Eyebrow Transplants, Revisited

/by William Rassman, M.D./4 /,

Here’s two more eyebrow transplant-related emails I’ve received…

In 2002 I cut my eye brows off. But they grew back very thin some parts did even grow back, like the ends. Only the inner part would grow but not so thick. Anyway to date they are not growing at all. My hair line has also thinned out about an inch. I do not know what is going on but I am tired of drawing it on. Please help.

Eyebrows can be successfully transplanted, if the eyebrows you had have not returned after a couple of years. The eyebrow hair is taken from the scalp hair, and as such will have to be trimmed about three times a week and cut on an angle for hair shape. I posted a blog entry recently about this: Eyebrow Transplants. You need to be evaluated for the hairline loss. Read my responses addressing female hair loss, as they do apply to you.

I am considering eyebrow hair transplantation and I have many questions. Does having permanent makeup interfere with the procedure? Should it be removed first or will it cause scarring to the follicle? Also, does the transplant have to follow the original eyebrow hairline or will it grow in any follicle (if I wanted it slightly raised for a more youthful appearance for instance)? Do eyebrow transplants yield a high success rate? I noticed you listed some special summer prices but they were specified for the strip method. What is the cost for the FOX method. Finally, I live near Riverside Ca, zip code 92313, is there an office near me?

Permanent makeup is cosmetic tattooing and is permanent by its nature. It will not impact an eyebrow hair transplant. You should be evaluated first, before any surgery is considered. Eyebrows can be angled for more lift, but it is difficult to angle them for less lift. The success of eyebrow transplants are high. NHI’s summer fees have been reduced by 10% but the FUE approach has not been discounted and still is priced at about twice the price per hair/graft as a traditional strip method of transplantation. Our closest office to you would be in the Beverly Hills area.

Avodart (Dutasteride) vs Propecia

/by William Rassman, M.D./2 /

Hi.DR.RASSMAN, I would like to know if type 1 DHT causes hairloss?? or is it just type 2..?? Please let me know when you get a chance… and do you think they will becoming out with anything better then propecia in the near future???

Propecia is a type 2 competitive inhibitor of DHT and Avodart is a competitive inhibitor of both Type 1 and Type 2 receptors. I think that is what you are asking. There is no clear evidence that blocking both Type 1 and type 2 receptors is better. What we do know is the Avodart does drop the DHT level in the blood stream more effectively than Finasteride (90% vs 75%). What this means is suggestive that it might work better in some people. But I must state clearly that safety and effectiveness is the mainstay of the FDA and until we have a handle on these two issues, I believe it is better to stick to Finasteride.

Is a Hair Transplant The Only Answer?

/by William Rassman, M.D./1 /

im 21, but have been going bald since sixteen. i hate it cause im so young and have no confidence. i used drugs to solve it but nothing happened. is a hair transplant the only answer? sick of seeing all these ways of growing hair back, as in using tablets

At 21, you are young to be balding, especially since this has been going on since you were 16. However, you are certainly not alone; see the Age postings in this blog for some of the other questions (and my responses) from men your age. I would suggest that first you have a complete physical to rule out any underlying medical conditions that could be causing the hair loss. Once that is done, your next step would be to see a doctor who specializes in hair loss. Be ready to discuss with them your medical history, what hair loss treatments you have tried and for how long, what effect they have had, and what is your family history of balding.

A hair transplant may be appropriate at your age if your future genetic balding pattern can be determined. A good, ethical hair transplant surgeon will be able to tell you whether surgery is an option, or if Propecia alone would be beneficial at this stage in your balding. Do not rush into surgery without a clear understanding of what your future balding pattern may be.

Itchy Scalp

/by William Rassman, M.D./2 /,

I am a 27 year old African American woman. A few months ago I saw some bald spots in the middle of my head. I thought it was the wigs and hair weave I used to wear, but later on the bald spots started to spread down to the front of my hair line. When my hair itches I used to bang my head with my hand so that I could stop the iching. I don’t know what to do with this situation. I want to cut my hair off and start all over re-growing my hair. What do you think is best for me to do?

