Body Hair Transplantation

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

Two different BaldingBlog readers had two similar questions…

Dr. Rassman,
recently some hair transplant surgeons reported very good results from body hair transplants. Other doctors remain more cautious and say it may yield good results in some, but not all patients. What’s your view on this?

Dr. Rassman,
Would you ever consider using bodyhair for some of the grafts in the scalp? I was wondering because it would seem a good way to increase density results. I am a bit paranoid about using only scalp hair to graft because I would not want to run out before getting decent density. I would think that you could mix in some sideburn or beard hair with regular scalp hair in the crown. What is your take on this. Thanks for your time.

Body hair has generally low densities (contrary to what it looks like on some men) so they do not make for a good donor supply in terms of quantity. A focus upon head hair should be primary. Then if you run out, moving to other body parts may be reasonable, especially as some studies are now appearing that indicate that this type of transplant works (leg and body to head or neck). What is still missing is the yield rates from the leg or body and the growth success from these areas.

As far as using sideburn or beard hair, this is an option in certain circumstances. They should only be considered as a last resort, when all usuable scalp donor hair is used. The other time that sideburn or temple hair can be used is when a patient is going to have a face lift and the sideburn/brow area is going to be excised as the brow is raised up.

Until the research information about body hair transplants is in our hands, it must be looked at as if it were human experimentation. A number of our patients have volunteered for this, so I am clearly interested in following the experience of others who I trust and then possibly get involved myself. I just do not want to sell hype and disappoint anyone.

I have performed one body hair transplant. The transplant was done from the abdomen to the eyebrows and it failed to yield hair in 10 months. I lost contact with the patient so I do not know if the transplant showed delayed growth or reflected some mechanism that caused it to fail. What I believe is that we need better scientific evidence on the following questions:

  1. Does it works reliably 100% of the time?
  2. If #1 is true, is that for all donor sites?
  3. What is the yield of viable grafts?
  4. What are the risks of body scarring / complications?
  5. Is it cost effective?

I would want to see many successful patients before I recommend it routinely for my patients.

While I can perform body hair transplants, I choose not to until they have been proven as a reliable procedure. If I make representations to my patients, I must be able to support what I say. If I embark on body hair transplants now (even on a limited basis), my patients must know the many uncertainties associated with the procedure. Until my comfort level is higher, I will not be doing body hair transplants.

Hair Loss From Propecia – Update

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

There has been some discussion by physicians about patients who take Propecia, or Avodart, who may experience shedding of hair. When this occurs, they believe it may be simply a phenomenon that as the finasteride or dutasteride begins converting the telogen hairs into anagen, the shedding reflects an acceleration of hair cycling. The same theory implies that some people may have a significant amount of hairs in telogen, so their shedding may be increased in the first few months of starting the drugs. If these people wait out the cycle, I believe for a 3-5 month time frame, the benefits of the drug will come on strong.

In my practice I do not remember hearing this complaint so what I am presenting here was precipitated by some questions that came through this blog and information I gleamed from my recent trip to Sidney at the ISHRS meetings where I asked other people about the experience hair loss on Propecia. But the explanation above makes sense to me, assuming the premise that hairs in telogen may be shed more once they are moved along into their anagen (hair building) cycle.

Hair Loss from Cancer Drugs

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

Dr. I am currently in the Star study and taking either tamoxofin or reloxofin and a placebo. I am having ample hair loss every time I brush or wash my hair. One of the questions on the form that I am to answer every year (this is my second in the program) is regarding hair loss. Within the past few months I have also started taking Glucosamine and Condroitin. I think the hair loss has increased in this time. Is this a conincidence or which drug, if any is causing the hair loss and is there anything I can do about it other then stopping the meds?

Many drugs that attack potential cancer cells because of their high metabolism, will also impact other cells with a high metabolism such as hair (one of the highest metabolic organs in the body) and the lining of the intestine (these cells have a high turn-over) with symptoms of loose stools and general ‘stomach’ troubles. Also, some of the other sensitive cells to anti-cancer drugs are the blood cells in our body, some of which live only a short time, even under normal circumstances. That is why many cancer patients have frequent blood tests and are monitored for side effects so closely. Hair loss is not one of the points that have become the focus of anti-cancer drug treatment by doctors, yet hair loss is often the most worrysome side effect from the patient’s perspective.

