Hair Restoration Blog

Q:

I had a hair transplant surgery a month ago.  As it turns out, I have a huge amount of shock loss right now.  As i’ve never taken propecia before, do you think it’s too late to combat this shock loss with propecia?  Any suggestions on how i could eliminate this shock loss from further damage?  I hope my hair will return.

A:

To prevent shock loss, it is never too late for Propecia (finasteride) if you really need it. You may not get the maximum benefit as if you started on the medications before your hair transplant, but your shock loss may not have been completed yet.

We generally start our patients on Propecia a few days prior to their hair transplant so the medication is in the system at its therapeutic level on the day of surgery.

Many people choose to continue the medication after hair restoration surgery and we encourage that. We continue the medication for 6 to 8 months after the hair transplant, depending on the degree of miniaturization for patients who do not want to be on finasteride for the rest of their lives or the ones who have minimal miniaturization. After the first few months, the chance of shock loss due to the hair restoration surgery is very minimal but it still may occur.

Q:

Thanks Dr. Mohebi,

Your input is much appreciated.  The shock loss you had mentioned has been my concern, as a few of my frontal hair seem lighter than before.  You had mentioned that the shock loss might be visible for a few weeks to months - will it be the case that after that shock loss stage, the hair will likely return back to original form?

There’s a very important question that i would like to ask you, and was thinking the it would be great for the blog to have.  Basically, when you saw my before and after picture, i feel like i changed a bit.  The “after” picture seems like i have more redness, and i’m hoping it’s not the case where the hair transplant affects the circulation (e.g., tight donor area/scalp affecting the blood flow to my head).  My surgeon told me before the procedure that i will eventually be back to the way i was before (i.e., the “before” picture), but just have a new scar and more gafted hairs.  That’s the ultimate question: would you agree that a patient who does a hair transplant will relatively return to the condition that he was before the particular sugery (w/ of course, a new scar and more hair)?  This is what keeps me up at night, thinking perhaps my scalp has worsened, or i am now more prone to lose hair.  I hope that’s not the case, and every patient should be aware about before she or he gets a hair transplant done.

Thanks again for your help.  If I see you in person at your office, I might be interested in discussing about future scar work.

A:

What is hair transplant shock loss

Some of the hair shafts that fall off due to shock loss might come back. Especially if the shock loss happens in an area with permanent hair like back of the head. However, losing hair in the frontal area because of shock loss might not be completely reversible. But, you have to understand that falling hairs are the ones that were supposed to fall off anyway and a hair transplant just accelerates the loss.

How to prevention shock loss

Again, using finasteride can significantly reduce the extent of shock loss. After surgery, in the transplanted area, the tightness should not affect the circulation of the scalp. After a few days to weeks, on the donor area, the tightness goes back to normal.

Donor scar in strip hair transplant

And to answer to your last question, I do not agree you go back to the condition before surgery with only a new scar and some more hair. What I personally do in a repeat surgery is remove the old scar; the patient at the end has only one scar that at times may be even better than the initial scar.

How to improve the appearance of the scar

I perform tricophytic closure when I think it is the final surgery that the patient may need.  Tricophytic closure is when we close scalp skin on the back in a way that hair can grow through the scar.  Tricophytic closure reduces the contrast between donor scar and surrounding areas that eventually improve the appearance of the scar, so you are not more prone to hair loss because of your hair transplant.

In some cases and when we are looking for even less visible scar, the scar may get filled with FUE into the scar in a few months from the initial surgery.

Be patient and you should be able to see results in the coming months.

The effectiveness of medical hair restoration alone with hair restoration medical options that are currently available such as finasteride or Rogaine has always been questioned.  Medical hair restoration without the surgical option (hair transplant), might work for some people, but should not be recommended to all as a cure-all solution, as you may find in some advertisements.

The available FDA-approved medications for hair loss prevention are finasteride and minoxidil.  Although both are effective, they may have different indications for male and female patterned baldness. They might not be considered a complete treatment for male patterned baldness, as pharmaceuticals may try to show.

Medical hair restoration should be seen as a preventative measure which should be considered, along with the surgical options, as part of a master plan. Most people are prone to shock loss that may happen after a hair transplant surgery and they need to be on preventative measures such as finasteride at least a few months around the time of surgery. Shock loss after a hair transplant used to be one of the biggest problems that hair transplant patients had up until the last few years. Now, most hair transplant patients go on finasteride after a hair transplant surgery.

What is Saw Palmetto?

Saw Palmetto is an extract of the fruit of Serenoa Repens. It is rich in fatty acids and phytosterols. It has been used in alternative medicine for a variety of indications, most notably benign prostatic hyperplasia (BPH).

