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Hair Restoration Answers

Can Rogaine Cause Miniaturization?

Q: Can Rogaine Cause Miniaturization?

When I am on Rogaine it seems – to my untrained eye – that I am having hair miniaturization and when I stopped briefly, I had shedding. Does this seem accurate based on what you have seen? Can Rogaine cause miniaturization? Is there a point you would recommend I stop Rogaine or is it something that likely can’t cause a negative impact on hair? — B.T., Brooklyn, NY

A: Minoxidil reverses miniaturization. It does not cause it. Shedding can occur after starting use of Rogaine but this means the medication is working should resolve with continued use. New miniaturized hairs are either from the progression of your genetic male pattern hair loss or newly forming hair that was stimulated by the minoxidil which can mimic miniaturized hair.

Posted by Updated 2018-10-23
Hair Restoration Answers

If I Am Starting to Thin, Should I Have A Hair Transplant Or Try Medication First?

Q: 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
Bernstein Medical In The News

Dr. Bernstein Interviewed by NY Japion Magazine on the Latest in Hair Transplant Surgery

Dr. Bernstein Interviewed in NY Japion Pt 2Dr. Bernstein was featured in a wide-ranging interview published in the New York City-based, Japanese language magazine NY Japion. Among the topics discussed were the differences between FUT and FUE hair transplants, updates on robotic hair transplant technology, the type of procedure most beneficial for Asian patients, criteria that determine candidacy for a hair transplant, and more.

Posted by Robert M. Bernstein M.D. Updated 2018-07-03
Hair Restoration Answers

Does Minoxidil Improve Graft Survival After a Hair Transplant?

Q: Does minoxidil play any role in the survival of the grafts after a Neograft/FUE procedure? — J.W., Philadelphia, PA

A: When a doctor performs a hair transplant, the hair should be taken from the permanent zone so, by definition, that hair is not affected by medication (i.e. does not need to be maintained by either minoxidil or finasteride). If the doctors using Neograft are suggesting that minoxidil increases survival, then they are probably harvesting hair outside the permanent zone. To clarify, I use the ARTAS robotic system for our FUE procedures, not Neograft, as the former is a far more accurate device for harvesting.

Posted by Robert M. Bernstein M.D. Updated 2017-12-01
Bernstein Medical In The News

Dr. Bernstein Interviewed for ‘Cosmetic Town’ Article on Benefits of Rogaine for Male Pattern Baldness

Cosmetic Town

Dr. Bernstein contributed to an article published on the cosmetic surgery portal “Cosmetic Town” about the benefits and usage of Rogaine® (minoxidil) hair loss medication.

The article also discusses the recommended dosage of Rogaine, a comparison of Rogaine and Propecia, when a patient can expect to see results of medical treatment of hair loss, and other related topics.

Posted by Robert M. Bernstein M.D. Updated 2016-01-29
Hair Restoration Research

Survey Finds Red, Low-Level, Laser Light Therapy is an Effective, Alternate Treatment for Androgenic Alopecia

Researchers from the Harvard Medical School surveyed five clinical studies designed to measure the effects of low-level light laser therapy (LLLT) on androgenic alopecia in both men and women. In each case, they found that red and near-infrared LLLT was a safe and effective treatment option for both men and women with genetic balding.

Posted by Robert M. Bernstein M.D. Updated 2015-10-28
Hair Restoration Answers

Is Propecia and/or Rogaine Mandatory after a Hair Transplant?

Q: I’ve heard that using Propecia and/or Rogaine is a good idea after having a hair transplant, but are they mandatory? — B.M., Short Hill, N.J.

A: Neither finasteride (brand name: Propecia) nor minoxidil (brand name: Rogaine) will have any effect on transplanted hair. That said, while you don’t need them to protect your transplanted hair, you will likely have original hair interspersed among your transplanted hair that will continue to thin and fall out over time. This vulnerable hair can be protected by finasteride which has been shown to reduce future hair loss significantly; additionally, you can add Rogaine for extra benefit.

However, with Propecia, you should only use it if you can commit to it long-term because it takes up to a full year to see any effect. With Rogaine, you should only use it if you can commit to using it continually and regularly – you should not stop and start it.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Do Propecia (Finasteride) and Rogaine (Minoxidil) Work on Front of the Scalp?

