Stretch the Donor Area Before Surgery?

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

I am preparing to have another session in September for added density. The only discomfort that I had in my previous surgery was that the scar(strip harvest method) in the donor area. Is there any way to stretch that area before surgery other than massaging that area? ie an implant device to stretch the skin?

Some people have tighter scalps than other people. Also, as some people get transplanted, the tightness of the scalp may get tighter, although this is not the routine case. There are tools that expand the scalp ahead of time. These tools were invented for scalp reductions, a procedure that has fallen on hard time (for the right reasons). Many of these devices (expanders and balloons) are painful and should be preserved for those with indications for their use (burn scars, large scars from accidents and the like). Your question is difficult for me because there is an implication that either you want more donor scalp removed than is safe, or that you had unusual pain associated with your donor wound closure. It would help me to understand your question better by further clarification, call me at 1-800-NEW-HAIR so that I can grasp the direction you want me to take.

Genes and Genetic Hair Loss

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

I know male pattern baldness is polygenic with multiple genes that contribute to the disease from both the mother and fathers side but i was just wondering with the news that the androgen receptor gene, is on the X chromsome given from mother to son.

Should we assume that mothers genes means “mother’s father” or generally speaking the whole maternal side of the family, which would include the mother’s brothers, uncles, and grandparents…..

I emailed regarding a similar topic and you mentioned that you could not comment on the whole androgen receptor gene article since its all new and i respect that but my main question has to do with when someone says “mothers genes”, should we assume this is exclusive to the mother’s father and that a male should look at his mother’s father to see what his hair will be similar to in the future or is it likely the other males on the mothers side have much influence also …………

Can an individual have the genetic susceptability and partly have some of the genes for MPB but for one reason or another it does not get experessed.

Thanks for your response

You have an assumption here that is confusing you. This is not an on/off gene. Gene expression can skip generations and there are variations in the way the gene is actually expressed. This makes your question moot to some degree, particularly if the X Chromosome comes from the mother’s father.

Yes, having the gene and having the gene expressed are different. We really do not understand the issue of expression or the various families that skip generations before the expression shows.

Steroids and Hair Loss

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

Hello, i just found out my male cousin aged 26 has colitis of the intestine, thus the doctor wants to put him on steroids namely cortisone. He has some recession but no definitive signs of male baldness yet but he has a strong family history of baldness with his mothers father and father balding early, most of his uncles on his fathers side are bald except one who maintained his hair. So at age 26 my cousin feels pretty lucky to have escaped the MPB gene thus far, which leads to his obsessive compulsive disorder, he is now worried to start taking steroids because its known that if you have a genetic predisposition to MPB, then taking steroids can acerbate the hair losss, if you don’t have the dispensation then you still wont suffer.

Now when they talk about steroids they are usually steroids ( androgens that promotes more testosterone production- anabolic) such that of athletes mainly baseball players take to make them stronger. Also if you ever watch bodybuilders many of them are balding or bald at young ages, so i have doubt there is a correlation.

My question are the steroids they give to colitis sufferers or anything that’s associated for medicinal purposes differ rent than the steroids athletes to promote strength? OR do they consist of basically the same chemical composition, the only difference is the usage ( how frequently)

Should my cousin be concerned about losing his hair due to the steroid usage, will it exacerbate the MPB? I know the MPB is trivial to what he is suffering and shouldn’t be any concern even if he does loose his hair but understand he’s in his mid 20’s. I tend to think if he was in his mid 50’s when this occurred, he would have absolutely no reservations in taking the steroids even if that means the hair loss because at that point looks are not as important to many people.

Your response would be appreciated, thanks

If your cousin has genetic male patterned baldness, but has not started to bald yet, the steroids will most likely accelerate the balding process. If he is not genetically ‘impacted’ (does not have the gene for balding) the steroids should have no balding effect.

FDA Approved Hair Loss Drugs

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

Hi, Im chinese and 28 years old and started thinning at the age 26. i’m using supplements (zinc,biotin and b5) and herbal topical solution like AO lotion made by bioscor international, and just started hair genesis topical solution and shampoo and oral gel. They claimed FDA approval and have clinical study. My doctor told me the only drugs FDA approved are rogaine and propecia. is that true? thanks hope to hear from your soon

What your doctor told you appears to be true. Only Propecia and Rogaine (Minoxidil) are approved for hair loss. That means that they show benefit and are proven safe.

