Transplanting Hair to Face

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

Hello,
Can hair be transplanted to the the chin and sideburn areas of the face to fill in where facial hair does not currently grow? Have you done any of these types of procedures? I’m 30 year old white male with very little facial hair.
Best regards

We do transplant scalp hair to the face. Often with face lifts, repairs are made to the pulled back hairline and to lost sideburns. We also repair beard and mustache defects (the mustache defect is common in cleft lips). I have also had some Asians patients who had sparse facial hair and wanted it filled out more.

I often tell my patients that the good news about hair transplants from scalp hair is that if you put a hair graft on the end of your nose, it will grow to pony tail length. That is often used as an illustration of the reality that hair transplants do grow, almost anywhere you put them.

Diseases Causing Women’s Hair Loss

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

What are the diseases that you previously discussed that women must look for that can cause balding or thinning? I am 30 years old and have some hair loss that is scaring me quite a bit.

Thyroid disease is one of the more common diseases that can precipitate hair loss. Anemia is also high on the list. Genetically induced diseases such as Alopecia Areata can cause both localized hair loss in patches (the more common form) and a diffuse pattern that can cover large areas of the scalp. The diffuse pattern of Alopecia Areata is hard to diagnose and when transplants are placed into areas of active disease, they fail as the disease attacks the hair follicles and kills them. Trichotillomania is also common as a cause of hair loss as a result of compulsive pulling on the hair. Traction Alopecia is caused by consistantly wearing hair styles that use a pulling force on the hair, such as ponytails, pig tails, or a tight bun, and is also seen when extentions or other hair systems use the tension of existing hair as an anchor. Short term hair loss is often caused by pregnancy and this may last for up to 2 years before returning to normal. I can go on and on and write a text book here, so I will stop at this point hoping that I gave you a flavor on the subject and urge you to seek out a good dermatologist or family doctor who would look into these possibilities.

Transplants in the Baldest Men

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

I am very, very bald and 60 years old. I am having a hard time believing that you can really help me. Please let me know why I should believe that this enormous bald area on my head can really be covered with hair.

Some people with advanced balding, low hair densities and high contrast (black hair and white skin), can not get great coverage with a hair transplant. On the other hand, if you have lower contrast between your hair and skin color, higher densities, good character hair, and a loose scalp, you might be surprised at what you could achieve by the artful distribution of hair in the hands of a good hair transplant surgeon (see below for an example). There is real art in making less hair look like more hair and that is just one of the reasons why you need to shop around. Come to one of our open house events and you will be able to examine these patients yourself and make your own judgments. If you have a wife, female relative or friend whose judgment you trust, bring them too, as women have more discriminating views on what they see than men.

This patient is in his mid 60’s and had multiple procedures, totalling 6,036 follicular unit grafts transplanted. “Before” is on the left, “after” is on the right.



More photos of the above patient on the NHI site: Patient ZU

Telogen Effluvium & Propecia

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

Hello, Dr.Rassman.
I have been on finasteride and minoxidil for eight months. In the first five months, they worked fine for me with shedding about ten hairs in my hand while shampooing. But after five months, shedding increased apparently and the situation seemed to suit for the Telogen Effluvium. Someone told me it was induced by finasteride and rode it out. Is it a good sign to indicate the possibility to reverse MPB? And if I experienced a Telogen Effluvium and rode it out, does it have the possibility to reoccur again?
Thanks.

What you are describing is the acceleration of the hair loss process that normally comes in spurts. Propecia does not cause this; it generally slows it down or stops the loss. Unfortunately, the genetics in some men has a stronger influence than the DHT blocking ability of Propecia. On the other extreme end, we have had some patients completely reverse the male pattern baldness, even in the frontal area where it rarely works to reverse it.

Calculating Future Hair Loss

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

Hi Dr. Rassman,

I have two questions. Is there any standard rate at which MPB occurs or is it completely unpredictable? I am 27 and would like to be able to look out 5-10 years and calculate where my hairline will be. I have been on Propecia for 3 months and am waiting to start a Rogaine program, but I am shedding so much that I would like my scalp to stabilize before I start.