Indications:

Prostate treatment

Saw Palmetto has also been used in treatment of benign prostatic hyperplasia (BPH), a condition known by enlarged prostate size to the degree that it makes urinating difficult.

Hair loss prevention

The role of Saw Palmetto in hair loss prevention has also been documented. Saw Palmetto is one of the few effective herbal treatments that can reverse hair loss process in some people to some degree and slow down the process of  balding in men. Saw Palmetto bio active ingredients prevent conversion of testosterone into dihydrotestosterone (DHT).

That is how Saw Palmetto helps to stop the process of balding on the hair follicle level. It can help increase the thickness of miniaturized hair and make them grow longer. The Saw Palmetto effect is comparable to finasteride or other DHT blockers by mechanism. Saw Palmetto is available in oil extract for topical use on scalp or as pills used for prostate enlargement treatment.

Q:

I am using another prescription drug for my prostate problem, which is RAPAFLO 8 mg. Please advise whetehr or not I can take it with finasteride that was prescribed for my hair loss problem.

Thanks,

A:

Rapaflo (Generic Name: silodosin) is in a group of drugs called alpha-adrenergic blockers. Silodosin helps relax the muscles in the prostate and bladder neck, and by doing that makes urination easier.  It does not help shrink prostate as finasteride (Propecia) does.  You can take finasteride (Propecia) in combination with Rapaflo and there should be no interaction between the two.

Q:

A friend of mine said that Propecia can cause bloody urine.  Is that correct?
A:

I think that has been a misunderstanding.  Bloody urine or Hematuria can be caused by a variety of prostate disorders.  In fact, finasteride has been researched and used for prevention and treatment of prostate gland enlargement in men.  There are many documentation that proof the usefulness of finasteride for prostate enlargement.  Puchner was the first to observe that finasteride reduced bleeding of prostatic origin. These early observations were confirmed with additional controlled studies involving larger numbers of patients.

These clinical observations led to the interesting hypothesis that an additional action of finasteride is the inhibition of vascular endothelial growth factor (VEGF) in the prostate, leading to shrinkage and programmed cell death in enlarges cells. The implications of this theory give further credence to the hypothesis that 5-a-reductase inhibition by finasteride or similar medications may be a viable preventive strategy for prostate cancer. It is known that prostate cancer is associated with increased microvascular density, which may be influenced by VEGF inhibition.

So continue taking your Propecia (finasteride).  If anything prostate protection against enlargement (BPH) or even cancer may be one of the good side effects of finasteride.  Finasteride may alter the levels of PSA, the lab test that is used to predict prostate problems including cancer.  You need to discuss finasteride use with your primary care doctor so he or she knows that your levels have been altered by finasteride use.

Q:

Hi Doctor how are you?

I have been working out and i wanna take some diet pill to help my body loose fat. Is it ok to mix with Proscar? Aalso ive been putting rogaine on the recepient area to speed up the growth. As you can see i have 75% growth i think? In 3 months. It seems like the right side is growing faster and the left side worries me.see alot of fine hair coming out left side though. Dont know if its from proscar and roggaine effect or transplant hair.

Well see in the months to come. Just wanna leave an update doctor.

Thanks and have a good weekend

A:

Here is your answer for your questions in the order you asked them:

1. We do not have any documented evidence on using specific diet pills and/or its preventative effects on the growth of transplanted hair grafts.
2. I do not believe that Rogaine can accelerate the rate of your hair growth on the transplanted area.  They will, however, grow to become similar to what they were in their native location with or without Rogaine.
3. The growth of transplanted hair is not often even.  My recommendation is not to worry about it at this time and give them at least 4 more months until you see the final growth rate.  If you did not have hair in a particular area, medications such as finasteride or minoxidil cannot grow any hair back there.  You may notice improvements in the areas where you experienced significant miniaturization (thinning of hair shafts) with use of these medications.  In those areas, you may see some increase in the bulk of hair over a period of 6 - 8 months.

My recommendation is to continue to be patient and in a few months you may surprise yourself with the density and quality of the transplanted hair.

Have a nice day,

Q:

I just had a few questions following the consultation,

As you said I have slightly more miniaturization in the crown than the donor area, but still in normal range, what would cause me to have more in one area than another other than MBP, is that normal for non MPB scalps?

• Could finasteride worsen the hairline due to the rise of testosterone, or is that irrelevant?
• Are there any safe and minor treatments to slow the progress of maturation or reverse it that you would recommend at this stage?

