Hair Transplant Density

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

what is the most you pack per cm2 when you do a transplant????? please let me know .. thanks

Density of the average person is about 200 hairs per square mm. A doctor can transplant as high as 10-50% of the original density. It is important to focus more in the issues of fullness. This is not a ‘weight lifting contest’, which is unfortunately what some doctors are pushing for. I could transplant as much as 50% of the original density, but the real issues are:

  1. Will it grow? There are many factors that will determine this: the health of the skin, the amount of atrophic changes in the skin caused by sun damage and the advanced level of balding, scarring that is present, etc. We generally expect that growth will approach 100% of what is transplanted, but that is only true when everything is right-on — and that rarely happens.
  2. What is needed? This is the most important question that must be asked. People with low hair to skin color contrast, good texture, good hair thickness, etc. do not generally require the greatest densities to achieve the look of fullness.

Hair transplantation is as much an art as it is a surgical process. The judgments of a good surgeon with years of experience will make the correct decisions that are in the best interests of the patient.

ViTrichol

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

Hi Doctor Rassman; I am a happy patient with NHI and have a couple of questions I would like to pose to you.

  1. Do you have an opinion on a new drug called ViTrichol? Dr. Randall Sword backs the product and information can be found on his website.
  2. Have you heard of a new topical based solution called Scalp Med? I saw an infomercial about the product.

Thanks.

I have reviewed the websites reflecting your questions. The FDA does not allow claims that suggest an effective treatment for hair loss without substantiation with good scientific research. If such research was done for ViTrichol, where is it? Could there be some get rich quick scheme to promote an unproven treatment? Doctors are entitled to give opinions on everything and anything. For example, I have opinions on why my dog’s ticks & fleas go away when I scratch his head, rub his belly, or when I use some of my deodorant on him. However, I do not think that I could substantiate my opinions on how to influence my dog’s ticks & fleas or bottle my deodorant with what would be an honest representation of a cure for my dog’s fleas. I would ask the person who backs the product what the benefit to him/her is if you buy the product? I am suspicious until I read the supportive science behind it. ‘Let the Buyer Beware’, so the saying goes.

As for ScalpMed, I’ve posted recently about this here: Scalpmed.

Kidney Stone Medication and Hair Loss

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

I had saline breast implants in June of 2004. Six weeks later, I went through a terribly stressful period (unrelated to the surgery). Four months later, I began to lose my head hair AND the hair on my legs stopped growing. I went to a dermatologist and was told I had Telogen Effluvium and it would resolve itself in a few months. It has been over a year since the initial loss began and still I am losing the hair on my head in greater volumes (still a diffuse spread though). The leg hair began to regrow four months ago. I do take Urocit-K for kidney stone prevention and I had 3 surgeries this year for stones. Is that the reason? Will my hair ever get back to normal? And, could the implants be responsible for the hair loss? Thank you.

Dr. Moldwin is Assistant Professor of Urology at the Albert Einstein College of Medicine, and is Director of The Interstitial Cystitis Center at Long Island Jewish Medical Center in New Hyde Park, NY. He is actively involved in IC research and is a member of the ICA’s Medical Advisory Board. During the December 1998 meeting at the Southeast Florida ICA Support Group, Dr. Moldwin addressed a similar question to yours. He stated: “Most of the side effects that patients encounter occur about 3% of the time. One problem people often worry about is hair loss. It is not a generalized hair loss. It tends to be in spots. Keep in mind that everybody has some daily hair loss. It’s probably a wise idea to monitor your ‘normal’ hair loss on your hairbrush for about a week prior to starting Elmiron. Significant increases in hair loss beyond your ‘baseline’ might be due to the medication. I think that in the past many people had stopped their Elmiron needlessly since they looked at their hairbrush for the first time 2-3 weeks into therapy. They saw hair in their brush (which was, of course normal hair loss) and immediately related this finding to their medication. By the way, in the unlikely event that hair loss occurs, it’s recovered with stopping the medication.”

