like a forcep. The idea was that it would be less manipulative and easier on the graft. The graft still needs to be rotated and adjusted. Whether this is done or not is up to the operator. Again, I don't think it is being used much due to some problems that need to be worked out.

dude 1 How old are you? If over 50, then it is possible that you are a candidate. If under 35, I would really be cautious. There are many factors that make a person a good candidate and you need to be evaluated. I also recommend getting several opinions and take very seriously an opinion for you to avoid transplantation- particularly if it comes from an experienced transplant doctor.

It is my understanding that the implanter pen had clogging problems and is not being used much right now. As for NHI, they do excellent work and I would have no hesitation to recommend them. There are hair mills and I would avoid them. NHI is not in that category.

I do know that the highest testosterone peak is in the early morning hours. I remember reading something recently that it also elevates right after sex but not necessarily with the thoughts of sex (thank goodness, or we would all be bald). I don't think these peaks would be that significant with Propecia but I am not aware of any studies. The tissues levels of Propecia last longer and should dampen these peaks. I guess to be safe, however, one should take the drug at bedtime so I believe you are doing the right thing. Good questions. Coincidentally, I just saw my first definite case of Propecia allergy a few days ago. A fellow had hives, stopped, restarted, and had hives again. It is very rare.

It is interesting to read some of the good questions- such as about DHT levels fluctuating during 24 hour day. First of all, I don't know the answer for sure- perhaps some of the researchers do. Logic would tell you that DHT doesn't last long in the serum. After a single dose of Propecia, the serum DHT levels will drop 65% in 24 hours. Since finasteride only shuts off production (affects alpha reductase II, not I)and has no effect on existing DHT, one would have to assume that DHT is extremely transient in the serum and is dependent on continuous new production. It takes 7 days after a single dose of Propecia for the body to restore the pre-dose serum DHT levels, so it isn't that quick and is dependent on new AR II enzyme production. Propecia has a half life in the serum of 4-6 hours, but disables nearly all of the AR II enzyme during that time. The tissue levels remain for a month. It is very unlikely that your DHT levels will fluctuate significantly at night while on Propecia. When not on Propecia, the enzyme has nothing to inactivate it and I doubt that the DHT level would vary much in the evening when not on treatment either. If I can find any definite information I will relay it to you.

I have found that the cause of the scar and the thickness of the scar have a great deal of bearing on the outcome. Scars caused by foreign bodies such as transected hairs and artificial fibers cause a thickened scar that is often still active. These type scars have a higher frequency of poor growth. Fibrotic ridging at the hairline is therefore a problem. Thickened scars from scalp reductions can sometimes be a problem. If the increased surface tension are part of the above conditions, then I find they don't accept grafts well. In my experience burn scars, radiation therapy scars (or loss), and split thickness grafts allow hair to grow well. I think that the bulbs of the planted grafts need to be below the scar and not implanted into the middle of them. No studies, just my experience.

Some hairs in grafts never fall out and, after being dormant for a couple of weeks, start to grow. I have had a few patients where nearly all of the grafts started growing immediately. I have had some that, after the hair initially fell out, the growth didn't start until after 8 months. Most are right about 3.5-4 months before anything is seen. Pretreatment with Rogaine and postop treatment with GraftCyte have been reported to help speed the regowth but this is inconsistent. Long term results don't appear to be affected by the time of onset of the growth.

I agree that this is probably not ridging. Ridging is a raised "ridge" along the frontal hairline do to deep fibrosis. Some people are just prone to it but usually it is due to deep irritation. It was not uncommon it patients with plug grafts but is very rare in patients with follicular unit grafting. It sounds more likely that you have a graft that is buried or upside down. This usually becomes irritated near the 3 month mark when hairs start to become active. It would be best to see the doctor that did the transplant. If not, see a dermatologist as he might need to do a small lancing and draining procedure, and possibly put you on a short course of antibiotics. I wouldn't let it go, because it could do some slight damage to surrounding grafts if left untreated. This is not terribly uncommon and, if treated, is not a great significance.

This is a good timely question. First of all, I would avoid transplantation below age 25. This is a perfect time to use medications, as our most dramatic responses occur in the young. If the only effect is perservation, then these meds are also very effective as it is better to save hair while there is more to save. If a transplant is done on a very young person, I would recommend 2 things: 1) stay in a frontal forelock pattern 2) don't transplant the temples or lock in the fronto-temporal angle. Young people losing their hair are likely to be the ones with severe hair loss later. Locking into a forward fronto-temporal angle could be a major problem later. Some might do well with it but some will pay a dear price. Bottom line- it isn't worth it. Better yet, don't do a transplant at all until nature shows a little of its hand first.

Even though it is small, a hair follicle is a small organ and will be rejected just like a kidney, heart, etc. It could be done with a good match and anti-rejection drugs. Would hair be worth the side effects and the increase risk of cancer? It is not practical. However, if you have an identical twin somewhere, you would be in business.

Shady, There are times when it is questionable, but this is not the case with you. Don't get a transplant. Not now. Not next year. Not ever. You are going past a NW7 to a NW8 at least- you can already see the pattern. Your donor site is not apparently good. The only thing that can help you now is Propecia and Rogaine- and if they work, still don't do a transplant. I can't imagine a transplant anyone could do that would look good 20 years from now (and maybe 3 years). Don't do it!

No. These camouflage agents (or concealers) are safe to use. I would recommend at least a week after a transplant before starting to use them again.

Unethical may be too strong, but I think it would be very ill-advised to do a transplant on an 18 year old. The more I practice the older the age becomes before I would transplant them. I have worked on a few before age 25 if the hairloss is extremely mild and it has worked out so far. My hair loss was moderate (NW3V at age 25. I started transplants at 35. Now I am 59 and have been very happy. However, I have seen some patients who at 25 had less hair loss than me at that age but then went on to have a more extensive baldness. My inclination now is to not do transplants on patients under 30 years of age unless they have limited baldness (mainly frontal) and wide rich donor areas - even then I would be very hesitant. As you can tell from these sites, there are many people who have been scarred both physically and emotionally by panicking while a young man and suffering great consequences later. Doctors should have enough sense not to operate on a person who is too young or too bald-but you can always find someone. I can't emphasize enough to wait as long as possible to start and always get more than one opinion.

I have looked at hairs under the microscope and found most of them have their full shaft diameter within 4 weeks. The problem is that they need the length to give the best cosmetic effect.

I doubt many of us have exact numbers. I would expect that I have done over 3,000 transplants. For the past 6 years I have done follicular unit transplantation on over 1,200 cases. A small percentage of them have had some slot grafts centrally but I can't remember doing any slot grafts in the past year. All grafts are prepared microscopically. Be careful about what numbers mean. I spend 6-9 hours daily transplanting but only do one transplant per day. Others use a lot of assistants and may do 6 or more daily. That doesn't mean that they don't do good quality work, but it isn't the same. What is your definition of doing a transplant?

You are lucky. Dr. Pathomvanich is an excellent conscientious hair doctor. I have seen him work and am most impressed. He probably has less transection of donor hair than anyone in the world. You will be in good hands.