Hair Cloning, Revisited

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

It has been about six weeks since I’ve posted an entry about hair cloning, but I’ll revist the topic again because I get quite a few requests for information. People generally want to believe that cloning is just around the corner.

Why can’t we clone hair, since scientists can clone a sheep? When can we expect to get a cloning treatment and how will it be done?

When it comes to cloning, hair follicles are in a tough spot. They are too complex to be simply cultured because follicles are not whole organisms like Dolly the sheep. The focus of cloning for hair is to move cells that can stimulate growth from a normal hair follicle, to an abnormal (genetically impaired) hair follicle. Although this is not actually cloning, the growth stimulating cells from the normal hair follicle can potentially be multiplied in a Petri dish and then moved to the area of genetically impaired hair. Some of these cells are capable of turning themselves into hair, bone or muscles and this has been shown in what I will call ‘uncontrolled experiments’. Because people who are balding always have some non-genetically impaired normal hair, we do not need a person to person transfer.

There are problems that are yet to be solved. The primary problem is to identify which cells are to be moved. Other problems are once the cells have been identified. We must ask, “Can we successfully create enough of these cells to work with, and is there certainty that the cells that are created and moved will maintain their capability to stimulate growth in the genetically impaired hair follicles?” It is anticipated that whatever process we come up with, there will be a type of medical ‘soup’ which the doctors will inject into the genetically balding areas of the scalp. When they are injected into the balding scalp, they must consistently be able to stimulate hair growth. Unfortunately, the success of this entire process has been relatively low so far. There have been some successes, but these have not been replicable, suggesting that we do not have control of the process. We also have to be 100% sure that this process is safe. Do we know that these cells will not produce a cancer or other problem? Safety and effectiveness is critical for any FDA approval and it will take years for this to be worked out. Don’t hold your breath, no matter what you hear!

For more information, Dr. Bernstein wrote an article about hair cloning in our 2004 NHI Newsletter, available here. Adobe Reader is required to view the file.

To read more newsletters, medical publications, and the PDF version of The Patient’s Guide to Hair Restoration, please see the NHI Medical Publications page.

Small Plugs

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

I had a number of mini and micrografts done 10 years ago behind the hairline, so they weren’t visible. Now, because I lost more hair, these grafts are now visible and they look like a transplant. What can I do to fix the situation?

There are two basic approaches to repairing visible grafts. The first directly involves the old grafts. If they are small, you can punch them out using a 1 mm punch. This will remove the bulk of the hairs, leaving a few straggler hairs which look OK and there will be a tiny round scar. If the grafts are bigger, you can remove several small areas in each graft to break it up, or you can remove the entire graft with a larger punch or a strip excision. But the latter would leave a scar that would need to be filled in with follicular units after a couple of months. The second way is to do a transplant proceedure around and in front of the old grafts to hide and camoflauge them. If the grafts are small this works well. If the grafts are large, a more radical surgery may be needed.

For an example of the procedure, please see Dean’s Story.

Thinning on the Sides

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

i have noticed that on the side of my head my hair is very thin and i notice bald spots on the side. can you please tell me why? please tell me why?

I would want to see pictures of your sides to differentiate between various forms of balding and skin/hair diseases. Please send me digital pictures to the address on the Contact page and I will give you feedback on what I see. Best if you could come to see me either in Northern or Southern California, where I have offices.

Island of Plugs

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

I had hair transplants 20 years ago. When I had them, my hair loss was just starting. Now I have an airport runway on my head and there are these plugs in the middle of my runway (rear of my bald area) like an island in the sea or an oasis in the desert. Can I take these out or do I have to get more transplants?

Your problem is a common problem which we see wherever crowds gather such as airports and sporting events. This surgery was done in the early days of hair transplantation and as the balding progresses, the plugs are ‘abandoned’ by the surrounding hair. My suggestions would be:

  • You can have them removed if there are not too many, as it should look better than to leave them, but there may be scars remaining after the removal
  • You can have a modern hair transplant procedure performed and bury them in a full-appearing head of hair, assuming the hair supply is adequate. In this way you can finish what you started years ago. The good news here is that the modern hair transplant will not produce these types of results and if it has been 20 years since the last time you did it, I suspect that the hair loss is largely finished and you will therefore not become another moving target, chasing more change over time.

Your question addresses two important problems:

  1. The balding process is progressive in young men unless drugs like Propecia are used to slow or stop the progression. Anything you do that alters the course of your appearance will be modified by the progressive nature of the hair loss. When you had it done 20 years ago, there was probably only some crown thinning so that the transplants made you look fuller. As you continued to bald however, the older plug technique showed itself in all of its awfulness.
  2. These problems can and should be fixed. The good news is that repairs work in most situations to return a person to a normal appearance.