Unfortunately, there have been no effective medications that have been shown to protect against hair loss. That is the bad news. The good news, however, is that the hair in women that falls out from the impact of these anti-cancer drugs, always comes back within a year or so in most women, that is, unless they have genetic hair loss. Those with female genetic hair loss and hair loss from anti-cancer drugs in combination, find that although the hair usually returns, it does not come back as strong hair. Show patience, and the hair will probably return to its pre-treatment quality, again as long there was not genetic hair loss prior to the commencement of treatment.

Hair Transplantation in Filipino Man

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

I am a filipino male with brownish black hair that is semi thick in nature. My hairline is receeding and would like to have the FUT procedure done. but before this takes place, have you done this procedure on clients that fit my description, and if so, may i see pictures of them? may i also call them if possible. as far as medication goes, do i need to take propecia, rogaine or any other prescription? because i rather not. my next question is time off work. because i am self employed and serve clients face to face i can not afford to take more than 5 days off from work. is there way to discreetly hide my surgery as it heals? my last question is i enjoy having my hair cut very short, is possible to do that without showing that i have had hair transplant surgery? do you have pictures of your clients like this?

thank you

What you have is typical for our practice. Our website has many, many patient pictures of what you are talking about in our Before and After Photo Galleries. Our monthly open house events allow you to meet former patients and see the results for yourself. You do not have to rely solely on photographs when you get to meet the patients in person. In addition, an open house allows you to see a surgery, talk with the patient having the procedure, and see how he looks immediately after surgery. We also invite patients who have had surgery during the previous week to stop by, but I can not guarantee that they would have the same hair characteristics as you.

The use of medications relates to the natural hair that you are losing. Medications may be necessary to hold on to hair that is genetically not going to last, but medication is not needed for the hair that is transplanted. I strongly recommend that my patients use Propecia, to maintain their existing hair.

You can return to work fairly fast. I have performed FUT surgery on a number of celebrities who have appeared on television within days or even hours of their surgery. I have had a few people run a marathon within 5-7 days of the surgery. Going back to work is easy, but the question relates to just how bald you are and if you care if someone notices that you had a hair transplant. For the very bald man, this can be an issue, yet for those not very bald, they can be undetectable within a day or two. There can be a little redness in the recipient area for the first few days and if you allow your hair to grow a little longer than usual, it will hide the donor area nicely. If you do schedule a surgery, you may want to shoot for a Friday, taking the following week off, then you will have nine full days before your next work day. As far as wearing your hair short after the healing is completed, that will be up to you. FUT surgery will leave a thin scar in the donor area, the length of which is determined by the number of grafts you need, your hair density, and scalp laxity.

My advice is to visit us at an open house event and get comfortable with what we do. Review our website, where hundreds of patients are shown, and get the book I wrote, The Patient’s Guide to Hair Restoration, which is probably the most comprehensive book ever written in this field.

Losing Hair Grafts After Transplant

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

Hi, Dr. Rassman, I hope that this email finds you well. I had my surgery in June and have lost about 9 grafts (4 in the last 3 weeks or so). I didn’t lose this many last time. Should I be at all concerned?

Nice to hear from you. I would doubt that you lost any hair grafts. After 5-10 days, once the scab is off, most of the grafts actually can not come out even if pulled on. What you may have lost was the remnant of the graft and the hair shaft. The growth center will remain and will grow its hair in 4-5 months. If you are at all concerned, call my office at 800-NEW-HAIR and make an appointment to come in. I will be happy to take a look at your early results.

Transplanting the Crown

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

What do you think about filling on the crown on 39 yr old because that is where my hair loss is. I was told that I am in good shape because most of a person’s hair loss happens between 20 and 40. They also told me because I am on propecia that chances are very good I can keep most of my hair. Please let me know you thoughts.

A crown transplant uses hair from the donor area, which may be needed for frontal area transplantation should you continue to bald. If the hair loss is controlled, then transplanting the crown in a person of your age may be reasonable, provided that your donor density is good, your laxity is good, and the pattern of genetic hair loss is predicted. Being on Propecia may help slow or stall the hair loss, but long term planning is critical.

