Limited Donor Area

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

Hi,
I visited NHI for a consultation about three years ago and was told that while I was a candidate for a procedure, my donor hair sites were limited. I guess they determined that the back of my head just didn’t have enough follicles to take care of my developing baldness in the front and on the top of the head. My question is this: I’m curious about the recent developments in cloning and gene therapy. How far are we away from these advances? I hope soon.

Since you are in the Los Angeles area, please come back again and let’s talk. A re-examination may have value. With regard to cloning, I have had a number of questions on this subject, which I’ve answered in the Hair Cloning section of this blog.

Scar Reduction

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

As a former patient of NHI, I remember that it was desired/required to keep the hair length longer in the donor area in order to “cover” the post surgury scar/shaved area. Do the new procedures (scar minization) used for the donor area make this no longer necessary?

Only about 5% of former patient developed noticeable scarring. Most of these scars are the result of the healing properties of the patient, although some are technique dependent. With new techniques recently developed over the past year or two, the risk of scarring in first time surgery patients has been reduced. We have notified all of our patients from over the years to contact us if they had scars that were noticeable or bothersome. New techniques can reduce these scars and there are a series of options now available to treat problematic scars. As you can see from my publishing your question in my blog, my goal has always been to focus my efforts on good patient follow-up and communication. I want 100% of my patients to be satisfied and I will work towards that end. Please contact me and make an appointment.

Crown Thinning – What To Do?

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

I am a 39 year-old man whose hair is moderately thinning. I have taken Propecia for about 5 years with excellent results but now it seems to have little to know results on the crown. The past two months hair has been falling out consistently. It has finally started to stall but now there are two very noticeable areas on the crown. I never really found minoxidil too helpful. What can I do?

You need to have an examination to determine the extent of miniaturization in order to predict what will happen to you. You also need to quantify the donor supply, so that you will know if there is enough donor hair to meet your expected needs. Transplants work well, but before embarking on this path, you need to know what your future has in store for you.

Need More Crown Hair

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

I would like to do a corrective procedure. I have way too much hair on the frontal hairline and I am receding in the back. Presntly, I can comb over much hair to create a look of fullnes; however, I fear a wind storm or having my hair wet; the result is too much long strand hair which looks awful (when wet or during a wind storm) ; I am tired of “faking: my hair style; I would like a style that is easy to care for. allows me to get my hair wet and allows me not to wear as much hair spray. I realize that means that I will be bald in the back-so be it. If I had my choice, I would be bald all over whithout transplamt scars and dolls hair look.

Is it do-able-I have some donor hair left but not a lot.

When working on the crown, there is a balance between donor supply, need and the worst case scenario for your hair loss. Often the donor supply is limited and you should have some reasonable assurance that your donor supply will not outlast your need as you continue to bald. It takes a real expert to make the most out of the least. A visit to a competent doctor with experience in corrective work will be invaluable. Be sure that the doctor will watch for your long term interests and not just transplant you today for how much money he/she can make now. When transplanting the crown, you must balance what might happen to you tomorrow. Can you send some pictures to me? It might help. My email address is on the Contact page. If you are in California or can easily come to California, please visit me.

Donated Hair for Transplantation?

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

why can’t someone use another person’s hair if the blood types match and he is willing to donate his or her hair for you

Good question. When you think about hair you think of that stuff that grows on top of your head. Hair on the top of your head is dead as it exits the skin. The frozen Eskimos and ancient Egyptians in the tombs still had hair after thousands of years. Of course, it is dead. Now when I think about hair, I think of an organ. Each follicular unit of hair has blood vessels, glands, nerves, skin, and fat. It takes all of this plus a growth center and the right genes and nutrition to make hair grow. Since by definition hair is an organ, transplanting the hair from someone else is like transplanting a heart, kidney, lung, etc. These organs are rejected by a person unless the recipient is given drugs to suppress rejection. If you had a twin, then hair from that twin with the exact same genetic blueprint would give you a successful transplant. We did that exact process on identical twins and it worked wonderfully. The usual problem is that when one twin has balding, so does the other.

