This question, asked by a member of our hair loss social community and discussion forums, was answered by “Garageland” – a clinic representative for Coalition hair transplant surgeons Dr. Victor Hasson and Dr. Jerry Wong.

I’ve been taking Propecia (finasteride) and 10% minoxidil for 10 months now and results have been mixed. I experienced some significant shredding during the initial stages but it did stop and my receding hairline hasn’t moved since. So I think I can safely say the medication has halted the receding process. I don’t think I have experienced much new hair growth although there might be a small area of the headline where the hair appears to be thicker. I use Toppik hair loss concealer to cover my receding hairline. I believe I am at II on the Norwood Scale.

I am seriously thinking about getting a follicular unit extraction hair transplant because I want to have my hair short at the back and sides and long (lengthy) at the top. However, I don’t have the money for it at the moment so I was thinking about getting a loan. I have had a loan before and repaid it so I know I can do this.

The hair restoration clinic I received my consultation from has appeared in the media and has performed hair transplants on many celebs. I still don’t know if that particular clinic is right for me. As I am taking out a loan, I have to be sure the clinic and procedure is right for me.

This question comes from a member of our hair loss social community and discussion forums: 

I recently underwent hair transplant surgery. Everything went well, but I’ve experienced this strange “spasm” in my forehead since the procedure. I am wondering if it was from the local anesthetic; my doctor said he performed a “supraorbital and supratrochlear nerve block.” Is this normal? Do patients experience muscle spasms after hair transplant surgery?

First, and foremost, I think you should discuss this issue with your hair transplant surgeon. The doctor may have experience with this issue and offer an explanation to help put your mind at ease. 

facial nerveMuscle twitching in your forehead would likely be related to activity of the facial nerve (cranial nerve VII). During the procedure, it sounds like your doctor performed an anesthetic “block” of the supratrochlear and supraorbital branches of the trigeminal nerve (cranial nerve V). These nerves exit the skull directly above the midline of the eyebrow. The temporal branch of the facial nerve, which controls the muscles in the forehead (and would likely cause the spasm), is a bit deeper and further lateral compared to the trigeminal injection site. This means it would be difficult to accidentally inject or damage this nerve during the anesthetic block.

The other concern could be nerve issues during the strip extraction process of a Follicular Unit Strip Surgery (FUSS) procedure. However, the facial nerve exits the skull near the bottom of the ear, and this position makes it unlikely to be damaged during the strip extraction process.

This question comes from a member of our hair loss social community and discussion forums

I recently underwent hair transplant surgery, and need to return to work. Part of my job requires me to wear a hat. I spoke with my hair restoration physician and he said I could wear a hat after the grafts were fully anchored. How long does it take for the grafts to anchor and become permanent? Can I wear a hat after hair transplant surgery?

bad hatIt takes approximately 7 to 10 days for the newly implanted follicular unit grafts to fully “anchor” and become permanent. Before this time, manipulation or compression of the grafts may cause permanent damage and affect growth. Due to this fact, most hair transplant surgeons recommend waiting 7-10 days before wearing any type of cap that could compress, move, or dislodge a graft.

After the 7 – 10 day mark, the grafts should be permanently connected; at this point, no amount of manipulation should cause any damage. Wearing a hat after this period should be perfectly safe. It is, however, important to discuss issues like this with your hair restoration physician. Many doctors have specific rules about activity post-surgery, and it is important to follow these closely.
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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

Follow our community on Twitter

This question comes from a member of our hair loss social community and discussion forums:

I’m finally ready to do something about my hair loss. I want to start minoxidil (Rogaine) and finasteride (Propecia); however, I’m not sure if I can start these at the same time. Is it advisable to start Rogaine and Propecia at the same time?

Propecia and RogaineRogaine and Propecia, according to many hair loss experts, have a “synergistic” effect when taken together. In other words: minoxidil and finasteride enhance the effects of one another; taking these drugs together may halt hair loss and regrow hair more effectively. Those starting these drugs together, however, must consider two important issues:

First, both minoxidil and finasteride are associated with an initial shedding phase. During this phase, patients may experience a drastic loss of scalp hair. This period is temporary, usually lasing 3-4 months total, and results in growth of newer, stronger hair. Both of these drugs, however, are affiliated with this shedding phase; this means taking the drugs together, or starting them at the same time, may result in a more drastic or significant shed. The shed is not likely to last longer (than the normal 3-4 months), but it may be more severe.

This common post-operative concern was recently discussed by Coalition hair transplant surgeon Dr. Carlos Wesley

post-op-pimpleA common observation among patients during the early phase of hair growth following surgical hair restoration (either Follicular Unit Strip Surgery or Follicular Unit Extraction) is ingrown hair follicles. The “pimples” that some (but not all) patients experience generally represent focal inflammation (folliculitis) where a newly-ingrowing hairs are beginning to surface.

Patients can often feel reassured knowing that these generally precede more apparent hair growth over the following weeks and months. They can be seen in both the recipient area (where transplanted hairs are coming in) or donor region (especially in FUE where any residual hair fragments may be coming in). They may be more commonly observed in zones where the angle of hair implantation is the sharpest angle (e.g. the vertex or crown).

In general, a simple cotton ball soaked in rubbing alcohol can be used to rub on each pimple. The microabrasion allows the nearly-ingrowing hair to surface and resume growth. It’s relatively rare that an antibiotic is required, but even a one-week course of antibiotic can have a positive impact. The ultimate appearance is not impacted by the presence absence of a few “pimples” and patients should simply be aware that they generally represent an early phase of growth. 

-Dr Carlos Wesley
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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

This question, asked by a member of our hair loss social community and discussion forums, was answered by “Garageland” – a clinic representative for Coalition hair transplant surgeons Dr. Victor Hasson and Dr. Jerry Wong.

