Q: I was wondering why you chose two years as the amount of time one should wait to judge the effectiveness of Propecia. Have you had patients who only saw results after that long? Why does Merck say 3-6 months and Dr. Rassman at New Hair say 6-8 months? I know these numbers aren’t arbitrary, but I’m just wondering what the logic is behind this and how does this relate to planning a hair transplant?

A: The Merck data showed that over 90% of patients had peak response at 1 year and this has been my experience as well.

Most patients show the most dramatic response between 6 to 12 months with some getting additional benefit up to two years. Prior to 6 months, the results are quite variable and there may even be a net loss due to shedding during this period, as the Propecia stimulates a new anagen cycle.

If one is planning to go on Propecia before a hair transplant to minimize any shedding from the surgery and to prevent future hair loss, one should start the medication at least one month prior to the procedure.

If one wants to use Propecia for the purpose of possibly avoiding hair restoration surgery, then one needs to wait at least a year to see if there will be enough regrowth.

Finally, if one is younger (i.e. in the 23-25 age range) one should be on Propecia for at least two years to give it every possible chance of working and see its maximum benefit before considering a hair transplant.

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Q: Can you perform a hair transplant into scar tissue? A.H. – Rockland County, New York

A: Yes, hair grows in scar tissue, but not quite as well as in normal tissue. The scar is not as elastic as normal tissue so the grafts are at slightly higher risk of being dislodged; therefore, more care must be taken to protect the grafted area after the hair transplant.

In addition, the blood supply in scar tissue is less than in normal tissue, so that area should not be transplanted as densely and the hair replacement should be performed over multiple sessions.

Finally, grafts do not grow well in thickened scars. If a scar can be thinned using injections of cortisone, it may improve the chance that the transplanted hair will grow.

 

Q: If a second hair transplant is performed before the first had a chance to grow could the second procedure destroy the follicles from the first?

A: Hair from the second hair transplant session would not damage the follicles transplanted in the first session, even if follicular unit grafts were transplanted in exactly the same spot as in the first session.

The reason to wait until the hair grows in, however, is so that you can better plan the subsequent hair restoration procedure. If two follicular units are placed on top of each other or very close together, you will essentially be creating a mini-graft and the results will not look natural.

We advise waiting at least 8 months between sessions with 10-12 months being ideal so that the grafts of the second session can be evenly distributed among the grafts of the first.

The extra few months not only allow the surgeon to identify all of the previously transplanted grafts, but enables him to get a sense of the “look” of the first session (i.e. the wave, the density, and how the patient will ultimately want to comb his newly transplanted hair). This is very useful in guiding the placement of grafts in the second session to maximize its cosmetic benefit.

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Q: I am twenty and think that I am starting to thin. I am also experiencing a slight tingling in my scalp. Are these related?

A: Most likely. Early androgenetic alopecia can be associated with a slight tingling or slight tenderness of the scalp.

You should see a dermatologist for evaluation and, if you have early male pattern baldness, consider starting finasteride (Propecia).