Bad Scars from Old Transplants

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

Hello,
I went through several procedures with a well known medical group back in the early 90’s. I was a 6 at the time.
In 2002 I was called back to military service to head to Iraq. I am an Infantryman and nedless to say our haircut is ‘extreme’. I was ridiculed and questioned constantly as to my ‘scars’. My scar from my MPR is particular noticeable and shows as ‘hole’ in the back of my head that dark hair grows out of. Since this was highlighted by the fact that everyuthing around it was shaved the jokes became of an obscene nature. Also, I was asked all of the time about my ‘smiley face’ scars on teh back of my head. My hair has continued to thin on the crown and tapers in to a long almost 1/2 ” scar that trils down to the ‘hole’. Even with my hair grown out now my ‘friends” refer to the reverse ‘mohawk’.Baghdad was hard enough without a year’s worth of snide remarks. Do you think this is ‘fixable’.I was upset at the amount of money I spent at the time only to end up being MORE self conscious then I was when I was losing my hair.
HELP!
Thanks

First I would have to see the problem as it presents. The ability to cover a scar with an almost shaved head is basically impractical/undoable. With your hair grown out and some creative work, yes, the entire donor area may be covered reasonably well. It depends upon the remaining supply and the strategy. The scars and ‘holes’ from scalp reductions have surgical solutions other than hair transplants. All the solutions, however, require that the hair remains long.

When you are teased about the scalp scars, I would use humor to deal with the uncomfortable and personal questions – tell them you had brain surgery and that’s why you are so smart! People can be insensitive and this is particularly true for young men. Be sure that you take Propecia, it is highly probable that all of the stress of Iraq is impacting your rate of hair loss. Let me know if you have trouble getting Propecia.

When you come back to the US, a visit with me would be great. Send me some photos too. My email address is on the Contact page.

Stress Hair Loss in Men and Women

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

I recently had a breast reduction performed under General Anesthesia and stated losing a lot of hair. Could general anesthesia cause hair loss?

In some women who have female genetic alopecia (and with what I refer to as fragile hair), we see hair loss that results from stress. Assuming that there is no medical condition going on, this type of stress hair loss takes on two forms. The first form is typical, progressive genetic hair loss which comes on in phases and at different ages, then stabilizes for years before going into another progressive phase. The second form is less common, but it results from stress and often reverses within a year or less. We see a common variation of this second type of hair loss with pregnancy and in some women who have the stress variation, they often see a repetitive pattern of hair loss with stress, re-growth, then loss again with the next stressful reaction.

Stress induced hair loss is also common in men with genetic balding and is often seen as the precipitating cause that starts the process. Most common amongst the social precipitating factors for men include divorce, death or sickness of a family member or close friend, and stress in school or work.

South Africa Doctor Recommendation?

/by William Rassman, M.D./9 /,

im from south africa. im 22 years old and losing hair from the front to the back.im busy using minoxidil.its working a little bit but not to much.do you know of any good hair doctors in south africa as good as you for hair implants? i would really appreciate your help. thank you and best regards

Rogaine / minoxidil does not work well for the frontal area, while Propecia does work nicely at preventing hair loss in a person of your age. The effects of Propecia will probably impact the entire head if you catch it early enough.

I do not know of any doctors in South Africa that I could recommend. I always go to the ISHRS (International Society of Hair Restoration Surgery) website for physician searches, but after such a search there, it did not turn up a doctor recommendation. That does not mean that there are no good doctors in South Africa. If you do find local hair doctors, please remember to conduct interviews with each physician before making any decisions about having surgery. You might also consider coming to the US, but frankly at 22 years old, I would expect that your response to Propecia is worth exploring BEFORE you consider a hair transplant.

Any Hair Cloning Update Yet?

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

I’m curious how many years away you are from being able to implant cloned follicles?

I’m a 28 year-old with significant thinning in the temple region and mild thinning elsewhere. I have been taking Propecia for about 3 years trying to delay the need for a transplant. So far, it’s working somewhat. My hope (fingers crossed) is that if I can stave off the inevitable for a couple more years, you’ll have the technology to clone my follicles. I’m nervous about donor area scars and the ability to create density. I assume that when you’re able to clone follicles, you will have solved my biggest worries.

Thanks for you help.

The topic of hair cloning comes up quite often, but there really isn’t anything new to report. Similar questions I’ve previously answered in this blog can be found in the hair cloning section.

I do not expect that hair cloning will be available for commercial use in the next 10 years. The political problems alone might take that long even if we had the solution in our hands today. As it presently exists, the science may be 10 years away and that could be an optimistic view. For you to wait until cloning becomes available will mean that you will have to live with your progressive balding for as long as it takes. Most men want hair when they are younger, so going bald may not be a good answer for you.

Today, I met with a man who had a single hair transplant in 1998. He was fairly bald (Class 6 pattern) and had amazing results (unusually good hair). He told me that the hair transplant was the best investment he has ever made. Had he waited for cloning, he would not have been able to enjoy the hair these past 7 years.

Nizoral and Fungus

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

Hello,
I was wondering about a couple of things: first about Nizorol? I believe I have a fungal problem and have flakes that sometimes become hardened and also bloody. Sometimes I can pull out a little hard bloody or red piece of I guess dandruff or skin?? I am not sure what that is. I guess my scalp is not in a good condition. Can Nizorol help this?

I guess this would be my first concern, If you can answer about this that would be great.

