Q: Does donor area hair thin with age? – T.W. A: Hair taken from the donor zone is considered to be permanent and should resist changes related to androgenetic alopecia also known as genetic patterned baldness. In other words, it will not be lost. Through the natural aging process, hair diameters may decrease over time […]
Posted by Updated 2019-12-05Q: My hair is starting to thin in the front, but it is not yet bald. I have been going back and forth about whether to get a hair transplant or use Propecia. I’m not sure what my first step should be. What do you think? — N.K. ~ Pleasantville, N.Y.
A: In general, patients who are thinning, but not actually bald, should begin with combined medical therapy (finasteride and minoxidil) for at least a year prior to considering surgery. In many cases, with this regiment, surgery can postponed or even avoided completely. Unfortunately, some patients cannot tolerate finasteride or choose not to take it due to concern about potential side effects. Minoxidil, although useful, does not significantly alter the long-term course of hair loss when used alone.
Posted by Updated 2018-07-03
A study published in the December 2015 issue of the Journal of Clinical and Aesthetic Dermatology suggests that Viviscal, an oral supplement designed for women with thinning hair, may promote hair growth. The researchers noted a 79 percent increase in healthy, terminal hairs and an almost 12 percent increase in hair diameter in female patients who took the supplement for six months. The evidence suggests that Viviscal may be a useful supplement to current hair restoration treatments, or an alternative treatment in patients not indicated for hair transplant surgery or medical treatment with finasteride.
Posted by Updated 2016-02-09A review of research on the efficacy of Viviscal, published in the September 2015 issue of the Journal of Drugs in Dermatology, suggests that the oral supplement may increase hair volume as well as the thickness of healthy, terminal hairs. The article presented more than two decades of research on the hair regrowth product and also included a discussion with a roundtable of dermatology and plastic surgery experts. Both the research review and roundtable discussion point to the benefits of Viviscal, however the article’s conclusions can be questioned due to the appearance of a conflict of interest between the researchers and Lifes2good, Inc., the company that produces Viviscal. Additional independent research needs to determine if Viviscal is a viable and effective hair loss treatment.
Posted by Updated 2016-02-02Q: The last few months my friend and I experimented with andro gel thinking it would make our T levels go up and make our work outs better. We got the andro gel online with no prescription (which I know is really stupid on our behalf). The past couple of months I have been experienced a lot of acne and hair loss. I went to the doctor and confessed and said what I did, and he was very disappointed and lectured me on how dangerous it was and stupid on my behalf – which I totally agree. He told me the rise in testosterone from andro gel contributed to the acceleration of hair thinning and acne. I had mild hair loss prior but the andro gel seem to have accelerated it. The doctor put me on Propecia and gave me some acne cream for the acne. He said the Propecia will undo some of the damage it did for the hair. In your experience, can Propecia reverse some of the damage? I am 28 years old.
A: Your doctor is giving you the right course of action. Testosterone supplements can accelerate hair loss, particularly in those with underlying genetic hair loss. Finasteride 1mg (Propecia) should help you to grow your hair back. You may also want to consider using minoxidil (Rogaine) in addition.
Posted by Updated 2017-10-17
Researchers at the University of Pennsylvania, who were investigating the biological causes of androgenetic alopecia or common genetic hair loss, have discovered that levels of a certain inhibitor protein, called Prostaglandin D2 (PD2), are elevated in bald areas on the scalp. This discovery could be an important breakthrough in developing a medical hair loss treatment that regulates the production of the protein, or one that blocks it from attaching to its receptor protein.
Dr. Eric S. Schweiger, board-certified dermatologist, is quoted in a few recent articles on the effects of chemotherapy on hair, genetic testing for hair loss, and caring for a bald or balding scalp. The articles were published in Energy Times and HairLoss.com. View the full post to read what Dr. Schweiger has to say on these topics.
Posted by Updated 2016-01-28Q: At what level of thinning should the hair transplant be done? — V.K., London, UK
A: A hair transplant should be considered in an area of thinning when:
Other factors that are important include:
Q: What are the most common causes of hair loss in women other than genes?
A: The most common causes for localized hair loss in women are traction (due to tight braiding) and alopecia areata (an autoimmune disease that produces smooth round patches of hair loss).
Other than genetic (hereditary) thinning; generalized hair loss is most commonly caused by medications, anemia, and thyroid disease.
Posted by Updated 2015-12-04Q: I started thinning and saw more hair in the tub. I began Rogaine and stopped shampooing every night and is seems that there is now more coming out every time I shower. What is going on? — E.U., Short Hills, NJ
A: Rogaine can cause shedding at the beginning of treatment (i.e. in the first 3 months) but this is expected as it causes some hair to begin a new cycle of shedding and re-growth. This means the medication is working.
Another reason for your apparent shedding is that the less you wash your hair, the more will be lost each time. Go back to shampooing every day and see what happens.
Posted by Updated 2017-12-11Q: I’ve been losing my hair just around the front of my scalp for years, but now it’s bad enough that I need to wear a wig to hide the top and back. Do you transplant women?
A: If you have thinning in such a broad area, most likely your donor area is also thin and you would not be a good candidate for surgery.
An examination can determine this and also determine if there is some other cause of your hair loss other than genetics.
