Balding on Mother’s Family Side

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

Dr I am 26, My father is 64 with a full set of hair, how ever on my mums side they are all totaly bald (males only) im just strating to lose my hair were my crown is. I dont have alot of faith with all these product as i have tried plenty in the past. Im hoping you can regain my faith to my hair loss problem. My hair is thin and very curly i do have alot of hair exept were for the top of my crown.

At 26, you should go on the drug Propecia as it should slow down, arrest or reverse the hair loss you are experiencing. You should be evaluated by a good doctor. Sounds like you will follow your mother’s family line, but the drug may forestall the balding or stop it from happening. After 8 months on the drug, you should be re-evaluated.

Friar Tuck’s Bald Spot

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

My husband has a bald spot which he slickly combs back his very long hair to hide. The problem is that the spot is too big to cover that way, so his long hair falls to the side. He knows this psychologically, but denies that he is constantly combing back his hair to cover the impossible. He is dead set against being ‘cut open’ with a hair transplant. What can he do about this Johnny Cochran bald spot (with respect to the departed Cochran)?

There are many things he can do. He can wear a hair piece like the skullcap the pope or a rabbi wears, he can use spray hair from a can which he can buy for under $10 in Walmart, he can try to have the bald spot removed (a very radical surgery today with great risks) or he can consider a new minimally invasive hair transplant technique called Follicular Unit Extraction (FUE) where he gets a limited hair transplant without being cut upon like a standard hair transplant strip excision.

If he goes the FUE approach, it will not necessarily take a lot of hair to accomplish this as we can put in something I call ‘tackers’ which are a limited number of single hairs placed into the crown (his bald spot) which when grown, will act like anchors to his comb-back. It will allow him to continue the use of his styling comb-back and then with a can of hair spray applied very lightly, the comb-back hair will be held by these tacking hairs in position for the entire day. The nice part of an FUE surgery is that there is almost no pain after the surgery (few ever complain), there is relatively low recovery time, and visibility can be kept to undetectable levels in most people. People like your husband who hate the idea of surgery, may still have a stretch to look at the FUE as a non-surgery. I have called this minimally invasive surgery when I first published this in the medical journals and so have the patients who have had the procedure, but your husband may be another case all together if he is inflexible in his thinking. Maybe there is no solution for him if he can not think ‘out of the box’.

A Day in the Life of Dr. William Rassman

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

This was a busy day. I started early this morning – today’s surgical patient (Patient A) had a Class 6 balding pattern. He had great donor and scalp laxity- we transplanted 5069 grafts in 7 hours! Patient A’s “before” photo is just below, on the left — his “after” photo was taken immediately post-op and is below, on the right.



My clinical staff is amazing; they are so efficient and focused on the needs of the patient. I hope Patient A enjoyed his shrimp cocktail, his Thai lunch, and the movies he watched.

I got to see the patients from earlier this week, when they came in for their hair washes. They are healing really well. I wonder if I could talk the staff into doing my hair every morning.

Starting mid-afternoon, I saw a series of consultations, some new patients and a few old patients coming in for follow-ups.

 

Patient B came in today. He has had 5870 grafts with us in three sessions many years ago. He told me an interesting story today. A friend of his came over to him, looked at his hair and said, “I know that you probably don’t follow this hair transplant stuff, but I have just seen a doctor about getting one. Do you think that I am foolish?” Patient B confided in his friend, “Well that is one funny question. Didn’t you know that my entire head is transplanted?” His friend had no idea. They both laughed.

Here is Patient B’s before (on left) and after (on right). He had a procedure in 1997, 1998, and 1999. Six years later, his hair is still looking great. Please note that the quality of the “before” photo is from a scanned photo, so it is not as clear as the “after” photo, taken with a digital camera.



 

Then I saw Patient C. He had a total of two surgeries with us, the first being only about 7 months ago to repair an old hair transplant. Many years ago he had the older technique of large plugs done by another clinic, and had been wearing a hair piece to help cover them. Every morning he had faced himself in the mirror and saw this:



I removed many of the big plugs, dissected them into follicular units and then relocated the hair. I replaced his frontal hairline zone with 1501 grafts of single hair units. The entire frontal presentation is what you see here:


After his first NHI surgery he tossed away the wig once the new grafts grew out. His second and last surgery was just a couple of months ago. The photos below were taken less than two weeks after this second procedure. I was able to place 992 grafts into his frontal hairline. The hair is still very short and beard like in length. I told him that I expect this last surgery will finish his reconstruction. He now sees a normal man in the mirror every morning and he is pleased. So am I.



