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Hair Restoration Answers

What Problems Can Arise from Transplanting the Crown Too Early?

Q: What is the problem with transplanting the crown too early? — P.L., Newark, NJ

A: If a person’s hair loss continues –- which is almost always the case -– the crown will expand and leave the transplanted area isolated, i.e. looking like a pony-tail. The surgeon can perform additional hair transplant procedures to re-connect the transplanted area to the fringe, but this is a large area that can require a lot of hair, and it is often impossible to determine when a person is young if the donor supply will be adequate. View the full post to see a photo of a patient who had an early hair transplant to his crown.

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Hair Restoration Research

Early Baldness May Suggest Prostate Cancer Risk

A study of Australian men between the ages of 40 and 69 suggests that men who were mostly bald by the age of 40 were more likely to develop prostate cancer in their 50s or 60s. The Melbourne Collaborative Cohort study of about 10,000 men showed that men who have high levels of testosterone may be more vulnerable to cancerous prostate tumors.

The team of scientists that conducted the long-term study, which was published in the journal Cancer Epidemiology, Biomarkers and Prevention, reported that both baldness and prostate cancer are age-related and androgen dependent conditions, so these findings are not surprising. The statement said, “We found that baldness at the age of 40 might be a marker of increased risk of prostate cancer.”

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Hair Restoration Research

Propecia Causes No Statistically Significant Change in Sexual Function, Says 2004 Tosti Study

The central finding of a 2004 study led by Italian researcher Dr. Antonella Tosti, in which he and his team investigated sexual dysfunction in hair loss patients being treated for androgenetic alopecia, was that there was no statistically significant change in sexual function after four to six months of treatment with finasteride 1mg (Propecia).

Interestingly, the research team found that sexual side effects were actually less common than reported in the clinical trials of the drug.

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Hair Restoration Research

Sato Finasteride Study Points to Long-term Safety, Efficacy in Use of Propecia

Led by Dr. A. Sato, a Japanese team of medical researchers published the largest finasteride study ever performed, “Evaluation of efficacy and safety of finasteride 1mg in 3,177 Japanese men with androgenetic alopecia.” It investigated the effects of finasteride over a 3 1/2 year period in men with androgenetic alopecia, or common baldness.

The study found that patients who had experienced hair loss for an extended period of time and were treated with finasteride exhibited notable hair growth. While a fairly small proportion of patients with a hair loss duration over 10 years exhibited “greatly increased” growth, 85% of patients with hair loss duration of more than 15 years experienced “moderate” or “slightly increased” growth. Physicians have thought that people with advanced hair loss do not respond as well as patients in the early stages of hair loss. However, in light of the results of this study, that determination should be reconsidered. Continue reading this article.

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Hair Restoration Answers

When To Assess One’s Donor Supply?

Q: I am 24 years old and just starting to thin. I was told by another doctor that it was too early to have a hair transplant, but the hair on the back and sides of my scalp seems really thick. Shouldn’t I have a hair transplant now, just in case I am not a candidate in the future? — A.S., Cherry Hill, NJ

A: The most important criteria in determining who will be a candidate for a hair transplant is the presence of sufficient permanent donor hair. When hair loss is early, it is often hard for the doctor to determine this, since early on the donor area can appear very stable. It is not until the front and/or top of the scalp has significant thinning that the donor area may also show thinning. Therefore, it is only at this time that the stability of the donor area can adequately be assessed.

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Hair Restoration Research

Research Groups Explore Genetics Of Balding

We all have seen that some bald sons have bald fathers, even when no one on the mother’s side of the family has any hair loss. This suggests that the genetics of male pattern alopecia is more complicated, with multiple genes influencing hair growth. And it is likely that the inheritance of baldness is polygenetic, with relevant genes coming from both the x-chromosome of the mother and non-sex chromosomes of either parent. So where are the other genes?

Two independent research groups, one from England and the other Germany, both published in the journal Nature Genetics, have identified a gene locus p11 on chromosome 20 that seems to be correlated with male pattern hair loss, and since the gene is on a non-sex chromosome, it offers an explanation for why the inheritance of common baldness can be from either side of the family.