Q: Both Propecia and Minoxidil definitely can work in the front of the scalp as long as there is some hair in the area. Although their mechanisms of action are different, both Propecia (finasteride) and Rogaine (minoxidil) act to thicken miniaturized hair regardless of where it is on the scalp. In fact, there are published data (Leyden et. al., JAAD, 1999) demonstrating this improvement in a controlled clinical trial of men with frontal hair loss. — J.S., Great Falls, Virginia

A: Both Propecia and Minoxidil definitely can work in the front of the scalp as long as there is some hair in the area. Although their mechanisms of action are different, both Propecia (finasteride) and Rogaine (minoxidil) act to thicken miniaturized hair regardless of where it is on the scalp. In fact, there are published data (Leyden et. al., JAAD, 1999) demonstrating this improvement with finasteride in a controlled clinical trial of men with frontal hair loss.

The source of the confusion on this topic is the fact that the FDA limited the application of the drugs to the crown on the package inserts for both Propecia and Rogaine. The FDA did this because Upjohn (the company that introduced Rogaine) and Merck (Propecia) only tested the medications on the crown in the clinical trials. Logically, the fact that DHT causes frontal hair loss and Propecia works by blocking DHT gives a reasonable explanation for the efficacy of the drug on the front of the scalp. Also, a side effect of the use of minoxidil is facial hair, so how could it not also work on the front of the scalp? It is regrettable that some doctors and many patients think that these medications won’t work on the front of the scalp. Unfortunately, many hair restoration surgeons have done little to educate the public and dispel this myth.

To reiterate, yes, both of these medications can work on the front of the scalp to prevent hair loss and thicken a thinning hairline. However, it is important to note that neither of these medications can grow hair on a totally bald scalp or lower an existing hairline. Hair follicles must exist for the medications to work. It is also important to stress that the best results come from using both finasteride and minoxidil together.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Research

How Does Minoxidil Work? A Review Of Recent Research

Since 1993, minoxidil has been the most successful topical treatment for hair loss in both men and women, yet its exact mechanism of action remains unknown.

A 2004 review of minoxidil’s possible mechanisms of action (A.G. Messenger & J. Rundegren, 2004) suggests that the best evidence supports the idea that minoxidil causes hair follicles in the later phases of their resting phase (telogen) to shift prematurely into an active growth phase (anagen) sooner than they otherwise would; this causes rapid increase in hair growth. They also found good evidence that minoxidil works to thicken the hair by increasing hair diameter.

While minoxidil’s effects on other critical factors known to affect hair growth — such as cell proliferation, collagen synthesis, vascular endothelial growth factor and prostaglandin synthesis — remain uncertain, more recent research has found evidence that it may also suppress the androgen-androgen receptor responsible for androgenetic alopecia (Cheng-Lung Hsu, Jai-Shin Liu,An-Chi Lin, Chih-Hsun Yang, Wen-Hung Chung, & Wen-Guey Wu, 2014).

Understanding minoxidil’s exact mechanism of action remains today an important line of research both for the development of better hair loss treatments and for a better understanding of the biology of hair growth.

Posted by Robert M. Bernstein M.D. Updated 2015-05-22
Hair Restoration Answers

Why Am I Still Losing Hair (Shedding) After 6 Months on Minoxidil And Finasteride?

Q: I have been using an increased dosage of Propecia now for around 8 months and Rogaine for about 6 months. I know that shedding can be expected for the first 3-6 months, but I believe I am now beyond that timeframe. Have you seen cases in which these products merely exacerbate hair loss without the expected regrowth? — N.E., Travilah, Maryland

A: It is a bit long to still see shedding, but from my experience, either the medications are working (and you are still in the shedding phase) or you are not responding to them. I have not seen minoxidil or finasteride worsen hair loss. My advice would be to continue the same course for at least a year before re-evaluating their use.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Can Andro Gel Cause Hair Loss?

Q: 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 Robert M. Bernstein M.D. Updated 2017-10-17
Hair Restoration Answers

Do You Recommend Azelaic Acid With Rogaine (Minoxidil) 2% Or 5%?