Here is a photo illustrating an “island of plugs” in the crown of a patient before we did his repair:

High Hairline in Teenage Male

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

Hi im 18 years old and i have had a high receded hairline all my life. Im thinking that a hair transplant might help lower it and fill in the gaps. Am i a good candidate?

At 18 years old, that might be a problem because no one knows the status of your genetic balding. You would need to be evaluated by a hair loss specialist, to discuss your options. If you should bald as you age (a 50% chance in most men prior to the age of 45), then moving your hairline down today may be a problem for a long term normal look. Unless you make a living as a model or actor where a high hairline might compromise your earnings potential, I would suggest that you wait for 5-8 years before making a decision to have surgery.

Feedback

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

If you are enjoying this blog, please feel free to leave a comment to say hello. If there is a particular topic you’d like to see covered, please fill out the contact form. I’m just looking for some feedback…

Thicker Not Thinner

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

I looked over your newhair.com site and noticed a wide variation in the amount of fullness with the same number of grafts between patients. For example, Patient BN has almost 2100 grafts and has a thin look, while Patient DP has 2500 grafts and had a full head of hair. If I go for a hair transplant, can I buy the fuller rather than the thinner look? I’d be willing to pay more.

For reference, these are the two patients you mentioned:

I looked at the subjects you were talking about. There are many differences between the two patient’s hair characteristics that could explain the difference in the results. The finer hair of Patient BN is only 1/3rd of the thickness of the hair that Patient DP has. The distribution of the grafts and the number of grafts placed per square inch of balding area is different. DP has a stronger hair character than BN and the size of the balding area is much greater for BN, despite what these photographs show.

People with finer hair have lived their entire life with a thinner ‘see through’ look, in contrast to the ‘gorilla’ look of the coarser haired person. Your results will reflect the ‘building’ materials your hair has in your donor area (like a 2×2 as compared to a 4×4 piece of wood). The key here is to give you a look like you had before you started to bald.

To answer your question, the fees are based on the number of grafts, not your hair characteristics.

Hair Loss in Autistic Female

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

I have an autistic 17 year old female whose normally thick and healthy hair is now thinning. I know her diet is not the best secondary to autism but she gets ample amounts of protein and loves all vegetables. There are no medidcations involved and no diet changes or home stress issues that I can pinpoint. She is not verbal so questioning her is not an option. Could you lead me to a resource for information or suggestions. Thank you for your time.

I have not read any research that indicates a higher instance of hair loss in autistic teens or adults. However, I would think that autistic people have a higher level of emotional stress, which is one of the ‘big four’ causes of hair loss. You should have a good doctor examine her and look for one of the many medical causes of hair loss. The following problems are among those that should be considered: 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. Many medications, including vitamins and over the counter drugs, can also contribute to hair loss.

Genetic causes of hair loss in a 17 year old female, is unusual. Look to the family and see if anyone had such a problem at that age or if there is female genetic hair loss in any of the women in your family. It is more likely that a medical condition, rather than genes, may be the cause of the hair loss.

Comparative Shopping for Hair Restoration

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

Why can’t you just buy on price? All that a hair transplant surgeon does is puts hair follicles into holes, so what’s the big deal?

Great question and an important one as well. We are all sensitive to price and there is no doubt that if you can buy the ‘car’ cheaper from one dealer, why pay the higher price from another dealer. The higher price dealers try to sell service, but the reality is that a Lexus is a Lexus and you can get maintenance from any authorized dealer so you could buy the car over the internet and save thousands of dollars. A better question to ask: Why is a hair transplant (or any cosmetic procedure) different from buying a Lexus at the lowest price you can get?

I think that you now might understand where I am going with this question. How does one value cosmetic surgery services by particular doctors in a comparative shopping viewpoint? When you are buying the services of a surgeon for cosmetic surgery, you are buying:

  1. Unique surgical training
  2. Artistic judgments, experience and talents
  3. facilities and skilled staff

In a major cosmetic procedure (like a face lift for example), it often takes years to get the experience ‘under your belt’ to make a great cosmetic surgeon. Doctors just starting off are taking their skills from training and finely honing them, often ‘practicing’ the techniques that they accumulated in training. For a hair transplant surgeon, the same is true. I see hairlines that are not quite right, that are not well placed, that are not balanced, not distributed properly or placed in the proper alignment and/or are not delicate or subtle. So putting hairs into holes without skills and artistic judgments may give you an Edsel rather than a Lexus and everyone (unfortunately) knows what an Edsel looks like.