I think that he said what you needed to hear. You should have your scalp hair examined by a competent hair specialist to determine the degree of miniaturization that is present through the various areas. This is an important baseline to establish for long term planning purposes.

Spironolactones and Hair Loss in Women

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

Are you familiar with using spironoclactone topically for hairloss???? one DR. said it might be the closet thing to cure we have. IT is antiandrogen , which stops DHT at the point on scalp with attacking the follice. I would like to know if you think it worth trying in a lotion on the scalp??? Please respond With you professional opinion. THANKS

Yes, I am familiar with Spironolactones use for hair loss. They have been around for some time. Medline states “Spironolactone, a ‘water pill,’ is used to treat high blood pressure and fluid retention caused by various conditions, including heart disease. It causes the kidneys to eliminate unneeded water and salt from the body into the urine. Spironolactone is also used to treat certain patients with hyperaldosteronism and in certain patients with low potassium levels.”

This is a potent medication and has had some reported impact on fascial hair in women. There are some doctors who use this in conjunction with other medications including Minoxidil, which is an anti-hypertensive medication. Although side effects from spironolactone are not common, they can occur and include: upset stomach, vomiting, diarrhea, stomach pain, frequent urination, dizziness, headache, enlarged or painful breasts, irregular menstrual periods, drowsiness, muscle weakness or cramps, rapid, excessive weight loss, fatigue, slow or irregular heartbeat, sore throat, unusual bruising or bleeding, yellowing of the skin or eyes, skin rash, vomiting blood, fever, and confusion. I do not believe that this is a viable treatment for hair loss as there is no objective evidence that it works in female hair loss, but it is used by some doctors to treat women with hair loss.

Hair Not Growing Back After Chemotherapy

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

Dr. Rassman,
I am a woman who finished an intense bout of chemotherapy and radiation about a year and a half ago. Since then most of my hair has grown back on the sides and back of the head. The center top and crown is still very bald. My dermatologist says it is a typical female balding pattern. Can you give me feedback on this subject? Is it possible I could be a candidate for hair transplants? Thank you.

Your dermatologist sounds correct. Some women develop patterned loss, which is less common than unpatterned loss. Hair transplants work better in patterned loss, assuming that your donor hair is adequate in quantity and quality. If there is diffuse thinning in the sides and back, you may not have enough supply for a transplant. A good assessment by a competent hair surgeon will give you insights into your supply for quality hair transplants.

European Office? BHT? FUE?

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

Do you do Body Hair Transplants (BHT), FUE, and do you have an office in Europe?

New Hair Institute has offices in Northern and Southern California. Sorry, we do not have a location in Europe.

We do perform Follicular Unit Extraction (FUE), and in fact, we invented it. See our site for information about FUE.

Body Hair Transplants (BHT) are still experimental. I do not do them because I want 100% predictability and I am not sure that this will be achieved with BHT. Some past BHT posts include:

Gap in Moustache

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

i used to pluck my moustache when i sit to watch tv and now there is a big gap left. Will it grow back or do i have do something else. Please advise and mail me.

It sounds like you have developed traction alopecia from the plucking of your moustache hair. People who pluck out the hair have a type of OCD (Obsessive Compusive Disorder) with a condition we call trichotelomania. Hair transplants work well for solving the ‘gap’ you are referring to, assuming that you have stopped plucking out your hair. Many people do grow out of the plucking problem as they get older.

Hair Evolution (by Dr. Richard Shiell)

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

A wise sage in the field of hair restoration is Dr. Richard Shiell, from Australia. He was kind enough to allow me to use some random thoughts on some evolutionary aspects regarding hair evolution in the human species. This was part of an email interchange between Dr. Shiell and others in the hair restoration community. I personally always find his scope of knowledge and his wisdom quite insightful.

Hair certainly traps warmth in winter and acts as an insulator from the sun in summer but is this why we have it on our heads? It is very much like the question of “what came first- the dinosaur or it’s egg” (birds evolved from a small species of dinosaur).