I love it when my previous patients come in to see me and to show me their results. Prior to surgery they are often anxious, and frequently during surgery they are so relaxed that they sleep through some of the movies they selected. These follow-up visits really give me chance to bond with them and share in their ‘hair happiness high’.

 

This is Patient D. He had three procedures with us totalling 4391 grafts and he stopped by to say “hello”. The “before” photo is on the left, the “after” is on the right.



 

Also, four new patients were on the schedule and it is the adventure in meeting new people that is most fun. Today I was able to spend at least 45 minutes with each of them. In my career I have personally consulted with tens of thousands of hair loss patients and their families. They are each unique, but they share so many of the same concerns. It is a pleasure to discuss their options, to encourage them to research, to seek out the best!

At the end of my day, I got a call (on my cell phone at about 7pm) from a very successful LA area businessman who was 4 ½ months out from his surgery. He just wanted to tell me that now his favorite activity is shaving in the morning. He said “Each and every morning there is more and more hair. It is exactly the reverse of what I saw when I was losing my hair. Back then, my nightmare started in the morning when I looked in the mirror to shave- all I could see was me getting older and older. Now, the mornings are the bright spot in my day.” His thanks and appreciation was a nice way to end my long day.
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Two Young Women with Hair Loss

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

I receive many questions each day, and because these two are both from young women with hair loss questions, I am posting both questions in this one entry.

I am 21 year old girl. Till now i didnt hav any hair problems . But for the past 4 to > 5 months i am losing my hair like anything. My hairline is gettin broader andn is gettin thin these days.Neither of my parents hav balding problems nor anyone in our whole family.Wat should i do so that i can get my lost hair back? Is this possible to get all the lost hair ?? Which shampoo shd i use?

I would first have a good doctor see you and look for medical causes of hair loss (there are many). The following problems are amongst those that should be considered: anemia, thyroid disease, connective tissue disease, various gynecological conditions and emotional stress. It is also important to review the use of medications that can cause hair loss, such as oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone. Many other medications can also contribute to hair loss so if you are taking any drugs of any type, then that should be looked into as well. The following laboratory tests may be useful if underlying problems are suspected: CBC, Chem Screen, ANA, T4, TSH, STS, Androstenedione, DHEA-Sulfate, Total and Free Testosterone.

It is possible that a medical condition may be the cause of your hair loss, so before you jump to conclusions that you have genetic hair loss, I would have you checked out for these conditions. The shampoo you choose will have no impact on the hair loss so I always tell people to use what they like, what feels good, what smells good and what makes your hair look good. Also, please read my previous blog entries on Female Hair Loss.

I am a 22-yr.-old female and am experiencing thinning hair all over my scalp, with several spots void of any hair. Possibly related elements of my history include irregular periods, dermatitis and eczema (both on-scalp and elsewhere), a family history of thyroid disease, an often-unbalanced diet due to graduate school lifestyle :-), recent emotional stress, and use of 0.1% Tacrolimus ointment (one potential side effect of which is alopecia). I know you cannot diagnose me sight unseen, but I have one question I hope you can answer:

If one’s hair loss is related to use of a medication, stress, or a dietary deficiency, is the hair loss usually only temporary if the behaviors causing it are stopped?

Thank you very much for your time.

Sometimes the hair loss is temporary and sometimes not. The key is quick and accurate diagnosis and taking the proper action to go after the cause of the hair loss. The outline given to the first question above is appropriate for your medical work-up as well. If there is a genetic component, then the hair loss may be additive to the other contributing factors.

Bargain Hair Transplantation

/by William Rassman, M.D./5 /

Today I saw a man who had surgery with us 6 years ago. He was very happy with the result but wanted more fullness. A couple of years later, he heard about a discounted price for hair transplants and had a procedure at that office. Unfortunately, the surgeon appeared to have made a mistake on the donor strip and excised a larger area than he could sew up. This resulted in a 1 ½ inch wide by 4 inch long scar which was difficult to conceal. He came for help.