In a hair transplant, there are issues of ethics and judgments on the extent of surgery, the indications when to do it and when not to do it, how much to do, how often to do it, what is the particular variables of each patient when it comes to planning, and what risks should be taken for what gain, etc… Doctors who cut corners in recruiting patients have to employ people who sell for them and substitute their expensive time to the more cost effective time of a salesmen. As long as you have the money, a salesman will tell you that you need the surgery in order to take your money. In my practice, I turn down more work than I perform because I know when to do surgery and do not value the almighty dollar over what is best for my patient. This is not a plug for me, but a statement that a doctor’s value is in his knowledge and honesty in placing his patient’s interests above his financial interests.

In modern hair transplant surgery, the team is as important as the surgeon. Experienced team members are critical to producing a successful hair transplant. Novice doctors get hair transplant failures on a significant scale, but unfortunately, the consumer only learns of these failures 6-8 months after the surgery was done because it takes that amount of time for the hair to grow no matter who does the surgery. By the time a patient may find out that the transplant was a failure, his check has cleared the doctor’s bank and the doctor may not be in business anymore.

Take a look at newhair.com, read our history, our publications, and request a free copy of the book we wrote on transplantation. Look at the pictures of our patients and their results (over 200 on our site). We have written the authoritative articles for the repair of hair transplant problems. Be sure to thoroughly check out your doctor. With our medical group, you can meet a dozen or more patients at our monthly open house events and judge for yourself the value of what your dollar buys. There is no need to overpay, just to get real value and that is the power you, as a consumer, hold.

Numbness After a Hair Transplant

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

I have had a hair transplant and I have numbness in both my front and back. How is this possible, how long will it last and will I become normal again as I love to have my scalp massaged.

Numbness does happen frequently after a hair transplant, both in the recepient and donor areas. Everytime a person gets a cut or a bruise, the area that is cut or bruised will develop swelling and numbness. The numbness will abate with time. The cutting and/or swelling of small nerve fibers are the cause of the numbness after a surgery, but in the scalp, there is a rich supply of redundant nerves so if one small nerve is cut, another picks up the function fairly fast. There should be no long-term numbness, but I have seen an occasional patient who had their major nerve cut in the back of the head. Even when this complication happens, the alternative pathways will frequently take over and that process may take weeks, months, or on rare occasions, up to two years to correct. Most experienced surgeons should be able to avoid this problem. In conclusion, many very small cutaneous nerves are often cut, but the sensation returns with time. Having had two hair transplants, I can tell you first hand that my scalp was normal within a couple of weeks and within a month of the transplant, I was able to enjoy a scalp massage.

Recent Plug Procedure

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

I had my hair transplant done by a cosmetic surgeon in California. This was the punch method leaving me with a doll hair look receeding on both right and left and crown. I had the procedure done in around August 2004. Now would i be a candidate for repair or would i have to wait longer? I do know my procedure was $2 a graft and I got what I paid for. Now i want to fix it before it becomes too detectable. I’m 24 and started Propecia in January 2005. Have been doing research for months and keep getting positive responses regarding NHI.

Thanks for the many points raised in your email. The plugs may have to be excised, particularly if they are large. There is an art in doing repair work – the critical decisions are how to manage the old plugs and how to use your present donor supply and not damage any future donor supply you may need. The decision to start Propecia was good as an add-on to what you are doing.

At NHI, we use a fine needle for preparing the recepient areas- we never use punches to place grafts! The needle makes a wound that is very, very small and by using the proper angles and density, I can give you a natural look and reasonable fullness in a single session if you are not too bald. The grafts are inserted into these needle sites using fine surgical forceps. These small wounds heal in a matter of a day or two, you can even wash your hair the next day.

You are now more than 8 months from the original surgery so it would be a good time to have an assessment done. You should call and make an appointment to see me at no charge. Our phone number is 800-639-4247 and we have an offices in Northern and Southern California. Examining you will make all of the difference in what you finally end up with.

African American Female, Age 52

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

I am an African American female age 52. I have very long sister locks and they are beautiful. trouble is, I had a hysterectomy last summer and noticed that my hair is balding on the sides. I went to a dermatologist who said it was my locks pulling, but I clearly had to get him straight and tell him that I never had braids in that spot, only a hair line that never was long enough to incorporate into the dreads. I am a professional person and am always in the public eye. I am now wearing scarves to cover the sides. I would like to know what I can do. I did notice that before I had surgery, my scalp was itching badly on the sides and the hair at the follicle became crusty at the base, as if it was dead. Any help would be appreciated

You should be seen by an expert. With a good history like yours, I would worry about a series of localized skin conditions that should be ruled out by a good dermatologist. As you are convinced (and have convinced me) that this is not traction alopecia, then a transplant might be a good solution provided that your dermatologist has determined that there are no skin conditions that would kill off the transplants. Transplants are undetectable in most African American hair types.