Do hairy people migrate to geographical regions where they feel more comfortable or do people with more body hair have an evolutionary advantage and better breeding potential in colder climates? Does this also explain why native tropical races have very little body hair? Neither of these points explains why the females of homo sapiens have very little body hair, whatever their “race”.

The Tasmanoids who were the first of the homo sapien groups to come to Australia about 50,000 years ago had curly/kinky African type hair and very little beard growth or body hair. Did they elect to go to Tasmania, which is colder than the mainland or were they pushed there by subsequent migrating groups known by their bone structure as the “Robustus” group (20-30,000 years ago). The current native Aborigines with their big beards and skinny limbs are known as the “Gracile” Australoids. They have been here since before the last ice age melted some 10,000 years ago. Early photos of these Australian mainland aborigines (before interbreeding with white settlers) showed that they had massive beard growth, no baldness and very little body hair, perfect for a hot climate. The three separate races were all presumed to come from where Indonesia is today and to have walked across when sea levels were much lower during the various ice ages in the past 100,000 years. America’s first humans arrived the same way across what is now the Bering sea.

“Global warming” (and cooling) is nothing new and it is the speed of the current warming and whether human interference with nature is contributing to the warming, that is causing so much concern at present. I will stay out of that debate as it is highly political and results of “scientific research” is being used freely and wantonly by both sides! I hope that we can keep politics and religion out of the current hair debate but suspect that matters of sex will be difficult to avoid.

I used to tell my kids to take notes at the beach. When you saw a guy with a hairy back and shoulders he would invariably have a bald head or a hairpiece. This holds true most of the time but there are occasional exceptions indicating that the gene for hairy back and shoulders must be close to the one for type 6 baldness but is indeed a separate gene. Both characteristics are responsive to DHT as we know but while it acts like a fertilizer for scalp hair it causes reduction of shoulder hair in many guys.

Humans seem to have had an obsession with scalp hair since the dawn of recorded history. I guess it acts as a source of sexual attraction to the females of the species like the tail feathers of the male members of the peacock and bower birds families. It is not as all-pervading in humans as it is with birds where the bower-bird male with poor display misses out on the ‘action” almost completely. Consequently the tail feathers have evolved to enormous sizes. Human males can start breeding long before they lose their hair so it gives them a chance to get established in a family unit and as a provider before this sexually attractive feature is lost.

Almost any anatomical feature can be singled out by the opposite sex as a source of sexual attraction. The labia majora were naturally enlarged in the African Hottentot women and the women enlarged them further by dangling weight from both sides to form what was known by the early white settlers as the “Hottentot Apron”. It is not recorded if the white males found them equally attractive but after 6 months in the outback of South Africa, I guess they started to look pretty good !!

In turkeys the combs and throat skin has developed to crazy proportions and of course the posteriors of some species of monkeys are grotesquely red and enlarged. The nearest example of prominent hair growth in mammals that I can think of would be the mane of the male lion. Judging by the shampoo advertisements on TV and in the glossy magazines, hair is still a potent source of sexual attraction in homo sapiens.

Non-Hair Benefits of Propecia

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

I read something that suggests that Propecia has other benefits besides hair loss. Is this true and if so, you you expand upon it?

Finasteride has many suspected benefits. Those that I’ve observed include better urination for elderly men with a poor urinary stream, less nightly urination (for people who may have early prostate enlargement) and an increased sex drive in about 1 in 10 men of all ages. Other potential benefits might include a slowing of the buildup of new hair in the nose and ears, a slowing of the building of new hair in the chest, and based upon a new article in the literature (J Dermatolog Treat. 2005 Apr;16(2):75-8) a new treatment to control symptoms for people who have a sweating disorder (Hidradenitis Suppurativa).

The greatest benefit may be the reduction of risks of prostate cancer, something that all men, if they live long enough, will develop. This has been well documented in the literature.

The dose for all of these potential benefits were obtained when finasteride was given in 5mg doses, but some people feel that similar benefits may be obtained with the lower dose of finasteride in Propecia.

How Bald Should I Be Before a Transplant?

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

I am a 25 year old male, and I am probably a Norwood III Vertex. Most of the balding is at the crown, but now the front is getting thin as well. My father is completely bald, Norwood 6 I guess.

I have a feeling I’ll end up like him or close to it. I have been on Rogaine and Propecia since I was 19, and 21, respectively. They may be slowing down the balding process, but it is still gradually worsening.

Do you recommend waiting until I’m totally bald like my father, before considering a procedure? What is your best advice for me? Thank you.

At the age of 25, it is not unreasonable to consider hair transplantation to restore the corners of your hairline. The key is to develop a good Master Plan with a doctor who will know how far to push it and not to be too radical. Any crown loss that is transplanted in someone of your age with your pattern, may not be a good medical decision. It sounds like you have done well with the Propecia, so it is not unreasonable to put the corners back and expect that Propecia will allow you the enjoyment of hair for much of your youth. Your worst case, of course, is your father’s hair loss pattern, but provided that you stick to transplanting the front only and that your hair is healthy and of adequate densities, you will never look abnormal and should join the choirs of men your age who want to maintain their youthful look. Generally, I do not recommend hair transplants in men under 25, but there are always exceptions to that general rule.

Higher Scalp T Levels with Avodart?

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

Dr Rassman
Have you heard any speculation concerning the significantly higher scalp T levels with Avodart vs Propecia and long term hair implications?

Thank you

Testosterone increased 4.4% for Finasteride, 6.4% for 0.05mg Dutasteride, 16% for 0.1mg Dutasteride, and 27% for 0.5mg and 2.5mg Dutasteride. Although the rise in Testosterone may seem high, the Testosterone levels were almost always within normal range according to Roger S. Rittmaster, MD.

Scalp DHT measurements were also assessed for both DHT and Testosterone. Scalp DHT was decreased 27% for 0.05mg Dutasteride, similarly for Finasteride (38%) and Dutasteride 0.1mg (37%), 54% for 0.5mg, and 82% for 2.5mg Dutasteride. Rittmaster concluded that these results show that most of the DHT in the scalp comes from type 1 5-alpha reductase.

Scalp Testosterone rose 24% for Finasteride, 46% for 0.05mg Dutasteride, 44% for 0.1mg Dutasteride, 104% for 0.5mg Dutasteride, and 154% for 2.5mg Dutasteride.

Acne Related to Hair Loss?

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

Hi Dr. Rassman,
I have a hair loss problem for you. I’m 25 yrs old and started to notice that my hair is thinning & my hair volume is decreasing. I first started to notice is that I keep dropping a lot of hair during washing,drying & combing of my hair. Lots & lots of strands of hair can be found on the floor, my hands & the floor. I think more than 100 strands of hair had dropped per day. I compared my recent photo with photos I took some time back & I really do notice that my hair had thinned a lot. This have been continuing for quite some time already & does not seem to be stopping.

I sleep late almost every night & skip my meals at times. Recently I also have some acne problems on my face as well. Could the acne problem & hair loss be related & is there anyway I can stop this hair problem of mine. I’m worried & saddened by this hair loss problem. Thank you for the attention.

I am not sure if you are taking any acne medications, but some of those medications do have hair loss as a known side effect. Both acne and hair loss reflect the hormonal influences in young people. For the hair loss issue, Propecia works to block the DHT (hormone) effect. On a humorous note, both hair loss and acne can be successfully treated for men by removing the testicles, but few are willing to go there, me included. We cherish our manliness, so the cost of that manly appearance, unfortunately for those with acne, is a process that may required good medical care until it gets under control or abates with time.

We lose about 100-150 hairs each day and restart growing the same number of hairs, I have little doubt, based upon what you said, that you are experiencing hair loss, made worse by worry and stress. You should consider Propecia, but a good doctor must be your first point of starting a comprehensive search for solutions that work. Do the right thing by starting with a good doctor. Don’t mess with your future.

HairGenesis

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

Dear Dr. Rassman,
I’ve been taking propecia since I first noticed my hairloss, at age 20. Now I’m almost 24, and while I’ve retained some hair in the vertex, there’s been substantially more loss in the front/temple areas. Transplants are probably not a financially plausible option for me presently, so I’ve weighed other solutions (mostly vitamin/herbal supplements), bearing in mind the advice published in your blog. The website for “hairgenesis” touts an FDA-regulated published study supporting it’s claims: Is this information credible, or is it merely a marketing ploy? What other information should I look for when considering treatments other than propecia and surgery?

Thank you in advance for considering my question.

I do not like the Hair Genesis site, because it is very heavy on claims that appear unsubstantiated. As I have no experience with it, I can not tell you what I do not know or have not learned, but when there are so many claims and reflections on FDA ‘endorsements’, I would doubt their credibility. The field of homeopathic and herbal medications is generally unregulated, but it is not proper or ethical to claim FDA ‘endorsements’ like this company seems to have done. To my knowlege, only minoxidil and Propecia have been FDA approved for safe and effective hair loss treatment and there is good scientific evidence that minoxidil and Propecia works. When it comes to natural and herbal medications, there are many harmful natural and herbal medications. Arsenic, of example, is a natural medication that has been used in historical medicine for the treatment of syphilis, but I would not use it for prevention of syphilis nor for any human use as it is a well known poison, so ‘natural’ does not imply safety. The message here is BUYER BEWARE, and remember that just because claims are posted on a website, it does not imply true safety or effectiveness.

Side Effects by Taking More Propecia Each Day?

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

Hello Dr. Rassman,

I am a 26 year old male, and have been losing my for about 4-5 years now. I’m currently a Norwood class 3.

I am using 2milligram of Propecia daily as it seems to work much better for me than 1 milligram. This might be because of my size (I’m 6’3″ and 205 pounds). I had tried one milligram daily, and still noticed substantial fallout. This fallout was hampered once I started on the two milligrams daily.

My question is weather or not the 2 milligrams of Propecia I am taking can come with any side effects, and weather or not it is completely safe to keep up with the 2 milligrams daily.

If you are not having a side effect at the 2mg dose, then I suspect that you will not see any side effects over time. I do not see a down side to taking the larger dose. The official dose response studies that I am familiar with show that 1mg is as effective as all higher doses and I believe that the studies take it to 5, 10 and even 20 mgs in one doctor’s case. I am not recommending higher doses but it it works for you, I do not see a problem with the 2mg dose.

Depo-Provera Caused Hair Loss?

/by William Rassman, M.D./8 /,

I took a shot of deproprovera 2 1/2 years ago, and 3 months after I decided not to get another shot (b/c of weight gain and shoulder/neck aches) may hair started falling out like crazy, now it is 2 1/2 years later and it is still falling out, about 30-50 in the shower/combing out every morning. I’m down to about 1/2 the hair I had 2 years ago. Any advice? It is so frustrating. My 3 sisters have not hair loss issues (in fact 2 of them complain about too thick of hair). My mother’s hair has thinned the last 5 years because she is on strong cancer/rheumatoid arthritis drugs, but no problems before that (all my male/female relatives have hair also–my dad’s is thick at 68 years old–no bald men in my family, and woman all have hair too. Help. 2 dermatologists say I have TE and to ride it out.

Depo-Provera is a contraceptive and has hair loss as a known side effect (between 1-5% of women), as do many birth control pills. Female genetic hair loss does not follow the patterns of genetic inheritance that run on the male side of the family, but it is not unusual for women who have genetic hair loss to have other women (mothers, aunts, sisters, grandmothers) with similar histories and findings.