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Bernstein Medical In The News

Oprah, Dr. Oz Inspect Hair Transplant Patient, Interview Dr. Bernstein on Oprah Winfrey Show

The Oprah Winfrey Show features Dr. Bernstein discussing his pioneering follicular unit hair transplant procedure, focusing on the newest diagnostic and treatment techniques for hair restoration.

Dr. Mehmet Oz (health expert on The Oprah Winfrey Show) presents video footage of Dr. Bernstein performing a hair transplant and then invites the patient live onstage to be inspected by Oprah.

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Hair Restoration Answers

Which is the Preferred Treatment for a Young Patient: Hair Transplant or Medication?

Q: I am 25 year old who just started going bald. My doctor confirmed that I have pattern baldness and put me on Propecia and Rogaine. I don’t want to go bald at any age. So, instead of prolonging the process for 5-10 years and then having a HT, isn’t it easier to let the hair loss continue and then have a HT, so, that I can save the money on drugs for years. — Z.B., Greenwich, C.T.

A: It is far better to keep your own hair. Keeping your own hair will generally look fuller than a hair transplant, since a hair transplant just re-distributes existing hair (until hair cloning techniques are available).

The medications (i.e. finasteride and minoxidil) are relatively cheap if you get the generic forms.

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Hair Restoration Answers

Should Young Person Start with Hair Transplant at Crown?

Q: I am 26 years old, have had two successful hair transplants, but am still losing hair in the crown area. The doctor I have worked with told me that he does not do crown work on anyone until they are at least 40 (due to lack of donor area). I have very thick hair and the transplanted area looks as if nothing was lost. Would you do work on someone my age in their crown area if they have enough donor hair? — A.W., Brooklyn, N.Y.

A: Although I am hesitant to start with the crown when transplanting a younger person, if you have good coverage on the front and top of your scalp from the first two sessions then extending the hair transplant into your crown may be reasonable. It depends upon your remaining donor supply and an assessment of how bald you will become. I would need to examine you.

If it is likely that you will progress only to a Norwood Class 6, then transplanting your crown can be considered. If you will progress to a Class 7 then you should not since, in the long term, hair that was placed in the crown might be better used for other purposes, such as connecting the transplanted top to receding sides.

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Hair Restoration Answers

Can Avodart Hair Loss Medication Cause Shedding?

Q: I’m male, early thirties and in the early stages of hair loss, too early for hair transplants. I am experiencing extreme shedding. I took Avodart for 6 weeks, but because of the shedding I stopped. Now, it still continues as strong as ever. I’ve been losing about 200 hairs every day in the shower. 3 months ago I had so much more hair, what is going on? I heard that shedding can happen, but not like this. Could this have caused telogen effluvium, or something else? — M.M., Boston, Massachussetts

A: Since Avodart (dutasteride) is a more potent medication than Propecia (finasteride), the shedding (telogen effluvium) may be more dramatic. If you have made a decision to use Avodart, then you need to tolerate this short-term effect. It should subside within the first 6 months on the drug.

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Hair Restoration Answers

Can Propecia Cause Hair Thinning?

Q: I am 22 yrs old and I started shedding hair in a very limited form since I was 20. I have now been on Propecia for nearly 8 months. To date I have not experienced any benefit. In fact, I have seen my hair continue to thin. Is it possible that this thinning is a result of Propecia? — M.M., Boston, Massachussetts

A: Usually the shedding associated with finasteride will subside by 6 months.

If you are still losing hair at 8 months, most likely the medication is not working. Unfortunately, it is not effective in about 15% of patients.

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Hair Restoration Answers

Can a Hair Transplant Treat Hair Loss that begins in the Early 20s?

Q: I am in my early 20’s and I was told my hair loss pattern is a Norwood Class 6, on its way to becoming a Class 7. My hair is brown in color and medium to coarse and I was told I have high density in my donor area. Although I was told I could have hair transplants, do you think that I should based upon what I have told you? — D.W., Pleasantville, N.Y.

A: The main concern I would have is that when someone is already a Class 6 by their early 20’s, he may eventually be left with only a very thin see-through fringe as he ages. A high donor density now does not ensure that this will not occur – and coarse hair at 22 does not ensure that it will not become fine over time.

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Hair Restoration Answers

Can I Treat Early Hair Loss with Laser Comb and What Age Should I Start?

Q: If I’m 20 years old and haven’t lost any hair yet, should I start using a laser comb now?

A: One should not treat hair loss until it actually occurs.

