Physician Answered Q & As

Accutane Related Hair Loss – Am I Candidate For Hair Transplant Surgery?

Hello. I am considering getting a hair transplant and I had a few questions. I am a 24 year old male and I began losing hair about 3 years ago immediately after taking the medication Accutane. I have always had very thick hair, but about a month after I started taking Accutane I noticed that I had lost a ton of hair of the front/mid area of my head. My hair went from being so thick that every time I got it cut they needed to thin it out using special scissors, to being able to see my scalp in certain spots within a couple of weeks. My hair loss began about an inch or so above my hairline in the front/center part of my head in a diffuse pattern. My hairline didn’t recede at all and I didn’t really lose any hair in my crown area. As soon as I noticed the hair loss I immediately quit taking the medication. For about 6-12 months after stopping the medication I lost a large amount of hair and was probably shedding between 100-300 hairs a day. Eventually the shedding slowed down drastically and I think my hair has stabilized for the most part now. I only notice about 20-30 hairs lost when I shower and comb my hair every day. The majority of my hair is still thick and healthy, but there is an area about the size of my hand that runs from the top of my head to my hairline that is incredibly thin and I have probably lost about 70% of the hair in that area. My hairline has not receded at all and I was told I have a juvenile hairline. Although my shedding seems to have stabilized, the hair that I lost has not grown back. I notice little “baby hairs” sometimes when I brush my hair so I assume that some hair is regrowing, but nowhere near the amount that I lost. When I first started losing hair I went on Propecia and used it for 6 months, but the shedding didn’t slow down during that time so I stopped taking it to avoid side effects. I also tried using Rogaine from last March to November, but I didn’t notice any results from that either (it seems to have made it worse). I have spoken with many people and read hundreds of message board posts about Accutane related hair loss and it seems like the overwhelming majority of people who lose hair from Accutane never grow it back. The pattern I lost my hair in does not appear to match anything on the Norwood or Ludwig scales. It most closely resembles diffuse pattern alopecia. Pretty much all the people I have talked to who lost hair from Accutane lost it in the same pattern that I did (both men and women), which leads me to believe Accutane had something to do with the hair loss. I have spoken with many doctors who agreed that Accutane can cause hair loss, but they said if the hair hasn’t grown back after 2 years it probably never will. There is some history of MPB in my family, but it seems to be hit or miss. My father is bald, but has a brother who has a full head of hair at 40. My mother has two brothers, one is bald and the other has a full head of hair with no recession at all. Both of my grandfathers had good hair. My hair characteristics most closely resembles my mom’s brother who still has hair. I have met with a hair transplant surgeon from Medical Hair Restoration. He acknowledged that Accutane probably had something to do with my hair loss but couldn’t say for sure. I was told that I have a good donor area with hair as thick as can be and good scalp laxity. He told me that with around 2000 grafts he would be able to fill in the area that is thin so my scalp would no longer be visible. He told me that I did not seem to be exhibiting signs of MPB since I have very little hair loss in the crown area and that I still have a juvenile hairline. He made it sound like I was a great candidate for surgery, but through my research I have found that a lot of people have problems with MHR and that they seem to be willing to operate on anyone. I was just wondering if you have any personal experience with hair loss from Accutane (or other medication) and whether or not a hair transplant is a good option for dealing with this problem. I just want to make sure that if I do get a hair transplant, the transplanted hair won’t fall out from whatever caused the hair to fall out in the first place. I have been off of Accutane for over 3 years and am not currently taking any other medication. I am currently living in Salt Lake City, but I would be willing to travel if you think I would make a good candidate. Any information would be very much appreciated. Attached are pictures of my hair. Thanks

You have a good understanding of your problem. It has the pattern of diffuse pattern alopecia, and very well could be a side effect of Accutane. My opinion is that your trial of six months of Propecia was not long enough. An occasional person will see results in six months but most take a year to appreciate results. If your hair loss has no component of dihydrotestosterone caused hair loss it will not be effective, yet I feel it most likely that some of the loss is coming from that. Most, but not all, hair loss attributable to male hormone sensitivity has a male pattern. As I read this, you stopped not because you had any side effects rather in order to prevent any possible future side effects. I personally saw no effect from Propecia at six months, but made the decision to continue for one year then quit if I saw no progress. I got one of the best results of thickening that I have seen. That does not represent a scientific study. That is only an antidote of one person’s experience.

Hair loss due to Accutane should eventually stop after the drug is stopped, but male pattern loss continues. If we can control the continued loss it is OK to fill in the previous loss with transplantation.

I would discourage transplantation at age 24 for your diffuse problem but may recommend it later. It is likely that transplantation would make you look better, but we would like to control the hair loss or at least see where you are heading before beginning surgery. Is your hair line going to be maintained? You are only 24 and the thinning is not as obvious to others as it is to you at this time. Don’t jump into surgical repair too early because the first sessions use the best grafts and we may find that they were not placed optimally ten years from now. This does not mean that you have to wait 10 years to solve your problem.

In summary: I recommend you go on Propecia for one year before considering transplantation.

  • Tommy Silva

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