A: Both Propecia and Minoxidil definitely can work in the front of the scalp as long as there is some hair in the area. Although their mechanisms of action are different, both Propecia (finasteride) and Rogaine (minoxidil) act to thicken miniaturized hair wherever it’s location. Neither of these medications can grow hair on a bald scalp. I would ignore the package insert in this case, because the FDA limits the indications only to the areas tested in the clinical trials. That is why doctors have the liberty to prescribe medication the way they see fit.

I suggest to stay on the medications for at least a year – results can take this long. If you have not gotten satisfactory growth by that time then a hair transplant can be considered.

A: Healthy hair can be temporarily shocked from a hair transplant and then shed (the process is called telogen effluvium) but it will not be permanently damaged.

Any healthy hair that is lost in this shedding process should re-grow.

Dr. Bernstein was consulted for the article:

Hair transplant: A possibility if your hair loss is concentrated in specific areas. Hair follicles (in groups of up to four) are surgically removed from an area on your scalp where growth is dense and then implanted in the thinning patches. Since female hair loss is often diffuse, only about 20 percent of female patients with thinning hair are candidates, says Robert Bernstein, MD, a New York City dermatologist who specializes in these surgeries. (The price tag can run from $3,000 to $15,000.)

In October 2008 Dr. Bernstein appeared on the Oprah Winfrey Show, where he spoke about hair transplantation and gave a live demonstration featuring the hair transplant results of one of his patients.

Read the full article at Oprah.com.

Asylum.com reporter Brett Smiley interviewed Dr. Bernstein to get his take on hair loss and the balding pattern known as a “power alley”:

“Power alley is an accurate term for that type of balding,” says Dr. Robert M. Bernstein, a clinical professor of dermatology at Columbia University and world-renowned hair-transplant surgeon. “It’s Norwood Class III balding, which is the most common type.”

[...]

“People with bald parents are the most susceptible to hair loss,” says Dr. Bernstein. “And it can happen at any age. I’ve seen patients in their late teens begin to lose their hair.”

Even though we have a healthy head of hair, Asylum pays homage below to the many successful men — from athletes to video-game characters — who have proudly sported the power-alley look.

The article cheekily describes the hair loss and “alleys” of several celebrities, including: Bruce Willis, Samuel L. Jackson, “Iron Mike” Ditka, Jude Law, Danny Glover, ESPN NFL Draft expert Mel Kiper Jr., Florida Gators men’s basketball coach Billy Donovan, and everyone’s favorite virtual celeb, Pizza Pasta from Nintendo’s “Punch-Out!!”

View the full article.

If you are a new visitor to our website, Dr. Bernstein personally conducts hair loss consultations in our facility in midtown Manhattan.

Read more about the cause, classification, and diagnosis of hair loss in men.

A: A hair transplant should be considered in an area of thinning when:

• The area has not responded to medical therapy (finasteride 1mg a day orally and minoxidil 5% topically for one year).
• The thinning is significant enough that it can’t be disguised with simple grooming (i.e. is a cosmetic problem even when the hair is combed well).

Other factors that are important include:

• the age of the patient
• the donor supply
• whether the thinning is in the front of the scalp or in the crown