Posted by Updated 2015-12-08Q: I have thinning hair and have heard about Low Level Laser Therapy (LLLT) for hair loss. I know that I can either buy a machine over the internet or go to a doctor’s office or medical spa for treatments. Which one should I do? A: The advantage of the in-office LLLT systems are that […]
Posted by Updated 2015-12-15Q: Why is the consult fee more for diffuse thinning than for a regular visit? — B.F., Altherton, CA
A: Diffuse hair loss, more common in women, can be the result of a number of underlying medical conditions and therefore it usually requires an extended medical evaluation.
If you are a male or female with obvious diffuse thinning from androgenetic alopecia (common baldness), or if you have patterned hair loss where the diagnosis is straightforward, the fee is less because an extensive evaluation is not required.
Please visit our Hair Transplant Costs & Consultation Fees page for more information.
Posted by Updated 2017-12-12Q: I am a 33 year old women and am just starting to thin on the top of my scalp behind my frontal hairline. What should I do? Should I have a hair transplant?
A: There are a number of things that you should consider that can be effective in early hair loss. These include minoxidil (Rogaine), laser therapy, and using cosmetics specifically made to make the hair appear fuller. Lightening or streaking the hair, as well as parting the hair off to the side, will also make the hair appear fuller.
If a surgical hair restoration is performed too early and there is still a lot of existing hair in the area, the hair transplant may actually accelerate hair loss. Surgery should not be performed prematurely.
Also, it is important that the doctor check the stability of the donor area, using densitometry, to make sure that the procedure is even possible. For those women who are good candidates, and if it is done at the appropriate time, a follicular unit hair transplant is a great procedure that can produce really natural results.
Posted by Updated 2015-05-21Q: 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.
Posted by Updated 2017-12-11Q: I seem to be thinning, but I never shed hair as such in the shower. I cannot see my hair falling out. Can it be androgenetic hair loss? — R.C., Cambridge, MA
A: In androgenetic hair loss one rarely sees hair falling out in mass, but rather the thinning is due to the hair decreasing in diameter and length (a process called “miniaturization”).
Posted by Updated 2017-12-12Q: 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.
Posted by Updated 2015-07-20Q: 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.
Posted by Updated 2017-12-11Q: I am a 22 yr. old male and have been on Propecia for exactly 4 months. When I started taking the medication, I was in the beginning stages of hair thinning/loss in the front and crown areas, with no change in my hair line. During the time I have taken Propecia, my hair loss has increased drastically. Is it that I just have to bite the bullet and am one of the few unlucky individuals that do not respond to Propecia? Could it be that I am taking the medication incorrectly? Wrong time of day? With or without food? Or, do I just need to give it more time? Is there still a chance I could at least regain the hair I’ve lost over these past 4 months? — A.B., St. Louis, Missouri
A: You are probably experiencing an accelerated phase of hair loss that is possibly made worse by the finasteride. The shedding from finasteride is common during the first few months of treatment and is temporary. The full effects of Propecia are not seen for 6 to 12 months.
I would continue to take the medication for at least a year before you judge if it is working. It does not matter the time of day or relationship to food.
Posted by Updated 2017-12-11Q: I have had a minor facelift operation and have lost a bit of hair. Have you heard of this before? The areas around the scars are the most effected. What treatments are best for this? — N.D., Westport, C.T.
A: Hair loss after a brow, or face lift, is quite common. If it is cosmetically bothersome, a localized hair transplant can correct the problem.
The hair can be transplanted directly into the scar (if the scar is flat) and into any surrounding areas of thinning. The complete correction may take more than one hair restoration session.
Posted by Updated 2017-12-01Q: 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.
Posted by Updated 2017-12-11Q: Should I cut my hair prior to the hair transplant? — R.R., Poughkeepsie, N.Y.
A: It is easier for the hair transplant surgeon and his team to work when the existing hair in the area to be transplanted is cut short, but a skilled surgeon can work well in either situation. Most experienced surgeons are used to working without cutting the hair in the recipient area, since so few patients want their hair to be cut – particularly in New York.
Posted by Updated 2017-12-01Q: 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.
Posted by Updated 2017-12-12Q: What is “shock fall out”? – D.B., Chappaqua, N.Y.
A: Shedding after a hair transplant is also referred to by the very ominous sounding term “shock fall out.” The correct medical term is “effluvium” which literally means shedding. It is usually the miniaturized hair (i.e. the hair that is at the end of its lifespan due to genetic balding) that is most likely to be shed. Less likely, some healthy hair will be shed, but this should re-grow.
Interestingly, if transplants are spaced less than one year apart, one often notices some shedding of the hair from the first transplant, but this hair grows back completely. For most patients, effluvium is not a major issue and should not be a cause for concern.
Typically, when shedding occurs, a patient looks a little thinner during the several month period following the transplant, before the transplanted hair has started to grow. The thinning is often more noticeable to the patient than to others. Shedding is generally noted as a thinning, rather than of “masses of hair falling out,” as the term “shock fall out” erroneously suggests.
In general, the more miniaturization one has and the more rapid the hair loss, the more likely shedding will be from the hair restoration surgery. Young, actively balding patients would be at the greatest risk. Older patients with stable hair loss would have the least risk. In either situation, since miniaturized hair is eventually going to be lost, the effluvium has no long-term effect on the outcome of the procedure.
Posted by Updated 2017-12-11Q: 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.
Posted by Updated 2017-12-11Q: 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.
Posted by Updated 2017-12-12Q: 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).
Posted by Updated 2017-12-12
Hair loss has a variety of causes. Diagnosis and treatment is best determined by a board-certified dermatologist. We offer both in-person and online photo consults.
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