Q: Have you any experience with Azelaic Acid as a hair loss treatment — is this something you would recommend using with Rogaine (minoxidil) 2% or 5% solutions? — S.V., Short Hills, N.J.

A: Azeleic acid has no direct benefit in promoting hair growth. Azelaic acid (like retinoic acid) increases the absorption of minoxidil, but also the side effects, so I would especially not recommend it in your case.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Are Patients in Photos of Medical Treatment Using Concealers, or are Results Genuine?

Q: Doctor Bernstein, I was looking at your website and saw the photos of medical hair loss treatments only, with Rogaine and Propecia. Doctor, are all those pictures just with medical treatments or is there concealers as well? I don’t mean to sound rude or disrespectful, but are the pics all real and genuine? Those are some impressive responses to medical treatment. — A.D., Scarsdale, NY

A: The photos are un-retouched and without concealers. These are responses to medical treatment alone. Yes, medications (finasteride and minoxidil) can work really well in select patients. Patients with early stages of thinning usually respond the best. Contrary to popular belief, the medications can work in the front part of the scalp, as long as the area is not shiny bald.

Perhaps about 1/3 of patients respond well enough to be put on the site. Most others have a good response, but not necessarily improvement significant enough to be easily noticeable in photos.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Before and After Photos of Medical Therapy Look Too Good To Be True!

Q: Are the “result” photos from taking Propecia and using Rogaine legitimate? Some of the after photos look too good to be real and a few patients looked like they combed their hair to look like they had more coverage. — T.Y., Darien, Connecticut

A: The before and after photos of patients using Propecia and Rogaine are my patients. All photos on our website are un-retouched. Often, when patients have a good response to medical therapy, they have more flexibility in how they can groom and style their hair. This is reflected in the photos.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Can I Stop Medical Treatment For Hair Loss Once Started?

Q: I am taking finasteride as you prescribed. You also suggested using minoxidil liberally over the entire front and top of my scalp once a day. During our meeting I think that you said that once I start using this I would not be able to stop it, and, if I did, it might lead to further hair loss. Hence, I decided to use the laser comb three times a week in addition to the finasteride. Having said that, if you still feel I should start using minoxidil daily, I will start doing so. — H.K., Brooklyn, NY

A: Stopping therapy doesn’t lead to further hair loss in that it doesn’t accelerate it; you just continue on the path that you would have been without the treatment. When you stop, there may be an initial shedding as you quickly lose any benefits that you had from the treatment.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Does Scalp Med Prevent Hair Loss By Unclogging Pores?

Q: Scalp Med is supposed to unclog pores. How does this prevent hair loss?

A: The active ingredient of Scalp Med is Minoxidil, which will help reverse miniaturization, the process that causes androgenetic hair loss. Hair loss is not caused by clogged pores, so unclogging them will not prevent going bald. Minoxidil, which is also the active ingredient in Rogaine is over-the-counter so it is a less expensive way to use the active ingredient.

Posted by Robert M. Bernstein M.D. Updated 2015-04-23
Hair Restoration Research

Researchers “Accidentally” Reverse Hair Loss Caused by Stress

Sometimes an “accident” in the laboratory can lead to a remarkable breakthrough. Penicillin, Botox, Viagra, and Minoxidil — the active ingredient in Rogaine — were all unintended discoveries that led to treatments for a variety of conditions. A similar twist of fate, this time by researchers at UCLA, could lead scientists to a new hair loss treatment.

Posted by Robert M. Bernstein M.D. Updated 2014-08-06
Hair Restoration Answers

Is it Normal to be Shedding Three Months After a Hair Transplant?

Q: I am about 3 months post-op after my hair restoration procedure. I have noticed some hair shedding in the frontal part of my scalp. I have continued both Propecia and Minoxidil. Is there anything I can do and should I be concerned? — M.B., Chicago, IL

A: Shedding of some of the patient’s existing hair in, and around, the area of a hair transplant is a relatively common occurrence after a hair transplant and should not be a cause of concern. The mechanism appears to be a normal response of the body to the stress of the hair restoration surgery -– i.e., site creation, adrenaline in the anesthetic etc. Some doctors claim that their hair transplant techniques are so “impeccable” that their patients do not experience shedding. This is a false claim. Although using very small recipient sites and limiting the use of epinephrine may mitigate shedding somewhat, shedding is a normal part of the hair transplant process and the risk is unavoidable.