It sounds like you have a dermatological condition of your scalp skin. I do not like blindly treating something that I have not examined, but a good dermatologist can make a diagnosis and then recommend the appropriate treatment. If, for example, you have psoriasis, then your solution of using Nizoral will probably not be effective. It becomes a hit or miss game to try and treat on your own, not a scientific one where the skills and years of experience of an appropriate doctor are brought to bear in making the diagnosis.

Transplant Hairline, Drugs for Crown?

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

sorry to bother you again just one more question. the front of my hair is going quite fast so i was thinking if it was possible to put hair transplants just for the front because that would look so much better. and then i would just use the minoxidil for the back?
best regards

You need medical treatment first, before surgical treatment. Propecia should be tested for a period of 8 months. It may regrow your crown hair. Hold off on the transplant option, as you will have a lot of time to consider having surgery. A try with Avodart may be appropriate if Propecia does not control the balding within 8 months.

Prostate Cancer Prevention

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

I ran into the following article which shows the general direction for exploring the prevention of prostate cancer. The following is the introduction to the the journal article.

INTRODUCTION: If an agent can slow the growth of existing prostate cancer cells, it remains plausible that it may be effective as an adjunct to surgery, radiation or chemotherapy.

DISCUSSION: Level-1 evidence will be needed in order to definitively prove the efficacy of agents as chemoprevention strategies for prostate cancer. Currently, only finasteride fulfills this criterion. Two major trials are underway that will assess the role of soy, vitamin E and selenium in prostate cancer prevention.

CONCLUSION: Tantalizing prospects for effective chemoprevention of prostate cancer exist. Fortunately, well-conducted randomized trials will allow us to answer many of these questions within the next 2 to 8 years.

Source: Can J Urol. 2005 Jun;12(3 Suppl):2-4. Prostate cancer: chemoprevention update 2005 by: Fleshner N, Al Azab R. Department of Surgery (Urology), University Health Network and University of Toronto, Toronto, Ontario, Canada.

Please note that Finasteride (Propecia/Proscar) is presently the only agent for prevention of prostate cancer so its use in hair loss has clear benefits beyond the ability of the drug to reduce the rate of or possibly reverse the hair loss.

Are Hair Plugs Still Used?

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

I am 32 years old and started balding about 3 years ago. My wife told me that I have about 60% hair loss located in the vertex of my head. The size is about 3″ wide and 2 1/2″ high. Here is my question: Do I need to wait until I lose more hair or all my hair in order to qualify for the transplant or can I start the transplant and make it a smooth transition so that no one will even notice a change?

Another question: Is hair plugs still used in hair transplants? or is this an old procedure? I do not like the look of hair plugs and it is obvious when someone has them.

Thanks.

You should be evaluated first to see if you are a potential candidate for hair transplantation. You should also consider the use of medications that will slow or stop the hair loss, possibly even return some of the lost hair.

The hair transplant methods have advanced light years since ‘plugs’ were the norm. Although there may be physicians who still use the ‘plugs’ you are talking about, they would be practicing outside the standard of care and as such, it could be considered malpractice.

Dateline NBC on Hair Loss

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

There was a great story on NBC last night, where Dateline followed five men on different hair treatments for 12 months. It compared Propecia, the laser comb, Minoxidil, a European fish oil claimed to grow hair, and hair transplants.

Best Time to Take Propecia

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

Is there a better time of the day to take Propecia?

I am under the belief that there is a diurnal variation in testosterone levels which are higher in the early morning than other times of the day. That might suggest that the best time to take Propecia is in the morning as the half life of the drug is only 4 hours. The half life of a drug is the time it takes for the body to reduce its concentration to half of what was taken.

Can Hair Grow In Scar Tissue?

/by William Rassman, M.D./6 /,

I would like to shave my head, but have a donor scar about 1/4 ” in width….. We communicated in the past about 2 choices:
1) Scar Revision, Not sure about this one, since, it seems my scar will just stretch again…the scar reaches the lateral side of my head, about the top of the auricle apex.
2) FUE into scar….This seems like the best shot…but will I really be able to shave my head…I would think you would still see a scar even if their is hair growing through it….and can hair grow into scar tissue?

Thanks for answering my concerns

Yes, hair can grow nicely in scars. The question then becomes, “Where will the donor hair come from?” If the scar is very wide, then the ability to produce donor hair (even with FUE) may be difficult. Some of the worst scars I have seen are very wide. In those patients with a collagen defect, the tendency for the scars to return is very high.

There are two causes of scars. The first is your body’s ability to heal. Some people with the same surgery that you had, developed no scars. The second cause may be technique-related and there are a number of techniques that work well in those patients with wide scars. These techniques include a) limited fascial repairs, b) balloon and expander use. Provided that there is no defect in the healing ability of the patient and the presence of non-stretchable collagen (no Ehlers-Danlos Syndrome) then there is a probable solution to your problem. As you appear to be in the Los Angeles area, I would be happy to meet with you to discuss your options.

With regard to shaving your head, even under the best of end results, some scar will remain, albiet small, so I would not recommend the shaving option.