It is also reasonable to postpone transplants in the crown for 8 months or so if you are just starting on Propecia, as sometimes the drug has remarkable results on restoring hair loss in the crown. It generally takes more hair than most doctors think to fill in the crown, so balancing supply and demand in the short and long term requires special estimation skills when transplanting the crown. Be sure that the doctor you select has those skills.

Hair Loss Worse on One Side of Head

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

I am clearly losing my hair and my right side is much worse than my left side, although the left side has the same problem, just not that bad. Could I be pulling on the right side when I brush my hair to the left too much?

Hair loss is rarely symetrical. Many people will notice one side is worse than the other. Based upon your email, you are combing it right to left. That means that the right side has more sun exposure than the left side and the sun exposed side generally has more ultra-violet damage than the other side which has been protected by the combed hair.

Hair Loss Following Pregnancy

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

Hello,
I recently had a baby at 28 weeks, due to a serious kidney infection that was almost fatal. since then we’ve been doing wonderful. Though, for the last month I have been noticing excessive hair loss. I know its probably due to a serious infection or hormonal but, how long do you think it will last and could I go bald before it then? Please help me!!!!

Hair loss following pregnancy is not uncommon and can be expected to reverse in most women within a year or so. In addition, I am sure that your serious illnesses contributed to the hair loss as well. You must show patience while you are going through this waiting process. I am assuming that you did not have a hair loss problem prior to the pregnancy. If this is incorrect, then I would have to know more about your history.

Graft Quality From Different Areas of Scalp

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

I am a 48 year old male who has had 3 procedures: 800,800, 2000. I was told that by the 1st doctor that the same donor area would be used over again for the 2nd procedure. For the 3rd procedure I went to another Doctor who told me that the quality of the grafts is better if they used another location. slightly higher than the first. I would like at least one more procedure and would like to know if I need another donor area or can one of the old areas work as well. Also is there any benifit to having a hair analysis done. Thank you for your time.

Some doctors take the hair from the high neck rather than the mid posterior scalp. This view is misguided because using the high neck has problems, including:

  1. it is not permanent hair
  2. it tends to scar
  3. it does not tolerate much taken from it without severe scarring that is difficult or impossible to cover up

I always take the donor area from the middle of the donor area (the 3 1/2 inch high band around the side and back of the head) as that is where the best hair is. I call this area the sweet spot, because it is highly productive for good quality hair. I continue to harvest the same area, at the same scar in subsequent surgeries, when they are needed. This gives me the ability to reduce any scarring, if it should occur. Since you are in my area, I would be pleased to give you another opinion, at no charge, and I will analyze your hair at the same time.

Subsidize Wound Scar Repair?

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

In a previous post you said:

“We subsidize the FUE repair of wound scars that were a result of a previous NHI surgery.”

What are the details of this, ie how much do you subsidize? Thanks.

I take the view that we are a full service medical practice. Because significant scarring is relatively uncommon, we will absorb the costs for scars that come about from our surgeries. If a scar came about from an NHI surgery, we will repair it at no charge to the patient with a modified scar revision surgery we recently developed. The results of this surgery has been very good in most situations.

On a few patients, the scars may reflect the person’s healing abilities, in which case a scar revision may not work. In those situations, for those who do not respond to this surgery to their satisfaction, we will perform an FUE at a cost of $2000 per surgery and put in whatever number of grafts that are available provided that this surgery can be done safely and effectively. Some patients may not qualify because they may not make good candidates for FUE surgery.

New York Woman with Hair Loss

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

Two years ago I went off of depoprovera, after being on for many years, I had an episode of hair loss. I saw a dermatologist and he said it might be telogen effluvium. He asked me if I had any trauma in my life, and the answer was yes. It never really grew back 100%, and now it is starting again. I have gone to a few fancy doc’s and they all seem so, full of it…seems like they just want to sell stuff. I just want to be evaluated, and told the truth. I am reading so much on this site and I’m really nervous. Please advise me where to go, I’ll go anywhere…Help!

You indicated that you are located in New York. I would recommend that you see Dr. Robert Bernstein. He has offices in NY and NJ and will give you great advice.

Fat Burner Causing Hair Loss?

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

For about 3 weeks, I used a “fat burner” that contained 75 mgs of 7-oxo DHEA (7-Oxo-Dehydroepiandrosterone) @ 225 mgs per day. I noticed hair loss after the third week, and stopped use. But hair loss continued and was rapid.