Posted by Robert M. Bernstein M.D. Updated 2015-12-04
Hair Restoration Answers

Can Propecia Cause Groin Pain?

Q: I started using both Propecia (finasteride) and Rogaine for roughly the past 15 weeks. In the last month I’ve been experiencing pain in my left testicle area. At first I thought this may be due to Varicocele; however, after some quick internet searches I thought it may also be the Propecia. The pain doesn’t seem to be in the testicle itself as much as the surrounding veins on the left side. What should I do? — B.L., Houston, TX

A: Your symptoms are the classic ones of a varicocele, namely pain on the left side that is adjacent to the testicle. Symptoms of finasteride would more likely be bilateral, although the discomfort does not need to be in the testicle itself. If your symptoms are worse at the end of the day when you have been standing, and less in the AM when you first arise, these suggest a varicocele.

In your pain is consistently worse towards the end of the day, I would see a urologist, as surgical intervention might be warranted, particularly if it is affecting sperm counts – which should be checked as part of the evaluation.

If this is not the case, then stop finasteride for a least a month and see if the symptoms subside. If they do go away off finasteride, I would not take the medication again. If the symptoms persist off finasteride, I would still see a urologist.

Posted by Robert M. Bernstein M.D. Updated 2015-04-23
Bernstein Medical In The News

Men’s Health Magazine Features Dr. Bernstein in ‘Hair Health’ Spotlight

Men's Health - Hair HealthMen’s Health has published a new spotlight, called “Hair Health.” The multi-article spotlight is featured on the magazine’s website homepage and covers a wide variety of topics related to men’s hair loss and hair transplantation. Dr. Bernstein was asked to contribute to the series of articles, including an “expert advice” feature which answers five commonly-asked questions about hair loss myths.

Posted by Robert M. Bernstein M.D. Updated 2019-05-02
Hair Restoration Answers

Should I Start Propecia Before Hair Loss Consultation?

Q: I am a 34 year old male and my dermatologist prescribed Propecia for me today. Most of my hair loss is at the hairline, but there is some loss on top as well. It’s not bad, I just want to stay ahead of it. If I get a transplant I want to get it at your clinic, but I will give the Propecia a try first. I am going to be overseas for a couple of months starting this Sunday and I was wondering about the necessity or desirability of having someone measure my hair density prior to starting the Propecia. Would you advise waiting to start the Propecia until I come back in two months and having my density examined at your clinic? — M.R., Great Falls, Virginia

A: I would start Propecia as soon as possible. What is important for a hair transplant is the density in the donor area and this is not affected by Propecia (or minoxidil). Your donor density can be measured anytime at an evaluation prior to surgery. If you want to wait to see the effects of Propecia prior to the hair transplant, you really should wait a year; since growth, if any, can take this long. If you just want to have Propecia on board for the hair restoration procedure, or to make sure you don’t have side effects, then generally a month will do. If you would like to do a photo consult through our website to get some preliminary information about how many grafts you might need, you can do that at your leisure, but start Propecia now since the longer you wait the less effective it will be at regrowing hair.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Can Propecia Or Rogaine Restore My Original Hair Density?

Q: You mentioned that the hair at my crown and other areas where I now have baldness hasn’t really fallen off but has thinned to a great extent and that taking Rogaine and Propecia might help increase their thickness. If the medications do restore the hair thickness, I’m curious why you said that I could look like how I was 1 to 2 years ago. Technically, shouldn’t I be able to regain much more of my hair (and look like how I was longer than before that) since the follicles are all still there? — H.D., Park Slope, NY

A: Although Propecia is much more effective than Rogaine, even when used together, the medications are just not that effective in reversing the miniaturization process. They may bring you back to the way you were a few years ago, but will not restore your adolescent density.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Could Taking Finasteride Or Minoxidil Make A Hair Transplant Possible If My Donor Area Is Thin?

Q: You said I was not a good candidate for a hair transplant because my donor area was too thin. Since finasteride and minoxidil can increase the thickness of the hair, could it make a hair transplant possible?

A: Unfortunately, the medication will not affect the donor area and, therefore, not make a person with low donor density a candidate for a hair transplant.

Posted by Robert M. Bernstein M.D. Updated 2015-12-15
Bernstein Medical In The News

ABC News Report On Hair Loss Features Dr. Bernstein, Consumer Reports Hair Loss Survey

WABC-TV Eyewitness News; channel 7 in New York, NY; featured Dr. Bernstein in a special report on hair loss and hair loss medications. In particular, the report, by ABC correspondent Kemberly Richardson, asked Dr. Bernstein about the effectiveness of Propecia/Finasteride and Rogaine/Minoxidil in the treatment of male pattern hair loss. Watch the report.

Posted by Robert M. Bernstein M.D. Updated 2014-01-07
Hair Restoration Answers

When Should Hair Transplant Be Considered For Thinning Area?

Q: 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:

  • The area has not responded to medical therapy (finasteride 1mg a day orally and minoxidil 5% topically for one year).
  • The thinning is significant enough that it can’t be disguised with simple grooming (i.e. is a cosmetic problem even when the hair is combed well).

Other factors that are important include:

  • the age of the patient
  • the donor supply
  • whether the thinning is in the front of the scalp or in the crown
Posted by Robert M. Bernstein M.D. Updated 2017-12-01
Hair Restoration Answers

Is Nioxin An Effective Hair Loss Treatment, And Is It Safe Or Advisable To Use?

Q: I have been using Rogaine and Propecia, but recently purchased a bottle of Nioxin Cleanser/Shampoo. However, I am reluctant to apply it because I have noticed that the Nioxin website recommends against mixing Nioxin products with Rogaine products. Do you think that it is safe or advisable to use the Nixon shampoo? Is there any indication that this product is even effective? Any advice?

A: Nioxin has no active ingredients that can grow hair. There is an increased incidence of scalp irritation when used with Rogaine – i.e., the likely reason for their warning. I would stick with the medications that are proven to work, i.e. finasteride and minoxidil.

Posted by Robert M. Bernstein M.D. Updated 2015-04-23
Hair Restoration Answers

Which is Better Hair Loss Treatment: Minoxidil With Retin-A or Without Retin-A?

Q: Is using Minoxidil combined with Retin-A better than regular Minoxidil for Hair Loss? — L.W., Gowanus, New York

A: Minoxidil has been prescribed (off-label) in combination with other medications, such as topical retinoic acid (Retin-A), to enhance its penetration into the skin and thus increase its effectiveness. This combination of medications can increase the absorption of minoxidil into the bloodstream and may increase the risk of potential side effects, including changes in blood pressure and scalp irritation. It is important to use combination therapy under the supervision of a physician.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Why Do You Shed Hair in First Months of Treatment with Rogaine?

Q: 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 Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Which is Preferred: Rogaine Foam or Liquid Formula?

Q: Do you think there is a difference in the efficacy between the 5% Rogaine foam or liquid formula? — N.N., Dallas, TX

A: In theory, the foam should be as effective as the original solution (liquid). However, an important part of the efficacy is getting the medication directly onto the scalp – rather than just on the hair.

For patients who are applying the medication to areas with a significant amount of hair, using the solution with a dropper applicator enables the medication to best reach the scalp. Because of this, I prefer that patients use the solution with a dropper applicator if they are using the medications in areas with a significant amount of hair. If patients find the solution irritating to the scalp (or too messy) and the foam less so, then using the foam is better than nothing.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

After a Hair Transplant Can I Replace Hair Loss Medication with Laser Therapy or Herbs?

Q: I am interested in a hair transplant, but am turned off by the apparent side effects of follow up Propecia. Could herbs serve the purpose of Propecia? Regarding laser treatments, do they work on their own, or do you need drugs to supplement? Can laser damage in some cases, rather than benefit? It seems odd that laser therapy has been undertaken in Europe for 10 years, yet there are no published studies on the results. Might this be because it doesn’t work in the longer term? — D.D., Richmond, U.K.

A: Finasteride is the best medication. Herbs are not particularly effective for hair loss. You should consider trying finasteride.

If you are in the 2% group that has side effects with Propecia, just stop taking the medication. If you do not experience side effects, then there is no problem taking the medication long-term. Hair transplant surgery doesn’t prevent the progression of hair loss. That is why it is used in conjunction with medication.

Click here to read the rest of the post.

Posted by Robert M. Bernstein M.D. Updated 2017-12-01
Hair Restoration Answers

Will Intermittent Use of Rogaine Stop My Hair Loss?

Q: Medical information suggests that Rogaine works for about 50% of the men who try it. Does Rogaine actually worsen hair loss in some men? The Rogaine website states that during the first three weeks of use Rogaine causes increased shedding. If true, would intermittent use of Rogaine make hair loss worse even in men for whom Rogaine would work if applied daily as directed? — V.C. Greenpoint, Brooklyn

A: Rogaine, the brand name for the drug Minoxidil, does not worsen hair loss, but can cause initial shedding (which actually shows that the drug is working).

The medication should be used on a continuous basis for the long-haul. Intermittent use of the drug, or pulsing, makes no medical sense.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

After a Hair Transplant, Should I Use Propecia or Rogaine or Both?

Q: I recently had a hair transplant about a month ago. Currently I’m on Propecia and I am a stickler to taking it at the same time every day. I don’t, however, use Rogaine namely because I fear the irritation it can possibly cause will halt graft growth and because I’ve heard that the grafts and post-surgical shock loss hair will return without its use. Is it ok to use only Propecia post-surgically? Or would adding Rogaine be of any significant benefit? — L.B., Rye, NY

A: I would definitely stay on Propecia and, if you like, you can add Rogaine – it may have a little additional benefit. The 5% foam formulation is less irritating and can be started a week after the hair transplant.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
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.

Posted by Robert M. Bernstein M.D. Updated 2017-12-01
Hair Restoration Answers

Allergic Reaction to Rogaine Liquid but Not Foam?

Q: Our dermatologist originally suggested our son use the 5% Rogaine and he developed an allergic reaction to it. Allergy tests confirmed it was the propylene glycol causing the reaction. I understand that Rogaine foam has 5% minoxidil in it but no propylene glycol. Is that correct? — B.M., Lower East Side, N.Y.

A: In addition to minoxidil 5%, Rogaine Foam contains: butane, butylated hydroxytoluene, cetyl alcohol, citric acid, fragrance, glycerin, isobutane, lactic acid, polysorbate 60, propane, purified water, SD alcohol 40-B, stearyl alcohol — but no propylene glycol.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

How do You Treat Early Hair Loss in Women?

Q: 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 Robert M. Bernstein M.D. Updated 2015-05-21
Hair Restoration Answers

How Long After Hair Transplant Should I Wait Before Continuing Treatment with Rogaine?

Q: I stopped using Rogaine for my hair transplant, when can I start using it again? And would it be any different with the new Rogaine foam. — J.N., London, United Kingdom

A: I would wait at least 7 days to use Rogaine (minoxidil) in either liquid or foam.

The foam has less alcohol and can be irritating when applied to open wounds, but should be fine one week post-op.

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Does Rogaine Only Work on Crown?

Q: I heard that Rogaine only works on the crown and not on the front or top of the scalp. Is this true? — D.D., New Haven, Connecticut

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).

Posted by Robert M. Bernstein M.D. Updated 2017-12-11
Hair Restoration Answers

Is Laser Therapy a Revolutionary Hair Loss Treatment?

Q: The makers of the HairMax LaserComb have claimed that it will “revolutionize the hair growth industry.” What do you think?

A: This claim is obviously overstated.

Since the Low Level Laser Therapy (LLLT) doesn’t affect the action of DHT on hair follicles, it doesn’t affect the underlying cause of genetic hair loss, and thus would be expected only to have limited effectiveness. The company’s own studies show that this is, indeed, the case.

Posted by Robert M. Bernstein M.D. Updated 2015-12-04

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