Impact of Change In Appearance

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

A former patient came to my office last week complaining that the hair from the transplant last year did not grow. He wanted to discuss his options with me. When he came in, I pulled out his before pictures to be sure that both he and I would be talking about the presence or absence or change. As he looked at his before pictures, I asked him again to repeat the complaint. He repeated it despite looking at a before picture of himself — when he was a bald man. Then I gave him a mirror and asked him to look at the pictures from one year earlier, and then look back at the man in his mirror. I asked him if there was a difference.

He looked confused. When I probed his confusion, he told me that his wife was totally convinced that the hair did not grow. She reported to him that she had watched for his hair growth very closely and never saw the growth occur. He did admit that the man in the mirror was hairy and the man in the picture was bald. To help him through whatever problem he was having, I told him to think about planting grass seed or watching a child grow. The more closely you watch, the less change you see. Clearly, his wife had that problem and complained over the past year that the transplant was a waste of money. Then I suggested that he take home pictures of himself before the surgery to show to his wife, and see if her view changed. That seemed to solve the problem and he left very happy.

We see the same thing echoed by many men who are amazed that their hair transplant was never detected, even by them. In the workplace, the change occurs so slowly, that people who see you every day never notice any change. We quickly adjust to what we see before us, not the image we stored in our memories.

I always enjoy these return visits a year or so after the initial transplants were done, to be able to compare the image stored in the before photos to the ‘hairy’ person in front of me.

Early 20s with High Hairline

/by William Rassman, M.D./14 /,

Hi, My son, who is 23, has very thin hair on top of his head and a high forehead. He tried avacore and it’s hard to say if it helped or not. He has very thick hair on the sides-we are prone to high foreheads in our family but the thin hair on top of his head is distressing him (which I’m sure doesn’t help). Is there someone he can see to access his problem-we live in New Jersey and are a train ride from Manhattan. Thanks so much for your help.

Is your son balding now? I would guess from what you are describing is most probably genetic hair loss. Avacor is overpriced and has minoxidil as its active component; I would have been surprised if it would have worked. The marketers of Avacor do a hell of a job promoting the ‘benefits’ of their product and as a result, they have one of the most popular sales efforts ever and it appears to be priced over 10 times that of minoxidil. Propecia, which is made by Merck (pharmaceutical company), is under FDA and FCC regulation so Merck can not promote claims that are ill defined or vague. In a 23 year old male, genetic hair loss comes from the ‘workings’ of DHT on the growth center of the hair follicle. Propecia is the only substance that has been clearly documented to block the effects of DHT on the hair follicle. It has documented benefits on retarding, stopping or reversing hair loss. A competent doctor would make the diagnosis and appropriately manage the problem for you. To answer your request for a doctor on the east coast, I would recommend Dr. Robert Bernstein at 201-585-1115, who has offices in Fort Lee NJ and Manhattan NY. He is as good as they come and I would not hesitate to have my son treated by him.

Transplant Failure To Grow

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

I had a hair transplant in November of 2004. The doctor was a member of IAHRS and had many good patient photos, and the procedure seemed to go very well from my standpoint. But I still have seen no significant results. I was a Norwood 3 with thinning in the frontal forelock. Now, my hair is significantly thinner on the sides, and while about 20 hairs grew in very quickly (about 2 months after the procedure they began to grow) no other hairs have grown in and my front is thinner than it was at the time of the procedure. I was wondering at what point can i be sure that no new hairs will grow in, and that the procedure did not work? Soon I will be 7 months post-op, and I still have no significant growth of the 1700 grafts I had.

Thanks for your time.

Generally I tell patients that by 8 months, fully 80+ % of the grafts should have reached styling length. That means that the growth should be well underway by now. On rare occasions, I see delayed growth, but that is not common. IF the procedure failed, speak with your doctor directly and ask him why he thinks this is happening. If he is a good person, then I would expect honesty and some reflection on his experience with this type of problem. He should be forthright and direct with you.

As a side note, many times when a patient tells me something is wrong, I make a point to focus on what the patient is saying, adding my observations to the mix. That is why a good doctor/patient relationship is important. Things can go wrong at the time of surgery that could cause this, but more often it is things that are not evident that need to be addressed. For a complete failure to occur, something bad happened at the time of surgery. But alas, doctors are not always in 100% of control of all variables. Pass me your doctor’s feedback and let me know.