I am also considering a FUE HT through my hairline. I have thinning in the front of the hairline but it hasn’t recessed yet. I’ve read that a FUE HT causes the hairs around the implants to thin out. Is this true? Is there any way to impant FUs in this thinning patch to make it appear thicker?

You have raised many issues here so I will try to separate them and address each of them.

Predicting hair loss is difficult. It is best done by looking to your family, finding the various forms of balding there and trying to identify one person that matches the timing of your hair los. Generally, those people who will become very bald, show their balding pattern well before the age of 30. You appear to be in the group where anything is possible, so look to your family patterns.

With regard to Propecia and Minoxidil, I like to start off with one drug (usually Propecia) and then after 8 months, add the second. In this way I get an idea of the value and effectiveness of both drugs and can separate them out. Propecia shows much of its impact in 8 months. Minoxidil, when it works, kicks in within 4 months.

With regard to Follicular Unit Extraction, when it is well done by those who really have a great deal of experience and expertise, it should not damage the surrounding hair. What often happens, is that when the experience is not there, the surrounding hair may be directly damaged in the transplantation process.

Putting in transplants to make hair appear more dense is done when there is reduced risk of damaging the thinning area. Good judgments are required here to be sure that the degree of miniaturization that is present does not reflect ‘active’ hair loss in one of its accelerated modes.

Alopecia Areata in Women

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

I had alopecia areata 7 yrs back. i am female -30. i had alopecia again after 2 and a half years. both the times it got cured by the use of minoxidil 2%. This time i have developed a bald patch at the hairline in the front and am having excessive hairfall all over my scalp. I count the strands. They vary fom 60 strands to 130 strands a day.There is excessive hairfall on the days i wash my hair. Also my eyebrow hair falls. What i have realized is that over these 7 years my hair has been becoming less dense and is not as thick as it used to be. My doctor has advised me to use minoxidil 2% all over the scalp [1 ml in the morning and 1 ml at night]. Also am applying Mintop on the bald patch at the hairline.

Will my hair ever be the way it was and will i ever get thickness in my hair? What do i do to arrest my current hairfall? Can my alopecia be cured permanently? India is not really that advanced. If i need to come to you i have no problem. Please help.

Alopecia Areata in some people comes and goes. After the first attack, if you are lucky enough to get the hair back, you get excited and think that it is over. In some people, one episode is all they get. In others, like you, repeated episodes are the pattern and then when the hair does come back, it is often a finer hair and often not all of it returns. The use of Minoxidil may have value and has little down side, as long as you do not develop any intolerable side effects.

Unfortunately, we do not really understand this disease, but there is a great deal of research going on that may point to better solutions in the future. I wish I could help you more.

Racial Differences in Hair Loss

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

Are there racial variations in hair loss. Which races have the most hair loss and which have the least?

Male and female hair loss is common to all races. If you separate the races, the American Indian whose ancestors came from the Alaskan bridge have no balding. The more advanced hair loss patterns appear to impact Caucasian males most frequently. There are different distributions of balding that may favor one race or another. Asians often do not have the very advanced hair loss patterns, but then again, I have seen such patterns in some from these ethnic backgrounds.

Prednisone and Hair Loss in Women

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

I have crohns disease and I went to the hospital and stayed for about 3 wks. I was given mega doses of prednisone intravenously. Shortly after I got out of the hospital, my hair started gradually falling out. (I am a 53 yr.old african american female) I eventually cut it all off. Will it ever grow back or is it doubtful?

Hair loss is not a published side effect of prednisone except in men with male pattern balding. You need to have a full evaluation for the presence of other diseases. Assuming you are healthy and do not have the female version of genetic hair loss, you styand a good chance to grow back your hair in one to two years. If there is a disease process that is causing the hair loss (e.g. thyroid problems), then the cause must be addressed first. For example, women may get hair loss with pregnancy and these women almost always grow the hair back, usually in less than one year (can take up to two years) after the baby is born.