Why is the balding crown known as the black hole of hair transplantation? Is it too hard to do? I’m losing my crown. I’m 31 and I don’t want a scar on the back of my head so I’d rather do follicular unit extraction (FUE).

0_6181The crown is known as the black hole because of the surface area is flatter and it therefore requires more grafts to get a full look.

The problem with transplanting into a crown when your hair loss is not stable is that of course you will lose more hair and potentially have an isolated transplanted area. Further sessions will be required to chase your loss. Some people are okay with that but donor hair is a finite resource and what happens if the front goes?

That is why hair transplant surgeons, in general, are conservative with the numbers when placing grafts just into the crown. The best advice is to get on Propecia (finasteride). Even at a low dosage of 1mg every other day you might regrow hair in this area. You will need to be on it at least 6 months to 1 year to fully assess.

AA before and afterTwo months ago, news broke that tofacitinib citrate – a rheumatoid arthritis drug – regrew a full head of hair in a patient suffering from alopecia areata. Now, it appears as if alopecia areata sufferers have more cause for celebration: Earlier today, Columbia University Medical Center announced that ruxolitinib, a drug used to treat a bone marrow disorder called myelofibrosis, restored hair in patients suffering from alopecia areata.

Alopecia areata differs from traditional androgenic alopecia, or male pattern hair loss, in several important ways: first, it is defined as an “autoimmune alopecia” – meaning it occurs when the body’s immune system mistakenly attacks and damages hair follicles; second,  it can progress and cause hair loss in regions of the face and body (this is commonly known as alopecia totalis and alopecia universalis); and third, it was, until very recently, extremely difficult to treat and caused disfiguring hair loss in an estimated 6.5 million in the United States alone.

One of these 6.5 million is Dr. Angela Christiano, a researcher in the dermatology department at Columbia University. Dr. Christiano’s team spent years determining the specific cause and underlying pathway behind alopecia areata, and came to the following conclusions: alopecia areata is caused by immune cells in two specific pathways; and both pathways could be blocked by a class of drugs known as JAK inhibitors.

This question comes from a member of our hair loss social community and discussion forums

Several years ago, I underwent a hair transplant procedure using all scalp grafts. I’m now seeking a second procedure to refine my hairline – which I think looks a bit “pluggy.” Can the surgeon refine my hairline with beard hair grafts? Are body hair grafts (body hair transplants) generally used in the hairline?

beard hair transplant fixedBody hair grafts – of any kind – are not usually placed in the anterior or temporal hairline. While the diameter of the hair shafts and duration of the hair cycling is most similar with beard grafts, the hairs themselves are still noticeably different.

I’m afraid placing beard grafts into the hairline would actually have the opposite effect: making the hairline look more “pluggy” and harsh. You likely have scalp grafts in reserve, and placing these in the hairline (via Follicular Unit Extraction or Follicular Unit Strip Surgery) would probably make the biggest difference.
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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

Follow our community on Twitter

Watch hair transplant videos on YouTube

Technorati Tags: hair loss, hair transplant, , , , Follicular Unit Extraction, Follicular Unit Strip Surgery

The following thorough response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “Gillenator”.

I have hair loss and I am HIV positive. I’d like know if it is possible to have a hair transplant. I mean, is there any problem with the doctors to have a HIV+ patient?

hiv-aids-630This subject has come up many times over the years. Generally speaking, there really are no “national guidelines” with the few exceptions where HIV is more prominent in the country’s population. For example, there are countries on the African continent that have much higher cases/incidents of HIV individuals.

Clinics tend to form their own policies and protocols for treating HIV positive patients as they administer various forms of medical care regardless of the type of care being provided.

Several decades ago, when HIV positive individuals first impacted a significant portion of the US population, various clinics, hospitals, and other medical facilities developed protocols that prevented the spreading of the disease. This clearly did not imply that HIV patients were not able to receive the same level of medical care and treatments, quite the opposite.

Regarding hair restoration clinics in the USA, many quickly adopted pre-op blood screening and that was in effect for about a decade or so. Then it seemed many got away from doing pre-op labs although some still do them.

This question comes from a member of our hair loss social community and discussion forums

Recently, I underwent a hair transplant procedure. The surgery went well, but I’m now experiencing an upset stomach from the post-operative medications. Is this normal? Can these medications cause gastric or intestinal issues?

medicationsHair restoration physicians frequently prescribe several medications after hair transplant surgery. These drugs include: pain medications, steroids, and antibiotics. Pain medications, such as hydrocodone and oxycodone, are most common. However, some physicians do prescribe anti-inflammatory steroids and antibiotics. Each of these medications can cause stomach upset and digestive issues.

Common side effects of opiate pain medications, like Vicodin (hydrocodone/acetaminophen) and Percocet (oxycodone/acetaminophen), include slowed digestion and constipation. Steroids, which may be prescribed for strip surgery (Follicular Unit Strip Surgery) scar stretching, affect the protective lining of the stomach. Steroids stop the production of the protective barrier lining and expose the sensitive stomach tissue to irritating acid. This often results in a “gnawing” stomach pain or the sensation of “acid reflux.”

Antibiotics are designed to kill bacterial organisms. When the body is infected by a foreign bacteria, this is great! It is not ideal, however, when the targeted bacteria is a natural part of the human body. The human digestive system is lined with “good” bacteria. These organisms help us break down foods and utilize nutrients. When antibiotics unintentionally attack these organisms, two unfortunate problems occur: 1) the body cannot digest properly and essential nutrients are lost; 2) the “good,” healthy bacteria are replaced by bad bacteria. These foreign, infectious bacteria go on to cause digestive issues like “crampy” abdominal pain and diarrhea.

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