Carlos K. Wesley, M.D.: Alternative to Propecia?

[Billena]

This 25-year-old patient in this video had tried finasteride 1mg (Propecia) prior to his decision to treat his thinning mid scalp with surgical hair restoration. He stopped Propecia months before his session and has not taken it since.

 

 

The pattern (outlined in one of the attached images) includes areas of future loss. Dr. Wesley believes that this approach is essential in young patients so that - as their natural pattern of hair loss progresses - they will continue to have a natural hair distribution.

Edited January 8, 2013 by Billena

[Blake Bloxham]

Billena,

 

Very interesting! Thank you for sharing.

[Spanker]

The answer to the question. No.

 

 

I understand and like the approach, but a 25 year old doing a crown that is not on fin is in trouble. He will likely end of a NW6 and should be treated as such.

 

On the plus side, he didn't use up a great deal of grafts in that area.

[Davis91]

Surgeons should never assume propecia will work or maintain. HTs should stand on their own.

[Bill - Seemiller]

Bilena,

 

I wouldn't consider hair restoration surgery an alternative to non-surgical treatments. In fact, most patients truly benefit from remaining on medical treatment to attempt to maintain their existing hair while restoring hair to thinning and bald areas through surgical hair transplantation.

 

While non-surgical solutions aren't guaranteed to work, in my opinion, their high success rate in maintaining existing hair is why they should be highly considered as part of any hair loss patient's long term hair restoration plan.

 

Best wishes,

 

Bill

[Davis91]

I believe she meant that in cases where propecia is not tolerated for whatever reason HTs can still be planned well.

[Dr. Carlos Wesley]

Hi, all.

 

Thanks for your comments and I do agree with what each of you have said. Perhaps the title of this post should be rephrased to say something more along the lines of: "A mid scalp surgical approach to a young patient who did not want to take or continue taking finasteride"

 

This is simply a surgical pattern that - rather than focusing a session in the crown/vertex of a young man - assumes the eventual progression of MPB (both on the sides and behind the area treated). The lateral regions (sides where he currently has hair) have been addressed with this session with transplanted grafts (as seen in the outline of the pattern) and the posterior (back) border of the pattern was feathered (akin to a hairline) with a concave arc. In time, he'll continue to thin in the crown/vertex and this concave border will be consistent with natural circular patterns of crown thinning.

 

Even if he never choses to return for another session to the frontal third, he'll be left with a natural-appearing conservative hairline in the front border of this pattern.

 

Believe me. Continuation of finasteride was encouraged during his first visit to my office. Even as we touch base down the road, I'll remind him of finasteride's demonstrated benefit to patients in their 30's over other patients of other age groups…

[Bobilero]

Excellent approach. I think people need to think outside the box a bit more if they cant or dont want to commit to propecia and have a reasonable amount of hair left.

 

Not everyone will progress right the way up the Norwood scale. Just look around on the street ,you see plenty of men in their 40's and 50's with bald patchs and recession but in no way a top norwood.

 

By intelligently planning and deciphering where the miniturisation is and will progress. Successful HT's like this can be made if the person dosent want to or cant handle finasteride.

Edited January 9, 2013 by Bobilero

[Getsome1]

Does Finasteride work better on patients in their 30's vs other age groups?

[Dr. Carlos Wesley]

According to this published study of 118 men (range 20 - 61 years old) with androgenetic alopecia (AGA) from 2011, patients over 30 years old with higher AGA grades demonstrated more improvement that their younger counterparts with a smaller degree of hair loss.

 

This is currently the longest investigation of finasteride 1mg (Propecia) efficacy. I should also mentioned that side effects were reported in 6% of patients (decreased libido and erectile dysfunction). Persistence of hair growth was not significantly less after ten (10) years versus after five (5) years of therapy.