Bald Spots in African American Women

/by William Rassman, M.D./18 /, ,

I and my daughter have severe bald spots. My other daughter has a bald spot also. Not as severe as ours. My daughter is devasted. I think she can be saved from what I am experiencing. I personally feel that there is something in our system. No other family members have this disorder. We have been unsuccessful in locating a doctor who is familiar with Black Hair care or disorders. Can you help us. I now wear a wig. My daughters do various things from sew-ins to wigs. If you provide address I will mail pictures. Thank you.

If there are spots of hair loss in you and your daughters, you should start off by seeing a dermatologist. There are genetic conditions that fit the description of what you are talking about. Please see a good dermatologist.

Resuming Physical Activities After Surgery

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

Hi Doctor,
I am an avid weight lifter and exercise quite frequently. I heard that after surgery, I won’t be able to my normal routine physical activities for 3-4 months. Is this true? What type of weight lifting am I allowed to do in that period and for how long? Thanks.

There are two types of surgical approaches in harvesting of donor hair. One is where the surgeon removes a strip of skin and then sutures back together (standard for today’s Follicular Unit Transplantation). I generally ask people who have strip harvesting to hold off on body presses, sit-ups and other such types of exercise that can strain neck muscles for a few weeks after the surgery. All types of aerobic exercises. otherwise, are ok.

The second type of surgery is Follicular Unit Extraction (FUE), where the follicular units are harvested one at a time. With this procedure, you can resume full exercise within a few days of the surgery with no limitations at all. The FUE surgery is more expensive than the strip surgery and the surgeon can not as easily move as much hair in a single surgery. This means that FUE requires more procedures.

Patients who had FUE surgery have not complained about pain, but those that have had strip surgery generally have some discomfort, mostly on the first night.

Is There a Scar-Free Hair Transplant?

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

I am a hindu. I have to shave my head at various religious cerimonies. is there a way where I can get a scar free hair implantation? Having a scar is out of question

Anyone who has a cut or break on the skin develops a scar. The proper question is, “Can the scar be seen in a routine social situation?” There is a surgery (developed and published by me in 2001) called Follicular Unit Extraction, or FUE for short — otherwise known as the FOX™ Procedure. With this procedure, individual follicular units of one, two or three hairs are removed with a 1mm punch. That leaves a scar measuring 1mm and a series of these are produced proportional to the number of such grafts that are removed. These scars close by ‘secondary intention’ which means that the skin from the sides of the wound, grow to the center as the center fills from below. The resultant scar can be seen in close-up detail on the FOX Megasession page at newhair.com. Near the bottom of that page, there are photos of scars shown at different levels of magnification and with the hair clipped and shaved.

For further information on FUE / FOX Procedure, please see our FOX Procedure page.

Burn Scars

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

I have terrible scars on my head from a burn I got when I was a child. I had many, many surgeries with balloons placed in my head to stretch the scalp and the scars (which are significantly better) are still there. Prior to the last three surgeries, I had a scar that ran from ear to ear which was about 1/3rd inch wide. The cosmetic surgeons tried to remove the scar but it kept coming back. Is there something that you can do for me with Hair Transplants?

Yes, hair transplants work very well for the scars you are talking about. Depending upon your hair color and the density we need to get in the scars, we can usually fill scars in nicely in one or two surgical sessions. In some patients we can not push the density so more than one session may be required. Still, after just a single session, you should see a benefit of the surgery.

Hair Multiplication

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

Hello Doctor.
I have visited the site you posted, www.clonemyhair.com. Within the site I read alot of information on Prof. Carl Bazan, M.D., MTTS. Have you ever heard of this Doctor before. I am asking you because I have heard alot of good things about you front the Bald Truth. In his site, https://www.itzan.com/, he claims that he is doing Dp-Hair Multiplication. My question is, have you ever heard of this doctor and this procedure. Is there any light to his claim?
Thank you.

Hair Multiplication is not a proven technique. There is no evidence that it works reliably. Whenever I hear claims that are unsubstantiated by any scientific or objective results, I am skeptical, to say the least.