On examination, his scalp was very tight. To address this wide scar on a person with a tight scalp, there are only two options for him:

  1. The use of a balloon placed under the scalp and inflated a few times a week. This process will last for 8-12 weeks while the head gets larger. It can be concealed by a well fitted hat.
  2. The use of FUE (Follicular Unit Extraction) with the grafts then placed into the scar. The limitations of FUE related to the quantity of the grafts that can be successfully removed from each patient has many variables.

Of interest, the bargain that drove him to get a second surgery is not a bargain at all. He is more fortunate than others because he can be become normal looking with good corrective surgery.

Bioidentical Hormones in Women

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

I started using bioidentical hormones in September of 2004. I started noticing hair loss and did some research and found that DHEA and Testosterone can result in hair loss. I removed these but my hair is still not growning back. I am currently taking progesterone and biest in cream form. I tried taking Selenium and thyrostin and that didn’t help either. I am at a loss of what to do, can you help me. I am devastated about this hair loss.

Bioidentical hormone replacement therapy includes such compounds as progesterone, estrogen, estriol, estradiol, testosterone, dhea, etc. I would assume from your question that you are post-menopausal. If that is correct and you have the genetic form of female hair loss without any medical cause, then it is highly likely that the trigger for the process has been ‘pulled’. Like a bullet from a gun, once the trigger is pulled, you can not call the bullet back. You need a thorough examination with a doctor skilled in quantifying miniaturization and the distribution of miniaturized hairs. Also, you will have to be evaluated with your complaint clearly outlined and understood. With that information, there might be some hope in the transplant arena, limited by the supply quality and quantity, and the size of the areas of need. You also need a good endocrinologist or gynecologist to ascertain hormone balances. I fully appreciate the traumatic impact of hair loss on women, but there is much I do not know about your unique situation. There is no substitute for a good doctor / patient relationship as a starting point. Find a good doctor and establish a trusting relationship with him/her.

The Comb-over

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

My father-in-law has the worst comb-over you can ever imagine. It runs from just above the ear on one side to the other side. My wife and I talk about it every time the family gets together. I can’t believe that anyone wants to look so foolish. How do he not see what is so clear for everyone around him? How can I tell him just to cut it short and join the bald man’s fraternity of normal looking balding men.

These comb-over styles start when there is just a little thinning, and as the thinning gets worse, the side hairline creeps down ever so slightly year after year and the hair grows longer and longer on the parted side of the head. The man who is inadvertently migrating to the comb-over never notices the end look. He is watching it so slowly that he blocks any vision of the look everyone else can see. You can see it and everyone else can see it, but a classic case of denial is fully deployed in such people.

I have seen many men in my office that employ the comb-over that progressively works less well for them over time. Men like your father-in-law rarely come to the office. When I get to see them on the street or in airports , I want to go over and tell them what I can do for them to help them solve the problem – but that would not be ethical of me, like ambulance chasing. Your wife (his daughter) could approach him, but be sure that your mother-in-law sees this as a problem before the ‘talk’ or you could be heading off of a steep cliff.

Young Man Wants Transplant

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

Dr.Rassman,
I’m 22 and have been taking propecia since I’ve been about 19. It has definately slowed or stopped my hair loss, but I am still pretty unhappy with my hairline. I don’t think I would need a very large scale hair transplant at this point, my hair is only thin in the front, and I was wondering whether you thought it would be a very bad idea to get a transplant at my age and given the circumstances.

For starters, please see Hair Transplants in Young Men.

As you see from this previous response, I do not have a problem transplanting a man of your age. It is important to read and understand the above link and we would have to develop a relationship. When both of us are comfortable with the analysis and the depth of understanding I require, then we can consider a hair transplant, provided it is indicated and not harmful to you.

Transplanted Hair Became Kinky

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

I had a transplant and the hair that was transplanted became kinky. Does this happen often?

No, change in hair character is not common, but it has been reported to me in about an estimated 1-2% of patients. It rarely gets very kinky, most of the time it just becomes more wavy. One patient that I do remember did get a kinky change to his hair after both transplants sessions. He loved it- his hair had never had any character before, so this was a most happy change for him.