Q: Why do some people have a full head of hair into their seventies or eighties and others start to go bald in their late teens or early twenties?
A: The cause is genetic and this poly-genetic trait can be inherited from the mother’s side, the father’s side, or both.
There is an old wives’ tale that it is inherited only from the mother’s parents. Although the inheritance can come from either side, it is actually greater from the mother’s side – but only slightly.
Q: I had a hair transplant of over 600 grafts using Follicular Unit Extraction (FUE) to my frontal hairline and the frontal part of my scalp. The procedure was done less than a year ago by another doctor. Since then I have had persistent pimples and redness in the area that the grafts were placed. Also, the surface of the skin in the area is irregular. — E.Z., Long Island, N.Y.
A: One of the causes of having pimples and redness following Follicular Unit Extraction may be buried hair fragments and there are significantly more hair fragments generated with the two-step FUE technique than with the three-step method.
In the three-step procedure, we use blunt dissection which minimizes transection (cutting of hair follicles) and thus reduces the incidence of hair fragments. See the Three-Step FUE page at the Bernstein Medical – Center for Hair Restoration website.
Q: If Rogaine is used only once a day will it still be effective? — I.P., Hempstead, Long Island, NY
A: Once a day topical use of Rogaine (topical minoxidil 2% and 5%) is probably almost as effective as using it twice a day. The reason is, although minoxidil has a relatively short half-life of several hours when given orally, when topically applied, it has a half-life of 22 hours in the skin.
This suggests that once-a-day dosing is a reasonable option. It is important to realize that Pfizer, the company that now makes Rogaine, specifically states that it will be less effective if used only once a day.
Q: I heard that Proscar, the 5mg version of finasteride, is now generic. Is that correct and is Propecia going generic as well? — F.J., Red Hook, Brooklyn, NYC
A: Yes, Finasteride 5mg (Proscar) is now available in a generic formulation. It is my understanding that Finasteride 1mg (Propecia) will not be available generically until the year 2012.
Q: I am currently taking Propecia 1mg a day for hair loss and heard that Proscar 5mg now comes in a generic form. If I get that, how should I take it? — G.A., Fort Lauderdale, FL
A: If you are currently taking Propecia 1mg a day, and want to switch to Proscar (Finasteride 5mg), you can either take Proscar 5mg, 1/4 pill every day or 1/2 pill every other day.
If you break up the pills, be mindful of the potential risk to pregnant women from handling crushed tablets. You can purchase a pill cutter in any pharmacy.
Q: It is my understanding that as a person loses his or her hair, the skin of the scalp undergoes a number of changes, namely there is a loss of fat, an increase in cellular atrophy, and of course the dreaded perifollicular fibrosis (now that’s a mouthful). It seems to me that these changes, in particular the fibrotic scarring, are the main obstacles in the way of regrowth, and the reason Propecia does not work for extensively bald men. What can be done about this demon we call fibrosis? Can it be slowed, stopped, prevented, reversed? If we could somehow counteract collagen formation, wouldn’t our baldness problems be solved for good? If a bald scalp is atrophic, how does it have the capacity to hold a whole new head of transplanted hair? Is there a limitation to the number of hairs we can transplant (outside of donor limitations)? — R.L., Rivington, C.T.
A: The findings that you are describing are well documented; however, it is not clear if these changes are the cause of the hair loss or are the result of having lost one’s hair. Most likely, the DHT causes the hair follicles to miniaturize and eventually disappear. This, in turn, causes the scalp to thin and lose its abundant blood supply (whose purpose is to nourish the follicles). The changes in the scalp are also affected by normal aging, which causes alterations in connective tissue including the breakdown of collagen and other components of the skin. The changes seen with aging are greatly accelerated by chronic sun exposure.
Q: I have a question about one of the products referenced under the Camouflage section of your website. As you suggested, I have begun to use DermMatch as an alternative to a hair transplant as I have diffuse thinning and been told that hair restoration is not an option right now. I have been very impressed with the results of DermMatch. However, I am concerned that the product might be damaging my existing hair or impeding future growth. Should I have any concerns about this product?
A: None of the well-known cosmetic camouflage products will damage hair or inhibit its growth.
Q: I have heard that staples are uncomfortable after the hair transplant, why do doctors use them? — B.E., Great Falls, V.A.
A: Staples are used for two main reasons.
The first is that being made of stainless steel; they don’t react with the skin and, therefore, cause little inflammation.
The second is that, unlike sutures which are used with a continuous spiral stitch, each staple is separate and this causes minimal interruption to the blood supply.
Q: Is there ever an age where you are too old for a hair transplant? — L.K., Norwalk, C.T.
A: One can be too young for surgical hair restoration, but not too old (as long as one is in good health medically).
Older people generally make excellent candidates for hair transplantation since their expectations are generally more realistic and the future extent of their hair loss more predictable than in those who are younger.
We have successfully treated a number of people in their 80s. In spite of the fact that their spouses and friends asked them, “What do you need a hair transplant for at your age,” the patients were uniformly happy that they did the surgery.
Q: What can be done if I want to have a hair transplant and my scalp is very tight from prior surgeries? — R.R., Long Island, N.Y.
A: Follicular Unit Extraction is ideal in very tight scalps, provided that there is enough hair to extract without leaving the donor area too thin and provided that the follicles are not too distorted from the scarring.
With strip harvesting, undermining techniques may be helpful to close the wound edges once the strip is removed.