Hair Breakage

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

I have bleached blonde hair which I have been bleaching for about 1.5 years now. For the past 10 months or so I have only bleached the roots and experienced the regular breakage associated with bleaching. It has all been quite normal and certainly nothing to be alarmed about. However for the past 2 – 3 months I have noticed a large amount of hair loss at least 50 hairs a day which is very unusual for me. The other unusual thing is that for example at the moment I have brown regrowth of about 1 cm length. If I purposely pull a hair out of my head it is blonde all the way down with 1 cm of brown at the root. However every single hair that comes out of my head on its own has a tiny 1 mm of brown on the end as opposed to the 1 cm of regrowth that I actually have. Every single hair that comes out has this 1 mm of brown on the end which is making me wonder if it is actually coming out from the roots or not as the roots are much longer. I am started to get very concerned and would appreciate any answers you could give. Thanks.

It is always difficult for me to interpret the meaning of what you are seeing without making my own observations of your clinical examination. I generally employ densitometry (a science I invented and patented) which allows me to visualize the degree of miniaturization of the hair and the area in different parts of your scalp. First, I need to know if you have genetic balding. A good visualization with high magnification would serve to address the diagnosis.

The average person loses 100-150 hairs per day, so your report of 50 is not alarming. Although we undergo asynchronous hair growth, many people do see some cycling of the hair loss, not to the degree of animals with synchronous growth (shedding), but certainly what you describe could be present on a temporary basis. Time will clearly tell us and after you get a good diagnosis (reassuring yourself that you do not have genetic balding), then waiting this out is a reasonable next step. The hair character does change with age, and it is possible that you are changing the character of your hair which makes you more conscious of your recent past history of hair loss and hair breakage. You might consider letting your hair go natural brown and see if the hair loss slows down, but the first thing to do is to get a good examination and diagnosis.

Missing Hair on Side

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

i have hair missing on one side of my head and i am only 26 years old please advise what i should do?

I am not sure what side hair you are missing. A diagnosis on the cause of the hair loss is critical. If the temples are receding back above your ears and it is part of the genetic balding process, then you need to treat it as part of that process. If you have defects in the temples since your youth, it may be another type of balding, something we call triangular alopecia. Send me a good set of pictures and I will give you an opinion if you can not come in person to one of my California offices. If you’d like to email me some photos, my email address is on the Contact page.

Propecia and High Blood Pressure

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

First of all, I’d like to say that this site is very informative, and thanks for providing it. My question concerns Propecia. I take high blood pressure medication, specifically a beta blocker (Toprol XL) and a diuretic (Triam-Hctz, the generic of dyazide). Are there any known cases of these types of drugs having an unfavorable reaction with Propecia? I ask only because a friend told me he once knew someone who had to stop taking it after having chest pains that he hadn’t had since he started his high bp meds. I would like to get on Propecia, but I’d rather be bald than have a heart attack. I’m just wondering if my friend was exagerrating.

There is no impact to my knowledge of Propecia on blood pressure medications or diuretics. The medication minoxidil (brand name Rogaine) may impact blood pressure as it was originally defined as a blood pressure medication. Maybe your friend is confusing the two.

Cheaper Proscar, A Bargain

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

Can I buy Proscar instead of Propecia and put it on my insurance? Is it as good as Propecia?

Finasteride is the generic name for Propecia (1mg) or Proscar (5mg). They are exactly the same medication. The drug company that hold patents on the drug determines the pricing in such a way that the 1mg pill is almost the same price as the 5mg pill. Some people try to cut the 5mg pill into 1/4 or 1/5 sizes, so that it should be the same value as the 1mg pill. Certainly, 5mg pills are far less expensive mg-for-mg than 1mg pills.

With regard to using your insurance, most insurance companies will only cover prescriptions that are for medically necessary reasons, not for purely cosmetic reasons. When I write the prescriptions, if a patient asks me for Proscar, I will write the directions to cut the pill into 1/4 pill. If the drug store gets authorization for Proscar from the insurance company, then so be it, but most of the time they will not abe able to obtain insurance authorization for use by young men. I am not familiar with which insurance companies routinely authorize Proscar.

Fragile Hair and Hair Gels

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

Hi Dr, may I know what is the difference between normal hair gel and alcohol free hair gel? Does alcohol free hair gel provides less damage than normal hair gel?

Anything that dries out the hair shaft will make the hair more fragile, so the use of alcohol based products may cause more drying in those individuals who already have dry hair. We are all different, so I generally tell people to experiment with the various product offerings and see what works for you. If your hair is in the balding phases, it will tend to dry easier, making it more fragile, so alcohol could be a problem for those with genetic balding.