Senior Member Dr. William Parsley Posted April 13, 2011 Senior Member Share Posted April 13, 2011 Pt is a NW4 with rapidly developing hair loss, taking him toward a NW6. Pt is in his late 30's. There was abundant miniaturized hair in the frontal and midscalp. My feeling was that this case required medical treatment before considering surgery- and that surgery might not be required at this time if the response was good. His treament consisted of finasteride 1.25mg daily, minoxidil foam 2x daily, ketoconazole shampoo and pyrithione zinc shampoo. Happily, he had a great response showing that surgery is not always the only or best option. he still has a little thinness over the vertex but it is cosmetically acceptable. I usually don't like to transplant the vertex until the patients is 45 years old and has enough donor to adequately treat any future hair loss. It was interesting to see that Dr. Brad Limmer just posted a case, showing that medical treatment can be impressive in good candidates. It should be noted that I have had equally impressive results with 0.25mg of finasteride daily. Dr. Parsley is recommended on the Hair Transplant Network Link to comment Share on other sites More sharing options...
Senior Member NEWHAIRPLEASE Posted April 13, 2011 Senior Member Share Posted April 13, 2011 That is unbelievable!! Newhairplease!! Dr Rahal in January 19, 2012:) 4808 FUT grafts- 941 singles, 2809 doubles, 1031 triples, 27 quads My Hairloss Website Link to comment Share on other sites More sharing options...
Senior Member multiplier Posted April 13, 2011 Senior Member Share Posted April 13, 2011 Interesting. When you say "ketoconazole shampoo and pyrithione zinc shampoo", are there brand names? What frequency of use? Also, did you prescribe Propecia or Proscar, or does it matter? Jan 2000 - 600 FUT with Dr Kurgis (MHR) Sept 2011 - 1411 FUT with Dr Paul Shapiro Jan 2013 - 1800 FUT with Dr Paul Shapiro Sep 2014 - 1000 FUE with Dr Paul Shapiro My Hairloss Blog » __________________ Link to comment Share on other sites More sharing options...
Senior Member Dr. William Parsley Posted April 13, 2011 Author Senior Member Share Posted April 13, 2011 The brand of ketoconazole shampoo is Nizoral 1%. The brand of pyrithione zinc is Head and Shoulders 1%. Both can be purchased at pharmacies or grocery stores over the counter. These are the only shampoos of which I am aware with studies showing hair growth. Even so I think they are not strong hair re-growers (the combo of finasteride and minoxidil is much more important). They have in common that they kill Malassezia Globosa, a spore that lives in the upper hair follicles of nearly all adults and feed on the sebum. This makes the sebum more and more acidic, which is irritating and a major factor in dandruff. I generally have my patients alternate their use on a daily basis but some use both at the same shampooing. In addition to killing the spores, ketoconazole might block DHT at the follicle receptor. Zinc has the ability to increase vascularity. I particularly like patients to pretreat their scalps with these shampoos before surgery as I don't want 3,000 blade/needle sticks causing acid oil to spill into the tissues. I used 5mg Proscar on this patient, divided into quarters for a dose of 1.25mg daily. I Recently I have been more commonly using Propecia 1mg divided into quarters (0.25mg daily). It reduces side effects and seems to work just as well. Dr. Parsley is recommended on the Hair Transplant Network Link to comment Share on other sites More sharing options...
Senior Member Blake Bloxham Posted April 13, 2011 Senior Member Share Posted April 13, 2011 Dr. Parsley, Looks great! A vast improvement using medication alone. Nicely done! "Doc" Blake Bloxham - formerly "Future_HT_Doc" Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician. Link to comment Share on other sites More sharing options...
Senior Member Tao Posted April 13, 2011 Senior Member Share Posted April 13, 2011 Wow, that is one helluva an improvement in the crown with no surgery. It would be impressive is that was done with surgery. But without- wow! He's lucky. My Hairloss/Transplant Website: http://www.hairtransplantnetwork.com/blog/home-page.asp?WebID=1772 Link to comment Share on other sites More sharing options...
Regular Member zo1279 Posted April 28, 2011 Regular Member Share Posted April 28, 2011 Dr. Parsley...are you saying that 0.5 mg or less can have the same effect as 1 mg? I am considering getting on Propecia but scared of the sides...was thinking of doing a lesser dosage to begin with to see what happens. I have heard that 1 mg is more than one would need...please elaborate on what you have seen in your practice and/or results with patients. Thanks!!! Link to comment Share on other sites More sharing options...
Senior Member T.C Posted April 28, 2011 Senior Member Share Posted April 28, 2011 I initially used .5 mg eod for 2 years and it worked fine as I had sides on any larger dose.I am now trying .5 mg every day (4 weeks now) and can manage it without the sides I got 2 years ago although get the slight ache now and then so I think the body does adjust over time.Was thinking of trying 1mg eod but not sure may stay with what I am on as it is working quite well.Its worth experimenting. HT 2006/7 Link to comment Share on other sites More sharing options...
Regular Member zo1279 Posted April 28, 2011 Regular Member Share Posted April 28, 2011 do you see any good results with the lower dosage? Link to comment Share on other sites More sharing options...
Senior Member T.C Posted April 28, 2011 Senior Member Share Posted April 28, 2011 definite slight improvement especially the thin area to thick hair transition zones infront if crown where it works the best anyway and the hair changed from almost invisible straw like to dark and thicker after 6 months. I mean the oldest loss area in middle bridge area has not improved as much as further back but still slightly better. Will try this current dose to see if it helps more but if it stays as it is i will be happy as I have full coverage just little thin on mid scalp. HT 2006/7 Link to comment Share on other sites More sharing options...
Regular Member Mustard Posted April 30, 2011 Regular Member Share Posted April 30, 2011 This looks like me. I”m going to try the shampoos you said. Link to comment Share on other sites More sharing options...
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