That said, once there is clear evidence that a person is thinning, non-surgical treatments are best started early to prevent further hair loss.

It is important to keep in mind that finasteride (Propecia) is still the most effective treatment for early hair loss and has a good record for at least some long-term effectiveness. It is not clear what additional benefit the laser-comb will have.

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Hair Restoration Answers

Can Hair Transplant Restore Hairline in 21 Year Old With Early Hair Loss?

Q: Hi, I am a 21 year old male experiencing the first signs of hair loss as of late. I looked at your before and after pictures of hair transplant patients and honestly right now I have a lot more hair than the patients, even in the after photos. By no means do I intend to criticize your work at all, but I noticed that they still had a receding hairline. I myself am an artist and pay close attention to detail. What I want out of a hair transplantation procedure is to basically have the full head of hair that I had even before puberty. Is it possible for this to be done?

A: Your concerns and goals, although understandable, are impossible to achieve through hair transplantation and is exactly the reason why we don’t perform hair transplants in young persons.

Surgical hair restoration can never give you your original density back since we are just redistributing a smaller amount of hair.

In addition, your original hairline should not be restored since a transplanted hairline is permanent and will not evolve naturally as you age. A mature hairline must be built into the design of the first hair restoration procedure, regardless of a patient’s age.

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Hair Restoration Answers

Can Hair Loss Increase on Propecia for Four Months?

Q: I believe I am an “early” IIIA or IVA. I am not losing any hair on the back of the scalp. There is no substantial hereditary hair loss on either side of the family, but I began taking Propecia four months ago and recently noticed a dramatic thinning of hair on the top (front) of the scalp, extending back to the rear of the head. — B.M., Lower East Side, N.Y.

A: Often people experience some shedding the first six months on finasteride as the new hair essentially pushes out some of the old. I would wait a full year before making any judgments about a hair transplant since you may see significant regrowth from finasteride in the second six months and may not need surgery at this point, particularly if the hair loss is early.

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Hair Restoration Answers

Instead of Hair Transplant, Can You Treat Early Hair Loss with Once a Day Minoxidil?

Q: I have some early thinning in my crown and the doctor said I am too early for a hair transplant. I don’t want to take Propecia, but using Rogaine twice a day is a big nuisance. Can I use Rogaine once a day? — L.B., Cleveland, Ohio

A: The tissue half-life of minoxidil is 22 hours.

This means that 22 hours after it is applied, about 1/2 of the compound is still bound to the skin and exerting some effect. Because of this, once a day dosing is probably OK.

Please note that this is hypothetical and that there have been no controlled studies to confirm this.

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Hair Restoration Answers

Can Hair Transplant Thicken Thinning Hair in Person with Early Hair Loss?

Q: I am 22 and losing my hair all across the top of my head. How can I thicken my hair to its level a few years previously? — I.L., Kentfield, CA

A: If medication, such as finasteride, is successful it can thicken hair by increasing the diameter of the existing hair shafts. Although the cosmetic benefits can be dramatic in a person with significant hair loss, a hair transplant can not restore hair to its original density, since it only moves the existing hair around and does create new hair.

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Hair Restoration Answers

Is Avodart Hair Loss Medication Safe for Male with Early Hair Loss?

Q: My query is prompted by your answer to another query “Is Avodart Safe?” My son, who is in his mid-20s, has been taking Dutasteride for hair loss for about two years now. He had tried Finasteride earlier but without much benefit. Medical supervision regarding Dutasteride is not available in Australia as the drug has not been released here yet. — N.V., Melbourne, Australia

I am concerned by your remarks that there is no biologic model to show the long-term safety of Dutasteride (as opposed to Finasteride). Would you suggest that he goes back to taking Finasteride? We would be grateful for your advice.

A: It is a tough call as I have never met or examined your son, so I can only offer an opinion based on limited information. If you feel your son will be emotionally or socially debilitated by the hair loss, then I think that it may be worth the risk (if there is any) of taking the medication; otherwise, I would use Finasteride.

Please keep in mind that you don’t need to make the final decision now. You may want to defer the decision until he is 28 or so, at time when he is more mature. It is a tough call. Please let me know what you decide.

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Hair Restoration Answers

Can Women Use Propecia to Treat Hair Loss and Does Their Age Matter?

