April 28th, 2005
Q: I have been taking Propecia for three months. Would it help to up my dose?
A: For most people (of average body weight of approximately 150 pounds) 1 mg is the ideal dose.
This is a statistical statement, however. There are some people who fall outside the bell curve. As we don’t know who these people are, we occasionally increase the dose on non-responders after 1-2 years, particularly for those who weigh significantly more than 150 pounds.
Remember, an increased dose also results in an increased risk of side effects and most people experience no additional benefit. There have been no scientific studies to support this regimen.
Topic: Drugs & Medications
Tags: Hair Loss Medication / Hair Loss Medication Dosage / Propecia / Propecia Dosage
Posted by
Robert M. Bernstein M.D. at
1:34 pm
April 21st, 2005
Q: If my hair is just starting to thin, when should l have my first hair transplant?
A: It is best to wait until at least 25 before considering hair restoration surgery, although there are exceptions. The most important thing is to wait until you have hair loss that is a cosmetic problem. A hair transplant is a treatment for hair loss – it should not be used as a prevention – that is why medications that treat hair loss are available.
Some hair loss in the temples is normal for a person in their mid- to late 20s as this represents the progression to a normal mature adult hairline. The hair loss needs to be significant before you should contemplate surgery.
This issue is detailed in the publication Follicular Transplantation: Patient Evaluation and Surgical Planning.
Topic: Age
Tags: Early Hair Loss / Follicular Transplantation: Patient Evaluation and Surgical Planning / Hair Loss in the Temples / Hair Loss Medication / Mature Adult Hairline
Posted by
Robert M. Bernstein M.D. at
9:25 am
March 8th, 2005
Q: Does dense packing hurt grafts?
A: There is no absolute answer to this question. In a hair transplant, dense packing has a risk of decreasing yield if there is a significant amount of photo damage to the scalp (which alters the blood supply) and if there is a tendency for the grafts to pop (this is difficult to predict pre-operatively). Very closely spaced grafts exacerbates the popping and exposes the grafts to desiccation (drying), hypoxia (lack of oxygen) and mechanical trauma from the necessary re-insertion.
That said, the skill of the hair transplant surgeon and placing team, the size of the recipient sites, and the way the grafts are dissected and trimmed all play important roles in determining graft survival in dense packing.
Topic: Hair Transplant
Tags: Blood Supply to Scalp / Dense Packing of Grafts / Desiccation / Graft Dissection / Graft Popping / Hair Transplant Surgeon / Hypoxia / Mechanical Trauma / Recipient Sites
Posted by
Robert M. Bernstein M.D. at
9:18 am
February 7th, 2005
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.
Topic: Drugs & Medications
Tags: Anagen Cycle / Dr. William Rassman / Early Hair Loss / Hair Loss Medication / Merck / New Hair Institute / Pharmeceutical Companies / Propecia / Propecia Duration / Propecia Peak Response / Shedding
Posted by
Robert M. Bernstein M.D. at
12:51 pm