If you have not yet seen a physician, I suggest that you get a thorough examination to rule out any underlying medical conditions, which could be causing the balding. The physician would also be able to determine how best to treat the itching.

Laser Comb, Again

/by William Rassman, M.D./1 /

I have recently began using the new lazer comb. It was given to me as a gift. I was curious if it has been effective in the hair loss fight? Any comments, advice, side effects would be greatly appreciated.

I have not read any impartial scientific papers that verify the effectiveness of laser combs. I tend to discount any reports that claim the combs work, if they are written by those who have a vested interest in the success of the laser comb industry. On the positive side, I have not read any papers that claim that is unsafe to use the laser comb. Since the comb was a gift, and you plan on using it as recommended, I see no reason for you not to try it. However, if you see any adverse reactions or have continuing balding, you may want to have a doctor examine you and see if there are any recommended and scientifically proven methods that may help you.

I’ve previously written about this in a previous blog entry, Hair Lasers.

Lateral Slits

/by William Rassman, M.D./0 /,

Thank you for answering all our questions. This site is a great help!
Can you address the below paragraph pulled of Hasson & Wong’s (Canada) website?

“Hasson & Wong have pioneered the revolutionary Lateral Slit Technique. This technique of creating recipient site incisions allows for far more accurate control of hair graft angulation and direction. In addition, the coverage of bald scalp is increased on average by two hundred percent…Hair transplant surgery utilizing the Hasson & Wong Lateral Slit Technique is the only technique that is able to duplicate the alignment and distribution of hair as it occurs in nature. The result of this amazing technique is the complete absence of plugginess seen in other techniques including standard follicular unit transplantation.”

Hasson and Wong do very nice work. I have nothing but admiration for them both. With regard to lateral slits, I have been doing them on all my cases for three years, but I have never been convinced that they are superior to vertical slits. The written studies done by different doctors throughout the world have not proven that lateral slits are any better. Patients who have had lateral slits on one side and vertical slits on the other side, are split on which side is better. So while there may not be any scientific proof that lateral slits are superior or inferior, it becomes a matter of physician preference, and my choice is to use lateral slits.

FUE Questions

/by William Rassman, M.D./2 /

Hi,
I am seriously thinking of having a FUE procedure during the next 2-4 months. I’ll appreciate if you can please help me with the following info.
1. How do i know if i am a suitable candidate for FUE?
2. How long do i have to wait after the test to have the procedure?
3. how long do i have to wait after the surgery, before i can go about my business?
4. I see that you have a special offer going on now, what is the final per graft price after taking into account the travel reinbursement and your offfer?

There are many things to consider before deciding on any hair restoration procedure. I’ll answer your questions on FUE (Follicular Unit Extraction) first…

  1. At NHI we use the FOX™ test to determine if you are a candidate for FUE. The FOX test lets us know how easily viable grafts can be extracted. If there is a high percentage of viable grafts, you would be ‘FOX positive’.
  2. The FOX test can be performed any time before surgery. There is no waiting period once you have had the test.
  3. Patients have different tolerances for surgery. Many patients go back to work the next day, others wait a day or two. As long as you follow the post operative instructions, you can resume your daily routine as soon as you are ready.
  4. The 2005 summer special fee applies only to traditional strip surgery. Travel expense reimbursement is up to 5% of the cost of the surgery.

Some of the other considerations to keep in mind are FUE is a good choice for patients who:

  • Need a small amount of grafts
  • Do not have an advanced balding pattern
  • Those who want to wear their hair very short
  • Those who have a very low donor supply, a scarred donor area, or very tight scalps
  • Patients who tend to heal with wide scars
  • Athletes who must resume full activity soon after the procedure

BUT, most importantly, continue to research, make sure all of your questions get answered, insist on seeing patient results in person, and make sure that you choose a doctor who has your best interests in mind.

Doctor Availability

/by William Rassman, M.D./0 /,

I recently had a hair transplant and I hate to tell you how much I paid. What I am writing about is that after the surgery, the the instruction sheet they gave me is very poorly constructed and when I tried to call the doctor to ask questions, I got a message telling me to go to my local emergency room. Is that an acceptable way to do business or are there standards that doctors must adhere to with regard to giving patients the information they need?

There are no standards other than the Hippocratic Oath which is: I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath. “To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction. I will prescribe regimen for the good of my patients according to my ability and my judgement and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.”

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Female Hair Thinning

/by William Rassman, M.D./1 /

Hello sir,
I am an Asian female and I am 24 years old.About 3 years ago, I noticed that my hair had started thinning. That was a period of time when I was under a lot of stress and used to hav a bad diet as well. So I thougt that was the reason for my hairloss and also thought it would come back in time. I have lost hair mostly from the front region of my head.But am not loosing much hair now.My hairloss kind of reduced on its own about few months ago and I also see few hair coming.

So does that mean that I am gonna get back my lost hair? Was the damage irreparable? Should I take treatement?

My mom had lost a lot of hair at a young age,my dad is 60 years old ,but still not bald. Could you please let me know more about my hairloss and whether it will come bacK or not.I would be extremely grateful sir.I am undergoing a lot of pain because of my hair.

You are not alone. Since I started this blog, I have gotten quite a few questions from women about their hair loss problems. Here is a link to the similar questions and answers. The first thing you need to do is to see a physician who can examine you and order tests to make sure that there are no underlying medical reasons for your hair loss. Some of the reasons for female hair loss are: anemia, thyroid disease, connective tissue disease, and various gynecological conditions. These laboratory tests may be useful if underlying medical problems are suspected: CBC, Chem Screen, ANA, T4, TSH, STS, Androstenedione, DHEA-Sulfate, Total and Free Testosterone.

If it is determined that there are no medical reasons for your hair loss, I would suggest that you visit a hair loss specialist. Since you are in New Jersey, I can highly recommend Dr. Robert Bernstein in Fort Lee- his phone number is 866-576-2400.

Minoxidil and Retin-A

/by William Rassman, M.D./2 /

I have been taking Propecia for sime time and I recently ran across a site that talks about a combination of 2% Minoxidil and Retin-A. Should I switch?

Propecia works at the cause of hair loss, by blocking the action of DHT on the genes that impact hair loss. Minoxidil is a drug that has a side effect: growing hair. The side effect of a noticeable growth of new hair occurs in between 3-15% of the Minoxidil taking population. Minoxidil does not block DHT, so its action is very different than Propecia. Retin-A is an acid which produces a burn to the skin. I generally look at burns negatively; why burn the skin? The burn causes increased vascularization and therefore allows a higher absorption of the Minoxidil. Retin-A also has it’s own side effects and warnings. Retin-A possibly may make the Minoxidil more effective, but at what cost to you and your skin? That is the question!

Biotin

/by William Rassman, M.D./3 /,

Hi Dr. How much biotin should I take a day for hair loss???

Biotin deficiencies can cause hair loss, so many people may include biotin in their vitamin regimen. However in healthy people it is almost impossible to have a deficiency of biotin. A biotin deficiency is therefore extremely rare in the United States. When it does occur, it may be associated with disease conditions of the gastro-intestinal digestive tract. An adequate daily dosage for biotin is 30-100 mcg for the adult male.

Running Out of Donor Hair

/by William Rassman, M.D./2 /,

I’m an existing patient of yours and had great results on the front of my scalp with the last session 2 years ago. I’m starting to get a little thin on the crown of my head and a little forward of that. If it stopped where it is now, I wouldn’t be concerned but continued loss would be unnerving.

My issue now is that I’m pretty much out of donor hair. Has any progress been made with something I read about a couple of years ago called hair cloning? Also, I have a few old fashioned plugs that could be thinned and dispersed I suppose.

Nice to hear from you. Please look at the other comments in this blog on hair cloning. There is nothing new that would apply to you. As you are near our Northern California office, visit me there and I will personally assess your balding pattern. You are correct that taking hair from old plugs works, but the problem is total supply versus need. We would have to determine whether there is enough supply from all sources to meet your need for coverage.

Propecia, When to Start

/by William Rassman, M.D./0 /

Lots of Propecia questions this week…

I am 21 and notice that my hairline is going. Should I start taking Propecia?

There are many important elements to your question and like all good questions, the answer may be more complex than you were expecting. There are many reasons for the hair line to move, the most common reason is the transition from having a youthful hairline to acquiring a mature hairline. This frontal change in the hairline occurs in 95% of young men and it is not reflective of the balding process. I can not tell you if Propecia will stop or slow this process down, but I suspect that it might considering that this is probably a DHT induced manifestation.

With regard to early genetic balding, I would get a good doctor to examine your hair looking for miniaturization of the hair shafts. The finding of miniaturization is an absolute sign of genetic hair loss, If you have it, Propecia is recommended to be started at the earliest appearance of genetic hair loss in the post pubescent male. Since genetic hair loss is a progressive process, the earlier you get a good diagnosis, and begin Propecia, the better your chance is to keep your hair for a longer period of time.

The Problem of Popping

/by William Rassman, M.D./0 /

I would very much apreciate it if you could explain what “Popping” is all about. As I understand it, it limits the amount of hair that can be successfully transplanted.

Popping is a technical term referring to a problem with placing grafts into the recipient sites in the balding area in a hair transplant. The grafts are placed and then do not stay in place, ‘popping’ out of the site. In the early days when we didn’t trim the grafts as closely and the recipient sites were larger, the bulk of the graft was so large relative to the surrounding tissue, that the graft would not be held in place. When the surgeon placed another graft next to the one that was only a couple of millimeters away, the ‘mass’ from the graft into this next site, pushed the last graft that was placed out of the wound. You can imagine a cascade effect, you place one graft and then another and the first pops out. Then you finally get both the first and second secured and place a third when the first two then pop out. That was the way it used to be.

Today things have changed. When we introduced the microscope in 1994, it was evident that smaller and more accurate dissection meant better results than dissection with other less powerful magnification tools. The grafts are smaller and can be more carefully dissected, so that the bulk of today’s follicular units is less than the old minigraft. The recipient sites are much smaller today, we use needles in the 0.8 – 1.0 mm range to make the sites. The results of the smaller site is that the ‘hole’ that is made tends to ‘hug’ the graft and the ‘bulk’ of the graft is of less consequence in the hands of an expert graft placer. Today the best surgeons have staff whose skills have built over years, allowing the grafts to be placed without disturbing the last graft placed. So, popping which was a major problem when we were getting the number of grafts from 500 up to 2000 in 1993, became less of a problem as we moved into the 3000-4000 grafts per session size.

To conclude, your question of popping is more of a historical question than a problem today. What is still relevant today, however, is that surgeons who use larger sites (greater than 1.2mm in size) to manage their grafts, are still practicing older techniques and popping (which is not a problem for us) still remains one for those less skilled in the art of today’s techniques.

Hair Density in Scars

/by William Rassman, M.D./0 /,

How many hairs can you transplant into a square centimeter? I have a scar, and I want to fill it in. I am trying to find a doctor who can fill it in with just one surgery. Is this a reasonable question?

An excellent question! The calculation is one that is used in the industry as a benchmark measurement. The average person with 100,000 hairs on his head has 1250 hairs per square inch or 193 hairs per square centimeter.

But what is the number to use in determining the correct density for a hair transplant? Some doctors use high density numbers to define how good they are. However, there is a balancing act between maximizing density at the time of a transplant surgery and maximizing growth months later. Experienced doctors are the key.

The reasonable upper limit of density numbers from a transplant perspective is up to 120 hairs per square cm. This type of density, however, requires supple skin that still has elastic properties. Scars do not have this characteristic. Also scars have an abnormal blood supply when compared with normal skin. Much of the infrastructure and microcirculation in the vasculature is not present in scar, so transplanting very high densities may not produce good growth.

You need to be examined by a hair transplant expert, who has the experience to give you a reasonable answer to your specific need. While I understand that you would like to have this completed in one surgery, that may not be in your best interest. Only your doctor will be able to advise you.