A:
I will be sending you a letter with all information that we discussed during our consultation at US Hair Restoration Beverly Hills Office.  You may have very initial signs of MPB, but the numbers for miniaturized hairs are not far from high normal.  Let us wait and see your progress before putting you on hair loss medication finasteride.  Early stages of male patterned hair loss may not always be obvious enough in our scalp microscopic evaluation to be differentiated from having upper normal levels of miniaturization.  Propecia (finasteride) is a great hair loss medication to prevent balding, but I know many people who went on it without the proper documentation of their miniaturization.  These hair loss patients may have to take it for the rest of their lives without knowing that they have really needed it to start with.

The main cause of hair loss is DHT (Dihydrotestosterone) and not testosterone, so finasteride can not deteriorate your hair loss or hairline maturation changes. Maturation of hairline is a natural phenomenon and should not be mistaken with balding.  We do not want to stop it.  I do not recommend any medications to stop the maturation of hairline either.

Q:

Hello,

I did a search for hair re-growth, hair loss, etc. and I found your email address.  These internet searches are definitely far from perfect, in fact sometimes they are way off!  So if this is not the type of business or practice you’re in, I apologize and please disregard this email.

I’m a 43 year-old male.  I started losing my hair, very slightly, at age 27.  I really haven’t lost a whole lot since then, however, my hairline has receded a little and I have been using Rogaine pretty faithfully.
I’m trying to find the best way or multiple ways of re-growing my hair.  First, I am curious to know if it is okay to use Rogaine (5%) and take Propecia?  Do you know if Nioxin or any other shampoos or hair thickeners are helpful?  Would you recommend any?  Are there any other factors that make a difference in re-growing hair such as: vitamins, hormones, foods or physical exercise?

Do you think these types of remedies are all stop-gap solutions and I will need to look for something more permanent? Do you have any insight or additional thoughts or sell any products or services that I can purchase that will help?

Thank you,

A:

Thanks for your email.  You have asked many questions which most have been answered in our Hair Restoration Blog.  There are many hair loss products in the market, but most of them do not have any active ingredients that can help your hair loss condition.  There are only two FDA approved medications that have been approved and proven to be effective and safe for hair loss treatment and prevention.  Those two medications are Rogaine and Propecia.  If you are suffering from male pattern baldness, hair transplant surgery may be the only option that can improve or eliminate the appearance of baldness by bringing good quality hair from the permanent zone to the front and balding areas.

I do not have any particular hair loss product nor recommend many different lotions and potions that are out there in the market for hair loss.  You can find other valuable information on our postings in our blog and can answer your questions on:

• Nioxin - hair loss product
• other shampoos for hair loss
• vitamins for hair loss
• balding and hormones
• foods for hair restoration
• physical exercise and hair loss

I recommend that you find a good hair restoration doctor who can evaluate you and come up with a master plan for your condition.  This may include medications, surgery or even cosmetic changes that you need to bring your hair and beauty back to your life.  We do offer an online consultation for hair restoration through pictures and if decided that you are a candidate and you choose to have a hair transplant with us, it could be easily done.  Our California offices of hair restoration can arrange your trip to our Los Angeles office for your hair restoration surgery.

You can contact our office at 888-302-8747.

Good luck,
Parsa Mohebi, MD

Q:

Hi,
my hair is very thin, i went to a dermatologist and he requested many tests, hematological and hormonal tests, they were all normal except for the modified form of testosterone, he prescribed me chronostim, i used it to 3 months, some times i missed some doses and i noticed that the problem came back, now after i finished the 2 bottles i feel like i did nothing,i want to have thick hair without taking medications for ever…my wedding is after 2 months and i have empty areas, would u please tell me what to do? i need your help deadly?
thank you

A:

I am sorry to hear about your hair loss condition.  As we previously discussed on this website, Chronostim cannot replace oral DHT blockers for people who have male patterned baldness.  At least it has not been proven as an effective treatment of typical baldness in men.  You need to be seen by a good hair restoration surgeon and your scalp needs to be evaluated through a miniaturization study.  If you are truly suffering from androgenetic alopecia or male pattern baldness with progressing hair loss, finasteride should become part of your hair loss treatment regimen to prevent further hair loss.

Hair transplant surgery can restore the areas of obvious loss by transplanting permanent hair from your donor area or permanent zone of the scalp.  Obviously it would be difficult to evaluate your condition before having more information about your situation.

Unfortunately, with only two months to your wedding date, none of the above medical or surgical options allows you to enjoy a full head of hair by your wedding ceremony.  However you can use cosmetic products such as Toppik or microfibers to cover the balding or thinning areas of your hair for the wedding night and wait a few more months to see the actual effect of medical treatment and the growth of newly implanted hair.

Good luck,

Dr. Parsa Mohebi
Hair Transplant Surgeon