I have been off it for about three weeks, but hair loss seems to continue. It seems to be a bit slower now.

I asked to have tests done, but my doctor simply recommended Rogaine. Rogaine doesn’t seem to do anything.

Is it possible that it is “too late”? That once this hair loss has started, it will simply continue on its course — even though I no longer take this fat burner? Not sure what else I can do at this point.

A recent article in the Wall Street Journal (September 13, 2005 issue) stated that short term weight loss of as little as 8-9 pounds, could cause hair loss. Whether it is reversible or not, only a proper diet will tell you. We have long known that malnutrition is a major cause of hair loss in the history of man and hsi hair problems. For those with the genetic balding process, stress can precipitate the process. A weight loss program that is associated with a good diet is not a problem for most people, but acute or chronic malnutrition in men and women can cause hair loss.

Procerin

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

Hello Doc,

I’ve wrote once before. I appreciate your reply. My question is I now have been using propecia for 1 1/2 months now. Sincerely, my hair thickness has degraded significantly. It has shed to a point where my scalp is visable in many areas. Maybe I am one of the small % of the crowd, but definate loss is more since AFTER initiation of treatment. Also, with reading in many different sites and encyclopedias, prostate cancer % is decreased in men, but tumors or certain cancers are more agressive. Also toying with testosterone and estrogen levels is not recommended. There are tons of products out there, I think most are scams fishing for suckers. I found this product called Procerin. It sounds safer to me. I value your professional feedback. If you don’t recommend this product, and I feel propecia isn’t the answer for me, please tell me the best product to use without scary sounding side effects? Thank you for helping…

I originally commented on Procerin a few months ago (found here).

I have read various articles about Procerin on the web, and there is an unsubstantiated claim that it is a DHT blocker. It might be right, but I can’t say for sure, as it is not FDA approved for that claim and good science for Procerin is just not there to give me comfort that claims can be substantiated. Your problems may not be related to Propecia, but you can always stop the drug and see what happens. I suggest that you take (whatever you do), one step at a time. Stop the Propecia if you want to see what happens. I would hope that any ill effects will be reversible in a month or two if you go back on it. Do not bind yourself to a medication you are not comfortable with. If you believe in Procerin, then try it after being off Propecia 6 weeks or so. Then see what happens. There may be competitive inhibitors to the DHT production sites that Procerin might impact (if it is a DHT blocker, that is), competing with the likes of saw palmetto and other DHT blockers at the actual active site in the body. I have written much about Propecia in this blog, so you can find out other things I have said about it by clicking here. I frankly do not know and do not know how to find out the answers to your questions, however.

Good luck.

Transplanting Someone Else’s Hair to Your Head

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

If one can transplant the face of another person, why can’t we transplant the hair from another person? Please read US plans first face transplant on BBC News for details about the face transplant.

You are referring to the face transplants that have been recently approved by the FDA. The answer is that a face transplant is like a cadaver kidney transplant. Some genetic matching helps, but anti-rejection drugs are essential. The issue is best exemplified by the old adage “Does the punishment fit the crime?” One can easily transplant most people’s own hair (an autotransplant) so that rejection of the hair is never an issue. If you transplant someone else’s hair, then you would have to use anti-rejection drugs to stop the body from rejecting the hair organs from the other person. These drugs are dangerous and in themselves have great risks associated with them. In the very deformed people, the benefits outweigh the risk. As your own hair is easier to use, there is little need or demand for transplanting someone else’s hair to your head. The few that are very, very bald, or those who have run out of donor hair after receiving far too many old type hair transplant procedures, are left without a solution for today’s focused world.

Recipient Area Scarring

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

I had two hair transplant procedures performed on me. The first was in 96 and the second in 98. I was only 21 at the time of my first procedure. I recieved a total of about 900 graphs between both sessions. I am very unhappy with the results. I’d like to know if my transplant can be reversed. What could be done about scarring in the recipient area? Any info would be greatly appreciated.

You may be able to have the grafts removed with FUE. This may remove the grafts, but the skin may still not be normal and it would shows scars. Alternatively, you can fix it and complete the process if the hair supply is good. You first need to be examined by a first rate doctor. For more info, please see the following links: