Q: I heard that Rogaine only works on the crown and not on the front or top of the scalp. Is this true?

A: Rogaine (Minoxidil) has the potential to work where ever there is miniaturized hair, either the front, top or crown (however, it will not work in areas that are completely devoid of hair).

The reason for the misconception that it will not work in the front is because the clinical trial performed by Merck in the 1980′s, that led to FDA approval, only studied the vertex (crown) and thus the company was limited to this labeling. Several years later, Merck realized that this was a misjudgment in the design protocol and ran a new study (approximately one fifth the size of their Phase III vertex trial) to document effectiveness of the drug in the front of the scalp. This allowed them to avoid the vertex restriction in their label.

Another reason for the confusion is that since the hair in the crown seems to have a longer miniaturization phase than hair in the temples, there is a greater window of time in which the medication can act on these hairs. This goes for both minoxidil and finasteride (Propecia).

 

Q: I had a hair transplant 4 days ago and am feeling itchy in the area where I have my grafts. When can I start massaging the area?

A: You can massage at 10 days post-op, as the grafts are firmly in place by this time, but I would not scratch the area for several weeks more, if at all.

Itching can be lessened by applying hydrocortisone 1% ointment to the area twice a day and by taking Benadryl 25mg every 4 to 6 hours (may cause drowsiness). Both medications can be obtained over-the-counter without a prescription.

 

Q: Dr. Bernstein, I saw you on TV where you explained why you haven’t had a hair transplant. If you had better donor hair and you could do the surgery on yourself, then would you consider having a hair transplant?

A: Yes.

 

Q: I heard that you could get a laser treatment for hair loss in a doctor’s office with a new laser called the Revage. What is this and how does it compare to the laser comb that I can buy myself?

A: The Revage Laser is a Low Level Laser Therapy (LLLT) treatment for thinning hair manufactured by the company Laser Hair Therapy of North America, LLC. It is FDA classified or permitted to be sold as a cosmetic device, but not as a medical device at this time.

The Revage system contains 30 laser diodes that rotate 180 degrees around the scalp. This dynamic process increases the contact of the laser energy with the hair follicles. It is available only through a physician’s office.

In contrast, the laser comb is available without a doctor’s prescription. It is a static device that depends upon the user to properly move it across his/her head in the time recommended for treatment, and at the correct angle, and thus may deliver significantly lower energy to the follicles.

 

Q: I heard that you can buy a laser for hair loss and use it at home. What are the advantages or disadvantages of doing this?

A: The advantages of home use are convenience and that it is generally less expensive than going to a doctor’s office for treatment.

The main disadvantage of using laser treatments without a doctor’s supervision is that a more effective treatment for hair loss may be available and you may not know about it. By spending time using the laser, the window for a more effective treatment may be missed. A good example is the 20 year old male who has extensive hair loss in his family and is just starting to thin. It is very important for this person to start Propecia (finasteride) as soon as possible, since the long-term benefits of using this medication are well established.

Laser treatment at home, without a prior evaluation by a physician, also risks missing the diagnosis of an underlying medical condition. This can be a particular problem in women where hair loss tends to be diffuse and the cause may not be readily apparent. If the cause of the thinning was due to anemia, thyroid, or ovarian disease, the diagnoses of these treatable conditions might be missed.

Finally, the laser therapy available in a doctor’s office may be significantly more effective than a home unit.