Q: I have early thinning on the top of my scalp and I was told to use Propecia, but I heard that is was only for men. What do you think? — T.G., Staten Island, NY

A: Women can’t take Propecia during the child-bearing years because, if ingested, it can cause birth defects in male offspring.

In post-menopausal women, where we see the greatest frequency of hair loss, it doesn’t seem to be effective.

In pre-menopausal women who do not plan to become pregnant or who already have children, we are still cautious about using the medication, since there effectiveness has not been proven and its long-term safety in this population has not been tested.

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Hair Restoration Answers

Do You Recommend Hair Transplant for Hair Thinning Over Entire Scalp?

Q: I am 19 years old and seem to be thinning all over, including the sides. My father has all of his hair but my grandfather is totally bald. Should I have a hair transplant now or wait until I am older? — T.K., Garden City, NY

A: Most likely you have a type of androgenetic alopecia called Diffuse Unpatterned Alopecia (DUPA).

In this hereditary condition, hair thins all over rather than just on the front, top and back as in the more common male pattern baldness.

The fact that the back and sides of your scalp are thinning (the donor area) precludes you from being a candidate for surgery. The diagnosis can be made by observing a high degree of miniaturization (fine hair) in the donor area under a magnifier. This instrument is called a densitometer.

For further information, please read the article:

Bernstein RM, Rassman WR: Follicular Transplantation: Patient Evaluation and Surgical Planning, published in the journal Dermatologic Surgery in 1997. Specifically, read the last part of the article.

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Hair Restoration Answers

Hair Transplant for Thinning Hair on a Crown?

Q: Should you perform a hair transplant on a crown that is just starting to thin? — R.R. Philadelphia, Pennsylvania

A: A “thin” crown should first be treated with Propecia, as it may thicken the hair to a cosmetically acceptable degree without the need for surgery. If Propecia is ineffective in restoring enough hair, then surgical hair restoration can be considered.

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Hair Restoration Answers

How Do You Recommend Treating Early Hair Loss?

Q: I am 27 years old and have a Class 3 degree of hair loss. Should I do a hair transplant or consider non-surgical methods of hair restoration? — Y.B., Lake Forest Illinois

A: At age 27 with early hair loss, you should consider non-surgical options first.

Propecia is the most important medication, but you need to be on it for one year at the full dose of 1mg a day to assess its benefits.

If you have done this and other parameters are OK for a hair transplant, such as adequate donor hair density and scalp laxity and you have little evidence that you will become extensively bald (i.e. no donor miniaturization and no family history of extensive baldness), then hair transplantation can be considered.

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Hair Restoration Answers

Should I Consider Hair Transplant if I Have Early Hair Loss in Crown and Donor Area?

Q: I’m currently 24 years old. Ever since turning 20, my hair on top began to thin little by little. I have noticeable thinning on the top part of my scalp and on my crown, but have no recession at the temples. My hairline looks amazingly young and hair on the donor areas seems quite thick. Am I in the early stages of male patterned baldness? I cannot place myself in the Norwood scale since my thinning doesn’t seem to follow the classic pattern. I just started on Propecia. Should I be considering a hair transplant? — B.R., Landover, MD

A: From the description, it sounds like you have typical Diffuse Patterned Hair Loss or Diffuse Patterned Alopecia (DPA). In this condition, the top of the scalp thins evenly, the donor area remains stable, and the hairline is preserved for a considerable period of time. Please see: Classification of Hair Loss in Men for more information.

Propecia would be the best treatment at the outset. When the hair loss becomes more significant, patients with DPA are generally good candidates for surgical hair restoration. It is important, however, that your donor area is checked for miniaturization to be sure that it is stable before a hair transplant is considered.

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Hair Restoration Answers

At What Age Should I Consider a Hair Transplant?

Q: If my hair is just starting to thin, when should l have my first hair transplant? — T.O., Bayonne, NJ

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. When hair loss is just starting, medical therapy is generally a better choice than surgery as it can both regrow hair and prevent future loss.

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Hair Restoration Answers

When Can I Judge the Effectiveness of Treatment with Propecia?

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? — I.P., Hempstead, Long Island, NY

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…

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Hair Restoration Answers

In Early Hair Loss, Can Scalp Tingling and Hair Thinning be Related?

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? — T.N., Philadelphia, PA

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).

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